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Should I break up with my therapist?
March 10, 2011 12:01 PM   Subscribe

Is my therapist a crackpot? Should I break up with her over it? If so, can you recommend a trauma-focused therapist in Los Angeles?

This is payback for all the times I enthusiastically recommended therapy here, I imagine.

A while ago, I had a thing happen where I almost died. I am physically okay now, but I have some residual mental issues relating to that trauma. I finally decided to seek therapy for help working through that stuff.

I picked this current therapist because she has a professional background in trauma. She has a PhD, which was important to me: although I know the thing about how the outcomes for PhD and masters-level therapists are the same, I was really hoping to find someone with a research background in trauma.

I've seen her several times now. Our rapport is okay. Her approach seems to be exposure therapy, basically. She wants me to talk about the sadness I have relative to the trauma until the bad feelings diminish. I am not an expert, so I don't know if that's the state of the art or what.

Once or twice, I have felt kind of "..." about something she's said, but not outside of the realm of Stuff I Can Ignore.

But today she said some things that make me really unsure about continuing the relationship. I would appreciate some insight from those of you reading this with some experience - either as a therapist, or a person in therapy - in this area.

I am not looking for LOL ENERGY RAYS - I have that covered on my own.

Okay, some background: one of the things I want professional help with is figuring out if some memory issues I've had since the trauma are:

a) all in my head
b) "mommy brain"
c) actual minor brain damage caused by the trauma

I have repeatedly brought this up with her. She seems to think that time will fix it, if it's a real problem. Today I asked her specifically if she thought I should go see a neurologist or someone in an associated field, just to rule out any issues.

She said that she thought my "brain chemistry" was out of balance. I said "Hmmm." She asked if I wanted to pursue traditional medicine or alternative therapies to fix this. I said that I was not interested in anti-depressants, because I don't believe that they're more effective than placebo for most people. (Also, I am not actually depressed. I know what depression feels like, and this isn't it.)

At that point she went on a long explanation of how I needed to get lots of good nutrition, exercise and sun exposure. She told me to make sure I got plenty of sun, with my sunglasses off. So the "rays could go into my brain".

I interrupted to say that I am a science-minded nerd, and while I am prepared to believe pretty much whatever, I need to see real studies backing up claims about stuff.

She then went on a long thing about how I should read about Dr. Andrew Weil and Dr. Oz and take Vitamin D and Vitamin B and "fish oils". And acupuncture, there were "many studies" showing how effect these things were. And she finished by suggesting that I visit a local psychiatrist who is a "bio-chemist" who does hair and blood tests and works with "enzymes" to balance your brain chemistry.

Because "trauma creates toxins" in your brain.

There was more in that vein, but you get the picture.

Okay. I am more of a hippie than many people on Metafilter. I am prepared to believe that trauma creates toxins in your brain, I guess. But... this all sounds like total bullshit to me. Maybe I could ignore it, but... This therapist also seems resistant to the idea of me going to see a neurologist. "They just do CAT scans!" She seems heavily invested in the idea of balancing your brain chemistry through nutrition, etc, and cleansing your system of "toxins".

Is there any real research out there showing that what she's talking about is legit when it comes to PTSD? (Specifically that thing about the rays going into your brain.)

If no... does this seem like something worth ending the therapeutic relationship over?

And finally, can anyone recommend a counselor who specializes in PTSD and can handle nerd clients, in the Los Angeles area?
posted by thehmsbeagle to Health & Fitness (37 answers total) 1 user marked this as a favorite
 
Er. All the reliably scientific literature I've read about "toxins" when it's not very specific about what toxins (like mercury or lead, for example) convinces me that it's bunk. So that's just to say, you're not alone in finding that approach a little too wifty to be convincing. Also, sun exposure I think is scientifically correlated with lots of good health effects, including improved mood, and my understanding is that your brain does get some of its cues from unfiltered sunlight, but her phrasing of that relationship would trouble me.

I wish I had someone to recommend, but a keyword to look for is therapists who practice EMDR, which has 20 years of clinical proof to back it up as being a really effective treatment for PTSD and post-trauma therapy even if it doesn't reach the level of PTSD diagnosis. I've found it pretty amazingly effective, myself.

