The mind, once expanded to the dimensions of larger ideas, never returns to its original size. ~ Oliver Wendell Holmes

Wednesday, February 16, 2011


Therapy, psychiatric or psychological, is a priceless tool for those seeking to heal from mental illness, adversity, trauma and so forth. It's value weighs on the knowledge, experience and professionalism of the counselor as well as the patient's willingness to work, open up and learn both in and outside the office. It would be nice to think that as long as you are properly motivated, the first part - finding the appropriate doctor should be simple. However, that is not always the case. 

I've written in earlier blogs about choosing and working with therapists; how the relationship between doctor and patient is no different than any other.  While some doctors take a stance that hatred towards the therapist is inevitable and that the lack of it proves weakness and poor standards of practice on the part of the therapist, I'm sure there are countless success stories of full recovery without this negative dynamic. Like any other good relationship there should be honesty, trust, comfort, empathy, respect, compassion and good communication. Otherwise, stress and further trauma will impede progress. The idea is to aid a person through difficult, sometimes painful realizations, helping them find new perspectives and a more positive outlook and not to bully, dominate and demean someone who is already troubled.

There are warning signs that you have met "DOCTOR NO".  In this blog I wish to address things to keep in mind to prevent becoming a victim of "bad medicine".

1) Make sure the doctor is indeed experienced, especially with your particular issue.

Although it may seem a bit discriminating, bear in mind senior doctors (age 65+) may be very set in their ways. They may not be as on top of newest research and techniques. You know they've been in practice too long if they fall asleep during a session. Trust me, I've been there. On the other hand, they have seen far more patients, which in itself is continuing education.

The young doctor may be up on the latest developments, however, they tend to be green. This is when they make the most mistakes. Starting out anew involves a steep learning curve. As much as you may want to give them a fair shake, weigh out how much you want to be their guinea pig as they "practice" medicine.

A middle age doctor offers the best of both worlds. This is not to say that there are not those who stand out and shine on either end of the spectrum. These are just things to take into consideration. Your personal preferances should be the desiding factor.

Make sure the doctor you seek specializes in the condition or situation you are facing. Just as with medical doctors, you would not go to a dermatologist for a tumor, make sure the practitionor you pick has experience in your specific needs.

2)  Use the preliminary appointments to get to know them. Ask questions, work out mutually agreeable boundaries, and set goals.

If they resist this, allow the red flag to go up. I have read blogs where therapists state that sessions are to be strictly client centered and therefore they refuse to engage in conversation, remaining strictly analytical. Some see the simple act of inquiry as a sign of resistance or refusal to cooperate on the part of the patient. This is more commonly found in rookies and those with an arrogant streak.

There are those who view any attempt on the patient's part to engage in self-help, even in as little as researching their condition on the Internet or reading a book, as a threat to their therapy. Now, you may want to advise them of your interest in doing this to make sure your sources are legitimate and can prove advantageous to your situation. A professional should gladly offer recommendations, home-work (so to say) and encourage self-education.

Then there are the control freaks who view and treat their patients like mindless children. They may take an authoritative stance, a "wait and see" attitude,  refuse to set specific goals, enforce rules without input or discussion, and refuse to discuss your progress or diagnosis. Remember, by law, you may have access to your records at any time.

3) Listen to you instincts. They will not usually steer you wrong.

If you feel truly uncomfortable (unless the whole idea of therapy is upsetting in general) chances are something is wrong. Perhaps the proper  "chemistry" is not there. Some personalities simply do not work out well together. It's not you and it might not be him or her either. It may be underlying social factors, personal history, personality and temperament,  or bias. All these are natural occurrences and sometimes barriers between people, professional or otherwise.

Maybe you feel the doctor is dispassionate and doesn't listen. Years ago I encountered a therapist who sat there checking his watch, taking calls, and responding with little more than "Uh huh. I see. Go on." A bit disconcerting to say the least. You want someone who is just as interested in helping you as you are in getting better.

Possibly their particular form of therapy is wrong for you. There are countless schools of thought, approaches and methods. It is not one size fits all. When my husband and I first were married 30 years ago, we sought couples counseling for baggage we had brought into the relationship. His approach to helping us was seeing us separately, and claiming the other partner was fully to blame; demanding that we not discuss our sessions with each other. We were not ones to harbor secrets. Needless to say this caused quite a bit of discord. We finally confronted him and he confessed to his "unorthodox approach". He then dismissed us as clients claiming we were to blame for the failure. While he certainly did not help us with our issues, he did get us fighting for our marriage rather than our differences.

