Don’t Call Me a Therapist

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Editor’s Note: This article first appeared on Mad in Norway. The author, Erik Rudi, voluntarily relinquishes the authority of being a “psychologist” and “healthcare professional.”

In no way would I be offended or angry if you use the term therapist for me. I just think that it is your expression of a misunderstood, imprecise and outdated definition of what mental health work entails.

If you struggle mentally, it does not mean that you are ill. It is not you, your personality, your demeanor, your thoughts or your feelings that is wrong with you. It is an expression that you have encountered loads or challenges in the encounter with your surroundings, which have become too demanding for the psychological mechanisms that the same surroundings have equipped you with in the past.

It is psychiatry’s view of what mental problems are and how they arise which in itself is pathological.

Erik Rudi
The author, Erik Rudi. “Psychology as a field of knowledge is closer to philosophy than medicine, and is far from being a precise, scientific discipline. Psychologists cure nothing. They lay the foundation for personal development that can lead to improvements in mental flexibility, adaptation and functional level.”
Searching for a way through

It is not treatment in the medical sense that I practice or have practiced in my work as a psychologist. I do not carry out any form of intervention, neither surgical nor chemical. Everything I do happens in dialogue. I don’t manipulate thoughts. I don’t change the way you think. But I give you access to my professional perspectives and reflections, in the hope and belief that you will be able to use them for increased self-awareness and personal growth.

I am not seeking a cure for cognitive or emotional disorders. I am looking for a real understanding and effective problem solving strategies for the individual. I have conversation tools that give you good prerequisites to get to know yourself better and what works for you.

But I’m not a therapist. I am only an interlocutor with certain, specific knowledge that can sometimes be very useful. Conversations can be encouraging, give hope and motivation, increased acceptance or possible alternatives for action. The most important thing that happens in the conversations, however, is finding security for shared wonder and the search for new insights. The collaboration to look for a good and passable road.

I cure nothing

It is not particularly controversial to say that I personally am not your doctor or healthcare provider. But it immediately becomes more difficult for many to swallow when I claim that talk therapy is a contrived appropriation, and that no psychologists actually provide health care.

Psychologists cure nothing. They lay the foundation for personal development that can lead to improvements in mental flexibility, adaptation and functional level.

Psychology as a field of knowledge is closer to philosophy than medicine, and is far from being a precise, scientific discipline. Descriptions of causal relationships and selection of “evidence-based” approaches are little more than qualified guesswork with a certain statistical probability of hitting the target. Qualities and characteristics of individual stories cannot be operationalized and quantified with any form of precision or objective neutrality. The psychiatric diagnosis is a medical theoretical construct with limited epistemic validity. Psychiatric diagnoses are hypotheses and not proof of the existence of real diseases.

Diagnosis as a pivot point for investigation and selection of treatment methodology is a biomedical paradigm, which is not automatically transferable to the psychosocial part of the human mind. Nevertheless, standardized investigation with differential diagnosis as the objective and allocation of the “best available” treatment resource as the endpoint has become the only goal for how we meet people who are weighed down by the burdens from their difficult encounters with a society and a reality that constantly puts more pressure on the individual.

The power of diagnosis

The diagnostic doctrine leads to it being considered irresponsible health care to deviate even the slightest from the Health Directorate’s guidelines, symptom checklists and NOUs on therapeutic procedures and recommendations. Emphasis on the individual’s developmental history, individual characteristics and preferences must be justified by measurable figures, instead of by an absolute minimum of trust in the shared, relationally developed understanding that good conversations provide.

I have chosen to say “take from me the authority of a psychologist and health care professional” as a protest against a Norwegian healthcare system that, under the heavy influence of an industrial efficiency mindset (New Public Management), has moved from having the optimal health condition of individual patients as the main goal setting, to using the least possible resources for the highest possible average health benefit as a guiding principle.

The introduction of the health enterprise model in 2001 gave economists and bureaucrats the mandate to override health professionals’ arguments from a cost/benefit perspective, which effectively transforms health personnel from professional service actors to gatekeepers for resources and rights.

Diagnosis is your power, with all the associated risk of abuse of power that it entails. The power of definition and the prestige that lies in being able to categorize people as either healthy and useful to society, or as sick, requiring treatment and a potential burden on society, will be difficult for those who manage it to convey. Be it politicians, hospital managers, welfare bureaucrats, supervisory bodies, children’s services, psychiatrists, doctors or psychologists.

