Mental Health Notes

Before Calling It Quits With Your Therapist

by Alicia Sparks, NAMI Affiliation Leader on March 10th, 2008

Back in September I posted I’m Firing My Psychiatrist. In short, the post explained the reasons I had for firing my psychiatrist. Actually, the post explained the one main reason I had for firing my psychiatrist: He assured me that I could stop taking Lamictal cold turkey without even glossing over the potential risks for seizures that accompany quitting Lamictal cold turkey.

Yesterday, reader Patrick left the following comment under that post:

This discussion of lamictal is quite educational for me. I really don’t like the person I’ve become, the edginess, being short tempered and irritable all the time but my shrink won’t even consider changing it. To get past the racing thoughts and to get some rest they have me on trazadone and xanax at bedtime. It makes for good sleep but that seems to be the only peace I get in a 24-hour period. Just changed to a new therapist (5 sessions) and am ready to give up on him. Any advice?

Yes, Patrick, I do have some advice. Read on.

When it comes to seeing a therapist, psychologist, psychiatrist, or any other mental health professional, five sessions may seem like a short period of time for some people, while five sessions may feel like an eternity for other people.

Several factors go into determining how long a “time period” five sessions actually feels to you, such as:

• The therapist himself and how the two of you connect. Does your therapist listen to you and consider the things you say? Or does it feel like he ignores you and follows a course of action he’s developed without your input?
• How far apart the sessions are spread out. How often do you see your therapist? Once or twice a week? Once or twice a month? If you see your therapist once or twice a week, you may feel that the two of you should be making progress after a month or two. However, if you only see your therapist once or twice a month, it may take several months before the two of you start to connect and make progress.
• How in depth the sessions go. This includes how long the sessions last and what’s covered during the sessions. For example, I find that a five- or 10-minute session is unacceptable. That’s barely enough time to get comfortable. If all five of your sessions have been short, you may not have had enough time with your therapist. (You may also want to suggest longer sessions to your therapist.) However, if all of your sessions have lasted an hour or so and you still don’t feel as if the two of you are on the same page, it may be time to speak up.

Given those factors, it’s really impossible for me to say, “Oh, five sessions, that’s long enough, if you don’t like the therapist you should fire him/her,” just as it’s impossible for me to say, “Five sessions isn’t very long at all. Stick it out.”

So, what I will say is this: If you’re truly ready to give up on your therapist, tell him. Flat out. Tell your therapist you’re ready to give up, and then explain why. This gives him an opening to fix whatever it is you feel isn’t working. Maybe your therapist doesn’t fully understand that you’re not happy with your medications. Maybe your therapist didn’t realize that the sessions were too short and not frequent enough for you.

In other words, whatever your problem is, maybe your therapist doesn’t yet realize it’s a problem.

If your therapist doesn’t work with you to try to correct the problems, or doesn’t feel that your problems are important and relevant, I’d start shopping around for a new therapist.

Think about this scenario: While walking down a flight of stairs you lose your balance, fall to the bottom of the stairs, and break your leg. You can clearly see that you’ve broken your leg. It’s a nasty break - the bone is sticking out of your skin! A friend rushes you to the hospital where a doctor tells you your leg isn’t broken. Maybe he gives you some pain medicine, but he sticks to his claim that your leg isn’t broken. Naturally, you say, “Hello?! My bone is sticking out of my leg! I can see that it’s broken!” If the doctor doesn’t look a bit closer and agree that your leg is broken, you’re going to find a new doctor, aren’t you?

Of course you are. And it’s the same with your therapist. Something was wrong, something was “broken.” You felt it. The edginess, the irritability, the short-temper - you felt it all. So, you went to a therapist. It seems as if your therapist keeps offering you a quick fix - the Trazodone and Xanax - just as the doctor in my example above offered pain medicine. While the Trazodone and Xanax may help you sleep (just as the pain medicine may help ease the pain of a broken leg), they aren’t “fixing” the problem. Your therapist needs to help you learn how to properly manage, treat, and maybe even heal whatever mental health condition you have. This may involve a different kind of medication and/or more intense therapy sessions. What it should not involve, however, is simply prescribing medication to knock you out.

The bottom line is this: You deserve a doctor who is going to listen to you and provide appropriate care. Explain to your therapist what you need - and what you’re not getting from him - and if he doesn’t take action to better help you, find someone who will.

I wish you the best of luck, Patrick!

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