Does the title of this article hint just a bit at my ire? I have had in my office recently patients who have shown the courage (and desperation) to continue to try to find help even after having been failed, even harmed, by the professionals to whom they were referred. Frankly, I am amazed at that courage when I hear of the extent of the incompetence they endured. My patients are not file numbers, they are not diagnoses, they are not appointments. They are people, sentient, hurting, and urgently looking for help. They are you and me, people you love and would never knowingly harm. Yet there are psychiatrists, psychologists, and medical practitioners who, with the promise (and credentials) to heal, unconscionably cause further harm. It is imperative that you are armed with knowledge in how to detect the difference between them and competent, experienced, compassionate healers.
There have been good articles written about how to find a therapist who is a right "fit" for you and the problems you present, but, while helpful, they tend to play it safe and fail to alert you to how to avoid the ones who can do harm. I am distressed enough now to attempt to do just that.
The Catalyst
A young man, Jud*, came to see me because he had decided to try, once again, to get help. His story simultaneously broke my heart and made me angry enough that I, frankly, had difficulty hiding my outrage. Three professionals, a psychologist, a psychiatrist, and a general practioner, M.D. had misdiagnosed his problem, "treated" him for it with "therapy" and inappropriate medications. Maintaining Jud's confidentiality, I will not describe the particular diagnosis, treatment, and medication. Three professionals independently contributed to the worsening of his self-esteem, his symptoms, his hope that there is treatment, and his life in general. Not one of them admitted that his problems were out of their areas of expertise, as they clearly should have done. This is harm practiced by three professionals who I would love to see ridden out of town on rails.
I applauded Jud's courage for seeking help again, in spite of his belief that his case was hopeless. I explained the rationale for my own diagnosis, explained how I treat such problems, began the process of teaching him self-care and conscious awareness of symptoms so he can begin to manage them, and referred him for a diferent medication evaluation. He deserved the best from the beginning. We are only beginning our therapy together and I have faith in his motivation (and my knowledge and experience) to make changes that will make his life much more enjoyable.
Jud did everything right in looking for help and following the advice of the professionals he saw. We professionals spend time educating the public about how to find therapy that helps, but we talk not at all about the failures of incompetents among us. It grieves all of us who love our work and care for the people who look to us for help. For Jud's sake, as well as others who have been failed, I feel a responsibility to them and to the great therapists in practice, to "pay attention to the man behind the curtain" (thank you, Wizard of Oz).
* Jud, of course, is not the patient's real name.
How to Avoid The Wrong Therapists
1. Get Referrals
The first step may be the most difficult for you because you already feel vulnerable, but it is essential: ask for referrals. Most people look at a list posted by their insurance companies and pick a name with an address close to home. While I am grateful that many of my patients have found me that way, I don't recommend it.. It's far too chancey. A name on a list tells you nothing except that the clinician has the proper credentials, and frankly, too many incompetent people can have those. (Think of finding someone to fix your computer from the phone book.)
Referrals may come from your general M.D. This might be a good source if the physicians have received positive feedback from their patients about the therapist. Ask your doctor how he knows that his is a good referral. If the referral is a psychiatrist in his practice, someone he went to school with, etc. it is not a good referral. Rely on feedback as your source of information.
The best referrals are those you can solicit from people who have seen a therapist themselves and can attest to their own positive outcomes. This is where your vulnerablility has to be trumped by determination. Ask your friends, your family members, your co-workers, your neighbors. "I have a friend who is having a problem and wants to see a really good therapist. Have you heard of one?" More people than you know have some experience with psychotherapy, even if it was a brother-in-law who saw a therapist, and are happy to pass on the information. Even hearing names of therapists they don't recommend is good information.
Take that first step. Ask. Have those you trust ask people they know. And find out why they recommend that particular therapist.
2. Check Credentials
Psychiatrists are almost never trained in therapy. (I've just breached a well-known, but unspoken fact. So sue me!) Once upon a time, their training as therapists was psychoanalytic (think Freud), which is only of value as a basis for the more evidenced-based therapies practiced for the last hundred years. These days, psychiatrists are our psychopharmacologists, capable of dispensing medications that address the biological underpinnings of anxiety, depression and other problems. Some of these are excellent practitioners because they stay up-to-date on all the research on medications. I have only two I trust in this city, though there are more, I am sure. But I know a dozen psychiatrists I assertively warn against people seeing.
Psychotherapists come with several theoretical backgrounds depending on their graduate schools' focus. Licensed Professional Counselors, Marriage and Family Therapists, Psychologists, and Social Workers can have similar training, but can be individually very adept or incompetent in the practice of psychology. Hence, the third step....
3. The Gut Check
Just because a therapist came as a referral and has appropriate credentials, you still have the authority and good sense to decide whether he is right for you. When you meet your therapist, use the same common sense you would in any other situation where you must rely on the expertise of someone else. Use your gut, that subjective something that leads you to make good decisions about everything else in your life. The two of you will be working together on the most important thing in the world: you. It is imperative that you feel you can trust her, her intelligence, her experience, her understanding, and her empathy. Your real trust is a crucial component of your treatment.
Do you like him, or is he just not your sort of person?
Are you comfortable with her? There is a fine line between establishing a rapport with you and being overly familiar, acting much like your mother or best friend. Be aware of that difference.
Does he actually listen, does he "hear" you? When you come in for what you know to be a crippling problem with anxiety and he tells you the problem is really Attention Deficit Disorder, walk away.
Does she talk down to you, putting an emotional distance between you? Or does she understand that you know yourself better than anyone else does?
Do you feel he is judging you and finding you at fault?
Where is the therapist's ego? Does it loom large in the room, or is it set aside so that you can be first priority?
Your therapist should be able to assure you that she has experience successfully treating your problem. She should be able to make an impact on you even in your first session. Don't just take her word for it. How does your gut feel about it?
There will be times in therapy when you hear something you don't want to hear (your active participation in creating or maintaining a problem, for example), so your trust in the expertise of your therapist is crucial at those times. If you are confident that your therapist knows you well and has always had your well-being as a first priority, it will be possible for you to make the sometimes uncomfortable progress toward change.
If you find yourself questioning the ability of your therapist to adequately address your problems, be a good consumer and find someone else who you can trust to help you.
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