Accountability for therapists?

[devils daughter]

As I mentioned in another post, I’ve been seeing a specialist therapist for about 18 months and --finally -- getting some help. This confirms my opinion a lot of the therapists I've seen in the past were useless to harmful.

Did any of them EVER send me a follow-up questionnaire or survey? (Just guess.)

Has anybody here ever received a follow-up questionnaire or survey?

Do the therapists WANT to know when they have been ineffective or harmful? Or is there such an implicit bias or stigma that the mental health professionals, and hence the profession in general, think that we, the mental health patients, don’t have any good information about whether the therapy has been effective or not.

Well, uh, duh!!! So the profession requires that we, the poorly functioning, mental health patients, choose our own therapist. But then, if it doesn’t work or is harmful, well, then, guess whose “fault” (socially) it is???

We’re functional enough to be responsible for choosing our own therapists, but then if it doesn’t work or is harmful, we are too dysfunctional to have a valid – or even partially useful – opinion about what didn’t work.

WTF????? Of course, these days what used to be called “mental health” is now called “behavioral health”.

Obviously, I’m a little angry, hostile, and sarcastic here. But given the social “power differential” between mental health patients and mental health “professionals” I’m not so sure that’s not a good thing. “Good” in terms of maybe connecting with frustration which other people here may have experienced?

Comments, anybody? Disagreement is OK.

[AmericanPsycho]

I had the same issue at the beginning of 2010. When I tried to hold the "professionals" assigned to my treatment plan accountable, I got booted and slapped with security blankets. The ONLY reason they got those security blankets is to stop me from successfully filing a lawsuit against them. What goes around came around and hit the NEC twice as hard as they did me. 12 staff members walked out soon after I was booted. What clients that weren't forced out quit and now get services at the Bowen Center. I see more and more refugees come to the Bowen Center every time I'm there for an appointment.

[Ralph]

The power differential is real. You're sticking your neck out to get help, that's why it takes courage to do so. Because the therapist has more power in society than the client, there is very little accountability unless they do something blatant like have sex with a client. Nothing about the quality of care or outcome is guaranteed to the patient and I think it is a minority of therapists who even care if their client is getting better, since a healthy client represents a decrease in cash flow. The good ones are fine with this as there are more patients waiting but those tend to be the ones that don't take insurance and anyway are not open to new patients.

[AmericanPsycho]

there is very little accountability unless they do something blatant like have sex with a client.

Mare Simone does. infact she's licensed to.

[Ralph]

I was not aware of that. Usually it is spelled out in the notice from the state board that sexual contact between therapist and client is not appropriate and the patient may bring a complaint to the board if such contact is initiated.

My point was that to DD's question of accountability for therapy that is harmful or ineffective there is very little in my experience. Usually the paperwork that is given at the start of treatment will contain a notice from the state board as to what constitutes misconduct and nothing about quality of care falls under that notice. One would think that in a professional field one could implicitly trust the provider, but as in any other business environment, "buyer beware" seems to be the rule.

[devils daughter]

Thanks, Ralph. I don’t think the “system” “should” be like that, but you’ve written a good description of the way things seem – to me, too -- to be.

That helps a lot, because then the question becomes why “should” I expect it to be different than it is?

Which I guess gets back to family-of-origin issues. Why "should" I expect my family to care about me? I need some more acceptance about that, too, I guess. But if/since they don't care, why do I care if I'm alive or not, well or not? Arghh. . . just goes round and round.

It's a pretty day where I am today. Guess I'll go outside some, play with my cats, and stop perseverating for a while.

[Ralph]

One of the CBT tricks is to replace "This should..." with "I prefer that..." So we "prefer that" the therapists have some sort of accountability (professional ethics, maybe?) regarding quality of care. However that does not appear to be the case except for individual practitioners who have a personal interest in how well their patients respond. This is not the state of affairs I would choose, but since the choice is not up to me, all I can do is make the best of a bad situation.

It might be worth asking about in a first visit with a new therapist, such as, "How do you monitor whether a patient is responding to treatment in the way you expect?" or something similar. If the answer is nothing or the provider becomes defensive the chances are he doesn't pay much attention to outcomes.

It is indeed a catch-22 as far as finding care in that if we were able to choose the appropriate provider we really wouldn't need any help in the first place. Yet you can only do the best you can with what you've got, meaning no we are probably not able to choose the best provider due to our own symptoms, but we can approximate an appropriate provider, make mistakes, learn from them, and hopefully judge who is a better provider after some bad experiences.

Not the ideal case but as long as we keep our eyes out for hazards and make progress in the right general direction, we'll eventually get to where we need to be.

PS- thanks for new word, "perseverating." Guess I'm guilty of that from time to time, too.

