Dear soon-to-be former therapist,
My husband and I came to you for the reasons most couples seek therapy: we needed help and the conventional wisdom is that a therapist’s office is where to find it. But when I would relay something my husband did that was hurtful or difficult, you would invariably instruct me not to “take it personally.” He failed to do something that I depended on him to get done? Don’t take it personally. He yelled “I felt no love for you on our wedding day” in a fight-or-flight moment during a volcano of a row? Don’t take it personally. He forgets whole conversations that involve plans with or commitments to other people? Don’t take it personally. As if the problem is not the thing not finished or the broken trust or the strained relationship but my feelings about these otherwise ostensibly neutral incidents.
My efforts to explain the problems with this approach have not budged your needle of understanding, it appears. Like a good client, I at first blamed myself, thought this failure of communication was because I wasn’t being clear. I tried different ways of explaining as I thought of them. You at one point accused me of repeating myself. I considered that perhaps I was wrong and that the problem was really that I was taking my husband’s broken commitments and his failure to follow through personally, that those issues were his issues, not mine and I was letting them affect me too much, not focusing enough on the good things or the overall nature of our relationship (which, despite the sounds of the snippets here, is genuinely positive).
But that thing that has always bothered me about therapists — that thing that kept me from seeking their help or any help for over a decade after I realized I needed some sort of outside assistance — wouldn’t let me lay the blame for this on myself. What has always bothered me is the attitude of those in the mental health field, the questionably named “helping” professionals, that they can never be wrong and that any friction or trouble between therapist and client must be due to that client’s diagnosis (or that the client needs a diagnosis). Because “the therapist is always right.”
I think I’m finally starting to understand why you keep repeating “don’t take it personally.” That’s your motto. That’s how you continue to excuse yourself for any possible mistake you could be making in relationship with me. That’s how you can treat my husband and I very differently in session and not even consider the possibility that this may be an impediment to whatever work you think you’re trying to do with us. You tell me not to take things personally because that’s what you do. If I react in a way that would otherwise indicate that a change of course is needed on your part, you don’t take it personally. If I straight-up tell you that what you’re doing isn’t helpful, you don’t take it personally. If my husband and I are making no demonstrable progress on the areas we ourselves have identified wanting to make progress on, you don’t take it personally and assume maybe we just need to find another therapist. That’s how you resolve the cognitive dissonance of encouraging us week after week to look inside, examine our own shit and so forth, while feeling no need to do so yourself. That’s how you maintain the paradigm that whatever you’re doing must be helping despite evidence to the contrary: because that evidence — me leaving session after session in tears (and conveniently blaming myself for failing to regulate my emotions), me “repeating myself” (which I conveniently felt bad about for “being stuck,” “fixated” or “holding a grudge”), us getting into arguments that detracted from the attention my marriage needed (which I conveniently understood as my anger problem), etc.
That’s also how you feel okay with the incident that will end our therapeutic relationship, or at least have shown no indication of being disturbed by it. I was immediately upset by it but attempted to find things in myself to work on rather than strike out (as you’d been directing me to do since lashing out is apparently always dysfunctional). That is, until I got outside affirmation that what happened was not okay.
You ask us how we want to use the time today. My husband, with my hesitant permission, brings up the issue of my increasingly frequently and strong suicidal thoughts. It had been hard enough to tell him; I wasn’t at all sure I was prepared for the equivalent of a “don’t take it personally” in this situation. But the suicidal thoughts were an issue in our marriage and we were, after all, in marriage counseling. Plus, I truly wanted help. I had been wanting help for ten years and hadn’t been able to identify appropriate, affordable or accessible versions of it.
I was bracing myself for some sort of “contract for safety,” one of those patronizing documents that professionals sometimes require their clients to sign stating they won’t kill themselves between the time the session ends and the next session or something like that, which are really more about liability and the emotional ease of being off the hook for the therapist than any sort of effective support measure the person brave enough to have broached the topic was seeking. I was prepared for you to ask me direct and uncomfortable questions about whether or not I had a plan and if I had the means to carry it out. I was even prepared for you to present a release of information for me to sign granting you permission to speak with my individual therapist, who had recently dismissed my request for help constructing a safety plan — steps I could take if the dark thoughts and feelings began to overwhelm me — because he’d judged that in the past I had done better and made more progress during the time we did not have a safety plan than when we did.
