Real, Not Sham, Mental Health Coverage

Enrico Gnaulati, PhD
22
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A little-publicized legal decision was just issued by Judge Joseph C. Spero of the U.S. District Court of Northern California that anyone who plans to use their mental health insurance coverage to secure needed care will want to school themselves on. Ruling on a class action lawsuit brought against United Behavioral Health (UBH), a subsidiary of UnitedHealth Group, the nation’s largest health insurer, Judge Spero drew the conclusion that UBH had reneged on its fiduciary responsibility to policyholders by adopting treatment guidelines that focused on cost savings through limiting coverage to the management of acute mental health episodes.

Would-be seekers of quality psychotherapy ought to be reassured by Judge Spero’s remarkably humanistic assertions: “…it is a generally accepted standard of care that effective treatment requires treatment of the individual’s underlying condition and is not limited to alleviation of the individual’s current symptoms.” He added: “…the appropriate duration of treatment for behavioral health disorders is based on the individual needs of the patient; there is no specific limit on the duration of such treatment.” In essence, Judge Spero sounded his gavel in favor of mental health treatment of sufficient duration to get to the heart of clients’ psychological difficulties, not the all-too-prevalent model endorsed by health insurers and perpetuated by academic researchers: short-term, crisis-management, protocol-driven therapies measuring progress in terms of symptom reduction.

It turns out that when people are surveyed about their psychotherapy expectations, they value overarching qualities like enhanced self-respect, improved work functioning, and more secure relationships with significant others as desirable outcomes, more so than numerically-lower scores on symptoms (e.g., more tired than usual, fewer guilt feelings, less irritability). This squares with my everyday experience as a psychologist. The clients I see who are afflicted with depression tend not to view recovery in terms of fewer pessimistic thoughts, hopeless feelings, and less fatigue. They hold goals for psychotherapy that encompass the enduring presence of self-confidence, optimism, hopefulness, and enthusiasm. Large surveys of mental health professionals reveal they rank symptom reduction far lower than clients’ overall social and emotional well-being regarding what they believe constitutes a desirable psychotherapy outcome. In an international poll of almost 5000 psychotherapists spearheaded by David Orlinsky in the Department of Comparative Human Development at the University of Chicago, “having a strong sense of self-worth and identity,” “improve the quality of their relationships,” and “understand their feelings, motives and/or behavior,” were ranked first, second, and third, respectively, as psychotherapy goals to be attained by clients. “Experience a decrease in their symptoms,” was ranked fifth.

This begs the question: “How much psychotherapy does the typical anxious and depressed person need to achieve meaningful and lasting change in their emotional outlook?” A reliable source of information on this matter is the judgment of experienced psychotherapists meeting with clients, day in and day out, in the clinical practice arena. Drew Westen at Emory University combed through questionnaires completed by over 240 of such professionals and asked them to pinpoint the number of sessions received by recent successful completers of psychotherapy. The number ranged from fifty to seventy-five. Similarly, findings from the Tavistock Adult Depression Study showed that 44 percent of depressed clients who were provided with 18 months of weekly therapy to talk at length about their past and present emotional difficulties no longer met criteria for a depressive disorder two years after treatment ended. Only 10 percent of those receiving standard short-term, crisis-management therapy, or medications, achieved comparable gains two years out.

Sadly, current mental health treatment standards stray far from notions of meaningful and lasting changes to a person’s overall social and emotional well-being derived from emotionally-expressive, time-intensive psychotherapy. The field is saturated with formulaic, evidence-based treatments that are eminently researchable because they are easier to logistically manage and fund due to being short in duration (typically 12 to 15 sessions), lean heavily on workbooks for practitioners to learn cognitive-behavioral techniques whereby talk is largely restricted to changing unhelpful client thoughts and behaviors, and measure progress strictly in terms of symptom reduction on a checklist. Naturally, these treatments appeal greatly to accountability-focused, cost-cutting insurance administrators. But findings are cropping up questioning their effectiveness. For instance, a reanalysis of the landmark National Institute of Mental Health Treatment of Depression Collaborative Research Program data set conducted by Jonathan Shedler has shown that a mere 24 percent of depressed patients receiving short-term, cognitive-behavioral type interventions manifested sustained recovery at the 18-month follow-up period.

