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Why I Quit Being a Therapist [video]

123 points| BobbyVsTheDevil | 7 years ago |youtube.com | reply

83 comments

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[+] intralizee|7 years ago|reply
Key points from the video:

1) People mostly benefit from having someone to talk to about their problems. Drugs apparently aren't much help.

2) People with the most trauma are the ones that have the least finances to pay for treatments.

3) Most trauma is from early life.

4) The therapist has no support from colleagues and cannot talk openly. When someone mentions suicide its recommended to send the person straight to the hospital and to be medicated (Video author does not agree).

5) The responsibility is too much, hearing the horrors and being on the minds of the harmed person.

[+] AltruisticGap|7 years ago|reply
I didn't watch the video yet but pt 2 and 3 is 100% correct.

I am in EU. We're supposed to have "amazing healthcare". Yeah, well, maybe if your face is in a ditch or you're dying alcohol poisoning? If you're one of those who managed somehow to function with insane levels of anxiety... you when you finally find the strength to reach out and heal.. you find out that you get a pityful 200 EUR a YEAR for psychotherapy (that's what my healthcare in Belgium pays).

Anyone healing significant trauma is going to do one year of therapy, probably more. At the very minimum twice a month, otherwise you lose the rhythm. Realistically, 5 times a month tapering down to 3-4 times a month, for a year or two or more. It's exhausting too. To heal and make real progress, you go to therapy like a beaten dog, keeping your heart open all the time, accepting to feel vulnerable all the time. You don't get to hold a mask, you have to undress and put it all out, every session... takes a lot of determination and courage. But who gives a shit. Here's 200 EUR for your troubles, good luck.

On top of that, in my case I have a 7 year gap in my career in IT. Doesn't help getting back into employment! Often times with trauma from early life, you don't grow in an environment surrounded by sane people. You're surrounded by dissociated parents / siblings. At school nobody gives a fuck or has the sensibility to ask questions. So in all likelyhood if you managed to function in adult life and hold a decent job, you're starting therapy much later, when it takes longer. So hopefully you got some savings otherwise well eat shit son.

I guess I have to be truly grateful that here in Belgium our "unemployment benefit" system is lax enough, that it allowed me to take the time to heal. But don't you go tell them that! I can only imagine what it was like for my parents, when they didn't have that kind of support.. because even with the unemployment benefits, I've had to fork out THOUSANDS of euros for my therapy.

Anyways just need to rant I guess.

[+] nothrabannosir|7 years ago|reply
In addition: there is a constant pressure to “upsell” the clients medication, i.e. refer them to psychiatrists. He felt frustrated at the institutionalised proclivity for medication, and had to fight hard when going against it.

(And one bit that struck me hard: he mentions suffering from vicarious trauma so much that at some point he was crying with patients every day. Makes the video worth watching, imo. It makes you think about the kind of therapist you’d hope to find yourself in a room with, if necessary, one day.)

[+] clarkevans|7 years ago|reply
Regarding point #3 -- In the 80's, clinicians at Kaiser Permanente recognized that success in a weight-loss program was correlated to stresses experienced during childhood. This lead to the Adverse Childhood Experiences study, using a measure which scores people on a scale of 0-10. Those with scores of >3 (factors such as separated parents, child abuse, sexual abuse, food insecurity) have significantly worse outcomes in later life. https://en.wikipedia.org/wiki/Adverse_Childhood_Experiences_...
[+] phnofive|7 years ago|reply
Thanks for the summary, as it’s the only way I’d have heard this person’s view. 1) paints a broad and inaccurate view unless there is more specificity about what kind of medication is being discussed. 4) & 5) are well taken, though; where do professionals with confidentiality restrictions get help, each other?
[+] reledi|7 years ago|reply
I wish all comment threads started with a summary. Thanks!
[+] panchicore3|7 years ago|reply
he also mentions that there are alternatives ways of dealing with the problems that only with medications, is he referring to psychedelics as one of them I am afraid, where you manage to lower your defenses in order to pain came out?
[+] julienmarie|7 years ago|reply
Something interesting is making a mental "disorder" a sickness. A mental trait becomes a disorder when this trait no more compatible with social norms ( it breaks the order of things, hence disorder ). Hence the pain. And we assume a pain is a sickness that can be cured, medicated.

Medication do not solve the root of the pain. Our brain is more than a chemical balance. It's a neural network, trained on the training set of our childhood. There is this fundamental age around 6-7 years old where the child creates its identity picture, its definition of self, which becomes the blueprint of its personality trait and evolution. This blueprint causes what psychoanalysts call "neurosis". When digging into it, there are so many things that makes sense in the field of psychoanalysis, and the parallels with neurosciences and even AI are staggering.

