A couple of mental health-related queries, pretty please (UK-based)

Los Pollos Hermanos

Craving the next chocolate hit...
Super Member
Registered
Joined
Jan 1, 2014
Messages
480
Reaction score
36
Location
England
When I say UK-based, I mean specific to England in case there are differences between different parts of the UK.

Disclaimer: The views in this post are merely those of my character. I am fully aware that many people find CBT a valuable experience in regaining control and enjoyment in life. I am not judging, although it may be difficult to say the same about my character.

Backstory: Character is absent from work as their employer has declared them unfit for work. Character suspects they are being gaslighted and has evidence to substantiate this.

Scenario 1: Character has been ordered by their employer to attend CBT sessions if they wish to be signed as fit to return to work. Character believes CBT to be a crock of faeces, but has decided to go along with it as a means to returning to work (as they are unable to apply for new jobs whilst signed off/suspended).

Question 1: What are the ways in which Character could convince Therapist they are successfully engaging with the CBT, in order to facilitate a swift return to work?

Scenario 2: Therapist prescribes antidepressants, which Character has no intention of taking. Character humours Therapist, intending to throw the pills in the bin (because flushing them down the toilet is really irresponsible).

Question 2: Are there any ways of proving that Character is not taking the medication (e.g. compulsory blood test)? If so, what are they? If not, what could Character say to convince Therapist that all is now hunky-dory, thanks to the prescription?

I think that makes sense? I've done some Googling, but the answers are ambiguous, so where better to ask than here?!

Big thanks in anticipation,

LPH.

p.s. I should point out that in this case the therapist is actually a medically-trained psychiatrist and therefore permitted to prescribe medication.

p.p.s. Ideas from outside the UK are more than welcome!!
 
Last edited:

Old Hack

Such a nasty woman
Super Moderator
Absolute Sage
Super Member
Registered
Joined
Jun 12, 2005
Messages
22,454
Reaction score
4,956
Location
In chaos
When I say UK-based, I mean specific to England in case there are differences between different parts of the UK.

Disclaimer: The views in this post are merely those of my character. I am fully aware that many people find CBT a valuable experience in regaining control and enjoyment in life. I am not judging, although it may be difficult to say the same about my character.

Backstory: Character is absent from work as their employer has declared them unfit for work. Character suspects they are being gaslighted and has evidence to substantiate this.

As I understand it (working at the level of company director but not directly involved with employment issues) an employer can suspend someone pending an investigation, or give written or verbal formal warnings that if a certain behaviour continues the employee will be at risk of losing their job: but they can't declare anyone unfit for work. They can just object to specific unprofessional behaviours. A doctor could declare someone unfit but that doctor would have to be the employee's GP or consultant, I think, or be involved in a significant investigation into the employee's behaviour--so, this would have to happen as part of an investigation into a major employee problem.

Scenario 1: Character has been ordered by their employer to attend CBT sessions if they wish to be signed as fit to return to work. Character believes CBT to be a crock of faeces, but has decided to go along with it as a means to returning to work (as they are unable to apply for new jobs whilst signed off/suspended).

Question 1: What are the ways in which Character could convince Therapist they are successfully engaging with the CBT, in order to facilitate a swift return to work?

Again, from what little I know of employment regulations, an employer can't demand that an employee attend such sessions; and employers can't prevent employees from applying for new jobs, not even while they are suspended. I'm sorry to be so negative here, and I know it's not what you asked for, but I am trying to help! I can see how this might be so if the company involved were some highly secret Government organisation, for example, so ignore me if that's the case, or if the employer is controlling and difficult and the employee is very nervous about being unemployed for Important Backstory Reasons. But for an everyday company? You're going to have to be very careful.

In order to appear to be engaging with CBT you would probably have to engage with the CBT to some extent. All this means is talking with the therapist, listening, filling out the questionnaires they give you (why, yes, I have had CBT!). It could be an interesting intellectual process even if you don't believe in its effectiveness. What might be useful for your plot is that it's possible to benefit from CBT even if you don't believe it's effective, so long as you participate in the sessions. So perhaps your character could make this clear to the therapist, agree to take part but from that cynical position, and then the therapist would be happy and the patient could remain unaffected (or not!). Just a thought.

Scenario 2: Therapist prescribes antidepressants, which Character has no intention of taking. Character humours Therapist, intending to throw the pills in the bin (because flushing them down the toilet is really irresponsible).

Question 2: Are there any ways of proving that Character is not taking the medication (e.g. compulsory blood test)? If so, what are they? If not, what could Character say to convince Therapist that all is now hunky-dory, thanks to the prescription?