I waive the statutory duty to follow guidelines taken from a knowledge base I can no longer trust. To paraphrase the “Iron Chancellor” Otto von Bismarck’s statement about lovers and sausages: Anyone who knows how statistics and diagnoses are designed will never again have a good night’s sleep. I know the diagnostic system. That’s why I choose not to use it. Descriptive statistics cannot function as a pillar for mental health care.

Facing a paradigm shift

You do not need treatment. You don’t need a full-blooded psychologist with a bland, public approval and a body of law and a disease terminology best suited to lead vulnerable people behind the scenes. What you need is a conversational partner who is able to reflect, explore, illuminate and wonder, together with you, on your terms.

You need a relationship that provides fertile ground for growth and development. Such relationships do not grow out of the health authorities’ organization of services. They come from knowledge acquired through education and experience, personal aptitude, relational skills and a genuine desire to contribute constructively to the individual.

We must stop pushing ready-made investigation and treatment procedures linked to diagnostic assessments. We must start taking people’s own experiences seriously. I have no doubt that we are facing a shift in the approach to mental health, forced by the inefficiency and inadequacy of the current paradigm. Eventually, there will be too many stories about misinterpretations and misdiagnoses, failed treatments and harmful, conscious and unconscious abuse of power and stigmatization.

Angry, impatient patients, who want to come to the conclusion that they are the experts in their own lives, no longer want to accept the above and the restraint that diagnostic categorization represents.

Anecdotes become empirical evidence, if there are enough of them. Not that those in power will ever care about the evidence, but loud protests and a disaffected electorate are something they don’t like. In any case, mental healthcare must, in one way or another, move away from the biomedical disease model, and into a more humanistic, relational approach.

I know what psychology and psychologists as a professional group are good for, but I also recognize the limitations. The subject and the knowledge will persist and develop further. But the management and application of knowledge and human resources must change.

I start by jumping off the high horse that is the title of psychologist, and move on a level that allows me to look people in the eye. I don’t know more about you than what you tell me, and I feel privileged if you choose to share your story with me. Then, and only then, can we figure things out. Together.

And be so kind: Don’t call me therapist.

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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.

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32 COMMENTS

  1. “You need a relationship that provides fertile ground for growth and development. Such relationships do not grow out of the health authorities’ organization of services. They come from knowledge acquired through education and experience, personal aptitude, relational skills, and a genuine desire to contribute constructively to the individual.”

    Formal education can be useful, but it’s important to appreciate that living life is the best education there is.

    Nevertheless, Erik Rudi is both brilliant and brave.

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  2. “Psychological distress occurs for reasons which make it incurable by therapy but which are certainly not beyond the powers of human beings to influence. We suffer pain because we do damage to each other, and we shall continue to suffer pain as long as we continue to do the damage. The way to alleviate and mitigate distress is for us to take care of the world and the other people in it, not to ‘treat’ them… Most of the evils of our society and certainly by far the greater part of the so-called ‘pathological’ emotional distress experienced by its members, are more or less directly attributable to the unequal distribution of forms (usually economic) power which are abused and corrupting… Instead of abusing power, we need to use whatever power we have to increase the power of others, to take care rather than to treat, to enlighten rather than mystify, to love rather than exploit, and, in general, to think seriously about what are the obligations as opposed to the advantages of power. Ideally, the foremost obligation on power is to ‘deconstruct’ itself… Changes of heart would have little impact on the real world unless accompanied by highly organized or concerted action… But unless our society does mend its ways we may expect no improvement to occur in our private lives, no greater satisfactions in ‘relationships’; there will be no ‘breakthroughs’ in scientific or psychological understanding to patch up our unhappiness and allow us to carry on as before.”

    David Smail from “Against Therapy: Emotional Tyranny and the Myth of Psychological Healing” By Jefferey Moussaieff Masson

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    • “… But unless our society does [a]mend its ways we may expect no improvement …”

      And the real Bible does speak to the need for repentance, and changing from one’s evil ways. Even for those people who are behaving badly, due to the fact they’re working within bad, scientific fraud based systems … whether intentionally or not.

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          • Karl, I get the sense that you speak from a biased perspective.

            You don’t seem to appreciate the fact that the very idea of “mental health” is a problematic one that causes people to believe things about themselves that aren’t true and do things they don’t need with money they don’t have which makes the entire field of “mental health” inappropriate.

            IMHO.