With political debates looming as to the preferability and feasibility of universal health care and Medicare for All, it is uncertain how the coverage and delivery of mental health care might fare under such arrangements. Let’s hope Judge Spero’s ruling in defense of mental health treatment of adequate length to achieve lasting improvement in personal well-being will not go unheeded as the debates unfold.

22 COMMENTS

  1. The perspective may be different, but the misinformation and stigma are the same. “Psychological issues” vs. social abuse and injustice. The latter is the cause, the former is the effect. Remove the cause, change the effect.

    NorCal is my turf, what I’m most personally and thoroughly familiar with re the mh world. And I will swear up and down that as far as “mental health, inc.” goes up here, it is in the toilet, doing all harm and no good, a ruanaway train of gross incompetence, delusional self-aggrandizement, and rampant power abuse. It is 100% elitism. This, I know for a fact. And that is the harm.

    This also includes all “advocacy agencies” up here, for whom I’ve contracted or consulted with many. They are pure shit double-standard hypocritical advocates for the system which funds them and gives them an identity, nothing else. In all the years I’ve worked with a variety of mh, inc. personnel, I’ve yet to meet someone actually qualified and skilled to work with the particular population for whom they are contracted to serve.

    Seriously, no people skills whatsoever, to say the least–basically, corporate drones and administrative bureaucrats is more like it. It is pure and unequivocal insanity. And I’ve no doubt anyone up here in or around this system will tell you that. It’s a very open secret.

  2. “Mental Health” care must not be reimbursed:

    1) The practice of psychiatry is charlatanism and no charlatanism must be repaid.

    2) Psychotherapy is only a cultural conversation and as such must not be reimbursed. Psychotherapy is in no way different from practices such as Catholic confession or Siberian shamanism; it has the same social function, the same methods and the same results. The reimbursement of some psychotherapists to the detriment of others is a caste privilege that reinforces the corporatism and institutional association between psychotherapists, psychiatrists and health insurances.

    3) Psychiatry must not be funded under any circumstances, and this judgment is bad news. It will allow psychiatrists to increase their income and plunder insurance and thus society as a whole, through contributions.

    You graduated psychologists, you are privileged who benefit from reimbursement for practices of charlatanism or cultural conversations. You are accomplices in psychiatry with which you share the same privileges, especially in terms of money-back and corporatist and institutional interests.

    Dare to pretend that you are better than a Catholic priest: do you have proof? You fulfill the same social function, you use the same methods and you have the same results. Your practice is not scientific, because it is not a technique practiced on an object, but a cultural conversation with a human being. “Technique” is actually “folklore”.

    Psychotherapists and psychiatrists are new priest, and like priest, many are crooks, many have unjustified and scandalous economic and social privileges.

  3. “…it is a generally accepted standard of care that effective treatment requires treatment of the individual’s underlying condition and is not limited to alleviation of the individual’s current symptoms.”

    First of all, a great deal of allopathic medicine is about treating symptoms, rather than treating the underlying condition.

    Second, the DSM itself confesses that there are no known etiologies/underlying conditions for any of their made up diseases, disorders which have all been confessed to be “invalid” by the head of the National Institute of Mental Health already.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

    He added: “…the appropriate duration of treatment for behavioral health disorders is based on the individual needs of the patient; there is no specific limit on the duration of such treatment.”

    Since the “mental health” field has wrongly been given the right to force “treat” their clients, “the appropriate duration of treatment for behavioral health disorders is” NOT “based on the individual needs of the patient,” it’s based upon the greed and lack of ethics of the force “treating” provider.

  4. It is very helpful for me to learn about the terrible experiences many of you have had with your therapists, I’m very grateful for that, and I’m not just saying that, either. I mean it.

