Compassion versus experience in a doctor or a therapist.

[losingconfidence]

Hi everyone.

Pretty soon, I'm going to be looking for a psychiatrist to resume my depression treatment (which I left off over the summer and am seriously regretting). My last psychiatrist was way too expensive and was very pushy about adding extra meds to my pile that I couldn't really afford. My problem is that I seem to have the absolute worst taste in psychiatrists and therapists imaginable. It's confusing to me because I hear stories about these psychiatrists who research and put in late nights to help find the perfect medications for their patients and these therapists who just believe their patients and care about them endlessly. These professionals sound like unicorns to me. I always do lots of research into what professionals treat and what they care about, but then 9/10 when I go see a professional, they do the following things:

- Lots and lots of name-dropping. They like to show off how well-read they are and how many professional associations they're a part of and how many big name therapists they've had lunch with. Problem is, I studied psychology in college, and I've read a LOT of books. Usually if I try to engage name-droppers in real conversations about the books and therapists they claim are important to them, they prove that they know next to nothing about those books and therapists or that they can't explain the theories in them beyond "well uh... .she writes about attachment. Cuz... .y'know, babies!"

- Interrupting. Constantly. A lot of therapists I see try to "finish my sentences" or guess what I'm going to say next. I get that they want to sound smart, but it's REALLY upsetting to me. On one occasion, I was telling a story about how someone broke into my apartment and trashed my house, and the therapist tried to "finish my sentence" by suggesting that I entered a dissociative state and trashed my own house. It was really hurtful. If you tell a therapist like this "no, that's not it at all, please stop finishing my sentences," they give a very insincere apology and then keep doing it.

- Salesman-like conversation control. I'll want to talk about something, and they'll cut me off before I'm finished explaining a situation and then try to jump to a very overly-simplistic suggestion without letting me finish. For example, I was trying to talk about how an abuser manipulated me into risk-taking behaviors, and the second I mentioned risk-taking behaviors, the therapist jumped in with "oh well, that's normal for people at the age you were at." It was instant invalidation and made me feel like she didn't really care about the rest of the story.

- Weird gaslighting behaviors. A lot of times I'll say something like "I know this intellectually, but it isn't sinking in emotionally" and a therapist will say "oh I think you DO know it, both emotionally and intellectually," and then want to change the subject. This is a big reason why I never seem to be able to change the way I think about things when I see therapists. They just tell me my thinking is already fine and I'm overthinking my thinking issues.

- Either medicine-phobia or obsession with throwing medicine at me. I've had some professionals just certain I shouldn't need pills. I've had others who have lied about side-effects and misrepresented what certain medications are meant to treat, mostly to make money.

- Refusal to accept that an idea isn't working. A lot of times, I've gone in and said "I've been taking this drug for about 4 weeks (per your instruction), and I'm still having side-effects" or "it still isn't working" and just gotten blank stares and silence. Either that, or I've been told my problems don't matter. Not being able to sleep isn't a problem because sleep isn't necessary for health . Not getting better just means "whelp, you can't expect a miracle" (even when what I'm asking for is the improvement that I paid for, not a miracle treatment).

- Just not caring at all. The last person I tried to get help from kept laughing any time I told her about the ways I was abused or tortured or whatever. She'd say it was funny because the abusers were just so grandiose or so dysfunctional or something. I don't really care why she was laughing; I just would like people not to laugh at my trauma.

It just seems like a lot of the therapists I see are narcissists if not borderline. They can do no wrong, always think they're right, etc. Considering this always seems to happen to me, I'm wondering if something is wrong with my search criteria. Why do I keep ending up with these know-it-all robots?