Unless you're sectioned you're not obliged to take any medications you're prescribed. So a decent therapist isn't going to do anything more than talk to the employee about antidepressants, and to decide with them whether or not they're an appropriate treatment. They're very unlikely to demand proof that the person is taking them as prescribed and again, it's extremely unlikely that an employer would be able to force a blood test or anything else on someone in the way you're suggesting--unless they were controlling and abusive etc. Which might be the case in your book, of course.

Antidepressants aren't magic pills which make everything better instantly. It can take months to find an effective medication and to then adjust the dose. I've got a friend who trialled half a dozen different medications over eighteen months before finding one which suited her, and then it took another six months to get the dose right; after that she took it for six months before her GP would even consider talking about weaning her off them. So getting your character to be able to convince the therapist all is ok and to do this realistically is going to take some time. Generally you'll get some side effects within a few days of starting to take the stuff, then an improvement won't show for a couple of weeks, even if it's the right medication for you; and after that, it takes weeks or months for you to feel better, and "better" here means "less bad", often, not "all bouncy and happy". So the therapist is not likely to expect or believe for the patient to feel fine very quickly.

I think that makes sense? I've done some Googling, but the answers are ambiguous, so where better to ask than here?!

Big thanks in anticipation,

LPH.

p.s. I should point out that in this case the therapist is actually a medically-trained psychiatrist and therefore permitted to prescribe medication.

p.p.s. Ideas from outside the UK are more than welcome!!

Thank you--I was going to ask.

In addition to all these therapy/medication details, you're going to have to work out a way to justify this employer's involvements in their employee's mental health issues and treatment. Because as I've said, it's just not how things work on a general level and there is legislation in place to prevent people being targeted by their employers like this. I'm not trying to tear your premise apart, just trying to give you some background so that you can make sure you don't end up with plot holes. I hope that's a help and I'm sorry if I've caused you more problems than you started off with.
 

Los Pollos Hermanos

Craving the next chocolate hit...
Super Member
Registered
Joined
Jan 1, 2014
Messages
480
Reaction score
36
Location
England
Ahhh! Many thanks for your excellent and informative reply, and I should have included more details. I was trying not to be too waffly - ha! I've got the basics okay; it's the fine details I need the info for. You've certainly not caused me any problems!

Employer (dodgy - and gaslighting?) has said Character is too mentally unwell to be at work (debatable), as evidenced by their "behaviour" (can't ruin plot by saying more) and suspends them on medical grounds.

Employer forces Character to see workplace-associated doctor, who (falsely?) backs up Employer. Character told to engage with CBT, or they won't be allowed back to work (yes, the legalities of this are questionable, that's part of the plot).

Therapist suggests antidepressants, so Character agrees as part of the charade (this is why I needed the "can they check you're taking them" issue clarifying). Character researches side effects, etc., so knows how to present themselves to Therapist (safe in the knowledge I now know there won't be a blood test) for the benefit of Employer. I've got a couple of friends who've taken them in the past, so had vague knowledge that they're not magic instant bullets - and what works for one doesn't necessarily work for another.

The applying for new jobs issue surrounds Character not wanting to mention on any applications that they're currently not at work, if they can avoid doing so. The situation will eventually work in Character's favour, shall we say?

Sorry it's all a bit ambiguous - I've honestly done a fair whack of research, even if it doesn't sound like it!

Big thanks. :)
 
Last edited:

Parametric

Super Member
Registered
Joined
Sep 17, 2007
Messages
10,814
Reaction score
4,674
I did a course of group CBT classes recently through IAPT and there was no requirement for anybody to contribute in any way, so if the character is forced to attend, he could just sit in the back row and do the crossword. The teachers try to draw out answers and engagement from the participants, but they're not allowed to single anyone out. Just a FYI.
 
Last edited:

Los Pollos Hermanos

Craving the next chocolate hit...
Super Member
Registered
Joined
Jan 1, 2014
Messages
480
Reaction score
36
Location
England
I didn't know that - many thanks! Unfortunately, Character is 1-to-1 with Therapist, so hiding at the back sadly ain't an option.

Actually, if Character refuses to engage with the CBT, can Therapist report that to Employer, or is doctor-patient confidentiality in play here? Hmmm... that could give me something new to work with!
 

cornflake

practical experience, FTW
Super Member
Registered
Joined
Jul 11, 2012
Messages
16,171
Reaction score
3,734
No, a therapist isn't going to tell the employer anything at all.
 

