Turpins 3: 2 Monsters, 13 Victims (WARNING abuse and torture)

[Palimpsest]

4 minutes ago, Tatar-tot said:

It is not uncommon for hospital staff to bond with their “frequent fliers” for example kids/adults going through chemo or chronic conditions.  The staff are human.  There is no way they would not bond with them on some level.

Yes, of course they bond.  There is absolutely nothing wrong with that.  But hospital staff don't normally insist on relationships after the patient has left their care.  The odd card or letter, perhaps.  Demanding an ongoing relationship or control - no.  That is the boundary that Uffer seems to be crossing. 

[luv2laugh]

The hospital sounds like it's being unprofessional. I found the CEO's enjoyment of the publicity on the free guitars he had donated to them to be bizarre. He went into some excruciating detail on the kids and how they're recovering. I enjoyed learning about them but a brief statement would have been enough. Giving an entire interview to the press on their recovery seemed unethical. I asked myself 'What do the Turpins have to gain by the CEO speaking out on intimate recovery details? Nothing. Only the public gains an insight into their lives at the expense of their privacy. I don't like Mark Uffer, the CEO, and I find his many interviews on the k-adults exploitative and selfish.

Also, many hospital CEOs are MBAs (businessmen) and not always MDs (healthcare trained professionals). They are operating the hospital from a business administrative perspective and he doesn't seem to realize that he's making himself look like a fool from an ethics standpoint.

I think the hospital CEO became too invested in the publicity and media attention the Turpins brought the hospital. One of the healthcare team members should tell the CEO to stop talking to the press as he's making the entire hospital look bad by whining.

The Turpin adults are vulnerable and they need to be educated on how to care for themselves and handle their finances so that they aren't in a position where they can be exploited or manipulated again.


Also, this is a pretty inappropriate interview (it's like the millionth interview given by the CEO) for Uffer, the CEO, to be giving:
"Turpin Adults Wore Children’s Clothes At Hospital Since They Were So Underweight

The Turpin adults wore children’s clothes while recovering at a hospital since they were so underweight, Mark Uffer the CEO of the Corona Regional Medical Center told ABC News Tuesday.

Uffer revealed shocking details about the seven Turpin adults’ recovery at the California hospital since getting rescued in January, ABC News reported. The adults spent two months at the hospital after spending most of their lives in captivity, allegedly being tortured and enslaved by their parents David and Louise Turpin. The adult children were so badly malnourished they had to wear kid’s clothes.

The oldest Turpin child, 29, weighed only 82 pounds after getting rescued by police in January.

"What initially started out as patients coming in through the emergency room turned into sort of a higher calling for all of us," Uffer told ABC News. "We essentially adopted them. We recognized that they were in a bad place when they came here.

"We just took a personal interest in them,” he added.

Hospital staff bought the clothing with their own money and even washed the garments at their homes, the CEO said. The clothes the Turpins were wearing upon arrival at the hospital were so dirty that the garments had to be thrown away.

The children also had never owned shoes, according to Uffer. The hospital staff bought them shoes and Uffer recalled they were paranoid that their belongings would get taken away from them. So, they slept in their shoes overnight.

“Maybe more than one night,” said Uffer. “They were afraid that anything that they got was going to be taken away … anything that they got, there was always a question — at least from one or two of them — ‘Is anybody going to take my things?'” he added."

Though all of them were old enough to drive, none seemed to fully understand the mechanisms of seatbelts, sidewalks or stop signs, much less what to do behind the wheel, Uffer said.

They regarded their first tomato with the kind of suspicion reserved for an alien object, Uffer recalled. Same with those small, strangely colored and fuzzy fruit the staff offered them: berries. They told staff they’d never seen them before.

[EmCatlyn]

7 hours ago, Palimpsest said:

Yes.  I can easily believe that the hospital staff went over-and-above when the siblings first arrived, and over time became very bonded with the 7 adults who stayed longer.  Perhaps too bonded.   ...

I think that some professional boundaries may have broken down.  And that is not good.  That goes for the nursing staff, doctors, and other therapists, including the psychologists and psychiatrists involved.  From day one the staff should have known that the siblings stay there was temporary, and focused on helping them have a smooth transition to the community and to other health professionals.   

Nurses and therapists have ethical responsibilities and Best Practice guidelines about how and when to "terminate" with patients and clients.  For nurses it is supposed to be at discharge.  Of course termination isn't always easy and clear cut in real life.

The staff may have prepared the siblings properly for transfer.  They may be anxious about the siblings.  However, this decision did not happen overnight, so Uffer's tear-choked statement makes him (and them if it is true) look unprofessional.  Again, IMO.

