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Old 10-20-2008, 06:15 PM   #1
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Breaking 'Safety Contract'

My wife has been diagnosed with BPD. She has battled it seriously the past two years -- many suicide attempts, cutting, alcohol, etc.

About a year ago, she got a psychiatrist who deals more with psychotherapy than with prescriptions. I won't say she got better, but she had more awareness and more understanding.

She signed a safety contract which states if she makes an attempt, then treatment is stopped.

This past weekend, she made an attempt. Not only has she lost her job (one of her co-workers found out and told the boss) but now she has no therapist (he fired her today). While I understand why they have those contracts...I'm really scared because now she has nothing. No job, no therapist...she's in limbo.

I don't know what we're going to do. It took her six months to find this therapist, then another 3 months to open up. And damn it, when she needs to talk to someone the most, she has no one.

Has anyone had experience with the fallout of breaking a 'safety' or 'no-harm' contract?

 
Old 10-22-2008, 12:26 AM   #2
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Re: Breaking 'Safety Contract'

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Originally Posted by luthar28 View Post
Has anyone had experience with the fallout of breaking a 'safety' or 'no-harm' contract?
Hello luthar,

Although I am not completely familiar with the concept, I would like to think that the therapist still has an obligation to the patient; at the very least, a referral elsewhere.

If said therapist feels an inpatient setting may best suit her, then it should be discussed.

Respectfully,

Phoenix
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Old 10-22-2008, 10:25 AM   #3
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Re: Breaking 'Safety Contract'

I have had therapists stop seeing me when they learned that I self harm and it had made a comeback but I am a little surprised to see a therapist would just cut someone off for a slip. Normally when you break this type of contract a number of therapists will ship you off to the psych ward or at least threaten to do so. Part of me thinks that you may have a legitimate complaint for the state medical board. Safety contracts are all good in theory but they should not be an automatic dismissal if one is broken.
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Old 10-22-2008, 06:31 PM   #4
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Re: Breaking 'Safety Contract'

Hi there...well, she did make an attempt on her life (I think...she took sleeping pills, but not enough for harm, and she called someone right away). And yup, when the psych ward attending doctor called her therapist, he asked to speak to my wife. The conversation lasted approximately 1 minute and pretty much summed up:
- our treatment ends

She realizes that she messed up...but I'm so worried because without a therapist, without a job (he fired her yesterday)...and even Children's Aid is getting involved (not sure why...so I'm assuming this is standard when a parent attempts suicide).

I was REALLY hoping that he wouldn't cut her off without a referal. But that seems to be what has happened.

 
Old 10-23-2008, 12:55 AM   #5
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Re: Breaking 'Safety Contract'

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Originally Posted by luthar28 View Post
when the psych ward attending doctor called her therapist, he asked to speak to my wife. The conversation lasted approximately 1 minute and pretty much summed up:
- our treatment ends
Luthar,

Have you tried speaking to the psych ward attending and asking for his/her medical opinion on what the next move should be?

Desperate times call for desperate measures.

Phoenix
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Old 10-23-2008, 06:55 AM   #6
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Re: Breaking 'Safety Contract'

Thanks for the advice. I will talk to the attending doctor...hopefully he'll have some suggestions. The only positive thing is that she's always VERY lucid after an attempt. It's almost like it's a wake-up call for her. It just seems like such stiff punishment.

The stigma of mental illness is hard to overcome. I hate it.

 
Old 11-22-2008, 10:39 PM   #7
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Re: Breaking 'Safety Contract'

I am also a BiPolar Disorder Sufferer and I have severe BiPolar suicidal Depression, PTSD, and self-harm. I have both a Psychiatrist whom I see for psychotherapy, cbt, and med management, and a psychologist whom I see for talk therapy. Both of my Dr.'s are aware of the self harm issues and both know everytime there is an instance, I'm actually asked by my pdoc each visit and he documents it. He knows of my suicide attempts, he's had me put in psych for In Patient once. My tdoc and I talk about the self harm issue every week and work on alternative coping mechanisms and undoing learned behaviours, etc. I guess my point is I've never even heard of the type of contract your wife had to sign. I mean if she wasn't on medication for her BiPolar then the chance of something going out of control was pretty high. And lets face it with BiPolar and self-harm put together, the chance of harming oneself or attempting suicide is pretty high, so for a pdoc to say, if you ever try this even though I'm seein you for a disease that may cause is, we're done....I would seriously consider reporting him to the AMA and APA.

