Therapy: The Good, the Bad, and the Ugly.

The following are my personal thoughts regarding the benefits and drawbacks of therapy. I would like to express them to the forum.

I dislike therapy and do not have a whole lot of good things to say about the therapists I have had exposure to. However, even though I have had a number of negative experiences with the industry, I am smart enough to know that these are just my experiences and what may or may not work for me, may or may not work for others. Each person is different and Therapy/Psychiatry is not an exact science. When talking with people who have undergone some form of therapy or psychiatric treatment, you usually get two types of reactions: Those who have had relative success will swear by it; Those who have had largely negative experiences(like myself) will condemn it. Rarely, if ever, will you hear someone give a neutral appraisal. I am trying to step back in a neutral manner and do that here. As my study of philosophy and mathematics has shown me, Truth is not something subservient to emotion.

I will begin by offering a few general statements of opinion which I have formed from two decades of exposure to the system.. You may not agree with many or all of these statements and that is fine.

I personally believe the following statements hold true:

-- Therapy is not just walking into a clinic and talking with someone(although this often is all that takes place.) Productive therapy involves a working relationship between the patient and therapist over an extended period of time.

-- Engaging in therapy is not a passive activity. You need to do more than listen to gain any benefits. You must work hard to get results.

-- For the most part, therapy is not about a cure. In my opinion, therapy, for most people, is about coping. A therapist will not and cannot make a problem go away. Likewise, no pill dispensed by a physiatrist will cure you. Psychotropic medications are not anti-viral medications that destroy an invading organism. If you are dealing with serious and complex personality issues, these issues are likely to stay with you, forever. For many people, therapy and medication can make your reaction to the symptoms manageable, but they will not usually make the symptoms go away entirely. In therapy, you may or may not learn to cope with and manage the negative feelings that occur as part of your disorder. If anyone, doctor or therapist, tells you they that coming to therapy or taking a pill will cure you, they are quacks, frauds, or simply crazy themselves. In short, there are no quick fixes to complex issues.

-- Therapy and psychiatry are not exact sciences and misdiagnosis are quite common. I recently read an article that stated the most commonly misdiagnosed ailment is Bipolar disorder. The diagnosis is usually made years after an initial contact with the MH system. The reason for this has a lot to do with the nature of the symptoms, I suspect. Diagnosis is very important for some as it determines the method and approach that is used as part of your treatment. It also determines what medications you may be advised to take to help you deal with the issues. It always helps to get a second, or third opinion.

-- Some patients with complex issues are placed into programs that just are not compatible with the personality or traits of the patient. There are many different approaches to therapy and many different philosophies on the best methods to deal with a various disorder. You have CBT(Cognitive Behavioral Therapy), DBT(Dialetcial Behavioral Therapy),and so forth and so on. Many of these take place in a group setting.

-- What program or therapeutic approach you get involved with largely depends on what therapist you get placed with, regardless of your needs or desires. Most therapists and clinics ally themselves with one particular therapeutic approach and use this on all of their patients. Those of us with HMO or PPO policy have extremely limited choices on whom we can see, unless you plan on paying out-of-pocket and have the funds to do so(it can be very, very expensive.) The result is, you sometimes get placed into a program you are not compatible with and there are very few other options unless you have the financial resources to pay out-of- pocket, outside of your plan.

-- I would speculate that results gained from therapy are inversely proportional to the severity of your issues. In my opinion, those with the least severe issues are most likely to see the most progress. Those with the more severe issues are the least likely to benefit from therapy. Why this is, is a complex matter, and I will discuss this below.

