Discerning Incompetent or Greedy Mental Health Professionals
If you want to use a mental health professional, you need to be aware that it’s like shopping around for a good hair stylist or a good contractor.
You need to do your research, check whatever mental health equivalent to YELP review exists online, ask friends who they would recommend… because just as there are lazy, greedy, or incompetent hair stylists and contractors out there, so too is this true in the world of psychiatrists and psychologists.
Is any of this to say that because there are some incompetent hair stylist or contractors out there you should never, ever hire or visit a hair stylist or contractor, and instead, do all your own hair cuts or re-modeling?
No. I am not saying that at all. I’m not saying that any more I am saying that nobody, nowhere, should ever visit someone in the mental health profession. If you think visiting a therapist may be of benefit to you, then you should doctor shop around, make an appointment to see one, and go see one. I’m not saying otherwise.
I’m just saying be aware there are incompetent people out there in all professions, including the mental health field – this is something I have experienced personally, have read others discuss it online and in books, but this truth, sharing this reality, really offends some people, who want to falsely believe that all mental health practitioners and any and all forms of therapy or medications are the solution for everyone for whatever problems they are facing.
These types of people drop into my blog here when I make posts that critique psychology, psychiatry, or anti-depressant medications, or to post articles that expose flaws with those things, to lecture me I am not positive, happy-clappy, or nice enough about any of it. Why should I be happy-clappy about any of it, when I did in fact have lousy experiences with different mental health professionals I saw for over twenty years?
You gotta love how these “Fans of Psychology” just want to instantly flush TWENTY YEARS OF LIVED, FIRST HAND EXPERIENCE down the toilet, as though it amounts to nothing, because it does not support their view on their pet topic.
I saw any where from 6 – 7 mental health professionals over a 20+ year period in approximately three or four different states. And they all failed me.
One wonders why “The Psychology Fans” bother to read this blog or post to it to begin with – is there some sort of ‘Reverse Scientology Cult’ I’m not aware of, consisting of people that run around blogs deriding anyone who speaks the least bit ill of secular psychology and psychiatry?
Funnier still is that some psychologists whose books I’ve read say the very same thing as I’m telling you here and now.
I have read books by some psychologists and psychiatrists who warn the reader towards the end of their books to “shop around” for a mental health doctor, because not all doctors have your best interests at heart.
Not all counselors, psychologists and psychiatrists are qualified to treat you, not all are skilled or talented at their profession, and again, this according to material I’ve read by psychologists and psychiatrists themselves.
One therapist lady, who specializes in verbal abuse, spends a chapter in her book telling you what to look for and what to avoid when doctor shopping.
This counselor says in her book on verbal abuse there are some therapists (and psychiatrists) who are arrogant jerks who assume they know better than you what is right and wrong for you. She tells you to avoid this type of “know it all” doctor.
This therapist author whose book I read explains you need to find a MHP (Mental Health Professional) who will guide you on your journey and help you to find the truth for yourself, rather than browbeat you to live life their way.
To reiterate, it’s not just me (and only my opinion) telling you and informing you that some MHPs are dangerous, sloppy, greedy, or Quacks – it’s other MHPs saying this.
I even provide a list further below with links to pages, some by mental health professionals, who critique their own profession and who give you lists of what to look for so you can avoid incompetent psychologists or psychiatrists.
The good MHPs who exist don’t want to see you end up being used or abused or further traumatized by a shoddy, con artist MHP.
As I have explained more than once on this blog, I saw around 6 – 7 different psychologists and psychiatrists (and at least one therapist lady) over a 20+ year period.
The two earliest ones I saw diagnosed me with clinical depression, and the rest all agreed I had anxiety.
Though all of these mental health professionals I visited were happy to keep tossing pill prescriptions at me (such as for anti-depressant medications), none of them demonstrated any interest in getting at the root of my depression and anxiety.
Not even after I told these mental health professionals I suspected something more was going on, and that the medications were not alleviating the panic attacks, depression, and low self esteem.
At least one psychiatrist I saw for around five years, starting in my late 20s, who was a blond lady with short hair, would get annoyed and hostile towards me on the rare occasions I asked her if we could discuss my depression in depth, rather than me sit there and get a written pill script from her and leave, as was my custom.
Dr. Blondie, as I will call her, would always spit at me in an unfriendly tone,
“I am not a ‘talking’ therapist! I prescribe pills! If you need to see a ‘talk therapist,’ I will give you the name and number of my colleague who has an office down the street.”
Oddly enough, though, Dr. Blondie was inconsistent on this point.
There were occasions when I showed up on time for my appointment, and the nurse would have me sit down the hall waiting for my turn, because Dr. Blondie was running late, and I could hear muffled voices down the hall – it was Dr. Blondie engaged in conversation with her other patients.