Parametric

Super Member
Registered
Joined
Sep 17, 2007
Messages
10,814
Reaction score
4,674
Is it possible for an employee to consent to the employer accessing their confidential information? Maybe the fictional employer sneaked a clause into the signed employment contract that allows them to request a report from the therapist - so the employee opted out of confidentiality, like you can opt out of the European Working Time Directive?
 
Last edited:

bombergirl69

Super Member
Registered
Joined
Mar 12, 2015
Messages
1,594
Reaction score
400
Location
Montana
Well, US based psychologist here and I agree with Old Hack. Yes, while someone could have issues at work (say, an angry outburst) and the employer might say, "you need anger management" (not the correct name but that's what people think it is). The "you need anger management" is based on the "if you want to work here" condition. The employee certainly could say, "Screw this" and just leave. The employer can't put out a big public notice HEY THIS GUYS UNFIT FOR WORK.

He might be referred to an EAP therapist (Employee Assistance program) If this guy really really wanted to work for the company, he'd go and would sign a release so the therapist could report his progress to his employer. He might not want to sign the ROI, but then the therapist couldn't say what his progress was (or anything else) so his employer would have no way of knowing if he were compliant. Most people sign pretty readily. Personally, I've never had someone referred for "CBT" - that's a little like showing up at a doc's office saying, "I need an MRI." The doc is going to want to know - what are we looking for? CBT is an approach - a very broad approach that can encompass a LOT, so CBT is used for anger stuff, for depression, for trauma, for medical procedures, for anxiety, for insomnia, etc. That might be a US thing - that referrals come for issues.

I agree that people play along all the time (criminal thinking classes are pretty much CBT) Many clients learn how to be more skillful criminals using some neat new techniques. Sadly, I've probably helped a few. I like the idea of skeptic playing along then realizing how helpful it is!

And meds, not sure your guy can be compelled to take meds. Certainly not for work. And no, they wouldn't check. The "outcome measure" would be that he feels better (self report) so he could say he felt great.

If your plot is some version of employer is screwing around with this guy, gets him into counseling where he is more vulnerable, and they keep messing with him, one angle might be to refer him to substance abuse treatment (for some minor drinking thing, at an office party or something.) So, there (here in the US) you have poorly trained (if at all) people making decisions about length of treatment, type of treatment (in or outpatient), and "progress." I have, unfortunately, seen many "progress reports" where the client is actually doing fine but the "therapist"--term used very, very loosely--"just doesn't think he's 'getting it' recommends more groups/consequences, etc. And the client is stuck(if they are mandated, like parole) So, again, can't "mandate" him but could make it a condition of his continued employment (or he could get picked up for a DUI, which would put him in the CJ system, and from there, depending on the state, he would be mandated for both DUI classes and as assessment (also rife with fraud and poorly trained people)

Anyway, good luck!!
 

cornflake

practical experience, FTW
Super Member
Registered
Joined
Jul 11, 2012
Messages
16,171
Reaction score
3,734
The therapist would go over that, specifically and carefully, with the client. Privilege is discussed in the first session, in detail -- with any and all exceptions noted. Usually that only includes something like everything you tell me is strictly confidential ... potentially except in the event I believe you present an immediate danger of harm to yourself or others or specific instance of X type thing, but in a court-mandated evaluation can include that nothing is privileged, or that records of an evaluation will be sent to the legal team and... etc.

It is all laid out, verbally, and sometimes in writing as well to the client, and you're meant to ascertain the person is clear on their rights and your legal and ethical obligations. There's no way something like that would be slipped in and not mentioned, no, not if the person is an actual licensed professional who isn't a total quack or fool. Also, in a general sense, no decent psych would take on clients for whom the employer wanted reports, and certainly not that the employer wanted confidentiality waived. It's just a gross violation. There are psychs working in gov't positions, who see law enforcement personnel, gov't workers, etc. It's all confidential, same as anyone else, and they're very clear on that (save if you go in talking about you're gonna go kill Bob in the next cubicle at lunch, this is how, see, this is what you're going to use <insert clear, specific, viable, immediately dangerous plan>' or you say you're molesting your toddler or something -- but again, these are specific scenarios covered in the first meeting's discussion of basic confidentiality).

If you go in to an appt. with your psych and tell them you murdered someone last year, well, they're not telling. Same as if you tell your lawyer. Your lawyer will get more mad at you for telling them though. :)
 

bombergirl69

Super Member
Registered
Joined
Mar 12, 2015
Messages
1,594
Reaction score
400
Location
Montana
Is it possible for an employee to consent to the employer accessing their confidential information? Maybe the fictional employer sneaked a clause into the signed employment contract that allows them to request a report from the therapist - so the employee opted out of confidentiality, like you can opt out of the European Working Time Directive?

