My experience of this guy as an EMDR therapist was not good: Nick Adams

I spent 18 months getting funding for EMDR for trauma (recommended in the NICE guidelines) and found a therapist Nick Adams
http://www.psychtherapy.co.uk/about-nick-adams-msc-ba-dhyp-tftdx
we did 12 sessions
and on the morning of the 13th, he called me to say he no longer would be working with me.
No referall. Nothing.
 the funding we had obtained, was linked only to him.
I was in the middle of massive trauma processing.
I insisted he refer me and we try to get the funding changed to a new name
He gave me the name of one of his supervisees who would not see me due to Nick Adams being her supervisor.

He told me and my husband that he can cure PTSD in ten minutes, or in four sessions and was adamant that he could cure all my traumas.
He actually bailed out on me with no concern for my safety.

Premature Ending of therapy: Attachment Disorder

I am meeting a lot of people who have had their therapy terminated prematurely - either to do with the NHS funding being pulled or because their therapist/psychologist has had enough of the cuts and stress and are pulling out to retire early or move to private work elsewhere. It is getting increasingly common. 

I am beginning to feel most uncomfortable (understatement) that this is not only 'allowed' but worse, it seems professionals are not considering the long term damage it can cause the client. 

I am going to cut and paste some of the comments that I am receiving from people who have experienced this in therapy. (see below).

I consider it damaging. One person told me it was worse than any of the rapes or childhood abuse that had brought her to therapy in the first place. 

another client explained that although she had to sign a contract as a client saying she will not terminate suddenly and give advance warning of cancellations, she is now considering drawing up a contract for any subsequent therapist where the therapist has to prove that they will not terminate therapy prematurely unless a huge unforeseen event occurs. Because, the client explained, it is like having a surgeon do open heart surgery and then walk away with the job half done. Leaving the poor client in no fit state to get up off the operating table. 

American friends have told me that they would lose their licence for not providing a transition to a new therapist that they have referred to, so that the client is not left half way through heart surgery. 

So people are telling me:

I did 14 months of therapy with a counsellor and she drew me out and to my shock, I discovered that I am hiding a tiny little girl inside myself and that little girl was coaxed out by the counsellor and after many months of reassurance and repeated reminders that she would not leave me when I was feeling so fragile, I felt like I stepped out and trusted and loved for the first time from that small terrified part of me. I believed her. After a few more months she sent me an email out of the blue saying she was terminating with me. I felt like I was dropped from a cliff miles high. that feeling of free fall and terror and pain kept me awake for four months. I had no name for this. No one understood. No one recognised the trauma of what had happened to me. I still feel it was worse than the traumas that had caused me to go into therapy in the first place. 

A friend emailed me and said:You describe it really well - it is the "rape of the emerging self" and it happens a lot in the name of psychotherapy- and sometimes it happens with people who are being pseudo therapists to people too, (friends who believe they mean well but haven't the wisdom or experience to continue the work and bail out early).

ending therapy early when things are only just beginning to be known or come out into the open, it feels like 

rape of the emerging self

betrayal, rape and abandonment of the emerging self. 

In it's aftermath comes horrendous pain, abandonment on a seismic level, damage to the sense of internal self and a deepening distrust and suspicion of people and especially people who say they know what they are doing and kind of seduce you into opening up.

It is like throwing in a hand grenade into the very soul/heart/core of a person's sense of their emerging self and then BOOM ! everything shatters. connection goes, self disintegrates.

It is violent, causing immense damage even years after the event. It is so destructive.  

I still don't feel any of the terms I have tried to use to tell friends and family are really conveying the destructiveness of the experience. 

I wonder if the CFT approach has this written in to the contract with clients, that they won't be opened up and then abandoned - because it needs to be recognised as abusive and not part of a compassionate approach at all. 

I am beginning to think a book needs to be written about how therapy can go terribly wrong when therapists bail out prematurely and that it is being 'allowed' to happen, causing great harm and damage to clients who are actually being abused rather than helped. 

My heart bleeds for these people. 

I suspect many of you know other cases and people whom it has happened to. I would like to know 

1. what you do to safe guard it happening to your clients 

2. whether you truly take into account the damage premature endings can cause vulnerable clients

3. whether it would be helpful to write a book with accounts from clients of the damage they have experienced from unskilful badly managed premature endings. 

a Colleague replied:

Very helpful, Sarah, to draw attention to this important issue. Especially to remind us of the client perspective. And I would not like this to happen to me. Which actually reminds me that this has happened to me. However, though puzzling thankfully it did not happen too have too great an effect on me, G

and I replied:

 it depends what you ended up in therapy for. 