-- Most clinics have a philosophy that quantity is more important than quantity. Obviously, clinics and hospitals are a business and I understand the need to make a profit. ; However, if possible, it is best to shop around for a clinic or therapist that is not inundated with patients. Visit the office--how many people are sitting there? Are patients stuffed in the waiting room like sardines? Are people looking at their watches? Years ago, I saw a therapist every Thursday at 3:45. I would get there at 3:30 and the office is full. Everyone looks flustered. At 4:20 or so, the therapist would hurriedly rush me back to the office. Sometimes, I would get cut off at the end and the therapist would state, "I really hate to rush you out but I don't like to keep patients waiting." If you encounter this type of office, run, do not walk, to another clinic or therapist. Unfortunately, too many clinics are set up like this today and the result is many patients feel like cattle being pushed and shoved through doors. The industry today too often resembles a fast-food industry. I am wondering if, perhaps in the near future, there will be Drive-Up therapy windows?.

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Now that is out of the way, I will present what I feel are the good, the bad, and the ugly.

The Good:

For many people, therapy and/or medication will help you cope if you want to really work on it and are open to change. The measure of change any individual can realistically expect, I believe, is largely determined by your effort and the severity of your issues. Some patients logically would be most likely to receive the greatest benefit:

Those undergoing serious life-events and are impacted mentally etc., Those with dependency issues and addictions. Those with mild to moderate personality disorders. IMO, these individuals stand to gain the most. I also believe they are the meat and potatoes of the industry and this is where therapists thrive.

The Bad:

I believe that therapy begins to fail when dealing with those with very serious or debilitating issues.Those individuals who have a condition that profoundly affects a persons personality and mood will find therapy exceptionally challenging, confusing, and often will find the rewards do not come as expected. I am not stating that those individuals in this category should not participate in therapy. It is simply a personal opinion that these individuals should not realistically expect big results. The reason, I believe are numerous:

1) Most therapists, in my opinion, have very limited experience with serious, complex, and unusual issues.

2) Many therapists use language and metaphors that many with personality issues will find vague and esoteric. Here is an example: Yesterday, I had someone respond to a post of mine as listed below. I appreciate that the person was trying to help and meant well. I am just giving you an example of the road-blocks some of us face.:

"You know in every one's life, there are good and dark moments to face.....You have to apply all your positive thinking on those bad moments. You are feeling sadness because you had kept it in your memories.."

Now, this is similar to the type of well-intentioned talk that therapists often employ. The problem is, for people like me with a serious emotional and personality issue, we have trouble understanding emotions to begin with, even more trouble trying to understand someone else's emotions or meaning. Someone like me finds myself totally lost here. It's not that I don't understand the intention. I don't understand how to do what is being stated. It's like trying to explain to a blind man how to see in color.

The question that someone like me will often ask the therapist is," How do I do that? What do you mean by that? How do you know what a positive feeling is?" Now, your average therapists will simply become befuddled and really not have anything to fall back on. This is when they will often start pulling out textbooks or cliches. I have literally had this happen on more than one occasion.

Therapists are in their prime when dealing with relatively simple solutions to relatively simple issues.

This is where expertise is critically needed, and unfortunately one is not likely to find it unless you have the money to shell out on a very specialized psychologist. IMO, certified Counselors are neither educated enough or experienced enough to handle these issues. They will be in way over their heads and will indeed be pulling out textbooks. There are some, but you must shop for these specialists and you must be willing to pay out of your pocket, as nine times out of ten your PPO or HMO will not have such an expensive therapist on their plan. So, if you have the money and can find someone with experience with your type of issue, you can benefit from the system. If not, you are stuck with the PPO, HMO. Chances are, you will become frustrated with the therapist the therapist becomes frustrated with you, you eventually leave, feel guilty for failing, and your emotions are further in shambles..
In essence, it is too easy for people like me to slip through the cracks. The system is geared towards the average, not the exceptions. We get jacked around a bit and are out of a lot of money.

The Ugly:

Unfortunately, most people must limit themselves to visiting therapists and psychiatrists approved by a particular PPO or HMO policy. Usually, one has maybe two or three therapists in one's local area to choose from.