Most clients sign a release of information (ROI) very readily as they WANT the therapist to report their progress. A good ROI is specific in scope, though. So, I could report attendance, progress on the referral issue and so forth. I would not report on unrelated stuff, history of child abuse, marriage problems, etc.
 

bombergirl69

Super Member
Registered
Joined
Mar 12, 2015
Messages
1,594
Reaction score
400
Location
Montana
Yeah, confidentiality can be tricky (entire workshops on just that!!) The key is being clear and upfront. Certainly assessments are quite different than therapy, and issues then come up as to who the client really is, the person in front of you or the agency hiring you!! (and most therapists form very different relations with assessment clients than therapy clients, as you are NOT the advocate, you are an objective assessor. Again, most clients do sign ROIs because they want to be compliant. Forensic evals can have stacks and stacks of them. But therapists do see clients who are referred for therapy from a third party - Child protection Services, Parole nd probation, and employers. Again, the key is clarity, what does and does not get reported. Sometimes clients get really engaged in therapy and will hire the therapist on their own - again, the employer may want progress reports or to be able to find out "how Bob's doing" and the client has to decide whether they will grant that or not. Good therapists are able to answer employers' concerns without giving up much information. Shitty therapists approach case conferences like a gossip session. Evil characters in books might collude with the employer in some way! :)
 

Old Hack

Such a nasty woman
Super Moderator
Absolute Sage
Super Member
Registered
Joined
Jun 12, 2005
Messages
22,454
Reaction score
4,956
Location
In chaos
Ahhh! Many thanks for your excellent and informative reply, and I should have included more details. I was trying not to be too waffly - ha! I've got the basics okay; it's the fine details I need the info for. You've certainly not caused me any problems!

I'm glad to hear it. I didn't want to fall into the gap of critiquing your story rather than helping you with this issue.


The applying for new jobs issue surrounds Character not wanting to mention on any applications that they're currently not at work, if they can avoid doing so. The situation will eventually work in Character's favour, shall we say?

Strictly speaking, though, Character IS in work. Character is employed, still, so doesn't have to say anything about their break on their application. The only way Current Employer would be able to tell New Employer about the whole CBT/antidepressants thing is via a reference, and companies do not send out negative references. They just return the reference forms blank, because of the legal issues of saying bad things about people. So I do think you're going to have to rework this bit, or at least find a way for Nasty Manipulative Employer to twist things to their own advantage.

I have, unfortunately, seen many "progress reports" where the client is actually doing fine but the "therapist"--term used very, very loosely--"just doesn't think he's 'getting it' recommends more groups/consequences, etc.

The focus in England's NHS right now is to cut back on all services, though. So even when people are being forced into therapy (which doesn't really happen because the NHS is so strapped for cash at the moment) they are only usually allowed a maximum of ten, sometimes twenty sessions, and therapists are encouraged to end therapy ASAP even if the patient has not had their full quota of sessions.
 

bombergirl69

Super Member
Registered
Joined
Mar 12, 2015
Messages
1,594
Reaction score
400
Location
Montana
Old Hack;10177752 The focus in England's NHS right now is to cut back on all services said:
That can happen here too (EAP sessions are usually 5! Insurance will definitely limit if they can) but in the substance abuse world, things are a little different. Then employers and anyone else who refers, not to mention the client, can be at the mercy of very poorly trained people who can keep one in the system fo'EVAH. Insurance companies may (and do) balk, but if the client is referred by their employer or parole, they're stuck as those folks are waiting for the "All fixed!" from the counselor, so one way or another clients need to finish (usually)
 

cornflake

practical experience, FTW
Super Member
Registered
Joined
Jul 11, 2012
Messages
16,171
Reaction score
3,734
Yes, sorry, I mean reports to an employer in the vein of 'how open Bob is in therapy/how Bob is progressing in therapy/with his personal issues' not 'Bob has attended therapy/Bob imo should be allowed to return to full duties/etc.'

Those are different -- when I said no good psych would take on clients for whom the employer wanted reports and confidentiality waived, I was talking about in the way it seemed laid out in the OP's scenario and Parametric's q., which sounded like 'write me reports on how Bob is doing in his personal therapy sessions,' not in a 'Bob was referred for Anger Management, has Bob completed the program and is he ready to be back at work now?' way.
 
