When Shrinks Go Wrong

This morning I read an article in the New York Times that really upset me. Titled, “My Shrink is my Co-Author” the author, Susan Shapiro, describes the ups and downs of writing a book with her longtime psychotherapist “Dr. W.”

The good doctor, it seems, is an expert on addictions who helped Ms. Shapiro quit “cigarettes, alcohol, marijuana, gum and bread” several years and somehow they decided to co-author a book on addiction together. (The article is unclear as to whether Ms. Shapiro or Dr. W suggested writing the book in the first place.) Ms. Shapiro goes onto write that Dr. W’s sessions cost $200 a pop so, in return for her writing the book, he would treat her for free. Uh-oh.

As she engages in this process, Ms. Shapiro discovers that her relationship with Dr. W had changed. “As a therapist, he was perceptive, sensitive, caring,” she writes. “As a coauthor, not so much.” She also learns personal details about him, like he had an abusive alcoholic mother, and starts dispensing advice to him. When Dr. W. flubs a biography detail in a magazine article designed to pitch the book to prospective publishers, Ms. Shapiro tells him, “Afraid of success, you subconsciously took the title off the bio that would get us the publishing deal…..Perfect sabotage, the kind of thing you taught me not to do. How does that make you feel?”

Realizing the situation is not working, Ms. Shapiro laments that Dr. W has rescheduled her appointments to the daytime, leaving his evenings free for higher paying clients. Upset and hoping to unravel the situation, she leaves voice messages and sends “twenty-emails” with no reply. She eventually has to arrange a paid session with Dr. W to work things out. So they come to a compromise. She will keep the entire advance for the book in exchange for paying Dr. W his regular fee. But when she finds out that Dr. W jacked up his fee 25 dollars without telling her, Ms. Shapiro is again upset, thinking it’s retaliation. When she goes to another psychotherapist for advice she’s told that the “boundary crossing” Dr. W was doing was ‘unethical.” The article wraps up with Ms. Shapiro finishing the book and comparing the writing process, in self-deprecating neurotic New Yorker fashion, as an addiction unto itself.

When I finished the article I wanted to throw my iPad against the wall. The reason I was so pissed? Because Ms. Shapiro’s piece just reinforced something I’ve known for years.

A great many therapists are flat fucking crazy.

I have friends who are therapists. I also worked in the mental health industry for ten years. In that that time I learned that wackjobs permeate the entire mental health world. We had a saying in the psychiatric hospital, “How do you know the difference between the patients and the staff? The staff has keys!” And there was many a time I wanted to throw the healers into a straight jacket. I knew a psychiatrist who married one of his former patients and another who talked to himself on a regular basis. I worked with a hygienically challenged child social worker that wore the same clothes and ate the same food everyday. (The resultant smells thrilled the parents.) I also dealt with; nymphomaniacal manipulative psych nurses, active anorexics treating anorexics, drinkers treating drunks, people sexually acting out all over the place and dozens of depressed, anxiety-ridden and bi-polar therapists refusing to take meds or seek treatment. Sad to say, there are lots of therapists who should never get near a patient.

However, the biggest gripe I have with field is the same ones all my therapist friends have: that the therapeutic community is filled with badly trained clinicians and those with poor boundaries. I am not qualified to talk about how therapists are trained but, as one retired psychoanalyst with four decades of experience told me, “It’s gone downhill over the past twenty years.” But I can talk about the whole fucked up boundary thing.

A few years ago, a friend of mine started seeing a therapist. Excited about her quest for self-improvement, she told me to take a look at her West Side shrink’s website. My first reaction was, aren’t therapists supposed to be a kind of blank slate? What the hell is she doing with a website? And when I looked at the site I was seriously aggravated. It was basically an ad for the books the therapist had written about “putting the zing back into your sex life.” Worse, at the bottom of the webpage, there was a notice that she had been a signatory to a petition to end the war in Iraq. When I told my therapist friends this, they were aghast.

This is just one example of poor boundaries. This therapist has a right to express a political opinion of any stripe, just not in her professional space. Imagine going to a therapist’s office and seeing Tea Party or Occupy Wall Street literature on the coffee table? What if a depressed conservative came in for help and saw a Che Guevara poster hanging on the wall? How would a liberal neurotic feel discovering an NRA magazine in the waiting room? The less the patient knows about the therapist’s personal life, the better.

