Friday, December 23, 2005

How to Tell if Your Therapist Sucks Like a Bilge Pump

I frequently get calls and emails from people who wonder how to find a good therapist or who tell me that they wonder if the therapist they have is any good. If the person is in therapy, I generally tell them to talk with their current therapist about their concerns. However, there are some general guidelines I can give you to tell if your therapist's behavior or technique should raise a red flag.

Let me start with some personal experiences. I had a good friend in New York who married fairly young and had two children within two years. She divorced and was left to raise the two kids by herself, one of whom had ADHD and was a handful. Because of her stress, she would get tense with the kids and one time, grabbed her son which scared her. She immediately called and went to a therapist. During the intake with this social worker, she told her about grabbing her son and that she was seeking treatment to help her deal with the stress of the kids without resorting to anger.

Instead of help, she got a visit from the Department of Human Services who showed up at the door to investigate this young mother's possible child abuse. My friend was devastated. The DHS investigation turned up nothing but my friend worked in social services and feared that she would be labeled as a child abuser. I told her to find another therapist--one who didn't jump the gun without getting all the facts. (I understand that the law is such that mental health professionals must report suspected child abuse but my friend's act of grabbing her son was questionable as an abusive act and one that should have been explored in more detail than the therapist just getting hysterical immediately). My friend refused to go back for treatment after this negative epsiode--and who could blame her?

I have had my own bad experiences with an unethical therapist. In my last years of doing my PHD, I became stressed about grad school and sought out a PHD psychologist to help--she seemed nice enough but I got the feeling she was not crazy about men. If I talked about fear of relationships, she would say something cheerful like, "Well, most men abandon you after a while." I found out she had been recently divorced and obviously was not handling it well. I left after figuring I could make it on my own.

One day, however, I was talking with my post doc supervisor who told me that she had heard I had seen this therapist for treatment. I nearly fainted, I really did not want my supervisor to know I had been in therapy--it was private. I was steaming. I wrote this unethical therapist to tell her she was lucky that I did not report her to the ethics board and told her that she better not dare do this to another patient in the future. Her response--nothing. Note to other doctors and therapists out there--one of the biggest reasons for law suits is dismissing a patient's concerns. Don't do it.

Anyway, enough of my story. Here are some additional tips on how to find a good therapist or determine if you need a new one:

1) The best way to find a good therapist is word of mouth. You might ask others for recommendations or ask your insurance company to match you with someone who specializes in your specific problem.

2) Once you call for an appointment, pay attention to how you are treated on the phone. Does the therapist call you back promptly if you leave a message on the answering machine? Or does his/her staff act courteous over the phone? Arrange a first meeting to see how you get along with the therapist. You are after all, trying to interview and find out if this professional is right for you. If the therapist is good, they will feel the same way. I let clients know that the first few sessions are a trial period to see if we can work together. If not, I give them three names of other psychologists who might be better for them.

3) Remember that the most important ingredient in patient change is a feeling that the therapist likes you. If you sense that there is no real connection with the therapist or the therapist seems to deal in generalities such as "men are this way, women that way etc.," you should bring your concerns up in the first few sessions and discuss them to determine whether or not you should continue which brings me to our fourth point.

4) Do not be intimidated by the therapist's PHD or MD--it does not give them license to hold their degree out as a reason you should listen to them. Listen to the words of your therapist and see if they are beneficial to you or just downright silly or ineffective. Once a therapist says something like, "Listen to me because I have such and such degree," you might want to be heading to the door. This is not to say that degrees and training aren't helpful--they are as hopefully your doctor has a good range of experience with those of similar problems. But it is the knowlege they have to deal with your problem that is important, of course, not just the fact that they made it through school. Sharing with you their degrees and experience in a form or verbally at the beginning of therapy is normal.

5) Finally, if you are in therapy and you feel that no progress is being made, address it with the therapist and listen to the feedback. None of us is past interpreting our problems incorrectly and it may just be a misunderstanding or miscommunication between you and the therapist. Give him or her a chance to help you change these misperceptions but if that nagging feeling continues that you are not getting the help you need or the therapist does not like you/respect you, it may be time to consider a change.

38 Comments:

Blogger Brummbar said...