Last edited:

bombergirl69

Super Member
Registered
Joined
Mar 12, 2015
Messages
1,594
Reaction score
400
Location
Montana
yes! I got that difference! And yes, that's just what therapists (good ones) do - Bob's attendance is whatever, I might even say, let me see how I can answer that without violating confidentiality (even with an ROI)- just as a reminder. MOST third parties don't ask, are fine with can he work now? has he attended? but you'll get some who think it's a gossip session (so, has he told you all about his sister?? what has he said about his mom?) I just ignore those (so, I'm trying to think of what else might be helpful...) :)
 

Los Pollos Hermanos

Craving the next chocolate hit...
Super Member
Registered
Joined
Jan 1, 2014
Messages
480
Reaction score
36
Location
England
Chuffin' 'eck!! I disappear for a short while and return to lots of ideas/help from the good people of AW. Actually, in the crime trilogy I'm currently sending off to agents, the good people of AW are mentioned in the acknowledgements!

Sooooo... I'll add a few more snippets of detail. This query isn't about the main storyline, btw. However, it all ties together in the end.

Employer has repeatedly stuffed up an issue relating to Character, under the Equality Act 2010. Character is fed up and planning to cause well-deserved ripples for Employer. Employer gaslights Character over something else (can't say for deeper plot reasons) and then medically suspends them, stating they're too "mentally unwell" to be at work and in collusion with Employer-connected doctor who "confirms" this.

Character continues to be gaslighted, but isn't fooled and is told that for a return to work to be considered they have to attend an initial appointment with Therapist (i.e. the psychiatrist). Employer wants feedback from Therapist. These are private rather than NHS-funded sessions, as Employer is trying to cover their @r$e after the Equality Act 2010 stuff up. Therapist and Employer-connected doctor seem to be rather pally with each other too, but to what degree hasn't been decided yet.

Character wants to stay in their current job until they can secure alternative employment purely because they've got a mortgage to pay!! They also want to later expose Employer's incompetence and unpleasantness.

Two more questions I do have:

1). Character attends on a 1-to-1 basis. Say for the sake of argument they were to answer every question with "no comment", would Therapist report to Employer that Character has refused to engage (but not specifics)? Or, can Character stipulate nothing is reported to employer, apart from their attendance at each session? I get the release of info form thing, but I want Employer to receive the absolute minimum of info.

2). Could/would Therapist report back to Employer-connected doctor, who'd then report back to Employer? Or, can Character re-stipulate that the doc can only report back if they've been authorised to do so?

More big thanks to all you lovely people! xx
 

bombergirl69

Super Member
Registered
Joined
Mar 12, 2015
Messages
1,594
Reaction score
400
Location
Montana
So, lemme see. IF you get a chance, you might want to watch a youtube of a therapy session, or video, to get a feel. One hopes (sadly, in vain sometimes) that therapy is not a series of questions to which a client can simply respond, no comment. It's not a grilling!! It's (should be) interactive -with OPEN ended questions. A client who doesn't feel like engaging just won't, or will just give the briefest answers. Few therapists enjoy playing dentist and extracting responses, so they'd ask about that. And if they client doesn't engage, they don't engage. Sometimes there are consequences (if they're mandated.) If they aren't mandated, a therapist would probably just share they don't feel like they're being helpful and suggest a referral elsewhere.

Regarding releases, if a client has not signed a release, there is no communication with anyone (short of the exceptions Cornflake pointed out-self harm, harm to others, sometimes subpoenas) client doesn't engage, end of session, good-bye. Sure, a release can be very specific, attendance, general progress on whatever the issue is, fitness for work, whatever. IF a client doesn't engage, and there is a signed ROI, I would tell the referent the client appeared but didn't engage, and recommend somewhere else. Sometimes clients freak out when you tell them that's what you'll do, and amazingly can find topics around which to engage! Excellent! I have refused to complete assessments if clients won't engage - no hard feelings but it's not going to work, and/or been very clear in my write-up about my impressions (it'll be validated in testing, a big part of assessments)

Not sure why the therapist would go to the doc and not to the employer directly. And the Character can a) not sign the release (which might lead to termination) or b) sign the release (which is the only condition under which the therapist can speak with the employer.) But again, the character (I think) would WANT to sign, would want to look compliant and cooperatve, right? good sociopaths are terrific at this (unless pushed)

On the gaslighting bit, I'm not sure i'd buy a character hanging in a job for that. Why not quit and report them? What's the thing that 's keeping them at the job? (you don't have to say it but it would need to be really super duper compelling--- > medical experiments! Character figures it out but needs evidence which they canonly get if they stay, but to stay they need treatment themselves (a little like Coma?) :) don't mind me!
 