    I wonder if I am the only one who feels that some of these responses are getting to be a bit of an echo chamber. I feel like sometimes one of you– often it’s Alex– will start off with a great post that has some insights I’ve never heard before, or a different way of framing an issue or problem. Then someone else will add something equally incisive or thought-provoking… but somehow, after about 5 or 10 posts, the thread has degenerated into something more like a Yelp review. The targets of attacks are indiscriminate, the ideas become more vague and repetitive, the ideas harder to follow.

    I would ask a few questions:

    Do you imagine that practicing psychotherapists have never been on the receiving end of abusive prescribing, bullshit happy-talk interventions, and coercion and manipulation by health care providers?

    Do you think it’s possible that maybe that’s WHY some of us got into the profession in the first place?

    Sylvain– do you actually confront individual psychiatrists on the job and challenge their prescribing practices? Or… do you just prefer to express your thoughts on blogs like this, maybe go to a few demonstrations, organize some letter-writing campaigns? I do not mean to insult you, only to challenge your thinking a bit. Because ‘raising awareness’ on these issues has not gotten very far in the US, at least, and direct action is impossible unless you have direct access to the individuals and social institutions perpetuating the abuse, yes? I grow weary of the academic conceit that having anything to do with an oppressive institution makes it impossible to avoid becoming complicit in it. Yes, that is often true… but not always, I think.

    Do you imagine that every therapist who accepts reimbursement from insurance companies follows the protocols that they ask us to follow?

    Do you think that insurance companies are somehow allied with psychotherapists? From my perspective, this is just an incredibly strange idea. It seems to me more likely that insurance companies are working as hard as they can to abolish psychotherapy completely, and I think one of the reasons for this is that psychotherapy sometimes really does work– and that means less repeat visits to primary care, less dependence on medication, and less revenue for the corporation.

    Sure, people told me I should be a therapist most of my life, and I’d always thought about it. But it was only after a dozen doses of Paxil shredded my entire sense of identity, and robbed me of happiness for nearly 6 years that I decided I had to try to make sure it didn’t happen to someone else. Not the only reason I chose the career, just the final and catalytic one.

    • When you work to reform something it has to have some value to begin with. Consciousness-raising is for the population as a whole, so that they can reject the psychiatric narrative and stop giving it power. Those who profit from fraud are generally impervious to reason and genuine information; the goal should be to eliminate their legal and social power so that it doesn’t matter WHAT they think.

    • Catalyzt, I appreciate the validation, I do try to move beyond the ordinary conversation but it’s challenging because I believe there are competing agendas and motivators in here. And I say this with complete neutrality because I also believe whatever is motivating anyone’s communication and perspective is valid, of course, whether we’re talking about beliefs, ideas, or emotional expression. We’re in murky waters with all this, nothing is terribly clear. But I do feel the agendas conflict more than harmonize, which may be why you are noticing what you’re noticing. Nowhere to go with that.

      My personal goals and motivation has everything to do with healing and personal growth & evolution (I happen to find these creative processes both fascinating and profoundly practical)–not just on individual level but also what I call “social healing,” which addresses marginalization as social abuse caused by the inherent divisiveness of the current “mental health practices” paradigm–starting wtih toxic psych drugs and bogus “diagnoses,” which make the division clear and palpable.

      But also I’m concerned about many things in this paradigm which are considered standard practice, which are more subtle yet equally powerful, if not more so, in a way which is potentially debilitating to the client. That’s a long list and I would not get into a discussion like that on here, it’s too complex. In short, I believe it can all be so risky for clients in all kinds of ways, short and long term.

      In general, I think it has to do with the parameters of the dialogue and the expectations and boundaries from such a relationship/contract. I think this is always really unclear, and there seems to be no intention of making it clear, which is interesting to me.

      I see “psychotherapy” as a service, whereas I have found often that a “therapist” falls into a counter-transference way too easily, and wants to become a surrogate parent or “best friend,” or something like that, and that is where I feel psychotherapy can fall off the rails and power/ego issues begin to compete, and it is not a fair fight because the client is open and vulnerable, as it should be for healing, but it should be SAFE, which so often it is not, pure and simple.

