A few weeks ago I decided to give CBT another shot. How is it fair for me to fully reject it as a treatment option for myself, when my experience with it has been so poorly applied?
I picked out a local prestigious research center and gave them a call.
I felt that maybe the failures with my previous efforts to get “real CBT” were because I was looking for treatment in the community rather than from researchers. Maybe this “empirically supported treatment” only exists in the magical world of academia. The treatment outside might share the same name, but maybe it is something different.
In the past I’ve avoided treatment research studies (even though I’ve participated in many other types of studies) because I worried about the guilt I’d feel when I didn’t get better. I don’t want to ruin their study.
I don’t talk about my work here much, both to maintain my anonymity and due to confidentiality rules. I love what I am doing and I am making amazing professional connections. It is doing wonderful things for my developing career, but not so good things for my ability to find treatment. I am very concerned about keeping my crazy separate from my professional life. Most of the people I work with are therapists.
As my therapist list grows longer and longer and my work social network also expands I’m running into increasing problems of overlap between the two. I know that both therapists number 23 and 25 in particular had some form of connection to people whom I work with. I’m sure others have had connections I don’t know about.
S.M has tried to assure me that some amount of this problem is very typical for folks working in the mental health field and that clinicians should be able to handle it tactfully. The problem is that most people only have one therapist they are awkwardly avoiding in their professional life. I have 25 and counting.
If I knew for sure, ‘ok this therapist is the last one I will ever have to see, because this therapist will be a good fit’ then I might be less concerned about the therapist possibly knowing a coworker or attending some of the same conferences as me. The problem is that in all likelihood therapist number 26 won’t be able to help me any more than the other 24 (S.M is excluded as I only left him because he’s located far away). As I see more and more therapists I cut off more and more career options. I wish I could wipe my identifying bits of information out of a therapists head after I fire them.
The ideal therapist for me would be completely professionally isolated, the problem is that someone that isolated is not likely a very good clinician.
It may seem like I got a bit off topic in the above paragraph from my thesis sentence, but here’s where it connects. Something that made this Prestigious Research Center (henceforth known as PRC because psychologists love acronyms almost as much as Unitarian Universalists) a wonderful choice for my treatment is that I have zero desire to work there. We have differing theoretical interests and this is a place that would be particularly hostile for a person with my perspective to work. I could go there as a patient and not feel like I am blocking off a future job opprotunity.
I played telephone tag for a week with PRC and finally got in touch with a fellow who conducted a phone screening interview. I prefaced the interview by letting him know that I realize I’m not the ideal person for their research, due to my large amount of treatment experience and number of co-morbid diagnoses. He said this was fine, because the research clinicians also see patients there outside of the studies.
I thought this was great. I could get the research clinician without the guilt of sabotaging their study.
He said that sometimes they do have to refer people out with certain kinds of problems that they don’t work with e.g. substance abuse. As substance abuse is not a problem of mine, I wasn’t concerned.
I became even more attached to PRC when he told me that all of their patients go through a thorough assessment prior to therapy (things like personality measures, structured clinical interview etc) with an accompanying report.
I have a large stack of neuropsychological testing, but never any formal assessment, independent of the treatment, about the rest of my crazy. If nothing else I was excited about the idea of a beautiful organized report with charts and standard deviations. I adore data. Even if this therapy didn’t work out at least I’d have a report (albeit one biased towards militant CBT research) to show future clinicians.
The phone interview lasted an hour and a half. I was told I’d get a call back from the main desk to book an appointment for the assessment. Instead the fellow from the phone interview called me back to say they were unable to work with me. He’d talked to his supervisor who told him they had a policy of not working with anyone who has had more than 2 hospitalizations in the past 5 years (I’ve had 3). Then he offered me a referral to Other Prestigious Research Center.
The problem? Other Prestigious Research Center is where I work. Not in the specific part he referred me to, but very closely affiliated with it. This isn’t just a matter of me being obsessed with boundaries where I avoid people even loosely associated with my work. This is closely related enough that it would be unbelievably inappropriate for me to look for treatment at this particular location.
I was so taken by surprise that I actually told him why I couldn’t use that referral. An unusual self-revelation for me.
He got back to me the next day with more referrals except this time for people in private practice. When I googled them it turns out they both worked at the same Other Prestigious Research Center that I have to avoid.
So my plan of getting CBT was foiled again. I called S.M. asking for a referral. I feel so awful coming back to him over and over. He has a hard time making these referrals because he doesn’t know many people in my area.
For the past couple of years he’s been trying to get me to see a “senior analyst” for a consultation. Someone too busy (or mostly retired) to take on any new patients, but who could be a fresh set of eyes for my problems and would know clinicians in my area well enough to select a strong match.
I’d been turning him down, because I didn’t want to add an extra person who knows my problems to the world unless they were someone I was planning to meet with long term. I finally agreed to give this a shot.
He told me a name and I googled her to establish sufficient separation from work. She is loosely connected but far enough apart that I can tolerate it. S.M told me he would give her a call and see if she could see me for a consultation.
It been a couple of weeks. I’m not sure what’s going on. I guess she’s not answering his call? S.M. keeps telling me he expects to hear back soon, but it hasn’t happened.
