Breaking up with my therapist

September 12, 2012 9:00 AM

I have been seeing a therapist for about two months now and am not happy with our sessions. I want to try to find another person, but I'm not sure of the protocol of leaving one therapist for another.

I'm seeing a psychiatrist for Biopolar disorder, which has left me unable to work or function much at all at the moment, and he recommended a therapist for me to talk to as he adjusted my medication. The two of them communicate about my case, which I suppose is an effective collaboration, but it's started to make me paranoid, like I feel they are ganging up against me (not rational, I know).

Anyway, I don't feel like I'm getting much out of my therapy sessions. The therapists mostly gives me dietary advice or tries to get me to go to AA meetings - I was self-medicating with alcohol during a bad period, but I've had no trouble getting off the sauce. Our last meeting only lasted 20 minutes because I just had nothing to say (besides I'm not going to fucking AA), and she just sat there, looking at me.

What is the protocol here? Can I just cancel my next meeting and find someone else? Am I allowed to find another therapist if this one is working with my psychiatrist? Is this dissatisfaction with therapy a standard part of the process? I feel very nervous saying "I'm sorry, but you're not helping me," but I'm also extremely non-confrontational.

posted by Lectrolamb to health & fitness (17 answers total)

I have changed therapists. Personally, I usually sneak out like a thief in the night. Request your written records, and then go.
posted by corb at 9:18 AM on September 12, 2012

You can do anything you like. You're the client. You can fire your therapist. But don't let your firing her allow you a chance to get away from going to therapy.

Have you mentioned your paranoia to either your psychiatrist or therapist? Can your psychiatrist refer you to someone else?
posted by inturnaround at 9:18 AM on September 12, 2012 [2 favorites]

Speak to your psychiatrist and ask for a referral to another therapist.

Sometimes you just don't click. It's no big deal. Work through this with your Psychiatrist.

Just cancel your next therapy appointment, to avoid charges. No need to discuss why.

Therapy is a very personal thing, and a professional will know that not everyone will respond to his or her methods, or will mesh with his or her personality.

If someone recommends something and you don't agree, ask them why they are recommending that particular thing.

For example, the AA meetings. What kept you from asking, "Gee, since I've stopped drinking, and this isn't affecting me any more, why do you recommend this?" There may be a very good reason, or they may just say that for every situation where someone mentions alcohol. You can't pronounce the advice useless if you don't understand the context or the reasons it was given.

Your Bipolar Disorder will naturally make you skeptical of any advice being given to you. You should be suspicious of your desires and motivations. Before you poo-poo it altogether, at least understand WHY. (Diet is a pretty large component of mental health, for example, sugars make me hyper, agitated and screw up my though processes.)

But if you feel like this relationship isn't working, find one that will.
posted by Ruthless Bunny at 9:20 AM on September 12, 2012 [2 favorites]

I would cancel the next meeting, request my written records, and start visiting new therapists until I found one I liked and wanted to work with.
posted by SkylitDrawl at 9:43 AM on September 12, 2012

A couple of things.

1. To "fire" your therapist, just cancel your next appointment (and all future appointments, if they've been scheduled.) If you have a lot of trouble getting yourself to do this, you can send an email, send a letter, call in the middle of the night/on a weekend and leave a voicemail, or do whatever other passive/passive-aggressive thing you need to. You must cancel the appointment, however. Otherwise you're on the hook for the no-call/no-show fee, which could be pretty big. Get help from a friend or family member to cancel the appointment, if needed. I have seriously lost a couple of hundred dollars by not formally cancelling appointments.

2. Tell your psychiatrist you have already cancelled your appointment with the therapist and do not intend to go back. THEN ask them for a referral, bearing in mind that they're going to want to know why things didn't work out with this therapist. You should probably have a bullet-point list of reasons, with examples, that you can share. It's important that you have already cancelled the appointment, so that you don't come across as someone whose mind can be changed.

3. You need to work on expressing your boundaries more clearly and definitively. I don't know whether this was a case of "I said no and the therapist kept pushing because the therapist didn't listen" or "I tried to say no but didn't do a very good job of it so the therapist kept pushing." Either way, I would have this be, like, job #1 in the interim between therapists.