Finally, I have an awesome therapist (in the Boston area) who is often happy to make recommendations for therapists she knows and likes in other parts of the country, so if you don't get any suggestions out of this post, drop me a memail and I'll ask her if she can recommend anyone in your part of the world.
posted by rosa at 12:13 PM on March 10, 2011 [2 favorites]


I've MeMailed you some resources for "what, exactly, the local cutting-edge research neurologists do to evaluate people," and for neuropsych evaluations. The UCLA neurology service loves them some nerd clients.
posted by fairytale of los angeles at 12:13 PM on March 10, 2011 [5 favorites]


"alternative therapy" is an alternative to science. you are not supposed to ask for evidence. there is none.

you are not qualified to diagnose yourself for a mental illness. not even trained professionals can diagnose themselves.
posted by paradroid at 12:16 PM on March 10, 2011 [4 favorites]


Personally, I don't understand why she has trouble with you getting a CAT scan, since it could help you to rule out some of your concerns; even if I were more woo-inclined, I would think that she was being pushy about her own beliefs. I've heard that lots of therapists recommend fish oil, so that might not be so strange, but I'm wary of someone who would rather you get rid of toxins that she just assumes exist in your brain than get a definitive medical exam.

But more generally, I really believe that if you're not comfortable with your therapist, you should end the relationship. She's not the right one for you and you don't share the same approach to ensuring your mental health.
posted by pineappleheart at 12:17 PM on March 10, 2011


I think this is definitely break-up worthy. Sadly, not even a Ph.D. can protect people from feel-good quackery.

That's all I can weigh in on, but I'm positive you'll get great resources about where to go from here from the brain trust.

But, hey, I hope this all clears up soon for you, or at least gets a definition so you know what to focus on. That's a lot to deal with.
posted by batmonkey at 12:17 PM on March 10, 2011 [1 favorite]


First, it is I who is more of a hippie than most people on MeFi, but even I was thinking "Beagle needs to go see a neurologist" about the brain trauma possibility. Some background: Mrs. Bubba & I are both hippies from back in the day. Both of us have read Andrew Weil and both of us believe that good things happen from (limited) exposure to the sun's rays.

But Mrs. Bubba had a persistent, chronic condition that MD's couldn't quite diagnose & since there was a history of diabetes/endocrine problems in her family, she took as symptoms of hypoglycemia. It looked like a duck, quacked like a duck, etc. For almost 20 years, allopathic doctors could not find an organic problem, and she ran the gamut of naturopaths, aromatherapy, acupuncture, chiropractic, and so on, and so on. At wit's end and at the suggestion of a friend who is also an MD, she went to the neurology department at our large research hospital. A couple of consultations, a couple of tests & cluster migraines was the diagnosis & she's been able to control the occurrences with fairly common meds.

Now, we both go to a therapist for other reasons, and we would be STRONGLY resistant to a therapist suggesting that closed head brain trauma (or any brain injury) could be fixed by Fairy Dust. Now, this does not mean it isn't all psychogenic, but you woe it to yourself to check out the possibility of physical damage. IANAD or your doctor or a therapist, but I do think that you need to eliminate the possibility of physical damage before moving on to the "fish oil cure."
posted by beelzbubba at 12:18 PM on March 10, 2011


Boy, I do think that getting sun is good for you and can help with mood and recovery, but when people start to ramble on vaguely about vaguely-defined "toxins," I back away slowly (or quickly). Also, Dr. Weil can bite me and my evidence-based butt. He and, I think, she are pointers that a PhD isn't always all that meaningful. She wouldn't meet my standards, and if I were you, I'd go look for someone else.
posted by wintersweet at 12:19 PM on March 10, 2011 [5 favorites]


Well, UV exposure, which is what I'm assuming she meant by the sunlight comment, is good for you if you're low on vitamin D. Granted, overexposure is pretty bad, but there's a lot of research about how industrialized societies have low vitamin D from being indoors all the time. I believe the FDA is planning on raising the minimum amount of dietary vitamin D soon, if they haven't done so already.

The other suggestions like B vitamins or fish oil seem to be a shotgun approach to address depression or mood issues without resorting to prescription drugs, although fish oil's effectiveness seems questionable outside of people with heart problems. The health benefits of acupuncture are pretty much zero, but with some people and I think one reputable study claiming it helps with minor pain slightly better than a placebo, but far worse than an ibuprofen.

