To think this therapy program is unfair

[Happiestyearofmylife]

Nhs dbt program they are saying people have to have their camera on to take part. My dd is very self conscious and also has social communication problems. They say it’s because she could have someone else in the room with her but surely you could with the camera on? I understand it for the group bit but it also has a 1-1 bit where only her own problems will be talked about and they still want the camera on Aibu to think people shouldn’t not be allowed therapy over this?

Good to see disability discrimination is alive and well in NHS mental health services of all places

OP, is there any part of your daughter's treatment that you aren't criticising? Your opinions could be encouraging her to refuse to engage with things that could actually help her.

[quote Porcupineintherough]**@AndyKaufmanIsAlive* yes of course. If the camera is an insurmountable barrier to the OP's* dd and the therapy cant go forward without the camera, then it's not suitable and an alternative should be offered.[/quote]
It should but due to Covid I'm sure face to face has a much longer waiting time, so I think in this case OP's DD will either have to engage with the device as is or be on the waiting list so that reasonable adjustments can be made

@AndyKaufmanIsAlive

I find if you mention that she is disabled and covered by the equality act they tend to backtrack.

The other option is for them to provide therapy face to face, which would probably be better for the "therapeutic relationship" but probably a ballache for them to arrange.

DBT is delivered in a group. It is a group therapy. The confidentiality of all concerned participants needs to be maintained. Having camera on is one way for the therapists to safeguard that right for everyone.

Further, one of the basic premise of DBT is to participate 100%, literally throwing yourself into the activity wholeheartedly. If you have your camera off, you aren't doing that. The therapists are also likely to need to physically see the participants to check they are engaging in the activities properly/using correct techniques in order to benefit from the therapy.

A lot of people with not a lot of knowledge chucking their well intentioned, but misguided opinions in here.

DBT is a huge commitment which takes massive amounts of work. People have to be able to push themselves (with support). Maybe it isn't the right time/circa for your daughter. Is there any plan for them to move back to face to face deliver soon? That may suit her better

Can you practice first, having camera on video conversations with trusted people? Even in a group?

In don't think 'camera on' calls are going away any time soon, be in school, work, medical, therapy. Is there any way you can help her to feel more comfortable with it rather than going down the 'we're not doing that' route. It's hard enough to secure any MH support. I'd try to work with them rather than against.

@NeverDropYourMooncup

OP, is there any part of your daughter's treatment that you aren't criticising? Your opinions could be encouraging her to refuse to engage with things that could actually help her.

I guess the OP just wants accessible mental health care for her DD.

Refusal to engage = inability to engage without adjustments for her social communication disability.

It is possibly the case that the OP's daughter has spent 20 years coping without the adjustments she needed that has given her the mental health problems in the first place. Which is usually the case in autistic people. Especially girls/women.

Your daughter can minimise her image of so that she doesn't have to look at herself. Then that would be a facsimile of attending a group face to face

I don't know whether its unfair, it does sound like its unsuitable.

A lot of people with not a lot of knowledge chucking their well intentioned, but misguided opinions in here.

I agree. It's all very well accommodating a disability in terms of saying someone can have their camera off - but there might be other people in the group who has PTSD who won't feel safe not being able to see one participant as the sessions play out. Why would you want to put yourself in a vulnerable position not knowing who one of the group members actually is? It can be a really eery feeling having black screens and that's without it being therapy.

Something like DBT is not easy, it's challenging for everyone joining in. What therapy works unless you fully jump in and participate? If the camera issue is such a huge issue then this isn't the right thing for the OP's daughter to participate at this point in time. It's really unfair on the others in the group to join in but keep the camera off. If they were flexible with this rule, most of the people attending would choose to have their cameras off for very genuine issues around social anxiety etc and then very little with be achieved. They have to have boundaries.

Actually, mention equality act would not sort the whole thing- especially not when the camera being on etc in the group part of the session is for the sake of everyone participating. Therefore, it could be argued that is not a reasonable adjustment. Similarly, if clinicians feel it impacts on safety or reduces effectiveness of therapy (thereby wasting resources), the “reasonable-ness” of the adjustment could be challenged.

DBT is hard going, perhaps your DD is not quite ready to engage with it, or would be better with face to face, although that may mean a wait as things stand. Our psychologists are seeing patients face to face but due to waiting room restrictions etc, they are seeing fewer than before. I am not sure if group work is back face to face though.

@AndyKaufmanIsAlive

It’s not fair on the other people in the group who have their cameras on.

This is absolutely no reason not to provide adjustments for disabled people. That's like saying blue badges aren't fair on non-disabled people. IT's pure discrimination.

The Equality Act legislates that reasonable adjustments must be made. Reasonable adjustments may be that she waits for a face to face group (which may be a year away). It doesn’t mean that other patients should be disadvantaged. I say this as a person who lives with a severe and enduring mental health condition and a permanent and substantial physical disability. Therapy is literally about a therapeutic relationship, you can’t do that if you have one participant who isn’t following the group rules regardless of whether that is because of a disability or not. Say, I’m in a a group talking about my panic attacks triggered by sexual abuse I’ve experienced. How do I know that black square isn’t a bloke wanking off whilst I cry about what happened to me? I’m not going to share my vulnerability if I can’t see that every one else has been nodding and looking like they care about me and what I’m talking about.I would if I can see that person’s face. OP, perhaps your DD needs some support to work up to attending a group, practicing video calls with family for instance to boost her confidence? So often with forms of therapy it’s about making sure it’s the right time for someone to engage eg you have to self refer to the local CBT service because it shows it’s something you want and are committed to doing rather than your GP or whoever saying you need to go. Maybe this just isn’t the right time for her or she needs supports do encouragement to do so.