I've had several therapists over the years and have developed a pretty good "BS Meter" regarding them. Here are some things which worked for me:

(1) Be very wary of therapists who want to play Dr Happy Pill within the first few sessions. I think some of these guys own stock in pharmacies. I'm not - repeat: NOT - talking about drugs used for real, diagnosed medical problems, but rather those therapists who pathologize normal human feelings and reactions and propose to "solve" the problem with chemistry. Hey, maybe you do need drugs - but maybe you DON'T. Still, in my humble opinion, for a shrink to reach for the Rx pad after spending a grand total of eight or ten hours talking to a new patient is a giant, flashing red light.

(2) Ask the therapist point-blank about his education and training. Is he a member of any specific school of thought or theory about psychology? Who does he consider his mentors and inspirations? Does his think Carl Rogers was on to something - or was he a sentimental clown? What does he think about psych as a "science?" Is he an essentialist? A social constructivist? Does he think, for example, that all devout religous people are loons or morons? Ask these questions. An honest therapist will be frank and direct about his own beliefs and methods.

(3) If you're comfortable enough with a therapist to begin serious, extended treatment, ask him when you will be done. Seriously; have the therapist define the "victory" conditions for whatever problem you are dealing with. Is there a goal line, or are you going to be in therapy for the rest of your life? Maybe you will. The point is, you and the therapist are a team and you both need to know the game plan.

3:57 PM, December 23, 2005  
Blogger Frank Borger said...

Shortly after my Father died, my mother sought professional help getting on with her life. Since I was still living at home, I attended some sessions basically involved in becoming "man of the house."

One session was interrupted by a phone call. From the Psychiatrist's side of the conversation, I quickly painted the picture of a father totally unable to handle a rebellious teen-age son.

When the conversation ended, I remarked "That patient must be a handful!"

"That was no patient, that was my partner!" said the psychiatrist.

3:59 PM, December 23, 2005  
Blogger DRJ said...

Good advice. I've found in my work that there is a broad range of skills and strengths among professionals in this area, and it's important to find a good fit. Frankly, it also applies in other areas such as in hiring an accountant, lawyer or doctor.

I assume that this might also apply - at least in part - in hiring a psychiatrist or psychologist to serve as an expert witness in a civil or criminal proceeding. I was surprised to learn that some professionals let their personal agenda guide their opinions even more in these situations.

4:04 PM, December 23, 2005  
Anonymous Auld Pharte said...

It seems I never lack for opinions. Appending to Dr. Helen's cogent advice...

A few hopefully useful points, based on some years of therapy and post graduate training in applied psychology. Please note: I am NOT a licensed practitioner. These are my personal opinions only.

Psychologists can't prescribe drugs. That's a good thing. Start your search for therapists on this basis if you believe therapy can improve your life. A good psychologist will recognize the possible need for treatment involving medication and refer appropriately. This approach immediately eliminates the risk of getting into therapy with a psychiatrist who believes that drugs are the treatment of choice no matter the problem. (Yes, I am biased.)

Good therapist respect the wants and needs of potential clients, and you should receive their complete and undivided attention when you are interacting with them. They will openly answer questions regarding their background, methods, fees, etc. They will outline their responsibilities in the therapeutic process, and yours (It's a joint venture.). They might also administer tests and on the basis of initial analysis, recommend particular methods (group as opposed to individual sessions, for example) or even recommend another therapist.

Therapists are change agents. Many people seek out therapists because they want to "feel better" without making any difficult changes (which are often painful), and they will select a therapist with whom they are comfortable. Often this means one who will allow the client to drift along indefinitely without confronting any difficult issues. (Keep this in mind when evaluating possible therapists on the basis of how you connect emotionally. The flip side is, if you sense any antipathy or discord, look elsewhere.)

This is where I believe therapy separates from counselling (which could be the right answer for some). Counsellors are discrete problem solvers and will take a highly proactive approach, frequently recommending specific actions be undertaken by their client(s) to achieve immediate [though hopefully enduring] results. Therapy, I believe, tends to allow clients more latitude in the pacing of a process and the amount of "discovery" involved on the road to change. In addition, typical therapy concerns, the "real" causes as opposed to the more obvious effects, are often something very different from what the client might initially believe or be able to articulate. Minimally qualified counsellors don't even attempt to uncover deeply buried issues or treat them, nor should they.

