I frequently get asked by people on the internet whether or not I think their therapist is good. For a variety of reasons, I usually do not feel comfortable answering them directly. However, I do feel comfortable writing about the subject here, as a sort of amalgamated response. As such, here are some questions I might ask such people, and here is how I might respond to their answers.
What does your gut tell you about your therapist?
I have learned that those who want my opinion generally have mixed feelings about their therapist, which is why they’re asking me. The problem I’ve noticed is that many people who are in therapy lack confidence in trusting their gut, and may have actually gone to therapy to become better connected with their gut in the first place. So that can make my question confusing to answer.
As a personal example, I recall my gut telling me that one therapist I worked with, back around 1999, was bad news. This was early in our relationship, but I so wanted to believe in her quality, and so wanted to have her like me and validate me, that I found it very hard to trust my gut. I ended up sticking with her for a year-and-a-half and replicating with her my childhood relationship with my rejecting parents — which is a perfectly common thing to do in therapy. The problem was, she, like so many therapists, was so much like my parents that she did nothing to help me resolve this core issue. In fact, I came to sense that she preferred my inability to trust my gut, because it worked to her advantage. She was a person of limited self-questioning abilities, she was unaware of these dynamics herself, I came every week like a hopeful and idealizing child, and I paid up on-time. What a farce!
What is your therapist’s opinion on psych drugs?
I don’t trust any therapist who is quick to suggest psych drugs, both because the drugs have lots of side effects and because they block people’s growth processes. The message in suggesting psychiatric drugs is this: “You can’t do the inner work yourself, thus you need a medication.” Not only is that false, but it undermines a person’s potential.
But what about therapists who are slow to suggest psych drugs but still suggest them occasionally, let’s say for more extreme problems like that thing known as psychosis?
Well, I don’t trust them either. My reason is that therapists who suggest psych drugs are really saying that what they have tried has failed and that they don’t know what else to do to be helpful. But really, what have they tried? How far have they gone to really be creative in the relationship? What alternatives have they explored? And how much emotional risk have they taken to self-reflect on — and be open with their clients about — their own shortcomings?
I recognize, however, that some people, especially if they are in great emotional pain, might wish to try psychiatric drugs. Although I don’t think it’s a good idea, and I’m all for exploring non-drug alternatives, ultimately I respect their choices. But that doesn’t mean that I support therapists who suggest the drugs themselves. I don’t.
How would your therapist work with someone who feels suicidal?
A therapist’s job is to try, by all means that respect a client’s autonomy and confidentiality, to prevent suicide. The best way to do this within therapy is to build a stronger, deeper relationship with the client. I’m against hospitalizing people or using any forms of force against them. Instead, the therapist’s job is to create an environment where clients can feel free to speak their minds and not have anything they say held against them. When a client — or anyone — feels heard, understood, respected, and welcomed in a relationship, things begin to change in them, such that they begin to experience the template for a more meaningful life. I’m not saying this is easy, because that has not been my experience, but that is what I’ve seen. In short, when there’s a strong relationship between a therapist and client — or between any two people — that relationship becomes a leverage against suicide.
Also, from what I’ve seen, if therapists are really afraid someone might kill himself or herself, they can always offer to see the person more often. See him or her twice or three times a week, maybe every day if possible. Lower the fee. Be more flexible. Be more honest. Talk on the phone between sessions. And explore ways with the client for him or her to engage more deeply with others beyond the therapy relationship. All of this is part of the real job description of therapist. And if the therapist is not up for the task then he’s in the wrong field.
That said, if the person who feels suicidal is not interested in engaging with the therapist in a more deep, meaningful, and flexible way, or simply is not able to, then I think it’s fair for the therapist, who naturally would be extremely uncomfortable by this, to talk about his or her feelings openly with the client and potentially extricate himself or herself from the therapeutic relationship. After all, doing the healing work is not just the therapist’s job. It’s primarily the client’s.
Does your therapist have children?
Although this question might seem odd, I find it important. Speaking generally, I am skeptical of therapists who have children. Too often they have, by becoming parents, stymied the potential of their own internal growth process. Also, with our world as screwed up as it is, and with this knowledge having been no mystery for the last fifty years, I am skeptical of anyone who has kids. After all, those who have children most directly contribute, and have contributed, to the problems of the world.
I am most troubled, however, by therapists who have young children. After all, their job is to give the best of their emotional energy to their children, not to anyone else. When therapists have young children, someone gets abandoned in the equation — either the kids, the therapist, the therapist’s partner, or the clients. And more often than not, to some degree, it’s all four.
Meanwhile, the answer to this question alone is not enough for me to assess a therapist’s quality. I have seen some simply rotten therapists who never had kids. And there are some therapists who have kids whom I think are far better than average, even brilliant in some ways. But for engaging with a therapist in the deepest work, I’d still prefer one who had no kids.