      To my mind, this should be a professional service, not a takeover of client’s life. I think this is where the dissonance is, and what causes serious problems. Transference/counter-transference psychotherapy is most commonplace, and is part of the education and training, and even history. I believe that is more about the therapist (i.e., ego) than the client, and can become terribly and insidiously abusive, in so many ways.

      Overall, I do agree with oldhead. I don’t think there is reform here, the imbalanced and divisive paradigm is too embedded. I don’t see how the field could function without it, that is the foundation of it. And yet I see it as the core problem, as far as healing goes. I had trained and interned as MFT, but I shifted to an entirely different way of healing when I experienced my own betrayal from the “mental health” field as client AND professional, and that became my new training and life path–energy, balance, grounding, natural and self-healing, all streamlined into ease and accessibility. I find it much more universal, human nature-based, and completely voluntary, supporting and encouaraging our uniqueness. These studies not only guide us in our healing (via self-healing), but they also raise our awareness around how we are co-creating our lives, to give us more control and power in that process. That information is gold!

      I do believe in what I’d call a “healing dialogue,” which requires a specific awareness around the energy of our communication. It’s something I practice and teach. I’ve facilitated quite a few group discussions this way, and they’re awesome, everyone feels expanded and grounded from it. A lot of healing and shifting happens, too, because it is in the moment and with a focused goals of clarity, walking our talk, and manifesting our way forward.

      I have to put politics aside when I talk about healing. The two do not mix, to my mind. Healing is about truth and authenticity, whereas politics is about social power. I’m only interested in the power of healing right now. I believe society calls for it.

  5. Thanks so much for that, Alex. As I was reading your post and writing this response, I found myself circling back to Gnaulati’s article, and the other responses, too– it all started coming together for me just a bit more.

    I can understand why you wouldn’t want to go into the long list of built-in problems with the paradigm, though it would be a fascinating conversation to have.

    My short version of it is, the two biggest baked-in issues are the exchange of money, and the transferential and counter transferential problems you are alluding to. The other one you identify– the ‘professional service’ issue– can be framed as a boundary problem, and I think the licensing boards and training programs are doing a little better job with those than they did 10 or 20 years ago. But like the first two, it cannot be completely solved. One sort of has to make an uneasy truce with all three of these, and those agreements have to be constantly reexamined and renegotiated.

    Of course there are others– if I don’t mention them here, it’s not because I think they should be ignored. Rachel mentions sexual predator therapists, and historically, this has been a huge problem. There was a terrible cult that evolved from a splinter faction of primal scream therapy in Los Angeles; it took forever to prosecute the ‘clinicians’ involved, but the case law that evolved completely changed the licensing process in California. It’s still a real issue, and it does still happen– I heard of one really shocking case during my internship.

    • I’ll tell you one thing that keeps going around in my head regarding all of this, which makes me eschew this particular psychotherapist-client paradmigm we have going on, and all the “social requirements/rules” that go along with it–

      During my training, one thing we were told repeatedly was that if we are to see a client outside the office–like, in the streets or at the store, etc.–the “appropriate” thing to do was to ignore unless we were approached first, to avoide SHAMING the client (so others wouldn’t know they were in “therapy”). This is common practice in San Francisco, where people run into others on the street all the time. I’ve had therapists do this to me, and it felt totally like snubbing. I always said hi to anyone I knew whom I saw in passing, including my clients. No one objected or felt “shamed,” of course not! Not only is this rude, but even simply philosophically, this is an extremely marginalizing social program which should not in the slightest be perpetuated. It CREATES and projects shame where none exists, or needs to.

      The reason I say it’s complex is because of things like ” avoid dual relationships,” which I believe is also a very oppressive and unnatural concept, but at the same time, it speaks to the boundary issue. It’s not so cut and dried, and it’s all going to depend on a person’s ability to discern between boundaries and what is naturally human. It all gets murky and controlling because these “relationships” are so poorly defined, and everyone seems to have a different idea of what is appropriate or not. What I learned in my training was definitely based on duality and division, and which to me, would only cause more trauma and splitting.

