Monday, July 09, 2012

Psychotherapy: the Down Side

In my review of Lou Breger's book Psychotherapy: Lives Intersecting, several readers commented that they felt injured by psychotherapy.  It's a favorite topic of ClinkShrink who wrote the section for our Shrink Rap about how therapy can be harmful, and likes to note that any treatment with the potential to heal also has the potential to harm. 

So I got to thinking Why Would Psychotherapy be harmful?
There's bad therapy, like those mentioned by ClinkShrink and by Dr. Breger, where the therapist has their own belief system and thrusts it upon the patient, whether or not the patient feels the interpretations resonate.  We've talked before about what makes a good therapist.  Maybe we should talk about what makes a bad therapist?
I'll give you my list, please write in and add to it.
A bad therapist:
  • Falls asleep during the sessions
  • Forgets to show up for the sessions (repeatedly, we all have emergencies or calendar/technological failures).
  • Does not return phone calls (or other communications) or is generally not responsive.
  • Over-emphasizes money issues with patients who have traditionally paid.
  • Makes interpretations that don't feel relevant to the patient and insists they are true even when this repeatedly upsets the patient.
  • Takes non-urgent phone calls during sessions routinely.
  • Is generally disrespectful of the patient (curses at him, eats pizza during the session, berates or belittles him).
  • Is preoccupied and not attentive on a regular basis.
These were my thoughts off-the-top of my head, certainly not a comprehensive list, but this list is more inclusive and includes a list of more obvious red flags like licensing issues, the therapist initiating a physical relationship, revealing the identities of other patients, etc.  
 I want to say that there are always exceptions, and so these "bad therapist" ideas need to be general.  If the therapist just found out his wife has cancer, he may be less sensitive than usual or preoccupied, it doesn't mean he's a bad shrink.  And therapists have their own bills, and their own individual financial issues which may or may not permit them to be flexible or reduce fees, but some ways of talking about fees are more sensitive than others. 

 Finally, there is no perfect therapist: Someone who does everything wrong and has an awful reputation may be seen in a totally different light by a patient who feels very helped by his/her style, and the most wonderful of shrinks will still see patients who don't like them--- there's an element of chemistry that can't be ordered off the menu.

So tell me your list of bad shrinky things to do.


chewing taffy said...

I had a therapist many years ago who regularly ate dinner during our sessions. I didn't think anything of it at the time, but looking back, wow. Odd.

She also told me way too much of her own crap. There were sessions where I felt like she should have written me a check at the end.

When I finally bailed out of the therapy, she became stalker-ish, phoning me at home and work, leaving messages, asking how I was doing. Ironically, as creepy as all of this is, she helped me in some ways. This was the first time I was able to stand up to an authority figure and set real boundaries (i.e.: stop calling me). That has helped me immensely in life.

And twenty years later, I found a real therapist and wow...the difference is startling!

(But if you have nothing to compare it to, and no friends in therapy, how would you even know? I didn't.)

Anonymous said...

From my experience with therapy gone wrong:

- criticizes rather than trying to understand
- fails to recognize your limitations, attempts to push forward too fast despite you making it clear that you're seriously struggling with jumping the hurdle he then spends the next three months trying to jump in the exact. same. way.
- focuses too much on what things were like with previous therapists
- attempts to push their religion on you, even after being told that you are not interested in their religion (or any other)
- "freaks out" when discussions of suicide come up. One should be able to discuss the existence of suicidal thoughts, but if the therapist cannot maintain their composure, how's a client to feel safe?
- over-complimenting
- frequent cancellations and/or
- calling to "discuss some issue" for a minute or two only to reveal at the end of the conversation the real reason he'd called - needing to reschedule.
- is excessively late for appointments (because he became distracted while doing yoga with another client).

This is two therapists meshed into one.

With one therapist, I felt he didn't really care, and that he had a religious agenda. He was also very disorganized and I really have no idea where he was trying to take our therapy, and I'm not sure he did either. Did I mention he spent our first session sitting on a yoga ball? Very distracting and awkward for me.

