Three Things to Know Before Making An Ethical Complaint Against A Therapist

When people think about filing a complaint against a therapist, or when they actually do it, they may envision any number of things happening as a result.

But there are certain aspects of the complaint process that most clients never think about. There are aspects of the process that most clients probably don’t even know about – which is a shame, because the number of frivolous complaints might decrease if clients understood what the process really entailed.

Filing an ethical complaint against a therapist is similar to having a rape kit done at a hospital. It is intrusive, it is violating, and it’s a miserable experience for the clients who undergo it.

I think people must not understand this as thoroughly as they should, considering some of the patently ridiculous complaints I’ve heard reviewed by the Board. And yet, each of those complaints, however ridiculous, was some clinician’s headache and hassle, and each one left a negative impression about a diagnostic population on a room full of people who might now think twice about taking on a client with that diagnosis.

So, in the spirit of helping to protect our therapeutic resources from the clients who abuse them and thereby cost us all, this week I’m discussing a few of the things that people should know about the ethical complaint process before they choose to file a complaint against a therapist.

1. HIPAA doesn’t apply.

For those who aren’t familiar with it, HIPAA is the Health Insurance Portability and Accountability Act, a broad-based piece of legislation which was passed in 1996 as part of the regulatory effort to catch up to the modern era of medical record-keeping. The overarching goal of this act is to protect the privacy and confidentiality of each individual’s personal medical information.

If you ask ahead of time, the Board tends to be very reassuring about the confidentiality of the information you give them. They might tell you that your name will be whited out of the complaint so that even the therapist about whom you’re complaining won’t be able to see it, or that nobody will have access to any of the personal information you provide to them.

Presumably there are people who actually rely on this promise of confidentiality when they file a complaint against a therapist – but unfortunately for those people, the promise just isn’t true.

Oh sure, your name might be whited out of the actual complaint – but it will be left visible on the Waiver of Confidentiality form that is a required part of the complaint submission.

And since it’s on that form, and since that form circulates everywhere along with the actual complaint, confidentiality becomes a moot point. Everyone who sees the complaint will also see the form that has your name on it.

So the suggestion that your complaint will have any degree of anonymity or confidentiality, while technically true, is still completely false in any practical sense.

And there’s nothing you can do about this, because the form is a waiver of confidentiality, meaning that you’ve voluntarily given up your right to confidentiality in all respects affecting the investigation and pursuit of your complaint.

Between the people affiliated with the state services and the people associated with the clinician’s defense and insurance, your complaint will cross the desks of literally dozens of people during the course of the investigation. And none of those people are prohibited from talking about what they see.

I mean, imagine that someone you went to high school with happens to work for the insurance company that provides malpractice insurance to the clinician about whom you’re complaining.. Imagine that person recognizes your name when your complaint crosses their desk. There is nothing constraining them from going home and calling your entire high school class to tell them all the gory details. They have no obligation to keep your information confidential; in fact, you no longer have any confidentiality with regard to your complaint, because you’ve already waived your confidentiality, and…

2. Once you waive it, you can’t get it back.

Does anyone really think about what they’re giving up before they sign the Waiver of Confidentiality?

The Waiver is a required part of the complaint package a client sends to the Board. The Waiver gives permission for the Board to speak to the clinician about the issues mentioned in the complaint. It also allows the clinician to defend themselves against the complaint.

This much is fairly obvious, but I still suspect that most people must not really understand what they’re giving away when they sign this Waiver, or fewer of them would be willing to sacrifice their right to confidentiality for the momentary satisfaction of filing a complaint that is unlikely to accomplish anything beyond wasting everyone’s time.

In addition to the possibilities mentioned above, here is something of which every client should be aware before they submit a complaint:
A clinician is permitted to use anything and everything the complaining client has ever said or done as part of their defense.

Think about it…

That means everything you ever told that clinician, every shameful secret, every embarrassing revelation, every humiliating confession, every moment of suboptimal behavior – all the things you thought nobody else would ever know.

By signing and submitting the required Waiver of Confidentiality with your complaint, you are voluntarily giving permission for the clinician to reveal absolutely everything about you in a public setting.