4. Please remember you can fire a therapist at any time. You should actually put a lot of effort into making sure the new therapist is the right one - this does not take 7 or 8 appointments. You should really look into the characteristics of a good therapy relationship, review the ethical standards for therapists, and check out the different kinds of therapy available to you.

5. Please sit down and make a rational list of reasons you will not go to AA. Keep the cursing out. You're going to want to be able to share this list in a clam and collected manner with anyone who brings it up (if the psychiatrist is in regular contact with the therapist, this will probably come up.)

6. Plan a script for the dreaded "she isn't saying anything and I don't know what to say and this isn't working" moment. I put "I am really uncomfortable with the silence and feel like I'm being judged and found unworthy and hopeless. Could you please talk to me?" on an index card. Generally, this moment only happens when things are Really Going Badly in Therapy (TM) and so you won't have to use it much, but it's very reassuring to have it ready to go.

7. Plan out some of your goals for therapy. Not just generic "I want to be functional and go back to work" but also things like "I want to be able to get myself out of bed before 11am" and "I want to stop finding myself thinking about suicide every single time I get near a bridge." This gives both you and your therapist an idea of what to do. If you just say "I want to feel better," then "diet and exercise" is a totally rational response.

8. Lots of people are going to recommend AA, dietary changes, and exercise. Try not to take it personally. Just tell them you aren't interested in those avenues and would like to explore something else instead.

9. Three types of therapy you should get to know really well, even if you never ever ever go through them with a therapist, are Interpersonal and Social Rhythm Therapy (IPSRT), CBT for Bipolar Disorder, and Family-Focused Therapy. These are the three proven short-term treatments for Bipolar Disorder, so lots of therapists rely heavily on them. You can check out a TON of CBT tools here. CBT is not great for serious mental illness in terms of going from a 20 on the Global Assessment of Functioning to a 90. But it can get you from a 35 to a 50 - from lying in bed all day long every day to getting out of bed often enough to get the laundry done and eat once or twice a day.

10. Bone up a LOT on your psychoeducation. I personally like McMan's site the best, but I can suggest books or whatever if you want. I'm sure I've offered plenty of suggestions in my various answers.

11. For me, one of the cardinal rules of having bipolar disorder is straight from the wisdom of the Ents: Don't Be Hasty. That is, don't walk out of a therapy session after five minutes, sure it's not going to work. Give it a good night's sleep. Check your assumptions with your psychiatrist or a trusted friend (someone in person, who can tell whether you might be manic.) Make sure you're not hungry, angry, lonely, tired, super-stressed out, etc., when you show up to a therapy appointment or make a decision about your treatment plan.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 9:47 AM on September 12, 2012 [23 favorites]

Everyone's giving great advice here, but I should point out that to make yourself more comfortable you can always say that you just want to try someone new and leave open the possibility that you might come back. Your therapist is a professional, they'll understand. (And for all you know, you might really come back at some point when you're at a different place, on different meds, etc.)
posted by XMLicious at 10:12 AM on September 12, 2012

Therapists (as opposed to psychiatrists) generally do not have medical or nutritional training. Psychotherapists really should not be giving dietary advice ("You should eat X, you shouldn't eat Y") and are often prohibited from doing so by state laws (especially if they are claiming that following their advice will alleviate your mental condition) because it is outside their scope of practice. They can, and sometimes should, offer dietary information ("Some people find that sugar increases mania") and they should, if they're offering that information, encourage you to try out the information on your own ("Maybe track your sugar intake for a week and see if it correlates with your manic symptoms?").

So, if she's being really directive about what you should or shouldn't eat, that alone seems like a red flag.

Dissatisfaction with therapy is often part of the process, but it shouldn't be the whole process, and there's a difference between occasionally being annoyed for pushing against your resistance (which is likely a good thing) and continually feeling unsupported.

I agree with others who say that you are going to have to watch any tendencies you might have to impulsively disengage at any sign of conflict or difficulty, which is why is probably is a good idea to work through this change with your psychiatrist's oversight, but I also agree that canceling your next appointment is perfectly reasonable -- AS LONG AS you immediately also call your psychiatrist and at least leave a message about what's going on and ask for other recommendations. It may take the psychiatrist a while to get back to you, but giving him an immediate heads-up about a major change in your treatment is the responsible thing to do here.
posted by jaguar at 10:13 AM on September 12, 2012

So, yeah, it sounds like this therapist is a terrible fit with you. The therapist and your psychiatrist will understand.

