Man. This story is making me feel some kind of way, (as the kids say). All I have to say is that you seem to be a good, ethical, thoughtful guy Freddie. Please keep doing what you do. Thank you.
Thanks for following up Freddie. I had some of these concerns myself but mostly I'm just glad to hear more as this entire episode left me pacing around my computer like a caged animal at the stupidity of this "therapist". At least there's a donation link to take the sting off of it, my God.
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.
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 for writing this follow-up Freddie. Like a lot of your readers, I found this woman's letter really upsetting to read, and my heart goes out to her. I don't know if it's the intimate nature of the therapist-patient relationship, but I had a really strong emotional reaction to reading her story.
I think the sense of disbelief some readers have stems from not wanting this to be real. I, for one, don't want to live in a world where someone goes to therapy for help and gets put through a social justice guilt trip. Even though I'm aware of how pervasive this worldview is, this situation feels a step beyond the pale - an awful perversion of what therapy is supposed to be. Unfortunately, I think this therapist's 'methods' are pretty indicative of the direction that psychotherapy and counselling education have gone over the past little while. She doesn't exist in a vacuum.
I know a therapist who reports getting amazing pressure from her professional peer group to intrude politics into her sessions. Her colleagues genuinely believe she has a duty to raise the political consciousness of her patients. She's horrified, but she also reports that the various "insurgent" professional chat groups she belongs to are constantly welcoming new members with similar horror stories.
Side note: I love the "why didn't she just...?" title. Whenever someone (including me) starts a sentence with "why can't I just...?" or "why don't they just...?" one can be fairly sure what comes next is not going to be very kind. That lead-in is a signpost for a failure of compassion, when we direct it towards ourselves as well.
This post was very good at explaining just how difficult it is to switch therapists, to challenge them, or to find the right fit. I think finding a good therapist is difficult even if insurance, costs and compatible schedules weren’t additional challenges. Heck, it’s a major task to find the right kind of any professional or any kind of help, and that much more to find someone to guide you when you feel most vulnerable.
But what I still don’t understand is why it’s hard to walk away altogether. Replacing the therapist is a gargantuan task on many fronts. Yes, you still need a therapist. But why isn’t not seeing this therapist, or any other therapist at all in the short run, not a viable option? How is going to a bad, even damaging therapist, paying them your hard earned money and investing the time for no progress and even added stress, damage and insult, better than not going to any therapist at all?
I want to echo Radar's comments below. First of all, her story is exceptionally believable and broke my heart. As a primary care doctor, I hear stories of casual abuse like this from patients all the time- both how they were treated by therapists and by other doctors. Also, I can't emphasize enough how difficult it is to find affordable, decent mental health services (both therapists and psychiatrists.) In fact, coincidentally, our doctor's meeting this morning was about optimizing/strategizing referrals for mental health therapy -- how to get it covered, who is good and how to get patients in. It's a nightmare. Seriously.
And one other comment: this racial justice theory is now embedded in training programs. I actually forwarded Freddie's post from this morning to my brother who works as a psychiatry attending at a teaching hospital. He said the psychiatry program at his institution has had racial justice training sessions for the residents week after week for the past year. Not just one or two, but over and over. And when he tried at one point to push back on some of the teaching, to question it at one of these guest lectures, he said the lecturer was polite and thoughtful about it. But the residents were horrified -- came to his colleagues afterward, crying, asking whether my brother is a white supremacist. The residents hold weekly meetings amongst themselves to discuss racial justice issues. I can only liken this to the fervor of religion. My brother, telling me about this, was just baffled because the whole premise of psychiatry should be to question, and yet they are swallowing this whole. So ... yeah... I can see how some therapist has now made this her mission.
thanks for the follow up. If it helps any, I understand. I've been in situations with a "professional" and it was clear to my intuition and knowledge as far as it goes of the space that the "professional" didn't know what they were talklng about, but since I wasn't credentialed and they were I told myself "maybe I'm not understanding the whole picture," or later on when it was clear I was right it was just too exhausting. Who would listen to me, a regular person, about all of the young women in my kitchen who gossiped about the CEO propositioning them when the HR director and General Counsel basically threatened me when I went to them quietly and said "um, you have a problem our guy is so blatant this is getting out into the community." A year later the guy went down for the exact thing I had heard about in my kitchen.
Should I have pushed harder? Should I gone over the heads of the local team? My experience has taught me sadly no. It's exhausting and all you get is the "experts" talking down to you about how you are racist or in my case I must hate and be jealous of the CEO mentoring people other than me. I swear I am not making this up.
So I get this woman's dilemma--the self doubt. The wanting to make it work because it's fucking hard to find therapists.
I have friends currently training in therapy and social work fields and I believe this woman completely. I hope she finds a good therapist, as this one cannot provide her with inadequate care and prioritizes her ideology over her patient's needs.
