Addendum: "Why didn't she just...?"
walk a mile in her shoes please
The emails-to-views numbers on this morning’s post are some of the highest I’ve ever gotten in my life of writing, but I suppose that’s to be expected given the sympathetic figure the emailer cuts. Most of the email is just a combination of angered at the therapist’s attitude and supportive of the emailer. However there are some other recurrent themes I want to address, principally the number of you who asked (with one degree of tact or another) “are you sure you aren’t getting rolled here?” I admit I’m a little frustrated. Here are my responses.
“Do you trust that she’s telling the truth?” A bit more context. She first emailed me over a month ago. I debated asking her in the first place and she understandably wanted to think it over a bit. During this time we communicated back and forth for awhile about her life in ways that are not relevant to the post but which strengthen my sense that she’s legitimate. And I did do a little fact checking to be on the safe side. I was able to verify that she lives in a Minnesota suburb/exurb and Googling reveals a couple of mentions in a local paper. She is an alum of a Minnesota public university. Her name appears on a website for her job and at my request she sent an email from her work email address to prove she works there. Her older daughter (or at least someone with the name she’s given for her older daughter) ran high school track for the appropriate public high school a few years ago. And a couple other things. Yes, it’s possible that someone could have gone to great lengths and contrived the whole thing but… why would they? To harm a therapist who she insists remain anonymous? To enrich herself when she’s not revealing her identity? To illegitimately coax people into donating to a sexual assault survivor charity? Just seems unlikely to me, especially given that the story’s so lacking in dramatics.
Also, like, this is a friendly and vulnerable person who turned to me to share a story about something that hurt her and left her not knowing who to talk to. Forgive me if there are limits to my willingness to go Woodward and Bernstein on her.
“Will you share my contact info/pass on a message?” I have given contact details to her from two licensed mental health professionals who asked that I pass them along, in hopes of helping her find her next therapist. Beyond that the answer is no. I’m sure 99.9% of the potential interactions and messages would be profoundly positive and supportive, but it’s the internet and I’m not exposing her to contact with people I can’t vet. Besides, even supportive contact can be overwhelming in emotional situations. I have already told her about how much supportive email has been coming in about her story in general. (For the record she’s very grateful.) Thanks but I’m keeping a wall up.
“You should reveal the therapist’s name/what type of license does she hold/where did she go to school/etc.”
The very first thing the emailer said when I suggested publishing an excerpt of her email was that no specific details about the therapist be released. She does not want to participate in a doxing. That’s her rule and I’m sticking to it.
“Why didn’t she just get a new therapist?” This was asked not only of the therapist in question but the prior one who she conceded she had not been making progress with. It’s a frustrating question, for me. Let me use my personal example to discuss this one: I have had deeply imperfect access to mental health care over the past two decades, given that this is the American medical system, but I have had superior access to most people. And I still have consistently struggled to get into therapy. I should have been in therapy constantly given my mental illness and my biography. But I’ve barely been in it at all. Consider immediately after my last hospitalization. I was highly motivated to get a therapist; my life was a wreck, after all. I had time away from work to look. And I had access to NYC union health insurance, which is well-known to be strong despite years of erosion of benefits. What’s more, New York has one of the highest therapist/analyst/mental health professional densities in the world. I don’t have kids and my schedule was more flexible than that of most.
And yet trying to find a therapist was a nightmare. A truly discouraging number of places didn’t take my insurance or take insurance at all. Out of pocket costs that were cited were like $300 and up. Tons and tons of promising-seeming options were not taking new patients and several told me there were waiting lists. Also, many told me that they were “not the right therapist to meet your needs” when I told them about my bipolar disorder and recent psychotic episode. Two more discouraging stories. First, I went to one place, had an intake appointment, everything seemed fine, at the end the guy said “your appointments will be Mondays at 2:00 PM.” I said, that doesn’t work for me; back then I worked 8 to 4 PM, and it would be an hour commute on either side, meaning I’d be leaving work at 1 PM every Monday and not returning. I couldn’t imagine asking that of my boss. I’m sure I could have forced them to let me for ADA compliance but I was already in a very awkward situation given everything that had happened, and for the record I liked that boss. So that was out.
The other one really pissed me off. I had been having so many problems with insurance that I made sure that the therapist I was going to see was in-network. I went, had the intake appointment, it went great, she said they could be flexible with my work schedule, and then she said “your therapist will be Dr. X.” I was surprised. It turned out she just did that intake appointment and would not be my full-time therapist. That was annoying as I just shared a lot with her, but fine. I then found out that the therapist she assigned me to did not take my insurance, despite being part of the same group/place/whatever as the woman I had researched. Let me remind you that an intake appointment typically involves delving into some personal and traumatic background information. That incident left me feeling completely powerless.
I know people don’t mean to do harm but “why don’t you just get a new therapist?” is a callous and unhelpful thing to say. It’s really fucking hard even under good circumstances, that’s why.
“Why would she ever attend another session?” Because most people don’t question people in positions of superior knowledge or authority, guys. It’s very intimidating to do that if you don’t feel well informed about a given domain. I’m a housing activist here in the city and one of my weekly roles is to answer calls for a housing rights hotline, where tenants call up and ask questions about housing law and what to do when their landlords fuck them over. What’s remarkable is just how much people will put up with. One of the harder parts of these conversations is often convincing the caller that yes, the landlord lied directly to their face. This is hard even when I’ve sent them official resources showing what the law actually says. Because most people naturally think “the landlord knows better than I do.” Just like most people don’t ask critical questions of a doctor or auto mechanic. It’s really hard to break out of those power dynamics even when you’re aware that something’s not right; it’s part of why sexual abuse is so hard to prevent and punish. And again, it’s hard and draining to find a therapist you can afford. It’s perfectly natural to try and ride out unhappy initial interactions. Please try to practice a little better empathy.
