- Hey everybody, happy Thursday.
Now today I wanna talk about what we do
if we're constantly being told by different therapists
that we're better off in treatment elsewhere.
So many of you mentioned this to me.
You leave it in the comments,
you talked to me about it on Twitter, and I hear you.
And I wanted to really just talk about this
because I really think it's more common than people let on.
And no one, I looked online,
no one's really talking about it.
And I can only assume
that it's because we don't often talk about
therapy as a whole.
You know, hello stigma, it's still there.
And because there's a lot of shame and embarrassment
associated with being told
that you'd better off in another treatment.
You know, it's like you finally reach out for help
and you're seeing someone
and you're hoping that you'll feel better
only to be pushed off onto someone else
and that can feel really icky and invalidating.
And so I wanted to really break this down.
And first, I want to talk about
why this may be happening to you.
Because the cool thing is I'm a therapist, too, right?
And I'm also in therapy
so I can kinda see it from both perspectives.
And a reason that a therapist might say
that you're better off seeing someone else could,
number one, be because
you have borderline personality disorder or BPD.
And I just wanna bring that up
because not all therapists or treatment centers
treat people with BPD.
There's even a stigma,
I've talked about this briefly,
but there's even a stigma among therapists
about treating those with BPD
because some of the symptoms,
like splitting, I have a video I talked all about splitting,
if you wanna learn more about it,
but it's essentially the belief
that people are all good or all bad,
and we tend to then cut people off
or lash out when we feel
they've done something that's hurtful.
It's really difficult for us to recognize
that most people fall in the gray
and can do things that are good and bad
and they can still be helpful and loving in our life.
And so some of those symptoms,
like that, can scare therapists.
And I'll even be honest.
I've had patients in the past threaten me,
curse at me, shout in my office so much
so that I've had to, you know, call the police
or I've had to call my own lawyer
to be like, "Hey, do I have to see them again?
"I'm kinda scared and I don't wanna abandon them.
"What do I do?"
And so that's just me telling you
that it can be really difficult.
And also, we know that through statistics and research
that BPD patients are more likely to file complaints
with the board and try to take our license.
And so I just wanna put that out there.
That's not to say
that what therapists are doing is right or okay.
I really don't think it is.
I think we have to communicate with our patients.
We have to do our best to help.
But there's a reason that therapists prefer
not to treat those with BPD.
But there are plenty of us who do.
Like I still, that's still primarily what I treat
and who I see in my practice
because those with BPD, like we talked about before,
are really just like emotional burn victims
and you feel everything so intensely
and it can make it really hard for us to not be upset
and so finding a therapist who can work with you
and meet you where you're at can be super, super healing.
So I don't want you to think that all therapists are bad,
but that can be one of the reasons
why they keep referring you out.
The second reason,
and something that's also important
to think about, is untrained therapists.
And no, this doesn't just mean that it's therapists
who are young or newly out of school.
In some ways, they can actually be more trained
because they're more up to date
and they're more recently reading about things
and educating themselves
and challenging themselves to do better.
Untrained just means they're not trained in what you need,
so you may need to see a specialist, for instance.
Like, if you have BPD and you're wanting treatment
you are gonna need to find a therapist
that uses DBT or even CBT, other types of therapies
that could be most beneficial for you.
And if we don't have a therapist that can do that,
they may say that we're better off in treatment elsewhere.
I mean, that makes sense, right?
If I went to see a podiatrist, foot doctor,
for, you know, sinus infection,
he'd probably send me away
and tell me I need to see someone else.
And we have to think about mental health in the same way.
But I do wanna say that it's not always specialists,
it could just be someone who's untrained.
And the third reason this could happen
is that you're seeing a therapist
who struggles to maintain healthy boundaries.
Or they don't know how to work through that with a patient
if they've already overstepped those boundaries.
Which I understand it can be really hard,
but it's totally possible
and I think it's a great learning
between patient and therapist.
I mean, if I've misstepped in therapy
or I feel like what I'm doing isn't working,
I like therapy to be we're all the same
like me and my patients we're the same, right?
I don't know more than them.
I do know more when it comes to therapy,
but they know more about themselves, so we are equal.
And so if I mess up or I offer a tool or something
they're like "Hey, that really made it worse,
"that wasn't better,"
or "You referred me to this psychiatrist
"and I hated him or her."
I meant there's all these things
that I think are great,
they're great situations
in which we can practice healthy communication.
Even though it's awkward and uncomfortable.
If a therapist, if I've overstep boundaries
and I've allowed you to email me
and I've emailed you back
and you call me between sessions
and I'm picking up.
Or if, you know, I've, I don't know, communicated to you
that I'm always available,
it could be a ton of different things.
Whatever it is,
if I decide then I go see
another therapist, another psychiatrist,
another mental health professional
for my own kind of guidance
to make sure that I'm helping you the best that I can.
And they tell me that I've overstepped boundaries
and I need to walk them back
and that's when I say to you like
"Hey I was getting some supervision on this
"because I know things haven't been
"moving forward the way we were hoping
"and what I've come to realize
"is I've overstepped some boundaries.
"And so what that means is
"is if you email me between sessions
"I'm no longer going to be able to reply
"and I know that's hard."