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          • Birdsong – I can’t claim to be unbiased, but I don’t think that any of us can. I do agree that the idea of “mental health” can be harmful in many circumstances. However I do believe that in many circumstances it can be helpful and used constructively. I even believe that there are people who receive mental health care in our very messed-up health system (the messed-up nature of which goes well beyond mental health) who genuinely benefit from it and are not harmed. So I agree that the idea of “mental health” can be problematic, but that is sometimes and not always

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          • avoidable harm at that.

            I spoke with a Senator yesterday who wants to keep the human rights legilation in the States, and not bring it under Federal legislation.

            If they keep it ‘in house’ then the problems of the Feds looking at the levels of torture and ‘unintended negative outcomes’ can be manipulated a little easier. And the local corrupt officials are much easier to control.

            I asked him where the “competent authority” is that is spoken about in the Convention against Torture, and which I have a right to complain to…. but have not been able to find in more than ten years (the Chief Psychiatrist doesn’t know what a burden of proof is so he could hardly be described as “competent”). The Attorney General doesn’t know, nor a whole bunch of lawyers (including human rights lawyers). So it appears the ratifying of the Convention is nothing more than window dressing, while they use hospitals as torture center’s and claim they’re meeting the agreements they signed.

            It appears what they are doing is to try and fix the old farm truck with no engine or wheels with a can of WD 40, which allows them to look like they’re doing something about the torture of citizens and all the while enabling it. Justifying the failures by saying they’re working on fixing it…. despite knowing the laws we have are adequate.

            The laws we have work just fine if the people who have a duty to enforce them are not being criminally negligent. Its just that their conspiring to pervert the course of justice which is destroying both the health AND justice systems is going completely unchecked. And it then becomes an ‘election’ issue. Disgraceful, but I do believe that eventually the eagle will come home to roost.

            Swings and roundabouts of course, the human rights abuses are resulting in some people getting very wealthy. I think police are a little disappointed that they’re not getting a bigger cut of the pie, after all it wouldn’t be possible without their thuggery.

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    • I don’t totally agree with this, as the understanding most people have of where they have been and what they have done is woefully incomplete.

      With our current understanding of the mind, probably the best policy for most of us is simply to treat each other better. But ultimately there is more to it than that. There are trainings and therapies that CAN be done to improve our mental (and spiritual) abilities, and they are actually sorely needed on this planet.

      There are people on this planet who can communicate with animals. Most of them had to train themselves to do it. What they are doing involves real psychology! We should all have this ability, but here it has to be trained in because most of us are convinced we have lost that ability. Mental health isn’t that much different.

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  3. “Indeed, the superior-inferior, therapist-patient relationship actually stops us from coming to value and accept our own self. Friends and equals can help us discover the ancient wisdom that we should simply be, and that if we choose to do good things, it is not because we are trying to overcome our sense of badness but because being loving and kind and helpful and all those things that we call good gives us pleasure.

    When we accept and value our own self we cease to be afraid of other people. We no longer have superiors and inferiors, but only equals with whom we can co-operate and share while we take responsibility for ourselves. We can no longer feel deprived and envious, so we can abandon revenge and greed. We have leanrt the wisdom of Lao Tsu: “He who knows that enough is enough always has enough.” Because we value ourselves, we value others, now and to come, and the planet on which we all live. We reject those who seek to dominate and manipulate us, and who, in elevating greed, revenge and pride to virtues, place our lives and our planet in jeopardy.

    Obviously, if we all decided to accept and value ourselves, we would cause those who have power over us a great deal of trouble.”

    Dorothy Rowe from “Against Therapy: Emotional Tyranny and the Myth of Psychological Healing” By Jefferey Moussaieff Masson

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        • I’ve mentioned the book often on MIA. The very concept of psychotherapy is absurd, inasmuch as thoughts, emotions, and behaviors are incorporeal entities that cannot be healed in a truly medical, literal sense. I don’t believe that credentialed or licensed mental health “professionals” have superior knowledge, wisdom, and insight they so readily arrogate for themselves. Without the arbitrarily concocted categories, diagnoses, and treatments advocated by the ethically dubious panels of experts who cobbled together the work of fiction known as the DSM, what is the basis of the legitimacy and authority claimed by the motley host of LSWs, psychoanalysts, psychologists, clinicians, and other engaged in this disgraceful, fraudulent pursuit of money, prestige, and power?