How much does your therapist charge?
From what I’ve seen, better therapists generally charge less money. They’re not in the business to get rich and comfy and they recognize that higher fees often just add to a client’s anxiety. Instead, they’re in it for altruism first. They want to help others, and wealth be damned. If this isn’t the case, they’re in the wrong profession. However, I understand that everyone needs to make a living. I was a therapist, after all, and had rent and student loans to pay. But I worked on a sliding scale, and a very sliding one, and I often asked my clients if whatever they were paying felt fair to them. If it didn’t, or if I sensed it didn’t, then it didn’t feel fair to me either.
Meanwhile, so often people have told me they pay therapists, often quite substandard therapists with a glossy exterior or some degree of fame, ludicrous amounts of money — on an ongoing, long-term basis. It’s enough to make me want to throw up.
Do you feel your therapist understands you?
I feel a therapist should have a quick, intuitive understanding of people — and a wide range of people. If you don’t feel your therapist understands you then I think this is a problem — and one that might well be worth bringing up in session. Who knows, it might lead to some unexpectedly fruitful discussion.
For me, I wouldn’t want to work with any therapist who I felt didn’t understand me pretty quickly. And personally I never did work with one who got me — which is part of why I haven’t been in therapy in years. Yet one might argue that my therapists did understand me and I just didn’t realize it. To that I would disagree. I know how it feels to be understood. It’s a totally different feeling for me than being misunderstood.
Also, therapy is probably the easiest place to understand someone, especially in light of their childhood history, because therapists have a great power, and even responsibility, to ask clients personal questions and create a safe environment to witness their replies. The problem is, to really understand a client, the therapist has to understand comparable sides of his or her own self first. And from what I’ve seen, a lot of therapists don’t.
Does your therapist love you?
I learned as a therapist that love comes in different forms. Not infrequently I felt love for clients in the first session. I could feel very drawn to them, have a sense of deep compassion for them, even cry with them. It didn’t always happen, but often it did. But there was another type of love, a deeper kind, which for me, I learned, took about six months at the minimum to develop. This second kind was based more on understanding, connection, and relationship — a real and personal relationship that needed time to develop. It was never an instantaneous thing. Maybe it’s a bit parallel to love in romance — the difference between falling in love and really loving someone.
I think everybody deserves a therapist who really loves him or her on that deeper level. But did I love everyone I worked with? Honestly, no, I did not. But I did love some people who most people probably thought were pretty unloveable, and also some people who probably were convinced that they themselves were unlovable. And I also came to learn that I don’t think I particularly helped the people I didn’t love. But why didn’t I love them? I think the reasons are varied. Maybe they weren’t that open. Maybe they weren’t that honest with me or with themselves. Maybe they triggered something in me, something unresolved within myself that blocked me from being more open or honest. Maybe we didn’t have enough time. Or maybe they hated me for wanting them to grow, because growth was so painful for them. I don’t know. It’s been five years since I was a therapist, which was, incidentally, the most difficult and confusing job I’ve ever done. I loved it, but I’ve found being a filmmaker much easier, and not even comparably so.
Meanwhile, I don’t think any of my therapists ever loved me. I only ever saw one for more than six months, and I’m confident she didn’t love me. I think my realness threatened her facade too much. I think she actually hated me for it.
How does your therapist act when you challenge him or her?
Challenging a therapist can foment a crisis — and crisis, as they say, is made up of two parts: danger and opportunity. To stick with the opportunity part, there’s a lot to learn in these moments of crisis. If your therapist is a jerk when challenged — gets defensive, becomes insulting, puts you down, tries to make you feel stupid, is rude, cuts you off, uses psychobabble, rejects you, never acknowledges what he or she is doing — then that’s a pretty good sign that your therapist isn’t much good. There are a lot of arrogant therapists floating around camouflaged, and sometimes their arrogance isn’t too noticeable until they get challenged. So I think it’s not a bad idea to challenge them, if, that is, you feel the urge.
However, sometimes therapists get challenged unfairly — get accused of unfair things, have words put in their mouths, have clients act out traumatic, historical, emotional dynamics on them, etc. These moments also tell a lot about therapists’ characters — in essence, their quality. For instance, do they still behave respectfully when under pressure? Or do they regress into childlike behavior? Do they blow up? Do they make threats? Do they start diagnosing you? Do they practice the silent treatment? In light of this, even a potentially unfair challenge is, in my opinion, actually fair — because it’s all an opportunity to learn.
I will admit, though, being challenged when I was a therapist could be exhausting. Yet I always felt it was part of the job. And I believe that if a therapist doesn’t see it that way, and doesn’t defend a client’s right to challenge, then he or she is in the wrong profession.