[fromheeltoheal]

Hey losing-

My goal with a mental health professional is to have a safe place to talk about what's really going on with me, and I expect validation, empathy, compassion, and hopefully some useful information, but that is really secondary to the first three.  I'm not into drugs and think they're a substitute for healthy, nurturing relationships with other people, that's what I've gone to see a professional for, and those healthy, nurturing relationships can eliminate most any mental ailment I'm experiencing, not true for everyone I realize, but I've avoided psychiatrists because of their ease grabbing the scrip pad, and have favored counselors, therapists, even life coaches, the title doesn't really matter to me, it's a person, one I'm paying to connect with, and they better be good at it.  The main reason I've seen people is reparenting, I didn't know that or call it that initially, but that's what it is, get in adult life what I didn't get as a child, supportive parenting, and that seems to be most of the challenge.  The other piece is to see the professional as practice, it's not a real friendship if I'm paying them to be my friend and there's always a professional boundary, that doesn't mean it's not effective, but it's practice for the real world, an example of what's possible, and that's where my life is, not in someone's office for an hour, so the goal has been to take it out into the world and connect, we don't need to do life alone, and that makes everything better.  I'm feeling a little lonely right now, the Holidays can do that if we don't have strong connections in our life, and I have a little work to do right now, but 2016 is going to be awesome because I know what to do, it's the best kind of work, partly because of what professionals have taught me.

You don't have to put up with any of the crap you listed, it's your dime after all, and those situations don't sound like they were helping.  One thing I've found very helpful is instead of going in thinking I'm a project and something needs to be fixed, go in thinking I'm a human who needs to connect, and the "professional", who is supposed to be good at that kind of thing, is just another human, and if you aren't getting what you need immediately, move on, there are plenty.  Good luck to you, and may you make it all about you and your connection, which is as it should be.  Take care of you!

[losingconfidence]

Thanks for your advice.

The reason I'm seeing medicine is because I have too much chaos and static in mind for connection to be possible without it. I'm in a constant state of emotional agony that actually makes me a little too unstable to listen to words or gain anything from talking. I think there actually is a chemical component to my issues because it's genetically there and it's difficult for any amount of listening to work if I can't talk because of mental static and chaos.

Right now, I feel like I do need "fixing" because I just don't function very well, and it isn't entirely related to connection. The confusing thing for me is that I have a compassionate friend who listens, but listening only goes so far. I end up needing something like ideas, information, etc., that no one seems to have. I also end up feeling like I need someone who isn't frightened by the depth of my pain but who also takes it seriously, and that's a rare combination.

It's also hard because I've seen psychiatrists who look awesome except they're $300 a session, and the ones I can afford tend to not look so awesome.

[fromheeltoheal]

Hey losing-

I commend you for digging into this stuff and looking for answers, and it's great that you have a compassionate friend on your life.  You might try telling us what information you're looking for currently, and someone might have a book recommendation or something that provides a missing piece for you; that's happened for me a few times here, by stumbling upon something that turned out to be really valuable.

It's also hard because I've seen psychiatrists who look awesome except they're $300 a session, and the ones I can afford tend to not look so awesome.

And I don't know that there's a strong correlation between price and quality.  May you find exactly the person you need, and may they be highly affordable.

[eeks]

Right now, I feel like I do need "fixing" because I just don't function very well, and it isn't entirely related to connection. The confusing thing for me is that I have a compassionate friend who listens, but listening only goes so far. I end up needing something like ideas, information, etc., that no one seems to have. I also end up feeling like I need someone who isn't frightened by the depth of my pain but who also takes it seriously, and that's a rare combination.

Because your personal history includes repeated traumas over a significant period of time, you might want to check out somatic based therapies, that work with physiological trauma defences that regular "talking" therapies can have difficulty accessing.

Somatic Experiencing (Peter Levine), Focusing (Eugene Gendlin - not a therapy modality per se but a way of accessing experience through body sensations), Trauma Release Process (David Berceli)

Types of mindfulness/meditation that work directly with emotions (Tara Brach, Pema Chodron, Bruce Tift)

I've also recently come across something called Coherence Therapy, in which the depth of your pain would (if I understand correctly) be treated as "coherent", that is, there's a reason for it being there, it "fits" with your implicit memories and beliefs, and the idea is to make the implicit (the things you are not currently conscious of) explicit. 

