The summer of 2003, I was thirteen and I was moving into my summer camp bunk. I remember wanting to dig a hole and bury myself alive when I randomly spotted my therapist whizzing by on a golf cart and waving to me, wearing a khaki fishing hat, dorky round sunglasses, and cargo shorts. As it turned out, his daughter also attended the camp and he recognized me.
As a child, I would leave school early every Wednesday to see the aforementioned dorky hat therapist, and I would tell my friends I had an “eye doctor” I needed to see, so none of them would think I was crazy. When I finally admitted I had a psychologist, some dipshit named Cory said “You’re psycho! It’s in the name!”
But today, therapy is considered a universal good. If you have any problem, your friends and family will likely tell you to seek therapy. If you post about a relationship issue online, most of the comments will tell you to seek therapy or couple’s counseling.
But what if therapy could theoretically do more harm than good?
I’ve been in and out of therapy for twenty years. I’m in my early thirties, so obviously some of this was my parents’ decision and not mine. I have OCD, which wasn’t diagnosed until my late teens, and it was at that point that I realized the best form of therapy for me would be CBT (cognitive behavioral therapy) which is the gold standard for treating OCD. Traditional analysis can make OCD worse, by encouraging rumination or assigning too much meaning to obsessive thoughts.
I’m privileged enough to have grown up in a family where mental health wasn’t a taboo subject, and more importantly, a family where we could afford good therapists (Dorky Hat was responsible for fixing my recurring nightmares about our fire alarm coming to life, climbing out of the ceiling, and eating me). Not everyone is as lucky. Many people self diagnose, not because they’re attention seekers but because they can’t afford a diagnosis. And many people who are lectured repeatedly to “seek therapy” can’t actually afford it.
Although I can afford a therapist, it would not be a good financial decision for me to see a therapist who doesn’t take my insurance. A few years ago, I caved to repeated lectures from friends and family to “get back into therapy.” I’ve always been a bit of a fatalist about OCD- I’ve only had two therapists who were at all helpful for it, and several who were more like expensive hired friends for me to rant at for hours. By my late twenties, I knew I was going to have OCD forever, and therapy wasn’t going to cure me. When people tell me to get therapy, I can’t help but think they’re actually saying “if you get into therapy, you’ll annoy me less.”
That doesn’t mean I think therapy is useless, by the way- just that at this point, for my particular issues, learning coping mechanisms and behavioral adjustments (which I’ve learned from some of my good therapists) will be more helpful than talking to someone about how the ancient Egypt episode of Bert & Ernie traumatized me as a child.
Perhaps to ward off the endless accusations that I “wasn’t taking care of my mental health” I looked up therapists in my area who took my insurance and decided I’d see one. While many therapists do take insurance, there’s one important caveat: CBT and DBT therapists (the main two types of structured behavioral therapy that help with OCD) generally don’t. And while many in-network therapists claim to practice CBT, it’s often more of a buzzword than a real specialty. I learned this the hard way.
I found a doctor, who we’ll call Dr. A, through one of these searches. Like a true authentic therapist, he had a terrible website with Papyrus font and a headshot that was at least twenty years old. He mentioned specializing in anxiety, and CBT was listed as one of his specialties. Because I knew this could mean nothing, I emailed him and asked him specifically if he practiced CBT for OCD. He said yes.
Dr. A looked and talked exactly as a therapist in a movie would look and talk. He was old and soft-spoken, just like Dorky Hat. In our first appointment, he asked me a lot of the typical day one questions: how was my relationship with my parents/siblings/spouse, etc. This is pretty normal regardless of the type of therapy you’re doing, so I didn’t think much of it. Because I’ve done this intro appointment with many different therapists, I knew exactly what to share with him. After I went over everything, he rubbed his eyes and said “You will need a long course of intense therapy.” I didn’t think I said anything that shocking, to be honest, especially compared to other patients seeking therapy. Previous therapists told me I had “high insight” so perhaps he just wasn’t used to seeing someone identify everything wrong with them right off the bat.
I noticed after a few more appointments that we weren’t doing any CBT. I kept thinking that part was coming later. CBT tends not to involve a lot of rumination or discussion of your past- like I said earlier, that can be detrimental to OCD because it assigns too much meaning to intrusive thoughts. CBT does, however, involve “homework,” usually encouraging incremental exposure to your fears. When I asked Dr. A about homework, he gave me a worksheet to determine whether a thought was irrational.
These sheets weren’t making me feel better. In fact, they were making me feel worse because one of the questions was, “What’s the worst that could happen if this came true?” Considering one of my fears was losing loved ones, the “worst thing that could happen” would actually be really bad. Perhaps these were meant for people with phobias of everyday situations, like parties or public speaking. For someone with health anxiety, it didn’t make as much sense. “What’s the worst that could happen if this fear came true?” “I’d die!” Another question prompting me to ask myself how likely the bad scenario was just encouraged more rumination and research.