Little nuggets I found enlightening in my day to day perception of life :

- We learn language and the meaning of things from others ( our parents usually ). As a consequence, we naturally expect truth and meaning to come from outside. That's why we look for confirmation from others. That's why we expect the people we fall in love with to give our life meaning.

- We create our identities based on our environment. We define ourselves against the others as to define is to draw a boundary, a difference. That's why you'll often see the cliché in family where if the elder's dominant trait/definition is to be good at school, then the second child will take the opposite route.

- Our neurosis is mostly our limiting factor to approach life. This is what we fight against everyday, this is the wall between what we can be and what we are.

I understand this can be seen as a controversial view for many.

I'm no psychiatrist or psychoanalyst, but was raised in a psychiatrist / psychoanalyst family. A weird but enriching experience.

[+] thomasfedb|7 years ago|reply
> A mental trait becomes a disorder when this trait no more compatible with social norms (it breaks the order of things, hence disorder).

Your definition is close, but not quite in keeping with the medical world.

Broadly, something would become a disorder if it results in a) distress, or b) dysfunction.

Distress is usually self-reported, dysfunction can also be observed (e.g. unable to eat, sleep, care for self).

I'm a student doctor, currently on rotation in psychiatry.

[+] exolymph|7 years ago|reply
> Medication do not solve the root of the pain.

Contradictory anecdata: Therapy never helped me until after I started taking venlafaxine (generic Effexor) which took away my anhedonia and made it possible to process my trauma productively, rather than continuing to wallow in misery and dysfunction.

[+] PavlovsCat|7 years ago|reply
> As a consequence, we naturally expect truth and meaning to come from outside. That's why we look for confirmation from others.

Yes, we look for confirmation, just like we give it, but that's not all, we also decide how to weigh opinions based on our opinion of the people holding that opinion. I mean, how can others give you confirmation, if they in turn get their truth and meaning from the outside? That'd just be pointers going in a loop. By the same token "the outside" can tell you anything, you can tell "it" anything.

[+] throwaway2018-2|7 years ago|reply
One of the things that really scares me about working with a therapist is that I have suicidal thoughts a lot. Like, I don't deserve to be alive or that I want to die. I'm still pretty productive, make a good salary, was recently promoted. I'm scared that if I were really open about these feelings, something bad would happen, that I could be hospitalized. Which feels like a real step backwards to me. A step towards not actually getting better.
[+] DanBC|7 years ago|reply
You didn't say what country you're in.

If you're in England you can write an advance directive saying that detaining you under the act would be harmful, and you can work out who your "nearest relative" is and make sure they say to the AMHP "I object to the section". These don't make it impossible to hospitalise you, but they do make it much harder.

But, importantly, you deserve help. And you don't need to disclose suicidality. You can just say that you feel very low, that you feel desperate.

There's good evidence that cognitive behaviour therapy is effective for about 60% of the people who use it. You may want to think about combining it with medication.

[+] jakegarelick|7 years ago|reply
If it makes you feel better, I seriously doubt a (certified) one will do that. The smart ones realize that hospitalization can really derail your life and make you an even higher suicide risk.

Additionally, there is a big difference (in my opinion) between suicidal thoughts and actually acting on those thoughts.

Just from reading your post it doesn’t sound like you have much to worry about.

[+] baselined|7 years ago|reply
Suicidal ideation is different than having a plan and access to the method to follow through.

It’s when ideation proceeds to having a timeline and decision to die by suicide is when hospitalization is absolutely necessary. At the end of the day, if I a person wants to die by suicide, there is very little anyone can do about it.

[+] julienmarie|7 years ago|reply
I agree with jakegarelick, a good therapist will not hospitalize you.

What matters is for you to talk.

Why would anybody not deserve to be alive? Life is fundamentally nonsensical, and our struggle / cross ( depending on how you see it ) is to put meaning into it. This is why life is at the same time a tragedy and a liberating experience.

We are ephemeral, and not this important at the individual level. Only thing that matters is not harming others, eventually doing good to others if we are lucky, and finding joy in little things ( intellectual endeavours, earthly pleasures, art, sunsets, you name it ).

If it can help, a reading that helped me when I was deep in depression in my 20's was the The Gay Science, by Nietzsche. Don't read it in one go. Keep it with you, and read a few aphorisms every day. Some three liners aphorisms from Nietzsche made more impact in my life than everything else I read combined. This book literally saved my life.