OK. Time to stop now. Merry Christmas all.

5:06 PM, December 23, 2005  
Blogger jw said...

Good advice all.

I've got one of those "Minimally qualified counsellors" in the family. She is VERY useful in her area of expertice, which is taking a young lone parent and turning her/him into a relatively decent parent/adult. All practical, highly useful and worth every penny.

Therapy on the other hand ... as was said, is about making deeper changes. Some suggested changes are insane, some are good advice. The good therapist aims to help the patient make changes which are useful in arriving at the patient's aims/goals.

I'd tell new patients to watch therapists for:

- rigid opinions
- not knowing what they are talking about (of critical importance to those of us who are highly read)
- sexism & rascism
- flighty psycho-babble (you can't translate most of the T's words into English suitable for Kindergarten)
- anger
- no sense of humor

Any of these things are red-flags in my mind.

4:08 AM, December 24, 2005  
Anonymous Jeff said...

Helen,

I couldn’t identify a competent therapist if one fell on my head. In the one attempt my wife and I made to get counseling, the therapist closed ranks with my wife and excoriated me for all of my grey failings. I’d rather chew broken glass than deal with flagrant idiocy.

Although pessimistic about whether we might actually find a competent therapist, I’ll study your advice and give it another try.

Thanks

9:54 AM, December 24, 2005  
Blogger Assistant Village Idiot said...

Start with the simplest things first. It sounds obvious, but we often miss it. My dysthymia, which I kept attributing to social and personal causes and spent two years in talk therapy about, was treated far more effectively -- and almost immediately -- when my OCD and sleep disorder were treated.

For those things which are more personally/relationally derived, willing yourself to "do better" is usually a recipe for getting worse. A good therapist can not only help you see yourself and and the events around you more clearly, but help you discover things you can actually DO to create change. I lean to cognitive-behavioral approaches myself.

1:46 PM, December 24, 2005  
Anonymous Ross said...

I just got done seeing a therapist two times a week for 3 1/2 years. Insurance wouldn't cover it, so I stopped my 401k contributions and instead gave him the money. It added up to $25,000, but since my company would have done 100% matching, it actually cost me $50,000.

I'm just as depressed as when I started. I wish I would have followed Dr. Helen's suggestion number five after the first year. Instead, I have nothing to show for it, and nothing set aside for retirement.

9:16 PM, December 24, 2005  
Blogger Svolich said...

My first and only try at therapy came in the middle of a horrible, on again off again relationship, involuntary career change and deep depression. After a dozen or so sessions I went to see her on the day the Rodny King 4 were acquited. The smoke was starting to rise over LA and I passed a burning building on the way to see her.

I walked in and was as agitated as you would think. She asked me what was wrong. I pointed out the smoke, and told her the riots had started.

She said "And how do you feel about that?"

I told her we both needed to get home, and walked out. Never went back.

9:35 PM, December 24, 2005  
Blogger Helen said...

ross,

I hate to hear that--I hope you can start now saving for retirement and have your company match it. Having no retirement money may have you down more than you know. If you need a therapist again, try to find one who is on your insurance list if possible. If there are only a few names, ask a professional in the area to give you some recommendations for who would be the best for you. Regardless of what a therapist may tell you, money is a factor in treatment--how can you feel comfortable if you feel you are sacrificing your retirement so you can sit in therapy? Dust yourself off and try to get back on track with your savings.

9:38 PM, December 24, 2005  
Anonymous Bob said...

Also--no Freudians nor Jungians!

11:19 PM, December 24, 2005  
Anonymous Anonymous said...

I don't understand what's the point of therapy? Good nutrition, exercise and a postive outlook is all one needs. Going to a therapist is waste of money and they don't really care about your problems.

4:44 PM, December 25, 2005  
Blogger Echo Mouse said...

I am recovering from PTSD so I do see a trained trauma therapist in a trauma treatment program. I believe it's the only one in Canada, or at least it's the best. I got very lucky by living in the city where the program was started.