 .... If Uffer has a valid argument then the decision could have been appealed to DMH and -or- to a judge.  Perhaps he did that, was over-ruled, and so decided to spout off to the press.

Bottom line: I find Uffer very unprofessional and think that this sort of tug of war and stirring in the press is not in the best interests of the siblings. 

I agree with your points and thank you for checking out who is responsible for supervising/appointing the guardian and other details.

Mostly I share your opinion that Uffer is speaking out of turn.  The initial reports about how they had set aside a space for the young people, and even the business of getting them guitars was ok. Given the interest, reassuring the public that the young people are okay, thanking a donor for the guitars, etc., even mentioning that the young people are enjoying certain foods and tv shows etc. all seems fine.

But I have been struck by the way he thrust himself into the story, and I also think that he is inclined to over-generalize about the young people.  I have noticed this is a tendency for the media, and it has bothered me that we are going from “one Turpin kid didn’t know what X was” to “all the Turpin kids were ignorant of X.”  These are 12 different individuals (not counting the toddler whose situation is different).  The seven “adults” are spread out age-wise over 10 years.  They have had different experiences even within their restrictive family.  It is not the case that because one of them doesn’t know or understand Y, none of them do.  The media is bad enough. A person who supposedly “knows” them should know better.

I do want to note, however, that so far the CEO is the only one who is speaking out of turn.  I have not read any interviews with hospital staff (and hope I won’t) and I see nothing wrong with nurses and physical therapists, etc. weeping when they say good bye to charges that they have become attached to.  Nor do I fault some of them for hoping they could be more involved in the transition, if they felt they had the expertise.  (I know cases where people go back as outpatients for physical or psychological therapy from whomever they were working with while in the hospital or subacute facility.  Some of the Corona staff may have hoped that they would be able to continue helping.)  This isn’t necessarily a result of “inappropriate attachment,” but could be that the professional feels that continuity at this point is in the patient/client’s interest.

 In my opinion, it would probably have been good for the 7 to be able to come back say once or twice during the next month or so to get physical therapy, occupational therapy and counseling while they settled in their new place.  This might have meant a long drive, however and/or it might have been too expensive.

What really bothers me though is the “tug of war.”

 

 

 

[Tatar-tot]

The CEO should be slapped with some HIPPA violations.  His behavior is inappropriate and boarderline criminal.

[luv2laugh]

2 minutes ago, Tatar-tot said:

The CEO should be slapped with some HIPPA violations.  His behavior is inappropriate and boarderline criminal.

I COMPLETELY agree! I’m glad I am not the only one who thinks this. All of his MANY interviews he’s given to the media are extremely inappropriate! It’s a complete lack of concern for their privacy in their recovery.

[Carol]

I learned the hard way about boundaries a few weeks into my counseling career.  One of my group therapy patients told me he'd like to get together with me after he got out of treatment if I were ever visiting the town in which he lived.  I knew this wasn't possible but I was new on the job and didn't want to hurt his feelings.  Plus, if I'm being completely honest, I wanted him to like me.  Instead of being kind and direct I was noncommittal.    

After our conversation ended, about 2 minutes later(I kid you not), I was paged to the Treatment Directors office.   He told me in no uncertain terms I had to be very clear about my boundaries with every patient.  A staff member had overheard our conversation and turned me in for my own good.  I felt betrayed and angry because I was hired over a lot of other people and in my eyes I was Queen Bee.  I ate humble pie after that humiliating and well deserved lesson.

I was always clear after that.  

[Palimpsest]

I'm not seeing any obvious HIPAA violations.  A lot of people don't understand HIPAA properly.  It is part of patient confidentiality, certainly, but it has to do with releasing defined protected health information that can be identified with an individual without their consent.  For example, saying "some of them had flu" causing their release from hospital to be delayed would not count as a HIPAA violation (especially if the Guardian had given consent to disclosing that information) because it doesn't relate back to the individual.  Also, I think the 82 lbs for one sibling was also in the original police report and is now common knowledge.  Law enforcement is not governed by HIPAA, nor by the additional confidentiality rules that govern medical and mental health professionals in the community. 

What I am seeing is Uffer talking out of turn, over-emotionally, not showing enough sensitivity to the siblings' need for privacy, and blatantly stirring the pot with the Public Guardian.  (FTR, according to LinkedIN Uffer has a Masters in Health Care Administration and Management, a general Business and Management Degree, and started out as a Respiratory Care Therapist.  He's changed jobs quite frequently but has been at Corona since 2014.)

