I would not say that I am an expert at therapy, but I have certainly had my brushes with the noble art. Some of them I have written about in this very blog, like poor Marueen, others I have been rather tight lipped about. But I think, just as we need to be more open about therapy to reduce the stigma of getting help, we need to be more honest about the quality of the help we are receiving. And what to do if your therapist just doesn’t get it.
So just like with poor Maureen, the names have been changed, not to protect the innocent, but because I honestly don’t know what the protocol around that is. (And you know my love/fear of protocol.)
Let’s start with the most recent former therapist. Rodger. He was actually a fantastic counselor. I met with him after my sister suggested I try online therapy at a particularly rough time for me. She sent me to betterhelp.com, and it was not false advertising. Up until now, it was the best help I had ever had. He was a veteran of the war in Afghanistan and specialized in trauma as well as addiction. I had no problems with addiction but he also had experience with bipolar and LGBT issues, so when the website set us up, I went with it.
Like I said, he was one of the best counselors I had ever had. We would meet up online, and even though you can do video chat, I chose to text chat. That is just a better situation for me with my social anxiety. He was a bit of a typo guy, but his advice was really solid. This was so much better than the last therapist I had… His name was Jack.
Oh, Jack. I will always think fondly of Jack if only for the material he gave me. I came to him when I was in a particularly horrible phase of my mental health rehabilitation. I was going through awful medication side effects that included- night terrors, panic attacks, nerve damage, skin irritation, deteriorating self esteem, worsening ADHD symptoms, and probably the worst one of all, the sudden “fight or flight” feeling while being intimate. Essentially, I would feel like I was being raped in the middle of fooling around with my husband. It was traumatic to say the least, for both of us.
Jack was the kind of therapist that you sometimes questioned how solid his life was. He was a very nice man, don’t get me wrong. But he made huge gaffes in our sessions. When I told him about my son being autistic, he grimaced and asked, “Oh no, is he a screamer?” I honestly almost left after he said that, but I figured, he’s just like everyone else in this small town. So he might still be the best I can do.
Second gaffe came when he kept telling me about his other patients. I am a people-pleaser, so I didn’t say much when he repeatedly brought up other patients, but still, it was off-putting.
Third gaffe, or perhaps, just a bad therapist moment, was when I told him that I was LGBT, and he suddenly found ways to keep bringing up Jesus. I dig Jesus, but the conversation was suspiciously not about spiritual matters. It was definitely not WWJD.
Anyway, after several months of therapy, where I was just starting to understand my own autism/ADHD, I repeatedly tried to get him to talk to me about what I was feeling on that subject. In response, he repeatedly tried to diagnose me with Borderline Personality Disorder. There is nothing wrong with being BPD, it’s a very misunderstood condition, with some very misogynistic stereotypes and diagnostic issues. It just wasn’t my situation.
Here are some of the problems associated with BPD (and why they did not apply to me) …
- Frantic efforts to avoid real or imagined abandonment by friends and family. (This is similar to Rejection Sensitive Dysphoria, but I never actually thought they’d abandon me. Same Emotional Dysregulation, but different issues.)
- Unstable personal relationships that alternate between idealization (“I’m so in love!”) and devaluation (“I hate her”). This is also sometimes known as “splitting.” (Obviously debilitating, but not an issue for me.)
- Distorted and unstable self-image, which affects moods, values, opinions, goals and relationships. (Again, similar to RSD. But BPD can refer to distorted in a “I’m on top of the world” kind of way. Not my problem. )
- Impulsive behaviors that can have dangerous outcomes, such as excessive spending, unsafe sex, substance abuse or reckless driving. (I have impulsive behavior from my ADHD but no where near this level of harm. I’m in a healthy relationship with no substance abuse and I’m a relatively boring driver. It mostly becomes a problem with internet shopping.)
- Self-harming behavior including suicidal threats or attempts. (Any suicidal idealization I had came from medication side effects and sensory over-stimulation, which I tried to make him understand, but he didn’t want to listen.)
