Many clients come to see me wondering: Do therapists really help? They often complain that they have been to previous therapists for years or even decades, and it hasn’t seemed to help them very much… They are still plagued with depression, anxiety, low self-esteem and other emotional health problems, as well as great interpersonal difficulties. The therapists who treated them were all highly educated, experienced clinicians, some even celebrated for their expertise. Therefore these clients are extremely perplexed as to why the therapy hasn’t worked!
Case Study: Sarah
This is a case study of a real client who came to me in recent years. She has agreed to let me write about her case because she wants so much to help others so they should not suffer like she did! I am calling her Sarah and I have changed a few personal details to preserve her anonymity, but otherwise the story is 100 percent true to life.
Sarah had a challenging childhood growing up in New York City.
Although her parents loved her very much and were very dedicated to her, they both suffered from many stressors themselves, and on top of that were not really aware of the healthy way to parent children. Therefore they made significant mistakes which really affected their daughter for decades to come.
There was constant yelling and screaming in Sarah’s home. Everything was a big verbal fight. Not only was there terrible marital conflict and near divorce many times, but both parents were constantly screaming at Sarah and her younger brother, Bobby. On top of that the children were constantly criticized harshly. Sarah’s parents had good intentions, they felt that she would benefit from constant criticism, that it would help her improve, but after a few months of therapy with me years later, she came to realize that such constant criticism was truly devastating to her self-esteem and lifelong mental health.
In addition as a child and teen Sarah was constantly punished for every kind of supposed misdeed; there was a constant power struggle and her parents were very controlling. In their rage they often screamed terrible put-downs at her. She remembers once while sleeping a bit late as a 19 year-old, her mother screaming from the bottom of the stairs, “You suck! You really suck!!!” She came to realize in therapy that although her parents meant well, they were clueless about proper parenting and in the finally analysis, were significantly verbally and emotionally abusive.
Sarah had significant anxiety, depression, ADHD, OCD, and other problems as a child and as an adult, and eventually had significant suicidal ideation in her late 20’s.
She went to many therapists, for herself and for her children, throughout her life, but she was unable to find they help she needed until she found me at age 40. Why did it have to be so difficult for her? Let’s look at the evidence.
Back in the 80’s when Sarah was 11 years old, her anxiety was increasing. So her mother decided her daughter needed therapy, and brought her to a local group private practice of psychotherapists, where she saw a very experienced therapist with a PhD in Psychology, named Barbara. Sarah ended up seeing Barbara weekly for 3 full years, and she was paid 40 dollars in cash for each 45-minute session, which was very pricey for back in those days, like paying $150-$200 today. In addition, Barbara met with Sarah’s parents about once every 2 months to discuss progress.
I discussed with Sarah her experience with this first therapist. Then I asked her to inquire of her mother currently about some of the details. I was astounded by what I learned! Despite Barbara being paid very well to treat her for 3 years, she never once suggested of advised Sarah’s parents, “Maybe you should stop yelling, screaming and verbally mistreating your daughter? Maybe you should try and reduce all the fighting in the house and develop a kind, warm relationship with her?” Not only didn’t Barbara advise that, she didn’t even notice or ask if any such abuse might be going on! As a therapist who has been working with children and parents by years, I was completely blown away by the immensity of that dereliction of duty! When I see a new family, I interview the parents and children, and I know by the end of the second session at the latest basically the extent to which any abuse, mistreatment or conflict there is going on between parent and children, and I’ve already developed a plan for how to fix it. I make it my first order of business to discover such mistreatment and to fix it as soon as possible; it will surely be addressed within a month or two.
Do therapists really help? How could Barbara see her for three years and not even notice or care that her client was being terribly abused?
That is gross professional incompetence! In my opinion she should have her license taken away! Around the same time her brother also saw a therapist for a while from the same practice but it was the same thing! She never did anything to put a stop to the abuse!
Despite continued anxiety and depression, once the health and vigor of adolescence began, Sarah began to be able to keep her emotional illness more or less under control without therapy until after she got married in her mid-20’s. At that point she was becoming plagued with serious anxiety and perfectionism, rage, ADHD, totally inability to fall asleep, and great interpersonal conflict, especially with her husband. She was skeptical about therapy as it hadn’t helped her in her childhood so much, so she was careful only to go to a therapist who was highly recommended and experienced. She found a Dr. Paul, and although his fee of $160 per session was difficult for her, she would give it a try. Sarah saw Dr. Paul for 5 sessions and was impressed with his wisdom. She therefore decided to discuss with him what to do going forward, because it would be difficult for her to afford his fee for the long term.
I couldn’t believe his response when I heard it!
