How not to be a therapist

Tuesday August 31, 2021

Prince Harry’s very public travails made me recall my own experiences of psychotherapy, good, bad and inconsequential, mostly the last. Various things can go wrong, including having it in the first place, the type, the therapist, the themes and the outcome.

My worst experience was of so called psychodynamic psychotherapy. My bipolar illness was not correctly diagnosed till 10 years later. I had had a 5 month hospital admission with recurrent depression, treated with ECT (electroconvulsive therapy) and medication. I was a psychiatric trainee in my late thirties with three small children. My psychiatrist wanted to build on my recovery with some cognitive behaviour therapy (CBT) as prophylaxis, hopefully to prevent further episodes.

This was reasonable, although I didn’t see the need for it because I was convinced that my variety of depression was chemical not psychological. However, I had no objection. Some time passed before I started weekly meetings with a senior psychologist, but I didn’t get CBT. My understanding was that she had decided psychodynamic therapy was more appropriate (without meeting me).

Throughout the year or so that this continued, I never felt emotionally engaged. I dutifully recorded some of my more colourful dreams to recount but don’t remember ‘doing’ anything with them. I got depressed again. Matters came to a head at the end of a session. I was crouched in my chair, staring at the floor, feeling deathly with nothing to say. Eventually she broke the silence with: ‘Are you trying to make me feel as depressed as you are?’ I was utterly astounded and was trying to work out what she meant (more silence) when she announced: ‘Time’s up’ - and that was it. End of therapy, as it turned out.

I just knew I had to make contact with a real human being so stopped at my health centre to make an appointment on the way to collect my children from school and wept copiously when the health visitor greeted me. My GP referred me for ECT again.

Comments from 30 years’ perspective and professional understanding: I still think bipolar depression is a ‘chemical’ illness and psychological treatment alone is unlikely to resolve it. However, there is a person experiencing it and having to adjust and live with it, so psychological therapies are often highly relevant. The decision to refer me wasn’t wrong, but I’m sure the choice of psychodynamic therapy, which looks back and uses past relationships to inform interpersonal difficulties, was. Something here and now with problem solving elements for risks and triggers was more appropriate. As for the therapist, themes and outcome... no comment!

I’ve had good psychotherapy too. But I think what really matters is having a pleasant, warm, trusted, accepting person to talk to, in or out of therapy. (This has been shown to be an important factor in predicting the success of therapy). I’ve been very fortunate to know several such individuals professionally (not psychotherapists!) who have accompanied me for a little or a long way along my life’s journey. I hope I’ve been able to do the same for other people.

A Moodscope member.

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