Not only can all these things be revealed, but the clinician can offer their therapeutic interpretation about this information as well – and those interpretations will be presented to the review board in a very different manner than they would have been presented to you within the context of the therapeutic relationship.

This is because it is no longer about helping you to understand your own behavior or trying to benefit you in any way, and nobody cares at this point whether you like what you hear or not. Once you file a complaint and sign the required Waiver, the clinician is free to use any and all of the information they have about you without regard for your therapeutic benefit.

And therapists have a gold mine of secrets about their clients, collected just by spending time with them. Every single therapist has this kind of information about every single client. But we never really think about them using that information in this kind of context, even when we create the context by filing the complaint. The more paranoid among us might have all sorts of unrealistic fantasies about all the ways in which a therapist might hurt them with the information they reveal, but in terms of real world events that are actually likely to happen, nobody really seems to believe that a therapist would ever use what they know against us.

Most of the time, we’re absolutely right in thinking that. Most of the time, therapists protect our confidentiality no matter what we do to them.

But the complaint review process is an exception to this rule. If we put them in the position where it is necessary for them to defend themselves against us, a clinician can and will use every piece of information they have at their disposal, without regard for how we’re going to feel about it.

It is one of the most shamefully violating experiences a therapy client can have, even with an entire history of abuse taken into account.

But anyone who ends up as the subject of such a humiliating exposé has nobody to blame but themselves. Nobody forced them to expose themselves, or exposed them without their knowledge or consent. They chose to file the complaint that put a therapist in the position of needing to defend themselves, and they chose to waive their confidentiality voluntarily.

If they regret it later… well, that’s what they get for doing something so stupid in the first place.

Waiving confidentiality would be a tremendously stupid thing to do, even if the only people present for this airing of a client’s most private and personal information were the clinician and the Board. But…

3. Ethical review sessions are open to the public.

Yes, public. Anyone who wishes to attend these sessions of the Board is allowed to do so.

So if you imagine that your complaint will be reviewed by the Board in some private, sequestered room where there is nobody but your clinician and the Board members present to witness your mortification, you could not possibly be more wrong.

Complaints are heard before all the clinicians whose cases are scheduled to be heard that day, and all their lawyers, and all the people they bring along to provide evidence, and all the people they bring along for support, and whatever audience is in attendance – and I’ve seen the spectators range from as few as three or four people to as many as thirty.

In short, filing an ethical complaint puts you and your issues on display in a very public way.

Your complaint, and the clinician’s response to your complaint (that is, their written response detailing their interpretation of your problems which led you to file a complaint against them), will be seen by the seated members of the Board, the Board’s investigators, the people at the clinician’s malpractice insurance provider, the people at the clinician’s lawyer’s office, and the administrative support staffs of all those various organizations and offices.

The discussion of your complaint and the clinician’s interpretation of your problems can and will be heard, at the very least, by the Board members, the Board investigators, the other clinicians in attendance, the lawyers, the support people, and the spectators.

All of these people will hear your name, and all of them will learn about your problems – and for the complainants who actually show up at the hearings, they will also see your face and know exactly who you are in connection with the complaint being presented.

And there is nothing to prevent any of these people from discussing you and your problems with anyone else in the world if they so choose. None of them have any ethical obligation to you at all.

There are some people with legitimate complaints against therapists, and those people endure the complaint process for much the same reason that a legitimate rape victim will endure the process of having evidence gathered in a rape kit – because they actually have a reason to tolerate it, terrible as it is.

And there are some hardy souls who think any kind of attention is good, even when it makes them look bad – those people will probably continue to file their frivolous complaints no matter what the consequences are to them.

But for the rest of us, who are human enough to feel angry or hurt but sensible enough to put limits on how far we’ll go to get back at someone who has evoked those feelings, this is just some information to encourage better and more informed choices – or possibly to encourage someone think twice before engaging in the complaint process.

Too many people are willing to file complaints against therapists without legitimate reason because they don’t realize what they’re getting into. Filing an ethical complaint might look like a good way to punish a therapist for doing something you didn’t like, but the only person who will end up feeling punished by a frivolous complaint is the person who filed it in the first place.

News from the Front: Psychic Alert!

