Multigenerational and Administrative-Clinical Process
Interaction Insights in the Practice of Psychotherapy

Dr. King


by Dr. Jeanne King, Ph.D.



Like mother, like daughter. This little vignette illustrates how remote transference and contra-transference can reveal intergenerational dynamics—from parent to child, experienced and observed from administration to therapeutic process.

The mother of a patient asks me to give her an itemized bill invoicing professional services by sessions and dates—after she had been receiving monthly billing of an intervention by sessions, covering nearly a year of services, and said nothing about doing this any other way.

I let her know that I would have been happy to have provided this to her exactly as she is asking of me now, if this request had been made at the time the service was rendered or at the time the invoice was provided.

I told her that I am not going to create an invoice for services rendered over a year ago based on an estimate of consulting/psychotherapy day-to-day. I clearly indicate that this is improper practice for a clinician to provide real-time invoicing over a year later when multiple services are delivered in the context of a program, in which some of the services are reimbursable and some are not eligible for submission for reimbursement. This is less than authentic invoicing to the insurance company, and I do not engage in that practice.

She is unaware of or unwilling to acknowledge the fact that doing this compromises my professional integrity. Instead, she can only see herself as not being served…as being wronged—someone who is not being helped with her insurance claim. She does not even recognize or admit that she failed to help herself with her own insurance claim, by not filing it in a timely manner. The insurance company states that the services provided required pre-approval.

Then, there are the misrepresentations around the time when the insurance company was contacted. The insurance company claims that their first contact with the patient’s mother was May 5, 2009, which is 17 months after my first session with her daughter. The mother claims this is not true.

The subtle dynamics in play between mother and patient’s therapist are that the mother feels wronged when she fails to get the therapist to compromise the therapist’s practice integrity. And further, she persists over months seeking to get her way in the absence of any personal responsibility for her unmet reimbursement needs.

This is one of the dynamics that the daughter had been working on in therapy: the tendency to persist in meeting her needs oblivious to her fiancée’s boundaries, until they reached a breaking point. Their interactional combativeness was further fueled by alcohol abuse, controlling behavior and poor conflict resolution skills.

The core dynamic here was the very dynamic that the daughter knew from both ends. When on the receiving end, it frustrated and enraged her until imploding into physical symptoms or emotional withdrawal. The mother had been insisting on the daughter ridding herself of her fiancée to the point of denying his existence when taking part in her daughter’s life.

As an aside, through therapy, the daughter is learning more effective ways of meeting her needs and shows greater empathy and respect for the needs, rights and boundaries of others. The patient is headed toward breaking what appears to be a long-standing and pervasive dysfunctional pattern.

This little vignette exemplifies the intergenerational dynamics of a specific type of interpersonal conflict and shows lessons found in the most unexpected places.

For information on the dynamics of controlling relationships, visit http://www.EndDomesticAbuse.org/ebooks.php Dr. Jeanne King, Ph.D., psychologist, author and leading expert in the subtle communication patterns of abusive relationships, is founding director of nonprofit Partners in Prevention http://www.EndDomesticAbuse.org

Dr. Jeanne King, Ph.D. – Domestic Violence Prevention and Intervention

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Dr. Jeanne King is a licensed psychologist and domestic abuse consultant. Feel free to contact us if you need help with physical and/or emotional pain, stress-related illnesses, or relationship abuse issues at home or in court. Contact Us to reach Dr. King.