One of the things that I’ve wanted to write about, but that I’ve been afraid to discuss, is finding a therapist or med provider. The reason I’m afraid to write about it is because there are two schools of thought on the subject, one which can be potentially damaging: the first being that you should have control in the selection of your provider and find someone you can trust and have an honest and open dialogue with, and the other that a doctor’s opinion is finite and the problem lies with the patient if they disagree.
Certainly there are some people who think the latter approach is inherently problematic. Articles abound on the internet about accounts of overweight persons whose doctors tell them to lose weight before considering testing for conditions whose symptoms are apparent. And everyone has heard the story of a friend who has cancer who sought a second or even third opinion because there was just no way their concerns were being heard and validated. But opinions like these work slightly differently in the mental health field, which is divided between independently licensed therapists, psychiatrists, and LCSWs who often take insurance-free payment on a sliding scale and clinics who accept Medicaid and cater to low-income persons and people who are not on a high enough level of functioning to be working. The former, frequented often by wealthy WASPs who prefer to discuss their problems behind closed doors and pretend everything is rosy and fine when asked, tends to take on the attitude that the patient and their opinion is of value. Two to three sessions may be set up in the beginning of the patient-provider relationship to determine if the therapist is a good fit; if they’re not, the patient moves on, carefully selecting someone with whom they can do good work with. The clinicians in the latter situation, however, seem to think that they know what is best for their patients, operating often on little input from the client and making it clear that missed appointments and lackluster medication regimes are not tolerated. Because they see patients who don’t take their care seriously, they often become jaded and accusatory with those who put effort into their therapy.
Recently I ran into an issue with being assigned a therapist in a clinic. I asked to be assigned to a therapist who specialized in trauma recovery to cope with childhood sexual abuse, and was assigned to a therapist we’ll call M. After about a year and a half of therapy and not having made any progression in trauma recovery because M didn’t have enough experience in that area, I asked to be re-assigned. I saw my new therapist, J, for about a month before deciding that she wasn’t a good fit. I didn’t trust her and I felt that she was rather judgmental and because of that I couldn’t be open and honest with her. When I asked to be reassigned, the director at the clinic informed me that I needed to be in therapy for at least six months before accurately being able to determine whether or not a therapist was a good fit, that if M and J weren’t good fits for me then he didn’t have anyone else he could assign me to, that wanting someone to take a “cheerleader” or life-coach approach to support during the difficult work of therapy was not a valid quality to desire, and in short informed me that I was the problem and that I was not taking my therapy seriously.
In tears, I relayed the situation to several people I know and a hotline operator in hopes of receiving some sort of validation that in doing what I had been taught since childhood (find a provider who is a good fit and advocate for your own self-care) I had done the right thing. Being close to feeling solid in my actions, I mentioned the situation to someone I know who commented that it was their belief that the doctor is always right and that comfort is secondary in selecting a physician. I was absolutely devastated, and therein lies the root of the fear behind writing this blog post. I don’t know if I was right to seek out a therapist in the manner in which I have become accustomed. I don’t know if it’s a good idea to tell my future children or a good friend that it’s important to be able to trust your therapist, and if you don’t, immediately look for a new one. Despite the fact that I’ve had confirmation from therapists, social workers, and people working in mental health fields that I was doing the right thing, I still feel doubt and worry that G-d is punishing me for not taking seriously my mental health care.
Despite this recent shock to my resolve, I do believe that you are your own best advocate and you know best how to dictate your self-care. I believe that you should have a comfortable relationship with your physician and be able to confide in them and feel confident in their bedside manner. I believe that if you determine your care provider is not meeting your needs, you have the right to seek out one who does. I believe that you have a right to a second (third, and fourth…) opinion. I believe that even though the work done in therapy is often very difficult, you have a right to seek out a therapist who will support you, cheer you on, and encourage you. I believe that the stigma of certain health conditions – mental health, weight, or whatever else – should not excuse assumptions that you are a child who cannot care for themselves. I believe in me and my ability to make my own decisions about my healthcare. And I believe the same for you.
Hi I agree with you if its not working after 1 year it isnt going to work .. I wish that tgere was a way of rating doctors and psychs myself as its so hard to find a good one !
I know this entry is a bit old, but I wanted to say that I agree with your approach to choosing therapist. I have been on both sides of the “couch,” and I think any therapist should want you to trust them, and if you can’t, then you should find a different therapist. On the client side, I’ve found it helpful to address any concerns or blocks to trust with the therapist I’m working with. This helps me see whether the defensiveness is on my side or theirs. As counselor, if someone told me they were having trouble trusting me, I would want to explore why. But, in the end, if trust was going to be a major issue, then I would want the client to find someone they can work with.
Working with a therapist should be empowering, not the opposite, no matter what the problem/disorder.
Thanks so much for your input even though this is an older entry! I finally seem to have found a therapist and NP who are closer to where I currently live and with whom I can do good work. I saw the new NP the other day and he was glad that I was able to stand up for myself and not do trauma work with a therapist I didn’t trust. It’s sometimes difficult to know when to trust a doctor’s opinion versus trusting yourself, but in this case it seems to have paid off!