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        • I was the one who mentioned Masson’s “Against Therapy” on this website. I”m glad that you found it meaningful and compelling.
          A couple of questions for the author of this article:
          1. If you don’t call yourself a therapist, what is it exactly that you are practicing? Are you a mentor, a guide, a counselor, a facilitator, or some other term in Norwegian with which I’m unfamiliar?
          2. If you reject the prevalent western medical/biophysical paradigm of mental disorders, what precisely is the legitimate source of the skills, insight, and knowledge for which you are supposedly receiving insurance money from your clients? What is it you give them that a group of unpaid, intelligent, non-judgmental peers cannot provide with equal empathy and understanding?
          Unless you or any other “mental health professional” can answer these fundamental questions, I can see no raison d’etre for this entire pseudoscientific scam.

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          • It makes sense to me that someone educated in the field of psychology, who then rejects the tenents of power and imposed pathologizing of a person’s emotional distress would likely be in a better place to provide assistance than most (not all) people could.

            I say this from my experience as a nurse. If I came across an injured person out in the field, my educational background and experience are likely to be more helpful than those without a medical background.

            Compassion, empathy, and respect for the inherent wisdom of the individual before us is essential to any relational interaction. And they go a long way in providing emotional support for a person in crisis, but education and experience can add insight and a degree of understanding to that mix, which would potentially offer greater and more expedient results.

            This is such an important discussion, and it gives me a modicum of hope. I’m grateful for that.

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    • Unfortunately, being kind and helpful and good is not always what gives people pleasure. In a perfect world, yes, that would be true. Our sense of our own shame and guilt is something that can be painful, but it can also drive us to grow beyond our shortcomings. We are not being taught to value compassion, truth, generosity, etc. In fact, much of what all of us encounter on a daily basis seems to be leading us away from humane regard for our fellow man. Among the “friends and equals” I have had across my 60+ years, even those who professed to hold the most moral and empathetic and loving views did not help me discover any such “ancient wisdom.” Unfortunately. And I have not run with criminals or stereotypical “bad actors.” We are all human and have a great capacity for self-interest. If you figure out how to teach people to accept themselves and see others as their equals, that will be wonderful. But it will take more than philosophizing about inherent good in our hearts.

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      • The passage is pretty idealistic, but for me the main take-away is how the superior-inferior therapist-client dynamic operates on the mistaken notion that people who seek help are intrinsically ‘disordered’ instead of what they most likely truly are which is terribly hurt and confused and that relationships that foster dependency (i.e. “therapy”) are inferior to finding connection and affection with people who genuinely like and accept them for who they are while treating them as equals (i.e. good friends).

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  4. It is only with this kind of thinking about “therapy” that psychology will remedy it’s identity crisis which came about because they aped psychiatric thinking and methods.

    The world needs more psychologists like Erik. Excellent article.

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  5. My first though was about the title of the article.

    “Don’t call me therapist” I wasn’t the one who started it with the name calling lol.

    I found myself pondering whether this ‘approach’ you speak of would have had any influence on my journey. I’m sure my situation is kind of unique, though the outcome after being viciously attacked by the ‘mental health professionals’ and their ‘administrators’ for speaking the truth looks very similar to what they call their successes (that is people who have been damaged beyond repair, the true goal of many a therapist and psychiatrist)

    I wonder about your approach being applied to some of our Afghan veterans (Australian) who have been exposed as committing war crimes for the US. Videos of them executing prisoners laying on their backs holding up prayer beads with the words “Want me to drop this c*&^t?”. See, they can’t speak the truth and must keep it concealed for their masters, which surely causes some sort of internal conflict. Like the child raping priests who had no means to confess their sins (knowing of the eavesdropping technique and ‘elegant method of overcoming resistance’) In that regard your von Bismark paraphrase may be significant. It explains how they got away with raping more than 300 children and Police say they never noticed. “insufficient evidence”. And when they do finally charge these individuals they wish to be hailed as ‘heroes’? One case the perpetrator (a footballer) has been charged after 56 years with the rape of a 9 year old girl. It was common knowledge that he was doing these things, but Police were ensuring that he was not charged. And they now disappear into the woodwork with their pensions.

    So I wonder how you listen to these stories, both victims and perpetrators and manage to maintain the ‘model’ you describe above? To do nothing about the perpetrators is to ensure that the victims can never grow, never heal? I get the feeling that had something been done about the people who tortured and kidnapped me (other than trying to snuff me for complaining) that the perpetrator might have changed for the better once out of prison. But of course he has an Order of Australia medal and has friend with power and influence ……. he’s done a few favours for some of the perpetrators mentioned above by drugging and incarcerating people who tried to complain.