Work and life have been a little too hectic recently, and the blog is going to suffer for it because I can’t seem to settle down and write anything that makes sense.

So in lieu of an actual post, here is short anecdote from a 2008 session of the Texas Board of Examiners – the board which oversees the licensed members of the various mental health professions in this state.

Did you know that you don’t even have to be a licensed mental health professional in order to have a complaint filed against you with the Board? All you really need is a disgruntled person who isn’t too particular about choosing their audience.

Such was the case last year when a professional psychic was was obliged to come all the way to Austin to respond to a complaint which had been filed against her by some idiot who couldn’t figure out the difference between pyschic and therapist.

Needless to say, the Board of Examiners does not license or oversee psychics. The main and only concern of the Board in this matter was to be sure that the psychic was not in any way representing herself as a licensed mental health professional in the course of conducting her business.

And she wasn’t. The complainant was just a moron.

Although this is an extreme case, it is nevertheless representative of a certain problem which is ever-present at the Board’s ethics sessions – the confusion over what, exactly, constitutes an ethical violation by a therapist.

Clients have some very interesting ideas on that subject. Many of them seem to think that anything which hurts their feelings or makes them angry is actually a punishable offense.

Can you imagine what the world would be like if that were actually true??

Of course, hurt feelings and not getting your own way are not ethical violations – but each session of the ethics board is likely to have at least one (and often more) complaints filed by people who think they are – and the Board is required to investigate every complaint, no matter how obviously frivolous or stupid. They even had to waste time investigating the psychic!<

Fortunately, the Board is very capable of making the distinction between a frivolous complaint and viable one, and that is something for which we can all be grateful. But for the clinician (or the psychic) in question, even an frivolous complaint entails hassle and headache – which is why those client populations who are prone to creating complaints out of nothing are the same populations who have a hard time finding qualified therapists to treat them.

I have found the Board’s ethics sessions to be very instructive on the risks inherent in being a mental health professional. Everyone is so consumingly concerned about protecting the patient, but the safeguards in place for the professionals from their clients could really bear some attention.

I mean, a complaint can be filed against a mental health professional with absolutely no factual basis at all, and it will still have to be investigated.

So therapists put their professional lives and reputations at stake every single day by offering of themselves, their time, their skills, and their compassion, to a bunch of mentally unstable people who can turn on them at any time – for any reason, or for no reason at all.

And that really does happen – it happens all the time. Even if you never get the opportunity to actually sit in on one of the ethics sessions, a glance over the records of the Board’s ethical decisions (publically available on their website) can still reveal that there are differences in the complaints received and reviewed by the board.

There are some serious complaints which receive serious consequences, such as fines, Board-mandated supervision, license suspension, or license revocation (that is, some valid complaints). And then there are a substantial number where the complaint was dismissed, sometimes with a warning of some sort, sometimes without even that (that is, a substantial number of frivolous complaints).

Each of these frivolous complaints represents a clinician whose entire professional life and livelihood was temporarily called into question by one disgruntled ex-client with an axe to grind.<

And we wonder why it’s so hard to find a qualified therapist??
Looking at it from this perspective, it’s really more of a surprise that there are so many therapists who are willing to accept the potential risks of their work.

Keep in mind that the axe grinders who claim to share your diagnosis are representing you in the eyes of the world. Every complaint filed by someone with a dissociative diagnosis is representing DID to the Board, to the other clinicians and observers at the ethics session, and to everyone who hears about the proceedings from those clinicians and observers.

It behooves us all to be sure that we encourage the public representation we want people to have of us, rather than encouraging the people who are making us all look bad.

Just something to think about.

Haters II: How to Spot A Hate Campaign

[Note: This is a long one, but I won’t be posting next week, so I thought I might as well post something now that will last through my absence. Enjoy!]

This week, I’ve picked up my very own hater! (Please see the comments to this post if you’ve missed the excitement.)

It seems kind of ridiculous – who am I, that anyone would even bother doing the hater bit with me? But someone has! So this seems like a good time to revisit the subject of haters, and how to spot them online on the occasions when they’re a little less obvious than the one here on my blog.