With the other, I felt he was too emotionally intense, judgmental, focused too much on how he compared to other therapists, held an expectation of perfection both of himself and his client, and failed to recognize that there's life outside of therapy which can sometimes get in the way of clients' ability to attend therapy or complete homework.

I've had two great therapists. Not just good, but great. What made/makes them great:

- They listened and discussed without criticizing, and without appearing emotionally affected. It's not that they lacked emotion, but they didn't cry or panic, which would make me feel bad and as though I'd done something wrong.
- They recognized when something was too much for me and found ways to break issues and goals down until I felt capable of moving forward.
- They encouraged me to come to sessions on a recurring schedule, applauded me for always showing up on time and prepared, and didn't guilt trip me when I was unable to reschedule due to circumstances beyond my control.
- I didn't feel like I had to show up with a happy face on. I could be what I was, I could feel what I needed to feel, without them trying to "fix" my feelings in that single session. We'd look at the present, but more focus was put on the bigger picture.
- We were equals, and I felt that my ideas and suggestions on how to proceed with therapy were just as important as theirs.

They were/are the polar opposite of my two bad experiences. It's night and day, and both myself and those around me recognize a difference in my distress levels since getting back with a good therapist. If you're with a therapist and you're actually feeling more distressed than before *all the time*, then you probably need to look for a new therapist.

Sunny CA said...

In September, 2005 I was in "Partial Hospitalization" day program. We were divided into therapy groups. The psychologist who ran our group ridiculed patients and expressed withering disbelief at our genuine life accomplishments ("Sure you did".) One man had entered the program because he was suicidal. He had just been laid off from a management position with a major corporation and was suicidal as a result of the job loss and marital difficulties that followed on the heels of the jobs loss due to financial hardship. Once, while trying to explain something about himself, this man jumped up, grabbed chalk from the tray, and drew or wrote something on the chalkboard. The psychologist ridiculed his behavior in a schoolyard bully sort of way. The patient defended his behavior by saying that in the corporate environment from which he'd just come, this would be normal and typical behavior. The psychologist then dumped psych labels on him, telling that him he was narcissistic, and trying to self-aggrandise and "sure you were doing this a few weeks ago in a corporation". A few days later, this same psychologist said what amounted to a suicide dare to this man. Clearly the suicidal guy disliked the taunting from the psychologist. At the end of one day, when assessing our suicidality, the patient expressed doubt in his own ability to make it through his time at home that night. The psychologist puffed himself up and proudly said "Nobody who has made a pact with me that they won't kill themselves has ever left here and killed themselves." The man successfully suicided a few days later (following more ridicule and more comments like these). This was a handsome, well-educated, successful man. He had a wife and kids. He needed support, not humiliation from psych services. I felt that effectively, the psychologist killed him. From what I knew of the patients mental state, it was possible he should have been admitted in-patient for a few days. At the very least, he ought to have been treated kindly and with humanity.

Bing said...