Kat

 
Old 11-23-2008, 10:44 PM   #8
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Re: Breaking 'Safety Contract'

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Originally Posted by katlin09 View Post
I am also a BiPolar Disorder Sufferer and I have severe BiPolar suicidal Depression, PTSD, and self-harm. I have both a Psychiatrist whom I see for psychotherapy, cbt, and med management, and a psychologist whom I see for talk therapy. Both of my Dr.'s are aware of the self harm issues and both know everytime there is an instance, I'm actually asked by my pdoc each visit and he documents it. He knows of my suicide attempts, he's had me put in psych for In Patient once. My tdoc and I talk about the self harm issue every week and work on alternative coping mechanisms and undoing learned behaviours, etc. I guess my point is I've never even heard of the type of contract your wife had to sign. I mean if she wasn't on medication for her BiPolar then the chance of something going out of control was pretty high. And lets face it with BiPolar and self-harm put together, the chance of harming oneself or attempting suicide is pretty high, so for a pdoc to say, if you ever try this even though I'm seein you for a disease that may cause is, we're done....I would seriously consider reporting him to the AMA and APA.

Kat
Thanks for the input, Kat. Since I posted that...my wife has spoken to her psychiatrist once more. He basically said that he's never had anyone break a safety contract in his 21 years but that it has to enforce it.

I think that he never understood the depth of her depression. Not blaming him, since communication is a two way street (though he did take her off medication about six months ago that only seemed to make it worse). So easy to second guess now.

Since her attempt, she's really plugged into a lot of programs that are helping her. There's an out-patience program (six hours a day, for six weeks), then several Moms and depression programs that start after that.

She still doesn't have a therapist, however, as the waiting lists are huge.

I'm going to get my wife to read your post, Kat, as it seems your therapists have developed a strategy of coping with these negative tendancies. She needs that, as well.

 
Old 11-24-2008, 01:38 AM   #9
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Re: Breaking 'Safety Contract'

Quote:
Originally Posted by luthar28 View Post
Since I posted that...my wife has spoken to her psychiatrist once more. He basically said that he's never had anyone break a safety contract in his 21 years but that it has to enforce it.

I think that he never understood the depth of her depression. Not blaming him, since communication is a two way street (though he did take her off medication about six months ago that only seemed to make it worse). So easy to second guess now.

Since her attempt, she's really plugged into a lot of programs that are helping her. There's an out-patience program (six hours a day, for six weeks), then several Moms and depression programs that start after that.

She still doesn't have a therapist, however, as the waiting lists are huge.
Hello Luthar:

You said something extremely important here.

It seems(at least from your post) that he is partly responsible for your wife's present situation. I also understand that taking her off of the meds was a professional judgement call.
It is admirable that you take part of the blame.

Did you explain this to the "powers that be" when they placed you on the waiting list? Is the current program that she is in aware of the situation? Maybe they can intercede on her behalf or at least write a letter.

It is positive news indeed, that she is involved in a series of programs.

I wish her all the best going forward.

Take care.

Phoenix
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Old 11-25-2008, 10:08 AM   #10
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Re: Breaking 'Safety Contract'

Quote:
Originally Posted by Phoenix View Post
Hello Luthar:

You said something extremely important here.

It seems(at least from your post) that he is partly responsible for your wife's present situation. I also understand that taking her off of the meds was a professional judgement call.
It is admirable that you take part of the blame.
Hi Phoenix,

Thanks for the input. The whole meds thing was a weird situation. She asked him 'can I go off my meds' and he replied 'if you think it's okay to. Only you know your body'. It was like 'what?' We're not the doctor, he is. Sheesh. So she gradually went off them.

Then, a few months later, she said that she wanted to go back on them and he thought it would be detrimental to her therapy.

One month later...well, that was her attempt.

I just don't think he understood the extent of her depression. He's not a mind reader, and I wasn't in those sessions...so it very well could've been my wife who didn't convey her distress.

Truthfully, if my wife could get into a therapist immediately, I wouldn't mind that therapy with him ended. I don't think they were really getting anywhere.

In good news, my wife is very pleased with the group setting -- and says she's learning lots of good tools. So that's a big positive.

 
Old 11-25-2008, 11:07 AM   #11
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Re: Breaking 'Safety Contract'

Quote:
Originally Posted by luthar28 View Post
He's not a mind reader, and I wasn't in those sessions...so it very well could've been my wife who didn't convey her distress.
Hello luthar,

As her husband, I thought that you were stating that you may be to blame partly because you lived with her and if you noticed any differences that you could have reported them to her therapist.

Respectfully,

Phoenix
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Last edited by Phoenix; 11-25-2008 at 11:29 AM.

 
Old 11-25-2008, 06:51 PM   #12
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Re: Breaking 'Safety Contract'

Luthar,

Just wanted to check in and see how you and your wife are doing? I meant to do it earlier but it's been a rough few days, sorry. I hope she's hanging in there.

Kat

 
Old 11-26-2008, 11:40 AM   #13
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Re: Breaking 'Safety Contract'

yer i thought that id say hope you ok to i know that we dont talk alot but id hate to not say anything if your having a rough time

 
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