Disagreement with therapist

Post Reply New Topic

I am deeply troubled tonight. I had a therapy appointment today and it didn't go very well. I have Asperger's Syndrome and severe depression. I've been working with this particular therapist for two years and until today, I thought things were going very well.

I have a history of suicidal ideations. I think about suicide a lot. Maybe I'm using the wrong words. I don't want to die, but I don't want to be here. That is, in this existence. Things that happen, things people say and do, it seldom makes sense to me. I suppose if I had to connect a feeling to this, it would be frustration. Maybe confusion or anger. Loneliness, too. I think a mistake was made when I was born. I don't belong here. I don't think I ever did.

Anyway, I had a depressive episode two days ago and mentioned it to my therapist today. In the past, I've promised him that if I have any major episodes, I'd tell him. I take great pride in keeping my promises. A broken promise is no different than a lie and to me, any variation of a lie is the worst thing a person can do. He asked me for specifics, so I obliged. He interrupted me several times and this threw off my narrative. He finally asked me if I went to the hospital and I said no. He asked why and I told him my family refused to take me. He asked why I didn't call an emergency hotline and I told him my family refused me access to a telephone. (My family is rather clannish. They like to "take care of their own" and distrust outside influences. If they could have gotten me the medication I needed, they never would have taken me to a psychiatrist or any doctor, ever. They do not trust "outsiders.") That's when he raised his voice at me and told me that if I was really suicidal and really wanted help, I'd have found a way to get myself to the hospital.

He continued, saying that he thinks I enjoy being angry and depressed, that I threaten suicide to manipulate my family into spending time with me. He pointed out that he works in the emergency room and that 80% of attempted suicides that come in there are people who are attempting to manipulate another person. He told me he was getting tired of my "mixed messages." In the two years that I've known him, he's never said anything remotely similar to what he said today.

I'd like to say how I feel, but I honestly don't know how to express it. Any words that come to mind don't seem to fit. I don't believe his assessment of my situation, motivations and thoughts are accurate. I felt like he wasn't listening to me, that he had his own thoughts and when I presented information that didn't match those thoughts, he disregarded that and filled in the blanks. He hadn't done that in the past two years I've been seeing him, so I feel a little afraid. My reason for posting this is so that I don't feel so isolated. Even if no one really cares, at least I got to express myself completely without interruptions.

he can't know your motives and it was unkind of him to assume the worst and not very therapeutic to call you manipulative. he was frustrated and took it out on you.

on the other hand, you could have waited until your family was asleep and called the hotline secretly. is there any way you can live independently? sounds like your family is standing in your way of being healthy.

(we have folks named avy in our family.)

That sounds terrible, I would cut ties with this therapist and look for a new one....that kind of crap is likely to do more damage than good. I mean you mentioned your family denying you access to the means to get to a hospital...so instead of acknowledging that, he just goes and blames it all on you. And raising his voice at you? that does not sound ethical at all, as far as I am concerned he shouldn't have a license.

What he should have done is try and help...like maybe give suggestions or give you resources to maybe help with that creepy sounding family situation.

Whether or not to go to the hospital needs to be your judgement. True, it's not just last resort but also medium resort, just not in any kind of mechnical way, needs to remain feel and texture and your judgement call.

I agree that he took out his frustration on you in an unprofessional way.

And please don't commit suicide. We want you as part of the coming Spectrum Civil Rights Movement, and although maybe that's not the best reason, it is one reason. It may take a while but I think we will eventually he as successful as equal rights for gay and lesbian persons, and equal rights (still in progress) for transgend persons. What all this has in common is the right to be authetically oneself even if different.

You may well be able to stay with this therapist if you can accept that he has moral blind spots, just like Albert Einstein had moral blind spots, just like the great humanist Bertrand Russell. Even presidents have blind spots.

An analogy might be if you have a friend who's a devout, born again Christian. Sooner or later the conversation's going to get to him saying that you need to accept Jesus as your lord and savior, you're being obstinate in refusing to see the truth, etc, etc, and the whole thing comes from the back of his throat as if on a tape. Myself, personally, I'm an atheist-agnostic and comfortable being so. I left a strict, doctrinaire church at age 15, I rebelled, I had to rebel, I'm glad I did.