The jazz about toxins is really worrisome. Its a meaningless and should throw a red flag.
posted by damn dirty ape at 12:20 PM on March 10, 2011


I'm only somebody who has had therapy, but here's my two cents.

If your therapist is dismissing something you feel strongly about (seeing a real MD) and pushing something you are uncomfortable with (brain rays) then it's time to find a different therapist.

I'm pretty open minded about alternative therapies and even found that an herbal remedy for my anxiety worked better than the prescription ones. Still, if my mental health professional said I should spend time in the sun so the "rays could go into my brain" I'd be shopping for a new therapist.
posted by TooFewShoes at 12:21 PM on March 10, 2011 [5 favorites]


Bail. That....well, I'm not even going to start on the vague toxin stuff.

You know what she's shown? That she doesn't have respect for other professions or approaches: if she wanted to suggest you consider, say, a neuropsychological battery instead of a full neurological exam, then that's one thing. But neurologists do more than just CAT scans, just as good therapists do more than listen to you and blame your parents for your problems. That's simply not how you discuss other people's careers.
posted by Uniformitarianism Now! at 12:22 PM on March 10, 2011 [6 favorites]


The most important thing isn't necessarily about whether her claims are true are not. It's about whether you trust her. You don't, and that doesn't bode well for your therapeutic relationship. Find someone else.
posted by Wordwoman at 12:23 PM on March 10, 2011 [7 favorites]


I think you're right to be concerned. Toxins, schmoxins -- I would hope that any clinician I have would at least entertain the idea of me seeking a complementary opinion. If they don't, that's a red flag that they think their own diagnosis won't hold up.

Also, I'll second the recommendation for EMDR. It sounds kind of woo-woo and new-age-hypnosis-y at first glance, but all of the research I've seen (and clinical opinions I've gotten) backs it up. Both my partner and another fairly close friend have had fantastic results with it, and I've considered it myself.

It's great because it helps you work through things from the point at which they actually happened, not just trying to push them out of your mind or develop better coping strategies. In turn, that approach can help you deal with the ways in which the traumatic situations have affected the things that have happened as a result.
posted by Madamina at 12:26 PM on March 10, 2011


Yeah, once someone says "toxins" I would also start backing carefully away. I can't think of a good reason not to see a neurologist, certainly, or at least to seek out a therapist who will be willing to entertain the possibility. I would absolutely find a new therapist, because you shouldn't have to ignore parts of what your therapist says to be able to take her seriously. There are plenty of other ones out there who will make sense all of the time.

I wish I had someone to recommend, but a keyword to look for is therapists who practice EMDR, which has 20 years of clinical proof to back it up as being a really effective treatment for PTSD and post-trauma therapy even if it doesn't reach the level of PTSD diagnosis. I've found it pretty amazingly effective, myself.

Also this, yeah. I had a therapist who did EMDR and even though it sounds kind of woo-woo when described, it was freakily effective. I did not have any "real" trauma and she was mostly using me as a (willing!) guinea pig, so I was thinking of a particularly vivid and unpleasant -- but not "traumatic" -- memory, and ... then it went away. Pretty much after one session. I mean, I can remember it, but all of the feelings of anxiety and immediacy and so on are just gone. So, uh, that's weird. Yeah.
posted by little cow make small moo at 12:26 PM on March 10, 2011


Well, UV exposure, which is what I'm assuming she meant by the sunlight comment, is good for you if you're low on vitamin D. Granted, overexposure is pretty bad, but there's a lot of research about how industrialized societies have low vitamin D from being indoors all the time.

I'm down when it comes to this, having had an astonishingly shitty vitamin D level of 11 myself at one point-- but no therapist should be telling a client to embark on unsupervised, non-MD-overseen vitamin therapy when there are signs of potentially serious neurological complication. (You know this; I'm repeating for posterity.)

My neurologists examined the living hell out of me before they recommended anything for my complex migraines. I got a standard MRI run and two with contrast for veins and arteries to rule out vascular abnormalities and so on. I received multiple panels of bloodwork for vitamin levels, electrolytes, and all kinds of crap I never thought about-- the lab techs were truly afraid of the pile of vials they amassed. I was quizzed over my entire family history, asked to call my mother and ask penetrating questions about her pregnancies, etc. etc.