It is only common sense that the PPO and HMO corporations are going to employ the cheapest labor possible in order to maximize profit. Who will work for such entities? The most experienced, or the relatively new, or those that have no other choice? Basically, they attract those who, for whatever reason, can't find work anywhere else, do not yet not yet have the experience or credentials to form their own practice or become a partner in one that exists. I am not stating everyone employed by the HMO/PPO plans fit this bill; However, I would wager this is the general rule.
In essence, this means you are going to be paying to discuss your issues with what is quite possibly a twenty-one-year-old who just graduated from a community college and managed to pass the certification exam after the third attempt. Now, one might say this is an exaggeration. I have seen this, however. Most therapists who are approved as providers for PPO/HMO plans are very young and very inexperienced.

Also, I believe that many therapists have issues themselves and they transfer these onto patients. I have had one therapist who brought up the fact that she had dealt with issues surrounding how her boyfriend once 'dumped her.' I have had one woman therapist display clear anger and animosity towards men. She would always make negative statements about men. Once, I asked why I was the only man in a group therapy setting. She stated, quite angrily with a look of animosity in her eyes," Because Men are too afraid to talk about their emotions."

In short, if you are experiencing complex and serious personality issues, seeing a therapist is a crap shoot. If you are lucky, you will get to work with someone who has actually dealt with complex issues. Most likely, you will find your therapist is quickly in way over her head. If you have the money, you will be able to forego the HMO/PPO plans and find someone on your own. For many, however, like me, you would have been better off just forgetting about it altogether. You would have saved quite a bit of time, aggravation, guilt, and money.

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Thank you for reading my thoughts on the matter. Feel free to offer your own thoughts on the issue.

If you respond, please follow these rules:

- Pleae do not simply make a statement without trying to explain how and why you arrived at the position in your statement. Does your statement come from experience or opinion?

- Please do not disagree with me simply by saying you disagree. Please present some type of rebuttal or argument to the contrary.

Sorry you've had such a horrible time with therapy. I've never had anything but good, positive experiences... sorry yours was so awful.

The Exceptional:

A medications specialist who determined that particular physical ailments were related to psychological issues; kept an open mind, ears and eyes; worked with the patient to illuminate complicating factors in the illness and to create a successfull treatment plan; sought out and enlisted the aid of other providers, viewed the patient as one entity--mind and body, considered all possible causes and treatments, and most importantly always acted and spoke with genuine compassion.

A rare doctor that one was! But really a saving example of what one hopes for when seeking medical treatment. The docotr cared, listened and actively worked to heal and to empower the patient.

The Great:

The nurse practitioner who issued an order for my employer so that my schedule would accomodate my medical needs. Who promoted all aspects of health, not just medications. A confidant who cared for and respected me.

The Good:

A psychiatrist who said basically "Okay, if that's working for you I won't insist you do otherwise, but please stay in communication with me."

Wow, a psychiatrist who respectfully disagrees, doesn't demand authority or control, and only offers an open invtation to treatment?!

The So-So

The doctor who would just write whatever script I asked for. I had a doc say "What? Do you want morphine? I can write that?"

Um, that's sort of okay, but I'm not that well trained. I don't always know what I need. That's why I'm enlisting their help. In that particular case I wanted his recommendation for physical therapy authorized by my healthcare plan--not drugs. I wanted to be well, not doped. I've had psychiatrists act the same way. Like salespeople at a drug store. "So, did you like that last stuff? Can I get you something different?" Ugh!

The Bad:

The therapist who responds to "I don't understand the role of therapy." with "Then don't come."

Um, okay.

Or clock watchers. Gees. I've seen tactful therapists keep tabs on the time. You don't have to look at the clock every few minutes and definately not while I'm mid-sentence.

The doctor who says "Wait it out." when I told him side effects were unbearable. When I told him I was growing increasingly psychotic. The wait proved disasterous. This might actually be Ugly, but it does get worse.

The Ugly

The doctor who answers "Why am I supposed to take this drug? It is making me stubid, numb and blind." with "Cause I said so."

Really?