Now, if you're Christian, that's perfectly okay with me. I currently have a good friend who's a Christian. To run the analogy, just assume you have a friend who's a Muslim, sooner or later, the conversation's going to come, certainly a logical person like yourself should see that although Jesus is a good prophet, Mohammed is the last and greatest prophet, the facts are plain, etc, etc. It's like a tape which once started tends to continue.

Now, as one option, it's perfectly okay to cancel one appointment and then see your therapist the next time. It's perfectly okay to not cancel an appointment and see him the very next time. Both are fine.

I would be scared of a therapist who believes most suicide attempts are manipulative acts.

I sometimes struggle with bouts and periods of depression. I am aware that other people may struggle and suffer quite a bit more than me.

I have not yet tried antidepressants, but kind of feel they're my Ace in the hole.

What I've read is that it's trial and error in a respectful sense. That something like zoloft may help one patient a lot and not really do much for another patient and that it typically takes a month to tell.
http://articles.latimes.com/2009/aug/03 ... ug-choice3

Also that it's sometimes important to step down from an antidepressant in phases even if it doesn't seem to he working.
http://articles.latimes.com/2009/aug/03 ... ing-drugs3

Now, you may already know all this, but you may not. This is the kind of thing I really feel should be common information, much more so than it seems to be.

Thank you for the responses and advice. It makes me feel better to know there are people out there who can listen and understand. It seems that's rare for me.

Now that I've had a chance to calm down, I talked to my husband and my parents about not taking me to the hospital when I asked. Their reasons were sound. My husband said that what I needed most was to cry it out and just have someone listen to me, which he was willing to do, but at the mental hospital, that wouldn't have happened. They would have put me on heavy medications that would exhaust me. When he mentioned that, I thought, "Oh, yeah...there is that..." Such a thing has happened before and once the medications wore off, the original problem was exacerbated. My mother explained that when I'm upset, I have an annoying voice that makes people want to gag me and that if I were to bring any outsiders into the situation, they would have medicated me just to shut me up. I can believe that. When I was a teenager, my uncle recorded one of my meltdowns on tape and I do have a rather annoying voice, especially when I'm doing what my family calls the "banshee scream."

The only reason I asked to go to the hospital is because I promised my therapist I would go the next time I felt despondent and suicidal. I told him I didn't think it would help, because it's only hurt me in the past, but he asked me to promise, so I did. My family doesn't agree because they mistrust outsiders, especially the psychiatric community. I don't want to go into it in depth, but when I was a teenager, I went to a mental hospital and they did things to me that I don't like to remember.

As for my therapist, I agree he seemed frustrated. I just don't understand why or why he took it out on me. I suppose he's the only one who could tell me, if he were to admit it, that is. If anyone has reason to be frustrated and take it out on others, it's me, but I don't. Mainly because I'm used to being berated when I do. It's as if I have to behave twice as good as everyone else to be perceived as half as good.

I've told my therapist what I want from therapy, but it seems like every other session, he makes some comment about not being clear on where it's going. I thought he was saying that was a "conversation placer," while he was getting seated because the statement seems as inane as a stranger walking by and saying, "Hihowyadoin." Especially because I've told him that I want (1) suggestions for coping with the irritating things people do (and he's given me great suggestions that have improved my interactions with others,) (2) suggestions for relating to my more difficult relatives better (also a great help,) and (3) someone to help me identify various feelings that I don't understand (I thought that was going well, but now I'm not so sure.)

One thing my therapist said that upset me was, "I wish I had the DSM in front of me! You don't act like a person with Asperger's! You are acting like you have a severe mood disorder! People with Asperger's act nothing like this!" I didn't even mention my diagnosis before he said that. I wonder if he was trying to elicit a reaction? He knows that AS is a social identity issue for me, that I'm seeking help for my depression and anxiety. I think he wants me to have only a severe mood disorder or a personality disorder because then he'd be more comfortable interacting with me. I think he'd be more comfortable with me if he'd quit attempting to decipher my body language and listen to my words as they are spoken.