Reassures patient about experience they describe yet proceeds to document or tell other treaters that they (shrink) have now decided patient has a sever mental illness. Chooses the most serious diagnosis to explain difficulties that might be better explained in other terms. Uses that a rationale to over prescribe meds or tell patient they need to be in therapy for many years. Uses patient to prop up own ego. In doing so, acts in ways that serve to create enormous feelings of dependency in patient, who feel they may die without the shrink who is driving them insane. Tells patient how much they mean to shrink, echoing the voice of past abusers.Note that while this need never descend into sexual abuse,it is a form of therapy abuse. It is akin to a parent locking a child in a room in the home to "take care" of them, such that said child never develops as an independent person.
Send mixed messages to patients. Is unwilling to explore topics patient brings up; these are all seen as signs of the "illness" or shrink tells patient they are just being manipulative. (If the patient is manipulative, this could be explored,correct?)
Shrink never considers the interaction of the environment and the individual, beyond the obvious such as alcoholic parents or poverty. An example might be that shrink has never considered that patient is not mentally ill but is responding in a way that would be normal for a person of a certain sensitivity, to events or stimuli that are difficult for sensitive persons to cope with. Diagnosis trumps normalization. This is seen in shrinks who have the same or similar primary dx for most of their patients. It is also seen in shrinks who are intellectually stunted. Yes, a shrink can have many degrees and be intellectually stunted or, at the very least, have sever tunnel vision or not have read widely enough to consider all possibilities. No one can consider all in a short time frame. One might expect that over the course of years of therapy, during which patient does not get better and may get worse. If patient gets worse, shrink blames it on the illness or on the patient not trying hard enough. Shrink is threatened by some aspect of the patient that may be stronger than shrink despite the fact that patient does not actually threaten anything other than shrink's ego. When shrink is tired of a patient who no longer meets shrink's needs for love and validation, shrink unloads patient.
This is also a list which incorporates experiences with more than one shrink,but not more than two.
I do believe some people benefit from seeing some shrinks.No shrink is perfect. Some shrinks are mentally ill and they create illness in patients which causes far greater distress than whatever patient initially sought help for.

Bing said...

sever was meant to be typed as severe.

rob lindeman said...

Just want to emphasize the distinction between bad therapists and the judgment that therapy is bad. Talk therapy, when conducted between good therapist and an insightful analysand can be very beneficial indeed. Certainly there can be unintended consequences (trival example: analysand realizes he married his overbearing controlling mother and learns he needs to end his marriage).

Analysis has several advantages over "standard psychiatry" (for want of a better phrase). There is no lying to the analysand. There is no telling the analysand her brain is sick and will remain sick forever. There are no horrendous side-effects of medication. The relationship tends to be consensual and non-coercive

Bing said...

"There is no lying to the analysand". (???)

No offense to those who never lie.

rob lindeman said...

Fascinating article. But it's about Freud's lies to US.

The good analyst does not tells lies to his analysand, such as "you will need to take citalopram for the rest of your life"

Bing said...

Rob, you make two different statements.They do not mean the same thing. One is that the good analyst does not lie to his analysands. (I use the words they/ theirs rather than he or his. Poor grammar, but not as bad as assuming all analysts or therapists are men.) Your earlier statement was that analysis is better than psychotherapy because there is no lying to the analysand.If that were true, no analysand would ever have slept with an analyst who promised it would be a healing experience. It happens. Freud lied to US about some important things. People who lie to the masses often have no difficulty lying to individuals.

A good analysand will not lie to analysands. That is part of what makes them good. A good therapist will not lie to patients and neither will they lie to themselves.

rob lindeman said...


Well said.

I used the Strunk and White "he". I am nearing completion of a book on the first six months of life in which I refer to babies always as "she". The developmental editor (a woman), took exception. See what happens when you try to be politically-correct?

Alison Cummins said...
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Alison Cummins said...
This comment has been removed by the author.
Alison Cummins said...

This is like saying “what makes a bad medication?” or “What makes a bad exercise?”

Even a very good medication can cause unacceptable problems. A medication that is excellent for treating multiple myeloma might be very bad for treating an infant’s stuffed nose — even if the medication is prepared to the highest quality standards. (Even when used to treat multiple myeloma, it’s unlikely to prolong life much. “Excellent” here is relative.)

Swimming and running have downsides. Very few people can afford horseriding, some horses are mistreated and you might get asthma in barns, but that doesn’t make horseriding a “bad” exercise. Even the “best” exercise is no good at all if you don’t do it. The risk of injury from exercise is balanced against the pleasure and physical benefits it provides.

So Rob has decided that psychoanalysis is the “best” treatment for everything because there is no potential for side effects (because the analyst has no input). Only unintended consequences (like developing life-changing insight). That’s a little like saying that homeopathy is the best medication for everything because it has no side effects (how could it, it has no effects) but harnesses the “power of placebo.”

