Last week I posted about the NASW’s ethical guidelines for Social Workers, particularly in regards to termination practices.
Since then, I’ve been reading Treating Complex Traumatic Stress Disorders, by Christine A. Courtois and Julian D. Ford. Chapter 4, entitled “Best Practices in Psychotherapy for Adults”, outlines the best evidence-based practices for helping patients with C-PTSD and related disorders. They essentially highlight the same 3-phase model that Zooey’s DID “expert” supervisor advised her to use and that many trauma specialists accept as the best approach for trauma. I read the “expert”‘s book as well and I liked the model, so Zooey and I agreed to try that. It is also very similar to how they approach treatment in the residential trauma program I attended in the Fall. I’ll write more about that treatment and the phases in future posts, but here’s a basic rundown:
- PHASE 1: Safety and Stabilization
- PHASE 2: The Processing of Traumatic Memories
- PHASE 3: Reintegration
My understanding is that the idea is to get the patient stable and in a safe place so that they are able to engage with their traumatic memories without resorting and/or regressing to unsafe/destructive coping skills. Then, once the memories have been processed, phase 3 is essentially a culmination of the previous two phases. The client is able to use their new skills and information to analyze themselves and move beyond the effects of abuse. Or something like that.
Anyway, what struck me about this specific chapter is how lengthy and detailed the issue of termination is addressed. Here is part of what the authors say:
ENDING THE TREATMENT
At its best, ending treatment is part of the entire process and is related to the completion of stated goals and thus can be a cause for satisfaction and even celebration. At whatever point treatment comes to an end, it poses special issues and often stirs up clients’ feelings of abandonment, grief, fear, and loss of security as well as satisfaction. However or whenever it occurs, the ending of treatment is best as a collaborative process with a clearly demarcated ending. It should be anticipated, prepared for, and not come as a surprise to the client. In the event that a therapist is only available for a set period of time…the client should be informed of the situation and be given adequate time to process the change and plan for the future. In any event, it is incumbent on the therapist not to abandon the client. This is especially the case with clients who have been relationally challenging on an ongoing bases and whom the therapist might act out against by “dumping” them without warning or preparation. When a therapist chooses to discontinue a treatment, professional ethics require that he or she take care to communicate reasons to the client and provide treatment referrals.
I think it’s safe to say that Zooey did none of the above. In fact, she arguable did the exact opposite. I know this isn’t terribly different than what I’ve posted before, but it helps me to “collect evidence” about this. It helps to see other mental health professionals talk about termination in a way that clearly shows how unethical and irresponsible Zooey’s actions were. It helps me feel like it’s okay that I am feeling all of these awful emotions, even two months later. Because to be honest, I can’t stop blaming myself. I can’t stop asking “what if?” I can’t stop wondering if I had only been different, acted different, spoke different….would things have ended better? Probably not.
I don’t even know that it makes me feel better to know that Zooey was in the wrong. I think, in a way, it hurts just as much to know that she acted so unprofessionally. I take it personal. I guess I just really want or need to believe she is better than that. So I keep blaming myself.
But I don’t want to do that anymore. It hurts too damn much. So I’m going to re-read this passage over and over again and remind myself that even if I had done something wrong, she still shouldn’t have ended things the way she did. I still deserved better. And she was still ethically bound to do better.