I would say it is also worth asking potential therapists what their experience and training working with trauma is.  The only way I've found therapists who were helpful to me was by getting a referral from a family doctor who knew what they were doing in terms of mental health care (i.e. giving the proper referrals and comprehensive care, rather than just some pills and a pull-up-your-own-bootstraps lecture).  In my case, that was a group therapy program at a teaching hospital with a reputable psychiatry department, and one of the therapists there who I really connected with gave me a referral to an individual therapist.  I have a friend who was really helped by a recovery from abuse program at a different hospital.  I live in Canada, so I don't know if this is relevant where you are, but you might want to try researching programs available at hospitals or mental health research/teaching facilities.

[thisworld]

Hi Losingconfidence,

I have seen a number of therapists in my life; some were very expensive authorities in their field, some were not. I felt most comfortable with someone I found through my activism connections actually. She was a feminist who supported LGBTQ rights and volunteered in some organizations. I felt comfortable because I knew we would be speaking more or less a familiar language. And she heard me in a very different way. She was familiar with physical and emotional abuse and she was the most validating, empowering and understanding psychiatrist I ever met in my life. I think the fact that I respected the way she conducted her profession helped me, too. Maybe you could find someone whose views or values you connect with through a field of activism, too. Before her, I felt that many issues I had were pathologized in very strange ways by psychiatrists; this woman's activism did not particularly relate to my individual problems but her honesty, her experience with many people from different walks of life, her respect for human rights etc helped me feel that I wasn't talking to a robot who would proudly prescribe Abilify to me in a matter of minutes. Just an idea. I hope you find someone who suits you.   

[aubin]

Unfortunately, there are a lot of bad therapists out there. While there are many professionals in different fields who aren't that great at their jobs, it seems worse with therapists because we go to them in such vulnerable states and with such personal issues.

I spent years drifting from one bad therapist to another, convinced that therapy was BS and would never help me, yet I was so desperate for some help that I kept going back. I did eventually find a great one who fit my needs. She didn't have the advanced degree or many years of practice that I originally wanted, but she was incredibly compassionate, a great listener, and offered a sliding scale fee. She also worked in a group practice with psychiatrists who, in consultation, could prescribe meds if necessary.

If what you need the most is someone who is compassionate and caring, then perhaps try to discern those qualities from their website or a phone call, then base your initial "interview" of the therapist solely around those needs. How do they deal with trauma? What role do compassion and validation play in the therapeutic process for them? Do they tend to talk a lot during the therapy session or little? Will the conversations be more formal or informal? If they don't have a medical degree, do they work with docs who could prescribe meds?  I think you can get as specific as you need to discern not just how the therapist practices, but also to see how they explain themselves to you (i.e., do they find these question invasive or irrelevant? do they respect your desire to find the therapist you need?).

[shellbell]

I wish there were an obvious answer to this. I am a therapist who has also spent years in therapy with various clinicians. I had one's that I felt I really connected with and others that I knew right off the bat that we were not a good match. It is very hard to find someone that you get that connection with, but both my personal and professional advice is that it is trial and error. In my own opinion, your high priced practitioners love theory but often have a hard time putting it into practice. Searches don't yield much assistance either as many professionals put every disorder on their list of "things they treat" in hopes of roping in more clientele. I have found that word of mouth is an excellent tool in finding a good therapist. If you have friends in treatment, don't be afraid to ask. A first hand experience from someone you know and trust is an invaluable review of what you will walk into. I hope that helps, best of luck.

[ladylee]

I'm so sorry you are experiencing difficulty finding a suitable therapist. Don't give up. I have never experienced what you are describing, but it does not sound like your fault.  Doctors are people.  I have been in therapy over 15 years and have only had one or two therapists in all those years who I can say were not that helpful, but I was able to find the right ones by changing. What you described sounded more difficult than what I went through... Sometimes the chemistry just is not there. I had one psychiatrist that I chose not to go back to because she was counting my anti-anxiety pills one by one in as if I was an addict and I'm not, so that relationship was not going to work because I felt shamed. She was cold and at that time I needed compassion and support. I found a replacement, and a better med, and felt much better.    It's not easy, But I never give up on myself.This time I was lucky, I found someone perfect who was on my plan and inexpensive. She is experienced in many areas of counseling and a nonjudgmental good listener. She also knows how to ask the right types of questions without making me feel shamed that help me look at myself. That's what matters.