The people I am encountering have had presented with  'trauma' but as therapy progresses, it becomes apparent that there was huge developmental disruption due to early trauma and so attachment was seriously compromised. I think this client group is especially vulnerable when premature termination of therapy takes place as they have been coaxed out into attaching to the therapist and actually the 'premature ending of therapy' trauma is so severe that I would go so far as to say it is negligent on the part of the therapist to 'allow' it or to initiate it in these circumstances.

Also of course, the damage is severe when the therapy has been longer term, not just a six or eight week course of sessions but one where the therapeutic relationship has been ongoing for a year or more. 

he replied

Absolutely, and thankfully I did not have that trauma and could think it through. and make sense of it.

And yes I have some clients who might well be affected greatly by such a termination. Which emphasise the need for great care indeed with how we are with clients and of what we say, and how we say something. And boundaries in many  other ways as well.

Any papers on this would be interesting and thought provoking so that awareness of this and so that we are less likely to do this in any kind of unawareness.

I wonder how the sudden changes in this country with the referendum and politics might be affecting our own security just a bit more now! And might play out with clients if we are not careful,

G 

Another colleague replied:

I share your concern about this issue.  Whilst it's hard to know what happened in this person's situation it does sound as if something went badly wrong.

If it is the case that clients are being abandoned by their therapists in this way then to my mind this represents a failure in compassionate behaviour and, importantly, also a likely breach of professional practice.  Certainly the regulatory body which oversees my practice (The Health and Care Professions Council) and the body that provides the guidelines for ethical practice for clinical psychologists in the UK (The British Psychological Society) would regard such behaviour as unethical and unacceptable.  I would suggest that any client who thinks that they have been ill-treated by a therapist seeks to raise it with the body with whom the practitioner is affiliated/registered.

With all good wishes,

W

I posted:

Several colleagues I have spoken to have admitted that they don't actually end contact with clients who need connection and attachment to be maintained and so keep in touch after formal therapy has ended, to keep the continuity and attachment that enables healing. One colleague said that some clients are in his life for life - not in a dependent way, but because the relationship is such that it requires something different and he sees that as the more compassionate approach. 

another posted:

 Phase oriented treatment reminds us that stabilization is the first phase which would include being in the present moment and building a capacity to compassionate self. 

I also want to put a plug in for therapists who are working with the most complicated clients and not getting the support they need to process the counter transference and the huge unknowns.  Having done a lot of consultations with therapists in these situations it seems important to give them a lot of compassion when they have to choose, for whatever reason, their own sanity and mental health even if it means terminating. 

D

G replies:

I am finding this conversation very helpful. Yes,it is important for us as therapists to be able to look after ourselves so that we do not end with a client early. Doing the Sensorimotor Therapy training as I am, is incredibly resourcing, I am finding in being able to be more with the depth of peoples trauma, whether it is small t(rauma) or bigger stuff. And helpful so that they can learn to be in touch with the tremendously difficult feelings clients have so that they can learn to be comfortable with them. And of course compassion is of the essence.

And this course IS very expensive, so reflects what D says. And then another issue can be that the client might have financial issues with paying, and this can impact on the relationship with us, if it breaches what we can afford to live with. So there are really big issues here which can affect endings and one way or another play consciously or unconsciously into early termination,

G

I wrote:

a student gave me permission to anonymously post this, written to me yesterday:

I can relate to this, and I'd agree with abandonment or say emotional abusive. The emotional destruction can be a million times worse. The feeling of trusting them with your inner self, especially your inner child, and having them leave is terrible. Especially if you were unable to be a child. I've experienced that situation quite a few times. I hate to say that I don't trust people but it's true and it's more than that. I realize that everyone is in their own head, in their own world, and we can't believe that they will "save" us in any sense. We can believe that they will be a temporary support, or someone who will teach us something directly or indirectly. But I don't any longer believe anyone will be there for me in the way my inner child needs and I can't do it myself so I close off inside. 

and another wrote:

The betrayal aspect of my sexual assaults was far worse than any physical effect, but the abandonment damage in two different settings when I finally let down my guard enough to risk getting close to people after that has been the worst of all. It was like having my heart ripped out and stomped on in front of me. And neither of those were the sort of closeness you're describing.

The one person with whom I have that sort of closeness now is my therapist, and the pain of even the tiniest hint of abandonment by him is immense. That feels like the entire world has ceased to exist, leaving me completely alone, cold and in pain and darkness that will never end. And that is just perceived abandonment. I honestly don't know if I could survive an actual abandonment by him, or anyone else I had opened up to that much. I certainly can't capture the depth of that pain in just a few words or find a term for it.