The internet is a brave new world for haters. It used to be that haters were limited by being identifiable. In order to spread their poison, they had to communicate it directly, by telephone or in-person conversations – and the risk always existed that what they said would be traced back to them. Their words could be directly connected with their face and their name, and they might end up being held accountable for anything they said.

With the advent of the internet, however, all of that has changed. People can hide behind screen names, announce their identities or not, claim to be someone they are not, present themselves as several different people – the possibilities for deception are virtually endless.

Further, the anonymity of the internet has made accountability pretty much a moot point. On occasion, a hater’s poison can be traced directly to them, but it’s rare. When Kelly (Secret Shadows) admitted, in a momentary fit of conscience, to posting three viciously hateful comments about her adjunct therapist under three different names on a public website, that tied those comments directly to her – but most haters do not have those kinds of moments. They thrive on the fact that, even if people know who they are, it can’t be proven, and they are careful not to provide that concrete proof. As a result, they are free to say whatever scurrilous nonsense they choose, secure in the knowledge that there is not likely to be any accountability for it whatsoever.

This being the case, it is necessary for each of us have our own common-sense defense in place as we surf the web – and part of that defense is knowing how to recognize a hate campaign when we see one. Here are some tips on what to look for.

1. Haters run in packs.
Any time you see a flock of people “coincidentally” descending on the same place at the same time, all repeating the same negative message, odds are that they are haters.

Haters never stick their necks out all alone. Individual people with personal gripes post single comments, as their individual spirit moves them. With haters, what you see is post after post after post written by what appears to be a veritable crowd of different people. They will claim they don’t know each other, or that they knew each other “way back when” but they haven’t spoken for years – and yet, by the magic of fate, with no coordination whatsoever, they all just decided to come to the same place at the same time to write the same nasty message about the same subject.

Well – I’m sure we can all see what bullshit that is.

Of course the haters know each other. They have their own places where they congregate, bonding in their negativity and coordinating their more public hate campaigns, and when they head out to the public arena, they do it in concert.

Haters also tend to enlist backup singers – people who aren’t actually part of the hate campaign but who don’t know any better than to support it. The backup singers don’t usually understand the real issue with the target – likely they’ve been fed the same lies that the haters are about to make public. But they don’t have to know the truth, because the only purpose of the backup singers is to sing the praises of the haters – their honesty, their victim status, what an all-around wonderful person they are, and how we should believe every terrible thing the haters say about their target because haters are just that trustworthy.

Normal people venting about real issues do not have backup singers. But haters almost always do.

The backup singers will also claim to have just happened to find the hate campaign. Like the haters themselves, they never admit to being part of a coordinated effort – but really, how many people can be involved in something before the “it’s all coincidence” story loses its last shred of credibility? I top the limit at four – because four people can’t even manage to meet at a restaurant for dinner without some serious coordination and planning – so the idea that all these haters and their backup singers just happened to get together is just plain ridiculous.

The pack is never as large as it appears, though – it is usually a relatively small group of people posting multiple times under different names in an attempt to appear substantially more numerous than they are.

The goal is to accomplish through numbers what they can’t accomplish through logic or evidence – that is, if ten people repeat the same gossip or tell the same lie, then maybe people will be impressed by the volume and forget about the fact that there is no concrete proof to back up whatever they’re saying. Concrete proof is never part of a hater’s arsenal, because the things they’re saying are never true.

2. Haters are self-referencing.
Haters generally run their hate campaigns in places that have no direct connection to them. For example, Secret Shadows and the others involved in that hate campaign didn’t post their comments in her blog, which everyone knew was hers and where accountability might be an issue – instead, they all went to post at the same random review site under anonymous names (further decreasing the likelihood that any of it happened by happenstance).

But in lieu of actual proof to back up what they’re saying, haters might offer a reference to another group or blog or site, constructed by themselves, where the intrepid surfer can view more examples of the same message being espoused. Of course, this is still not concrete proof – but it is another site broadcasting the same message, and sometimes readers fail to realize that it’s just the same people saying the same things.