I spent years not knowing what was wrong. I maintained I was depressed but had trouble finding a professional to agree with me. I submitted myself to therapy with the expectation that the therapist would know what was wrong and what I should do. I was miserable in therapy but had no means of judging why. Maybe I was doing really good work and therapy hurts; or I had a personality disorder; or I was doing therapy wrong; or the therapy was inappropriate. (Therapists suggested variants of the first three. I suspected the fourth option but how would I know?) I just knew I was miserable and relied on my therapists to refer me if they thought the therapy was inappropriate. (This never happened. Why would it? Therapy is always appropriate.) In the end I would quit when I ran out of money (I was desperately poor in those days) and have to deal with therapists reproaching me for being avoidant.

This inability to evaluate benefits on the part of the client/patient is inherent to therapy and is a built-in danger. It never ceases to amaze me that it’s so rarely addressed. (I haven’t read your book, but thanks ClinkShrink! I will have to buy it now for the sake of your section.)

Ultimately what was wrong was that not knowing what I wanted out of it, I was a poor candidate for therapy. I have a therapist I see occasionally now, and I know exactly what I want from her: I want her to be nice to me. The relationship is beneficial and has few side effects. Medication works very well for me. I am bipolar-ish. I became very ill while in therapy and was finally conceded to be depressed. I take an antidepressant and a mood stabilizer. I transformed my life without therapy within months of starting medication. When the downsides of medication start to approach the upsides, I talk to my doctor. She doesn’t tell me I’m doing medication wrong, she changes the medication to suit me.

We all know that medications can have side effects. The idea is familiar, lists of side effects are provided in patient inserts and prescribers will warn patients about particular dangerous side effects to watch out for. This means — paradoxically — that patients are better able to protect themselves and make risk-benefit evaluations. If they are more miserable when they take the medication than when they don’t, it’s normal to blame the medication and find better alternatives.

Without an objective way to evaluate therapy, it works like alternative medicine. If you feel worse in treatment, if your cancer is getting worse despite homeopathy, if the coffee enemas are keeping you awake and you haven’t slept in weeks, if you are starving on the bizarre diet — those are all signs that the “toxins are working their way out of your system” and you need to continue! Don’t give up! Your misery is proof that it’s working! Not a flattering comparison.

rob lindeman said...

"Rob has decided that psychoanalysis is the “best” treatment for everything because there is no potential for side effects (because the analyst has no input0"

Rob didn't say this and meant nothing of the sort (go back and look).

I will concede, however, I meant that talking therapy has an advantage over standard psychiatry in that the former, understood classically, is non-coercive and contractural.

EastCoaster said...

I suppose that eating something in a group therapy session with another therapist might be okay, say if the session was from 6-7:15, and the psychiatrist had another patient at 7:30.

You would just need to apologize.

Ronald Pies MD said...

Dr. Miller has invited me to comment on this interesting discussion, and I'm pleased to do so! I have found the discussion informative and sophisticated, and actually have little to add, except for a few important distinctions; namely, it's helpful to distinguish "bad therapists" from "bad therapy", from "inappropriate" or "mismatched" psychotherapy. I will focus on the last category.

Historically, we have two fairly extreme examples of "mismatched" or inappropriate therapy. The composer, George Gershwin, complained of chronic headaches. These were (mis)diagnosed as a psychosomatic problem, and treated with psychotherapy. He turned out to have a brain tumor! The take-home here is to be sure that so-called psychiatric problems have been properly evaluated for an underlying OR contributing medical or neurological cause.

The other historical example comes from the treatment of Borderline Personality Disorder. Leaving aside the many controversies regarding this diagnosis per se, the syndrome (it is probably due to a variety of causes) was first identified in patients who "fell apart on the couch"--that is, they had very bad reactions to classic psychoanalysis. The deeper the analyst probed, the more regressed the patients became.

