If counseling doesn't help, switch therapists

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This is the second in a six-part series that explores challenges people face when they seek treatment for mental health issues. The final two articles in the series will explore reasons for problems with care, and how to help yourself and loved ones to get care that works.

Monica grew up in a troubled household. Her father didn't hesitate to hit her mother or Monica or her two brothers, often with no warning. When she was in her 30s, Monica had enough self-awareness to realize that her childhood experiences were coloring her view of the world. Her relationships with her husband and children weren't what she wanted them to be, and she had trouble dealing with bosses at work.

She hadn't gotten much out of some earlier attempts to get talk therapy, but she was determined to keep trying. She found a counselor who saw her for free at a nonprofit that specialized in treating women who had experienced domestic violence.

Monica reports, "She helped work through family problems and helped me see how profoundly the violence affected me. But after a while she wasn't helping me, just consoling me, and even chatting like a friend. I fell into deep depression while having trouble finding a job and had persistent thoughts of suicide. This counselor would tell me what a great job I was doing looking for work, when I wasn't looking at all because I could barely get off the couch."

Monica continued, "Through all that I was seeing a psychiatrist quarterly who'd offer me an Rx (prescription) and lots of sympathy because I wasn't improving over the two-plus years I went to her. When I'd ask if I should change my meds, she'd ask me what I thought I should do, and made no suggestions."

It got worse. Even knowing that Monica was unemployed, when the economy tanked the counselor said that she thought there would be more suicides, since "if you don't have a job, what do you have to live for?" The thoughtless brutality of her offhand comment was breathtaking to Monica. Still, she kept going for treatment.

Monica recalled, "Since I was seeing a psychiatrist and a counselor, I couldn't figure out why I wasn't doing better. I hit a low point, and out of desperation starting researching depression treatment."

She found eye-opening insight from a depression support group and from a book called Depression for Dummies. Like all the books in the "Dummies" series, it was designed to demystify its subject and help people who weren't familiar with the topic to understand important basics.

"I learned that I should have been doing much better (after three years with the same counselor) ... I confronted the counselor in a fit of angry sobs, and she gave me excuses about how she wasn't trained for dealing with depression, just at counseling women dealing with domestic violence (as if those aren't related)."

Monica tried another therapist. "I then had one and a half sessions with a woman who barely spoke, just stared at me, and when I said I felt like I was talking to a wall, she said, 'Can't you hear yourself?' Then she fell asleep. I fired her on the spot, which shocked her."

Another low-cost service got better results: "I then went through a university counseling program for a year and a half where I was put with students in a master's program, and sessions were monitored via video or audio by professors. It was hard to keep starting over with new counselors each semester, but the program had written goals and regular assessments to check progress, which no other counselor had done, and at that point I'd seen many over 20 years. The goals, and my being more assertive in asking for what I needed, made a big difference."

Meanwhile, Monica switched psychiatrists. "The next one upped my meds dose, which helped a lot. But on my third visit I complained that the staff kept giving me appointments for 8:30 a.m. but no one was there to open the door until 8:45, and then the doctors were even later, which cost me paid work time when I temped. This doctor got really nasty with me and said I must be bipolar since no one with depression would complain."

That uncalled-for response was only the first of several salvos that led Monica to feel mistreated. She found another psychiatrist, who was patient and respectful. Monica made good progress with him until he moved away, and then she found another who also was a good fit.

Monica commented, "I learned that support groups are invaluable," when trying to find a therapist who is a good fit. On her own, she had no idea what questions to ask. She had also felt so beaten down that she wouldn't have made the effort to find a good fit, without the encouragement of her support group.

If Monica had it all to do over again, she would have insisted on written goals and regular progress checks right from the start. It can take persistence to find the right therapist. But it shouldn't have to take 20 years.

-- Next -- Stigmatized: dealing with doctors' dismissal of symptoms once you're treated for a mental illness

Elizabeth L. Bewley is president and CEO of Pario Health Institute and the author of "Killer Cure: Why Health Care Is the Second Leading Cause of Death in America and How to Ensure That It's Not Yours." To tell Elizabeth your story or to ask her a question, write to thegoodpatient@pariohealth.net.

Author: 
Elizabeth L. Bewley