What the haters don’t offer (because they can’t offer it) is anything concrete that readers could check out themselves for independent verification. Haters can’t use facts, because facts will never support what they’re saying – so instead, they try to create such a volume of crap that it overwhelms the facts. They want people to assume that, because the same message is said so strongly so many times in so many different places, then it must be true.

But this is a false conclusion – no matter how often a lie is repeated, or in how many different places, it is still a lie.

3. Haters get personal.
Also in lieu of proof, haters take things to a personal level immediately – their approach is never about a person doing a bad thing, it’s always an attempt at character assassination.

Why do they do this?

Well, the first reason they do it is that everyone loves drama. When things get juicy and the gossip and accusations start to fly, do readers even care who’s telling the truth? Or are they just enthralled by the spectacle of watching people zing each other?

The point of a hate campaign is always to distract and discredit, and making things personal is the best means to the end – haters distract from what the target is saying or doing by taking the focus of the discussion straight into the spicy heat of personal confrontation, and they discredit the target by attacking them on a personal level and hoping that some of the shit they throw will stick.

Hate campaigns attract attention, and the haters want the attention focused on them, on what they’re saying, on what they want other people to think about the person they’re attacking.

The other reason that haters get personal is that the personal level is the emotional level.

Haters use rhetoric geared toward provoking an emotional response – both from the target and from the spectators. They use loaded words and catchphrases intended simultaneously to demoralize the target and to turn the reading audience against them – hoping that, with emotions provoked and engaged, nobody will actually think about the messages enough to notice that they have no substance.

Does this sound like any other situation with which dissociative survivors are familiar?
Who else tries to hook people through their emotional responses in order to slip their messages past common sense and rational thought?

Programmers do. Manipulators do. Liars do.
And that’s really what haters are – they are manipulators, trying to manipulate you, the reading public, into swallowing their poisonous hatred and to turn you against their target.

But instead of blindly believing them, it is worthwhile to ask yourself why it’s so important to them to discredit their target. Why did they choose that particular target for destruction? What does that person or group or cause represent to them?

Thinking about it from that perspective can throw a whole new light on a hate campaign.

4. Haters have no point except hate.
Haters have plenty to say – but what prompted them to say it? Why did three, or ten, or fifty people suddenly show up at the same place to talk smack about someone?
Why did even one person show up here trying to insult my character?

The world may never know…

They’re not going to explain themselves. There will be no A=B, cause-and-effect connection that can be made. The real reasons behind the haters’ actions, whatever they are, will never even be hinted at in the slew of negativity that makes it into public view, because haters really aren’t there to explain themselves to us.

Their goal is to cause as much damage as they can to the public perception of a specific person, group, or cause – nothing less, nothing more – and their goal is not going to be furthered by explaining themselves, because if you knew the real motivations behind what they were saying, you would probably think twice about listening to them.

If you knew that hate campaigns were being engineered by predators, to discredit the sources of information available to us so that we are more likely to stay their victims – would you be as likely to believe what they said?

If you knew that a hate campaign was part of a borderline revenge tactic best defined as “I imagined that you hit me, so I’m hitting you back ten times as hard”… would you still consider it to be valid? Would you still want to support it?

Probably not – because you’d feel pretty stupid believing or supporting the haters if you knew that’s where they were coming from, right?

So we need to ask ourselves why it’s so important to these people that we hate their target with them, because the haters will certainly never tell you – they’ll just show up, start the blitz, and hope that nobody remembers to ask.

5. Haters never let go.
We’ve all been angry or suffered hurt feelings in the course of our lives – but how long do these feelings normally last?

Assuming that we’re not talking about our feelings toward perpetrators, and that we have enough self-awareness to separate those feelings from the feelings that are evoked by other events – how long do the feelings last?

How long do we wish we could exact revenge on a person who made us angry? How long do we want to hurt back in response to feeling hurt? How long do we have to keep venting about something before the emotions wane and it’s just not that important any more?

In short, how long does it take before we get over it?

We might continue to feel some emotional response for a while, but the kind of emotional intensity that drives us to do something about it is a much shorter-lived phenomenon… unless you’re a hater.