- Periods of intense depressed mood, irritability or anxiety lasting a few hours to a few days. (I was being treated for Bipolar so this always felt a little like lazy diagnostic thought to me. Duh.)
- Chronic feelings of boredom or emptiness. (I have ADHD, I am not bored. I get depressed but that is different.)
- Inappropriate, intense or uncontrollable anger—often followed by shame and guilt. (Ahem… Bipolar, RSD.)
- Dissociative feelings—disconnecting from your thoughts or sense of identity or “out of body” type of feelings—and stress-related paranoid thoughts. Severe cases of stress can also lead to brief psychotic episodes. (This was a problem for me only in the aspects of Autistic burnout. Different animal.)
Now, if you know anything about RSD or autism, you can understand how Jack might have been confused. Especially because of the longstanding psychiatric idea that women are not autistic, and men do not have BPD, which has lead to misdiagnosis all over the place.
My problem with Jack was not that he misdiagnosed me, but that he wouldn’t even listen to my objections to that diagnosis. Then he made the mother all gaffes, that allowed me to leave him without any second thoughts…
He told me all about his former patient that was “just like” me. More and more I agreed with his description, until I finally asked with hope, “Well, what did you do for her? Did she get better?”
His face went white, he gave this very old man clearing of his throat and said, “Well, she told me that she would always remember the time that we shared together, and that made me feel better after she… uh… passed.”
That’s right, folks. His patient killed herself. And he forgot about it right up until I asked about her.
So, even if he were not so incompetent, I would still say that he just didn’t get me.
Before Jack, was Marueen, who you can read about here. I only had two appointments with her a year apart. And neither were helpful. Not only because Maureen didn’t get me but because I wasn’t telling her the truth. I didn’t know it at the time, but I was masking.
Before Marueen, there was Debrah, when I was about twelve years old. She told my mother that I was depressed from the novels I was reading. Yeah. That was over before it started.
So that brings us back to today, where I made the difficult decision to leave the best therapist I have ever had. Why? Did he compare me to his other patients? Did he try to diagnose me with a disorder that I didn’t have? Did he compare me to a tree? (Again, check out Maureen’s story.) Did he completely ignore my autistic diagnosis?
No, he was a great counselor. But he just didn’t know enough about autistic people to help me with my atypical relationships and problems. He was great for emotional regulation and RSD, but when it came to my autistic traits, he dismissed them. Purely from a lack of knowledge on the subject. He fell for all the usual tropes, assuming that I had a lack of empathy, that I don’t understand emotions or that I would be unable to understand facial cues (I do not have this particular problem, some autistic people do, I don’t. Don’t make assumptions.)
STILL, he was the best I’d ever had. But was that “best” good enough to keep seeing him, even though his advice was becoming more and more neurotypical? No. It wasn’t. So I took the chance that I might hurt his feelings and asked for a new counselor on BetterHelp.
Again, it delivered. I am starting with a new therapist, let’s call her Donna. She is LGBT with personal autistic experience (!!!) And I am hopeful, if not confident, that she will get me. And I would have never met her had I not had the strength to stop using Rodger’s services.
So like the title of this post says, therapy is a bit like Russian Roulette. Counselors and therapists are still just people. And people can be both good or bad at their jobs. They’re either the bullet you need to take out your problem, or they’re just an empty chamber. (And the damage from an empty chamber is worse in this scenario, in case my metaphor is mixing you up.)
My point… If the therapy you are experiencing is not right for you, get a new therapist. There is no shame. As always, reader, I implore you … demand help.
Check out any of the internet based therapies out there, but I will always suggest betterhelp.com. They really made a difference in my life.
Also, if you are interested in the fun “finding yourself” journal check it out in Emily McDowell and friends shop. She’s one of my favorites. Like she says in the product description, technically that journal is a lot cheaper than therapy.