Last time we spoke with M.D., board-certified psychiatrist, and Blisstree pal Dale Archer, he schooled us on When to Tell a White Lie: 10 Situations Where Honesty Doesn’t Pay. Today I asked him for more straight talk, but this time on the tricky issue of individual therapy — specifically, when and if you need it at all, and if you do, how to break up with your therapist when things just aren’t working out. (Because I happen to know that Dr. Dale has some pretty unorthodox opinions on these subjects.) This is one smart shrink with some seriously good (and free!) advice:
In one of our past conversations for Blisstree, you mentioned that, even though you’re an M.D. and a board-certified psychiatrist, you firmly believe that not everyone needs therapy during their lives. Why not?
America has become overdiagnosed, overmedicated, and over-counseled with respect to mental health. The simple fact is that you can’t prescribe “normal,” there is no one-size-fits-all in terms of dealing with life issues. Most of us have to deal with stress and obstacles in our lives and have developed a coping strategy that works fairly well for us. If we become overwhelmed or if we develop symptoms that affect how we choose to live our life (indicating a chemical imbalance) that could indicate the need for an evaluation and possible treatment.
My upcoming book Better Than Normal: How What Makes You Different Can Make You Exceptional (Random House, 2012) will address this issue, among other things:
Over the last 20 years, psychiatry has gone from being stigmatized to glamorized as we try to cram everyone into a mental health box called “normal.” This expands the abnormal universe to include almost everyone, but we tell them: Don’t worry, here’s a pill that will make you “normal,” just like everyone else.
Psychiatric conditions don’t come with an on/off switch, but rather occur along a continuum. High levels of any given trait can represent a severe psychiatric diagnosis requiring medication, but in small to medium doses, these very same traits can represent our greatest strengths.
Build your life around your traits rather than medicating/counseling them into oblivion and remember this: If you try to please everyone and conform to the norm, you lose your uniqueness, and hence, your greatness.
I know it’s different for everyone, but what are some circumstances where you think a person should definitely seek out therapy?
When you have symptoms that prohibit you from doing (or enjoying) the things you want to do in life.
A young clinical psychologist friend of mine says that if you want to stop seeing a therapist you’ve had for a while because you feel like you and your therapist just chit-chat like casual friends during your sessions, it’s not because you’re emotionally “cured,” but because you aren’t digging deep enough during your therapy sessions. Thoughts on that perspective?
Totally disagree. Often the role of therapy is to help you see things from a different perspective or give you a new way to cope. Modern therapy tends to be very focused on a problem, and when that’s resolved, it’s time to move on. Many people become dependent on their therapist, using them as a sounding board for everything. Often times, a friend would do just as well.
Is it possible for a patient to be in therapy for far too long?
Yes. I think the role of a therapist should be similar to a parent. You know you’ve done a good job when your patient no longer needs you.
When, if ever, is it appropriate for a patient to “fire” a therapist?
It’s appropriate for a variety of reasons: If they violate your confidentiality, make a pass at you, are rude, are often late, you don’t click, or if you’re just not getting better or want a second opinion.
When, if ever, is it appropriate for a therapist to “fire” a patient?
Same issues above apply, or if you feel that they’d be better served with another therapist for whatever reason. So it may not actually be a firing.
If you decide it’s the best course of action, what’s the best way to go about “breaking up” with your therapist?
Most people cancel their next appointment by phone, say they will call to reschedule, and then never do and never go back, because they fear confrontation. Of course it would be healthier to discuss the situation with your therapist, give your reasons, allow a rebuttal, and then move on. But actually, the reasons you’re thinking about “firing” them should be a constant source of the discussion during therapy; and if the problems aren’t resolved then it becomes easier to tell your therapist that this isn’t working for you — and that you’re moving on.
Dr. Dale Archer is a medical doctor, board-certified psychiatrist, and Distinguished Fellow of the American Psychiatric Association who has helped thousands of patients for more than two decades. His focus is to give good common sense psychological advice. Specialties include chemical imbalances of the brain, relationships, and personal responsibility.