Wednesday, October 04, 2006

When bad therapists happen to good patients

Last night I saw more than myself in my cognitive therapy reading: I saw my evil ex-psychologist, Dr. Incompetent, the one who almost killed me.

I mean that literally. Dr. Incompetent talked my mother out of hospitalizing me by saying that if I went into the hospital, I'd never get another job or get married. I proved her wrong on one point, and I'm doing my darndest to prove her wrong on the other.

This week's class topic is therapeutic empathy. Because cognitive therapy is more formulaic than traditional psychoanalysis or psychodynamic therapy, some have accused cognitive therapists of being cold and uncaring. Au contraire, say the cognitive therapists: a healthy rapport with the patient is essential. If the patient feels patronized, or if the therapist becomes defensive, that damages the therapeutic relationship and leads to a less successful outcome.

Well, defensive is what my Dr. Incompetent was. Massively so. When I felt that she was cold and withdrawn, she told me that everyone else found her warm and compassionate. Implication: what is wrong with you, Ayelet?

Her hostility was palpable. I didn't like Dr. Incompetent the first time I met her but thought that I needed an orthodox Jewish therapist to help me. Let me tell you: NOT TRUE. I felt more comfortable during my first private session with a clinical social worker on the psych ward. She wasn't even Jewish, but she really understood me and we got along well.

It's hard for me to believe that I spent eight years -- and thousands of dollars -- with such a horrible woman.

The morning of the day that I overdosed, my mother called Dr. Incompetent, frantic. I wasn't returning anyone's phone calls. She was terribly worried about me.

"Ayelet's out of control," said Dr. Incompetent.

What a load of crap. I wasn't out of control -- my illness was out of control. And Dr. Incompetent was out of her depth. She thought she could cure me. Even when I told her I wanted to find a new therapist, she insisted I had to stick with her through this crisis. Refused to help me find a new therapist -- which is standard procedure when therapy isn't working.

So I stopped going. And Dr. Incompetent kept billing me. She also never suggested that I enter a partial hospitalization program -- intensive outpatient treatment where I attended therapy during the day but slept in my own bed at night. That's either gross incompetence or malpractice. Or both.

After I overdosed, Dr. Incompetent called the hospital every day. I'm sure she was only thinking about her potential liability if I died. Because after I woke up and spoke to her on the phone, she was cold and callous.

I asked Dr. Incompetent if she had any suggestions for what I should tell my co-workers about the episode. Long pause, then she said, in a voice marbled with sarcasm: "I don't know why you would think I'd have any suggestions about that."

Um, because you're supposed to be my psychologist?

Dr. Incompetent sent me a bill for all those sessions I missed. And like an idiot, I paid it. And enclosed a note thanking her for our work together and telling her my attempt wasn't her fault.

I wish I hadn't. I wish I hadn't paid that bill, and I really wish I hadn't tried to make her feel better. Because she was directly responsible for my attempt.

One of the suggestions that came up in the wake of the tragedy this summer was creating a referral list of West Side mental health professionals for shul offices to keep on hand. I don't know if that's been followed up on. Tomorrow I'm meeting with my rabbi and a person from the Jewish Board of Family and Children's Services to talk about setting up a Partners in Caring program for the shul.

I'm going to ask that we look into some other programming as well. Including that referral list. And I want to compile it. Not out of revenge, but out of concern. I don't want Dr. Incompetent telling another family with a person in crisis that she can help them without resort to hospitalization. Because she can't.

There's actually legal precedent for me to sue Dr. Incompetent for malpractice, but I doubt I'd win. For one thing, her husband's a hotshot banker and VIP at another local synagogue. Suing them could potentially make me look very bad; religious Jews aren't supposed to sue other religious Jews. For another, she comes from family money, and I don't. I'm having enough trouble paying for grad school, let alone a lawsuit. If I do file suit, it will be against my horrible den-of-torture gym to recover the money I wasted there in search of better health.

But I truly believe she's not only incompetent but uncaring. Dr. Incompetent became defensive and hostile when therapists are supposed to be caring and acknowledge their own limitations. She's one of the worst therapists I've ever encountered.

Sadly, this kind of therapeutic ineptness is fairly common. Studies have shown that therapists routinely overestimate their own empathy and their patients' regard for them. And when patients don't find their therapists sympathetic, they don't get better; only patients' estimates of therapeutic warmth and empathy correlate with recovery.

Ironically, Dr. Incompetent got her doctorate at the school I'm currently attending. Fortunately, I know that a lot of changes have been made to the curriculum in the interim. But I still wonder if anyone on staff remembers her, and what they thought of her. They must have thought she was pretty good, or she wouldn't have graduated.

They were wrong.
Copyright (c) 2006 "Ayelet Survivor"

11 comments:

  1. Oh my G-d...and I thought I had been burned by bad therapists. That's just awful. She sounds like the most uncaring, callous, insensitive goon I've ever heard call herself a therapist.

