Category Archives: The Client’s Side

BAD THERAPY? A DISGRUNTLED EX-PSYCHOTHERAPY CLIENT SPEAKS HER PIECE

Valuable perspective from the client’s side. Can’t agree with everything that’s written here, but I count description of six significant ethics violation. Wish Disequilibrium1 knew how many ethical, competent therapists already follow her seven suggestions.

Disequilibrium1's Blog

In blogs and book reviews, I see reference by therapy professionals to the “disgruntled ex-client.”  I assume this label is pejorative and the classification perhaps is to warn therapists to create a strong filter when one hovers nearby.

So here’s my warning label: I’m a disgruntled ex-client.  My therapy mostly was harmful.   Before I’m tuned out, I hope some therapists may consider listening as I speak my piece, so they might find fewer like me at large.

I entered therapy hoping to broaden my social life and to confirm my suspicion that my typical family—wasn’t.  I never was in crisis.  My past persona was far too obliging and obeisant to authority, but not unlike a significant population percentage.  Pre-therapy I had friends, a job, occasional dates and was reasonably cheerful.  My total tally in treatment (I hate that word) was just under three years with different clinicians in different formats.

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Filed under Diagnosis, The Client's Side

Icarus Project Seeks New Flight Plan for the Mentally Ill

In a 1963 clipping from the New York Daily Mirror, passers-by were asked, “If a Woman Needs It, Should She Be Spanked?” Strangely, none of the four interviewed were women.

It’s this kind of selection bias the Icarus Project stands against.  The Project is a San Francisco-based collective promoting the voices of the mentally-ill..  They organize peer support,  create on-line art galleries, and rally clients to speak out on their own behalf. One thing they don’t do? They don’t accept the idea that mental illnesses are solely impairments.

The Icarus Project’s logo: falling or flying?

Normally, mental health staff face-palm over calls to, “challenge standard definitions of psychic difference as essentially diseased, disordered, broken, faulty, and existing within the bounds of DSM-IV diagnosis.” Too often, treating mental health issues as a “dangerous gift” means a client goes off their meds, lands in the hospital, and disrupts their progress towards recovery. The  Icarians’ language is counter-cultural, but there’s nothing mindless in their anti-authoritarianism.  They aren’t against meds, diagnosis or treatment – only the belief we mental health professionals know the whole story. This balance is reflected in their name; Icarus, you’ll remember, perished when he flew too close to the sun.

Sophie Crumb’s self-care flyer for The Icarus Project

Talk of “societal oppression” and “urban shamanism” may induce woozy flashbacks of 1970s identity-politics and the backlash that followed.  Should we worry their printable pamphlets on self-mutilation  don’t urge clients to stop? A close reading shows the pamphlet promotes harm reduction, including many safer substitutes Marsha Linehan would endorse. When project members critique profit-seeking drug companies’ influence on mental health treatment, they have company in the highest and most respected levels of  psychology.

The project celebrates an impressive tenth anniversary this year. Whereas decentralized collectives usually veer from dialectical moderation to the ditches of extremism, Icarus continues to walk a narrow path: meds and therapy are okay, self-care and community are crucial, and mental illness, while no blessing, is not necessarily a curse. This quote from Scatter sums up the project best:

Our society still seems to be in the early stages of the dialogue where you’re either “for” or “against” the mental health system. Like either you swallow the antidepressant ads on television as modern-day gospel and start giving your dog Prozac, or you’re convinced we’re living in Brave New World and all the psych drugs are just part of a big conspiracy to keep us from being self-reliant and realizing our true potential. I think it’s really about time we start carving some more of the middle ground with stories from outside the mainstream and creating a new language for ourselves that reflects all the complexity and brilliance that we hold inside.

In the 1960s and 1970s, the Whole Earth Catalog provided tools for those ready to challenge social and economic norms. Today, Icarus does the same for those who question psychiatric norms. It also challenges mental health professionals to make “empowering clients” and “person-centered diagnosis” more than platitudes. “Mentally disturbed,”  is synonymous with “unreliable witness”, and yet  no one else can tell us what the experience is like.   If Freud hadn’t analyzed himself, would there be a field of psychology today?

@ 2012 Jonathan Miller All Rights Reserved

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Filed under Bipolar Disorder, Borderline Personality Disorder, The Client's Side

Graham Greene on Antisocial Personality Disorder

In the postwar classic The Third Man, novelist Graham Greene’s protagonist, Holly Martins, confronts racketeer Harry Lime about his black-market sales of worthless, diluted penicillin.  Atop a ferris wheel, he asks his old friend, “Have you ever seen any of your victims?” Lime’s response is telling:

Orson Welles as Harry Lime in The Third Man (1949)

“Victims? Don’t be melodramatic. Look down there. Tell me. Would you really feel any pity if one of those dots stopped moving forever? If I offered you twenty thousand pounds for every dot that stopped, would you really, old man, tell me to keep my money, or would you calculate how many dots you could afford to spare?

