Shrink etiquette: should I call or should I write?

November 16, 2008 6:05 AM

Even my psychologist doesn't know who I am.

I've had 5 sessions with a psychologist. He's been relatively helpful despite there being annoying things about him: after the first session it became obvious he would generally not have familiarised himself with his notes from the previous session, he frequently runs late (30 mins or more), can be patronising at times. However this is my first time seeking counselling and I needed help badly so I decided I could live with that.
Our last session was a disaster, it did not build on our previous session at all and sometimes took a strange direction which I then tried to steer back to the issues at hand. Halfway through it became obvious why: he thought I was someone else entirely because he addressed me as Christina* whereas my name is Naomi*. I was mortified and too embarassed to say anything. It was an unpleasant experience to say the least.
I know he realised his mistake at some point but he never said anything and wrapped up our session well before the hour was up.
What is most upsetting is his lack of honesty (and mine too maybe, but I'm the one seeking therapy for stuff like this). In some of the previous sessions he could have said, I am running horribly late again today, give me a couple of minutes to catch up on your file. But in that last session he should have admitted to his mistake which was pretty obvious to both of us.
I am going to cancel my next session but am thinking about doing that in writing and explaining in a few brief sentences why (focussing on his lack of preparedness). I believe in providing feedback (I used to be a teacher and got my students to do that regularly). I'm thinking at best it may useful to him at worst he'll ignore it. But maybe I should do this over the phone? Although I'd feel more comfortable doing it in writing because I can then choose my words carefully. Or maybe I should just cancel without any further explanation?

Also, I'm in Australia and if I want to get a referral to another psychologist (they only cover 6 sessions) I'm going to have to tell my GP why I don't want to go see this psychologist anymore, which I will since I owe him this feedback on someone he referred me to. But if I send the letter, should I CC my GP? The psychologist has to write a letter to the referring GP after the first session and after the last covered by the referral (he mistakenly believed our last session was the sixth). "Clients" never get copies of those letters (which I think is an outdated practice but whatever). The only reason I am considering this is that it would be the most honest thing to do, this way everyone involved knows what's what. Am I overreacting, or god forbid overthinking?
* changed the actual names but left the contrast equally stark

posted by anonymous to human relations (14 comments total)

Oh god, no. Writing a letter is a very good way to handle this, and I would not hesitate to be as honest in that letter as you have been here. Yes, send it both the psychologist and CC your GP.

Your therapist's ofice should be a safe place in which you can take scary risks and talk about everything. To have that safety compromised by someone incompetent enough to not only be regularly late but to get your NAME wrong? To think you were someone else?! Wow. Run away. Be firm that you should have another referral for another six sessions with someone who is competent, caring, and, you know, can provide the service you actually need.

Best of luck.
posted by minervous at 6:17 AM on November 16, 2008 [3 favorites has favorites]

Think of the relationship with your counselor as an employer/employee relationship. It is very important to understand that you are the employer here, the boss, not the other way around. You (or your insurance) are paying for the services received.

Those services are less than satisfactory. So, fire him.
posted by netbros at 6:25 AM on November 16, 2008

Anyone you talk with (including that weird neighbor upstairs who wears large hats even in summer as the sweat drips down and her makeup runs down her neck) can be 'relatively helpful' esp when you first start out talking with them about what's been troubling you. Entering into psychotherapy and speaking with a professional can be / should be really a release, finally venting the thoughts held in the confines of our heads.

This not knowing your name, and then not apologizing when he catches it -- beyond the pale. This being way, way late and not apologizing, comping the session, apologizing again upon ending of that session -- beyond the pale.

This guy is brain dead.

I like the letter writing, both for you and also for your GP to read and to have, and also for Mr. Running Late to have. On his desk. In writing. Knowing that others have read it. Knowing that it's in a file somewhere, and that it has cut his flow of potential clientele. And your reasons for writing rather than speaking on the telephone are sound -- you put down exactly what you want to communicate, no more, no less.

I don't think you are either overreacting or over thinking this -- it sounds like you've come to good conclusions and are on a good course of action.

Good luck with your new therapist.
posted by dancestoblue at 6:28 AM on November 16, 2008 [2 favorites has favorites]

Getting good results from therapy requires trust and respect, like any other relationship. Finding the right therapist is like shopping for clothes--you try things on, and if they don't fit you keep looking.

Your GP should understand this, and should--should, I say--facilitate finding the right therapist for you.
posted by Restless Day at 6:32 AM on November 16, 2008

I think writing a letter and CCing your GP is perfect. If you were planning on having an ongoing relationship with the therapist, such that him knowing you "tattled" on him to the GP would cause a problem, I'd recommend speaking to the GP in confidence later, but since you should never need to see this therapist again, just do it. Sending one letter and CCing to others who need to know is standard, accepted practice.

If you don't get some kind of reasonable response from the guy, I'd consider sending a copy of your letter to the licensing authority for shrinks in your jurisdiction, as well.

(And just to note, I don't think what you're doing is "tattling", I just think the therapist might view it that way. I think what you're doing if totally legitimate, and obviously desperately needed. I suspect this guy makes his living 6 sessions at a time, and people think 'Well, I've already blown 2 sessions with this guy and I only have 4 more, so I may as well continue with him rather than try and find another therapist who doesn't suck." and then their 6 sessions end, and they go on their way, almost entirely unhelped, and he nabs the next sucker with crap insurance.)
posted by jacquilynne at 6:43 AM on November 16, 2008

Oh god, no. Writing a letter is a very good way to handle this, and I would not hesitate to be as honest in that letter as you have been here. Yes, send it both the psychologist and CC your GP.