After all that, I came out with a pile of new scrips, and my vitamin levels are still carefully monitored and my meds assessed every six months in terms of how many migraine days I've had and how I've been doing.

That is how the science is done, not by letting the magic rays enter your eyes. (There is a retinal receptor back there that has a role in regulating the body clock! But that's probably not even what she's thinking about.)
posted by fairytale of los angeles at 12:28 PM on March 10, 2011 [1 favorite]


>Is there any real research out there showing that what she's talking about is legit when it comes to PTSD?

Well, you can Google Vitamin D/sunlight/depression... but particularly since the origin of the trauma was some kind of physical incident, Vitamin D seems like a somewhat eccentric approach to the issue.

The worrisome point here is that she seems to want to throw in some kitchen sinks (exercise, sunlight, nutrition, enzymes) but not others (CAT scans).

>This therapist also seems resistant

Eeesh.

Spending $150 to find a new therapist is cheaper than spending N*$150 on N sessions with a therapist whose approach you don't like.

So get the CAT scan.

Also, really, to the extent that you classify yourself as a nerd, you might want to use someone with a more, ah, linear approach. As the refrain goes, try NLP... but then, yeah, work in an exercise routine.

http://www.amazon.com/Revolutionary-Trauma-Release-Process-Transcend/dp/1897238401/
posted by darth_tedious at 12:30 PM on March 10, 2011


I think you do need to cleanse your system... of a flaky therapist. Shop around until you find feel someone you're more comfortable with. Psychology Today has a Find a Therapist site that can be sorted by location and specialty.
posted by Daddy-O at 12:40 PM on March 10, 2011


Whoops, better link.
posted by Daddy-O at 12:41 PM on March 10, 2011 [1 favorite]


Nthing UCLA for medical services. After a traumatic physical injury with lasting symptoms, I don't know why you wouldn't seek further medical attention!
posted by jbenben at 12:43 PM on March 10, 2011


Those folks she refers you to are ok, right on--but for healthy day to day living. What they offer has little to do with what you are seeking. That sort of thing will provide you in part with a healthy bodyl.Now you need something for the mind, and that is insufficient. my view. I am not a therapist.
posted by Postroad at 12:50 PM on March 10, 2011


Everything you put after 'Dr Andrew Weil' sounded like it comes directly from him, she's clearly spouting his party line. That's where her ideas about treatment are from - either him directly or his branch of pseudoscience. Given he's a giant quack I would personally run, not walk, away from this therapist.

It is possible that you have physiological signals in your brain which could be branded as 'toxins' due to the trauma, but they are things caused directly by tissue damage or other physical problems. Like how when you cut yourself the damaged cells release pain and inflammatory signals to the rest of your body. If that is the case then you need to see a neurologist and find out what's actually wrong, and it sounds like ruling out physical damage would be a good move at this point anyway. Even if the cure turns out to be taking off your sunglasses you need a proper diagnosis to find that out, and hair tests and 'enzyme' quackery aren't the way to do that.

Lastly, I've read studies about how constantly reliving trauma is a bad way to deal with it and is not the industry standard. I don't know a lot about what is industry standard or how this should be treated, but your description there set off a red flag. Definitely look into this if you do decide to keep seeing her, because there's a possibility she's just ingraining the trauma even more rather than excising it by making you relive it again and again. I may be wrong so I'm bringing it up as an area for further research.
posted by shelleycat at 12:52 PM on March 10, 2011


The toxins comment is indefensible, and I'm generally suspicious of anyone who talks broadly of "brain chemistry" was out of balance, however, current thinking about trauma is that it does affect the release of neurotransmitters and stimulus sensitivity (and memory), and that there is a strong bio-physiological cause to at least some of the subsequent symptoms associated with trauma. Referring to it in the way she did may either indicate that she doesn't understand that research, or that she disregards it in favor of her new-agey explanation, or that she does not think you can understand it. None of those options speak well of her. Her ideas about brain rays are similarly strange. You do produce Vitamin D from sun exposure, but that doesn't take place because sun gets into your eyes and then into your brain.

EMDR helps some people with trauma, but is not substantially better than other treatments for trauma. In general most therapies work about the same for most problems.