Last edited:

cornflake

practical experience, FTW
Super Member
Registered
Joined
Jul 11, 2012
Messages
16,171
Reaction score
3,734
Again, I think you're missing that the default, the assumption in all therapy in a professional psychological setting, is ABSOLUTE confidentiality (save immediate harm exceptions, which are, believe it or not, quite specific. If you tell your psych you want to kill your spouse, and you seem to mean it, but you have evidenced no plan and no specifics, the psych is not likely to do anything, and they're protected -- they may delve deeper to see if there is a plan, etc., but I'm going for an example here).

I'm not kidding -- you come in and confess to having murdered someone last year, they will not be calling the cops. Same as a lawyer. Confidentiality is no joke to professionals in which it is the bedrock of the profession.

It would not occur to a psych to start calling someone's dr., or supervisor, or spouse, or etc. Simply wouldn't, because that's not a thing that is done. Confidentiality is the given, the default.

There are exceptions, but those are specifically noted when you start, and the relationship is guided by them to some degree, but you seem to have the idea (I could be wrong, just what it seems like), that the therapist is like, working for the employer, or paid by the employer, or the employer sent the guy, so therapist would talk to the employer like a teacher would talk to a parent about a recalcitrant kid.

Even if a child is in therapy, there are guidelines about confidentiality. Any breach is going to be sussed out beforehand -- psych isn't going to think 'maybe I'll call the dr. and see what s/he thinks of how the person has been behaving in therapy,' any more than a lawyer would call your boss and say 'you know, LPH and I were discussing his case and he said this...' Out of bounds unless that's the agreement beforehand.
 

shizu

Super Member
Registered
Joined
Aug 5, 2015
Messages
126
Reaction score
22
I just straight up lied to my CBT therapist once or twice. One of the big techniques CBT uses is goal-setting wrt areas you want to address in your therapy. So you can say "I aim to do X, Z amount of times between now and the next appointment," and discuss the success/failure thereof at the next appointment.


Since my issues were centered around agoraphobia, I'd say something like I wanted to go for a 20 minute walk, by myself, three times a week (specificity of the goal is encouraged). On a couple of occasions, for various reasons, I said I'd achieved the goal even when I hadn't. Therapist then asked how it made me feel, what techniques helped me, where I wanted to go from there etc., and basically the answer is whatever they want to hear in order to assume you're getting something out of it all. "Yeah, it was a little stressful at first but I did the breathing exercises we talked about in earlier sessions and that helped a lot." "It was okay, but I learned something-or-other, and next time I could also try this-or-that which might make it better." And so on.

If there are specific things your character's employer has decided they need to address in relation to their behavior, and if the goals involved could be situations that rely on self-reporting that can't be contradicted, they could always just pretend to go along with it if that's plausible for them. Just like they could lie on questionnaires or quizzes their therapist might ask them to take.


In my experience, CBT tends to be quite patient/client-driven in the sense that you set the pace and the direction. I realize that might be different for your character if outside influences are directing things, but in general patients/clients have a huge amount of control in 1-on-1 therapy sessions when it comes to what they want to work on. So in that respect, your character could lead the therapist in a merry dance by making up issues they wanted to pretend to work on, and make it seem like they were accomplishing a lot when in reality they weren't.

I was self-employed at the time of my therapy, so employer confidentiality wasn't an issue. What was made very clear to me, right at the beginning of my treatment, was that everything that was said during the sessions was absolutely confidential. Only the police with a court order could learn what had been discussed, in the unlikely event that ever became necessary or relevant (such as me being a danger to myself or others, or in the course of a criminal investigation). If the therapist isn't somehow colluding with the employer or the employer's doctor -- or unless the client explicitly consents to a certain amount of info sharing with certain parties -- then as others have said, that confidentiality overrides everything else.

(You've probably run across all of these before, but if your character has been referred via an EAP, they have guidelines regarding ethics and confidentiality, both in terms of employers and clients. There's also the BACP's ethics framework, and the BABCP's standards of conduct, which might be of some help. And there's this info from a privately practicing counsellor that could be useful too.)
 

bombergirl69

Super Member
Registered
Joined
Mar 12, 2015
Messages
1,594
Reaction score
400
Location
Montana
you might be in a different country, so my comments might not apply, but in the US...

