How To Tell If Your Therapist Is Crazy (Part Two)

As tempting as it is to believe that most mental health workers are wacky and maladjusted, the data tell a different story. For the most part, we seem to be fairly sane. Our downfall, in my sometimes overbearing opinion, is that we have a tendency toward muddled thinking. Our logic chips are frequently on the fritz, and it is our patients who pay the price in time, money, and heartache.

Consider this example. The case is fictional, but it is based on far too many real situations that I've had the misfortune to witness.

Sally goes to a psychologist complaining of depression. Ever since her divorce and layoff last year, she just can't get out of her blue funk. Prior to those events, life was grand for Sally. She was happy and surrounded by friends. She believes that the events of last year sent her into depression, and she simply wants to get her life moving again. The psychologist disagrees with Sally's assessment. After several sessions, he concludes that Sally's problem stems from childhood abuse and that she may be suffering from Multiple Personality Disorder 1.

Sally thinks she is depressed; the psychologist thinks she is Sybil. Seems illogical to reach that conclusion, doesn't it? Not if you went to graduate school. Reaching that type of conclusion a simple matter of ignoring the facts.

If the psychologist doesn't believe Sally, if he buys into preconceived notions, or if he believes he knows more about Sally than Sally does, then he is free to reach any conclusion he wishes. It is rarely so egregious, but it happens in smaller ways more often than you might imagine. Brain blockages like this one are important to screen for in choosing a therapist.

How to pick a good one

It can be difficult to find a therapist who is competent and is also a good fit for you. There are a few things that every potential client should look for: Check the therapist's teeth and fur. Make sure his shots are up to date. Above all, be sure that male therapists have been properly neutered (graduate school usually takes care of that).

Beyond those basics, there are scores of websites offering standard advice. Make sure you're comfortable with the therapist. Make sure that he/she/it is a good listener. Only hire someone who has successfully worked with your particular issue.

Yawn. It's sound advice, but pedestrian and safe. There is a reason psychologists have a reputation for wackiness. We may not be mentally ill, but we have a remarkable capacity for irrationality.

The best clinicians I've known have had something in common beyond good personalities and great clinical skills: they're logical. Irrational mental health workers -- and there are scads of them -- can waste your time and money. No matter how personable or empathetic, you probably won't get far with a psychologist who can't think straight. Unfortunately, sloppy thinking skills can be tough to detect in early interactions with a therapist, so I'll offer a few warning signs from someone on the inside.

Fallacious is as fallacious does

We all have our moments of irrationality, and I'm no exception. Why, I can still remember the day in kindergarten when I committed the fallacy of affirming the consequent during a simple test of inclusiveness. Ah, the impertinence of youth.

Momentary lapses are understandable. But I've known too many mental health workers for whom irrationality is practically a religion. The most common error seems to involve working backward from a predetermined conclusion, just as Sally's hypothetical shrink did. By the time you recognize the problem, you may have already wasted a great deal of time and money.

In writing these columns, I pride myself on sticking to the data, so let me be clear: I'm offering my opinion today. I'm thinking back on my experience with psychologists, psychiatrists, counselors, and social workers who have struck me as irrational in some small or large manner. Irrationality harms our patients.

But hey, maybe I'm the irrational one. If I were, I probably wouldn't realize it. So I'll give you the same advice that my clients hear: Don't believe me. Check my words against your own experience and make your own judgments.

Consider yourself disclaimered. I hope the following tips will help you weed out the type of therapist who views facts as inconvenient speed bumps on the road to predetermined conclusions.

1. Political or religious crusades. I thought it was a joke at first, but it's true. There is a living, breathing branch of clinical theory called feminist therapy. The belief is that psychological problems stem from power imbalances endemic to Western culture. Gender imbalances are a debate for another day. The problem is that these therapists use political theory -- not empirical data -- to define their treatment. Regardless of the problem you hope to discuss with this therapist, there is a good chance that she is simply waiting for you to stop talking so that the indoctrination can begin.

Sadly, one of my clinical professors instructed my class that it was our ethical duty to advance our political agenda during therapy. (To be more precise, we were to advance his moonbat political agenda, not ours.) Even more troubling, some of my classmates took his advice to heart. Their clients continue to pay the price, I'm sure. Imagine seeking help from someone who views each client as an opportunity to advance Allah, Greenpeace, or the GOP. At the first sign of this behavior, find a new therapist - one who will listen to you rather than try to brainwash you.

2. Fad diagnoses and pet theories. Mental health diagnoses come and go. In the 80s and 90s, a phenomenal number of women were diagnosed with multiple personality disorder; now MPD is virtually unheard of.

Then there was the great ADD epidemic of the 90s. Doctors began doling out Ritalin to scores of boys who were wrongly diagnosed with attention deficit disorder. Now "experts" are beginning to recognize that many normal, healthy boys have a high level of energy, and that the discomfort of adults does not necessarily constitute a disorder in the child.

More recently, bipolar disorder is the flavor of the month. Genuine bipolar disorder is a debilitating and unmistakable condition, yet many doctors seem willing to suggest heavy, sedating psychotropic medication to anyone who complains of mood swings. This is like taking a sledgehammer to a thumbtack. The real problem lies dormant, only to resurface once the sedation is removed.

Fad diagnoses and pet theories can be comforting to a psychologist. They provide an easy answer and they often include ready-made treatments. Unfortunately, the wrong treatment can be a complete waste of time for the patient. It can even make things worse. If you feel that you are being diagnosed unfairly, unreasonably, or prematurely, get a second opinion.

3. False Consciousness. I'm borrowing a phrase from Marxism, and bastardizing it a bit, to capture a certain special thought process that can only be found in playgrounds and psychology clinics. False consciousness, in the traditional definition, says that a person's suffering is his own creation, and he's too damned dumb to realize it.

I once witnessed a student therapist ask a patient if she was progressing in the sexual abuse survivors group to which she had been assigned. The patient replied that she had not attended the group because, as she had already tried to explain, she had never been sexually abused. The student tersely responded that the patient would be best served to face her past and do something about it. Translation: you don't understand the problem, you are making it worse by questioning me, and you're too damned dumb to realize it.

That's the first half of the false consciousness technique. Here's how to take it to the next level. Imagine the same client denying a history of abuse. Denial, it has been said, is a defense against an unpleasant truth. What truth might denial be serving to suppress? Abuse, of course. Ergo, denial of abuse is evidence that abuse occurred. Checkmate, baby! The stronger the denial, the greater the evidence. Once a therapist invokes the false consciousness technique, there is no way for him to lose. If this happens to you, it's time to find a new therapist.

One of my all-time psychology heroes, Dr. Paul Meehl, wrote a piece entitled Why I Do Not Attend Case Conferences. In it, he outlined the errors in thinking to which mental health workers are particularly prone. His paper, including suggestions for monitoring and correcting ourselves, should be required reading for any mental health worker who sees a single patient.

...And I should have been born rich and good looking. Until my wishes come true, it's up to you to keep us in line. Psychotherapy sometimes involves hearing things that we don't want to hear, but even unpleasant truths should be grounded in reality and reason. If you feel that your therapist is ignoring the facts and following his own agenda, there's a good chance that you are right.

Footnotes
1. Joan Acocella's Creating Hysteria (Jossey-Bass, 1999) offers an outstanding account of the MPD fad. Back.

References
Meehl, P.E. (1973). Why I do not attend case conferences. In Meehl, P.E. (Ed.), Psychodiagnosis: Selected Papers (pp. 225-302, Chapter 13). Minneapolis: University of Minnesota Press. It's available here and it's every bit as relevant today as it was 34 years ago. It is also fun to read.