Tag Archives: bad therapy

The problem when therapists bring their emotions into therapy: Firing #28

I wrote in my last post about my plan for therapist #28. That I planed to ask her to do med management and that I would see someone else for therapy. Although this was my plan I went into my session with the willingness to be open to making therapy with her work if at all possible. So I didn’t mention this plan right away in my session this week.

I’ve been so desperate to avoid restarting the therapist firing cycle I went through as an undergraduate where I went through 16 therapists in 4 years. I moved here and started seeing #28. I was incredibly determined to make this work. If anyone had asked me what my main goal in therapy was I would have said that my goal was to not fire my therapist. Unfortunately I think this determination allowed me to stick around in therapy that was detrimental to my well being and stability.

My therapist firing cycle was part of a reaction to bad therapy. Bad therapy scares me so much that I have been inclined to leave at early signs of problems. With #28 I was so focused on avoiding the awful cycle of firing therapists (fire therapist -> relief -> panic -> new therapist) that I partially lost sight of the adaptive parts of this process. I didn’t see the red flags for what they were.

With #28 the problem was in 2 phases. The first phase was before school started. I wasn’t feeling any desire to talk to her about things. I didn’t feel any attachment. I was feeling like we had no therapeutic alliance. It wasn’t bad other than that it was not good. Then with school starting my stress increased and I brought more emotionally charged issues into therapy. The problem of a lack of a therapeutic relationship became dramatically highlighted. #28 made interpretation comments, but outside the context of a safe supportive relationship these comments just felt critical and unempathetic which furthered the problem of lack of alliance.

But I was determined to make this work. I tried to explain what I explained above. I tried to point out examples of these problems as they happened. The problem is that #28 ended up taking my comments personally. It wasn’t obvious right away that this was what was happening.

I was making comments about behaviors that were making me perceive her actions as unempathetic and she interpreted that as a judgement against her. Read that sentence again. Doesn’t that feel backwards?

The problem is when a therapist brings their emotions into therapy it fall outside of the pattern therapy is expected to follow. She was trying to interpret my comments about her as part of my pathology. I know myself well enough to know that it didn’t fully ring true. But at the same time I could see that she was activating things I am touchy about and see some truth in it.

A big source of my conflict with my mom is that she takes my problems and makes them into her own problem to the point where I have to put my emotions aside and deal with hers. So when #28 was telling me that ‘most of her other patients think she is very empathetic’ and I tried to explain (without success) that a comment like that is exactly what I am upset about, it makes things very messy. It plants this doubt that maybe I am blowing things out of proportion. Maybe I am imagining slights that are not there. Especially when #28 is trying to make interpretations about my interpretations about her.

I have been in enough therapy to know it’s okay to sometime leave feeling a little more upset. But that also that should not be the norm and therapy should not be making me feel worse about myself as a person. At the same time I was feeling desperate to work things out. I was feeling worse because I desperately wanted to find a way to explain what was wrong and therefore fix the problem to avoid my therapist firing cycle. The problem is that the more I desperately tried to explain, the more #28 took things I said personally.

I went into my last session with her open to trying to resolve it (but with an alternative plan in mind). #28 gave me the push I needed to be clear that the problem was not all in my head. Before telling her about any plans to leave, she in a very angry tone and raise voice started scolding me for being too negative and telling me how she felt like I was never going to forgive her for one mistake. I responded that it wasn’t about one mistake it was about how she kept responding to my attempts to discuss the mistake. I’ve never had a therapist be so openly hostile towards me before. It was scary. But it  made me realize that I wasn’t wrong for seeing hostility in the sarcastic comments she had been making in other sessions. #28 even admitted that she was experiencing countertransference. I had been seeing anger leaking out in little ways and when I tried to talk about those angry responses as being unempathetic she had been trying to place the problem onto me.

What makes a therapist bringing their emotions into therapy so damaging is that there are no witnesses. There’s no one I can ask to say, am I overreacting? That should be the therapist’s role, but when the therapist steps far enough out of the role of neutrality I can’t get a fair judgment on my emotional state. I spent the past month on edge, feeling crazier than normal. I’ve been feeling like I went back to emotionally being age 18, like years of progress were erased. And then her reaction became obvious enough that there was no way I could doubt it was happening. Before that though I had to wonder if it was me. Am I too critical? Am I not giving her a chance? Am I overreacting?

#28 refused to meet with me only for medication. She said she does not see people for med management only and that if I even just needed a stop-gap until I find someone else it would need to be on a different day of the week (A day which I spend in class and can not go to therapy). I realize now that this is for the best. But right after the session I spent an hour sobbing in a parking lot down the street from her office as I panicked about the possibility of running out of my ADHD medication.

I had to pull myself together enough for a class at school. I hid myself in a corner before hand and booked an appointment online with the therapist who was the top of my list I selected last weekend. I was able to get an appointment for the following morning.

This post is too long so I won’t go into detail about that but I will say that meeting with this new therapist (#29) made it clear to me how bad things had been with #28.

#29 did all the things he’s supposed to with forming a therapeutic alliance. Even though I know the basic strategies he was using to convey warmth, understanding and empathy they still work and they work really well.