I looked back carefully at that original ABC report and am now going to try to be fair to Uffer.  He has, as @EmCatlyn says, thrust himself into the story so much that he has become part of it. 

14 hours ago, EmCatlyn said:

I also think that he is inclined to over-generalize about the young people.  I have noticed this is a tendency for the media, and it has bothered me that we are going from “one Turpin kid didn’t know what X was” to “all the Turpin kids were ignorant of X.”  These are 12 different individuals (not counting the toddler whose situation is different).

See above about HIPAA.  To be fair, he may see them as individuals but is watching his words and over-generalizing so as not to identify individuals.  

14 hours ago, EmCatlyn said:

I do want to note, however, that so far the CEO is the only one who is speaking out of turn.  I have not read any interviews with hospital staff (and hope I won’t)

Uffer is the official hospital spokesperson and is speaking on the record.  However, ABC states that it interviewed a lot of the people who had been caring for the siblings over the months.  One hopes they all had hospital permission to be interviewed.  It is possible they had permission, but if not they have every reason to want to stay anonymous! Who knows who said what, unless directly attributed to Uffer.

So let's just look at the most problematic quotes (IMO) directly attributed to Uffer.

Quote

"What initially started out as patients coming in through the emergency room turned into sort of a higher calling for all of us," Uffer told ABC News. "We essentially adopted them. We recognized that they were in a bad place when they came here.

"We just took a personal interest in them,” he added.

Yeah, a higher calling.  Check.  And they did not "adopt" them essentially or otherwise.  Even the minors are not available for adoption (it is still alleged abuse) nor are they a collective.   "Personal interest" as opposed to professional interest, while understandable, doesn't give Uffer or the hospital rights over them.  All this is proprietary and seems like a lax professional boundary.

Quote

Uffer says he is concerned with the public guardian, which has cut off all contact between the children and the hospital, despite psychologists and the siblings’ own attorney’s recognition that continuity of care for the siblings is critical to their recovery.

This statement is way out of line.  Whoa, mama!-type unacceptable.  Them's fighting words.  I'm going to assume that there has been a massive battle behind the scenes. 

I agree with the psychologists and the sibling's attorney (and @EmCatlyn) that continuity of care is very important (if perhaps not absolutely critical) to the recovery of people in this kind of situation.  It would be the ideal plan to allow some overlap and taper off any (possible) overdependence on the hospital staff.  So why would the Public Guardian cut off all contact?  It seems both harsh and abrupt.  

So now let's look at it from the Public Guardian's point of view.  On the one hand, she has Uffer's proprietary attitude towards the siblings as he emotes and chokes back tears all over the place.  On the other hand she has seen all those stories in the press.  Perhaps she suspects some staff have been leaking information and giving unauthorised interviews to the press?  Perhaps there have been security breaches at the hospital that the Public Guardian found unacceptable?  She can't give her side of the story.

I feel for the Public Guardian.  She has a very difficult job.  She has to be up-to-date in all developments in the criminal case, manage all finances, be familiar with all the medical records, and get to know 7 adult special needs people - as individuals with different needs, wishes, and choices - well enough to use good ethical substituted judgement on their behalves. 

They don't pick Public Guardians out of the gutter at random, you know.  They often have both legal and mental health backgrounds.  They are professionals who are assigned in abuse cases when no family member or friend has been deemed up to the task.

[EmCatlyn]

@Palimpsest , thanks for your take on this.  

Just to clarify, I totally understand that the hospital CEO may be generalizing to avoid violating HIPAA.  But there are different ways to generalize.  We know that one of the 7 took guitar lessons at the community college. So the broad statement that none of the Turpins had ever held/seen a guitar up close is a misrepresentation that denies their individuality.  He should have said, “some of them had never seen a guitar up close” ( unlikely, if J2 was practicing at home) or “many of them had never held a guitar before” (which could very well be the case).  Similarly, I don’t believe that none of them knew what a toothbrush was, or that they all had to be “taught” how to wash.  By speaking of them collectively, the CEO is denying that they are not identical.  About the only time he didn’t speak of them as a group was when he mentioned that some of the young people indicated concern that their shoes, clothing, etc. would be taken away. Then he did he say that “some” had worn the shoes to bed for fear of having them taken away.   (I suppose it would have been too big a leap to say that all did. ). The way he characterized them in general was patronizing.  I do believe he was sincerely moved by them and meant well.