    So in that sense your talking about a new field, and not the ‘therapists’ we have grown to despise for their breaches of confidentiality. Trust in haste, regret at leisure.

    Anyway, you’ll possibly never read this so …….,

    https://www.youtube.com/watch?v=cntvEDbagAw

    …. better think of your future,…….

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  6. Hello Erik,
    I agree. When I had a private practice, I sometimes would say to a client, “In the end we are just 2 people in a room being as honest as possible with each other.” Earlier I contemplated getting a PhD, but then asked how will this make me a better therapist. I concluded it would only serve to create a distance between me and my clients. Wanting to help as many people as possible I created a not-for-profit EMDR program that many therapists use to help people make changes more easily. If you are interested, you can see a UK Podcast where I was interviewed at: https://lockedupliving.podbean.com

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  7. I appreciate that this person who studied psychology has made a step forward in distancing himself from the “medical model.” But psychology should have no allegiance to a medical model anyway. Psychology is supposed to be the study of the psyche, which is not a medical entity.

    What is not yet appreciated by most psychologists is what the psyche actually is. I hope they some day soon make this breakthrough and begin studying what they are supposed to be studying. A few have.

    I am happy to see more articles here about spirituality. This at least takes us in the right direction. Though social justice deserves more attention than it gets, it is not really at the core of psychology. You could have a totally just and fair planet, and you would still have people with mental problems. Injustice is NOT the ultimate source of mental strife, though righting wrongs would help.

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  8. Great, then are you a therapist or merely a human being with understanding who is listening and responding honestly? But anyway, as a therapist, you can only listen to and understand another to the extent that you have understood, so let me ask you: what are you, actually? WHAT are you, not who are you? Are you thought, awareness, feeling, sensation, imagination or all of these things? What is thought, actually not theoretically? These enquiries are what they do in the Eastern approach to mind, which we are slowly drifting towards, and having enquired through perception, which every one of you can do also, this is what I find.

    There is just awareness, which is always ever there, which is always the same, which is never biased, which cannot itself be confused, which simply shows what is without labeling it, and because it doesn’t label anything or say what it is, because it doesn’t say anything at all, it can never be wrong. And because it never changes, it can never change and therefore can never be perverted or altered or corrupted. And because although its existence is proven with every colour seen or sound heard, if you try and grasp it or isolate it or find it’s form you cannot, because it is nothing, as in no thing, no thing or nothing at all, yet it is everywhere. It has no form so is pure emptiness yet is that within which everything is so is pure fullness, and this may sound like theory – it’s a simple attempt to describe awareness using words, which we never do in the West because it is so subtle, illusive, formless, ineffable. Everything else in awareness comes and goes, comes and goes, and is never the same from moment to moment.

    But thought pretends to be ‘me’, and lays claim to much else besides – it says ‘my’ feelings, ‘my’ awareness, ‘my’ body etc. Yet ask your own thought this question. Does thought even know what IT is? Well thought? Do you know what you are? Ask it! It says ‘no, I don’t’. So you don’t even know what you are, yet you pretend to know what everything else is by merely pointing at it and calling it a word? Obviously thought can know NOTHING. It says. It doesn’t know. And it says ‘I’, ‘me’, ‘mine’, but there is no ‘I’, ‘me’ or ‘mine’ besides thought – the thinker is thinking itself, is thought. And you are not thought but the awareness within which it takes place. And thought is a socially conditioned process, a mechanical process, pretending to be you. You may feel like moving your arm and then move your arm, and this is feeling manifesting as movement, but when thought controls the organism this is thought, i.e. socially conditioned life activity, i.e. society, controling you, turning you into one of it’s machines through which it maintains itself and carries out it’s operations. By thinking you were it, it became the subject. If you realize you are not it, you can hope to steel back your natural life from the unnatural total process destroying the health and sanity of each one of us within, and the whole world and humanity outside.

    They call me a psychotic. I say psychiatry and society are insane, and I’m a creature of nature, i.e. no more or less sane then a child, until it is conditioned by you, and then: ABC. 123. She is ill. Juggling knives, she carves up a meat sculpture. A meat and bone machine. A you and me. Frightened meat people. They buy happiness – that new green disinfected. Bleached the world with that: it happened.

    Black oil.

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