Should a therapist contact you?

In My Humble Opinion
1

Think about friends, family, coworkers or others who have significant mental health or substance use/abuse issues. Do they/have they ever received any treatment? If they didn’t, or are/were reluctant, would it make a difference if a good therapist/social worker/interventionist made contact with them, or even knocked on their door?

In the world of therapy and addiction treatment the burden is always on the “client” to make contact with someone if he/she needs help. I think this is part of the flawed mythology behind the theory of “hitting rock bottom”. My thinking is that sometimes people don’t know how to reach out, or they are scared or truly despondent. Especially with younger people (18 through 20s) who don’t necessarily live at home, a service like this could be helpful. A relative/friend could make contact with this service and then the worker could make contact with the person, explaining different options or just offering a basic consultation depending on the context of what’s going on.

The thought occurred to me about hearing about someone’s daughter who is addicted to pills, but is unwilling to reach out to anyone for help and is basically estranged from the family.

Thoughts?

2

Hmm. Seems to me that, if you have critical family or friends, you could be hounded. Does your mother disapprove of your job (she wanted you to be a teacher like her but you went off and became a cop)? She could “refer” you to a therapist who calls every evening to offer you Career Counseling. You can’t get them to stop because they say they are trying to help you. Your sister, who never liked your spouse anyway, could convince a Marriage and Family Therapist to call you every week.

Do you disapprove of the religion your son joined? Just call an Ex Cult therapist and get him on their Monday Autodial.

If the answer is “the therapist evaluates the situation independently and determines whether or not to make contact”, well, I don’t want random therapists running background checks on me, building files on me, writing reports on me, and making referrals on me behind my back, all to determine whether robert_columbia should be offered relationship counseling, alcohol abuse counseling, career counseling, what have you)

3

I’m not sure what kind of HIPAA rules this would violate, but I’m sure it does.

4

It also doesn’t seem very likely that all the friend’s daughter needs is a phone call from a therapist to convince her to stop taking pills.
Until she really wants to quit there’s little anyone else can do.

5

ecoaster, I’m concerned about you. I know a therapist in your area who specializes in helping people with sexual and gender identity issues. Would you like to schedule an appointment?

6

You’re not supposed to ask permission!

7

You can’t help someone who doesn’t want to be helped.

8

Assertive community treatment is a model that is being championed as intensive, but less expensive than chronic inpatient treatment. I attended an inservice given by an agency that offers it in south Louisiana at our state’s counseling association conference. It’s aimed at the severe and persistently mentally ill population, i.e., the most likely to drop treatment, stop medication, and have repeated hospitalizations. The clients must fully consent and commit to the treatment model and can drop out at any time. Staff members of this particular program continue to seek contact with the client until three session appointments have been missed, at which point the client is removed from the program. The client has previously been advised of this and given permission for the follow-up.

9

Sure!!
But seriously, calm down folks, I am not talking about aggressive or assertive intervention, I am talking about an outreach call. To people who maybe, just maybe want to talk to someone other than a family member.

I truly get the complications to this concept. Yes there may be some HIPAA issues, but the treatment provider does not need to release any details to the original reporting party unless there is consent. Nothing here is mandated. Also the provider would screen cases and obviously not do a call/outreach because someone is concerned about someone’s sexuality or religious beliefs. The reality is the police departments do well-being checks all the time in big cities, this is a similar concept.

Sheesh :slight_smile:

10

Pretty much this. Unless I’m doing something that endangers myself or someone else, it’s up to me to decide whether to seek help. (If there is a drug or alcohol problem, stage a proper intervention with trained people.)

I can also see where such a service can be used to abuse, harass or stalk another person. For example, I can see a scenario where an abusive spouse can unleash a therapist on the other spouse as a means of gaslighting. Or someone who wants to stir up some drama for their own reasons. The negatives far outweigh the positives, as far as I can see.

11

Sheesh.

And I though my spam couldn’t get any worse.

I vote shut the hell up, unless I ask.

Tris

12

Yes, like a spurned lover sending relationship therapists chasing after their ex (to convince them to return), Mormons referring all their friends and family that drink (at all…) to drug and alcohol therapists, sending a therapist trained in transgender issues at your nephew after you found out that he registered for a sewing class…

This applies even if the referral is in good faith - because all of us know a few people who are too “concerned” about the way others live and want to impose their attitudes and beliefs on you, believing that they would be doing you a favor.

13

No…but you’re on a good track. There’s got to be a better way to let people know what options are out there. Right now, if I wanted to get a therapist, I’d really have no idea how, or how to pick a good one. Let’s see…EAP is something, so I’d probably start there. Then what?