But the therapeutic boundary slippage usually isn’t political. It’s mostly personal. Just last week a therapist I know was bemoaning how a colleague of hers was socializing with his patients. Going with them to bars and concerts! When I did a catering gig as a waiter I was shocked to see that the host’s therapist was in attendance at the party! Another friend of mine saw a therapist for an initial interview and told me that the guy spent the time griping about his own problems. Nuts. And don’t even get me started about the therapists who’ve slept with former patients.

In her article, if we take Ms  Shapiro at her word, she describes a therapist with a terrible sense of professional boundaries and ethics. It is unethical for a clinician to work with a patient on a project for financial gain. It’s a no brainier. The reason you go to a therapist is to talk to an impartial observer who will advocate for your mental health. In order for this process to work the clinician, unlike your friends, family, coworkers, or spouse, can have no vested personal interest in you. Sure, you pay a shrink, but that’s part of the process. It tells you that you’re not just gabbing into a friendly ear but making an investment in your well-being. But it’s not a barter system. You can’t clean your clinician’s house in exchange for free analysis! And when a clinician does what Ms. Shapiro claims Dr. W. did, he commits a gross violation that makes you wonder about his own emotional health and ability to treat patients. Keeping your shit together is a necessary discipline for a therapist. If you can’t do it, quit.

I sort of feel sorry for Ms. Shapiro, but not quite. To an extent, she is complicit in this entire mess.  I can’t help but feel she’s  angry at Dr. W for reasons we’ll probably never know. I mean, look at it. What author writes a piece in the NY Times that describes the grossly  unprofessional behavior of  her therapist co-author three months before their book on mental health issues comes out? Will people looking for help want to read a book partly authored by a man who committed the transgressions Ms. Shapiro just wrote about? Is she lashing out in some demented passive aggressive way? That’s just catastrophically self-destructive. If I was her publisher I’d ask for the advance back. And it works both ways folks – a great many patients are flat fucking crazy too.

If everything Ms. Shapiro wrote is true, then Dr W is a terrible clinician. If he committed these kind of boundary violations with Ms. Shapiro, then you have to wonder if he’s done it with his other patients. If so, the damage could incalculable. If it’s true, Dr. W. should stop seeing patients and get his head in order. If it’s true then his license should be revoked or, at the very least, he should be seriously sanctioned. But if what Ms. Shapiro wrote was an exaggeration or untrue, then Dr. W had better start defending himself in the most strenuous terms. He’s welcome to tell his side of the story here. But I’d start soon buddy. You’re in trouble.

Years ago, the great Ross Macdonald’s fictional detective Lew Archer talked about the quandary he faced when trying to help his flawed and troubled clients.”The problem was to love people,” he said. “Try to serve them, without wanting anything from them.” Of course that’s not completely possible for anyone in the helping professions, but it’s a goal to strive for. Having been in both religious life and mental health, I’ve seen countless examples of people falling short of this goal, including myself. But while I saw many situations that could be written of as simple human weakness, I also saw caregivers act in ways that were malignant and evil. I never forgot that. The damage they did was incalculable. So therapists, who often have their patients lives in their hands, should think about Lew Archer’s words everyday.

And word to the wise. If you are seeing a therapist who wants things from you, run.

(This post was edited after initial publication)


Comments

When Shrinks Go Wrong — 26 Comments

  1. I’m not going to entirely debase this individual, because he/she did help me come to grips with a few certain issues in my life & past and move on from them. But what really bothered me was that she asked me to do a self-esteem exercise, which involved writing on a piece of posterboard all the names people have called me or I’ve called myself over the years. When I brought it into his office, the shrink fixated on the word ‘faggot.’ Never mind the literal hundred of other words that had nothing to do with orientation (I’m straight, but not necessarly redneck macho jock straight, a little alternative and in small blue collar towns, well), the doctor spent the entire remaining session (which I was paying for) talking about Narcissus and the roots of homosexuality in narcissm and… I don’t even know what else. It felt as if she suddenly decided that I had latent sexual orientation issues and she exercised a favorite complaint.