It will be relatively difficult to find a clinician who is also involved in research, and your best bet really is to find someone attached to a medical facility. You might also keep in mind that being involved in research often means having an agenda, and while that agenda might nominally be to help patients, the vagaries of the human animal mean that often times the agenda devolves to furthering the favored therapy whether the patient is truly being helped or not. The statistics on research bias in psychotherapy studies are pretty astounding.

Best of luck.
posted by OmieWise at 1:00 PM on March 10, 2011 [10 favorites]


about how I should read about Dr. Andrew Weil and Dr. Oz

If she has a Ph.D and recommended that garbage, you should have walked out of the session with your middle finger up in the air.

The "rays" do not go into your brain. Jesus Christ, what's her Ph.D in? She's talking about toxins, but told you to get on anti-depressants? Tell her you've already tried alternative medicines, but sadly vodka isn't indicated for PTSD.

See a psychiatrist or a licensed clinical psychologist. If you don't want meds, look for CBT or hardcore psychoanalysis. But see a neurologist first. The touchy-feely Oprah crap belongs in the garbage.

"The rays go into your brain." That's gold, Jerry!
posted by Pastabagel at 1:07 PM on March 10, 2011 [1 favorite]


She told me to make sure I got plenty of sun, with my sunglasses off. So the "rays could go into my brain".

No thanks. If you don't wear your sunglasses, you can get problems.

"Rays can get in your brain" indeed! Run, don't walk, from this crazy hippie lady. Yes, your therapist is a crackpot!
posted by humpy at 1:12 PM on March 10, 2011


A simple comment on your primary question, "Should I break up with my therapist?"

A therapeutic relationship is based on trust. If you do not trust your therapist, regardless of the reason, you are handicapping your ability to get better.

So, do you trust your therapist? If not it is time to move on.
posted by m@f at 1:19 PM on March 10, 2011 [2 favorites]


It sounds like, that in her heart, she's one of those west-coast, experiencial therapists that wants you to do things like "take a walk," "open your mind" and "let the good energies in." Having hippyish tendencies myself, I don't think there is anything wrong with that, if its what you're looking for or if you're open to that sort of approach.

However, I see two problems. First, she seems incredibly close-minded towards traditional science. i find it hard to imagine anyone dismissing a neurological workup is there was physical trama. Its one thing to say that its not her area -- its another to completely to dismiss it out of hand.

Second, she seems to being trying to disguise her chosen modality using the same scientific language that she seems to dismiss. I have nothing against, and see value in, someone who wants to treat the mind and not the brain. In fact, I personally think psychology has been recently tilting too far towards neurologics. But she seems to be trying to sell what she is doing as science. Which means either that she is unsure and/or confused about what she is trying to do, or she is trying to blow something by you. Neither of which is going to be effective or helpful.
posted by rtimmel at 1:37 PM on March 10, 2011


She would have lost me at Andrew Weil. There's no way I could continue to see a therapist who hasn't seen through his charlatanism after being exposed to it enough to suggest it to a patient. What's the poing of continuing therapy with someone with such obviously flawed insight?

If you have trouble finding a trauma specialist, I'd suggest finding a psychiatrist or an analyst with an MD. Not only could he/she give you a more informed opinion on whether you should get a neurological workup, but med school also tends to weed out a lot of the woo-practitioners.
posted by patnasty at 1:50 PM on March 10, 2011


At that point she went on a long explanation of how I needed to get lots of good nutrition, exercise and sun exposure. She told me to make sure I got plenty of sun, with my sunglasses off. So the "rays could go into my brain".