It is now generally acknowledged that while psychodynamically-oriented therapies may be adapated for use in patients with Borderline PD, "classic" psychoanalysis is usually contraindicated or very risky. Most psychiatrists would also argue that psychoanalysis per se is inappropriate for patients with schizophrenia (in which, however, cognitive-behavioral therapy may sometimes be a helpful adjunct to medication).

Other examples of "mismatched" treatment include: 1. use of classic psychoanalysis alone for treatment of substance abuse (which rarely responds to psychoanalysis alone and may actually worsen); 2. use of psychoanalysis for most cases of male sexual dysfunction (which are often due to physical factors or performance anxiety, and can be treated in a matter of weeks with more appropriate behavioral techniques).

I do not mean to "pan" classic psychoanalysis! When used for the right type of patient with the right type of problem, I believe it may be helpful, although solid controlled studies are lacking (and are very, very tricky to design, since "blindng" is nearly impossible!).

Cognitive-behavioral therapy (CBT) may also be mismatched with the "wrong" type of patient; for example, CBT alone is unlikely to control severe bipolar disorder (though it may be a good adjunctive treatment)or be very successful with some personality disorders (e.g., antisocial PD).

Finally, there is premature or unnecessary psychotherapy. After 9/11, it was found that those exposed to the trauma actually did worse than controls when they were given a form of "crisis de-briefing" treatment--maybe because it was provided by therapists unskilled in working with traumatized patients. (It is easy to make things worse in traumatized patients, by over-stimulating the traumatic recollections without the proper psychological "safety nets").

Finally, as some readers have wisely noted, nearly every useful medical/psychological treatment can have unintended or negative consequences, if given to the wrong person for the wrong reason--including aspirin and over-the-counter antihistamines!

In general, there is abundant evidence that all the major forms of psychotherapy are of benefit for the common conditions we treat; e.g., most depressive and anxiety disorders. But correct diagnosis; matching of treatment, and a "good fit" with an empathic therapist are critical predictors of success.

With good wishes to Dinah and readers,

Ronald Pies MD

Alison Cummins said...

Rob, you said: “Analysis has several advantages over "standard psychiatry" (for want of a better phrase). There is no lying to the analysand.”

The only way that not lying to the analysand can be an inherent part of analysis is if the analyst does not communicate with the analysand. Since this corresponds to the model of analysis where the analysand is positioned such that the analyst is not seen and cannot communicate nonverbally, and where verbal communication is limited to “mm hm” and “what does that remind you of?”, that is what I thought you were referring to.

There is no model of any human transaction that involves communication that can categorically exclude lying. Nobody knows for sure that an analyst who makes a statement of any kind is not lying. So now I have no idea what you meant.

I disagree that there is no coercive element to analysis. I felt completely coerced in talk therapy, some of which used analytic approaches. I was miserable, didn’t want to be there, didn’t know what I was doing there. I was afraid I would reveal myself as a “bad patient” undeserving of any kind of help if I quit or if I rejected a therapist’s interpretation or insisted that being worse after a year of therapy really was a sign of being worse, that being worse was not any kind of sign of being better. I’ve had therapists actively interfere with my getting medication, thereby keeping me dependent. I went anyway because I needed help and that was the only choice available to me at the time.

Many of the techniques used in therapy are indistinguishable from some interrogation techniques that police use to get people to confess to crimes they did not commit. Asking the same questions over and over and over again. Promising release if you will only confess to this one little thing, you might as well confess because nobody believes you anyway, you are the only person with the power to rescue yourself and the only way to rescue yourself is to confess.

Medication is completely non-coercive in my case. I take it because it enables me to make my life better by my own standards. If it doesn’t, I don’t take it. What I love about medication — besides the better life bit — is how completely empowering it is. I don’t have to get someone else to agree with what’s important to me. I get to decide that.

Sarebear said...