Your advice is excellent and I'm glad you posted this. Many people ask me how I found my therapist. If not for the trauma program and the incredibly trained and experienced professionals running it, I'd be in a bad state today.

Note: My therapist is actually an R.N. with a Masters in SW and years of trauma training under the doctor from the U.S. who named PTSD. She's so good , the University here asked her to teach. I wish everyone could find someone as good and emotionally balanced and normal as mine. It's scary trying to find help out there.

8:45 PM, December 25, 2005  
Anonymous Anonymous said...

jw-

Some of the things you said about your past and situation on another thread were very interesting. You also talked about finding a group of people who have been through similar experiences.

I made this inquiry on another thread, but I don't know if you saw it. Do you have a website or something talking about your experience or the experiences of those you found? If not, do you know of websites that cover similar topics? Any information appreciated.

4:10 AM, December 26, 2005  
Anonymous Anonymous said...

This is interesting, because I come from a molecular biology background.
And in my case, I had "battered womens' syndrome". (This is a few years back, better now).

My only point is that I wish the therapist had said, "Honey, when you have battered women's, your immune system is on high alert, your dopamine system is depressed, and your oxytocin/vasopressin receptors are in hiding. You need to go into -- say -- massages or meditation or pills -- whatever it would take to cure the physiological part. Here's the number of an MD who can diagnose."

Instead, we had long, empathic discussions but this really didn't do me much good beyond intellectually understanding the entire situation. I feel a good therapist will have an understanding that "nature v. nurture" is important, and that it is important to have an understanding of what physiologically/neurologically/anatomically, you're going through.

Keep up the good work, Anon.

9:05 PM, December 26, 2005  
Blogger Helen said...

anonymous 9:05,

Yes, the ability to differentiate between a physiological/neurological problem is very important. If you have physical problems that are causing a psychological reaction--all the talking in the world will not help. Heart problems cause arrythmias and panic disorder but once my heart problems were addressed, the anxiety attacks lessened. Imagine if a therapist tried to address this type of extreme anxiety by talking! But some try--make sure your thearpist knows of any medical conditions or other health conditions you have which may be causing psychological symptoms.

6:47 AM, December 27, 2005  
Anonymous Rob said...

Here's another hint you may be going to the wrong therapist: she sees you for several months and comes to the conclusion that a divorce is the only cure for your depression.

This actually happened to my wife. She left and never went back. Ten years later we are still married, she is much better and the therapist is no longer practicing.

This is good advice Dr Helen; there are some absolutely terrible therapists out there and getting stuck with the wrong one can move you backwards rather than forwards.

5:14 PM, December 27, 2005  
Blogger Helen said...

rob,

I would think that a therapist would let a person come to their own conclusion about whether or not to get divorced. One problem with marriage therapy is that it often makes the problems worse. I have seen research indicating that marriage counseling often cannot help with problems and people can get worse from it. Glad you and your wife made it through despite the "counseling'.

9:32 AM, December 28, 2005  
Anonymous Anonymous said...

I have been in and out of therapy for the last 20 years. I'm 33; I was first taken to a therapist at 13. There were years when I needed it and got it; years when I didn't need it ; and years when I needed it but didn't get it :)

I have had terrible therapists and excellent therapists. Dr. Helen, your comments are spot-on, but I think there needs to be a bit more to say, because when you're in trouble, or in crisis, or afraid, or depressed or TERRIFIED of having a shrink lock you in a mental ward, it's difficult to trust your own judgments.

I'd add the following:

your comment about "they need to like you" is so important. At one point, I moved cities and had multiple people, including therapists, recommend the same new therapist to me in the new town. On my first appt with her, I explained that I worked at a defense contractor creating Chem-bio-rad sensor systems and her response was "well, at least you don't work on weapons systems, some people have to." Er, she didn't even NOTICE her bias, her judgment of me--and i like weapons systems and shooting my pistols, etc. I never went back, because she wasn't going to like ME, and no matter how great she was, it'd be a disaster.

continuing your list:

6) Find a therapist who is as bright as you. Some of us are of average intelligence. Some of us are REALLY SMART. Certain mental issues happen more to people who over think, over analyze, are highly sensitive, etc. some mental disorders seem to only occur to high-IQ people. But there aren't IQ tests for therapists. Therapists can be taught about the mind, but that doesn't make them all brilliantly insightful. If you're more insightful than your therapist, FIND ANOTHER ONE.

