6mo ago

Anyone ever have a therapist/psychologist who was any good at dealing with people who didn’t already have their shit together?

Like, I’ve had several therapists/psychologists/psychiatrists/counselors throughout my life who either seemed disinterested or flat out unfit to deal with people like me, and I don’t even think I’m the worst case scenario (who knows, maybe I am?).

What’s their main demographic, who do they even help? Yuppies, professionals, people in manager positions who already have had successful professional, social, and dating lives?

They’re already too expensive for most of the population, they seem to be absolutely oblivious to the problems of most men of color or trans folks or most gay folks, they can’t help early career young people, definitely not working class people, like what the fuck are they good for? And can people just shut the fuck about ‘just go to therapy, honey’, ‘men will do anything but go to therapy’ like fuck off. I went to therapy, and holy shit yeap, the world still sucks and society is still extremely hostile to me.

Oh I can change my reaction to things? to live in delusion is almost what they seem to be prescribing and nah, I’d rather just save the 100 dollars per session and spend it on 2 months supply of fucking OxyContin.

And motherfucker, if you’re a psychiatrist, and I’m here for adderall or anxiolitics or fucking laxatives, you had better fucking give it to me. I didn’t fucking pay 150 to prescribe me children’s medication or to be lectured about the importance of therapy.

51 comments

In my experience, talk therapy is pretty useless for dealing problems that arise from societal issues. It's for people that have interpersonal and relationship issues that are otherwise totally fine with the world. When I was doing therapy I made progress on those two things but the therapist had nothing to offer for my depression stemming from class war, genocide, climate change, etc.
Also, in regards to living in delusion, therapy (and all medicine under capitalism) exists to "fix" workers so they can keep making money for the capitalists. Oh, you're sad because a loved one died? Take this pill and get back to work.
- 's wife Harriet Fraad has a podcast about the intersection of economics and mental health
  
  Do you have any particular episodes of that podcast that you would recommend?
  
  whoa this looks great. thanks for sharing
- talk therapy is pretty useless for dealing problems that arise from societal issues
  A sick society casts its own pathologies as individualized mental illness.
  I haven’t read it, but I remember from a Jonas Čeika video that Erich Fromm analyzes this concept from a Marxist perspective in The Sane Society

I was once in group therapy. One of the other people there told about how being poor and on unemployment benefits took a toll of their mental health. The trained psychiatrist there, who worked out of a spacious and expensively furnished office with a great view and who had until that point had given off nothing but nice radlib vibes had no empathy, she directly berated them for complaining instead of being grateful for the meagre alms they received, telling them how they had "chosen" to be unemployed themselves. I lost all confidence in her at that moment.
- telling them how they had "chosen" to be unemployed themselves
  liberal ideology is a cancer on our species
- A friend of mine complained about job- and boss-induced stressors at an AA meeting. He said everyone raced to jump down his throat, because he should have been grateful that they gave him a job.
  
  The only people who are ever "given" a job are family of business owners. The rest of us have to fight tooth and nail for a job.
  
  Yeah. There seems to be a hierarchy of misery. Not only is the suffering caused by class society considering invalid, even expressing it is considered a taboo. Deep down liberals understand that the legitimacy of the system they benefit from depends on that suffering being kept hidden. That is why they react so emotionally to it.
  ✅ I'm sad because I can't go out due to the anxiety chemicals in my brain misfiring
  ❌ I'm sad because I can't go out due to everything costing money and I'm being denied the realistic ability to acquire money
  I am not saying that all psychiatry is bunk. That psychiatrist who jumped to maintain ideological purity in the group session was the same who prescribed me my ADHD meds who has really been a help in all areas of life. But there is a certain element of gaslighting in there when people who are sad for good material reasons are being pathologised and told that their misery is due to their brain chemicals being out of balance. Ultimately what we need is a form of psychiatry enlightened by marxist analysis. Genuine psychiatric disorders intersect with the misery caused by class society in a dialectic way and insisting on being blind to one half of that dialectic is doing patients a disservice.

That was my experience with therapy. The only thing I ever got from it was someone to talk to when I was completely isolated. Everything else felt very unsuited to the seriousness of my problems.
My guess is that they just don't have the tools to really help with serious mental health problems. I have no real knowledge of what therapists are taught, but it seems like therapy is really more geared toward helping with less serious issues.
One thing I noticed is that there is no kind of consistency of treatment. They all seem to be just trying different unproven things and deciding what they think works. I've had therapists that want you to find some kind of spirituality, want you to try some weird device, want you to fill out worksheets, even had one that wanted me to smile in a particular way. It's the wild west out there.
- It really does seem like they all just wing it. I’ve wanted someone to give me a structured approach to deal with my emotions but it’s 95% is how’re you feeling today and just them socratic methoding the fuck out of whatever you say.
  It's the wild west out there.
  Genuinely. It’s really all koombaya bullshit disguised as something rigorous. Maybe I haven’t found the right fit but holy shit, if I have to literally scout for someone who isn’t full of shit maybe the entire profession deserves scrutiny?
  
