ON MENTAL ILLNESS: Psychotherapists; The Good, The Bad, and The Unworkable

By Jack Bragen
Friday April 18, 2014 - 10:57:00 AM

For many non-afflicted persons and not just those with mental illness, a good psychotherapist with whom you can talk can be an asset. And yet, not all therapists and not all therapy techniques are good for all recipients of therapy.

To begin with, if the therapist's paycheck isn't coming from you and is instead coming from a government affiliated and/or Medicare funded agency, then that therapist isn't necessarily working for you. In these cases, there can be several agendas at work other than just your recovery.  

If you are talking about Medicare rules, they appear to look at costs versus results. If someone can have their condition treated in a cost effective way and then can end up costing taxpayers less money overall, then Medicare is happy. For example, if someone is given medication and psychotherapy, and it prevents them from incurring spending in the criminal justice system, or prevents them from requiring expensive inpatient treatment, then the agency which is receiving those Medicare dollars has done its job.  

Thus, while your recovery seems to still be on the map, another primary goal of state funded psychotherapy is that you will end up costing less money to the government.  

However, some psychotherapy, such as when the therapist has ambitious ideas of a major therapeutic breakthrough, in effect just ends up stirring up bad feelings--and this can be counterproductive.  

The therapeutic cliché that you should be in touch with your feelings does not always hold true. In some cases, being in touch with your emotional pain can mean falling into a bottomless abyss.  

In the course of a therapy session, (if you are seeing a therapist who employs the model of releasing the bad feelings) the therapist will tend to maintain control of the session and will make you dwell on the negative. This can be quite painful, and it can feel like you are being tortured by this therapist. It doesn't very often help to dwell on the negative, since it reinforces a neural path that will create negativity.  

If it isn't broken, don't fix it. This ought to be the first rule that gets taught to newly licensed therapists.  

If a therapist is dealing with someone who already has a "system" that at least to some extent works for them, it should not be tampered with. (When I use the word, "system" here, I am not referring to a "delusional system" which is a bad thing--rather, I am talking about methods of approach to life situations and ways of problem solving.)  

If dealing with a therapist with whom the sessions are not going as you'd like, you can confront such a person and tell them specifically what's not working for you. If that doesn't pan out, it might be possible to go to the therapist's supervisor.  

Sometimes the therapist can get away with avoiding culpability by psychoanalyzing your complaint. In general, I feel mocked and cutified by this type of treatment.  

Some of the time, a particular therapist just isn't a match with you. In these cases, you should be open to seeing others, or to getting help from alternate avenues. Perhaps if individual therapy isn't working, you could try group therapy. Whenever you can describe the problematic issue and communicate what works for you and what doesn't, it puts you in a better position. It is not good to simply abandon treatment because one individual isn't helpful.