I’m upset with myself that I left myself stay with someone like #28 when it was having such a negative impact on my well being. After all the therapy I’ve been through, it is terrifying to realize I can still miss warning signs like I did. When I talked with #29 I got to talk about some major stressors I have been experiencing in the past month. None of these things had been things I had been able to talk to #28 about because all of our sessions were spent with me trying to explain why I didn’t feel safe talking to her and her doing more things to make me feel less safe talking. With #29 I was alternating between sobbing about things I am upset about and gleeful relief over finally being able to talk about them.

I still need to solve my issue of getting a prescriber because #29 is a PsyD and therefore can not give me medications, but at least I have someone on my side now to help me navigate the situation. I’m very glad I was able to get that appointment with #29 for the day after firing #28 because the anxiety of not knowing if the situation will work out well is unbearable. I’m already feeling myself coming out of the emotional hole I’d been falling into because now I have a little bit of hope.

Partial Hospitalization #1

A partial hospital program is sometimes also called a day program. You spend the day at the hospital, but then go home to sleep.

My first partial hospital program was right after my first hospitalization. I lasted two days there.
This is the program that I mentioned in my post about how they sent me someone else’s records.

The social worker in my hospitalization set up the intake at the partial hospital program for me.
I told her two requirements I had for it:
1. It needed to be an adolescent program
2. I did not want to do DBT

When the social worker informed me it was set up, she told me my requirements had been met.

When I arrived on the first day, I quickly learned neither request had been fulfilled.

I realize now that avoiding DBT in this type of program is likely an impossibility, but I’d have appreciated her being upfront with me about this. To be fair she probably didn’t know the program contained DBT. But the reason for this is probably because she didn’t put any effort to find out.

My request for an adolescent program was reasonable. I was 19. My inpatient hospitalization had been with adolescents (their cut off was age 21).

There was a group of about 6 others in the program. I was by far the youngest. Most were old enough to be my parents.
I was very uncomfortable. I listened to people complain about their children and spouses. I couldn’t relate.

At my intake meeting a ‘No Harm Contract’ was presented.
‘No way’, I said ‘I will self injure if I want to and forcing me to sign that just will force me to lie. I’d rather not need to lie.’
The contract was pushed aside to be reevaluated in the future.
I left that meeting with the understanding that I had in no way suggested I would refrain from self-injuring.

I was very angry and aggressive (verbally, not physically). Largely because I was stuck at this partial hospital program because I’d been kicked out of school and possibly also in a small part because of a bad reaction I was having to Celexa.

I was under the impression that successful completion of this program was necessary to help my return to school. Despite despising the program, I felt I needed to stick it out.

The first day was a Friday. That weekend I returned to the school to move everything out of my dorm room.
Most was removed Saturday. Sunday morning I came to retrieve the last few items and discovered another person sleeping in what had been my bed and a large bong in the bathroom.

Monday I returned to the partial hospital program. The first day I had left my sharp items at home. I wasn’t sure what I was getting into (would my items be searched?) and decided it was in my best interests to leave them at home. Monday, the second day, I came prepared with a swiss army knife in my pocket. This seemed fine based on my experience the first day.

Inpatient hospitalizations are under-structured. Too much time with nothing to do. Partial hospital programs are over-structured. One group after another. Spending the entire day dwelling on problems, because the structure prevents one from going out and doing anything enjoyable.

I was frustrated with the way the people leading the groups spoke down to us, as if the depression meant we were cognitively challenged.

During the lunch break I made a few little tiny cuts on my leg. Very minimal, close to zero blood draw.

In the afternoon I had a daily check-in meeting with a social worker. As a side note I mentioned cutting a little during lunch. I didn’t think it was a big deal to mention. I’d never agreed to the no harm contract.

I was transported into an office with another woman (someone with a higher level of authority). She demanded to see what I’d used. I handed over the knife.
A lecture proceeded in a disgusted tone, wondering how I could have possibly thought it was acceptable to bring a “weapon” (aka a small swiss army knife) into a hospital.

She demanded to see the cuts.
I refused, explaining they were minimal and did not need medical attention.
She argued that because I had done it “on the premises” she had to see them.
I continued to refuse.
“I’d have to take off my pants to show you”, I protested.
She seemed unconcerned.
I was scared and eventually intimidated into giving in.
I tried rolling up the pant leg to show the cuts, but as I’d suspected the leg wouldn’t push up far enough.
I unzipped, pulled down my pants and showed her the cuts.
I felt very violated.

“Well there’s not too much damage this time“, she huffed.

That was it. The last straw. I announced I was leaving the program.

She bombarded me with questions assessing my current suicidal risk, trying to trick me into saying something to allow them to keep me there.
I didn’t fall for it.

My knife was returned and I went home.

I still didn’t have a therapist. While making phone calls to find one, many therapists refused to see me on the basis that I’d not properly completed the partial hospital program. I only was able to get into therapy (although this was my fake therapy, because anything I said was at risk of being reported back to my school) eventually when I left out the bit about the incomplete partial program.