If therapy has been going on long term without improvement,  it's either time for a second opinion of a sign you should switch doctors.  Early on in life I found myself in a situation where I felt intimidated into answering questions the way the doctor wanted to hear, according to his prompts and arguments. This is a clear sign of a toxic situation.  First you should never feel afraid of the therapist, nor should you be afraid to be anything but yourself. Say it as you mean it. There may be times that they help you to take a new perspective, however, you should not be lying about your feelings to accommodate their expectations.

4) Remember, a diploma and even certification does not guarantee that doctors do not suffer from their own issues, that they are stable or competent.

During our lives we have had three medical doctors who committed suicide, several that went through painful and messy divorces while we were under their care, a few that had malpractice suits brought against them. Of course, these days, it is much easier to research credentials and disciplinary actions taken against a professional through the Freedom of Information Act. Reviews and comments by former or current patients can be found on sites such as and others. Recommendations from your PC is also helpful since personal matters may be known among colleagues.

One would think that being "normal" is a basic requirement of any health worker. The truth is, a diploma only proves one went to school and graduated. You do not have to pass a psychiatric exam to practice medicine. When you take into account that mental health workers represent a microcosm of the general population, and that half of all Americans face mental health issues, addiction to drugs and/or alcohol (treated or untreated) during a lifetime; that means half of mental health workers are also vulnerable. In fact, the rates of suicide, drug addiction (due to access), burnout, depression, as well as the normal incidence of mental illness are of great concern among this population.  It is not uncommon for those seeking help with their own lives to enter this field. How can one help others if the very mechanisms that prevent patients from self realization may afflict them? This is not meant to place a stigma upon the medical field, but rather open patient's eyes so that they don't place these people on a pedestal over any other person with higher education in a professional field. If you are sitting there thinking, "This doctor has more problems than me", you might be right.

A good doctor listens and is interactive. He or she will ask you what you think is wrong, knowing most people know themselves better than them. They respond, ask questions, give suggestions, and share stories about themselves. If you feel like the two of you make a good team against your issues, you on the right track. However, if your input is arrogantly dismissed as wrong or you are quickly written off as a malcontent, resistant or a hypochondriac, find someone who has a little less ego and more people skills.

You should not be subjected to a verbal lashing, degradation or humiliation. This lousy bedside manner may work for "Dr. House", but there again, he is a fictional character (not to mention a Narcissistic Addict with sociopathic tendencies). Some doctors may fancy modeling themselves after this character. No matter how gifted the doctor is, there is no excuse for this behavior.

Certainly doctors are not always going to tell you things you want to hear. Let's face it. If you are obese, they may say you need to lose weight. If you smoke they should tell you to stop. A good therapist or doctor can challenge you in a friendly sort of banter or wry humor and still get the message across without lowering himself to attack.

5) You are the patient - not the doctor.

If you find a doctor using your time to moan and groan about insurance companies, the medical system, or financial struggles; if they cannot remain neutral if you express opinions or ideals that go against their personal beliefs or bias without recusing themselves; if they talk about their problems in any way other than to show empathy or to teach from their mistakes; they should be paying you and not the other way around.

6) Among the "angels" there are bound to be a few "devils".

If you ever feel endangered, threatened sexually or physically, verbally or mentally abused - get up,  walk out and file a complaint with the your state medical or licensing board. Although certainly not common by any means, there are doctors who overstep the boundaries of ethics, morals and the law. They are after all - human. Boundaries should not be crossed from either side of the room, and that includes the patient being responsible and behaving appropriately.

There are countless wonderful doctors out there, most of which have entered this field out of compassion and the yearning to help others. With proper referrals and recommendations from other doctors, friends, and aquaintences you can enter a rewarding relationship where two minds come to meet.  Just make sure you end up with DOCTOR YES and not DOCTOR NO.


  1. Excellent article!!

  2. Thank you so much for the feedback!

  3. Wow !What a comprehensive article !You have certainly been there &seen all.How about reading my blogs &giving your feedback?Counseling through blogs has to be one-sided but still it is of some help-esp for those who can't discuss their problems face-to-face.