I also started to notice that Dr. A had a particular specialty that he didn’t advertise on his website. I’m not talking about anything nefarious- he wasn’t dealing drugs behind his desk (although he did only accept copays in cash) but rather, he seemed to have a passion for helping women with low self esteem and body image.
One problem: this isn’t why I was there to see him, and it isn’t a problem I have, at least when I’m not looking at my front-facing camera by accident. Sure, I may have mentioned being unhappy with my looks a couple times, but never my weight, which seemed to be Dr. A’s main thing.
During one appointment, out of nowhere, Dr. A said “Just so you know, those magazines you see…women don’t really look like that. You don’t need to be stick skinny to have value.” I didn’t really know what to say. I mean, duh. I wasn’t even upset about my weight. Strangely, a little while later, I casually mentioned being a size 2–4 (I forget the context but it wasn’t about wanting to lose weight), and he said “That surprises me, you look much smaller than that, I’d peg you as a 0.”
Another time he said he would try a technique with me that never failed to cure previous patients of poor body image. To his credit, I actually was feeling a little ugly that day (read: ugly BUT skinny), although it wasn’t exactly my main priority for therapy. I figured, what the hell, sure.
“Give me your phone,” he said.
Weird, but okay. I gave him my phone.
“Now stand over there and pose for a photo.”
Oh, come on. “I really don’t like how I look in photos,” I said. And this is true, even though I don’t hate how I look in general. I just don’t love having photos snapped of me first thing in the morning when my under-eye puffiness makes me look like Vince Vaughn.
He took the photo, before asking me to “do something sexy.” I made a judgmental face and he said, “Sorry, I mean, something cute!” I put my hands on my hips and smiled. In hindsight, I regret not doing the ahegao face.
He then showed me the photo he took. I didn’t get it. “Don’t you see?” he said, “That’s how you really look!”
Did he think I was literally blind? Of course I knew how I really looked.
“Strange,” he said, realizing I wasn’t thrilled with this miracle cure. “My other patients were moved to tears. They said they had never seen themselves like this before.”
I didn’t want him to be a bad therapist, although it was becoming obvious that he was. It was so hard to find a “CBT” therapist in network and I wanted to believe that the CBT would start any minute. Perhaps it was my fault, I rationalized. I wasn’t pushing for CBT enough. I was getting too chatty and friendly.
I noticed Dr. A was looking for his “hot button topics” in me wherever he could find them. Specifically, body image issues, issues trusting men, self esteem, and marital issues. Only problem: I wasn’t there for those issues, and those are actually some of the areas in which I’m fairly stable. When he found out that I married very young, he got hooked on the idea that all my anxiety secretly came from resenting my husband because I hadn’t slept with enough people before him. Dr. A wasn’t just barking up the wrong tree, he was barking up an entire wrong forest.
If I mentioned even a small issue with my husband, he would cling to it and assign way more value to it than necessary. He told me a story about another patient, boasting that he “convinced” her to leave her husband. Although this woman’s husband sounded a bit full of himself, nothing stood out to me as a great reason to get a divorce. And a little voice in the back of my head asked, “Is it really a therapist’s job to tell you to get a divorce?”
At this point I knew the CBT was never going to happen. But I wanted to believe I could still get value from this. I even started letting Dr. A convince me that I had certain issues I didn’t really have, because as a therapist he must have been the expert. If I thought he was wrong, I figured perhaps I was just “repressing” real trauma. At one point I mentioned feeling like my mother had an inaccurate view of the type of child I was (from the way she describes me sometimes, you’d think I was in and out of the principal’s office and dropping acid on a regular basis. In fact, I was an A- student who occasionally had detention for being late). Dr. A glommed onto this and convinced me not only that my mother favored my brother over me (in hindsight, she didn’t) but that she resented me for being a girl. I actually called my mother and had a bizarre intervention in which I unloaded onto her for things she never actually did. She apologized anyway, even though she did nothing wrong.
Dr. A also felt very strongly about me joining a women’s support group that he hosted. I’ve never been a fan of group activities unless it involves me as the center of attention orating to an adoring crowd, and I had a feeling group therapy wasn’t my kind of thing, but it came up at every single appointment. He said “These are very accomplished, attractive women. Many of them struggle with being unable to trust men, or having issues with the men in their lives. They’re all single.”
I said, “Oh, well, I don’t think it’s a good match, that’s not really something I’m dealing with.”
He said, “I know. That’s why you need to be there. They need to meet a woman who has a healthy attitude toward men.” I thought this was odd, especially because he had just insisted I resented my husband for keeping me from a wild single life full of Eiffel towering and rusty trombones.