    I didn’t deal with it well. I went into the next session extremely angry and ended up yelling at him (I was in therapy for a reason…). To the doctor’s credit, they stayed calm (obviously when a patient is angry at YOU). Of course I paid for that ‘session’ and left. Like I said, I did benefit from the sessions. I wish I’d been able to come in the next time and just clearly say, as I see now, “hey, I don’t appreciate the last session and your fixation with that, and basically wasting my money going on about Roman fables because you think I’m gay or something.” Of course if I was emotionally stable enough to deal with it in that way, well, I wouldn’t have been in therapy. But it really was like, huh? What is going on here?

    It’s tough because I believe in the mental health profession and I believe that we need professionals to help us deal with those things through therapy or appropriate medication or whatever, but as a kid the shrinks all seemed to put me on some weird meds or suggest things that didn’t seem relevant, and as an adult they all have gotten weird on me (I haven’t seen -that- many). My current psychiatrist is good though.

  2. I’ve had a few therapists in my life (you’re shocked, I can tell). I have usually gravitated to therapy when some situation turns out to be more than I can handle. I’ve been very… VERY… fortunate to either find just the right therapist to deal with whatever emotional baggage I was trying to shed, or a really good sense to know when to end the sessions and either go it alone, or find someone else.

    Sadly, not everyone is as lucky as I’ve been, and bad therapy can do more damage than bad parenting.

    And, by the way… how did a therapist manage to marry a patient without losing his license? In California, that’ll get you a quick trip to Unemploymentville.

    ~A~

  3. I used to say: people study psychology because they don’t understand other people. The rest of us don’t need to study it.

    My (engineering) tutor in college used to say: never date a psych student, they’re all f*cking nuts!

    I love what Amanda above had to say: “bad therapy can do more damage than bad parenting.”

  4. Ideally, a therapist is someone who offers impartial advice on matters of stuff in your mind.

    As soon as you think of your shrink as your friend (or worse, treat him/her as such), something went wrong.

  5. I like what Amanda said, too.

    Once I had a lay-shrink (!) via my church (!!) who saw me for free, of course. We clicked. We clicked on every level. One day many years ago, he, as it turns out, volunteered for the unenviable task of informing me that my best friend and only sibling, my big brother (his name is Steve, so you already know he’s an extremely talented, insightful, compassionate, and wickedly funny writer, as well as a gifted, self-taught musician. In addition to being just an all-around class act…I’d say good looking but that would be creepy) had been involved in a highly-televised accident that had occurred the day before at Ramstein AFB in what was then West Germany. My boyfriend, John, and I had been watching TV and had actually seen an initial report of the accident. So much fire, I remember…jet fuel splashed over the crowd of spectators. People running, already separated from their friends and loved ones by the percussion of three fallen, twisted, molten, exploding aircraft…the Italian version of our “Blue Angels”.

    The news anchor said it was unclear if there were any Americans among the dead. John and I commented that we thought it was kind of arrogant to make a differentiation like that; as though it would have been somehow less meaningful as long as no “Americans” were there in the horror.

    My brother suffered 25% full-depth 3rd degree burns and had severe head trauma. They knocked out a quick brain surgery there in Germany, then flew him home within 48 hours of the accident to Brook Army Medical Center in San Antonio, known for its state-of-the-art treatment of victims of severe burns. He was stationed in San Antonio. USAF. Worked out well for his wife.

    Years before, he was stationed at Luke AFB just outside Phoenix. It was 1975 and I was sixteen. I’d gone out solo from our home in SoCal to see him. (“And over there,” he pointed to another non-descript dusty-looking building off in the distance during our first night’s walking tour from the civilian barracks to the Chow Hall, “Are the WAF Kennels.” Yep. Steve always had a way with the ladies.)

    Steve also had a fair whack to the old brain stem, and despite repeated threats to climb up on the bed, pin his arms to his sides with my knees and tickle him ’til he peed , (“Payback’s a bitch…” I hissed in what remained of his right ear), he remained in a coma for five weeks and died without ever regaining consciousness. He was 32.

