[CN: mental illness, self-injury, sexual violence.]
It’s been almost a quarter-century since I first began seeking out professional help to correct the undefined something that was going terribly wrong inside my head. During those 24 years of searching-but-rarely-finding, I have worked with 9 therapists, social workers, and psychologists; consulted with over 12 psychiatrists and psychiatrists-in-training; and been prescribed more pills, poppers, and potions than I have fingers and toes (or maybe brain cells) with which to count.
I submit to you: this qualifies me as having a certain expertise.
Mostly it’s expertise in how to go slowly mad. But — work with what ya got, right?
Everything that follows draws from my own experiences (some of which has also occurred to friends and acquaintances). Consider it all contraindicated! Though, I suppose, one could follow the advice as written. Maybe you like to live on the edge.
You’ll certainly find greater madness out there.
Assume every client is depressed, until proven otherwise.
If, at some later point in time, your client starts describing symptoms not consistent with depression, criticize her choice of language and chastise her for disrespecting your profession.
Once you’ve reduced a client to sobs through a lengthy interrogation about her family of origin, conclude with: “You have not said anything that proves to me your father would not love and support you, no matter what you do.” Let her know that your diagnosis will be based in part on the irrational anger she displays towards her father.
Feel confirmed in your assessment when the client now begins displaying an irrational anger towards you.
When informing a new client you think she has been misdiagnosed by previous psychiatrists, lean back in your chair, grin broadly, and say: “Guess what my diagnosis of you is!”
If the client reacts to the new diagnosis by saying nervously, “That sounds like a death sentence,” tell her it’s actually quite treatable now — then dismiss her with a xeroxed newspaper article on the mood-enhancing benefits of exercise and no recommendation for a follow-up appointment.
Respond with a spit-take upon learning that a client does not come from a broken home: “Wait! Your parents are still married?? TO EACH OTHER??!”
Refuse to answer point-blank questions.
For instance, if a client asks, “When you say that you think I had a ‘big breakthrough’ today, what are you referring to? What is it you think just happened?” — reply only: “Well, what do YOU think just happened?”
For best results, ensure the client never figures out what you are talking about.
Attempt to build rapport by repeatedly saying things like: “You’re someone I’d love to hang out with, if you weren’t a client.” Or “we’d be great friends, if we had just met somewhere and you were not my client.” Or “you’re just like people I’m friends with, except we can’t be because you’re a client.”
Never ask the client for her own thoughts or feelings about this hypothetical friendship.
Cut a scheduled appointment short because you decide the client needs to go to a nearby psychiatric hospital for immediate evaluation — and then don’t alert the clinic that you’re sending her over (or why), despite promising to do so.
Remember: The possibility of getting committed becomes extra-exciting when no one (including the client!) understands what she is being evaluated for.
Take on the role of a punitive parent: “I am terminating my services with you because you need to learn that actions have consequences.”
Bonus points! if the action in question is self-injury, and the client’s sole expressed reason for seeking therapy at this time is: “I can’t stop cutting.”
Minimize a client’s own assessment of her self-injuring. Correct her on language you don’t agree with: “I thought you said you had ‘cuts.’ Those are just scratches.”
Do not worry about the client escalating the severity of cutting shortly after you refer to her injuries as scratches. Chances are, she won’t feel safe talking to you again and will thus become some other medical professional’s problem.
When a patient comes to the ER for stitches on a self-inflicted injury that is not life-threatening — and that she assures you did not result from a suicide attempt — have a cheery intern call her at home a week later to ask if she is willing to participate in a research study on people who have attempted suicide and survived.
Be certain you do not have the client’s permission to share her medical records before giving them to the cheery intern.
Refuse to believe a client’s stated sexual orientation. Reject the term(s) she uses to describe her orientation. Insist that the client still needs to “come out” as something else.
Remember: Just because the client doesn’t have a problem with her own sexuality, doesn’t mean you can’t make it a problem for her!
[tl; dr Be shocked to learn bisexuals exist.]
During your first meeting, insist the client must have been sexually abused as a child. If she tells you she wasn’t, suggest that “maybe [she] just doesn’t remember” being abused. But be clear: you’re absolutely sure abuse happened.
So much depends upon the trust and rapport built in at the beginning.
Or perhaps I’m just thinking of a red wheelbarrow…
If a client expresses shame around a sexual event severe enough to make you ask, “Were you raped?”, and her response is “I consented to everything that happened to me” — take this statement at face value.
Make no attempt to clarify what “I consented” meant to her in this situation.
Use scare tactics to prevent a client from questioning the efficacy of a drug:
Client: “I’ve been on this med for over six months, and — as I’ve told you before — I can’t tell that it’s making any difference at all.”
Doctor: “But think how much worse you might be if you were not taking it!”
Prescribe a potentially lifelong course of antipsychotics following a single quasi-psychotic episode. Do not be deterred by the fact that this episode was precipitated by a difficult topic coming up in therapy for the first time, and without adequate time to discuss.
Both therapist and psychiatrist should make a point of NOT following up on said topic later, especially if the client’s only psychotic symptom consisted of a voice in her head saying, “I’ll kill you before I let you ever talk about [redacted] again.”
Clearly: let that sleeping dog lie.
If a client strongly values her identity as a writer and tells you that, since starting a new medication, she can no longer write — that she does not recognize the only “voice” now in her head as her own — assure her this is great news! It means the drugs are working…
And that’s what really matters.
That’s all that really matters.
Got any horror stories of your own? An “I CANNOT BELIEVE THAT JUST HAPPENED” moment you’d care to share? Please comment below!
Mi schadenfreude es su schadenfreude.