Q:
I was in a six-year abusive relationship with my ex, who, in hindsight, displayed many covertly abusive traits. My therapist at the time, also of six years, missed it. Instead of recognizing the signs of abuse, she also became my ex’s therapist and a therapist to many of our friends during the time we dated. She never told me that any of this was a conflict of interest.
I ended up being misdiagnosed by her with a highly stigmatized and highly debated mental health disorder that’s disproportionately diagnosed in trans folks, queer folks, and cis women. The disorder was then blamed by her (and my ex) for a diagnosis she gave my ex. At the time, I trusted her judgment more than my own, but I stopped seeing her at the suggestion of my ex. The next therapist I saw during the breakdown and eventual breakup of the relationship also missed the abuse and instead doubled down on my reactions to my ex’s abusive behaviors as symptoms of the (mis)diagnosis.
Both of these therapists were queer, both shared aspects of my racial identity, one shared my gender identity, and both had closely aligned political views. However, structurally, their identities are more closely aligned with my ex. I believe that this, alongside the covert nature of the abuse, influenced the more forgiving attitude they had toward my ex and the stigmas they placed on me.
How do I trust mental health providers again when the two I’d extensively vetted failed me?
A:
Dear LW,
What you experienced is serious mistreatment by your therapists and their actions are an indictment against the field I love. A therapist ought to do their best to avoid making things worse for their client, especially one experiencing abuse. You are also entirely correct about there being a conflict of interest when your first therapist treated you and your ex simultaneously. While it might be understandable that the relationship wasn’t obvious during intake, she failed at her responsibility to stop treating your ex once the relationship came to light. I’m writing with the assumption that your therapist did know about your relationship, but that won’t justify the rest of how they (mis)treated you.
Importantly, conflict of interest for healthcare providers is a broad, but strict standard. They are diverse in their manifestations, so there is discretion about when something gets ‘too close’ to a conflict. However, providers are pushed to err on the side of caution. Measures like transferring a client or politely refusing due to the risk are purposefully routine. They’re off-ramps that ease the burden on client and provider alike. Treating your friends could be an ethical grey area, depending on the circumstances. But treating two people who are in a relationship and divulging sensitive information about that relationship is just terrible. If she knew about this, the correct decision would have been to transfer or decline your then-partner to preserve the more existing process with you.
Regardless, that ethical failure doesn’t excuse the effect she had on your mental health. Mental health providers are human subject to biases and errors like anyone. However, much of their training is meant to make them aware of their biases so they don’t harm the client-therapist alliance. Their training should also prepare them to identify harmful factors in a client’s life (e.g. abuse) and support them to realization and action. Slapping a diagnosis on someone without being sure that it’ll open care rather than close it is just… bad.
While I’m glad you removed yourself from that abusive relationship, I can tell your therapists weren’t the supportive factors they should have been. And yes, mental health providers can be fooled or manipulated. However, even if they have misgivings about a situation, they should, at worst, transfer the client to someone who can provide effective support. It’s fine for a provider (of any kind) to get in too deep, as long as they still prioritize the client’s care.
The diagnosis that was imposed on you also seems unhelpful. I don’t know where your therapists were trained, but even my undergrad went into depth about the implications and risks of (mis)diagnosis. Good mental health practitioners do not just slap a DSM/ICD diagnosis based on rote checklists. If that constituted a valid diagnosis, then anyone using Google can diagnose anyone. The mental health provider is a person-in-the-loop who uses expertise and discretion to bridge the client’s experiences to procedure. Clients don’t always have to agree with a diagnosis, but they should always feel heard.
I feel like I’ve gone on at enough length about the inadequacies and missteps you faced during treatment. I’m sure you understand most of what I’ve written intuitively, but I hope my stance clarifies these topics for you.
I won’t exaggerate: I’m a little surprised that you still trust the mental health field enough to consider seeing more providers in future. I commend your forward-thinking, given that your mistrust in therapists is very, very well-placed. I’ll make some suggestions about what you can do about future providers.
Worst foot forward
My first recommendation is to look to future providers with an eye toward specialization in interpersonal abuse. This whole constellation of mistreatment you’ve been through warrants a provider whose specialties align a bit to your experiences.
When people start therapy, they usually come in with a ‘presenting problem’. It’s the ‘obvious’ issue that gets addressed first—the tip of the iceberg. Underlying issues are unveiled once therapy gets underway. If I were in your position, I would make interpersonal trauma and mistreatment one of my presenting problems to discuss first.
For one, that would guide you to relevant providers in your search. If you want long-term talk therapy rather than a more medicalized approach, you’d probably angle away from psychiatrists toward psychologists and other counsellors. If their profile describes experience with long-term traumas like C-PTSD or intimate partner violence, that would be a green flag with me. Those specializations imply a history of speaking to people who have been maligned or disbelieved.