      I just think that when people “study” people, then we are forgetting how to RELATE to each other. Those are two different aspects of our brain, heart, mind, and being. I say we relate to one another, and stop studying each other. That’ll be a big change to come.

      My personal example of how convoluted reality gets when talking to a psychotherapist–the last therapist I ever saw (this was about 8 years ago) was at a public clinic which had one way mirrors as its walls to the street, so no one could see the waiting room and who was in it, and also a security guard just off the waiting room, who carried a gun. I told the therapist I was seeing how this could so easily elicit shame and fear for people, why such hiding and drama?

      Honestly, I cannot remember how he responded in the moment, but when I got my notes upon leaving (which I always recommend to people they stay on top of their casenotes, as God knows what can be written in there), he had written that I was feeling fear and shame. AHHHHH, made me want to scream. I’m over it, but it took a while. That felt like emotional rape to me, so invasive, twisted, and insane. Not a word I said was heard (other than those two “buzzwords” and totally out of context) and instead, this guy made up his own reality, projecting all of HIS crap on me. The gun is there because of THEIR fear, and I’m sure this would cause them shame to realize they feared their clients.

      What can one do? Abandon ship was my best option, and never look back. If only for the sake of my own sanity!

      • Oh, and btw, I did try to communicate with this guy, and with his supervisor, after reading these notes, and was stonewalled all the way. I ended up leaving a Yelp review advising people to get their notes, that it is their legal right to do so. And I made a film about all of this, with a few others, and sent it around the SF “mental health” system. Best I could do, that I could think of.

        The film did make an impact, this I know because word got back to me from a variety of sources, and I was invited to do screenings and to give workshops. Plus, an agency with whom I had worked and which had treated me very badly, thanks to blatant stigma, pure ignorance, and corruption, closed soon after I sent the film around, lost its funding from what I heard. Not what I was after, but they preferred to close rather than to dialogue, learn, and make some vital core changes, which is tragic.

        And I wasn’t slamming anyone in that film, but more so, trying to start a dialogue using our experiences as the starting point, from “the client perspective.” I’d never seen this before, and it was my attempt at opening a critical discussion about the “mental health” system, for the sake of everyone expanding awareness and learning from each other. Given the extraordinary number of homeless and marginalized people in San Francisco, I thought it was time to hear everyone’s voice at the table. But the hard lesson which I learned here is that, truly, there is no back and forth dialogue, that is impossible. Yet another problem here–no quality dialogue between clients and psychotherapists! How can a session, therefore, be productive?

        An up-close analysis of a typical client-therapist dialogue (if there is such a thing as “typical” in this case) would be most interesting and revealing, I’m sure of it. Were a client and a therapist from the same closed-door discussion to agree on the details of that dialogue, I’d be truly shocked. It would be a matter of who one would tend to believe over the other. Yet again, why I feel these 1:1 meetings can be dangerous and do quite a bit of damage to an unsuspecting and vulnerable client.

  6. Yeah– the discrepancies between what the client heard and what the therapist heard– if that is not approached from a position of mutual respect and genuine open-ended inquiry, that could be extremely damaging. I have one or two clients where this does happen occasionally. The client will say, “Last week, you said X, and I felt like you were angry at me.” The natural, and (in my opinion) completely wrong thing a therapist could say in this situation would be, “No, actually, here, look in my notes, what I said was something different, obviously I wasn’t angry at all.” Or, even worse, to write in their notes, “Client is being manipulative, exhibiting borderline features,” etc. That sh*t makes me want to hurl.

    How about, “Gee, I didn’t feel like I was angry at you– but maybe you’re on to something. Maybe part of me was irritated, or frustrated, or maybe I really was angry and didn’t know it. I’m so sorry that happened, and for my part in it. Let’s try to figure out what was going on.” I think therapists sometimes are afraid they will be sued for admitting they might have made an error– or that they might have been human. And that makes absolutely no sense; the real liability– both emotional and legal– comes from dishonesty and inhumanity.