Haters go after their targets like rabid dogs. They don’t get over things and move on – because in truth, whatever natural emotion they might have felt regarding their target (assuming they ever had anything that might be called a reason for their feelings) has long since been subsumed in a soupy morass of bitterness and resentment and desire for destruction that has nothing to do with the target and everything to do with the individuals themselves.

And this is why, although people with normal and genuine complaints or reactions are generally satisfied with one public statement of their feelings (and many never feel the need to make a public statement at all), a hater just never runs dry. Haters spew their venom over and over and over – not just for the few days when an emotional reaction might be expected to remain intense, but for months, or even years, long past the time when anything natural or reasonable could possibly be driving them.

So what is driving them??

There’s that question again – and it’s the most important question to ask yourself when you see a hate campaign in progress – why does it matter so much to them? Why are they putting in the time and the effort to seek someone out and beat on them over and over and over? Why do they keep showing up to grind the same old axe?

WHAT, EXACTLY, ARE THEY TRYING TO DESTROY BY CLUBBING US ALL INTO SUBMISSION WITH THEIR HATEFULNESS, AND WHY ARE THEY TRYING TO DESTROY IT???
And what would it cost us if we let it work?

We might not be able to answer those questions – I know that I certainly have no answers, even with regard to myself. Why do I merit a hater? I have no clue – but clearly someone thinks I’m worth the time and the effort. So I guess I must be saying something that someone doesn’t want said.

So… think about it.

There’s not much we can do to stop the haters right now – the law is a long way from catching up to the speed with which the internet is growing. No doubt, in future decades, the anonymity factor will be removed – precisely because of these kinds of abuses – but it hasn’t happened yet, so right now the haters are running amok.

But even if the law can’t stop them, we can – because it’s our belief they’re after. It’s us that they’re trying to manipulate. And it’s up to each of us to decide how much credence we’re going to give the haters.

Do we believe their lies? Buy into their messages? Follow where they lead?
Or can we hold on to our common sense – step back from the dramatic intensity of the fracas, consider what they’re trying to accomplish – and wonder why?

Haters I

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** Weekly Disclaimer**

Whoever you are, I’m not writing about you personally. I probably don’t even know you. So if anything you read here makes you think I’m talking about you personally, you need to consider what you’ve done to make you think this applies to you. And whatever it is, it’s your problem, not mine.

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My blog got a comment! That’s exciting. 

And there was a good point there – what is it with the haters?? I totally agree that people seem to feel free to say and do anything behind the safe anonymity of an internet screen name – things they would never do if they could be identified and held accountable for it.

A case in point – consider the web sites where patients can rate therapists for the interest and edification of the rest of the therapy-seeking population. It seems there are two kinds of patients who post on these sites. There are the ecstatic patients who write glowing encomiums about their therapist’s skills and compassion so everyone else knows what a wonderful human being the therapist is. And there are the disgruntled patients searching for a safe place to vent their spleen, somewhere they can be as vicious as they want without having to prove their accusations or take responsibility for having made them.

Isn’t that like the modern-day equivalent of writing insults on the bathroom wall?

Except this is a bathroom wall with a world-wide audience…

I don’t know how seriously anyone takes the haters. All I’ve ever seen in their writings is their own hurt feelings and vengeful spirits. They obviously didn’t get what they wanted out of therapy, and they obviously blame the therapist for that, and now they hope to “hurt back” – which is a very human response, however immaturely they handle it.

But what if someone does take it seriously? After all, the point of those sites is supposed to be for other consumers to find qualified therapists who can help them – so what is the potential effect of haters writing spiteful messages on these sites?

Because the great and terrible danger is that they can say whatever they want. It doesn’t have to be true, it doesn’t even have to be close to the truth. I could rate a therapist I had never even met and say they were terrible, unprofessional, unethical, inappropriate, and crossed every boundary in the book – and nothing could prevent me from doing it, and nobody could trace it back to hold me accountable for those lies – and what about the therapist I accused? What would be their possibility for defense? They don’t get the chance to respond. They might not even know that that kind of information is being posted about them – many of the sites I’ve seen allow the patient to add a therapist to the database and then write whatever they wish, with or without the therapist’s knowledge or consent, and with absolutely no verification or quality control at all.

Does anyone else see a problem with this?

