Friday, March 16, 2012

Firing Your Therapist

It’s not just the thrill that’s gone. The mystique that has traditionally shrouded what takes place in the sanctum sanctorum of the therapist’s office seems to have disappeared.

Blame it on the internet if you like—because everyone seems to be blaming everything on the internet these days—but nowadays the open discussion about therapy has acted as a potent disinfectant.

Yesterday I quoted Justice Brandeis to the effect that sunlight is the best disinfectant. Surely, the same principle works for the experience of therapy.

In the bad old days the experience of therapy was shrouded in secrecy. Some patients were even told that they should not share what was going on in session with friends and family. They were led to believe that when they were not getting better the fault was all theirs.

Patients learned that if the therapist was bored or distracted that could only mean that they were not offering sufficiently salient pieces of information, that they were bad patients, and that their conversation was tedious. If someone who was being paid to listen was bored that must prove that you are boring. 

The bad old way owed much to psychoanalysis. Better yet, it was the basis for psychoanalysis.

Psychoanalysts believed, as an article of faith, that your problems were all in your mind. And by that they meant “your” mind, not your therapist’s mind or method.

Since therapists claimed complete and utter innocence, any problems must be the patient's. 

Classical Freudian analysts hid behind their supine patients, but they also hid behind their role as blank slates.

Whatever a patient attributed to them could only have been a projection—as in movie projectors—of their own fantasies on the blank screen of the therapist’s person.

If you got angry in your therapist you needed to uncover the infantile root of the anger. If you were disappointed in your therapist you were merely showing that you were disappointed in your parents, or even yourself. If therapy was not advancing you were resisting the truth.

Patients were persuaded that any aspersions cast on their therapists were really aspersions on themselves or their mothers. Thus, they were less likely to share it with others.

Therapists could do what they wanted in their offices and they could do it with impunity.

In brief, psychotherapy conducted on the psychoanalytic model was one long guilt trip.

No longer is this the case.

I like to think that this blog has contributed to the greater willingness to hold therapists to account, but I suspect that other factors were more important. Among those factors were the advent of effective anti-depressant medication, the influence of insurance companies, the rise of cognitive-behavioral therapies, the discovery of alternative therapies, and the internet.

The dirty secret of psychoanalytically oriented therapies was that they did not work very well. Often they left people in a mildly depressed introspective and introverted state that did not contribute to their mental health.

But, when Prozac entered the scene many of those same patients discovered that they could feel appreciably better by taking a pill. Thus, they did not need to adjust to a vague and generalized depression. They could do better and they would do better, without pouring out heart and soul on the couch.

Worse yet, for the therapists who pretended to be treating depression was the revelation that aerobic exercise was an excellent treatment for it, in some ways even better than therapy.

And then, insurance companies started refusing to pay for psychoanalytically-oriented treatment. For a time insurance companies were generously paying for therapy at the rate of three or four times a week for years on end. After all, that was the prescribed dosage for such therapy.

Eventually, they understood that they were wasting their money and they started putting limits on the number of therapy sessions they would pay for. It was a vote of no-confidence, at the least.

For whatever the reason, today’s patient has a more pragmatic, more realistic and more cynical attitude toward therapy. He is not intimidated by the pretense that powered psychoanalysis through the culture not too long ago.

Recently, Randi Newton wrote about her own had-enough-therapy moments. She raised the issue of how you could know whether your therapy was working for you and how you should go about firing your therapist if she is not doing her job.

Most therapists today are female so, unless designated otherwise, it seems appropriate to use the generic female pronoun. You would do the same if you were referring to a generic nurse.  

Ironically, the therapists that Newton fired were all women. The one she is working with now is male. As it happens, she is far happier with the work she is doing with the male therapist.

Of course, this would tend to contradict the notion that only a woman who feels what another woman feels can help a woman. The conclusion seems self-evident, but Newton does not draw it.

If you read Newton and the commenters on the two sites where her article appeared you will not find very many female therapists expressing very much empathy for a female patient.

Read through Newton’s description of her encounter with a psychoanalyst. There is no mystique, no aura, no spiritual quality to the experience of lying on a psychoanalyst’s couch.

I then started seeing an extremely sweet soft-spoken woman, Dr. A. She told me that she didn't usually work with patients, but evaluated them and placed them with other doctors. In this case, however, she would personally take me on.

Dr. A would make me lay on a couch with a piece of paper over a pillow, in a very bland medicinal room with muted Van Gogh art prints and several boxes of Kleenex. I didn't like laying down. She asked why. She asked "Why" a lot.

I spent our sessions doing all of the talking, spilling my guts out, working myself up into a frenzy, and when it was time to leave, I'd be frustrated. After working with Dr. A for about a month, I realized I liked her a lot as a person, but as a medical professional it just wasn't working.

Why did Dr. A ask why so often? Clearly, she was encouraging introspection. She was forcing her patient to get into her own mind to discover what was wrong with it. As I said, it’s all in the patient’s mind.

At the same time a therapist who keeps asking why?... is also defending herself against dialogue, conversation, and connection.

