Search terms answered #4: “dbt therapy contract legally binding?”

This is part of a series where I answer interesting questions that come up in my search terms, that are not already clearly answered in this blog.

“dbt therapy contract legally binding?”

DBT contracts can vary in content but a year long commitment agreement is a very common component.

Short answer is no. It’s really more of a social contract or a promise. Same applies for any of the “self-harm” or “no-suicide” contracts.
I’m not a lawyer so I can’t speak to all the details of why it would be legally unenforceable. My understanding though is that a breach of (a real) contract is a civil issue, so monetary compensation would be what was at stake if one party broke the contract. Imagine if any other medical professional tried to do something similar. Can you picture an Oncologist telling their patient that Chemo is a really taxing process and they want to be sure of a patient’s commitment before beginning so they need to sign a contract? No. And that Oncologist certainly would not bring a patient to court (seeking monetary damages) for changing treatment options if they decided some other route was a better idea.

Your treatment is your own to control. Provided you are not in some type of court ordered (or inpatient involuntary) treatment you always have the right to refuse to do anything at any time.

I hate these contracts. Whenever people have presented me with them it’s always been them telling me to sign it or not get treatment with them. I feel bullied by it. Especially in the case of something like a contract to stay in therapy, I don’t think it is fair to always assume that leaving the therapy is a symptom of the problem. Some therapies or practitioners are not a good fit for some people.

Here’s my question for you readers: Is there anyone out there who feels a contract in therapy really helped them in the long run? Did it help you stick things out, in an ultimately helpful treatment, at a time when you were having doubts? Or was it coercive and damaging to add guilt about breaking a “contract” into the already difficult decision to change treatment?

Do I need to rethink my feelings about DBT?

I don’t usually post links to other articles here. That’s generally not my style. And judging from the content of this one, it’s probably going to get posted many other places.
I just have to share some of my reactions somewhere.

Here is the article
You may need to make a free NYT account to be able to read it.
tldr version: Marsha Linehan reveals her personal history of self-injury

DBT was not helpful for me. With other therapy types that have not helped I never really felt anger towards the big names that created it. I don’t have strong feelings towards Aaron Beck as a person even though there are some complex emotions going on for me about CBT. Things have been different with Linehan though.

Her name has been all over my experience of the therapy. When I was in DBT I worked in her workbook, which I pursed a copy of. In hospitals when DBT was shoved down my throat I used xeroxes of the same workbook.

After I quit DBT my (non DBT) therapist pressured me to take home DVDs of Linehan’s to watch. If I refused to continue the DBT therapy, she thought maybe the DVDs would help. They just made me angrier. I have pages of typed notes picking apart every detail of those DVDs. Some of them were obnoxious and irrelevant such as my criticisms of the lighting quality. Mostly I just felt that Linehan just didn’t get it. Combined with later viewings of youtube clips of her and videos of her I saw in school, I’ve developed a view of her as cold, mean and out of touch. The cultish language of DBT did nothing either to endear her towards me either. That she could possibly have a personal history of these problems was not something that ever would have occurred to me.

A lot of my anger towards this therapy, that was repeatedly forced upon me, became directed at her. She created this overhyped therapy that no one will believe is ineffective for me.

This article really turns a lot of my feelings upsidedown. I guess she’s not quite as out of touch as I thought. Some of these comments she made that seemed cruel make me think more now that she’s using humor as a way to deal with some fo these things.

I am not going to become a hardcore DBT advocate, but it does make me feel its worth a little more examination. Not so much as a treatment for myself (I’ve long ago ruled out the possibility of it being effective for me and strongly believe anyone who treats any therapy as a panacea is delusional), but in terms of general professional knowledge it could be useful. I still have theoretical objections and think DBT is backwards (behaviors should not be the first issue address with in a therapy, IMHO), but this gives it a little more credibility.

This news is certainly going to take over my therapy session today.