I think writing a letter and CCing your GP is perfect.

EXACTLY what I came here to say.
posted by grapefruitmoon at 6:56 AM on November 16, 2008

Another agreement that your thinking here isn't excessive, but justified. I had to say goodbye to two therapists when I was in counseling because we weren't compatible- did not provide them with any feedback because I didn't feel that it was necessarily something they needed to fix. We simply didn't fit. But if I had found myself in a situation such as yours, I would have written a polite, clear, and brief letter explaining the incidents which led to my decision, because there's a change, however small, that it might help him with problems he may have not noticed were a problem. Or enough of a problem, if no one else has mentioned them to him. Writing might be better than calling, since it's not as easy to tune out constructive criticism on paper. Same for your GP, though I expect you'll probably talk with him or her in person anyway when getting another referral.

In a way, it's fortunate (although frustrating) that he made obvious errors near the beginning of your relationship. It can be difficult enough to find a personality match with someone who can help you without having inattention and carelessness and whatever else might be going on with him to deal with as well. You're definitely not overreacting. Good luck.
posted by notquitemaryann at 6:59 AM on November 16, 2008

Echoing what others have said above. Write your letter, and remember that you have the right to be angry about this. I see no reason why Medicare should pay for the (at best) inappropriate session you describe, and I think the guy sounds like an arrogant so-and-so who quite possibly takes advantage of the fact that his new patients are unsure of the protocol or don't know the ropes and won't call him on his failure to provide the services he advertises.

Stand up for yourself, definitely CC your GP (they won't refer patients to this guy any more if they don't think he's competent) and keep in mind that you have the right to kick up a fuss. Imagine that you went to this guy for a French lesson and he started teaching you as if you were someone else, with a different level of knowledge/different skills, then ended the lesson early rather than apologise when it became apparent that he had no clue what he was doing. No way that it's ok - he is so fired, and he's not gonna get paid for that session!
posted by different at 8:00 AM on November 16, 2008

Nothing further to add, I just hope that you do continue to seek help. Counseling, when done right, can be a very, very good thing. It has certainly saved my life.

Another thing to consider: if you're having problems with insurance payment, ask any new counselors you might "interview" if they have any low-cost options. Many counselors have a sliding scale fee (especially if you're not reimbursing them with insurance). I've seen two different counselors who kept a set number of patients (usually figured as a percentage of their whole client base) as low- or no-cost patients.

Good luck, and be well!
posted by CitizenD at 9:43 AM on November 16, 2008 [1 favorite has favorites]

DTMFA. What everyone else here has said. Don't be afraid to shop for shrinks the same way you would for a mechanic or an attorney.
posted by Rykey at 10:55 AM on November 16, 2008

The therapist is unworthy of that title & employment. Get a new one; odds are good the next one will be miles better.

But don't settle for anyone who doesn't make you feel like you're making progress - which is VERY different from feeling good, sometimes.
posted by IAmBroom at 12:04 PM on November 16, 2008 [2 favorites has favorites]

For some reason, this therapist isn't meeting basic professional standards. If you want to be very compassionate, assume he's got personal problems or some such, but he's letting you down. You'd be justified in moving on because of any one of the things you mentioned. How should you communicate with him? With the GP? Should you bother to communicate at all? Decide those matters based on what feels right for you.

With a good therapist, an in-person or phone confrontation usually goes well and the relationship improves. But a bad therapist will make excuses, tell you you're wrong, become defensive. You can save the difficult conversations for a doctor that is more professional. You don't owe it to this therapist to tell him why you're quitting; you can just send a note saying, "I prefer not to continue meeting with you." You don't really have to explain to the GP either; balance what you think is "the right thing" with how much anxiety you'd experience. Also, you don't need to send the same letter to both if you don't want to. If you would feel good about explaining the problems to the GP, by all means do so.

If you do write or speak with the GP, include a lot of facts: I've seen him five times; three times, he was more than x minutes late, and once he ended the session 15 minutes early. That way, it won't feel unfair or too subjective to you, and might cut down on your embarrassment; also, the therapist won't be convincing when he says, "anonymous is exaggerating; he/she needs to bring these things up, I can't read minds."
posted by wryly at 4:07 PM on November 16, 2008

I've been in therapy during several traumatic life events. It's a field in which there is far too much incompetence and lack of accountability. Please call him (in writing) on his unprofessional behavior. If you are paying for the sessions, ask for a refund of the last session.
posted by theora55 at 8:11 AM on November 17, 2008

Nthing all the above, with the additional note that therapy is a delicate dance of both personal and professional. That is, you need to feel comfortable enough with this person to trust him with your deepest thoughts, yet at the same time you're paying for a service, which includes punctuality, an understanding and review of your previously given information, and for God's sake, recall of your name. While some of these things might be forgivable in a more personal setting (e.g., your oft tardy friend), they are not in a professional setting. It's a service, like anything else. Taking this notion to its basest element: you wouldn't return to a restaurant that wasn't timely in its service or didn't give you want you want. Same deal with this guy.

PS-feel no guilt about moving on and writing a letter outlining what's happened. It's kinda like dating sometimes: you have to shop around, as Rykey says, before you find a good fit. Additionally, writing a letter that matter of factly states what's transpired may eventually prevent someone else from having to deal with this cat's (very unprofessional) antics.
posted by December at 3:41 PM on November 17, 2008