Dr. Paul said that those 5 sessions were enough and she didn’t need any further therapy, all she needed to do was read some self-help books he would recommend to her, and pick herself up by her bootstraps! How could he say that to a person who would a couple of years later make a near suicide attempt amid increasingly devastating anxiety! When I see adult clients, I always know within one or two sessions who actually needs therapy and who doesn’t, and approximately how much therapy they will need. For someone with Sarah’s symptoms and history she would obviously need at least two years of serious therapy to get better. How could Dr. Paul let her go with a clean bill of mental health like that? That’s criminal incompetence! That’s like if you have a person whose body is filled with many different forms of cancer; tumors from head to toe, and he goes to a cancer specialist, who examines him thoroughly for five sessions, and tells him “You’re fine! Go home there’s nothing wrong with you!” Shouldn’t such a doctor lose his license?
Discouraged and still wondering, Do therapists really help, Sarah sought treatment through a great technique everyone had been talking about, Cognitive-Behavioral Therapy, or CBT.
She went to 3 CBT specialists over the next several years, who although they were cheaper that Dr. Paul, they did not take insurance as they were very experienced and had good reputations. These therapists taught her about how she needed to change her unhealthy thought patterns and eliminate her irrational core beliefs, which were causing her anxiety and depression. Sarah actually found the CBT somewhat helpful, at least in the short run. But she expressed to all three therapists a nagging desire to address her childhood memories, many of whom were very traumatic and deeply distressed her. In addition she felt a lot of anger towards her parents and still had a conflicted relationship with them.
The response of all three therapists was the same: “The past is the past, there’s nothing you can do to change it,
just put it behind you and focus on changing your thoughts and attitudes in the present and future. In addition you need to forgive your parents and even be grateful to them for raising you! You need to be strong and get over the past and move on!” Sarah attempted to do that but she found it increasingly unsatisfactory. She deeply felt that she must somehow deal with the past first in order to move on. The problem was that most of the therapists she researched couldn’t help her with that. Now in my practice with adults I know that CBT is great, but it must be done concurrently and in conjunction with what’s called psychodynamic therapy, where we specifically explore the past and where your symptoms are coming from, especially in childhood. I truly believe it is irresponsible and unhelpful to ignore the past, as the past is what made you what you are today!
As time went on and Sarah suffered from her own individual problems, she began to have severe marital problems.
She loved her husband very much, but he seemed to be very emotionally unavailable for her, he didn’t seem to be able to fulfill her emotional needs, and conflict as a result was increasing. So as usual, Sarah did her research and found a highly recommended and expensive $150-an-hour couples’ therapist, Dr. Braun, who advertised a unique and effective communication technique which promised to resolve marital conflict quickly. Sarah and her husband saw Dr. Braun for six sessions, and they religiously implemented his communication program, which involved carefully repeating back to each partner what he or she had stated to show you had listened, no matter how much you had disagreed with it. After 6 sessions and hours of outside homework, they were fighting actually much more, and didn’t see and end in sight, so they gave up. But I was amazed when I heard her story! “You mean all he gave you was the communication technique?
Didn’t he assess you and especially your husband for individual mental health problems?
As was revealed years later, Sarah’s husband also suffered from significant emotional health problems such as depression, compulsive overeating, and repressed emotions. When I see a new couple for couples therapy, the first thing I do is assess each member of the couple for mental health problems that may require individual therapy for one or both partners. I have learned over the years that couples therapy is mostly ineffective if one or both partners is suffering from unresolved emotional issues. In my opinion a couples therapist who doesn’t do so is grossly incompetent! How could Dr. Braun, with his doctoral training, stellar reputation and hefty fees, neglect that critical step?
Soon after that time, Sarah began to have increasing problems with her oldest son, who had a history of anxiety and social problems.
He was assigned by the Department of Education a licensed psychotherapist to treat him in school for 2 half-hour sessions per week, named Loren. However despite this significant treatment, his anxiety only increased. When her son was 10 and a half, Sarah decided that although Loren wasn’t hurting, she wasn’t resolving the problem and due to her son’s alarmingly increasing anxiety and refusal to take medicine or do schoolwork, she took him to a highly recommended top Registered Play therapist in Queens, New York. He saw Sarah’s son for three months and had regular meetings with Sarah and her husband as well, and concluded, “Your son is making it all up, he is totally fine, look at how well he plays in my playroom! He’s just fabricating all his problems because he is spoiled and wants to control you and doesn’t want to do his school work!” Now bear in mind that 4 months after terminating with that Play Therapist, much to Sarah’s horror her son had a major suicide attempt, where he tried to throw himself into the Hudson River, and luckily some onlookers grabbed him and held him back. He was the hospitalized inpatient for three entire months, and only through great use of medication, was able to get past his suicidal ideation an be released. Again I was stunned!
How could such an experienced and celebrated Play Therapist not notice that his patient was suicidal!