Oh my god. This is not a therapist. This is a Discordian telling you to stimulate your pineal gland. DTMFA.
posted by Sys Rq at 2:00 PM on March 10, 2011 [2 favorites]


Previously and previously-er...
posted by jejune at 2:27 PM on March 10, 2011


The the sun to the brain stuff is beyond mere pseudo-science and straight on into tin-foil underoos territory. The pineal gland is an unassuming hormone regulation structure, that's apparently your 'third eye', the seat of mystic powers when exposed to the sun, a source of all healing. Beware of fluoride though, apparently the pineal gland is the primary target of fluoride accumulation within the body, and that over exposure can cause early puberty and free radicals (toxins in the brain?). So there's a think for you.
posted by bonehead at 2:36 PM on March 10, 2011


There is definite peer-reviewed literature about the benefits of various vitamins and fish oil (which doesn't really deserve scare quotes - it's literally that, and it's basically an omega-3 fat supplement.) That being said, it sounds like this particular person knows just enough to be dangerous about this stuff - there are real, concrete tests you can do to find out if you have a vitamin D deficiency, and fish oil doesn't have anything to do with "toxins" per se. And why anyone would be reluctant to check for organic brain damage after actual physical trauma just flat-out mystifies me.
posted by restless_nomad at 3:37 PM on March 10, 2011


Whether your therapist knows what she's talking about or not, her style of justifying her approach is inadequate. You are a person who really needs a solid justification of the therapeutic approach to trust the process. Sometimes the match between a therapist and a patient just isn't good. I think this is one of those times.

(If only you'd managed to work in an outdated foodstuff, you could have hit the AskMe trifecta of seektherapy-DTMFA-donteatthat.)
posted by gingerest at 4:23 PM on March 10, 2011


WHAT she was recommending is fine. HOW she was recommending it was loopy.

(Sunlight does help with a lot of things as do fish oils, and this is widely recommended and not flakey but it sounds like how she presented it was a bit out there. Sounds like your doc is not a good fit for YOU. And really that is all that matters.)
posted by St. Alia of the Bunnies at 4:33 PM on March 10, 2011


DTMFtA

Seriously, your gut feeling is telling you to let this go. You need a therapist you can trust.

Good luck
posted by MiggySawdust at 5:46 PM on March 10, 2011


Yeah, not a good fit. All the credentials and recommendations in the world don't guarantee that two people's approaches to a problem will be compatible. It sounds like you want something more empiric, and she wants something more faith-based [faith in her, and her special insights, not Jesus]. I'm bothered by the fact that she doesn't want you getting a medically valid second opinion. As a therapist, she should have nothing to lose by this move: Finding a physical problem will make you no less traumatized. Honestly though, I would expect a therapist to welcome additional datapoints regarding your condition, or at least respect your anxiety regarding this possibility enough to stand aside while you resolve it.
posted by Ys at 6:06 PM on March 10, 2011


You should not just break up with her—you should also tell her why. Namely, that's she's a fucking irresponsible quack who should have her Ph.D. and her license revoked.

This stuff isn't just bullshit; it's dangerous bullshit. Your instincts are spot-on.

Go find someone who has enough sanity—and enough respect for you—to treat your problems with real medical science, instead of leeches and magic potions.
posted by ixohoxi at 6:39 PM on March 10, 2011 [2 favorites]


I'm weirded out by the vitriol in this comments section. ("Should have her license revoked" etc.) I see two issues. One, are her recommendations bunk? And two, do you like and trust her?

Regarding the first point, most of her suggestions are "alternative/complementary," not crazy. Obviously the sun's rays don't go into your brain. But acupuncture has had some success in clinical trials as a PTSD treatment (according to the National Center for Complementary and Alternative Medicine -- a branch of the NIH). Fish oils are often recommended as a mood/cognitive booster because of the omega-3s, and were recently trialed as a PTSD-specific therapy by no less than the Veteran's Administration. The jury is still out on whether your Vitamin D levels are correlated with cognitive performance or whether Vitamin Bs might have a memory-protective effect, but these are questions which scientists are asking today, and they seem like relatively cheap and non-harmful interventions which you could try for yourself. Folks at Yale, Duke, and the VA agree that PTSD might go along with having your "brain chemistry messed up."

Regarding the second point, it sounds like you don't particularly trust her. Either she's a bad explainer ("sun's rays go into your brain," unable/unwilling to point you to good studies) or she's a flaky thinker (!!!). You want to see a neurologist and she is unsupportive of that, which sucks. So if your gut is telling you to break up with her, I'd go with it. Maybe this guy's office could give you a referral to someone you'd like better?

Good luck with it.
posted by hungrytiger at 3:25 AM on March 11, 2011 [3 favorites]


Thanks, everyone. I've marked a couple of best answers, but there were many good insights.
posted by thehmsbeagle at 9:44 AM on March 12, 2011


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