Eventually I went to the support group and found it insufferable. None of the other women there had OCD or even an anxiety disorder, so I didn’t feel it was even relevant to me. One of them talked for a solid thirty minutes about the anguish of how busy she was with her local theater troupe. Most of the women, in fact, didn’t have any mental illness at all, just generic “trust issues with men” or “stress.” Which is fine, but not why I was in therapy. If I was going to be in a group, it was going to be a goal-based, behaviorally focused group, not a chit-chat guitar circle about self-love and time management. In addition, several of the women there had an unfortunate habit of seeking out married men for sex, then laughing over it together. As a married woman, this wasn’t exactly something I wanted to hear at 8:30 AM. Yay: these are the women trying to fuck your husband! If I didn’t go into the support group with trust issues, I probably developed them while there.
I told Dr. A it wasn’t a good match for me. I mentioned that nobody else in the group had OCD, and his response was that their issues were similar enough because they were a “form of anxiety.” I then said that it was a two-hour meeting in which I only spoke for twenty minutes- not that this time allotment wasn’t fair, but that it wasn’t a great use of my morning. He responded, “I want you to think about what you just said- it is a little narcissistic. The other day when you weren’t able to come, the other women mentioned you seemed narcissistic.”
At this point you’re probably thinking “What the hell is wrong with you? Why were you still seeing this guy?” and honestly, I probably should have been in therapy to answer that question. I was scared. Scared of offending him, scared of disappointing my family and friends who insisted I needed to be in therapy. Every time I complained to my social circle about my anxiety, they would shoot back “You need to be in therapy.” If I left therapy, they’d see me as a self-saboteur who wasn’t listening to their advice.
I knew, at this point, that he wasn’t helping, but because “getting therapy” is considered so universally good, I thought I’d be a failure or a quitter if I actually fired my therapist. This is compounded by the fact that I knew I was unlikely to find another “CBT” therapist who took my insurance, even if he wasn’t a CBT therapist at all. Basically, I was seeing him to be able to tell people I was in therapy, just in case they lectured me to get into therapy.
I convinced myself that while group therapy was a waste of time, individual sessions were valuable. I realized my best bet to get out of group therapy (since he argued with me when I told him I didn’t get anything out of it) was to tell him it was too expensive. See, he billed for group therapy different from regular appointments. Regular appointments carried a $15 copay. Group therapy, on the other hand, was a $60 monthly copay that assumed I’d be there for all four sessions. If I missed a session it was still a $60 copay. I told him that since I couldn’t always come to every session, the $60 copay was starting to get a little impractical. His answer was that he understood- he would waive the entire copay and just bill my insurance regardless of whether I showed up or not. I’m not a lawyer, but I’m pretty sure this was insurance fraud. It also explained why he took all copays in cash.
Ironically, the belief that my therapist was trying to commit insurance fraud spiked my anxiety. I got it into my head that if I went into Dr. A’s office again, he might actually kill me, to keep me from reporting him (this was, of course, irrational, but I couldn’t very well ask Dr. A about it). I emailed him and told him I didn’t want to inadvertently do anything illegal and therefore I wouldn’t be going to group therapy at all, because I didn’t want my insurance billed for appointments I didn’t attend. I got so worked up that I was scared if I didn’t stand up to this, I would be an accomplice in his insurance fraud scheme and I’d go to jail.
At this point, continuing regular therapy with him seemed absurd because I didn’t trust him to follow the law, let alone be a good therapist. So I ended it over email, and vowed that I wouldn’t respond to any pleas to continue therapy. I told him I would feel more comfortable with a female therapist (I actually didn’t care, but I figured this was the one thing he couldn’t offer to change.) He was surprisingly civil about it, and I felt free. I did find another therapist after that- she was a clinical social worker who specialized in CBT, as opposed to a psychologist- but she helped me more than he did. Unfortunately, when I left my job later that year, I no longer had access to her.
While my story with Dr. A is specific to me, it highlights a bigger issue in America. “Being in therapy” isn’t necessarily good. CBT and DBT therapists (the real ones, not the ones who merely claim they do CBT/DBT) typically are out of network. You can see them and pay out of pocket, then file a claim with your insurance company, but this is complicated and often still very expensive. Let’s also not forget that many people don’t even have mental health coverage in their health insurance plan- or health insurance at all.
For the people who are lucky enough to even have mental health coverage in their insurance plan, they may not have access to the right type of therapist. This could lead to them seeing therapists like Dr. A, because he’s simply all that’s available. And if someone doesn’t have a history of seeing therapists, and a full understanding of the type of therapy they need like I do, they might stay with a therapist like Dr. A for a long time, assuming that because he’s the professional, he de facto knows their brains better than they do. As someone I confided in told me, “Seeing a bad therapist is inviting someone to play around in your brain.”
There are great therapists out there. I’ve seen several of them! But as a general rule: if your doctor only takes copays in cash and takes photos of you, they might not be a good therapist.