How could he let him go, blaming the whole thing on the child, saying that he was making it up! In my experience as a child therapist, I know immediately within a few sessions if there is any risk of self-harm! I never downplay the symptoms of accuse a kid of maliciously making things up! I don’t believe such children exist! How could that Play Therapist be so incompetent, especially after taking so much money! And even more astounding, the boy was still seeing Loren his therapist in school the whole time up until his suicide attempt, and in the whole year leading up to it, Loren never called Sarah or her husband once, saying “Gee, I noticed your son is a bit anxious and not doing so well… Maybe we should talk about it.” She never even noticed anything was even wrong! How could a therapist see a kid an hour a week for years like that and not notice or assess for and upcoming suicide attempt! How could she be so out of touch with her clients parents! That is terrible incompetence!
Sarah’s son was doing somewhat better as far as anxiety and suicidal ideation was concerned of 4 different medications,
…but now a new problem arose: At least twice a week the 11-year old would have violent tantrums.
There seemed to be no clear triggers for these events, and they left as quickly as they came, but Sarah was clueless how to resolve them. Her son would get so violent that they had to call the police several times! He had seen several therapists over the course of the year as part of his discharge from the hospital, as well as a child psychiatrist to manage his meds. None of them had a clue how to resolve his tantrums. Some of them blamed it on Sarah, “You must be provoking him somehow!” But Sarah didn’t understand, she was tirelessly patient, tolerant and loving to her son, nothing she could do seemed to be able to resolve the tantrums. The last straw with that clinic came when her son’s latest therapist, named Nancy, began recommending and strongly encouraging that the boy begin a regular habit of masturbation. She felt it would relieve his stress and make him happy. Now wait a second! Sarah and her family were observant Catholics, they attended Mass every Sunday, and tried to follow the Bible. Nancy knew them and knew that very well, how could she strongly advise masturbation! Everyone who has any shred of an education knows that for Catholics and other religious people, masturbation is strictly forbidden and strongly discouraged! How could Nancy disrespect their religion so much? How could she be so culturally incompetent?
Feeling desperate but still determined, Sarah found the biggest, most experienced child specialist in Manhattan, a $275 a session proposal.
Maybe she would succeed where others had failed. After 5 sessions the specialist blamed the whole problem on Sarah; with her anxiety, she was provoking her son’s tantrums! But she was clueless as to what she needed to change, no matter what she did the problem continued. A few weeks later her son’s psychiatrist was alarmed that the child’s weight had been increasing rapidly, he was now sporting a nice pot belly. Therefore she decided to cut out one of the SSRI’s, and anti-anxiety medication, which he had been taking, and she felt it was responsible for his weight gain. Well he didn’t lose any weight, but immediately, as soon as the anti-anxiety med was discontinued, the tantrums disappeared completely. It’s been years and they have never returned! He became instantly a completely angelic, healthy kid!
So obviously the tantrums were a medication induced condition, but the question that again stunned me was, how could that fancy, Manhattan child specialist not check for that?
In my years as a child therapist, I have learned that if you have a child with a problem that does not respond to therapy, always consider meds, and if he or she is already on meds, you must immediately check with the psychiatrist about the possibility of changing meds! But that child specialist never thought of that or even communicated with the child’s psychiatrist! How could she be so irresponsible and incompetent!
Finally, Sarah found my webpage about Childhood Emotional Neglect, and she came to see me.
I expressed a tremendous amount of empathy for her difficult situation, and her terrible luck at finding competent therapist who could help her. I began to see her weekly for 3 years, and although I use a lot of CBT, I mostly focused on psychodynamic work. I helped her understand, mourn, grieve and process her childhood trauma, gain awareness of all her repressed anger, fear and shame, and reconcile her difficult relationship with her parents. She was so immensely relieved to finally have a therapist who gets her and understands her need to heal from her past! At the same time I helped her build her self-esteem and self-confidence, replace perfectionistic and self-critical thought patterns with healthy ones, and celebrated and called attention to all the wonderful things she does and qualities she has. At the same time I began to see Sarah and her husband for couples therapy, and I immediately got her husband into individual therapy with a competent colleague of mine where he stayed for 2 years.
Finally, Sarah reported that her mental health problems had become 70 percent resolved. She was highly motivated to have others benefit from her experience, and was enthusiastic about writing this article, having answered her decades long question: do therapists really help!
So what is the takeaway from Sarah’s history?
It seems that one has to be very careful and diligent in seeking out a therapist, and even have a bit of luck, too.
One needs to be sure to hire one who uses a psychodynamic orientation which addresses childhood trauma, as well as CBT, and one who is very skilled at identifying problems and the need for therapy. For children one would have to be meticulous to find a therapist who works on the parent child relationship, corrects parenting errors, communicates with the parents, takes the child very seriously, and considers all the angles, including working closely with a child psychiatrist.
Sarah had a rocky journey, but a happy ending. I sincerely wish that everyone reading this article find the competent psychotherapist that he or she truly needs!
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