[frazzled1]

A man goes to the doctor for a pain in his arm. The doc is with him less than 10 minutes and says "you have tennis elbow. please pay the receptionist." The man says "I don't play tennis!" Doc, "doesn't matter. you have tennis elbow. please pay the receptionist."

When the man stops to pay the receptionist, he is outraged that the bill is $90. "For 5 frickin minutes!" and he scoffs off. On his way out, he sees a machine (like a vending machine), it says DIAGNOSIS for a quarter. This intrigues him so he takes a cup, pays the quarter, and pours his urine in. 1 minute later a receipt comes out saying "Your diagnosis-Tennis elbow." Now the man was blindly enraged so he takes another cup. This one he takes home, has his wife, daughter, and dog use the cup as well as himself then takes it back to the machine. He puts the quarter in and the receipt comes out "Your wife has VD, Your daughter is pregnant, Your dog has heartworms, and You still have tennis elbow."

It's kind of a stupid joke but I use it to illustrate that we can search for answers, pay for answers and never get them. Then out of the blue, someone says some random thing and we give ourselves a head slap thinking gosh I'm so dumb

[Stigmabegone]

Devil's Daughter -- yes, I think there should be accountability among the professionals for their behavior. I have also experienced a mind boggling disastrous therapy session with a psychologist that almost destroyed me. It was about 20 years ago and I still remember it like it was yesterday. I remember it, but I no longer dwell on it. I had to come to the point where I chose to let it go. I had to let it go and move on from the situation in order to treat myself.

Ralph -- thank you for your comment on "I prefer that" opposed to "should". That is an eye opener for me and something I will have to try to incorporate into my way of thinking because I am a huge "should" person.

Frazzled1 -- I appreciated the joke:)

[devils daughter]

Sorry, frazzled, I don’t get it.

If the doctor diagnosed tennis elbow when it was really cancer in the elbow, and the wrong diagnosis meant that the patient didn’t get treatment that could have saved his life, then I think that the doctor could be sued for malpractice.

Or if the doctor said that he could cure the tennis elbow and that it would cost $90 a week for a year and the treatment did nothing but make the elbow feel better for a few hours, then I think that is coming close to fraud. Of course, the patient might have something “wrong” with him psychologically (such as a personality disorder) so that he kept going back, but still . . . that’s why doctors have licenses to “practice”, to prevent people from being taken advantage of when they are ill and desperate.

My personality disorder has now been successfully treated, I believe. And so does my therapist – once again, her credentials are impeccable. And thanks to this innovative website I hope that I am learning how to function in society as myself and not a puppet or Southern-lady-robot.

But it has certainly not been so simple as a slap on the head.

It’s not just myself that I am concerned about at this point. As a member of society, I think that the lack of accountability is a social problem, limiting people getting access to treatment which can actually help them. I understand that 50 years ago there was no good treatment for personality disorders. Freud’s theory didn’t really apply and Freud himself said that personality disorders were not “analyzable” (in the sense of psychoanalysis).

At a personal level I have let go of my disappointments, frustrations, and hurts from bad and ineffective therapy. Getting good therapy has allowed me to do that. I do not think that any of the therapists intended to harm me.

So, in addition to helping myself to become better socialized, I have also hoped to use this website to try to alert both professionals and other people with mental health issues about some of the problems with the practice of psychotherapy that I have experienced.

I don’t see the humor in it. At least not right now.

[frazzled1]

DD it is a stupid joke and not about accountability so much as finding what you seek only when or where you do not look

I agree with your position on therapists though and what I think is that the "paper" does not equate to compassion humanity or even to sanity. It just says that you can be taught.

I think follow ups are especially important for the very reason that you expressed about the joke. What if it was cancer? Physicians do regular check ups and follow ups why then would it not be equally expected of a mental physician?

Physicians have a pain scale posted on their walls maybe we should petition to have a "how am I doing?" scale on the walls of therapists offices. It could work but who would we petition? Do you know?

[devils daughter]

No, I don’t know who we could petition. And there’s not really a group that I know of who could do it either. It would need more than one or two people to make an impact.

NAMI and other mental health consumer groups I am familiar with are mostly focused on the severe and persistent mental illnesses. There’s nothing for what I would call “moderate and chronic” mental illnesses, where the people can function socially – sometimes well, sometimes not so well. Obviously I think personality disorders would fall in that category.

Currently personality disorders have a terrible reputation. People think they don’t exist or that we can control them or just decide to get well. I had to get well myself in order to be in a position to dispute that. And in the process I think I am an example of what current therapy can do. In that respect I am the only ME that I know of, but I’m still hoping to find others.

I’m still bugging my therapist from time to time, too. But she’s busy with other things, such as just being a good therapist.

Anybody here interested in joining an advocacy group?