Family and Caregiver Schizophrenia Discussion Forum

Therapist says don't tell psychiatrist about voices

Hello Everyone,
I am my daughter’s guardian, so her therapist and psychiatrist are pretty open with me. My daughter has been doing very well but had a rough episode with intrusive thoughts and urges last week. In talking with her therapist, I learned that the previous week she had heard voices again. The therapist insisted that I tell my daughter’s psychiatrist about the intrusive thoughts episode but said not to tell him about the voices. She wants to preserve my daughter’s trust in her. I feel like the voices are important for him to know about - more so than the intrusive thoughts.I suggested that she contact the psychiatrist (there are releases) but got no response. Has anyone ever run into this kind of thing before?

As far as antipsychotic medication goes, I don’t think it matters much whether the psychiatrist knows any specifics about voices or not. The drugs don’t target only voices and psychiatrists generally do very little talk therapy, and don’t seem particularly interested in the content of voices or delusions. They largely dispense medications by assessing the aspect, speech and self assessments of patients.

As a patient I’m not likely to admit to hearing voices or profound delusions for fear of being over medicated, and even if I wouldn’t couch their existence as “hearing voices”. The experience of “voices” is difficult to describe and you tend to integrate them with your daily life and they appear “normal” to you.

There was a thread a while back that discusses reticence to talk about voices. You may want to review it for additional support. My suspicion is psychiatrists bake-in a significant amount of withholding of symptoms by patients, and counterintuitively being aware of voices and not talking about them to people you may not trust, shows a degree of sophistication of coping behaviors and recovery. Recovery is NOT an absence of symptoms; it’s the development of coping mechanisms so they are less burdensome to coping with life and society. Trust is a big part of therapy, as well as guardianship. These are her voices to talk about, not yours or her therapist’s. I would leave the decision whether to talk about them or not to her.

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Thank you - your perspective is always helpful. According to her therapist, she did handle the voices well. She knew they weren’t real and used her coping skills to deal with them. The episode was relatively brief. My daughter did say to me, “do you know how hard it is to tell someone about your symptoms?” She often believes that any symptoms will land her in the hospital. I assure her they won’t. She is lightyears away from that.

Her psychiatrist actually spends a lot of time talking with her and is genuinely fond of her. He is conservative with medication. She has treatment resistant sza so it took years to get the meds right. She has not been over medicated for about the last four years. She hasn’t been hospitalized for 4 years either. I wouldn’t have told the psychiatrist about the intrusive thought episode - it does happen and she deals with it. Granted, this time it went on longer and she had a lot of trouble getting a handle on it. I only contacted him at the therapist’s insistence. I just don’t know why she doesn’t think the other episode is worth reporting - I guess because she is the only one that knows and keeping my daughter’s trust is so important. Her psychiatrist could know without mentioning it though.

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Hi mmm61, As Maggotbrane has written, the trust factor between your daughter and her therapist is extremely important. I would follow the therapist’s advice.

I wish we could put this statement of @Maggotbrane 's on a poster with mountains or something equally inspiring in the background, or maybe the one with the kitten hanging on by its paws would be more appropriate.

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A nuance here I think is important: Trust is a two-way street. When you jump in and tell psychiatrists and others about symptoms and other PHI, what you imply to your daughter is you don’t trust her to manage her illness on her own, and possibly set her up for life-long dependency. I feel for parents in these situations, because it becomes an ultramarthon of parenting. The choice of when to step in and when not, is always difficult, but the eventual goal is for children to manage their own lives.

Trust is also a big part of learning, which is what recovery is all about. Learning to cope with your new “reality” and when and how to ask for help if you need it. And this is a lot harder without bonds of mutual trust.