The use of “adopted” in his reference to how the staff of the hospital related to the young people didn’t bother me.  I took it to mean that the hospital staff became attached to the young people and tried to do more than just meet their medical needs.  This is not in itself unprofessional.  I do agree that “adopting” in this case doesn’t give a person any proprietary rights.  

Like you, I suspect there was quite a tug-of-war in the background and the hospital lost its bid to be part of the long-term care of the siblings.  It is unfortunate that he is making the quarrel public, albeit indirectly.

 

[SilverBeach]

Medicaid reimbursements are low and do not cover the cost of care.

[EmCatlyn]

More news:

Quote

 According to District Attorney Mike Hestrin, the siblings suffered "severe neglect" and the alleged prolonged harm left them physically and cognitively damaged.

Hestrin has acknowledged that while the abuse was extreme, there's no evidence the Turpins had an intent to kill. But the D.A. was tight-lipped as to a possible motive. He alluded to a pattern of behavior that pointed to the defendants' gratification from manipulation.

Perris Couple Back in Court

The hearing is in progress, I believe. The whole thing is pretty routine and there probably will be no real news, but we may get some minor details reported later, and possibly some interviews.

What interested me above is that they seem to be avoiding any specific explanation/motive for now.

[scribble]

It seems as though the CEO's interview isn't to be trusted anyway, as there are details that clearly aren't right. The kids never owned shoes? They were all wearing shoes at the multiple weddings and they took trips to Disney, one of the Turpin sons went to college -- I'm pretty sure they weren't barefoot in those locations. Perhaps their parents took away their shoes to prevent the children from escaping-- but they certainly had shoes at some point.

I realize this is relatively minor in the grand scheme of things, but it just causes me to discount everything the CEO says because it's clearly not accurate.

[EmCatlyn]

2 hours ago, scribble said:

It seems as though the CEO's interview isn't to be trusted anyway, as there are details that clearly aren't right. The kids never owned shoes? They were all wearing shoes at the multiple weddings and they took trips to Disney, one of the Turpin sons went to college -- I'm pretty sure they weren't barefoot in those locations. Perhaps their parents took away their shoes to prevent the children from escaping-- but they certainly had shoes at some point.

I realize this is relatively minor in the grand scheme of things, but it just causes me to discount everything the CEO says because it's clearly not accurate.

Wearing is not the same as “owning.”  I can believe that they did not have shoes they could call their own.  The parents could have bought the shoes (maybe even second hand) and doled them out, but they wouldn’t have been “ Jxxx’s shoes.”  The parents may have controlled the shoes to reduce the chance of the kids “wandering away,” or just to show power.

Obviously they wore shoes in public and so forth, but they weren’t shoes they could claim.  At least that is how I read it.

 

[Palimpsest]

14 hours ago, SilverBeach said:

Medicaid reimbursements are low and do not cover the cost of care.

Very true.  I suspect the hospital's agenda is more about good publicity and genuine affection for the siblings than money.

14 hours ago, EmCatlyn said:

What interested me above is that they seem to be avoiding any specific explanation/motive for now.

That's very common.  The press always ask but DA's don't usually speculate or pontificate about motive until later.  They are still in the discovery phase.  If this goes to trial the prosecution will come out with a theory then.

And I totally agree about the shoes.  Being assigned a pair of shoes to wear for an outing doesn't mean owning them.  In one of those vow renewal ceremonies the girls were having a very hard time walking in quite low heels.

[EmCatlyn]

This article from People says a little more about the young peoples’ plan to get their GEDs so they can go to college.

Quote

They are all bright and articulate and incredibly eager to study,” Caleb Mason, an attorney for the seven siblings, tells PEOPLE. “The thing they want more than anything else is an education.”

The first step, Mason says, will be obtaining their GED or high-school diploma. He is working with local university officials to “put together an educational plan for all of them” and says the siblings “for the most part have not had any kind of formal schooling.”

“None of them has had what I think anyone would consider adequate exposure to education, and that is what we are trying to remedy right now,” Mason says.

I am wondering if the 17-year-old, JT-8, the one who escaped out the window and posted on You-Tube,  will be included in some form of this education plan or if she has been placed in a regular high school.   She will be 18 in November and will not be a minor, but she may not be ready for college right away either.  The report was that she was academically at first grade level, though that doesn’t mean that she was at that level across the board.  

The People article didn’t have any information about the younger ones.  — not even the information, published elsewhere, that the minors are in two different foster homes

Quote

While the older siblings have been discharged, the status of the six minor Turpin children is unclear. They had been treated in a separate facility from the seven adults, though a hospital official told PEOPLE the siblings were in touch via Skype.