However, every therapist will want to communicate with your psychiatrist, and your psychiatrist will want to communicate with whatever therapist you choose to work with over the long term. They won't be "ganging up" on you any more than a rheumatologist and a primary care physician would be "ganging up" on you.

You have a brain illness that is best treated by a combination of modalities, in this case psychoactive drugs and talk therapy. The treatment doesn't work unless all the providers are kept mutually informed.

I strongly urge you not to get treatment notes from this therapist, but rather to have her send them to your psychiatrist. You've identified what you describe as "paranoia" and what looks to me like some resistance and hostility about needing treatment (which is understandable, because getting treatment for any kind of illness basically sucks, and getting treatment for mental illness is additionally stigmatized). My fear for you is that you will be made angry by reading the therapist's treatment notes and refuse to work with another therapist.
posted by Sidhedevil at 11:40 AM on September 12, 2012 [1 favorite]

My fear for you is that you will be made angry by reading the therapist's treatment notes and refuse to work with another therapist.

This is a possibility - but I think it can also provide a valuable perspective that not all of your emotional responses are wrong. If you felt that you didn't trust the therapist, and the therapist proves to have not been worthy of your trust, then that may mean your internal lever is not, as you might fear, completely and totally screwed up.
posted by corb at 11:50 AM on September 12, 2012

I don't think the OP is in a position to do a good job evaluating whether the therapist was "worthy of trust" or not, given what the OP describes as "paranoia". The OP's psychiatrist, on the other hand, will be able to get objective information from the treatment notes.
posted by Sidhedevil at 11:59 AM on September 12, 2012 [3 favorites]

I feel they are ganging up against me (not rational, I know).

...

They won't be "ganging up" on you any more than a rheumatologist and a primary care physician would be "ganging up" on you.

i want to point out that that feeling is not totally irrational, and that the annalogy above doesn't really follow. when you hire your psychaitrist and psychologist you're paying them to change the way you think and act. their plan doesn't have to involve informing you about every part of the plan. again, their job is to change the way you think and act, not to give you The Truth, and if changing the way you think and act involves deceiving you in some way, then that's how it is. it's what you've signed up for. if it's not what you want, then, yea, your feeling has a grain of rationality to it.

on the other hand, your arthuritis won't get better or worse depending on if your doctors are honest with you or not.
posted by cupcake1337 at 12:11 PM on September 12, 2012 [1 favorite]

cupcake1337, I could not disagree more. Psychiatrists and psychologists do not conspire to deceive patients any more than primary care doctors and rheumatologists do. Primary care doctors and rheumatologists don't have any more access to "The Truth" than psychiatrists and psychologists do. They may have additional sources of objective data, like blood tests and MRI images, but those need to be interpreted and conveyed through that filter to the patient, just like psychiatrists and psychologists do with treatment notes.
posted by Sidhedevil at 12:41 PM on September 12, 2012 [3 favorites]

Rationally or not, I'd be worried about "ganging up," too, if I had a therapist I trusted as little as the OP trusts hers (or his, if you're a guy, OP.).

What's more, the current therapist seems unworthy of trust, if she KEEPS giving dietary advice and KEEPS (lazily!) suggesting AA. (I mean, really? I love 12-Step. I know that Al-anon saved my life. People are probably sick of me suggesting it. But AA is NOT the only fish in the sea, even if the OP were alcoholic, which it doesn't even sound like she is!) If your patient feels compelled to leave before the session because you'd rather sit in silence than give direction, you are a crappy and stubborn therapist. I'm annoyed with the therapist just reading the description.

When you find a therapist who's a good fit, who's trustworthy, who's good at communicating, you won't worry about her ganging up on you with the psychiatrist. You will KNOW she's in your corner, no matter how paranoid you are. (Ask me how I know!) She will tell you what she's going to say the psychiatrist and why and she'll hear out and validate your concerns.
posted by small_ruminant at 1:29 PM on September 12, 2012

cupcake1337, honesty is part of the code of ethics for therapists. The ones who lie (there are lots of therapists out there, I'm sure there are quite a few liars) are breaking their own rules.