7) Find one who has a sense of humor that you relate to. This comes over time, of course, because the issue is about trust, but if you have a witty or slightly biting sense of humor, find a shrink who does to. Yes, it's possible that a patient is misusing humor or sarcasm, but a doctor who never uses those things and can't find the same things humorous isn't someone you can relate to. If you find that humor offputting, find a shrink who doesn't use it either. I knew I could trust my shrink when she joked that if I ended up in a mental ward, she'd bake me a cake with a file in it.

8) Don't assume that all training is similar. If you have some real issues where you're afraid of being hospitalized, find a psychologist who has dealt with patients who needed hospitalization--they will have VASTLY better calibrated senses of your crisis or level of need than a young family counselor or social worker. If you have real anxiety issues, find someone who has worked with a VARIETY of techniques to address anxiety, not just one. If you have seuxal abuse issues, find a shrink who has dealt with those issues over and over again in a variety of contexts. Basically, you want a shrink who is never shocked by anything you say, because they've seen worse before :) that will keep you calm, when you're afraid of how shocking your issues are.


9) Therapy should treat a PERSON, not a disease. Yes, you may need a specific diagnosis for insurance purposes, but if your therapist makes you feel like all that is happening is a disease is being treated, then you are still being defined by that disease. Therapy is more than that.


10) If you are lying to your therapist, well, sometimes, that happens. But if you aren't getting more honest over time, something's wrong, and often it means the relationship with the therapist isn't gelling. See number 5.


btw, I also had little or no insurance coverage during those times, and had years in college when I was afraid of what it would do to my future if anyone knew I saw a shrink, so I refused to use insurance even if I could have. I spent 40k on therapy, and it was the BEST INVESTMENT IN MY LIFE. sure, 10k of that was probably entirely wasted, but still, it was worth it. I've tried to explain why therapy worked, but all I can figure out is that the relationship helped me to get better at living--I was able to actually create a relationship the way I wanted, and to have it thrive. Somehow, that helped me. It happened twice, with two different shrinks, and it was amazing.

12:44 AM, December 30, 2005  
Blogger Helen said...

anonymous 12:44:

Great tips--thanks.

8:42 AM, December 30, 2005  
Anonymous Daniela said...

Yeah a therapist that won't be shocked once gets to know about your problems but that also won't be like, "What's going on with you is no big deal after all, yes you've been raped seven times, but I had patients who had been raped seventy times." Rigid opinions -- a therapist that shouts to sin, shame or selfishness whenever you mention suicide, whether you've been contemplating it or you had lost a loved one to suicide (I am a bereaved sister) is a bad therapist or that's just his opinion and he has every right to have them? And what about therapists that cringe at you because your performaces at school or at work have been deteriorating from time to time (pretty common if you're going through a stressful time, I guess) and you even ended up quitting everything?

11:07 PM, June 28, 2007  
Blogger counselingseattle said...

I enjoyed your treatment of a serious subject in a humerous way.

My website, CounselingSeattle.com, actively campaigns against Washington State counselors who appear to be using misleading "generic acronyms" in their credentials to con the public into believing the counselor has unearned licensure or certification.

In its "Call to Action" section, members of the public are encouraged to contact offending counselors in person, by telephone or email and ask them why they are engaging in such misleading activities.

In 2007, CounselingSeattle.com is focusing on the unethical use of MHC and MFT as in “John Doe, MA, MHC, MFT.”

MHC in this instance is used by counselors with the justification "Mental Health Counseling is what I do!" Ethical standards require that counselor credentials (or initials) should be limited to those awarded by national certifying agencies or to licenses issued by the state. The meaningless "MHC" could by used by anyone regardless of training or education level, and easily be confused with "LMHC"-- Licensed Mental Health Counselor.

CounselingSeattle.com holds that the use of MFT is unethical when used in counselor credentials and justified by the counselor with the "Marriage and Family Therapy is what I do" excuse. Again, anyone can use "MFT" regardless of education or background and is unethical and unprofessional because it resembles the LMHT credential which refers to "Licensed Marriage and Family Therapists."