I understand the need to protect the children’s privacy, but it would be nice to have a general report on their well-being and some of the short-term plans for their education and so forth.   

 

[church_of_dog]

On 3/12/2018 at 3:19 PM, Palimpsest said:

Yes, it could just take a call from someone other than landlady to make him understand the severity of the situation.  I jumped to the conclusion that he didn't want to be involved but I was probably wrong.  My deep sympathy to him too.  Looking after aging parents isn't easy.

And you are very welcome.  Landlady is a lovely person to be so concerned about GOT and so are you.  

Going O/T for a moment -- wanted to update @Palimpsest and others that read our exchange a few weeks ago, the saga of the landlady and the Grumpy Old Tenant.  It ended in the best possible way (well, other than someone finding a cure for dementia).

Between landlady's and APS' contacting of the son, son showed up, realized Dad wasn't safe to drive, took away his keys, and promptly moved Dad down to somewhere near son.  Presumably to a facility but we don't know the details, maybe he moved in with family.

A day or two ago, a family member called landlady to say he was out of the house and apologized for leaving it uncleaned.  Today I went with landlady for a walkthrough.  Yes, there were a lot of things that were really dirty, and a bunch of clutter left behind, but frankly I was expecting much worse.  This was hardly more than one would expect for a single male (sorry for the stereotyping) tenant who had lived in the same house for 15 years.  Landlady will need to replace some carpet, hire out a deep cleaning and some serious yard work, but at least there are no holes punched in the walls, no creepy crawlies indoors, no broken windows, etc.  And Dad/GOT is safe and near his family, and all APS and the sheriff needed to do was a couple of welfare checks, no eviction necessary.

[Palimpsest]

@church_of_dog, thank you so much for the update. 

I was wondering what had happened and hoping it turned out OK.  What wonderful news.  I hope GOT is happy as well as safe in his new home, and a big shout out to the son.

I'm also glad for landlady's sake that the house wasn't too bad.  I still think she is a really lovely person to have been so concerned for her tenant.

[Jellybean]

I totally understand the attachment of medical staff to long-term and/or frequent fliers. I’m a frequent flier and have visited patients (friends) on wards that I know well and friends always comment that it’s like a celebrity coming to the ward because everyone knows my name and wants to say hi to me. I’m always so grateful to the staff who take such good care of me and ‘love’ me even when I’m really struggling.

I had a(nother) horrible asthma attack in September last year and was rushed by ambulance straight into resus (the resuscitation area of the ER) and had what felt like everyone surrounding me and keeping a very close eye on me. It’s a little bit fuzzy, but I do remember the paramedics coming back to check on me after bringing in another patient. I ended up in intensive care, predictably enough. Once I was well enough, I was moved to a medical ward, where I saw some of the doctors who had worked so hard to keep me alive when I first arrived, and who were delighted to see me sitting up and smiling, pink (well white, but tinged with pink) rather than blue, and able to chat, rather than gripping onto the side of the bed trying to force each breath or maybe (‘breath’) and almost totally unable to talk. They thought it was hilarious that I put on lipstick before being transferred to intensive care...

I love the feeling of security that comes with the nurses letting me set up my own TPN (it’s been almost six years) and making sure I have supplies by my bed. They know the 30-something medications that I take, and know that I can be helpful because I know my medications well, and have been taking most of them for years. I remember things about the nurses, and snippets about their families, so I always ask how things are, and they always ask after my lovely husband (he’s good looking and brings treats for the nurses) and we just have that easy rapport that comes from months of close contact.

I often see ‘my’ nurses around in my neighbourhood (I live near the hospital, which has one of the biggest and busiest ERs in Europe) and will wave and stop for a brief chat if that seems appropriate - they’re always pleased to see me ‘free range’ and I like seeing them out of uniform.

Close as we may be, it’s very rare for me to stay in touch with anyone in a non-patient-nurse or patient-doctor sense, and I think that’s right. 

I’m sure it was hard for the hospital staff to say goodbye, as it is for them to say goodbye to anyone who has been inpatient for a long time and has gone from very, very ill to much, much better, but that’s (without meaning to sound harsh) part of the job...

[EmCatlyn]

3 hours ago, Jellybean said:

I totally understand the attachment of medical staff to long-term and/or frequent fliers. I’m a frequent flier and have visited patients (friends) on wards that I know well and friends always comment that it’s like a celebrity coming to the ward because everyone knows my name and wants to say hi to me. I’m always so grateful to the staff who take such good care .... [snip for brevity]

Close as we may be, it’s very rare for me to stay in touch with anyone in a non-patient-nurse or patient-doctor sense, and I think that’s right. 