[+] viraptor|7 years ago|reply
You can find therapists who has remote sessions over internet. If you're worried about someone acting against your will, you can have a Skype session without revealing your real name. Even with someone in another country - if your primary language is English, you have lots of options.

You can't get things prescribed this way. But it doesn't sound like that's an issue here.

[+] anonuser123456|7 years ago|reply
To be considered suicidal, I believe you need to have formulated a plan. Feeling worthless or not wanting to be alive is not the same, that's just bread and butter depression.
[+] DubiousPusher|7 years ago|reply
I was hoping for something insightful but really got more of the same antiestablishment alt-med ranting you'll find elsewhere on the web.

Dude even cites his anecdotal experience to claim psych meds don't work while at the same time claiming mental healthcare is full of psuedoscience and vaguely endorsing something that sounds an aweful lot like Freudian psychoanalysis. So that was pretty rich.

Well, if we're comparing anecdotes, my experience is that when a certain relative of mine was on lithium, she didn't try to stab me in the bathtub with a steak knife to keep the demons from getting me and when she wasn't on her lithium, she did.

[+] andrewvc|7 years ago|reply
Psych meds for something like schizophrenia or acute psychosis are very different than for things like ADD, Depression, etc. Additionally, it is objectively true that these disorders are overdiagnosed (there are many studies backing this up).

Some psychiatric issues fit much more closely with the disease model of medicine (like psychosis), and others are in a huge gray area.

Most of psychiatric work is in that gray area and does a poor job of it.

Even a former DSM chair thinks so. I highly recommend reading "saving normal" for more info.

[+] noetic_techy|7 years ago|reply
I wouldn't call experience handling hundreds of patients in in a major metro area such as NY City "anecdotal".

None of this smelled of alt-med ranting. It's the true accounts of a therapist who saw the deficiencies of the system from the inside.

[+] hutzlibu|7 years ago|reply
Well, if someone is only peaceful while on meds, I would not feel at peace at all with that person around. People forget their meds/choose not to take them. And then all that was supressed comes out. So does your anecdote sounds. So maybe if she would have had a real therapy which does not rely on meds so much, she would know how to handle her demons better when beeing without drugs.
[+] withdavidli|7 years ago|reply
It's a profession that's mentally and emotionally draining. My education background is in psychology, worked at a mental institution for a few months as a mental health assistant. Never met a psychologist that was actively encouraging students to go the therapist route, in fact the opposite. It's something to think long and hard about. One memorable encounter was an aunt of my friend literally grabbed me by the arm when she found out I was planning to be a psychologist and advised against it. Thought "who is this crazy lady", she was head psychologist of several institutions for the district...
[+] kopo|7 years ago|reply
>> in fact the opposite

What are you telling them to do? I have a psychiatrist friend who consults at the medical center, in a college town. She is getting called in so much she wants to move to a different town.

[+] chippy|7 years ago|reply
> Thought "who is this crazy lady"

Did you become a psychologist?

[+] biophysboy|7 years ago|reply
I wish he had gone into more detail about the specific issues with anti-depressants.

Most anti-depressants target serotonin or norepinephrine because the medical industry is still more or less following the "monoamine hypothesis". The hypothesis goes like this: monoamine neurotransmitters are crucial in the human brain, depressed people have depleted levels of them, therefore we should give them a drug that prevents their reuptake.

But there are issues. SSRIs take roughly 5 hours to become bioavailable, but the positive effects of antidepressants take weeks. Why? If the core issue was depleted serotonin levels, shouldn't the person be happier same-day?

Perhaps I'm building a strawman (I doubt med professionals believe the mono-amine hypothesis either), but antidepressants are being prescribed at record rates, and they are being increasingly trusted by the public. Why? The science is trial and questionnaire, the drug efficacy is low, and the side effects are many.

[+] johnchristopher|7 years ago|reply
> But there are issues. SSRIs take roughly 5 hours to become bioavailable, but the positive effects of antidepressants take weeks. Why? If the core issue was depleted serotonin levels, shouldn't the person be happier same-day?

Also we don't see negative effects on non-depressed people that take drugs to reduce serotonin levels (or so I was told).

[+] outlace|7 years ago|reply
Most SSRI’s are prescribed by general practitioners and often with fairly low thresholds. I’ve seen interactions like this: Patient comes in to follow up high blood pressure. Doctor: Have you been feeling depressed lately? Patient: Well, yeah I have actually. Doctor: Do you want to start a medication for that? Patient: Uh, ok.

Most psychiatrists would not do that. And I think psychiatrists at academic centers would not pretend to know exactly how SSRIs work at this point.