He accused me of playing "word games" with him when I clarify what I mean. I don't see how that's a game. It seems very serious to me. Definitions are very important, especially between people who come from different cultures. And as a person with AS, I don't have an innate understanding of the culture in which I was raised. So when I'm clarifying what I mean, I'm not playing games! (Maybe next time, I should have a deck of cards with me and then pull them out when he accuses me of playing games. Probably not a good idea. He probably wouldn't appreciate such a mocking gesture, although he would certainly deserve it!)

I would like to find a therapist familiar with people on the spectrum, unfortunately, there aren't many available in my location who take adult clients and none of those accept my insurance. So I have to take what I can get. For a while, this therapist was doing research on the spectrum so that he could help me, but not I don't think that went so well.

I've read books about how NTs tend to think, how they interact, so I've become aware that many of my mannerisms come across as manipulative, erratic, suspicious and selfish. I can only go so far in "acting" normal and honestly, I don't think I should have to. So I thought that if I tell people, "Hey, I'd like to make you aware..." then they'd not get so upset by inferring implications that just aren't there. Kind of how people give the same benefit of the doubt to immigrants who just moved in down the street. But I've learned the hard way that most people don't listen very well and end up treating me worse, so I quit going out of my way to interact with others. I thought my therapist was different, but after my recent session, I think I grossly overestimated him.

Yes, betrayal is exactly what I'm feeling.

So what's the next step do you think?

I would have fired him and find someone else. He should know better. He is a therapist for god's sake. Or does your family make you see him?

So far, I've seen four options I can take:

1) Cancel all my appointments and end therapy altogether.
I've done this with therapists before and it doesn't leave me with a good feeling. As honest as I am, I'm not an aggressive person. I genuinely care about how other people feel and don't like arguments. Still, it seems rather cowardly and adds to a destructive cycle. If anything good comes out of this at all, I at least want to end that cycle.

2) Go back for one more appointment, tell my therapist that what he said was rather cruel and then cease therapy.
There's a chance he was having a bad day. I wouldn't want to be judged like that because of one bad day out of at least 100 good ones. In two years of weekly therapy sessions, he's never behaved this way. Perhaps I should find out what he's got to say about it and go from there.

3) Go back, talk about what happened and see if the therapeutic relationship can be salvaged.
I'm inclined to try this one. I have a difficult time getting my point across while speaking, but writing is another matter entirely! Maybe I can bring in a written list of the things he said that upset me, why they upset me and ask him why he said them, and ask him to refrain from doing it again. Then, if that doesn't work, just say, "Well, thanks for all the good you've done for me, but I think this is as far as we can go. Good luck in all your endeavors."

4) I could go back, not bring it up and if he brings it up, say, "I'm over it."
Although it's an option, it's the one I'm least comfortable with, as it involves dishonesty. And, if I did this, it could happen again and I don't want this to EVER happen again.

No, my family doesn't make me see him. And things had been going very well for two years. He's never been this aggressive before. I do know that he's been increasingly frustrated with me. He's unfamiliar with ASDs and specializes in personality disorder, mood disorders and addictions. I do have a mood disorder that tags along with my ASD, but I believe that was caused by abuse I suffered in my early life. He's always trying to read my body language, my tone, my face and trying to find "hidden messages" in my words. Sometimes I feel like saying, "You're looking for hidden messages? How about I start speaking in cryptograms; would that make you happy?" Egads...therapy isn't supposed to CAUSE this much angst.

Well, naturally. *wink* You know what's really infuriating about this? He focuses on my dichotomous black-and-white thinking quite frequently, acting like it's the main thing that's keeping me from being healthy. So it strikes me as odd that someone who with such a strong aversion to black-and-white thinking does it so much. Even I know that Asperger's and mood disorders aren't mutually exclusive. In fact, in a great percentage of people, they are co-morbid. It's not an either/or type of thing!

I've also informed him repeatedly that my words and body language don't add up. I thought he accepted that, but I now have a nagging suspicion that he might not believe me. It would be nice if he could work with me from my capabilities, not from what he wants my capabilities to be.