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.