Last year a local independent psychiatrist retired who was heavy handed when it comes to poly pharmacy and controlled substances. I inherited a patient on 12 mg of Klonopin. Made it very clear at initial appointment my plan would be taper and she was free to seek a second opinion. She wanted to move forward. Without getting into specifics it came to my attention that another provider she sees was telling her to advocate for herself and push back on my taper plan. I have been tapering slowly at 25% every 1-2 months. In another case from this provider there’s a 67 year old on Xanax and Valium. Same scenario with letting her know what I would recommend and offering a second opinion. Got her off the Valium without too much trouble and over 8 months have reduced Xanax by 0.5 mg. Now I get a note from her therapist saying they spent the majority of the session discussing how she wants more Xanax and he recommends she be more assertive with me. I did send a message to the provider in the first case asking for follow up on their statement but they have not responded. Trying to decide how to handle things with this therapist and seeking input.
Sounds like a therapist with poor boundaries. I'm assuming that they're a non-prescriber. If so, they should stay in their lane. Aren't there state laws against practicing medicine without a license? Scope of practice?
To me, the therapist contacting you directly is clearly countertherapeutic in this sort of situation. I'm assuming the patient is an adult, can use a telephone, and could reach out to you to discuss their medication plan (which is YOUR plan with the patient and falls within YOUR scope of practice). The therapist could help the client explore the issue and could offer any number of appropriate/helpful therapeutic interventions, including:
(a) utilize Socratic questioning, collaborative empiricism, and examining the evidence after identifying likely cognitive distortions around their 'need' for the benzo
(b) I've heard that there's this thing called applied relaxation and all kinds of these things called psychological interventions to address many common conditions (such as anxiety/panic) that are often the clinical targets of benzos
Relatedly, I have been seeing a
sharp increase over the past several years of clinical practice (as a psychotherapist) of what we probably need to nominate as a clinical disorder for further study in the next version of the DSM, namely, 'Adult Maturation Deficit Disorder.'
(c) assertiveness/communication training, teaching the client to clearly but respectfully articulate what they see as their needs/opinions/boundaries and to assert their opinion ('I NEEEED BENZOOOS') as an
opinion and not an incontrovertable
fact and to do so properly with their prescribing provider while inhabiting the
patient role
From what you wrote, the gist of the note from the therapist was...'the patient whom we share in common spends the majority of the session discussing how she wants more Xanax and he recommends she be more assertive with [you],' I dunno...if you respond at all, I'd imagine you could/should just say, 'Thanks for keeping me in the loop. I'll be glad to discuss Mr./Mrs. X's medication treatment plan with him/her at our next clinical encounter.'