    I’m pretty sure I came here to talk about shrinks, but I quit giving a shit about that at the memory of my hot little sixteen year old self trolloping through a military base and my brother asking me to pleeeeeease not tell anyone I was his sister. My old lay-shrink is now a full-fledged real-shrink, and I find myself back in therapy with him from time to time, whenever I happen to be living in SoCal. I have insurance and granddaughters and he gets to charge me a $20 co-pay now to talk about what really matters, peer-to-peer: one a highly educated family therapist with a heart as big as the world and a gift for painting in watercolors. One…still hot. Both grieving for his precious wife, gone only two years now.

    Not really any formal boundaries, because he was my mom’s friend at church and we both sang in the choir and he was studying to be a real counselor, and we talked and I took of his time and he didn’t get paid and I trusted him. I thought I was pretty good at bullshitting him, which never WAS necessary because he never DID judge me. And as it happens, I really wasn’t that good of a bullshitter, and he thought I was worth the trouble anyway.

    What I am is THE luckiest damned crazyass nut job in the world, because even though he wasn’t my first shrink, he was the first one to honestly give a shit (for free, right? HA! The experience of my madness was worth more than any book-learnin’ and he knows it, PLEASE…), so I knew the difference in sizing up the rest of the many (MANY) shrinks that little did I know would share the pleasure of my company over the years.

    So yeah — if your gut tells you your therapist is only giving a shit and listening to you because he’s getting paid to, you’re only partly wrong. He doesn’t give a shit and he isn’t listening.

    If it was easy, anyone could do it, but people are lazy, and you’re worth more than that. If it doesn’t feel right, trust your instincts. Unless you’re hopelessly batshit, and if you ARE, you’re probably the only one who doesn’t know it, so who’s getting the last laugh here, anyway…

  6. Man there’s nothing like a crippling bread addiction. It starts with what you think is an innocent sandwich, and before you know it you’re scarfing down whole baguettes.

    • Ah, you quote that as a joke, but try being addicted to food. It’s the worst, as you can’t even go cold turkey…

  7. “How do you know the difference between the patients and the staff? The staff has keys!”

    The patients line up for pills and the staff lines up for paychecks.

  8. When I was in college back in the 1970s a couple of my friends were psych majors, and one of them pointed out to me a survey his department had done on why people chose to go into psychology. Some said they wanted to help people, some said it looked like a way to make good money without heavy lifting, but the single most common reason, from something like 65% of the respondents, was, “I wanted to know what was wrong with me.”

  9. Steve, You are right on the money, I have been a social worker for 30 years and you would not believe some of the crap I’ve witnessed. Once the boundaries are compromised there is no therapeutic progress to be made. This one really resonated with me!

  10. I used to be a student of psychology, and the first thing that I heard from most people when they found out my major was “Oh, you know the people who are interested in psychology are the ones who need it the most.”

    However, in most cases, it’s not a case of “Physician, heal thyself.” I’ve often heard of some therapists/psychologists seeing colleagues for their own problems while they are still actively counselling patients. At least those people are working on their issues – we know that no one is perfect, but by working on known issues, I think I would trust those people a bit more than someone who insisted they have it all together…

  11. Having worked in and around mental health and addictions folks for almost three decades, I can say that there are bad apples in every bunch, every profession, every walk of life. Managed care has not helped medical training one iota: the financial pressures to get patients discharged/stepped down as quickly and cheaply as possible means that care given is necessarily “less than.” All the professional societies for mental health professionals have ethical standards which clearly state what constitutes a boundary violation, but there will always be bad actors. The sad thing is, people experiencing mental illness aren’t in the best position to recognize when something’s not right in the professional-consumer relationship. And those who are hurt in bad therapeutic relationships don’t always confront or come forward to expose the bad actors.

  12. Why can’t I click on the title image at the top of the site to get to the home page? I’d rather not have to edit the URL in the address bar just to get there (I came here from an RSS feed), but that seems to be the only way.

  13. So, just a random factoid: I’m a marriage and family therapist, licensed under the AAMFT. Our code of ethics actually allows for bartering: you can make a deal with your therapist. For instance, i could have one of my clients who is a contractor remodel my bathroom in exchange for therapy. (i would never actually do this, because i really don’t want my clients to know where i live, but it is ethically ok to barter).