I’m still processing my thoughts about this. I don’t usually like to post here without digesting thoughts more, but I wanted to share while it was still fresh news. Feel free to add your thoughts on the matter.

Edit:
I walked into therapy and said “Hey, did you read the NYT today?”
S.M. replied “I haven’t finished reading it yet, but I bet you want to talk about the Linehan article”
He’s got me figured out.

 

Edit Aug 14, 2018: I see I was linked on metafilter and am getting a lot of traffic from there. Be sure to see my newer post on this topicĀ https://psychologytales.com/2016/10/08/updated-thoughts-on-dbt/

DBT Summary Letter

This is a follow up to my post “A roadbump while looking for records”. You should read that first.

I googled the office address of the DBT therapist that I got off of his website. I found the therapist who moved into his office after him. I figured it was a long shot, but called her anyway.

She got back to me promptly and was very kind and apologetic, she said that she didn’t know how to contact him.
But then the next day I got a voicemail message from the DBT therapist. Apparently she had found a way to get in contact with him. He didn’t leave a number in the message, but said he would call again to try to reach me later.

I waited a bit over 2 weeks without a call back from him. I had no phone number to call him at. I called back the therapist who had moved into his old office and left her a message. Shortly after, I got a call from the DBT therapist. I wasn’t able to get him to agree to send full records (not a surprise) but he agreed to send a summary letter.

Finally I got a letter from him in the mail. No return address listed. I think he must not be practicing right now, because I never got a contact phone number for him and the letter doesn’t even have an office address as a heading or footer. Also, after speaking with him he took down the entire website with his outdated contact information.

I scanned the letter and put it up here. Edited out some identifying bits.

The envelope was post marked April 9th. So it took over a month from when I started at the end of February trying to contact him to when I got the letter in the mail.

This was probably the most work I have gone through to get any records and the least fulfilling.

It reads mostly like a textbook explanation of DBT. So little of the content of the letter feels specific to me.
I got a kick out of the bit where he wrote “We discovered several vital functions and reinforcing properties of her self harm..” as if I hadn’t already had an understanding of these before meeting him.

I realize 12 sessions is not a huge number of sessions, but I don’t think it is an insignificant number either. I get the feeling reading the letter and based on our no-pleasantries-exchanged-phone-conversation that he didn’t remember me and struggled to write the letter based on a few scribbles in a notepad.

I was most interested in how he would describe terminating the treatment.
He kept telling me that I needed to call him if I was going to cut. If I couldn’t agree to call him then he told me we couldn’t meet any more.

Phone anxiety aside (This has gotten better over the years, but never completely gone), I didn’t want to do this because it is hard for me to judge if I am going to cut in a situation or not. I don’t really know if I’m going to cut until I’ve done it. I think about cutting a lot. Only a very small percentage of the time do I act on it. If I called him and then did not cut after the phone call (even though the purpose of speaking to him was to help me avoid cutting) I would have felt guilty for making the phone call. If I didn’t cut then, I would have bothered him for no reason. I’d have worried I had called him during a time when I wasn’t going to cut anyways. I probably would have half-heartedly made a small injury to ease my guilt.
His request for me to phone him would actually increase my self injury rather than decrease it. And I’m fine with my self-injury in general (I was pressured into going to the DBT and was very ambivalent about it) but that doesn’t mean I want to intentionally enter into a situation that will needlessly increase it.
I’m not sure how well I articulated that to him. I’m better at expressing some of these things now, because my meta-cognition has further developed.

Whatever the reason, he doesn’t appear to have understood my objection to the phone calls. Still I had often wondered if he realized he messed up when he told me ‘phone calls or no therapy’. I imagine he thought the ultimatum would get me to fall in line with his rules, but it backfired and I left.
His letter reads as if it were more of a mutual agreement, instead of a “do this or leave” command.

Would people be interested in more posts like this where I post some of my records with comments? I have a few other topics I want to talk about here first, but if people are interested, I can also do more like this one later.