Your Therapist Could be Wrong

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A recent PsychCentral article zipped through my inbox almost into the trash until I reminded myself about the many clients I worked with as a therapist who accepted the word of previous therapists as if it were the truth. In my practice, I often worked with “hard” clients or the ones who had been through multiple therapists in the office and then passed on because the other therapists labeled them as “severe.”

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My clinical training focused on people who struggle with more than one thing at a time, in counseling terms known as co-occurring disorders. Unfortunately, there are many therapists not trained to work with people as a whole person. As a result, I was fortunate enough to meet with clients with a long pedigree of therapists and medications with symptoms that did not fit neatly into one diagnosis that could be treated with that diagnosis’s treatment manual. Folks with long histories of trauma, substance abuse, dysfunctional families, discordant relationships and overall feeling hopeless because therapists kept referring them elsewhere because their cases were too hard.

Upon meeting with a new client, many would tell me their diagnoses and expect a plan of action that would fix them. However, my opinion of diagnoses, inspired by my graduate school advisor, was that diagnoses do not tell you about the client’s experience. Not to mention, how does a therapist declare a diagnosis for someone they just met for less than an hour? They must because insurance will not pay the bill unless there is a diagnosis. To be honest, most of us make one up. Of course, the diagnosis is backed up by what the client reports, but it does not provide the full picture, which is why when I asked the client to talk about their experiences in life, I concluded that previous therapists were wrong.

The next part of the conversation usually went something like this: “I understand you were given XYZ diagnosis. However, I don’t agree with it and here’s why. But that does not matter much for the therapeutic process, because we are going to address things in session based on what causes you the most stress and go from there. The diagnosis is relevant for insurance purposes but not so much during therapy.” The client often looked at me bewildered. However, over time, it made sense to them.

For example, someone may present for therapy with a jumble of diagnoses that include bipolar, anxiety, excoriation disorder and substance abuse. Most of the time, a therapist will engage in cognitive behavioral therapy (CBT) because it is an evidence-based practice recommended for these disorders. However, what was missed? The why. The how. The “what goes on for you daily?” Therapists who specialize in BFRBs understand that one does not just jump into CBT. Why not? A client needs to learn to calm the body before the mind can engage in CBT effectively. Someone who experiences anxiety feels keyed up, on edge, at the brink of fight or flight engagement. When those systems activate, the executive functioning required for CBT is occupied elsewhere. Without asking a client how they experience anxiety or a BFRB or bipolar, the only purpose a diagnosis serves is as a cheat-sheet for a lazy therapist.

Trust your instincts when working with therapists. They can be wrong. Even the ones with pure intentions can be wrong. Pay attention to whether therapy is about treating what you experience or treating a diagnosis. You are a person, and nothing you experience occurs in isolation. Interview your therapist before committing to treatment; almost no one did that the entire time I was a therapist. Ask about their training, their theoretical orientation, how they approach treatment and why they think they are qualified to be your therapist. If something does not feel right, try another one. Shop around until you find someone who will work with you to treat your experiences.

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