I just straight up lied to my CBT therapist once or twice. One of the big techniques CBT uses is goal-setting wrt areas you want to address in your therapy. So you can say "I aim to do X, Z amount of times between now and the next appointment," and discuss the success/failure thereof at the next appointment. clients lie all the time to their therapists! All the time! How much they drink, what they said, did, etc, how they feel. We don't have a truthometer--we take their word for it, because the outcome is their (client) wellbeing, so if they're lying...not likely to improve. with mandated treatment, ie third party referral (CPS, parole, sometimes employer),it's a little different bc the client may not want to be there anyway. I could write you a book on how to engage clients who don't wish to engage, but in the case of that type of treatment, there could be a consequence for not engaging (lose job, don't get kid, spend a weekend in jail) because it can be interpreted as client is unmotivated to change. Again, specifics are rarely discussed but overall, client in working in therapy, certainly can be (with a release)


Since my issues were centered around agoraphobia, I'd say something like I wanted to go for a 20 minute walk, by myself, three times a week (specificity of the goal is encouraged). On a couple of occasions, for various reasons, I said I'd achieved the goal even when I hadn't. Therapist then asked how it made me feel, what techniques helped me, where I wanted to go from there etc., and basically the answer is whatever they want to hear in order to assume you're getting something out of it all. "Yeah, it was a little stressful at first but I did the breathing exercises we talked about in earlier sessions and that helped a lot." "It was okay, but I learned something-or-other, and next time I could also try this-or-that which might make it better." And so on. And again, most therapists are going to think great, s/he's feeling better--good ones tend to be able to suss out the "oh I'm just great" folks who make unrealistic progress--and leave it there. If, in fact, you were not feeling better and not telling your therapist, then...not much a therapist can do. Engaged clients who are committed to feeling better will tell their therapists - this isn't working! I don't want to do this! Can we talk about something else?

If there are specific things your character's employer has decided they need to address in relation to their behavior,bolding mine (and this applies only to the US) So an employer can refer a client for some issue (anger, usually, because there has been a behavioral problem) but they DO NOT set treatment goals. That's between the client and the therapist. A therapist (with an ROI) could say that treatment goals are relvant to the referred issue but no third party actually sets goals (in my experience anyway) and if the goals involved could be situations that rely on self-reporting that can't be contradicted and again, at least in the US, we don't follow clients around to monitor compliance! OTHERS can do that--say a parole officer busts a client for drinking--and tell us we need to address the infraction, but we don't play policeman. If I think a client is drinking, I'll ask them about it. , they could always just pretend to go along with it if that's plausible for them. Just like they could lie on questionnaires or quizzes their therapist might ask them to take. Hahahahaha, clients always think they can hoodwink us on these, and on some testing batteries, the face valid ones, they try. But on several common testing batteries, we have profiles that tell us-the client is exaggerating in one way or another, is NOT responding to the content of the questions, or whatever. Very helpful (questions are NOT face valid) VERY hard to fake those (we pick those up) :)


In my experience, CBT tends to be quite patient/client-driven in the sense that you set the pace and the direction. I realize that might be different for your character if outside influences are directing things, but in general patients/clients have a huge amount of control in 1-on-1 therapy sessions when it comes to what they want to work on. So in that respect, your character could lead the therapist in a merry dance by making up issues they wanted to pretend to work on, and make it seem like they were accomplishing a lot when in reality they weren't. And in that case, a decent therapist will notice. "A merry dance" can look like unrealistic progress, too many unrealistic goals, etc. Again, with no mandate, the therapist may just let it go--the client's the one paying, or may ask the client about it, but it's all on the client.

I was self-employed at the time of my therapy, so employer confidentiality wasn't an issue. What was made very clear to me, right at the beginning of my treatment, was that everything that was said during the sessions was absolutely confidential. Only the police with a court order could learn what had been discussed, in the unlikely event that ever became necessary or relevant (such as me being a danger to myself or others, or in the course of a criminal investigation)not exactly. Confidentiality is a little more complex. What Cornflake said ---> criminal investigations don't trump confidentiality unless a court issues a subpoena (and even then, sometimes they're contested) Certainly if a client is a danger to self or others (more complex than it looks), if a child or vulnerable adult is in danger/being abused, for billling purposes, some people have it so for emergency care limited info can be shared. When there is a third party, this gets more complex--ROIs are tailored for this. And again, when a client is showing up with a third party, they WANT you to tell the referrant they are doing well. If they don't, they don't show up. Also a client can quash an ROI whenever they want and a therapist can't reveal anything further (but may have already) Then the therapist just tells the referrant they cna't discuss anything further (and usually that referrant takes it up with the client) Again, this can look straightforward but can be quite complicated. I've had get legal consult on stuff with third parties (who gets an assessment, who can release it, and so on) If the therapist isn't somehow colluding with the employer or the employer's doctor -- or unless the client explicitly consents to a certain amount of info sharing with certain parties -- then as others have said, that confidentiality overrides everything else Most things, but again, with an employer, the client has two choices. They either a) show up and sign releases or b) don't sign releases. If a) the therapist can share certain info with employer. If b) the therapist can't share shit (so the employer will assume the client is not compliant and will terminate) But there is a LOT of grey area here. And some employers have their own therapists and confidentiality iis NOT assumed (police, in some cases) any time you have a third party paying, you get issues of who the client actually is a and it's complicated.