Man. This story is making me feel some kind of way, (as the kids say). All I have to say is that you seem to be a good, ethical, thoughtful guy Freddie. Please keep doing what you do. Thank you.
Thanks for following up Freddie. I had some of these concerns myself but mostly I'm just glad to hear more as this entire episode left me pacing around my computer like a caged animal at the stupidity of this "therapist". At least there's a donation link to take the sting off of it, my God.
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.
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 for writing this follow-up Freddie. Like a lot of your readers, I found this woman's letter really upsetting to read, and my heart goes out to her. I don't know if it's the intimate nature of the therapist-patient relationship, but I had a really strong emotional reaction to reading her story.
I think the sense of disbelief some readers have stems from not wanting this to be real. I, for one, don't want to live in a world where someone goes to therapy for help and gets put through a social justice guilt trip. Even though I'm aware of how pervasive this worldview is, this situation feels a step beyond the pale - an awful perversion of what therapy is supposed to be. Unfortunately, I think this therapist's 'methods' are pretty indicative of the direction that psychotherapy and counselling education have gone over the past little while. She doesn't exist in a vacuum.
I know a therapist who reports getting amazing pressure from her professional peer group to intrude politics into her sessions. Her colleagues genuinely believe she has a duty to raise the political consciousness of her patients. She's horrified, but she also reports that the various "insurgent" professional chat groups she belongs to are constantly welcoming new members with similar horror stories.
Side note: I love the "why didn't she just...?" title. Whenever someone (including me) starts a sentence with "why can't I just...?" or "why don't they just...?" one can be fairly sure what comes next is not going to be very kind. That lead-in is a signpost for a failure of compassion, when we direct it towards ourselves as well.
This post was very good at explaining just how difficult it is to switch therapists, to challenge them, or to find the right fit. I think finding a good therapist is difficult even if insurance, costs and compatible schedules weren’t additional challenges. Heck, it’s a major task to find the right kind of any professional or any kind of help, and that much more to find someone to guide you when you feel most vulnerable.
But what I still don’t understand is why it’s hard to walk away altogether. Replacing the therapist is a gargantuan task on many fronts. Yes, you still need a therapist. But why isn’t not seeing this therapist, or any other therapist at all in the short run, not a viable option? How is going to a bad, even damaging therapist, paying them your hard earned money and investing the time for no progress and even added stress, damage and insult, better than not going to any therapist at all?
I want to echo Radar's comments below. First of all, her story is exceptionally believable and broke my heart. As a primary care doctor, I hear stories of casual abuse like this from patients all the time- both how they were treated by therapists and by other doctors. Also, I can't emphasize enough how difficult it is to find affordable, decent mental health services (both therapists and psychiatrists.) In fact, coincidentally, our doctor's meeting this morning was about optimizing/strategizing referrals for mental health therapy -- how to get it covered, who is good and how to get patients in. It's a nightmare. Seriously.
And one other comment: this racial justice theory is now embedded in training programs. I actually forwarded Freddie's post from this morning to my brother who works as a psychiatry attending at a teaching hospital. He said the psychiatry program at his institution has had racial justice training sessions for the residents week after week for the past year. Not just one or two, but over and over. And when he tried at one point to push back on some of the teaching, to question it at one of these guest lectures, he said the lecturer was polite and thoughtful about it. But the residents were horrified -- came to his colleagues afterward, crying, asking whether my brother is a white supremacist. The residents hold weekly meetings amongst themselves to discuss racial justice issues. I can only liken this to the fervor of religion. My brother, telling me about this, was just baffled because the whole premise of psychiatry should be to question, and yet they are swallowing this whole. So ... yeah... I can see how some therapist has now made this her mission.
thanks for the follow up. If it helps any, I understand. I've been in situations with a "professional" and it was clear to my intuition and knowledge as far as it goes of the space that the "professional" didn't know what they were talklng about, but since I wasn't credentialed and they were I told myself "maybe I'm not understanding the whole picture," or later on when it was clear I was right it was just too exhausting. Who would listen to me, a regular person, about all of the young women in my kitchen who gossiped about the CEO propositioning them when the HR director and General Counsel basically threatened me when I went to them quietly and said "um, you have a problem our guy is so blatant this is getting out into the community." A year later the guy went down for the exact thing I had heard about in my kitchen.
Should I have pushed harder? Should I gone over the heads of the local team? My experience has taught me sadly no. It's exhausting and all you get is the "experts" talking down to you about how you are racist or in my case I must hate and be jealous of the CEO mentoring people other than me. I swear I am not making this up.
So I get this woman's dilemma--the self doubt. The wanting to make it work because it's fucking hard to find therapists.
I have friends currently training in therapy and social work fields and I believe this woman completely. I hope she finds a good therapist, as this one cannot provide her with inadequate care and prioritizes her ideology over her patient's needs.