Nonetheless, SSRIs have a modest effect on average but for some patients they’re life changing. Recently met someone who was so depressed she could barely get out of bed in the morning. Started on the right Med (after a first failed trial) and she’s been happy ever since (more than a decade).

Soon enough we’ll be able to specifically identify which patients are likely to be good responders and who won’t.

[+] omosubi|7 years ago|reply
What are good countries/societies that have good mental health systems? What does that even look like? Is this a uniquely American problem?
[+] intralizee|7 years ago|reply
Canada is better than United States from my experience of living in both countries.

I sought help with gender dysphoria in the United States. Ended up being drugged with antipsychotics, while stuck in a hospital for two months against my will and when I just wanted to start HRT. Doctor wrote untrue statements on my medical records and I couldn't find anyway to sue since I was a poor university student at the time. Almost resulted in suicide. Insurance was billed approximately $55,000

Now I'm in Canada and I'm suicidal from the past events in life but I can see a psychiatrist once a week. She doesn't recommend drugs and mostly just wants to talk with trying to improve my outlook. I'm trying to get death with dignity in Switzerland and got a positive evaluation from her after several months. Everything in Canada is covered since I was born in Canada (citizenship). I'm in Montréal and from what I've seen most doctors don't push prescription drugs compared to what I saw in United States (Michigan). Canada also has a phone number (similar to 911) but is a direct line to speak to a nurse or social worker for help. People here actually can get help concerning their health right away and not fear having to pay anything.

edit: I think the cost of the healthcare in the USA is why people that don't get help, end up mass shooting and mental health stigma is a result of people not being able to afford it; trying to rationalize it's for people really messed up (not them).

[+] mjevans|7 years ago|reply
At least in the US:

    * Health-care is a cost center.
    * Denying Health-care is a profit center.
    * The populace has been conned in to believing it's an "insurance"
    * vvv
The population also mostly doesn't realize, at a logical level, that those without coverage still factor in to costs.

    * Increased suffering
    * Increased crime
    * Decreased GDP (both from less able workers and more broken windows)
    * Actual costs of care are passed along as inflated prices.
I would really like, and as long as there weren't other blockers would vote, for candidates that supported at least /basic/ healthcare for all. Profits to be had in line cutting during non-triage critical moments.
[+] hiker512|7 years ago|reply
Germany, Sweden, Norway, Finnland, Austria, Switzerland, France, Netherlands. Not sure about the other countries in Europe.

But honestly, every time I hear anything about the American healthcare system, I'm not sure if I should laugh or cry.

[+] analyst74|7 years ago|reply
The field of psychiatry is actually undergoing a lot of changes and improvements. With progress in understanding how our brain works at chemical level, and newer drugs to balance the chemicals when they are out of balance. Many of the previously untreatable mental problems are now treatable with medicine.

That is unfortunately only available to psychiatrists, who has medical designation.

source: a psychiatrist friend

[+] patcon|7 years ago|reply
> With progress in understanding [...] and newer drugs to balance the chemicals [...] Many [...] mental problems are now treatable with medicine.

The catch here is that those deciding what "progress" is, are the same therapists and health professionals of the sort speaking in the video. And as they said, they are under immense pressure of their own. The alternative to "medication" is social support, of which they themselves are often primary sources. They are overburdened themselves and often under-supported by gov, so they're under stress (therapists for well-off people excluded).

tl;dr - they have a huge incentive (for preservation of their own sanity) to see "medication" as progress, because it relieves their own burden (which is structural to system).

I'm not saying this is malevolent or judging anyone to be bad, but it's something to be wary of

Disclaimer/source: sibling is community social worker

[+] zaroth|7 years ago|reply
At a macro level (population surveys of mental health) I think we can safely say your friend is biased, and that the field is basically stumbling around in the dark ages and generally unable to offer much help.

Didn’t the latest DSM get basically outright rejected by the NIH?

[+] carapace|7 years ago|reply
reading this is like taking a time-machine back to the dark ages. It's like the "Bring out yer dead!" scene in Monty Python's "Holy Grail", only not funny.

For the love of God, use Neuro-linguistic Programming.

The "vicarious traumatization" wouldn't be a problem if you used techniques that don't require reliving the trauma! It would be healthier for both the therapist and the client.

There are repeatable algorithms for dealing with e.g. early life trauma. You can actually "go back in time" and relive a different life and have it massively and permanently affect your real-world present-day life.

One of the strangest and saddest things about psychology is the disconnect between practitioners and researchers on the one hand, and the cutting-edge state-of-the-art techniques and "schools" on the other. (The NLP wikipedia page is all about how it's a pseudo-science. Sheesh!)