In other words, Dr. Blondie was keeping me waiting so she could provide talk therapy to some of her other patients, the very same talk therapy she claimed not to provide when I asked her about it for me.
At any rate, here is a list of resources and articles (some by mental health professionals) illuminating the fact that there are Quacks, Lemons, and Duds and Con Artists in their profession, and how you can avoid them or deal with them.
It’s not just me noticing there’s a problem among some in the mental health profession, it’s people who are in the profession themselves.
List of Resources:
(this is a list which I may amend in the future to add pertinent links as I find them):
I don’t know if I am necessarily in agreement with all views expressed in all these pages, but they go to show that even people who work in the mental health profession recognize it comes with problems, and not every mental health professional is helpful or qualified.
By Allen Frances (who is a psychiatrist):
Most psychiatrists do a good job of diagnosis, prescribing meds, and providing support. Of course, some are incompetent- every profession has its great practitioners, its boobs, and the full spectrum in between.
Results overall for psychiatric treatment are good. The majority of patients improve at rates equal to, or above, those achieved by doctors treating medical illness.
But, as in the rest of medicine, a significant minority of patients don’t improve at all and a small minority get worse.
Treatment failure may be due to the natural course of illness, difficult life circumstances, the patient’s behavior, or the psychiatist’s incompetence.
Some psychiatrists are not good at diagnosis, use too much medication, and/or fail to establish a good relationship with the patient.
And sometimes it may just be a bad match-up of doctor and patient- the nature of their relationship can strongly influence how well the patient does.
…I, and others within the profession, have criticized psychiatry for its increasing bio-reductionism, decreased humanism, diagnostic exuberance, and excessive dependence on prescribing medication.
…Psychologists criticize psychiatry for its reliance on a medical model, it’s terminology, its bio-reductionism, and its excessive use of medication. All of these are legitimate concerns, but psychologists often go equally overboard in the exact opposite direction- espousing an extreme psychosocial reductionism that denies any biological causation or any role for medication, even in the treatment of people with severe mental illness.
From The New York Times:
by Jonathan Alpert (who works as a therapist):
MY therapist called me the wrong name. I poured out my heart; my doctor looked at his watch. My psychiatrist told me I had to keep seeing him or I would be lost.
New patients tell me things like this all the time. And they tell me how former therapists sat, listened, nodded and offered little or no advice, for weeks, months, sometimes years. A patient recently told me that, after seeing her therapist for several years, she asked if he had any advice for her. The therapist said, “See you next week.”
When I started practicing as a therapist 15 years ago, I thought complaints like this were anomalous. But I have come to a sobering conclusion over the years: ineffective therapy is disturbingly common.
..For this 11 percent, therapy can become a dead-end relationship. Research shows that, in many cases, the longer therapy lasts the less likely it is to be effective. Still, therapists are often reluctant to admit defeat.
…Yet, according to research conducted at the University of Pennsylvania, therapists who practice more traditional psychotherapy treat patients for an average of 22 sessions before concluding that progress isn’t being made. Just 12 percent of those therapists choose to refer their stagnant patients to another practitioner.
The bottom line: Even though extended therapy is not always beneficial, many therapists persist in leading patients on an open-ended, potentially endless, therapeutic course.
…Therapy can — and should — focus on goals and outcomes, and people should be able to graduate from it.
…If a patient comes to me and tells me she’s been unhappy with her boyfriend for the past year, I don’t ask, as some might, “How do you feel about that?”
I already know how she feels about that.
She just told me. She’s unhappy. When she asks me what I think she should do, I don’t respond with a return interrogatory, “What do you think you should do?” If she knew, she wouldn’t ask me for my thoughts.
Instead I ask what might be missing from her relationship and sketch out possible ways to fill in relationship gaps or, perhaps, to end it in a healthy way.
Rather than dwell on the past and hash out stories from childhood, I encourage patients to find the courage to confront an adversary, take risks and embrace change. My aim is to give patients the skills needed to confront their fear of change, rather than to nod my head and ask how they feel.
In graduate school, my classmates and I were taught to serve as guides, whose job it is to help patients reach their own conclusions. This may work, but it can take a long time. I don’t think patients want to take years to feel better. They want to do it in weeks or months.
Popular misconceptions reinforce the belief that therapy is about resting on a couch and talking about one’s problems. So that’s what patients often do. And just as often this leads to codependence.
The therapist, of course, depends on the patient for money, and the patient depends on the therapist for emotional support. And, for many therapy patients, it is satisfying just to have someone listen, and they leave sessions feeling better.
But there’s a difference between feeling good and changing your life.
Feeling accepted and validated by your therapist doesn’t push you to reach your goals. To the contrary, it might even encourage you to stay mired in dysfunction.
by Noah Rubinstein, LMFT, LMHC:
But an academic degree, and even a government license, are not infallible guarantees that a particular therapist will be successful helping you.