There has to be a better way than word-of-mouth, but I’ll be darned if I know what it is.

14

For at least some kinds of doctors, outcomes are public record.

15

‘Assertive outreach’ is the term for this, in Australia at least. The link above covers the mental health side. The example people will be most familiar with is Child Protection.

It has been tried a number of times, its more effective for some kinds of issues and communities than others. It is of course controversial with some people, because of the kinds of issues discussed above, ie potentially invasive, coercive etc.

I briefly had a job for this for domestic violence, where if one partner turned up to the centre, the other was rung and an offer was made for someone to go out and meet them (usually the guy). This is obviously the softer end of things, where the person could tell me to get lost over the phone rather than at the door.

Otara

16

I think this is best answered if the different job roles are separated out. A therapist is not the same as a social worker.

For instance, in the UK, if a report is made to Social Services about a safeguarding issue, the Social Services will investigate the case. This could be about an adult or a child. It may be that you overheard likely domestic violence in the next door apartment. It may be that you saw bruises on your friend’s child. In that case, a social worker would intervene without being asked by the individual themself. This is quite tricky, as it’s not often that people are grateful to get a call from a social worker investigating a safeguarding alert. And there is a lot of scope for an intervention to not help (famous cases include Victoria Climbie and Baby P - though there are success stories too, where a child is saved from an abusive home, these are not generally reported in the media).

I manage a service which we call floating support; it’s quite similar to the assertive community treatment model. Basically we have a team of support workers whose aim is to maintain tenancies and independent living for vulnerable people. They aren’t mental health professionals or social workers, but they have a lot of expertise in the field - they develop a support plan and help people clear rent arrears, liaise with debt agencies, get back into work, rebuild family relationships etc. We take referrals from social workers, housing officers, neighbours, friends, anyone really, including a self referral. We then contact the person to offer our service. Sometimes, they tell us to F off. Sometimes, they engage with us and we get some amazing work done.

For a social worker to make an intervention, it’s different to a service being offered. We don’t have the same statutory obligations. (Though we do have to report safeguarding alerts to Social Services).

A therapist, in my opinion, is a whole different ball game. (I’m also a therapist). That relationship is not one that flourishes unless the client has chosen in some way to be there. In floating support, we’ll signpost people to therapy, and find them cost effective options (we are particularly interested in getting people registered with a GP if they aren’t already, and in the UK you can get six NHS therapy sessions at most GP surgeries) but for a therapeutic relationship to be meaningful, the therapist shouldn’t make first contact.

Interestingly, though floating support works with people in the community, there are assertive outreach teams who attempt to engage entrenched rough sleepers to facilitate change. And that help isn’t always welcomed(though again there are success stories!!). But that is another story.

17

Agreed.

Many people who aren’t yet ready to admit they need help will react negatively to what they see as others trying to dictate their behavior. Even if they agree on some level that therapy is a good idea, they’ll rebel against someone else choosing it for them.

18

This is the assumption, but in practise it often doesnt work out that way. Many people enter counselling for domestic violence due being legally mandated for instance, and one surprising research outcome was that ‘voluntary’ clients generally did worse than the mandated clients.

Otara

19

Certainly when it comes to addiction or significant mental illness…I agree with this.

I participiated in a well-planned intervention once (under the guidance of a counselor of some sort) and it went very badly. The friend in question was an out-of-control heroin/alcohol/pill addict - and not stupid, she was a lawyer - and when people descended on her house and took away her drugs she went apeshit. Completely out of control apeshit.

I don’t know how typical this is but in this case it didn’t work at all. I cut ties with her shortly after the intervention and have no clue if she’s alive or dead now.

To **Otara’**s posts - I volunteer as a counselor and general-help person at a domestic violence shelter currently; maybe it’s a somewhat different dynamic but I agree: we strictly mandate active participation in following up on legal, counseling and other remedies to anyone getting housing and help from us. For the most part it seems to be really effective. But the focus there is empowering, not fixing, so perhaps it is different.

Also it would be a violation of privacy for a counselor (depending on state law) to approach someone.

And, what robert_columbia said.

Being as how anything done officially may become public record, I sure as hell wouldn’t want random professional helpy-types poking me with pointy sticks.

20

Even if I thought I needed help and was just too scared to get it, I don’t think I’d like be contacted by a therapist that I didn’t even pick out myself.

If you think someone needs help, the best thing you can do is just express your feelings to them and offer to assist them. Doing anything more is being a busybody.