I’m sure it was hard for the hospital staff to say goodbye, as it is for them to say goodbye to anyone who has been inpatient for a long time and has gone from very, very ill to much, much better, but that’s (without meaning to sound harsh) part of the job...

Thanks for sharing a patient’s perspective.  

Indeed, those in the helping professions need to be ready to say goodbye, and those who are helped need to understand that the professional relationship, though it may have love and friendship as a component, is not the same as a friendship or family relationship in other situations.   

There is no reason to believe that any of the nurses, doctors and technicians who cared for the Turpin survivors was other than professional in his or her attitude. They may have been more engaged in some ways than usual, but I have not heard that they expressed the wish to stay in touch with the 7, only the willingness to be involved in and help with the transition.

It was the hospital CEO who seemed to want his hospital to be involved longer in the care of the 7.  And it is he who has made statements indicating that the Guardian forbade all contact between the Corona hospital staff and the Turpins once they were discharged.  Clearly there was some sort of tug-of-war over the arrangements and the CEO “lost.”  

What is not clear is whether the Turpins were indeed forbidden to have further contact with the hospital staff or whether it was only determined that the hospital staff would not be involved in the ongoing care.  If the latter, there is no reason to be concerned.  The 7 Turpins could exchange messages with the staff and they would be free to visit Corona at a later point,  Just as you visit “your” hospital and friends in it.

I think that forbidding the Turpins from making contact with the staff they had become attached to would be bad for the Turpins at this point. They need more, not less, autonomy.  However, I think we are all agreed that moving them out of the hospital and fostering independence from their first caregivers is part of the process.  There is no suggestion that any of the professionals who worked with them was trying to create an ongoing “social” relationship.

Furthermore, more recent reports suggest the 7 adult survivors are thriving in their new environment.  They have not expressed disappointment at not being able to stay in touch with the Corona staff.   Everything seems ok. 

 

 

[Aine]

On 3/22/2018 at 12:07 PM, Palimpsest said:

Demanding an ongoing relationship or control - no.  That is the boundary that Uffer seems to be crossing. 

This. I'm a therapist and I absolutely cannot just contact clients after termination no matter how long I was seeing them, no matter how intensive the therapy we did was, and no matter how much I worry about them or want to know how they are doing. That needs to come from them and them only and even then, I need to manage the boundaries very carefully. 

I have a handful of ex-clients who have reached out with updates since termination but I can't be their 'friend'. There is a fundamental power differential when you are a psychologist that cannot be easily equalized. I think that could be different in some other health professions but for mine, it needs to always be something I am very cognizant of. For example, I have one client and one family that I worked with years ago back in my home country that write me emails, often with photos in it and send it to my previous employer and they ask if she can make sure I get it. She then prints that out and mails it to me here in the US. I was in a role that involved a lot of case management as well as therapy at the time and home visits were apart of that and sometimes there was very intensive case management/therapy that was needed (all my clients had substance use issues and children in the home- sometimes a kid was my primary client, other times the parents) and almost all were court ordered and/or child protection cases. As a result, many of my clients felt very close to me and for a lot of them, I assisted them in breaking the Child Protection/Foster Care/Poverty/Substance Use cycle that may have been in their family for generations. I completely understand them wanting to make contact with me and I obviously adore getting the updates and I think of some of these clients with some regularity.

However, I will never ever instigate that contact. That would be unethical and a huge crossing of boundaries. I reply to ex-client's emails by typing a letter and mailing it back to my ex-boss and she then mails it using the return address of my old office. My replies are completely focused on my clients and not on my personal life at all. I might put in an anecdote like "tell John and James that I held an alligator on my vacation!" but nothing personal and only things that relate to them. So usually it's a lot of, "Wow! Look at Johnny! He's got so big and tall! Tell him I'm so impressed and proud of him for getting the class award for always being a hard worker and helping others. There is nothing more admirable than always doing your best, having a good work ethic, and kindness. I hope his rugby season goes well this year and he has a lot of fun." My replies cannot dip into 'therapy', I will not give 'advice' (not that therapists should be doing that anyway really), and I will not ask my ex-clients any questions in my response. It's all responding to their letter so that they don't ever feel obligated in any way to reply and answer my questions, if that makes sense?

So that ramble is basically me just saying that the boundaries seem very very murky from what Uffer has said.

[Jellybean]

Thanks @Aine! I really appreciated hearing it from another perspective. Obviously psychology/psychiatry is different from nursing (although I assume the Turpin siblings would have been receiving all sorts of therapies as well as input from doctors and nurses), and you made an excellent point about the power differential. It’s easy to overlook that because you’re not dictating to the patient, and (from what little I know of it) you’re often listening and questioning rather than talking.