You posted awhile back about a NYT article about ten things that shrinks shouldn't do, like rattle on about their experiments on rats in college, or something, among other things.

My second shrink actually rattled on about his experiments on pregnant rats using marijuana, in college. This was right after I think, within a week or two, of you posting that, or maybe it was a week or two before. Anyway, I just sort of let my mind wander until he was done.

Oh, there's a whole host of boundary issues . . . I still have a music CD this second psychiatrist lent me. I suppose I should mail it back.

How about, not calling you back when you call and leave a msg that the medication is making you suicidal? That was a biggie.

Leaving me on Cymbalta for a long time while it turned me into a zombie. (However, no craving for brains was involved.)

He showed up quite late, up to half an hour on an occasion or two, for at least half our appointments.

How about having dog hair, a really excessive amount, all over the place and the place smelled like dog? Dog toys all over the place, some in trippable places (and it left you wondering about dog drool and germs too).

How about the pushing drugs at you in a manner that seems as if you are in the pocket of the drug co.'s? Ie, within a few weeks of each other, there were things like the drug rep for the company that makes Effexor/Pristiq? Came to the front desk and thanked him for coming to their presentation dinner, and asked if he was coming to an upcoming thing, and then doing other drug company rep business right in front of you? Right around then, you are telling the shrink that effexor has stopped working for you, you need to switch to something else, so he starts shoving Pristiq down your throat which is almost the same thing, chemically .. . . he does this for the next couple appointments until he agrees to try something else.

How could I not assume there was drug company bias there? Seems logical to me.

Yelling at you when you tell the shrink you're afraid of her (and proving you right to be afraid of her lol). You've heard many of these things from me before over the years.

More recently, telling me that working on my marriage and family is selfish? Um, what planet are you from . . .

(Oh, you could also do a post asking about what really exceptional moments stand out for us, when have we felt that they've really gone above and beyond, or at the very least just exemplified in a particular difficult time of yours what the best of psychiatry or therapy is about? Cause this stuff happens too, not just bad. Which I know you and others know, but it'd be nice to throw all the good stuff in one place too.)

Having your intake done by an energy healer (wth? lol).

Having your shrink harangue you for 24 minutes about how YOU waste his time. Um, HELLOOOO!

Having the "friend" who hooked you up with that shrink, call and talk to your shrink in a way that was supposed to be supportive of you and instead was stabbing you in the back, and calling you all sorts of things that you weren't (my therapist even disagreed w/everything she said, and she's a friend of his too). like manipulatve and stuff, and the psychiatrist agrees with her, and types it all up, in a neat package, so in your SS hearing they see this and can then discount what you're saying . . . so many betrayals on so many levels there.

Sarebear said...

Jumping to conclusions about what's wrong w/you/what's going on with you/cutting you off before you are finished saying what you feel needs to be said in order to have any confidence in their decisions and judgement that they will be based on whats going on. Doing your best to keep it as concise as possible, though you aren't the most concise. How can you have any confidence his decisions are based on the symptoms, what's going on, if he cuts you off before you finish, and you only have 1-3 more minutes worth of stuff to say? Usually less, but essential stuff is cut off before you can say it. So he's just flying off the top of what you say . . . They gotta cut you off somewhere I guess but most of my appointments with first shrink fit within 15-20 minutes. So who's wasting whose time, mr. half hour harangue?

Having incompetent office staff, or the competent secretary takes several week long vacations in like a month (course who knows if some of that was for a sick child or whatnot, you never know), and important stuff doesn't get done because of it.

A psychiatrist who won't LISTEN, who won't HEAR you or give the impression that he's HEARD you; he just says what he decides is going on, sometimes even ignoring everything you said that appointment. ARGh.

Dinah, I hope you have a strong stomach to take all this stuff coming at you lol. Well mine (and I hope others) isn't at YOU.