  14. It’s absolutely ok to barter, even if it’s done with someone who can’t help you directly (they have to barter with someone who CAN help). I like the idea of this system because I currently work as a massage therapist and who doesn’t like those?! I get all sorts of free stuff in exchange for a quick rub. It’s all part of the human connectivity tissue we have running through us. I believe that thread keeps us needing each other – separated from it, we become depressed and withdrawn. Isn’t that why blogs are so popular?

    Have a great day!

  15. I’m launching (no pun intended) my me$$age in a bottle next Sunday, Nov 20 and I would love a link, like, thumbs up…

    Whatever it takes to get this moving. I’m giving away money (literally) by burying a bottle, along with a business card and a few lines of inspirational hope. And that’s it. And I’m hoping (and marketing the heck out of it) it will spread out and reconnect a disconnected population. And maybe a few businesses will catch on to the idea, too. But the whole concept is to do something free for someone you’ve never met, who will hopefully pay that forward by keeping the bottle moving, and eventually connect us all.

    How far can the bottle travel? I’m hoping somehow it travels across the country. Wouldn’t that be amazing?

    So, any help would be wonderful.

    Thank you.

    Adam

    http://www.viewchoose.me
    http://www.cashmessage.blogspot.com

  16. Nunya,
    Same here. I am *literally* the only one in my family who at 18 hadn’t been knocked up, smoked a joint, or had beer (I had wine every new year I spent in germany though). I have a pill phobia, which therapist decided meant I had a closet drug addiction. No, I have no addiction, I am phobic because I cant even take benedryl without trippin bawls and hullucinating. WTF?
    I want to get into counseling and have been looking into University of Pheonix because they have a degree and I’m a single working mother.
    Any thoughts on that? I’ve read good things online but amworried its spam/that one success story out of hundreds

  17. I’m an individual and family therapist. Unfortunately, I have to agree with your assessment of the mental health community. In fact, I often inwardly cringe when I tell people what I do, because I don’t want to be associated with all therapists who make the news.

    As I went through grad school, I continually hoped that many of my fellow students would fail the licensing test or be unable to find work in the mental health field, because of the things they said in class. If I could tell after one class with them that they didn’t know how to set appropriate boundaries, how bad would it actually be once they were practicing?

    I honestly think that one of the major reasons there are so many bad therapists and social workers is because the pay is usually terrible. I’m not talking about psychiatrists or private practice (I don’t know much about those), I’m talking about non-profits, state-run agencies such as child welfare, and hospital psych wards. Those practitioners get paid crap, so those agencies are unable to attract the more sane individuals. That’s been my experience, anyway.

    I think the whole field needs to be completely revamped. I feel that way about many fields, though. Thanks for the post.

  18. With the therapists I’ve paid, I’m 8 for 8 with unprofessional behavior or people who’ve spent the sessions I’ve paid for telling me their problems.

  19. AMEN.

    One of my jobs before I went back to waiting tables was as office manager of an intervention clinic. While the people I worked for were kind, the therapists/colleagues/conferences were a total butt circus of crazy. Want to know who gets into the intervention industry? PEOPLE THAT HAD AN INTERVENTION DONE ON THEM PREVIOUSLY. So glad I’m not at that job anymore.

  20. I worked as a low level security personell at a juvenile facility. It didn’t take long to figure out that most of my collegues had no training in the field of criminal justice, much less a college education of any kind. Most of them were hired because they acted as badly as the kids and that seemed to keep them in line, most of the time. After being beat up once or twice, watching a colleague have her cheekbone broken, and another his nose broken twice, I decided that particular branch of the profession wasn’t where I wanted to be.

    The therapists they pulled in every day did nothing to help the kids, from what I could see, except offer them an escape from the staff they had grown to hate. And most of them were incapable of handling the kids’ issues.

    I could relate with the kids, had been through some of what they had been through, but my inability to make a difference (partially because of the inaptitude of my fellow employees)still haunts me just a little. Part of the problem that I saw was too little involvement from the psych professionals. But dealing with juveniles is a whole different kettle of fish.

Leave a Reply

Your email address will not be published. Required fields are marked *


7 + one =

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>