In fact, what you did was worse than what my individual therapist did. My individual therapist at least gave me the dignity of a conversation, which, given how that conversation went, I hadn’t thought to be grateful for until our session with you. His clinical assessment of our work with or without a safety plan was sloppy and did not take into account any confounding factors, yet he was so certain of his opinion, and of his helpfulness, that my advocating for my needs — in this case a safety plan that involved more than self care but the real, actual, invested care of others — was construed as manipulative, attention-seeking and over dramatic. I basically had to convince this guy that I was suicidal “enough” to need the “extra” support of asking for other human beings to be involved in my healing. What could be worse than all that?
You changed the subject.
In the Adult Mental Health First Aid training I attended a few weeks ago as part of my job as a social worker at a crisis center, this is the first thing they tell you not to do. Even before the training really starts. Even before we get to the specific unit on suicide. Just like the cardinal rule of scuba diving is “never hold your breath,” the first rule of mental health first aid is take suicide seriously. To do that, one has to stay on topic. The material on suicide went over in depth, in various scenarios, how first aiders should address suicide and then we were required to practice. It appears that you have either never heard, did not understand or do not remember this vital information, which I can’t believe wouldn’t come up in at least one class required for your license-qualifying degree, so here are the guidelines again:
- Ask the person directly about thoughts of suicide. Do: “Are you having thoughts of ending your life?” or “Are you thinking about killing yourself?” Do not do: “You aren’t thinking about killing yourself, are you?” or be vague, indirect or ask about “self harm.” This, to many people, is a separate action with separation motivations than those related to suicide.
- Remember that you are not planting the idea in the person’s mind. It’s likely already there and they are waiting for you to bring it up because of the bogus and life-threatening stigma associated with suicide (or any level of despair, really).
- If the person answers affirmatively, ask if they have a plan.
- If they say yes, ask if they have the means.
- Either way, do not leave the person alone until you can get them to professional help.
And here’s where we have a couple of problems. There are definitely problems with the Adult Mental Health First Aid curriculum; they are outside the scope of this letter aside from the last step, which advises seeking professional help. It’s not like we have specific mental health paramedics we can call to rush to the scene like we do for physical problems — which, by the way, shows that despite our culture’s rampant adherence to the biomedical model, the mainstream does not actually believe in the equivalence of mental and physical illness. We call 911 for mental health emergencies, or we call the police and either way, we’ve generally made the situation worse. The point is that it can take days to weeks to get “professional” help for mental or emotional distress. Even if our approaches (or lack thereof) to mental health were not “leave it to the experts, friends can’t do anything,” it’s not possible to accompany another adult for the days or weeks they have to wait to get an intake at a professional’s office.
We have now arrived, squarely back in your office, at our second problem and the reason I’m writing this letter. Even if the first aider managed to stay with the suicidal adult for the days or weeks (or, in our specific case with you, months) until their intake (or the days until their next appointment provided they had a therapist already), the odds are that, whatever they find in that office, it will not look or feel like help. Why?
Because your colleague dismissed it and you changed the subject and it was not because you simply missed what my husband said. I get that you are a couple’s therapist and your job is to home in on the patterns in the relationship between the two parties in the room, but there is no justification for not even acknowledging that my husband just reported that his wife is experiencing increased suicidal ideation and that maybe, just maybe, it’s affecting the marriage. He asked how he could be supportive of me. He asked for resources. He took my suicidality personally — as in, he personally decided to do what he could about it and to expand his existing knowledge where he felt limited.
Why is it that members of the community who have no formal education in psychology or counseling or therapy like myself are receiving more training in compassion and effective responses to the public health crisis that is suicide than “professionals?” There may be flaws in said training, yet the nonprofessionals I’ve come across in the community as well as my coworkers at the crisis center who do not have formal education in counseling or psychology are far less pathologizing, cold and judgmental than those with licenses to “help.” Why is it that “mere” first aiders, volunteers who care, are being instructed to actively care while you and your colleagues evidently are not? Why is it that effective care is free while you and your colleagues feel fine charging money to ignore, dismiss or invalidate your clients? In not even acknowledging what my husband said, but “moving on” to “more effective” topics like “what’s happening between he and I,” you failed, in the name of “helping,” to take me, my husband or our relationship seriously. You also failed to take suicide seriously. I take that personally and I hope that someday you do too.
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.