Let's see, this next one could just be because they're busy, or not paying enough attention, or just human and can't remember everything, but I saw my current shrink for the first time about 3 months after my first knee replacement and a month or so before the second one. I told her the next one was in a month. She still said, make an appointment for four weeks out. Um, I'll be otherwise occupied . . . so I made the appointment for about 8 weeks out, a month after the second surgery. At that appointment, she saw how difficult and painful everything was for me and she protested that I should have let her know, we could have met over the phone, or done something, and I thought, UGH, I DID let you know.

But, everyone's human. Sorry so much crud! I'm currently in a better place with her, however, having posted on my typepad blog the other day about our relationship.

Sarebear said...

Some of my issues listed aren't really about therapy or the therapist, since my psychiatrist is not my therapist, for the most part. Most of em are related or something that therapists could do, however, (although some have to be doctors as well).

I also typed em up before reading the other comments.

clairesmum said...

Has been stable on Zoloft for years, so PCP managed it and stayed in psychotherapy with good LICSWs who understood incest survival, depression etc. With the arrival of perimenopause and a whole new set of traumatic memories that surfaced once my child left for college, the Zoloft wiped out. SW referred me to psychMD who did just meds, he felt it would be a good match, he knew her pretty well (personally and professionally.) Well, it didnt work well at all - telling someone who is feeling that they are NEVER going to get better that "well, you do have treatment resistant depression, you know" in a tone perceived as condescending by the listener was the last straw. SW found someone else, and I started to see her - in that time frame the med change that I had pushed PsychMD#1 to try, I had started to respond. PsychMD#2 did some fine tuning, and I did give consent for the two of them to talk/share records, etc. I think PsychMD#1 and I had some transference issues and I was not about to keep silent about how I felt when she said "you know, I don't need to know about what happened to you. This is just about the medicines. Don't assume I care about anything else, other than how you are responding to the medications." Well, I know she was setting limits but her manner was rather inelegant and rough for treating another professional (RN, masters level counseling degree and licensure) with NO hx of trips to ER, no physical scars of self harm/suicide, no criminal record, fully employed, married to 1st spouse and parenting a college age son at a good university, etc. Also, her insistence of talking about diet and exercise every time after being told why those behavior changes are hard for me added to that experience of 'she hears my words but she does not listen with her heart." The new MD and I got thru her missing 2 appts with me, her 2 maternity leaves, etc. with no difficulties, and more ability for me to accept the need for meds without the shame related to needing them. MD#2 has good eye contact, shakes hands, asks questions and waits for the answer, summarizes the visit, and tells me what the med plan will be - if OK w/ me - before writing up rxs and handing them to me.

Zoe Brain said...

sinny_ca wrote:

I felt that effectively, the psychologist killed him.

I agree.

I've been in a similar situation. The only time in my life I've had suicidal ideation - maybe 15 seconds of it. Truly terrifying at the time. I can easily imagine that others might complete.

The "therapist" responsible recently had their license to practice terminated. He was very good in certain areas, positively lethal when he misjudged the issue. He left a trail of corpses, not to put too fine a point on it, and it got noticed eventually. I think after he turned 80, his judgement became impaired. Doubly tragic, in his day he probably saved many.

Anonymous said...

Therapists need to know when to call in sick. If the shrink just found out his wife has cancer, cancel the patients and spend some time dealing with the feelings that will interfere with the ability to function on the job. Since most patients pay their shrinks, that is fair. If your mechanic screwed up the brakes on your car because he was so preoccupied, you would not be very pleased and you would sue or ask for your money back. Take time off when you are not on your game. Patients do not exist merely to line your pockets.

Anonymous said...

Telling a child and adolescent psychiatrist about abuse that was going on at home and being told that it was the "illness" talking. It wasn't.

Anonymous said...

I ultimately found even the kindest therapy useless, even harmful, because of its asymmetrical and unnatural paradigm.

I explored this in a blog,
Bad Therapy? A Disgruntled Ex-Psychotherapy Client Speaks her Piece.