There’s a certain mutual expectation between therapist and client:
I pay you to listen to me, help me process and move past my fears and depression. You get money in exchange for my continued presence in your office, warming your armchair, while you try really hard to feign attention and interest in me. When either part of that transaction fails, the entire relationship fails.
My last therapist ghosted me.
I wrote out the reasons I think our relationship failed, some complaints I have for our mental health system, and the red flags I noticed along the way.
2016 was a very big year for me. I got married, I finally graduated from college with no clue what to do for the rest of my life and moved out of my parent’s house for the first time in six years.
Everything was changing, and since being diagnosed with OCD three years prior and taking steps to improve my mental health but still not being 100% healthy, I was sure I was going to relapse. In the least surprising turn of events this century, I did relapse.
I realized the relapse was already happening so I decided to find an OCD specialist in my area.
I had previously only been to a counselor and a psychiatrist, and while the combination did help me realize what was developing in my head at the time, I ultimately found through research that traditional talk therapy is not very beneficial for OCD sufferers. In fact, in most cases of anxiety-based mental health cases, I’d say traditional talk therapy doesn’t get the job done. For someone who is constantly having conversations with their own doubt-filled brain, it’s not super helpful to go have yet another conversation about all the doubt and fear for an hour every week. So after finding out the best approach for OCD is a cognitive behavioral therapy called exposure-response prevention, I decided to try to find a therapist in the area who was well-versed in ERP.
I found two.
**Dear America, WHY is it so hard to get access to BETTER mental health care and support?**
One was WAY out of my price range.
**Dear America, WHY is mental health not something we prioritize and demonetize? WHY do we have to pay to feel and be safe?**
The other seemed less prestigious and well-versed, but still put forth a solid effort at teaching ERP. I chose them.
Red flag 1: Your potential therapist is very hard to reach.
I get that therapy is intensive work and it keeps practitioners busy, but it should not be that hard to schedule an appointment.
I finally made an appointment several urgent emails, and voicemails, and phone tags later and began my therapy process all over again.
First I had to be diagnosed with OCD, again. Check.
Then, I had to talk about my goals and the therapist’s goals. Check.
Then, I had to talk about what was bothering me. Hard check.
Finally, my time was up and I didn’t feel any better.
Red flag 2: You leave the first session and don’t feel better.
Which is not to say you should instantly feel cured of all worry or sadness or feeling because that’s just not how that works, but you should feel better than you did before you went in. You’ll feel a little scared about the process waiting for you ahead, but not as scared about the everyday worries you went to talk about in the first place.
So on went the weeks of therapy with me paying $135 a session out-of-pocket…
**Dear America, WHY is healthcare SO expensive?**
…and barely getting any type of jumpstart on the ERP I had been promised.
Red flag 3: You are scared to ask your therapist, or even talk to them, about where your relationship is going.
We needed to have a DTR, hard, but I was terrified to broach the subject because I didn’t want to insult her education and practice in the field. I thought she knew best so how dare I, her stupid patient, get in the way of her doing her thing? But week after week after week went by and I was no closer to ERP. I was talking about my mother. I was talking about my childhood. And she found subtle ways to get me to keep talking about it.
After complaining to my husband, I worked up the courage to ask about ERP. She said she needed to establish a baseline on me so that she could better tailor the exercises.
“Okay,” I thought. “At least that’s something.”
Life happens, and sometimes you have to cancel an appointment because work won’t let you leave early.
**Dear America, WHY do I have to tell my employer I need time off to go to a therapy appointment and then get ridiculed for needing to see a therapist; labeled as overly sensitive and neurotic?**
Red flag 4: Stuff happens, but your therapist isn’t accepting of that.
If they make you feel pretty horrible for missing an appointment without notice, and then quickly ask for payment for the missed appointment… they might be a rotten apple.
After that cancellation, I did my best to always notify in advance if I needed to reschedule or miss an appointment. Again, therapy is not cheap. There were weeks I just didn’t have the money. There were weeks I just didn’t feel like going, and that was on me.
After a few months, I was feeling worse than ever and finding no relief.
She sent me to a psychiatrist to get back on medicine.
The thing you should know about anxiety and depression is that medicine helps. It really, really does.
But it also masks things. It’s usually used to help people cope long enough so that they can start to do hard ERP work without feeling as anxious.
Red flag 5: The psychiatrist you are referred to can’t meet with you so they set you up with an intern.
I’m not saying she was inadequate. I’m not saying the medicine she gave me didn’t help. But there were things about a large-scale psychiatric practice that really put me off. I wanted to start the same medicine I had been on before, but she changed it. I drove there once a week for a few months, just to sit in her office for ten minutes to be told I was unfortunately still “fat” and needed to exercise more. I agree, but it’s not super helpful for a depressed and anxious person to hear every week for three months.
So I continued seeing the therapist into the new year, and she never really even broached the ERP subject. We talked about it in theory. We talked about what it would be like. We went over what an exercise might look like on her computer. She said we’d make a plan, a list, and then start checking things off of it.
Red flag 6: Your therapist can’t deliver on any of their promises.
Around the year mark, I was fed up, and doing slightly better on medicine alone, so I started canceling more appointments.
Not great, but that’s sort of the M.O. of an anxiety/depression sufferer.
**Dear America, WHY are we not better at this mental health thing?**
So, not only did I basically quit my medicine cold turkey, but I also stopped attending talk therapy.
I didn’t really get worse, but I definitely didn’t get better.
Red flag 7: Your therapist doesn’t reach out to you when you’ve skipped a couple of times.
They’re not concerned. They’re not curious. They’re as non-existent to you as you are to them.
One night in January 2018, my husband’s employer laid off almost everyone because they were bankrupt.
I had a therapy appointment the next day.
I had missed the previous week as well, but I knew I should reluctantly text the therapist and explain the situation; how we might not have enough money for a while.
Red flag 8: Your therapist is MIA.
I hope it doesn’t get to this for anyone else, and I realize I’m partly to blame. But… your therapist is not paying you to talk to them, you are paying them to hear you and help you. When your therapist stops answering you, it’s time to move on.
But I didn’t move on right away. I thought the therapist was preoccupied, as usual, and would get to my text later. Days turned to weeks, weeks turned to months, and then a couple of months later my husband had accepted a job out-of-state.
I probably wasn’t in the greatest frame of mind for making a decision like moving across the country, but when my non-ERP-practicing ERP therapist ghosted me, I figured the best way to enact change was to uproot my entire life.
I haven’t been back to therapy. I haven’t been on medicine again. It’s been over a year and I can truly say I have never been better. I’m in a place I didn’t think was possible because I’ve made changes on my own.
Why are therapists great ’til they gotta be great?
When they’re not, it can be really detrimental to your health and your life.
So what do you do when your therapist throws up so many red flags?
Push forward. Find someone new. Study the subject yourself and see what kind of tools you can apply to your own life.
There are things I could do better, even now. There are days when I still know I have OCD. More often, though, there are days when therapy feels like 10 years ago.
THAT is change. That is growth.
**DISCLAIMER: This therapist did help. She taught me a lot of behavioral things I still use to help myself in times of obsessing and compulsing. She knows CBT. I’d like to believe her other patients have better success with ERP. Choose someone who meshes well with you, your life, and recovery goals. Don’t be afraid to walk away from a bad one, but don’t expect everything to be perfect. Therapy is hard. Keep pushing through. Know there’s a much better life waiting at the other end of the journey.***
If you liked this piece, be sure to check out Therapy. It’s Brave.