Betrayed by the Therapeutic Process

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Reader’s Question

I went to a clinical psychologist-nutritionist in my university for treatment for disordered eating. For the past few years I’ve been restricting food intake and within a week started to count calories and used fiber to purge. Then I’ll start to “binge” on sweet stuff like chocolates and ice-cream, and eventually substitute my main meals with them.

But I’m of normal weight — in fact, slightly overweight.

My (then) therapist didn’t believe that I’ve had disordered eating. She thinks that I just have “weight management issues”, and purging to her is induced vomiting. Therefore she’d selectively attend to information congruent with what she believes, and whenever I talked about issues on family and control that affect my eating behavior, she would ignore it or twist it to suit what she wants…

I felt that I couldn’t work with someone who doesn’t believe in what I’m experiencing, so I quit. I wasn’t asking for a diagnosis, but I don’t want to wait until I have a “full-blown” eating disorder before I seek help.

My health has already been badly affected. We were frustrated with one another, and she asked if I wanted to continue. I was very upset that I had again allowed someone else to draw the line, and so I defaulted the next meeting. I also couldn’t bring myself to face someone who thinks that I’m a joke.

I felt betrayed by the process, but I know that I can’t go through it alone. I had a rude shock when my lecturer (counseling psychologist) told me that she heard I had quit therapy because “you were trying to run away from an intervention that was working but painful”. I was extremely angry at that accusation because pain was never a reason for quitting. I quit because I felt that I wasn’t believed in, that what she told me about counting calories and purging were confusing, and that she had initiated the termination (all of which she had conveniently left out). Plus, what is so painful about writing a food journal for weight-management anyway? Isn’t it more painful to talk about issues surrounding disordered eating? She also said that I believe that I have anorexia. I found that quite amusing, because I had never mentioned the word; and which part of me looks anorexic?

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I am very, very hurt and betrayed by her and the whole system. I just don’t know how to trust therapists anymore. I’m afraid that if I don’t deal with this, it will affect my new therapy work. What should I do?

Psychologist’s Reply

Compatibility is essential to the success of any therapy. The therapist and client must agree upon the nature of the problem, and the client must buy into the therapist’s proposed plan of action. On the client side, we go into therapy with certain concerns forefront in our minds, and if we don’t feel that our concerns are being heard and that they will be addressed, it’s frustrating at least. Worse, we can feel invalidated.

Therapists do go into the work with certain biases. If we are behaviorists, we may be disinclined to address family and control issues. If we are psychodynamic, we may not address the immediate behavioral issues that concern our clients most, expecting that they will resolve themselves when deeper issues have been dealt with. It is our job to explain our treatment approach and either gain the client’s understanding and agreement, or make a referral to someone more compatible with the client.

When, in ongoing therapy, either party detects a disconnect like you experienced, it is important to stop and address it. That way, the therapeutic relationship can be rescued before it is irretrievably disrupted. Even if you need to terminate, it can still be useful to go back and process with your therapist exactly what went wrong. This can help set you up for a better experience next time around.

The other essential element to any successful therapy is confidentiality. Processing your feelings about your therapist’s conversation with your lecturer may help repair your trust in the system.

With your next therapist, you can cover these topics up front. How important a diagnosis is as her starting point, what she considers your diagnosis to be, how she works with your issues, and boundaries of confidentiality all go into the therapy contract. You are hiring a professional to help you — and it is perfectly fair to interview her about her experience with similar problems, success rates, her style, and her approach. Knowing what has and has not worked for you before will help her address these points.

During the first few sessions, you can monitor your reactions — whether you feel judged, heard, understood or not, angry, safe or anxious, hopeful or frustrated — and talk about these feelings with her. If either of you does not believe that you have a match, you can keep shopping until you find the therapist who is right for you.

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