Principle C: Integrity
Psychologists seek to promote accuracy, honesty and truthfulness in the science, teaching and practice of psychology. In these activities psychologists do not steal, cheat or engage in fraud, subterfuge or intentional misrepresentation of fact. Psychologists strive to keep their promises and to avoid unwise or unclear commitments. In situations in which deception may be ethically justifiable to maximize benefits and minimize harm, psychologists have a serious obligation to consider the need for, the possible consequences of, and their responsibility to correct any resulting mistrust or other harmful effects that arise from the use of such techniques.

Principle E: Respect for People's Rights and Dignity
Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination. Psychologists are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making. Psychologists are aware of and respect cultural, individual and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language and socioeconomic status and consider these factors when working with members of such groups. Psychologists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone activities of others based upon such prejudices.


(APA Ethical Principles of Psychologists and Code of Conduct)

In my experience, therapists lie to "minimize harm" generally only in cases where they say something like "of course, Bobby, I won't tell anyone about how your father sexually molests you," and go outside and call the police (and then explain to Bobby what they did and why.) Engaging in a long-term conspiracy is not generally seen harm-reducing. I've gotten plenty of unpleasant news, unhappy tidings, etc., from my treatment providers.

There's quite a lot of stuff in those guidelines about the use of deception in research (they have to explain it as soon as the experiment is done,) about interacting with your client's other mental health providers (talk about it with the client, proceed carefully,) about informed consent (the information has to be accurate and as complete as you can make it,) etc.

(In any case, paranoia is unhealthy. If you're worried about how your therapist and psychiatrist - or any other medical professionals - are coordinating your care, speak up and ask them to explain themselves.)

Also, your therapist may not have to give you all your treatment notes. Do not freak out if they refuse - if they do refuse, you can select another provider that they will have to give the full notes to. They can refuse to give you notes if in their judgment it'll do you more harm than good to read them.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 1:33 PM on September 12, 2012

If you think all therapists are trustworthy, you're out of your mind. Of course, no therapist will see what they're doing as "ganging up" but they MIGHT see fudging the truth, or lies by omission, or "honest discussions between two professionals that we aren't going to share with you because you might get upset" as "for your own good", no matter what the code says about self-determination. You might be okay with that in your healthcare providers, but I am not.

I know too many therapists to hold any illusions that they never end up on power trips or get all father-knows-best about their patients. If it's important to you, (and it isn't to everyone), find one who's not like that.
posted by small_ruminant at 1:46 PM on September 12, 2012 [1 favorite]

Once again, thanks for all the help. I've got a few recommendations from friends who love their therapists, so I'm going to follow up with one of those in the next week or so. I'll probably get some blowback from my psychiatrist, who often has this disapproving, paternal air to him (how appropriate), but the hand that writes the prescriptions rules the world. And we have a shortage of mental health professionals in our town, so I can't go doctor shopping as much as I would like.

I know I'm being irrationally paranoid about the doctor/therapist communication, but both of them specialize in addiction psychology, and both have picked up on one detail of my recent history (nightly drinking) and decided to run with it. I'm frustrated because it seems like my current inability to function has nothing to do with my former drinking, which I was able to stop effortlessly and which I don't miss. Unfortunately, any attitudes about alcoholism turn the claim of "I'm not an alcoholic" into proof that one is, in fact, an alcoholic. And I have been vehement about not going, especially because of the religious aspect, but both are convinced that meeting people who "are in my situation" would be helpful. Sigh.

As for the nutrition, I agree that there is a strong connection between food and mood. But I know that already, and my therapist tells me to cut out refined carbs and sugar, which I want to do, but not how to go about doing so when feeding myself is a daily, and not automatic accomplishment. This thread is making me realize I need to better consider what I want to accomplish in therapy. Perhaps that's a future question.

Again, thanks so much for your insight. You are wonderful.
posted by Lectrolamb at 6:07 PM on September 12, 2012

my therapist tells me to cut out refined carbs and sugar, which I want to do, but not how to go about doing so when feeding myself is a daily, and not automatic accomplishment.

AskMe is an excellent place to ask for suggestions in this area, BTW. If you post a question about it, you're likely to get both general ideas (learning to plan meals, figuring out what tasty snacks are both healthy and easy, developing a different relationship with food and cooking, etc.) and specific ones (recipes etc.).
posted by Lexica at 6:37 PM on September 12, 2012