    As for the advice to ignore people, I never considered exactly why that bothered me– but you’re exactly right, it does reinforce the idea that someone must be terribly damaged to want to seek professional counseling. Fortunately, at the clinic where I trained, my supervisors kind of said, “Well, in our community, that’s sort of impossible, just don’t reveal your a therapist– if your patient reveals it, limit disclosures.” And on a college campus? It would be impossibly rude and bizarre to be in line with a student at the cafeteria and not even acknowledge they were there! It’s also incredibly patronizing to assume that the poor, helpless patient has no idea where the boundaries are, and they need me, the mighty dream warrior, to help define the limits of the exchange. Sure, if someone started talking about something too personal, I’d absolutely change the subject– but in the real world, this seems to almost never happen, and the cost of not acting like a human being is way higher.

    Your experience at the mental health clinic sounds… kind of surreal, and not in a good way, more of the bad-acid-trip Clockwork Orange variety. Maybe someone should write an article for Psychology Today listing things you never want to have in your mental health clinic:

    * Muzak in the waiting room.
    * Television tuned to station that blares propaganda
    * Comics to ‘warm up’ the audience

    Particularly to be avoided:

    * Mirrors– one way or of any kind, except in the bathroom
    * Guns

    Thanks again for this, Alex. You know, I think part of me likes to pretend that this doesn’t go on, that the only abuses of power are the more routine issues that I hear about more often from my colleagues. And I very much appreciate the spirit and tone of your posts.

    • Catalyzt, wow, I feel heard! Thanks for this. Your comment is wonderful through and through, and on point. A few things I want to highlight here and respond to–

      “The natural, and (in my opinion) completely wrong thing a therapist could say in this situation would be, “No, actually, here, look in my notes, what I said was something different, obviously I wasn’t angry at all.” Or, even worse, to write in their notes, ‘Client is being manipulative, exhibiting borderline features,” etc.’”

      Yes, this happened to me, exactly. I come from my heart and reveal myself honestly for the purpose of examination, and I never had any inkling of “personality” issue. I had anxiety and depression, and have always tended to be respectful (not perfect, but not anti-social, either). If this were not the case, I never would have had a successful career, friends, or have been partnered/married for going on 34 years now, in a very loving and mutually respectful, symbiotic relationship.

      But then this came along, what you describe. Trying to heal, I instead fell into the system and got trapped by exactly this way of thinking, which blindsided me completely, and also where I started to wake up. This was only the beginning.

      “That sh*t makes me want to hurl.”

      That shit almost destroyed me, my life, and that of my partner.

      “Let’s try to figure out what was going on.”

      Yes, that would be sound and reasonable, to examine why there might be miscommunication going on. It takes two to tango. To put it always on the client (which is the norm, AND the education and training) is to scapegoat, which is marginalizing and abusive. It’s also completely unrealistic and would indicate avoidance and delusional thinking on the part of the therapist. RED FLAG!

      “I think therapists sometimes are afraid they will be sued for admitting they might have made an error– or that they might have been human.”

      Yes, I believe both are true—the first one being “fear-based” (paranoid) and the second one being self-aggrandizement. Both are problematic when working with clients. These are the energies and beliefs which get transferred, and it’s a big mess for the client.

      “the real liability– both emotional and legal– comes from dishonesty and inhumanity.”

      Indeed, unequivocally, and without question!

      “Your experience at the mental health clinic sounds… kind of surreal, and not in a good way, more of the bad-acid-trip Clockwork Orange variety.”

      LOL, very well put and yes, I’ve called it going down the rabbit hole, through the looking glass, etc., but you say it well! Fortunately A Clockwork Orange is one of my favorite films of all time (from a filmic perspective–Stanley Kubrick is an artist hero of mine), so perhaps navigating this was my own personal surreal film to live—although I am not the Alex as in that film. I was not a Droog nor anywhere near that, nor am I a lover of ultra-violence nor violence of any kind. I am a peace-lover, and I embody that. That’s my entire reason for living, and what I healed inside of me—the trauma based on emotional violence in my childhood home due to textbook family dysfunction.

