Psychologist attending patient appointment

[Attending1985]

I’m next door to an np and I can hear what’s going in there if my office is quiet. I know she was seeing a cluster b patient I had seen the past. It was a virtual appointment and her therapist was attending with her. In my opinion this is a boundary crossing. What are others thoughts?

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[Ivos]

Not in the US, but why would that be a problem? Having social workers/therapists/family occasionally join appointments is usually great for collateral. If anything, the problem would be you hearing their appt.

 

[Attending1985]

Not in the US, but why would that be a problem? Having social workers/therapists/family occasionally join appointments is usually great for collateral. If anything, the problem would be you hearing their appt.

I would understand more in a lower functioning patient who may not be able to provide history accurately. In someone who has this ability and also in a situation where the therapist can easily collaborate with the np outside of the appointment it makes less sense. I can understand family being present but that is certainly a different role than your therapist. I cannot hear things clearly but enough to understand the patients therapist was present. But yes we need better sound barriers in our office.

 

[TexasPhysician]

My opinion would depend on the quality and likability of the psychologist/therapist joining.

 

[smalltownpsych]

It seems pretty odd to me and definitely not unethical. Question is more whether or not there is a sound clinical rationale. Your intuition that something is off about it is probably right though just because so many clinicians do so many thoughtless actions while trying to “help” their patients. Control, enable, or investigate are just a few potential dynamics that come to mind.

 

[calvnandhobbs68]

Why do you care....that's my thought.

You should also let the NP know you can hear her just as a courtesy, I've had this problem myself in the past and have said something like "hey I know the walls are pretty thin around here so sorry if you can hear too much of what's going on during my appointments! I'll try to keep it down"

 

[comp1]

Definitely let them know you can hear their conversations in your office. That is the much bigger issue. They may at least be able to move away from your wall. In terms of boundaries, it's entirely specific to the patient and therapist. Hopefully you weren't able to hear well enough to make this determination.

 

[Attending1985]

Why do you care....that's my thought.

You should also let the NP know you can hear her just as a courtesy, I've had this problem myself in the past and have said something like "hey I know the walls are pretty thin around here so sorry if you can hear too much of what's going on during my appointments! I'll try to keep it down

Because I work with her and I anticipate she may be doing the same thing with other mutual patients in the future.
And yes I appreciate the suggestion on the noise factor. She has a pretty loud voice and probably doesn’t realize it can carry.

 

[docloufan]

what "boundary???" I don't get it.

There is already too much nonsensical siloing and secrecy in the field. Care coordination and collaboration should be completely normalized.

 

[calvnandhobbs68]

Because I work with her and I anticipate she may be doing the same thing with other mutual patients in the future.

And? Are you her supervisor? If you are her supervisor and you have an opinion about the therapist attenting appointments, you can bring it up in a general manner and provide your general opinion on this.

 

[Merovinge]

Because I work with her and I anticipate she may be doing the same thing with other mutual patients in the future.
And yes I appreciate the suggestion on the noise factor. She has a pretty loud voice and probably doesn’t realize it can carry.

We have these $20 white noise machines directly outside the door. Can't hardly hear it inside the office and helps a lot make sure the conversation is private.

 

[PsyDr]

Psychologist here. Not normal. Almost never okay.

1) What is the supposed benefit of meeting with the patient? Why isn't this a professional to professional phone call?
2) Relative to demand, what psychologist has the time to do this?
3) Who is paying for his/her time? If unpaid, is this actually a professional service?

 

[Sushirolls]

There are treatment team meetings on inpatient units.
I don't see any issues.

Now, time, logistics, money, billing, etc, etc those are real world problems.

You have better things to do then let your ears wander. Practice the art of minding your own business.

 

[Candidate2017]

I’m next door to a new np and I can hear what’s going in there if my office is quiet. I know she was seeing a cluster b patient I had seen the past and dismissed for no shows. It was a virtual appointment and her therapist was attending with her. In my opinion this is a boundary crossing. What are others thoughts?

It's a win for everyone.

Patient gets their maladaptive behaviors validated, "therapist" gets to live out their countertransference/savior complex, and NP gets to live out their "heart of a nurse, brains of a doctor" fantasy, all 3 get to gleefully cackle and reinforce each other about how the "bad doctor doesn't care and doesn't listen", and OP gets a white noise machine.

 

[Mad Jack]

Psychologist here. Not normal. Almost never okay.

1) What is the supposed benefit of meeting with the patient? Why isn't this a professional to professional phone call?
2) Relative to demand, what psychologist has the time to do this?
3) Who is paying for his/her time? If unpaid, is this actually a professional service?

Thanks for chiming in, this is how I was feeling about it myself. By definition, if paid this could constitute duplication of services. If unpaid it makes me wonder how deeply enmeshed the patient is with their therapist. It honestly, in the case of a cluster B patient, sounds like it is likely an attempt at weaponizing one clinician against the other, but maybe I'm extrapolating too much based on negative prior experiences.

It reminds me of a couple of the cluster B patients I have come across over the years that are given bizarre or unfitting diagnoses by therapists and then use their therapist's opinion to doctor shop and advocate for specific medications, despite several psychiatrists in succession disagreeing with said therapists' opinions. They insisted that their therapist be contacted to discuss things, rather than any of the psychiatrists that had previously disagreed with them, because only their therapist "truly understood" them.

 

[littlefred]

Textbook counter-transferance in display here.

 

[Ceke2002]

I’m next door to an np and I can hear what’s going in there if my office is quiet. I know she was seeing a cluster b patient I had seen the past. It was a virtual appointment and her therapist was attending with her. In my opinion this is a boundary crossing. What are others thoughts?

I can't speak to the ethics of the situation, but I do think this sort of dynamic isn't healthy for a cluster b patient if my assumption that cluster b in this case means borderline is correct.