Meanwhile I’m waiting, feeling like I can’t try to pursue other options (as if I even have any) until this sorts itself out.
I’ll go to work next week where I’m surrounded by therapists, while I am still unable to find a therapist for myself.
Tales of a Crazy Psychology Major 
I think most therapists probably struggle with this to some degree. finding treatment and maintaining your own confidentiality must be very difficult when everyone available to you may be working with you in the future. I would think most therapist would be sensitive to this? Would it be the end of the world if someone you worked with knew your issues? Well I guess that’s probably hard to answer without knowing if you and the therapist would work well together. I’m not sure how I would feel in your shoes. Good luck in your search.
It’s hard because since my confidentially has been broken before I’m so distrustful of people’s ability to really keep it.
And even if they do keep it it’s impossible to interact with as person in the same way as they would without the information.
For the most part the people I work with don’t have a sense of my anxiety level. At least if they notice they don’t let on. There’s one person though who I feel sees right through me. It makes me way more anxious around him. In a way being able to pretend I’m not so messed up helps me to be able to function at a higher level.
The idea of people at work knowing about my problems feels similar to people at school knowing them. When the school knew, I was kicked out and lost all I’d established. I worry it could happen at a job as well.
I didn’t mean to sound like I was minimizing this issue. I totally see where you are coming from and I think I would feel similarly if I were in your shoes. I was just trying to think it through because I think therapy is important. :-)
I have only had a few therapists, but I know so many of them are not helpful and even harmful. I’m not really sure how CBT differs from psychodynamic therapy though. I’ve read about them but I have had therapists who say they are one thing but they all end up being pretty much the same–at least in my experience.
No worries. I didn’t think you were minimalizing the issue.
The idea of different therapies being 100% different isn’t really true. A lot of the time they’re doing similar techniques but using different names for the same thing. There’s an idea called “common factors” that those factors which are shared by all therapies might actually be more important.
The theoretical rational for what’s wrong with as person is very different in CBT versus psychodynamic, but in reality when put into practice either one might contain elements of the other.
Tales — What a disaster of a mess to be in. I would have been devastated by the refusal for treatment from the first PSR. While I don’t live in a city, I live in an area where I can access multiple cities fairly easily and my T said he wouldn’t even know where to refer me to for CBT if I had wanted it. Finding a good T is hard enough, let alone a CBT one who doesn’t have any close affiliates for you. How DIFFICULT! Do you have access to another agency/therapist outside your local area?
I’m sure there are places I can go that are a bit further away, they would be smaller and more obscure though. Most of the best options are pretty near to where I live. Unfortunately I don’t have a car, so I’m limited to public transport and even if I did have a car, my time is so limited I can’t really go that much further than I already have tried to go.
In my experience, confidentiality amongst professionals has never been a problem. It’s generally accepted that mental illness can happen to anyone, and that people recover. It is disappointing that your working environment is different in this respect.
Also, in my experience therapists with strong academic interests are more likely to be distracted by the latest fashionable theories, which can sometimes make them perform surprisingly poorly with real-life patients. A therapist in full-time private practice is more likely to focus on patient outcomes, it seems to me.
I see you removed our last post..
I personaly believe that being overly cautious can sometimes lead you to miss out on certain things
ie what about going to the local jym or swimming pool where you might meet a colleague or someone who is acquainted directly or indirectly to your T..
My T and I live less then 2 minutes from each other. i see her often at the jym or local functions ect..
Im also an aspiring future T (still a post Grad student) so there is a chance well meet in professional settings. I trust her not to blab about my sessions to others. If she did it will put a bad mark on her as a proffessional and less on me as a client
Thats my opinion
Yes the other post was deleted because while there’s a support component to this blog, I don’t like using it for immediate crisis support. I prefer posts here to be ones I’ve thought through for awhile and can think about with a more level head.
Dont you think that being overly cautious might lead you to lose out on a good therapist? or giving up on the whole idea all together?
There is always a chance that your T will know a work colleague or perhaps went to university together ect…
Perhaps if u do find a T make your reservations known to the T and ask that what comes out on the room stays confidential between the two of you and not discussed with anyone..
You could even have T sighn a writen contract
I might even do that with my T ;)
Also it doesn’t matter if my caution leads to missing a good therapist. I would much rather die than go through again something like what happened when I was kicked out of school. Anyone trying to get me to compromise on this doesn’t get how traumatic it was for me.
I understand that it was traumatic
perhaps you could have your next T agree to sighn a writen contract on cofidentiality. Explain that thats the only way you can feel safe.
If I thought that meant anything I’m sure it would help, but some words on a piece of paper are meaningless.
maybe DBT might be better for you since it recognizes some psychodynamic theories but also has a CBT base? Also psychodynamic therapy is recognized as “evidence based”, look for the september 2010 “Harvard Mental Health Letter.”
My DBT experiences have been pretty negative and my reading about it theoretically doesn’t make me any more interested. It’s not something I am looking to repeat. I’m very aware that there is evidence to support psychodynamic treatments, the issue is that division 12 with their “official” list of treatments mostly does not recognize this aside from some few exceptions. Yes there is an evidence base for psychodynamic treatments, but much of that is not recognized on the “official list”.