So you can see how it's like an uncomfortable conversation
but one that is so, so necessary.
And I think a lot of therapists
who aren't good at their jobs
and if they've overstepped boundaries,
they don't know how to walk them back
or they don't even know how to create boundaries
in the first place.
Because therapists are just people too,
some of us are good at that
and some of us aren't.
But I think that that could be a reason
that we're being referred out
because a therapist has allowed you
to overstep boundaries
and they don't know how to have the conversation
to bring those back.
And the fourth and final reason
is that you really do need a higher level of care.
I've talked about this a lot
that like, outpatient therapy where you see me
for one hour a week
and then go about your whole life that week
it works for some people but not for everyone.
And some of us need two sessions a week,
or three, or we need a day program,
or we need to be in an inpatient ward,
or we need to be hospitalized.
We're all going to have different needs
based on how we're doing
and how well we're able to manage outside of therapy.
And so just keep that in mind
that you could be referred out to other treatment
because you actually are in need
of a higher level of care.
And so if a therapist does say that to you
and gives you, like, referrals to inpatients
or hospitals or different treatment centers,
try to take that seriously
because we don't do that just for fun.
We do that when you need it.
And so if they are thinking that you need that,
that's a conversation that should be had
so that you both understand
where you're coming from
and can make sure the referrals that they offer you
and then pushing you out to another treatment
is really, truly what's best.
Now to get into the good stuff.
If we feel like we're being pushed off
or we've recently been referred,
what do we do then?
And the first thing is,
like I was talking about earlier,
maybe you need to see a specialist
so let's make sure we find a specialist.
I know we don't all have access to that where we live
but if we're struggling with anxiety
when we call to make an appointment,
we should ask them
"Hey, do you treat anxiety?
"Or do you do CBT based therapies?"
Like, what is it that you do?
Here's what I'm struggling with.
And try to say that up front
to ensure that you find someone
who can treat what it is
that you're wanting to get treatment for.
And my second thing is
work hard in therapy
and be open to a higher level of care
if you're working hard and still feeling terrible.
I know therapy is really hard work.
Trust me, I'm in it myself.
It challenges me in ways that I just,
I hate and love at the same time
and it makes me see things in a different perspective
and it's just really, really hard.
But, we have to work hard in therapy
otherwise it's a waste of our time.
And if we're not really working hard,
then we're not gonna be getting better.
We're gonna be like plateauing
or possibly getting worse
and our therapist could think
that we need a higher level of care.
And my third tip,
let your previous therapist talk to the one
that you're wanting to start seeing.
I know you're thinking Kati,
that old therapist was a jerk
and they passed me off and I hate their guts
and I just don't want them to talk.
I don't want them to have anything
to do with what I'm doing.
Please let them talk to them
because this is so important
and can save you from getting
into the same situation all over again.
Your old therapist can let them know
why they referred you.
I always say that to other therapists
when I communicate with them.
Hey, I referred them out
and I actually gave them, you know,
hospitals in the area that I thought
would be better because I really think
they need a higher level of care.
I don't think outpatient is right for them.
And that would save you,
if I'm telling that to your potential new therapist,
and they're like hey I talked to your old therapist
and I think you actually do need a higher level of care.
That can save you that time of seeing that therapist
three or four times only to get passed off again
and feel even worse.
And so please let them talk to each other.
Because if your new one doesn't feel confident
in their ability to help you,
then they tell you right away
and they give you proper referrals to the people who can.
And my fourth tip,
do some of the work on your own.
If therapy hasn't worked for you so far,
getting some workbooks, self-help books,
and even just watching some of my videos and tips and tools
for what you're struggling with can really, really help.
We don't have to wait until we see someone
to start improving ourselves
and working on our mental health.
Don't think that you have to wait
until you get settled in order to do the work.
You can start it now.
And yes it is harder when it's on our own
and it can take a little bit longer,
but it's still super beneficial.
And my fifth tip,
make sure you work on your own self-talk about it.
You know that self-talk,
that thing you told yourself
when that therapist referred you out?
What did you think that meant about you?
What did you tell yourself about it?
Make sure it's positive.
You're doing your best.
Therapy is hard.
I need to find a specialist,
that one didn't get me.
I wasn't making progress
and I'm gonna make progress next.
We need to pay attention to what we're saying
and make sure that that conversation is positive.
Because therapists are just people too
and not all of us are good at our jobs
or are capable of helping you.
And so, don't think that it's your fault
and you're the reason it wasn't a good match.
And so make sure that that conversation
we're having about being referred out is one
that is taken into consideration
all the information we just talked about
and not blaming it all on you
because that's not the truth.
It's not your fault.
We just have to find you a good fit
at the right level of care
so that you can start feeling better.
And I hope you found that helpful.
I think so many of us are
getting passed around between therapists
and we really just don't understand why it's happening.
And so I really hope that that just helps
you better understand the therapists perspective
and also, from your side,
what you can do to make sure that you're feeling better
and getting the treatment that you need
sooner rather than later.
And keep working with me
as we work together
towards a healthy mind and a healthy body.
And I'll see you next time.
Bye!
(jazzy music)