  how’re you feeling today and just them socratic methoding the fuck out of whatever you say
  This is so true and it's infuriating. My experience was exclusively this and "That's rough, maybe you should try harder? Oops, that's our time for today!" every visit.
- My impression from my personal experience with therapists/psychiatrists and my own amateur research into mental health issues is that for many issues, we simply don't really know how they work and/or what can be done about them. They try unproven things because there are barely any proven things that work.
- even had one that wanted me to smile in a particular way

Oh yeah, I'm of the opinion that the whole system of therapy is fucked and that good therapists are fairly hard to find in a system which seeks to uphold the hegemony of a conception of "wellness" under the doom-spiral of capitalism. My last therapist was an older white person who had absolutely no advice for me dealing with a horrific anxiety disorder, severe OCD, ADHD, autism, and constant retraumatization from covid, capitalism, and the difficult family situation I was living in. She actually victim-blamed me once in the aftermath of a moment of physical violence and then when I confronted her about it later, she denied it and tried to gaslight me. She also kept harping on about me wearing a mask and taking covid precautions. I also had no idea of how to even breach the subject of being a Chinese trans person with her. It was such a bad experience that it put me off trying to find a therapist again for months, and now I'm trying again but with OCD-specific therapy this time.

Therapists are for middle class white people who feel a little sad or anxious sometimes, or are dealing with loss or whatever most of the time.
If you have an actual personality disorder or are autistic etc they are kind of fucking useless.

when I went in the psych ward I got to see an actual psychologist and the difference between that and some regular talk therapist was night and day. I made progress at a rate I would have never thought possible before. I was also able to enter a DBT program which I consider by far the most successful mental health intervention I have ever undergone. regular talk therapy with some guy with a bachelor's degree isn't very useful in comparison, I see it as akin to writing in a journal basically but with some accountability. for reference I am autistic, have had severe depression for almost a decade, and when I went into the ward I probably could have qualified for a personality disorder diagnosis like BPD. regular therapists can't meaningfully help people like me but seeing the real brain docs did make a difference. obviously the shit part is that's unaffordable for most folks, I was lucky enough to have my insurance cover it and I also don't live in America where the whole system seems waay more hellish.
- I don't know anything about DBT. I did a self conscious giggle about the dialectic part when I read about it though. How do you feel the process of it was?
  
  the one i did was kinda a condensed crash course, 12 weeks of two group sessions and one individual per week. some of them are more stretched out over like 6 months or a year. yeah, knowing a thing or two about dialectics was something of an advantage lol. a lot of it is learning how to recognise your emotions, allowing yourself to feel them instead of e.g. dissociating, and then learning healthy coping mechanisms to control the emotions if they're overwhelming. i found a lot of the "let yourself feel the emotion" stuff hard bc autism makes it hard to identify emotions sometimes and also i dissociate a lot from difficult ones which i still haven't fully unlearned. there's other stuff too like interpersonal skills. overall applying the dialectical method to your own perspective of yourself and your environment is pretty powerful, all about getting away from binary thinking which comes up a lot when you're suffering with mental illness or whatever. i'd recommend it to anyone who has trouble with emotional regulation, i'm pretty cynical about therapy but i really bought into DBT and found it actually helped me.

My therapist of four years resigned during the pandemic. She was really good, she had some of her shit together but I think she was mostly able to put on a mask for her job - which was a queer oriented service up here in seattle that dealt with people from all walks, it was work she probably liked, and she is the only good therapist i've ever had. My last session with her she rolled her eyes at that - she felt her colleagues were on her level and actually defended them - and I see what she said, but nah, nobody has fought like she did, nobody keyed in and got me to think about my own shit like she did - nobody could even pretend to give a quarter of the shit she did.
The last few sessions she seemed to be genuinely cracking, like that professional mask came down and it was apparent she was just a human being with her own private disasters and stuff - I don't wanna share her life but I realized that like, good therapists are kinda sacrificing themselves to do it i think - eventually you burn out from that kind of give-a-fuck if the strain is too high.
- Covid broke a lot of people. As for burnout, It can help for a therapist to work for an organization—really the only way to help people other than pmc’s who “have their shit together” like the op describes—where they can eventually step into a role of mentoring other therapists. Otherwise, it can become too much.

Every therapist I've ever had has been dogshit
When I told my last therapist about my anxiety she was like "oh why don't you try aroma therapy to calm you down?" MOTHERFUCKER I need assistance leaving my own apartment to go grocery shopping I get so anxious, aroma therapy isn't going to do jack shit
And yeah basically everyone I've ever had has been really disinterested. My last one even ended a session 15 mins early seemingly cause she got bored
My physiologist is okay cause she just gives me meds and we talk like once a month, she still misgenders me and shit so still trash but better than any therapist
Mental health services are a joke in the US
- Mental health services are a joke in the US
  are they good anywhere? i could sell my possessions

I got diagnosed with "cannabis use disorder" once because when the head shrink in the psych ward asked me if I smoked I responded "smoke what?" Deeply unserious profession.

Best therapists you'll find for people who don't have their shit together good outpatient rehabs. I've had a few therapists throughout my life but every person there has known exactly how to handle people who don't have their shit together. I'm an alcoholic schizophrenic who was in an abusive relationship. I've gotten really good therapy so far, and so have other people I know who've gone to similar places.
- Do outpatient rehab therapists take outsiders and nonalcoholics?
  