“Why doesn’t she report the therapist to the accrediting/licensing body?” Here’s another one - think a little deeper about what this would entail. I did gently suggest this, but it’s not as easy as it may sound in your head. Forget about the specific emailer for a second and abstract this away to your average person. Your average person has, by definition, an average amount of social capital and knowledge of the system. They don’t necessarily feel that they’re particularly empowered. Filing a formal complaint against a therapist - a person with whom you’ve shared profoundly intimate details - is deeply confrontational by any measure. I assume the process is long and annoying (and for zero pay obviously). It’s also not at all clear to me that a complaint would be successful. Even outside of current political conditions it’s hard to see this as a violation of professional ethics, even while I hope most would agree it’s bad medicine and bad judgment. And you can imagine the outrage if this was successful: Antiracist Therapist Censured by State Licensing Board for Prioritizing Black Trauma. I too would like if there was some way for the writer of the email to help other potential patients avoid this scenario, but it’s not her job and I don’t blame her if she just moves on.
“How could you say this was mundane/unremarkable?” I chose those terms carefully. My point is not that this isn’t an ugly harm that’s been committed; I ran the email, after all. My point is that this story is so simple and lacking in obvious drama that it’s the sort of thing that simply doesn’t get reported on or prompt a response. “A patient had an uncomfortable relationship with a new therapist” isn’t the sort of thing that will get championed by most anti-cancel culture warriors. And yet it’s in the steady accumulation of these unfortunate interactions that I think the most damage can be done, not just because of the very real harms that can occur like here but because it erodes people’s openness to the social justice movement.
“I can’t believe this could happen.” This one I don’t get. I took pains to say that this is just one therapist. I have no idea of the prevalence of this type of behavior, though I got several emails from people knowledgeable about therapist education who report it’s a profoundly woke discursive space. But it seems perfectly predictable that something like this would happen. Look: we are delivering the message, over and over again, that good progressive people politicize everything. This is a relentless idea in mainstream media now, that any resistance to viewing any part of the human experience through the lens of social justice politics reveals a profound lack of sophistication. (For example.) Meanwhile, we are told over and over again that “to be neutral in the face of oppression is to take the side of the oppressor.” You have to be doing social justice all the time if you are One of the Good Ones. And so do I think a thoughtless youngish college-educated affluent professional in a highly liberal field would abuse her therapeutic duty by trying to enforce her politics on a vulnerable woman in her professional care?
Yeah. Yeah I do.
I just noticed comments aren't open on the previous post which is perhaps a thoughtful thing in this situation to not risk having any comments seem like a debate about this woman's difficult experience(s). It makes sense to me there would be a flood of emails though because the description in her own words of her experience with this therapist is agonizing to just sit with. I glanced through it this morning and had to close my computer and go do a bunch of other stuff to settle my nervous system down.
One of the features of being a psychotherapist is that I get to hear a fair number of stories about people's really bad experiences with past therapists (as well as doctors, dentists, etc). It's especially painful to hear someone with a history of interpersonal trauma describe being treated dismissively or inappropriately by the person whose job it is to help them recover from the earlier violations. I've heard two pretty egregious stories just in the past two days, so this one came on top of those and it's hard to sit with the anger I feel.
It seems ... helpful? important? ... to say clearly how inappropriate and unethical that behavior is. Yes, multicultural competency is part of our training, but there is no version of that training that includes minimizing any part of your patient's experience by comparing it to some other people's experience. Not by a long shot. There is no aspect of licensed psychotherapy in which this therapist's behavior as it was described is ethical.
It's crystal clear in our training that our job is to attend to the client's suffering in front of us. Where we use techniques of whatever kind, it's our job to be transparent about how and why those techniques are meant to help the patient with the concern they are bringing in. "Technique" includes why we ask the questions we ask or why we say the things we do. So likewise, a therapist starting sessions with culturally or politically-specific rituals without the consent of the patient or without explaining why they start sessions that way, isn't appropriate.
When psychotherapists violate ethical codes, they do so in some pretty predictable ways. The two most common are boundary violations (having inappropriate social relationships with patients, but also a dozen other things) and practicing outside one's area of competency. This situation sounds like a mix of both of those -- a therapist imposing a specific political/cultural world-view on a patient is a kind of boundary violation and then seeming to try to use that specific political/cultural world view as a therapeutic intervention in an incompetent and harmful way is what it looks like when therapists are practicing way outside of their competency (they're making shit up, in other words). I get that this situation has a particular culture war salience to it, but it is also old wine in new bottles in terms of therapist bad behavior.
Thank you, Freddie, for sharing this woman's experience. It's like she was shamed by the therapist for wanting help and expecting the focus of her sessions to be...her own trauma. It's infuriating and hurtful and unprofessional.
And thank you also for everything you said in the addendum. Your response to "why didn't she just get a new therapist" has me in tears. I have struggled for decades with trying to get mental help for myself (insurance problems, affordability, availability of the therapist, getting passed off to someone else after pouring my heart out) and now have the same issues trying to find assistance for my teenage daughter. It's heartbreaking.