So it is a big issue for vulnerable clients. I have been talking to a few psychologists about this and we agree that there can be support in place for the therapist, when they feel they need to bail out, but often the client is left stranded. The therapist is often encouraged to do this premature and sudden termination but often it seems not enough thought is put into the safe guarding of the client. Sometimes, by this point of terminal rupture, the client is being labelled 'difficult' and his/her distress is somehow minimised because they are seen as being distressed anyway. Often the client is demonised, in the sense that the therapist was the one doing their best and the client's complaints are just their pathology talking. In some cases I have encouraged clients to get the therapist struck off or at least reprimanded and they have succeeded.

About six years ago I talked with some American psychologists and they said they have a general policy that a therapist must do two sessions for every six months of therapy. So if you terminate, and you have been working for two years with a client, then that would necessitate 8 sessions to end and talk it through. they also said, as I wrote above, that they could lose their license for not putting in place alternative therapy.  I am afraid I have a list too long to mention of clients who have been terminated full stop by phone or email in the UK, private and NHS. 

I would consider this disrespectful at least and negligent and dangerous at worst. 

I presume NHS psychologists are trained and taught how to end with the clients best interests at heart?  And is there a booklet about this?

D replies:

I have always liked how CFT focuses on developing an internalizing secure base. Sensorimotor Psychotherapy, as Gavin writes, provides a great map of the brain and body experientially. Diana Fosha’s AEDP model provides a great relational/attachment model as well, tracking moment to moment processes in the client as well as between therapist and client.

On top of all others have offered, a group of us in Boston wrote a book that Norton is publishing in September which is both a full review of attachment theory as well as providing a positive treatment model for remapping insecure attachment. The outcome studies were quite good.  In writing the book I brought a lot of CFT into the conversation.   Dan Brown, our mentor in attachment and main author, has researched meditation (wrote a classic with Ken Wilber and Jack Engler, Transformation of Consciousness)  and teaches Mahamudra and Dzochen.  In this book we used the concept of an Ideal Parent Figure (which in many ways is akin to the compassionate self of CFT) to support the client in developing a representation of secure attachment.  http://books.wwnorton.com/books/detail.aspx?ID=4294990790

At the same time I was also writing another book on embodying secure attachment through yoga and meditation (Norton Publishing, coming out January/February 2017) which accesses CFT as well. http://books.wwnorton.com/books/detail.aspx?id=4294992067

D

Worse than Rape -: Rape of the Emerging Self

There  is the trauma of someone coaxing out the small child self, encouraging the small child self to emerge, getting that small child part  to have a voice, show her emotions, begin to trust, begin to reach out and hold on to a finger, begin to feel that maybe she matters, begin to feel she is 'real' , that maybe her needs and sorrows and rages and confusion have a reason - having a person encourage that small child to then attach and love the person, the person who is being so adamant about how trust worthy and committed they are, how sincere and loyal and determined they are to be there for that little child, that person being so determinedly convincing in how they are going to make the child trust and emerge and attach and for it to be safe enough- and then

that person sends an email to say they have decided not to be there for her/that small child part -  anymore. Or announces they are stopping seeing the client.

that is the trauma worse than rape, for me. 

That is the trauma that does not heal. It has happened several times - in different ways with different people. Each of them I loved and trusted as only a very small child can.

this trauma is not recognised by society. there is no forum or organisation set up to support survivors of it. there is no recognition of the damage and pain and dismantling it causes me. There is no term for it even. I have no way to refer to it.  

I have wondered about calling it 'rape of the emerging self'. It needs to have a strong label, one that conveys clearly how bad it is. 

anybody got any ideas? It is severe 'child abuse' but not in the conventional sense.

It seems one can heal from rape and CSA eventually, but this particular trauma is more difficult to heal from. The wounds go deep.  I wonder if it is because people refuse to hear that it is a trauma and refuses to acknowledge how severe a trauma it is?

Borderline Personality Disorder

I have never been diagnosed with Borderline Personality Disorder but my own PTSD symptoms sometimes inflame and appear a bit close to this diagnosis but then it all subsides again. Anyhow, I found this article interesting as I do have problem with rage but infrequently and rarely - and I do feel about two years old when I am in rage mode. I know that it links to the abandonments I experienced as a child by my parents and it is helpful to read the guidance here.
http://www.guidetopsychology.com/bpd.htm