The myriad of people who strip your clothes, your freedom, your self-determination, your dignity.

The Atrocious:

The social worker who lets a client move in "to help him out" and steals his drugs, keeps him housebound and restricts his food, but offers unlimited alcohol.

Criminal. Immoral.

The state-employed psychiatrist who releases an arrested individual, with well-documened and severe schizophrenia, in current need of treatment, onto the street rather than contact his family or have him committed "Because he's an adult."

The individuals who exaccerbate or worsen others lives.

I could go on forever with the spectrum of care. I haven't known any one to die as a result of or lack of treatment, but I would not doubt such a tale if told to me. I've seen the lack of respect for humanity that leads to death.

But I have seen the exceptional. So I will hold out, not hope, but confidence.

Fear is the belief that things may go badly.
Hope is the belief that things may go well.

I am confident it could go either way.

Moss

Butterfly Faerie wrote:Sorry you've had such a horrible time with therapy. I've never had anything but good, positive experiences... sorry yours was so awful.

Thank you for commenting. It is good that it has worked out for you.

Here in the US, many of us have to decide if we will make the car payment or pay the therapist. MH therapy really is a luxury here only available to those with insurance, the ability to pay-out-of-pocket, or those comitted against their will. As the providers are privately owned, most are motivated strictly by profit. It is pretty brutal if you don't have the resources for a good professional.

I just have not found most of my experiences positive or beneficial. I know everyone's experience is different and certainly would not say everyone gets a bum deal. I would just proceed with extreme caution and do your homework here before deciding on whom to engage with in terms of therapy.

Yes, medical care in the States is horrible, I feel bad for you guys.

To be honest I think that if someone is a harm to themselves or others they should be committed... when you sink that low and want to harm I think that is the bet course of treatment for them if it's to that extreme.

Yes, if you don't have good resources for professionals it can be bad....


It's too bad you've had so many bad experiences.... that you haven't benefited from good care from someone... sad to think there aren't that great doctors/therapists out there...


I would also say too, that if you EVER feel uncomfortable while in the care of doctor, psychiatrist, therapist etc etc you can always ask for a referral to someone different, that's your right, and ask a second or third opinion if need be.

Moss wrote:The Exceptional:


I could go on forever with the spectrum of care. I haven't known any one to die as a result of or lack of treatment, but I would not doubt such a tale if told to me. I've seen the lack of respect for humanity that leads to death.

But I have seen the exceptional. So I will hold out, not hope, but confidence.

Fear is the belief that things may go badly.
Hope is the belief that things may go well.

I am confident it could go either way.

Moss

These are all interesting examples. There are probably just as many experiences as there are people.

Regarding the therapist who respondend with, "Don't come then.", I would have responded with, "Well, give me my money back for this appointment and I will leave."

ThisIsMe wrote:Regarding the therapist who respondend with, "Don't come then.", I would have responded with, "Well, give me my money back for this appointment and I will leave."

I don't pay for medical treatment of any kind-not even deductibles. Limits my choices, but saves dollars, right?

At any rate, I did leave. And I didn't go back.

Moss

I don't pay a cent either.
Just pay whatever for medication, and it's cheap as i'm on benefits from the boyfriends work.

I disliked therapists until recently.

I find what my therapist helps me most with is simply giving me an objective view of my irrational view of the world. This may seem too simple, but my family and friends are not capable of being totally objective.

Some examples where objective thoughts have been helpful. I do not always have the capability of knowing whether someone is out to get me or not. I think everyone is talking about me and hates me and I don't always know that this is not true.

I think I would say that I lack social common sense.

I think people have wildly different ideas of what therapy is suppose to do. Lately what I have found is just trying to focus on what works for me in terms of getting better is what is best. Lifestyle choices make a bigger difference than anything a pill or talking to someone does. Trying to find peace within yourself is one of the biggest challenges of all.

You know, society determines what mental illness is and you always have to keep that in mind. [i]

I wonder what therapists would say to that ........