I appreciate that there will always be patients that ‘click’ and make a lasting impact on those treating them (and vice versa). This case was different because the Turpins didn’t have family coming in to take their laundry away and bringing things for them, but the Turpins won’t have been the first in that situation (I have a bag packed because Husbean has a demanding job and is often not able to do more than drop off my bag - or I can ask a friend to get it from home for me) and they won’t be the last ones. Maybe the hospital could think about the things that they did for the Turpins and whether they could find a way to extend that to other patients, if appropriate.

One hospital that I know well admits people from all over England and Wales (I don’t know about Scotland) so patients are often a long, long way from home for weeks at a time. Each ward has a laundry area with a washing machine and tumble dryer for patients to use. Other helpful things I’ve seen as a patient: laptops and iPads for patients to borrow during their admission, art therapy and music therapy, visiting therapy dogs, exercise areas that can be used by patients to do their prescribed exercises and/or stand in standing frames, free WiFi, tv screens for each bed (these systems are often clunky and a bit outdated, but the idea is still a good one, I think), hospital gardens and quiet spaces (prayer closets?!) accessible to patients who are not able to get out of bed, and hospital cinemas that are free for patients and visitors, have space for patients in wheelchairs or in bed, and/or who need oxygen or a connection to a power source (eg for IV pumps)...

[Aine]

@Jellybean, there are definitely some patients that make lifelong imprints in your memory for many different reasons and you of course have patients that you really think to yourself, 'If we'd met in a different way, we could be great friends!' You also have patients that you get to know more or feel more of a connection with or that do need you to go the extra mile for them (without blurring the boundaries too much). I especially noticed this working at a very large pediatric hospital (that is world famous for its cancer treatment) recently and the kids and their families usually live on campus for sometimes years so you do become their family in many ways, while still being a professional and desperately hoping that this kid you feel so much affection for never has to see you again when they leave!

I truly miss some patients that I've had over the years. I really deeply care about all my patients but some of them just really do get under your skin. But my goal as their psychologist is to give them the skills and knowledge that they need to manage their own life, their own emotions, and their own behavior so that when life gets hard again, they can deal with it without me. I want them to build resilience, develop perspective, and fully engage in a life that is meaningful and fulfilling for them. And I want them to be able to do that without me or any other mental health professional. That is always my goal and when I wonder about them and how they're doing when they come to mind and I haven't heard from them? I choose to believe they are doing just that- living their life and they don't need me anymore and that makes me smile because that's why I do what I do. 

I don't mind if an ex-patient stops to talk to me when I see them in public. I quite like it for the most part. But I do tell all my patients on intake that I will never initiate contact with them in public. I may even make eye contact with them (not on purpose but as I recognize them) but I will ignore them and that is not me being rude, it is to protect their confidentiality. If I say even 'Hi' and they are with someone, they are then potentially put in a position where they might be asked "who is that? how do you know her?" and if they don't want to answer that or they don't want to lie to whoever they are with, it puts them in a predicament. Likewise, if I'm with someone and I say 'hi' and they return the greeting, my family member/friend could ask the same of me and that puts me in a position of maybe breaking confidentiality. But if my current patient or ex-patient waves or says 'hi' or runs and hugs me (as my kid clients do often), I will not ignore that and I follow their lead (i.e. if they start a conversation, so long as it isn't therapeutic, I will stop and chat; if they say 'Hey!' and smile and keep walking, I'll do the same). Explaining this at intake stops a lot of the awkwardness for my patients as well because they don't have to work out if they should or shouldn't say 'hi' or what the right thing is to do etc. As one of my patients who has social phobia said to me in the session we had after she and I saw each other at Walmart: "It was such a relief to know that you weren't going to say anything that I needed to react to and that I completely knew that I wasn't going to have to navigate that awkward social interaction and I could keep walking and you wouldn't think of me as rude and I didn't need to be worried that I'd embarrassed myself!"  

[Aine]

35 minutes ago, Jellybean said:

It’s easy to overlook that because you’re not dictating to the patient, and (from what little I know of it) you’re often listening and questioning rather than talking.