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Thank you. It is a good reminder to hear that recovery is not the absence of symptoms. She has worked SO hard to learn to manage her symptoms. I know this, but I also battle the fear of the dark days coming back. It makes me hypervigilant. I want to catch everything before it becomes unmanageable. I do need to trust her more - she deserves that. She has excellent care - both her therapist and her psychiatrist have done an amazing job - and she has made absolutely remarkable progress through her own hard work. So I need to trust the care team more too. I’m holding on to the involvement that I needed to have in the beginning - she needed the advocacy, she needed the hypervigilance. She doesn’t now. Thanks again.

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There are times when my son does ask me to accompany him. I’ve come to realize its usually when he has to enter a new “arena” where he doesn’t know what will happen. Really good point MB, I need to remember that he is placing his trust in me at such times to remain quiet. He just needs me to be there in case a sticky moment occurs.

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Yes, it’s a shy way of asking for help or another respected opinion. To get more “meta” here, there’s also a level of your son’s trust in himself. To accept that you have a mental illness is a self-admission that there are times when you can’t trust your own thoughts and feelings. Good therapists model relearning to trust yourself and others in a more healthy manner, while learning warning signs of when that trust can be misplaced.

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Thanks (as usual) for the insights, @Maggotbrane All of this applies to spousal relationships as well, I think.

I have backed way off and have let my husband handle things, which seems to have worked reasonably well.

But his usual absent mindedness about taking his medication appears to have continued for several days in a row now, and I’ve been trying to figure out ways to bring it up that balance his need for autonomy with my need for a stable and caring husband.

This discussion has given me some ideas about how to bring together these different needs so they can complement rather than compete.

Love these wise words of yours … always so helpful @Maggotbrane … thankyou for making me think more clearly. @hope replied “put these words on a poster”…yes, let’s!.

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To clarify my original question- I was asking if any of you had experienced a therapist insisting you report one episode and not another. I’ve been living with this illness long enough to know that recovery does not mean an absence of symptoms.

Not spelled out that way per se, other than stating the obvious that session information is private and belongs within the session. The phrase “safe space” was used by more than one therapist. I had delusions at times that sessions may have been recorded and transcribed by outsiders, so it was important to me to assert this.

Another time I became paranoid and went into a file cabinet to read my file and my therapist noticed when she returned and became quite angry, I explained why I did it and that I only read my own file which was indecipherable to me. I think she would have dropped me if I didn’t give a satisfactory answer.

The safe space doctrine was doubly important when I started group work. My mother also saw one of my therapists for a while, so we spoke at length about confidentiality rules at that time. I saw both my therapist and some group members in social settings and we never acknowledged how we knew each other to others. Very much like “what happens in Vegas, stays in Vegas”.

My first therapist also cautioned me to have care when talking to authorities, other therapists and psychiatrists she did not know or were non Jungians, as they tended to pathologize and stigmatize serious mental illness and force expectations with confirmation bias. I believe it was largely to protect the significant investment in progress we had made. That said, I was free to do as I wished— these were just advisements.

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Sorry, I got us off track a bit. Many parents struggle to understand that meds aren’t a cure all.

In regards to your question. I have spoken to my son’s therapist and have been told to not relay information.

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Thank you Hope.

As far as safe space goes, I didn’t raise any of this. The therapist did. I had no plans of my own to tell the psychiatrist anything.

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It is so important to have a team of supportive people in place for this di sease and most difficult to acquire. In my experience the therapist has been the most help and have had psychiatrist just use the words ïf you are not willing to take meds, there is nothing I can do for you" so frustrating as we know most of them refuse to take meds and it leaves US the caretakers to try and figure things out. In my unofficially adopted sons case for the last 9 years has been NON productive except with his therapist who helps me to manage him and deal the best I can. Just recently he revoked the ROI so now I have nothing and his behavior is over the top with disrespect and emotionally abusive that I have to distance myself from him. He will be homeless in about 10 days and has done nothing or used his resources to find alternatives, he is just angry and insists he is being forced out with zero responsibility on his part. It is so true that their brains are managing so much that they are rarely in reality and I dont know what else to do as I cant continue to subject myself to his abuse. :frowning: Thank you all for always sharing your stories and doing your best. God Bless!