…Nobody thinks in terms of human beings. Governments don’t. Why should we? They talk about the people and the proletariat, I talk about the suckers and the mugs – it’s the same thing. They have their five-year plans, so have I …

… in Italy for 30 years under the Borgias they had warfare, terror, murder, and bloodshed, but they produced Michelangelo, Leonardo da Vinci, and the Renaissance. In Switzerland, they had brotherly love. They had 500 years of democracy and peace, and what did that produce? The cuckoo clock.”

(Rabid cinéastes will point out Orson Welles added the lines about Italy and Switzerland himself.)

 

@ 2012 Jonathan Miller All Rights Reserved

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Filed under The Client's Side

“It’s All in Your Head”

LicensedMentalHealthCounselor has a thoughtful post on parents’ denial of their children’s mental health problems. It reminded me of a pet peeve: family members who ask clients, “What wrong with you?” then dismiss the answer with, “That’s all in your head.”

What does “It’s all in your head” mean? “You’re incorrect”? “You’re making excuses”? “You’re lying”?  It might mean, “Please don’t talk about this.” Talk about mental health problems can trigger others many ways. For example,

1. Not everyone with problems is in treatment. If a client admits they are vulnerable to emotion, others remember they’re vulnerable,  too.

2. “I can’t,” isn’t in our vocabulary. Our culture values hard work, personal responsibility and triumph over adversity.  Only the most severe mental health issues are visible to others.  Most skeptics have long experience with The Jitters and The Blahs. They can have a hard time understanding what separates those from Panic Disorder or Major Depressive Disorder.

3. As a culture, we don’t talk about emotional problems. If we talk about them at all, we do so in an understated, hesitating way. When someone explains they have mental health issues, the other person is left to guess how much understatement just occurred. Does, “My nerves make it hard to go outside,” mean they have a moderate case of agoraphobia? Or does it mean the entire family will be murdered in their sleep? Much easier to sweep the entire topic aside by saying, “That’s all in your head.”

In fairness, “It’s all in your head,” often means, “You can do it.” It can come from the same well-meaning and wholly-useless intentions as, “Don’t worry about it,” “Relax,” and, “Just cheer up.” It can also channel condemnation those other tips don’t. Clients say this disregard is worse than insensitive – it’s invalidating. Even when their family hopes they’ll feel empowered, the client is often to wonder, “Do I actually have problems, or am I just a lazy coward?”

Different clients have handled dismissive relatives differently.  Shrill didactic lectures haven’t always been the answer. When a pithy conversation-ender seems appropriate, I’ve suggested, “Sure it’s all in my head. And your diabetes is all in your pancreas.”

@ 2012 Jonathan Miller All Rights Reserved

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Filed under The Client's Side

Napoleon Bonaparte on Depression

At age sixteen, 2nd lieut. Napoleon Bonaparte despaired. Always having dreamed of military greatness, he was enlisted in a military run by incompetent French nobility – one that offered Corsicans little chance of advancement.

“Always alone among men, I come home to dream by myself and to give myself over to all the forces of my melancholy, ” he wrote.  “My thoughts dwell on death… What fury drives me to wish for my own destruction? No doubt because I see no place for myself in this world.”

Eventually, he would rule much of Europe.

@ 2012 Jonathan Miller All Rights Reserved

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Filed under depression, The Client's Side

“Normal people don’t do everything perfectly.”

From: Madness: A Bipolar Life by Marya Hornbacher:

“See, the thing is, you’ve got this idea of normal that’s not normal. Normal people don’t do everything perfectly. You don’t have to do everything perfectly to be normal. To be normal, you’ve got to kind of relax and let some things go. Your problem is that you’re so used to being in crisis that your whole perception of yourself is as a fuckup, a permanent fuckup, never someone who gets to not be a fuckup, so you have to torture yourself and hate yourself just to be as good as everyone else. You’re having a hard time realizing that you’re not a fuckup anymore. You’re entering into a whole different period of your life where you are normal. And you’re having a hard time getting used to it.”

                I gaze out the window. “But if you’re not trying to be perfect, then how do you know if you’re doing things right?”

                “There is no right,” she says. “There’s the best you can do. And that’s fine. That’s normal.”

                “The best I can do is sometimes completely fail,” I say.

                She shrugs. “Fine,” she says. “The rest of us do it all the time.”

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Filed under Bipolar Disorder, The Client's Side

“Against Psychotherapy”

Photographer Brendan Bernhard catches an intriguing piece of advertising-turned-street-commentary here.

Three reactions:

  1. Solemn reminder of how difficult the therapy process can be for the client, especially when progress is slow.
  2. Aesthetic respect – both for the contrast between the torn paper and Helvetica font, and the harmony among the blues, yellows, greens and browns.
  3.  Suppressed giggle over, “The therapist gets rich either way.” Clients’ subjective perception of therapist motivation can’t always fit with our financial realities.

@ 2012 Jonathan Miller All Rights Reserved

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Filed under The Client's Side