Is your therapist a radical person?
Perhaps this seems like a silly question, but I think it’s vital. Being a therapist is a radical job, because real healing — real growth — is radical. Also, the underlying thing that causes people to come to therapy in the first place — trauma — was radical as well, just in a bad way. Thus, a therapist had better be radical if he or she hopes to be up to the task of walking with people through their traumatic history on the painful journey to healing.
Me, I don’t trust therapists who are not radical people. If I were seeking a therapist I would want someone who has walked and probably still is walking their own lonesome valley, through hell and high water. I am and all the best therapists I know are still going through real and radical struggle. It’s hell to grow. It’s hell to be honest in this screwed-up, abandoning, and rejecting world. I wouldn’t want to bring my painful and radical issues to someone who is living in comfort and for comfort. I think they couldn’t help me. In fact I know they couldn’t, because no one who was particularly comfortable ever has.
What is your therapist’s opinion on psychiatric diagnosis?
For me it’s simple: any therapist who puts belief in the healing value of psychiatric diagnosis is not someone I’d want to seek for help. I have often thought that it would be easy (though pointless) to teach Kindergarteners to diagnose people according to the DSM. It would probably be easier than teaching them how to read and write.
Psychiatric diagnoses are not only simplistic, but actually tell nothing about how to be useful with people, that is, how to have a relationship with them. Being a good therapist is a gift — the gift of an artist. Diagnosing people is painting by numbers. But worse than that, it’s harmful. It blocks growth, spawns stigma, and muddies waters. And though it might comfort some people coming for help, for there are always people who will be comforted by the air of science, diagnosis doesn’t help people find their way out of the maze of trauma.
What is your therapist’s opinion on forgiving parents?
When therapists are quick to forgive parents their errors, and are quick to preach forgiveness, I am quick to say that I don’t trust them and I don’t want to refer clients to them. To me, forgiving parents is not part of the healing process, no matter what the Dalai Lama or Eckhart Tolle or Mother Teresa might have said. Yet so many therapists preach forgiveness. Why? Because they haven’t done much to heal their traumas and instead took on the mindset of their traumatizers.
Those who preach forgiving parents are really just preaching dissociation. No one who has really gone into the depths of his or her childhood despair and rejection — that ubiquitous childhood experience — would expect or encourage forgiveness. Instead they would respect the anger and sorrow and even rage that comes with breaking dissociation, moving through depression, and following the trail of grief. Healing is hell, and there’s no way around it. Often it entails breaking, and breaking deeply, from those who set up or even directly caused the trauma. To touch upon an earlier subject, this is another reason why I tend to mistrust therapists who have children of their own. So often when people have a child they are quick to realize how imperfect they themselves are as parents, and in so doing are quick to forgive the imperfections of their own parents. This might sound healthy on the surface, but I have observed that it’s a lot easier for parents to forgive those who traumatized them than to look at the ways they are culpable of replicating those traumas on an innocent other whom they created. To me, preaching forgiveness is a sign of a stymied healing process, and why would I want to go to, much less pay, such a person for my own healing?
Does your therapist work to recognize the traumatic roots of your present-day problems?
A good therapist works with you to seek out the childhood root of your problems in order to help you solve them. Our screwed-up behaviors and thoughts didn’t just come from nowhere. They are not chemical imbalances and you are not a freak of nature. Our problems are coded — and sometimes not-so-coded — expressions of what happened to us. They tell the stories of what others in power did to us and didn’t do for us. They tell of our history of pain and abandonment and loss and letdown and violation. They tell of our parents’ failures, both overt and covert, intentional and unintentional. If a therapist doesn’t seek to look at your life in the framework of your childhood history then how in the world are they looking at you?
Although I acknowledge that there is definitely a time to study and face the here-and-now and not put it on the back burner, any good therapist knows that those who do not understand and heal the wounds of their childhood history are doomed to repeat them. I have, however, observed that many people who come to therapy are not interested in studying their childhood. They may not even remember it — and may want to keep it forgotten. This can help keep pain at bay, but it makes it impossible to evolve. In fact, I would go so far as to say that if people in therapy don’t study their childhood history and make really good sense of it then they’ve never really engaged in therapy. And chances are such people will think this essay is a little, or maybe more than a little, crazy.
What if you decide you’re stuck with a lousy therapist and simply can’t find a good one?
Personally, I’d try self-therapy — or whatever word you want to use for it. That’s what I ended up doing — and that made all the difference. In fact, I think even if people do find a really good therapist it’s still in their best interest to simultaneously do self-therapy. After all, it’s not the therapist’s responsibility to heal you — it’s yours!
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.