BAD THERAPY? A DISGRUNTLED EX-PSYCHOTHERAPY CLIENT SPEAKS HER PIECE

In blogs and book reviews, I see reference by therapy professionals to the “disgruntled ex-client.”  I assume this label is pejorative and the classification perhaps is to warn therapists to create a strong filter when one hovers nearby.

So here’s my warning label: I’m a disgruntled ex-client.  My therapy mostly was harmful.   Before I’m tuned out, I hope some therapists may consider listening as I speak my piece, so they might find fewer like me at large.

I entered therapy hoping to broaden my social life and to confirm my suspicion that my typical family—wasn’t.  I never was in crisis.  My past persona was far too obliging and obeisant to authority, but not unlike a significant population percentage.  Pre-therapy I had friends, a job, occasional dates and was reasonably cheerful.  My total tally in treatment (I hate that word) was just under three years with different clinicians in different formats.

Once in therapy, I bought the full mystique of the psychotherapist as a god with ex-ray omniscience and magic powers.  Therapists reinforced my idealization in subtext: with scornful disapprovals, supporting my unrealistic expectations of treatment, pretending to have “the answers” and contradicting my self-reporting.

The worst, most damaging bout was group therapy led by a disdainful psychologist and a syrupy psychiatric nurse.  Clients were encouraged to bring-your-own-whine, though often answered with bruising dismissals.  The nurse announced “something about you makes me want to kick you.”   They ridiculed my own exploration into cognitive theory via David Burns. When I tried to terminate treatment, the leaders’ simmer turned volcanic as the therapists did their best to retain me through withering diagnoses and threats of a dismal future.  They negated my perceptions.  Defensive and determined, they fired off interpretations like ammunition.  I entered therapy seeking more social interaction; I exited feeling contemptible, isolated and unsure of my sanity.

Another psychotherapist gave me what I wanted—I thought.  She comforted me as a poor wounded deer cheated out of a loving upbringing.  And I left “feeling better” because now I thought I earned my increasingly frequent self-pity.

A third therapist was insightful and respectful.  However my undirected meandering led me toward more self-pity and early-life obsession.

So I’m left to untangle this large knot left by so-called treatments.  I feel hoodwinked.  I combed professional literature and was dismayed by the denigration of unsuccessful clients and the limited discussion about harmful therapy.    We’re labeled resistant, and our dissatisfaction is labeled as transference.  Or we’re conflating our internal pain with an external relationship.  Or we’re difficult cases who don’t want to change or too unstable to be redeemed.   There’s scarce conjecture I reacted sanely to my therapists’ distortions.

As I read how therapists are trained to think, attitudes toward difficult cases, and the defensiveness toward official complaints, it’s clear why therapy left me feeling worse.

It’s entertaining for this alien-from-another-planet, otherwise known as a consumer, to survey the professional literature for a peek at how the profession reduces and codifies its world.   The more white-hot and chaotic the human experience, the more detached the exploration.  Intuition sometimes is forced through  a scientific mold.  When “real life” appears in a psychology textbook, discussion can be absurdly robotic in an “I feel anger when you ….” sort of way.  The milieu is so artificial, jargonized and removed from life in the living room, no wonder therapists see DSMs rather than human beings.  We’re not two people, we’re a dyad; I’m not talking to my doctor; I’m the dysthymic projecting my mother.  There is a pervasive bell-jar perspective of the therapeutic relationship.  With all this categorizing and theorizing, I’d expect the horse to become the zebra.

I’ve walked into a funhouse of twisted mirrors.  My personality quirks are a now a disease.  Stone silence—considered the cold shoulder in civilian life—is now a blank slate and a path toward mental health.  Sarcasm, intimidation and berating are labeled as treatment.  And most damaging—my “no” means “yes” because the therapist sees me as the helpless child incapable of rational observation.  The professional texts HAVE transformed me from a functional woman into a patient after all.

Antagonism in professional literature toward “difficult cases” seems prevalent.  As I read about these, I see images of frenzied, unanchored souls challenging the psychologist’s full, brute force to tame them.   I am amused to juxtapose this trope with the “difficult case” my therapists perceived me to be.

One textbook presents a treatment dialog between a doctor and a “schizoid” client wishing to terminate.  The doctor smacks down every client communication with diversions– argument, interpretation and accusations.  The doctor’s summary commentary condemns his ex-client as primitive, borderline, paranoid, controlling and unable to read reality.   Any sane person might be angry at this doctor’s stonewalling.  At least in this snippet, this “schizoid” client read the situation just fine: his doctor was hostile, unhelpful and mechanically unreal.

Therapy failure is frequently blamed on resistance.  The swath of literature devoted to resistance gives me images of a full-tilt wrestling ring bout.   That’s juxtaposed by another frequent term, non-compliance, which evokes a stern, disapproving super-parent.   Literature attributes these resistances to internal devils like fear of facing fears, self-deception, loss of freedom or even desire to manipulate the therapist.  I won’t argue with these ideas, at least the first two.  But this noncompliance, disobedience perception gives me pause.  Literature I sampled predominantly focused on a battle of the consulting room, a bell jar mentality, as if the client lives there full-time.  Discussions only grazed upon a client’s larger social system and its obstacles to change.    It underappreciated the daunting problem-solving of new behavior (such as losing one’s job or spouse), skill development, the turmoil of role and hierarchy shifts, unpredictable outcomes and the dilemma of compromise (i.e. choosing between the tyrannical boss or a dismal job market), to list a few scenarios.   Haven’t psychologists ever observed an animal pack duke it out for dominance?  Resolving internal conflicts are only the start of reinventing oneself.   I wonder how many theorists have vaulted their own confinements to understand this.

