michelle, weight gain

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In a message dated 12/28/03 12:26:57 PM, Graduate-OSSG writes:

<< I had a therapist pre-op and shortly post op until she terminated me

when I needed her the most via letter because of " alliance issues "

(her words)..I still do not know what that means.. ...PLEASE HELP! >>

I would like to respond to this part of your letter. " Alliance issues " is not

common jargon that most patients would understand without an explanation. If

your therapist did not refer you to another therapist, if they terminated via

letter without aftercare til you were settled again, they may have violated

both ethical and legal standards. It is REQUIRED ethically, to speak to a

patient about termination if either party feels the relationship is not 'a good

fit,' or if either one thinks after careful evaluation they cannot handle what

are

called' transference and counter-transference' issues--this may have been

what your past therapist meant by 'alliance issues' --how one becomes an ally of

the other.

Transference and counter-transference means how the patient feels about and

what they imagine about the therapist, often based on past disappointments and

triumphs. Counter-transference is the term used to describe the therapist's

thoughts and feelings toward the patient-- also based on past experiences.

Normally, these are to be resolved within the therapy, come to terms with, so

the

patient can work on what is real, so reality is the container instead of

fantasy, and with the best support possible.

I truly suggest if you do not understand the termination letter, that you

write a letter to the thera pist asking for clarification so that you can

understand. If you do not receive a reply within 30 days, I suggest strongly

that you

contact your State Board that regulates the therapists in your state, and

make a formal complaint about the therapists' " abandonment of patient, " " no

forthcoming referral to guard the mental health of the patient during or after

the

therapist's decision to suddenly terminate the patient. " If these are

present, they are all considered 'sub-standard practices.' Therapists are held

to 'a

standard of practice' by state law as well as to the ethics of their own

particular specialty group.

Even when a patient is very difficult, they still have a right to a proper

termination wherein both have a chance to say what they think and feel, and to

have a referral for another therapist, and for the therapist to make sure the

patient is in adequate care before final termination.

I am sorry to have gone on about this when your wueastion is really about

ways of dealing with weight. However, many, many, many people who have been

heavy

for a long time do not expect to be treated with respect, and sometimes

hardly register disrespect when it is present, for they have put up with it for

so

long it seems normal to them. But it is a new day now....

I hope I have been clear.

This is just ceep's two cent's worth.

Psychoanalyst, 35 years of clinical practice as of 2004