Strangely, her psychoanalytic malformation has taught her to defend against those aspects of treatment that might actually help her patient.

Newton spends most of her article explaining why she fired her therapists. She lists distraction, disinterest, and an inability to help her. If you keep walking out of a therapist’s office feeling worse than you had when you entered, something is wrong.

Newton expects results. She insists on receiving something more than why? for her money. She is right to do so.

Yet, she also shows that patients have increasingly modified their expectations of therapy.

Newton’s essay appeared first on the XOJane site. It was reprinted on Jezebel.

While preparing for this post I read through most of the comments on both sites.

If you do the same you will discover that many commenters have had multiple experiences of therapy. Most of them have had bad experiences. They feel as Newton does: skeptical and cynical about the profession.

Some commenters have had medication. Some have even had cognitive behavioral treatments. But, most have not.

Those who have been turned off by therapy had been insulted and disrespected by their therapists, fed pabulum as though it were a great idea, and sometimes even harassed about money.

Admittedly, the group that commented is self-selected. And yet, women who had had good experiences of therapy would certainly have been free to defend their experience. Precious few did.


Anonymous said...

Looking back on it 25 years later, I would say I had an excellent experience with my therapist, Joan Speck in Philadelphia, though I suspect a lot of it is due to her serving as a role model in addition to a therapist. When I mentioned years later to a professor that I had been her patient, he was in awe: I found out that Joan was internationally known for her skills and highly selective about her clients. In those pre-Internet days, who knew? I could certainly vouch for her tenacity and compassion, though.

Anonymous said...

My therapists were terrible. One was grossly overweight and would often eat during sessions. She also yelled at me on the phone when I declined to enroll in another expensive "group session." Send your kids to a priest or rabbi if they're having trouble - not a therapist.

Anonymous said...

I am currently reading your book Death of an Intelectual Hero and like it quite a lot. It is so dissapointing thoug to read the screeds against therapy and psychoanalysis in your blog.It is like you have turned to the dark side. It seems like psychoanalysis is an inquiry into the mind, asking important question and listening for surprising replies. You on the other hand seem to present yourself as having all the answers. It seems like you still have a Lacanian disposition and ethic so far as being enthralled with the grand and grandiose pronouncement. What happened!!!? Things like being anti-feminist just seem so reactionary. There are so many different kinds of feminists it seems that lumping them all together, like you do with psychoanalysts, crosses the line into something akin to bigotry. I am certain you have heard this all before but thought I would write this because I am sadenned to see that this is where you ended up, from Shakespear, to Lacan, to I don't know what... The dialectics of Stuart Schneiderman?

Stuart Schneiderman said...

Please feel free to express your opinions on any of the topics I discuss on the blog. We are all awaiting enlightenment.

You might start by responding to the posts about autism, and especially about the way autistic children, under the aegis of psychoanalysis, are treated in France. While you're at it, you might explain whether or not you favor censoring documentary films.

If you are willing to take the side of those who favor censoring free expression, then you ought at least to have enough integrity to stop calling people reactionaries.

Anonymous said...

I imagine are probably precious few great psychoanalysts in the world, and even fewer in the United States, and that the sheer cost per hour prevents nearly anyone from trying this process out. I have always wondered if it worked or not, and how it would work for me. I ultimately had the chance (was in France awhile) and asked around until I found someone. This came only many dead ends/failures with more conventionally trained therapists (cognitive psychologists, etc).
Result: one intensive year with a highly-respected French psychoanalyst has shown me the incredible process and profound communication and insights that can happen. Compared to it, other therapists did not even scratch the surface (one even did terrible damage, leaving me forever skeptical of any therapist of any kind).
But this time its so different. In the first 18 months of talking, I've had profound and vital insights into my deepest problems, things I thought I'd never understand.
And its not at all about receiving 'empathy' or advice. Instead, there is a trustful relationship consisting of listening closely, questioning intelligently, illuminating and clarifying, even helpful gentle criticism, on occasion.

And yes, its slow, but worth every precious minute.

I suspect that there is something terribly wrong with the training of anyone who end up just providing 'empathy'; that's an empty substitute for insight and real help.
For now that I know what 'real psychoanalysis' looks like, its nothing what I expected. (Not much about sex, for one! Never "why" is that or other cliches). And I definitely know each time when I have hit a 'truth' or insight, because there is a profound emotional/psychical release. Such moments are arrived at through work/talking which is done mostly by myself, with only gentle prodding or questioning or pointing out connections, from her side. She helping me explore and understand emotions and beliefs that have been there all along, but that I could not 'see' or grasp in their full meaning.
I am grateful every day that I finally found a real therapist to sort things out with. I'm sorry that so many incompetent ones have given a bad name to the field.

One more thing: besides having great therapist, one have to really deeply participate to get somewhere. To think about things, listen to yourself, ponder your own motives. A good analyst will help you sort out the authentic from concocted theories about yourself, too. If you're not ready and willing to go into your own depths, its not worth it, and won't work. But its a process that saves my life regularly. It's spiritual neuroscience. It's not for everyone.