(You've probably run across all of these before, but if your character has been referred via an EAP, they have guidelines regarding ethics and confidentiality, both in terms of employers and clients. There's also the BACP's ethics framework, and the BABCP's standards of conduct, which might be of some help. And there's this info from a privately practicing counsellor that could be useful too.)

And again, I'm in the US so I know zip about NHS, or how it works in other countries!!!
 

Venavis

Semi-benevolent overlord
Super Member
Registered
Joined
May 22, 2017
Messages
58
Reaction score
12
Website
venavis.blog
Here in the US, a shady employer would be better off slipping drugs to the employee somehow then having a random drug test or tip off cops to pull over the employee and bust them for driving under the influence. Discredit and that way they can get court ordered treatment going.
 

Los Pollos Hermanos

Craving the next chocolate hit...
Super Member
Registered
Joined
Jan 1, 2014
Messages
480
Reaction score
36
Location
England
I do really, really like you good people of AW -- I often feel guilty when I flick onto this page and find very little I can contribute to -- makes me feel like a freeloader -- haha!

Character wants to remain in employment with their current workplace so they can pay their mortgage and bills, choose when to eventually leave AND also create Big Ripples about the gaslighting and what led to such nefarious conduct. I'm a bit bloody-minded like this, so it's not outside the realms of possibility, I suppose.

I haven't yet worked out the finer details of whether they "no comment" or play along with Therapist by feeding them BS in order to be allowed back to work. Character is concerned that if they sign a release saying Therapist can report their attendance or (non)engagement to Employer, Employer may twist the info to stop them returning to work and exposing the gaslighting and other dodgy (UK version of hinky) goings-on.

Character needs to get back to work asap, and needs to know how best to manipulate the situation to their advantage to achieve this. Employer is paying for private CBT (i.e. not "free" on our over-stretched and underfunded NHS) in an attempt to look clean and caring. The employer's doctor is not trustworthy and colludes with Employer, shall we say?

Big thanks once again! xx
 
Last edited:

bombergirl69

Super Member
Registered
Joined
Mar 12, 2015
Messages
1,594
Reaction score
400
Location
Montana
Well, I like the suggestion above about having the employer getting your MC busted for a DUI or caught with drugs or something (I like the DUI better) I like it because you wouldnt' even need a corrupt therapist - just an inept substance abuse counselor who will of course consider your MCs protestations as "Denial!"So your MC is saying I DON'T HAVE A DRINKING PROBLEM" and the therapist is lecturing them about how hard it is to admit powerlessness. It would be interesting because then the MC would really have to lie (okay, I do drink) if they want to be assessed as "making progress."
 

Los Pollos Hermanos

Craving the next chocolate hit...
Super Member
Registered
Joined
Jan 1, 2014
Messages
480
Reaction score
36
Location
England
Employer isn't *that* dodgy - if it came out in the local/national press they'd done such a thing all hell would break loose, their reputation would be down the swanny and the business would likely fold.

I'm currently exploring the idea of Character playing along with Therapist, in order for Employer to get positive ROI (based on BS) and allow Character back to work.

Actually, can Employer deem Character fit to return to work based on the fact that they're (pretending to - ha!) engage with the CBT, or does this authorisation have to come from Therapist? Would Therapist deem Character fit to return to work if they appeared willing to engage, and/or would Employer-related doctor need to get involved here? I think I know what I'm trying to ask?!!

Humungous thanks again!! xx

p.s. Yup, here's another question(s):

Assuming Character arrives for first CBT session, are there any baseline assessments Therapist will do first?
If so, what are they so I can do some additional Googling to add to the relevant scenes?
Also, what sort of answers could Character give that may alert Therapist to a whiff of BS?
 
Last edited:

bombergirl69

Super Member
Registered
Joined
Mar 12, 2015
Messages
1,594
Reaction score
400
Location
Montana
Just a quick answer - an ROI is a Release of Information, so that wouldn't be pos or neg. It just gets signed!! :)