Right...in some ways it's a lot harder for psychologists (and psychiatrists if they do therapy...which most don't) for this reason. With a physician or nurse, you're dealing with physical things- doses of medication, various biologically based tests and scans etc but what we do is assess behavior and we are trusted with people's biggest secrets and truths that can sometimes make them look 'bad' or are caught up with all kinds of stigma. We do not reciprocate this. We explore these things in depth and teach skills and strategies to help manage their behavior and emotions and we help them process things and allow them to develop flexible ways of thinking about things that have happened in their life, situations, and the world. I see that as a huge privilege and developing that strong therapeutic relationship and trust takes time and it's precious and all the evidence basically says that without that solid 'therapeutic relationship', any evidence-based therapy modality will have limited success. That is our foundation. And it needs to be all focused on the patient- it's not an equal relationship. They will probably allow themselves to become more vulnerable in that room with me than they ever have before and I realize that. They will not see me become vulnerable with them ever. I will be empathic, caring, honest (I won't be their yes-woman), and an advocate for them but they will never really need to be that for me. I want them to be all those things I listed for themselves and for others in their life though. So it's a very strange power dynamic and we need to be careful with transference and also with the client overly bonding and becoming attached because of how much they share. They often feel extraordinarily close to us, as they should, but they don't really realize how little they know about us and how unequal that relationship is.

[FJismyheadship]

@Aine your replies have made me feel better about the situation I am in. My former therapist and I are still in contact, but I always initiate. She answers my questions, we don't get into anything therapeutic, and she never initiates. 

I was concerned that the level of contact could have been considered unprofessional, but after reading your response, you seem a lot like my former t and I feel better about it. My main concern was she would "abandon" me abruptly, but so far I am wrong and we are keeping things professional.

Thanks for your insight!

[smittykins]

Now that the Magnificent 13 are well on the road to recovery, I feel comfortable saying that I keep misreading "Turpins" as "Turnips."

[Aine]

On 4/4/2018 at 4:31 PM, FJismyheadship said:

@Aine your replies have made me feel better about the situation I am in. My former therapist and I are still in contact, but I always initiate. She answers my questions, we don't get into anything therapeutic, and she never initiates. 

I was concerned that the level of contact could have been considered unprofessional, but after reading your response, you seem a lot like my former t and I feel better about it. My main concern was she would "abandon" me abruptly, but so far I am wrong and we are keeping things professional.

Thanks for your insight!

@FJismyheadship, it doesn't sound like that at all from your therapist! So long as the person we've discharged/terminated is appropriate as well with boundaries, most of us are glad for the contact and appreciate the updates. The APA Code of Ethics does state to leave two years from last session if you're to establish a friendship with a client but even then, the therapist needs to be careful that the power differential has equalized or isn't still at play and that the client's wellbeing is at the forefront. This means that if it seems that the relationship could become unequal or that the client could be in any way taken advantage of or they could be harmed by that relationship (e.g. you likely wouldn't open up the possibility of an equal friendship after that two years with your client if they have a history of abandonment and rejection and that previous therapeutic alliance had been their one relationship where they felt accepted and unconditionally positively regarded as if you decided that you just didn't want to be friends with that person for whatever reason, you have the knowledge that that could undo all of the therapeutic good).

These things become more difficult in small towns or in places with a small mental health practitioner community, like where I live currently and like when I practiced in rural Australia. You're often going to have potential dual relationships through your kids playing on the same sports team or being in the same class or any other community involvement. As the therapist, you just need to be very conscious of it and aware of it and be willing to maybe go "without" something you maybe wanted (as far as attending something or even a friendship that you think would be a great one) if the risk is too high. 

I am friends with my first therapist who I saw for 3 years and she changed my life. She made me want to be a therapist and helped me so much. I terminated as I felt "done" even though I wasn't...thanks cPTSD...and then we ended up working together at a big university in a major city. We're friends. We're good friends. But she'll never ask me for anything and I recognize that because I'm aware of these boundaries. We don't go into any kind of therapy thing because I'm also conscious of completely avoiding that but I would probably argue that we have an "unequal" friendship and maybe it's more like a mentor relationship when I think about it? She does call me (we're 7 years post-treatment completion) and she is so genuinely interested in me and she shares about her life but it's more shallow or if it's deep, it's her resolved stuff that is deep. Like "when I went through ___________________ like you are, it sucked!"

As the therapist, it is our responsibility to have the tough conversation if we think someone's contact is crossing boundaries and to do it in a careful and respectful way. I'm sure your psychologist would do that if there was anything that wasn't okay  

****All of the above obviously doesn't apply to all psychologists- many bend the Code of Ethics but they could have their license taken if it goes bad and they're reported. Also, not all therapists are psychologists and I think psychologists and social workers are the only ones bound by a code of ethics for their profession as far as that umbrella term 'therapists' goes?