      My family is from the academic world, the fighting was almost purely psychological, and it was fierce, powerful, insidious, tortuous to the mind, and wounding to the heart and spirit. I had to go to great lengths to heal all of this, especially after the mh world and practices buried it, then perpetuated it, and the trauma snowballed, until I went to energy healing and grew wildly in my self-awareness. That was shocking and necessary, and most importantly, it was effective. Awakening always is.

      I would expand your statement, however, to my “experience in the entire mental health community of San Francisco” was “surreal, and not in a good way…bad acid trip…” That was 17 years worth, total, even though I was involved in other communities at that time as well (mostly theater and LGBT communities, where I had no social issues like I did in the mh world–that was unique for me).

      Started in graduate school, where these issues surfaced for the first time. I did not hide that I had a diagnosis and was on “meds” (as I called them at the time, now “toxic psych drugs”), and I had been all during my first career in retail management, and I turned that into an asset as a psych grad student.

      But it wasn’t long before a professor began to give me a really hard time–including trying to get me kicked out of school, at which he failed because it was not merited, I had an excellent reputation otherwise–all based on what I was revealing in my assigned papers, as per the assignment! This was an experiential program, so we were expected to talk about ourselves honestly. Oops! That’s where things started to get rough for me, and that downward spiral continued through my internship and upon graduating. That’s when I came off the drugs due to side-effects, and went into the system. Double whammy!

      From day treatment to voc rehab to professional “advocacy”—and with all kinds of clinicians along the way—it was a banquet of the absurd. I had no idea what world I had fallen into, but I wanted out. My challenge came as I realized that I could no longer tolerate this community, that it wasn’t sound, and no way I was compatible with it.

      Yet, I know I have a calling here, that bell went off big time for me, and this is corroborated by teachers, my partner, and my clients. It is evident by my way of being, and also by my life experiences, which were not all of my conscious choosing, of course. Otherwise, why would I have experienced all of this madness, only to heal from it so spectacularly?

      So I switched healing tracks and found my path. I can integrate much of what I learned here, but most of it is useless without certain awareness and tools which, in the end, actually undermine the traditional mh paradigm, simply by definition. That was my experience, in any event.

      But in the end, it was all shit, pure shit programming with the end result of projecting, marginalizing, and stigmatizing. That ruins people, it stands to reason. Can’t say it any other way and be totally honest about it.

      I can get angry thinking about it, but for me this was long ago now, and I don’t like thinking about it because it is so stonewalling, it makes one feel absolutely powerless, and that is the feeling that is most transferred to clients. That is bad, and not how I go around feeling in the world. We all have our power, but it is undermined by these standard by-the-book and bequeathed professional manipulations.

      “I think part of me likes to pretend that this doesn’t go on, that the only abuses of power are the more routine issues that I hear about more often from my colleagues.”

      Thank you for owning this, Catalyzt. I’m sure you are not the only one. However, I’m also sure that we both know that waking up is a good thing, even though it may mean waking up to hard truths. Well, truth feels better than lies, and way deep down inside, we all know truth. When our conscious mind is in agreement with our unconscious, then that, I believe is the first step to real freedom. When these are split, that is a constant struggle. But in synch, we can manifest our way forward with relative ease.

      Thanks for your honesty and openness, and for how you are taking in this information and processing it. And especially for wanting to do right by your clients. We all deserve to be well and happy, if that is what we most desire. For the mh world to be a booby trap like this is what I’d like to see change, one way or another. And if it can’t change, it should not exist! There are better ways of finding inner peace and well-being.

      Many of our experiences with mh have led us in the opposite direction, and we have no legal power to demand reparations. I was simply sabotaged repeatedly by my own colleagues (because I’d been a client) and sabotaged by my peers in the system (because I’d been a therapist). Another great film/book of that same time: Catch-22!