  Usually not

I told one therapist how much I hated having to engage with capitalism, even in small ways like going to the shops and buying groceries, and her advice was to start a business about it.
Unfortunately, like with the drugs, you often have to try a few before you find the right one for you.
- and her advice was to start a business about it.
  Yes, you hate engaging with capitalism, but have you considered engaging with it even more?

sometimes it seems like the actual help is gatekept behind having an attempt but it's more likely that it really doesn't exist.
just need a doctor who can prescribe communism, a social life, and companionship; and a magical pharmacy that has those in stock.

I've had some good trauma informed therapists at low points in my life.
I've also gotten some really bad advice and hot takes from talk therapists.
Experiences with psychiatry have universally been shit. Researching my own meds and asking a GP for them tends to work better. But I imagine they're more hesitant to prescribe controlled substances like ADHD meds.

I never really had, and I still have like a lot of mistrust towards towards the mental health system, due to like something that happened a long time ago. Where like a psychiatrist mistakenly thought I was in crises and sic the police on me. I also didn't have health insurance, so getting the ambulance bill + hospital bill + various other bills from different health professionals like a physician. I dunno it just taught me that to not seek help when in a crisis
- and sic the police on me.
  Oh man, I completely forgot they’re encouraged to call the coppers on you if you’re ‘in distress’.
  
  yea. and there just like that sense of power they hold over someone. Besides that, that sort of reminded me, like when I was involuntary detained in the psych ward. There had to be a court case whether to be involuntary detained longer or to be let go. And there was a state or court psychiatrist that visited me, I think he was? kind of forgot exactly who he was, but when it came to court time. He pretty much lied, trying to keep me longer.

From SPK (Sozialistisches Patienten Kollektiv)'s "Turn Illness into a Weapon":
"The capitalist production process is at the same time a process that destroys life. It continuously destroys life and produces capital. [...] Illness is the expression of the life-destroying power of capital. Illness is collectively produced: that is, in so far as the worker creates capital in the work process, which encounters him as an alien force, he collectively produces his own isolation. It’s therefore only logical that healthcare produced by capitalism perpetuates this isolation in that it doesn’t treat these symptoms as collective but rather treats them as individual bad luck, fault, and failure. However, capitalism produces, in the form of illness, the most dangerous threat to itself. Therefore it has to fight against the progressive moment in illness with its heaviest weapons : the healthcare system, the legal system, the police."
Yeah, oof. As someone training to be a therapist these threads pain me. Parts of me want to be like "not all therapists!", then I remember that I am constantly hurt, disturbed, and alienated by things my supervisors say and do. Even I have never really had a counsellor, therapist, or psychiatrist that I didn't eventually hate

I still believe good therapists and good therapies exist, but they are so few and far between. Most therapists are eager to round off people's edges with the (explicit or implicit) goal of conforming to neurotypical standards. I think there are real benefits to cognitive-behavioural approaches, which focus on shaping maladaptive/problematic/negative thoughts and behaviours - but these are not universal. I have more hope for the value-driven, person-centered kinds of care where a therapist can help someone find meaning, satisfaction, and joy in their life by helping them put their personal values into action.
I have no choice but to convince myself that I (and the other amazing, radical people I know and look up to) can make better care a reality, because the alternative is too grim.
- Right on. I’m in the field, and I’m all about helping kids embrace their strengths and put their personal values into action. Not to become cogs in anyone’s machine.

no. i've been to dozens of psychologists/psychiatrists since i was 12 and none of them helped me. the most useful one was the one who diagnosed me with ocd in my 30s, but that was 100% based on me admitting i had 'obsessive thoughts,' which could have stemmed from any number of disorders (i also had cpstd which i diagnosed myself lol).
then, when i did get a formal diagnosis i went to several after that and none of them mentioned CBT or ERP-- i learned about them on reddit. i ended up fixing my problems on my own.
all that professional help and i had to bootstrap my own therapy. fuckers were so useless i couldn't even get legit benzo prescriptions even though my anxiety was so bad i couldn't work (would have ended up homeless several times if it hadn't been for family).

My best therapist sometimes didn't stop me when I went on tangents and we actually circled back around to important shit. When they take my ADHD symptoms as avoidance of their question that I don't know the answer to, we end up at an impasse and not going anywhere.
- Your tangents are valuable information to a good therapist.

My therapy experience is just that no matter the therapist, they just said some banalities and fed my own confirmation bias

My current therapy office gives me free bus passes when I come which is cool and good but otherwise no I don't feel like therapy has ever helped me
- I learned to keep my compulsory (for my refills) sessions light, otherwise it becomes a loop of me saying "I feel like this" and my therapist saying "why?" with me getting progressively more frustrated and embarrassed until my 10 minutes are up

I had a very helpful therapist, but she ended up quitting because of the emotional stress of the job. I think that's a big part of it. The sorts of therapists who do care deeply and get invested in helping their clients can burn out easily. While the ones just in it for the paycheck will last a lot longer.

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