Some resistance articles glaringly omit practitioner errors and misdirected agendas. (I wish I HAD resisted a therapist’s silly solution that caused family distress thereafter.)

However I see the therapist-as-parent as the most misguided treatment model.  When I’m a 35-year-old, talking to a 45-year-old, we’re two adults.  If the doctor play acts I’m the child and he’s the parent, we both travel to a fantasy land which undermines my autonomy and our authenticity together.  He is reinforcing my self-image as powerless – a damaging metaphor for my life but even more harmful when he fails to control his agenda and anger.  Also he communicates that he holds some magic secret I’ll never fully receive. “Reparenting” is a flawed concept—adults no longer have a child’s hardwiring, and can’t return back in time.  We can only go forward.

Reading professional literature led me to feel I was sold on a subordinating, hired relationship aspiring toward strength and authenticity.   With my own tendency toward deference, a game of follow-the-leader-blind-folded undermined my growth. And why should I seek experts, pretending to have answers, in order to understand that experts don’t have answers?

Psychotherapy’s mythology is further inflated by our cultural zeitgeist.   The media elevates the practitioner to a near-shaman who can alleviate the pain of break-ups, unemployment, pet deaths and tense holiday dinners.  Therapy is promised to raise our lives from weary to celestial, remove unwanted pounds and exorcise our vices.  Is your sister trashing your premises or your spouse wasting away on the couch?  Send them to a therapist who’ll carry the lugs.

We need this easement. So no wonder we blindly obey, and no wonder therapists fall off the shaman pedestal.  But I fear the large holes in the literature of self-critique flag that some clinicians could be roped in by their own legends.

Years later as I’m left with many untruths on top of my own irrational remnants, I have a large job demoting my dubious healers.   Reinterpreting harmful therapy is layered and complicated, since I fell into a rigged game.   I unload the weight of my therapists’ self-delusions, similar to recovering from a cult.  I reframe their unclaimed anger.  I regain my selfhood after feeling invalidated by irrational authority.  I understand how I suspended my own judgment to surrender my free will to someone else.  I awaken to how I was defrauded by fake wizards, realizing wizards don’t exist at all.   It’s daunting to face the elements as my own protector and rescuer.  I have to relinquish fairy tales that I so needed.  But didn’t the therapists corroborate them?

Now that I’ve had my gripes, can I muse what I would do as my own therapist and client?

I would make it clear from early in the process that problems were mine to solve, and psychotherapy, at best, can only provide a few tools.

I would avoid all paternalism, regression, contrived sympathy and learned-dependence in favor of an adult-adult dynamic.

I would balance discussion of weaknesses and pain with discussion of strength, health and optimism.

I would explore and support improvement of my physical health.  (I have visible conditions that contribute to fatigue and depression which psychotherapists never bothered to notice.)

I would reinforce a present-life reason for any childhood excavation, so therapy doesn’t become an undirected self-indulgence.

I’d infuse the therapy interaction with a large dollop of real-world common sense.  Realizing when I’m driving, as opposed to being driven, is a cornerstone of mastery.

Most importantly, I would create conversation where “no” means “no,” and “I need to leave” is respected.  Complaints are regarded as legitimate rather than psychotherapeutic events, and my communications are heard and heeded rather than invalidated via diagnosis.

I challenge more professionals to learn from clients, particularly us treatment failures.   Assume most of us are thoughtful beings with credible perceptive powers.  Our dissatisfactions aren’t trivial background grumbling.  We’re talking about consequences that extend long into our lives.

Further Reading

Bates, Yvonne, editor (2006) Shouldn’t I Be Feeling Better By Now? Client views of Therapy. Houndmills, Basingstoke, Hampshire, UK: Palgrave McMillan.  A diverse collection of client essays exploring how subtle and not-so-subtle ways psychotherapy turned harmful, with further discussion for professionals of the many issues the accounts evoke.

Dineen, Dr. Tana  (2001)  Manufacturing Victims, What the Psychology Industry Is Doing to People.  Westmount, Canada : Robert Davies Multimedia Publishing.  Dineen critiques the “victim psychology” and pathologizing mindset which creates a detrimental influence on our culture.

Elkind, Sue Nathanson (1992) Resolving Impasses in Therapeutic Relationships. New York: The Guilford Press. A compassionate exploration of stalemates in psychotherapy which narrates how both clinician and client vulnerabilities might contribute to treatment breakdown.

House, Richard (2003) Therapy beyond Modernity. Deconstructing and Transcending Profession Centered Therapy. London: H. Karnac (Books) LTD.  House deconstructs widely-held precepts of the psychotherapy profession through questioning what he calls “the regime of truth” in search of a new paradigm.   A centerpiece of this book is House’s extensive focus on the literature of actual client experiences.

Sands, Anna (2000) Falling for Therapy, Psychotherapy from a Client’s Point of View.  Houndmills, Basingstoke, Hampshire, UK: MacMillan Press LTD.  Analyzing two contrasting treatments, a client reflects on the harm and help from therapy.

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