Since therapy is as much an art as a science, there is a degree of plain old talent required, which is difficult to define with credentials; not to mention human qualities of compassion, empathy and character. Some very talented counselors have no official credentials at all.
By Terence Campbell, Ph.D.:
Snippets (see their page for their questionnaire that can help you ascertain if your therapist is competent or not):
Choosing a therapist is a mind-boggling endeavor. Neither a therapist’s degree, nor his professional identity, predict his competence.
Moreover, one cannot assume that an older, experienced therapist possesses greater competence than a younger, inexperienced therapist. Experienced therapists are more inclined to cling tenaciously to an obsolete paradigm.
…Prospective clients should not hesitate to ask a therapist about his training. Such questions are altogether necessary and appropriate. Any therapist who refuses to answer, or responds evasively, is a therapist to avoid.
by Támara Hill, MS, LPC:
…It can be difficult to find a good therapist because it takes time. A therapist who is capable of understanding you and your needs, makes you feel comfortable and not judged, and who can step into your complicated situations and guide you into deeper insight, is worth every penny or time spent in therapy.
Each therapist has a different life course, educational course, and calling. Not all therapists have the capability to be effective.
It’s difficult to determine what specific characteristics and behaviors make a therapist less effective than others.
But it’s important for you to consider the kind of therapist you or a loved one is working with and what makes this therapist competent or effective in their work.
Sadly, there are many incompetent or ineffective mental health professionals and therapists in the world. But knowing which kind of therapist you are working with will help you avoid problems in the future.
Below you will find 10 things that often cloaks or hides a poorly skilled therapist. Unskilled mental health professionals and therapists often hide behind:
2. The psychiatrist or Medical Director: Believe it or not, the psychiatrist and/or Medical Director of a mental health establishment can truly cloak the mediocre skills of the therapists under him or her. A good psychiatrist and Medical Director can even cloak the mediocre skills of the clinical supervisor!
While the therapists are sometimes the most important part of the agency due to the fact that they are the “frontliners” and do most of the hands-on work, a skilled psychiatrist (who makes medication changes and ultimate decisions) and Medical Director can truly drive the bus and make the entire program look competent.
10. Credentials: Some people are really good at going to school, getting good grades, and achieving credentials, but very poor in working with others. A mental health professional and/or therapist can hide behind credentials and certificates.
Some therapists are good at reasoning, remembering what they’ve learned in school, and applying their book-knowledge. But these same therapists can be very, very poor in speaking with families, and providing therapy.
(please visit the page to read the entire list)
By Michael Karson Ph.D., J.D:
Here’s something interesting I’ve noticed over the years: While I am a snob when it comes to evaluating psychotherapy, only incompetent therapists get angry at me for it.
When a master clinician finds out that I think ending sessions on time is essential to minimal competence (because it promotes the first factor I described above), she may agree or disagree, ignore or wrestle with the proposition, but she doesn’t get angry.
This observation supports my view that the Number One thing holding merely harmless therapists back from becoming excellent therapists is the desire to be told that everything they do is beneficial.
This blinds them to the effects of their techniques. It’s like trying to learn how to bowl without looking at how many pins you knocked down, and insisting the scorekeeper record every roll as a strike.
Culturally Incompetent Therapy: When Therapists Do Harm by Monica Williams PhD
In the earliest stages of treatment the onus is on the therapist to appropriately establish boundaries and clearly articulate the parameters of the relationship. In this day and age that includes whether or not e-mails, texting, after hour phone calls, doing sessions by Skype, meeting you outside of the office, or connecting with you on Facebook are going to be an allowable part of the therapeutic alliance.
When it comes to these issues, we shouldn’t assume clients understand what is and is not appropriate.
Our job is to model what is appropriate, and then maintain consistency.
Blurring or crossing boundaries, engaging in a dual relationship or continuing to work with clients when there is a conflict of interest, repeatedly going over the allotted session time, making the agenda for therapy ours and not the clients, or fostering co-dependency, are often therapy missteps that have their roots in the clinician’s own unresolved issues.
…the therapist who cries alongside their clients and becomes overtly distressed, angry, dissociative, or overwhelmed, is operating from a place of emotional disequilibrium that can lead to role reversal or the client’s fear that they are “too much to handle” and irreparably “broken.”
The challenge for us as clinicians is the balancing act of dual awareness. It’s being “present” enough to simultaneously ask ourselves during the session, “what’s going on for my client AND what’s going on for me?”
When we lose sight of the client’s process or we lose sight of our own counter-transference, there is the potential for deviations in the standard of care, a loss of safety in the room, a breach of trust, a rupture in attachment, blaming the victim, missing critical information that is being communicated verbally or non-verbally by the client, an abrupt termination, or therapist burn-out.
(this list may be updated if I find other, pertinent links on this subject)