      Fortunately, I found my way forward despite all of this, and, in fact, learned how to perceive this is my guidance. That’s exactly how the change in perspective worked for me, and I disidentified as “victim,” and instead became what is known in the energy healing world as a “co-creator” which has to do with manifesting. That is our true personal power, that of manifesting.

      Still, I should stop talking about it because it riles me to think about it, and to think about a lot of people whom I feel very strongly should be legally reprimanded. It all feels like such a stalemate to me, no movement, really. Blech.

  7. Thanks, Alex. There’s so much in that message I’d like to talk about at some point– I did most of my training in the LGBTQ+ community, and I share your feelings about how supportive an environment that was, among many other things. But I also hear you about needing to stop talking so much, so this is a good place to sign off. I was particularly moved when you said this:

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    I choked back a sob, took a deep breath, and had a moment of clarity: I realized that my own truth is that there’s some personal business I need to take care of– that I have to be more mindful of self-care particularly in early winter and late winter/early spring when my caseload is very high. I get isolated, I feel like I don’t need to spend time with family, friends and colleagues, and that is a yellow flag– I’m putting myself, my friends and family, and the people I work with, at risk.

    I slammed the laptop shut and called an old friend; we talked on the phone for hours. I’m packing my bag right now, and heading out to spend a night in the country with my wife and the dogs.

    Apparently, I came to this blog to find something, and for the moment, it very much seems like I found it.

    I bet you’re pretty damn good at what you do. We’ve never even met in person, but I feel a lot better after hearing what you had to say. I’ll be back in a week or so. Thank you, I am very grateful for your thoughts and feedback, and I hope I can repay the favor someday!

    • Your response is so gracious, Catalyzt, thank you. And I’m extremely gratified that this has been of such value to you, that is always my intention when I speak about my experience as I do.

      I was feeling it as I wrote and it’s always a bit of an emotional adventure to revisit, but of course whenever my experience and perspective can be of value to others either personally or professionally, I’m very amenable to a hardy and productive back & forth. It is always healing to me, one way or another, and I enjoy hearing about others, too. Really and truly, any time!

      My particular passion is how the human spirit unfolds during this lifetime, that of mine and others, such an amazing (understatement) creative process. It’s really quite something from that perspective. I love experiencing and witnessing that.

      Enjoy your nature-filled getaway! Sounds awesome 🙂 I live among the Redwoods now, and it’s Heaven on Earth. Most healing thing ever.

      PS–I just realized your post was made a few days ago, sooooo, I hope your getaway *was* replenishing!

      And also, if you were to want to speak in private, please feel free to contact me through MiA. I’m sure Steve will be happy to forward a message to me, and I’ll respond. Email, phone and Skype all work for me.

  8. Whoops– the quote got deleted from my post! It was:

    “Well, truth feels better than lies, and way deep down inside, we all know truth. When our conscious mind is in agreement with our unconscious, then that, I believe is the first step to real freedom.”

  9. The best therapy I had ever heard of lasted one session. A guy I knew had been diagnosed with a hopeless condition called epilepsy. What was incorrect about the diagnosis was the permanence of his seizure condition. It is very common for teens to have seizures resulting from rapid hormonal changes. Without realizing that the epilepsy was temporary, he got a vasectomy, because he felt it would be irresponsible to pass along a disease to any offspring. Then he found out the truth: He did not have a seizure disorder anymore.

    The man became despondent over this. He bemoaned that he had destroyed his chances of having children. He even became suicidal. At this point, he decided to try therapy.

    The therapy lasted one session. The therapist told him that usually, vasectomies can be reversed. This bit of information-sharing was all the man needed, and thankfully, the therapist knew enough not to turn him into a permanent mental patient. The man had the necessary surgery, went on with his life, and was never suicidal after that.

    Unfortunately, this is not how it usually goes. People get addicted to the appointments and pampering, end up with the nasty habit of too much self-disclosure, become self-absorbed, and all this leads to chronicity. Therapy can be an awful crime, a terrible thing to do to a person.