DBT is very full on and while I totally understand your DD's position unfortunately it makes sense that they have that rule. You need to fully engage with the therapy and the therapist needs to be able to gauge your reactions. If it's not possible then group video sessions don't sound workable.

Maybe this just isn’t the right time for her or she needs supports do encouragement to do so

OR maybe group therapy over zoom is never going to be accessible for her because of her disability, and other people will accept that for what it is, and provide a different type of support that she can access.

I agree with previous posts that camera off is NOT a reasonable adjustment for this therapy, because with camera off the therapy won't work.

Removing self-view in your software is easy to do (use a post it if that is easiest) and can make a big difference to how people interact in an online conversation and how comfortable they feel. If that doesn't work, she may have to wait for face-to-face sessions.

@AndyKaufmanIsAlive You may be right in which case it may be that she has to wait until a face to face group is run. I don’t know OP’s DD and her needs. I simply hope that there is a smattering of sound clinical reasoning as to why she has been offered a virtual group in the first place (I may be unreasonably optimistic after a glass of wine though).

This is absolutely no reason not to provide adjustments for disabled people. That's like saying blue badges aren't fair on non-disabled people. IT's pure discrimination

They could argue the group isn’t suitable for her and she won’t benefit from it if she’s not at a stage where she’s ready to have her camera on. Group work takes commitment and motivation from all participants, they need to see each other and work together. As it’s DBT I imagine many of the people in the group have a disability that makes it hard for them to communicate on camera in a group.

Of course they could provide an alternative if they have one eg a self help manual or a phone call with a psychologist but it depends on resources and clinical need.

I’m part of a Zoom therapy group where everyone has to be on camera and on screen.

They have said there are two reason:

1. For the privacy and safety of all members, so they can see if people are too distressed etc and guide the session accordingly

2: For it to be effective you need to engage with other participants emotionally.

One difference is that you are allowed to leave the room, go for a wee walk, get a drink etc if you are getting overwhelmed. You can also point your camera at the ceiling for a bit.

But I think if you did that frequently or for the majority of the time in session they would start talking to you about whether the session was actually helping you or not and whether you needed something else instead.

Surely everyone in a DBT session counts as disabled under equality law, otherwise why are they being offered DBT?

It seems like turning up to a sign language group and complaining you are being excluded and discriminated against because you don’t want to use sign language.

I think people need to understand what a disability is. It's not something that can be magicked away by trying harder, even if other people force you to try. It's not lack of commitment, lack of motivation, lack of effort, lack of engagement, lack of willingness or any other personal failing. If the OP's DD has ASD she will have social communication differences, which will make group therapy incredibly difficult for her anyway. And then there's the "barrier" of trying to do sessions virtually, which even some professional, presumably NT people on this thread have said they had found difficult. I agree with Painismydayjob that you wonder about the clinical reasoning behind why this has being decided as the best treatment for her, and whether they even asked her if she would need any accommodations for her social comms difficulties.

Theoldprospector that''s a daft thing to say because there are different disabilities that need different adjustments. DBT is not a treatment for ASD AFAIK so you can''t assume everyone there will also have ASD.

Maybe therapy over Zoom is not appropriate for your DD at the moment, and it might be worth waiting until she can be offered face to face.

Therapy is so much more than listening to someone's voice. It is also observing body language and reactions. In a group setting, having one of the clients not have their camera on could distress any of the other people also in the group. When I did group DBT, we were not allowed to sit in the line of sight between one lady and the door. Her not being able to see the door clearly was a huge trigger. Not being able to see someone's face could be another when it is in a Zoom type setting.

@Catipepo

Could she have it on but use a post it note to cover the little square that shows her face/video feed? This may help her forget about it?

This is a good idea! The problem with allowing her not to have the camera on as a reasonable adjustment is that it might make other participants uncomfortable and as a result they wouldn’t get the full benefit of the therapy, so not sure if it is reasonable. Another idea, could she have the camera on but with a source of light behind her face is in the dark? Much better for other participants and the therapist, and it also means she could gradually decrease the shadow if she feels comfortable.

I understand the need In group sessions but I don’t get why in one to one they need to push it.

How do I know that black square isn’t a bloke wanking off whilst I cry about what happened to me?

How do you know that's not happening offscreen anyway?

A lot of people with not a lot of knowledge chucking their well intentioned, but misguided opinions in here.

Indeed. The idea that therapists don't understand what ASD is, or how the EA2010 applies is laughable- as is the idea that f2f appointments will be provided instead because they 'have to'.

I don’t get why in one to one they need to push it

You've had quite a few people explain: because this type of therapy doesn't work over the phone.

that''s a daft thing to say because there are different disabilities that need different adjustments. DBT is not a treatment for ASD AFAIK so you can''t assume everyone there will also have ASD

I don't think it's a daft comparison. The ASD will be a component of the difficulties addressed in the DBT, particularly the communication element. In that respect the other patients will have similar challenges (if for different reasons).

If DD is not at a point where she is able to have her camera on I can't see how she would be able to benefit from the other elements of DBT. The fact that the treatment may not be appropriate is not discrimination.