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  2. Hmm, after my suicide attempt my therapist had no contact with me whatsoever. He didn't call, didn't write. Do they not teach therapists how to deal when things go wrong ?

    Apparently it works for MDs:

    http://www.boston.com/news/globe/editorial_opinion/oped/articles/2005/08/25/when_doctors_say_theyre_sorry/

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  3. I'm telling you, psychologists are pure evil. They should be banned from ever conducting therapy. All they're good for is testing and research. Remember: Milgram was a psychologist. Zimbardo was a psychologist. Then again, Radovan Karadžić is a psychiatrist.

    I'm so glad I'm a social worker.

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  4. This guy was a psychiatrist *shrug*

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  5. Nazi psychiatrists wrote journal articles in the 1920s arguing for the euthenasia of people with mental retardation and mental illnesses. Psychiatrists have a lot to be ashamed of, too. To their credit, some of them are processing this shameful past.

    Psychiatry during the Nazi era: Ethical lessons for the modern professional

    Psychiatrists as a moral community? Psychiatry under the Nazis and its contemporary relevance

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  6. You're preachin' to the choir!

    Anyways, I just discovered your blog today and read a nice chunk of it.

    Thanks for sharing!!

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  7. "I'm telling you, psychologists are pure evil. They should be banned from ever conducting therapy."

    Whoa. This one sucked, I would say to the point of malpractice. But we don't all suck. Many of us haven taken quite good care of our suicidal patients actually, hospitalized them when they needed to be and been there for them when they came out.

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  8. I was abandoned by a psychoanlaytic social worker in the middle of therapy. She met someone in the basement of her building and decided to suddenly move to Florida. She referred me to the woman who was taking over her office space, and spent our last sessions yelling at me when I told her that I could not work with that woman because she did not have hours after 5 and I was starting full-time work. Rather than being pleased that I had finished school and was starting a career, she was angry because I did not fit into her plans. Her friends and colleagues all told me that she was being very good to me. There are incompetents in every domain, psychiatrist, psychologist, and social workers. Don't judge someone by the source of their degree, and don't be scared to judge someone by your gut reaction to them.

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  9. Well put, Arthur. There are good and bad clinicians of every kind -- psychiatrist, psychologist, and social worker. When I wrote this blog post, TikunOlam, I was being tortured and abused by the evil psychologists in The Bad Place, so I came down a little harshly on them. But Dean Evillene, Ms. Fascist, and Miss Thing certainly qualify as very bad social workers ;)

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  10. in a way, i almost feel like it's a social responsibility to out her. if you can't sue due to financial reasons, that's one thing. but filing a report with the BBB, the Attorney General, and naming her on this site- I feel it's something that has to be done to ensure that she doesn't cause this kind of damage to other in the future. common sense would dictate that if you know someone is going to potentially harm someone, you stop the harm. you can't wait outside the office and warn every client walking in the door, but you can make her misdeeds public, so that if anyone does a search on her, they can get an honest assessment. i for one would want to know who she is to ensure i never get mixed into that business. of course, you may have to modify your post and take out the adjectives and personal conclusions made- but even without them, just stating the facts of what exactly happened would be enough to dissuade me.

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  11. I'd have to agree with the Jewish aspect - I NEVER wanted to see an orthodox therapist or psychiatrist but did end up several years ago seeing an orthodox psychiatrist; since he was so highly referred, i tried it out.

    I wish I hadn't, or at least, that I'd had the guts to stop when I knew that he was not providing anything remotely resemebling "treatment." The man did not return calls or emails, including on the rare occasion of a crisis. He did not follow the treatment plan he proposed, and he completely ignored reports of serious side effects - passing out, all over rash, dizziness, etc. On several occasions he called the wrong dosage into the pharmacy - luckily, my pharmacy caught it. Despite telling him multiple times that I was acutely suicidal, his response was that so long as I was continuing to attend work and school, I was fine. He did not follow up with questions of means and plans, let alone. Any time I questioned him, whether about the scary side effects of the medication, his refusal to adhere to his original treatment plan in favor of a plan NOT supported by the literature, or anything else, his response was to state that he was 24 years of experience in the field and knew what he was doing.
    Perhaps worst of all, he missed a clear manic episode.

    I ended up in the hospital for over 2 weeks (where I did not hear from him a single time) but thankfully, came out with a referral to a new psychiatrist. I'm thankful I survived his care, but I only wish that I was not so intimidated (Jewish factor played a huge role there) and had the guts to sue him.

    When I read this post, I could definitely relate. Though I understand you may choose to not approve this post, or to edit it, I am going to name him, in the valiant hope that someone in the wider Jewish audience will not be trapped into the same hell that I was. His name is Joshua Lamm, and he has offices in midtown, Queens and somewhere on Long Island. I believe him to be perfectly capable of treating mild mental illness, but anything more complex is far, far beyond his capabilities. He is a dangerous man. Be careful.

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