In listing counselors who use MFT in their websites, CounselingSeattle.com tries to eliminate those who identify themselves as MFTs even though they are actually licensed. Such counselors have higher qualifications but are too dense to realize (1.) they run the risk of being confused with less qualified persons, and (2.) the importance of clearly identifying themselves as LMFTs.

The CounselingSeattle.com campaign has been carried out with the broad support from members of the public and by professional counselors. CounselingSeattle.com locates and publishes a list of the counselors it believes to be making use of unethical or unprofessional use of these acronyms and identifies them by name, website, email address and telephone numbers. Concerned members of the public are encouraged to contact the counselors directly and register their disapproval and disgust.

Offending counselors complain that they are being bullied, but in 2006, more than 83% have removed the offending acronyms from their websites. (When this happens, all identifying material is removed from the page except the initials of the counselor's name.)

[Just search Google.com for "unprofessional counselor" or "unethical counselor" for more information or to help eliminate these misleading practices.]

Sincerely,

Floyd Else, MA, LMHC, UTJAW (An unauthorized acronyn for "Upholder of Truth Justice and the American Way!" and an example of initials that should not appear in counselor credentials).
Webmaster: www.CounselingSeattle.com

9:06 PM, July 07, 2007  
Anonymous auntiegrav said...

Thanks for the advice. Some very good points, and especially the one by Anonymous that said "Find a therapist that is at least as smart as you are."

That'll be the day around here....;-)
Any help finding a therapist that is also a genius who might begin to understand the 'voices' in my head would be appreciated. If you could do everything but just don't do anything, where do you begin? "Set priorities" they all say, but 'They' don't have the world on their shoulders or the tools in their head now, do they?

8:29 PM, July 31, 2007  
Blogger etahasgard1986 said...

dont seek therapy--
since it is useless, it is a waste of money and time and has many other negatives-- the real possiblity of stigma, defamatory and/or adverse medical records, and emotional harm. It is not beneficial, therapists have no particular set of skills, training and experience is irrelevant because no specific "change " factors are known. Therapists are by definition "incompetent" because no one is competent to effect 'change". Many are unethical or worse, inflicting some degree of harm, through idiocy or actual malice. The people that go into such a field are not random-- the are high in every measure of psychopathology.

Bottom line-- just say "No" to psychotherapy. talking with a trusted friend is fine. The "relationship" is BS-- clinicians offer nothing. Just say no to psychiatry-- a long discussion for that advice is needed-- just get meds from a GP and avoid the psychiatrist. He/She has no expertise and his need to justify his fee and his years of "training" means he will concoct arcane defamations that are worthless and stigmatize you forever. The difference from medicine cannot be more dramatic Psychiatry is trial and error per a few basic medication classes. No one can predict what patient will respond to what drug, and how much, if at all. Medication has some degree of efficacy, but alas, much less than thought, with most patients having significant residual symptoms ( the Star* D research studies).

Unless you have a lot of money to waste and are so lonely or isolated that you must purchase what appears to be companionship, eschew the "mentl health professional". You purchase a relationship with a prostitute, too-- but she , at least has demonstrable skills and you are not led to think she "cares" when they don't, as in the mental health field.

Avoid the mental health professional of every stripe. Go to your GP and he can supply meds as effectively as any psychiatrist and provide equally valid and reliable diagnoses ( ie, with no such capacity).

From one who has looked at it from both sides

10:36 AM, September 06, 2007  
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1:57 AM, April 13, 2009  
Blogger Etain said...

I'm having an issue with my child's previous therapist, whose behavior has been completely unethical and has caused my child actual harm. I submitted a complaint to the ethics board who said she had found a loophole to get out of it...I'm wondering if there's anything else I can do. She is seriously harming my child; she has disregarding repeated outcries of sexual abuse by the child's father, some with physical evidence, and when confronted about ignoring them, stated that the 5 year old must have been coached which resulted in the child being removed from her home. It's serious and horrifying. Any ideas about what I can do would be appreciated.

8:25 AM, April 18, 2009  
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