Set that boundary
Good therapists are good with boundaries. They’ll work with clients who have been disempowered throughout their lives to be better at asserting boundaries. They’ll also respect the client’s boundaries in-session.
The client-therapist dynamic is an imbalanced power dynamic. That’s why therapists are bound by specific regulations and codes of ethics and clients just have to do the bare minimum of obeying the law. Not everything that happens in therapy should occur on the therapist’s terms. As long as your agency is intact, you can establish boundaries or decline to proceed with a therapist’s suggestion. There is a point at which a provider can override your agency, but that bar is usually set at a risk of imminent harm to yourself or others.
Given your past experiences, I’d start by stating to the next therapist that you’ve been abused by your ex and past therapists made it worse. Therefore, the first step to making you feel whole and contained would be to believe you. Something like that—gentle, but assertive—should be met with agreement and understanding by any provider. It’s a basic request that should not be brushed off. If they do strongly disagree, you’ll immediately know how they see you.
Wear that badge… or don’t
My last bit of concrete guidance concerns the diagnosis you were given. I can’t remark in great depth since I don’t know what it is, but it’s clear that you disagree with it. What I was taught in my studies is that diagnosis is first and foremost, a label. The thing that’s certain about a diagnosis is that it labels them for the duration. The outcomes of that label must always be weighed against the effect of someone wearing it. Diagnoses can create paths for treatment, give people insight, or build support structures. Diagnoses always attach a label to someone and change how they (and others) see themselves.
The thing about the diagnosis you were given is…you don’t have to wear it if it doesn’t support your healthcare. The emotional and social burden it imposes is only worthwhile if it gets you the help you need. Even if the diagnosis is accurate (broken clocks and all), you deserve to have it explained to you in a way that supports your well-being. That is the difference between treatment imposed on someone and treatment performed with someone. Sure, there are conditions that require treatment to be imposed whether or not the client wants it. But I don’t think you’ve reached that stage.
Based on what you wrote, I don’t see how the diagnosis has helped you. You don’t have to wear it if you don’t want to. You’re allowed to set it aside until you feel ready to revisit the topic—preferably with a better therapist.
I ran long in my elaborations, but that’s because mental health is a deeply important topic to me. I didn’t intentionally skip your discussion of the therapists’ racial identity, politics, and how they may have affected your treatment. They’re highly relevant points, but I didn’t feel like I had enough detail about your inner world to speak confidently about it. So I kept things more broadly applicable.
Mental health is never easy and any exploration of someone’s psyche without considering all possible subjectivities is doomed to fail. I have a feeling that your therapists failed you in that way, among others. I’m thankful that you’re still willing to give therapy a try and I wish you luck on the long journey ahead.
Comments
LW, I don’t know where you live, but where I live, only medical doctors (including Psychiatrists), Registered Psychologists, and Registered Clinical Social Workers (a subset of Registered Social Workers that have done significant additional training and successfully written an additional exam) can diagnose someone with a mental health condition under the DSM. So I am immediately concerned about your therapist having diagnosed you, even aside from the fact that it may have been a misdiagnosis. In my own personal experience, I have had a lot of success with mental health professionals with a strong clinical background, who don’t share my identities but are well educated about them. like, I am a bi poly white woman, and my counsellor is a straight monogamous Asian man. I appreciate having the perspective of someone who has some subcultural distance from my experiences (but who is knowledgeable and accepting of them obviously).
I do consider all of the concepts you have offered in your post. They’re very convincing and will definitely work. Nonetheless, the posts are too brief for newbies. May you please lengthen them a bit from subsequent time? Thanks for the post.
Wow. I was considering writing in with a similar question! My spouse and I saw a counselor together who was also their individual counselor, and that person failed to intervene in emotional/verbal abuse even when I named it as such during a session (which sent my spouse into a rage right there in front of them). We stopped seeing that person when it was clear to me that they were biased towards my partner bc of the individual therapy relationship, and our next couples counselor recognized the abuse and intervened, leading us to separation. I have been thinking about writing to the former counselor to let them know the harm they did, mostly so they can be more careful with future clients. But I don’t know if that’s a good idea.
Sending you support and solidarity, and affirmation that finding the right mental health provider makes a huge difference!
I had something similar happen and I wrote the previous therapist and she told me I didn’t really want to save my relationship if I did I’d have listened to her.
IMO. Don’t bother they know what they did. Report them to the state board representing an individual and a family is a conflict on interest and unprofessional they shouldn’t have ever done it and reporting it to the board of licensure in your state lets other people know this person lacks professional ethics.
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