No wonder disgruntled patients and borderlines on a rampage take advantage of these venues to air their spite.

The problem with therapy, especially with certain patient populations, is that there’s always a risk to the therapist. Any confrontation of the patient on their idiotic behaviors, any refusal to accede to their wishes, always bears the potential threat of having the patient stalk off with a heart full of anger and resentment which, in the termination of the therapy relationship, has no possibility of resolution. The ex-patients are left nursing grudges and steeping in their own bitterness, looking for something to do with all their unresolved feelings.

And thus the haters are born.

In my experience, this hate never seems to die. Even months later, a hater’s anger can reignite at the slightest opportunity, often seeming stronger with the passage of time instead of diminished by it. I can only imagine how much time these people waste on brooding about the subject in order for that to be true. I’ve seen patients crawl out of the woodwork years after a therapy relationship that lasted mere weeks to renew their bitter, hateful tirades against a therapist. Something about that time inequity is disturbingly… disturbed.

Patients I know have written about therapists I know, hateful comments full of twisted truths and outright lies about therapists who treated them with nothing short of courtesy and professionalism. Those same therapists, a few months earlier, were often getting soppy messages of adoration from the same patients. It’s like the borderline black and white – I love you, but you weren’t my version of perfect, so now I will destroy you.

And all this begins over something that was usually the patient’s issue to begin with, although the true events which ultimately lead to the tantrum, termination, and foot-stomping exit of the patients I’ve seen are usually lost to those patients long before their grand exit.

I have seen therapeutic ruptures occur due to, among other things, a patient breaking in to her therapist’s office and being angry that the police were called about it, a patient who expressed immediate suicidal intentions and was angry at being hospitalized in response, a patient who blatantly lied and got angry when the lies were proven, a patient who pried into her therapist’s private life through mutual acquaintances and then got her feelings hurt when she found out her therapist was getting married and she wasn’t invited to the wedding, and a patient who resented having one of her two weekly appointments cancelled because her therapist was going to be out of town for the weekend.

These are a few of the more extreme examples, but they are representative nonetheless of the types of things over which I’ve seen patients get angry and terminate therapy.

In each of the examples, the patient had twisted the situation to be the therapist’s fault even before the termination occurred.

And in each case, the patient has since become a hater. They have found like-minded people among whom they can share and nurture their feelings, they grow fine stocks of bitterness and anger directed towards their ex-therapists, and periodically their anger reaches a point where they act on it.

But rarely do they ever take a personal stake in their hate campaigns. While the occasional hater will attempt to file a formal complaint (which goes nowhere, as all spurious complaints should), most haters cruise the internet in anonymity, looking for ways that they can strike at the offending therapist without personal accountability.

One such hater even admitted that she would file a complaint… if only she could find anything on which to base it.

Let us pause for a moment to consider the stunning implications of that admission.

She admits she has no reason to file a complaint — in other words, there was no actual ethical or professional violation committed by her therapist — but she got her feelings hurt over something or other, and now she thinks the appropriate response is to attempt to get her therapist’s license revoked.

My mind reels at the unmitigated selfishness and self-centeredness revealed by that response.

And does this not, in a nutshell, capture the problem with all haters?

They have absolutely no valid substantiation to their claims that they were mistreated.What they universally share in common, however, is a situation where they did not get what they wanted and a proclivity to point fingers. I’ve never heard a hater admit that they bore even a fraction of the responsibility for the problems they experienced (or the problems they caused) — certainly not to their therapists, and not even among each other where they gather to nurse their grievances. The fault is only and entirely the therapist’s.

If I had my way, I would see the haters trapped on a desert island together with nobody to turn on but each other.

Since I don’t rule the universe, however, and there’s no sense in hoping they’ll learn anything remotely resembling dignity or restraint – I can only say, that others need to be aware that they’re out there, and they are not to be trusted or taken seriously.

So, iIf you see a little cluster of people getting together and bashing a therapist online – if you see two or three people showing up over the course of a few days or a week to post hate mail on therapist review sites – if you arrive at a forum and find that the majority of the membership is involved in a hate campaign – try to use some judgment, and don’t buy their crap wholesale.

The haters are making their own problems, but we don’t have to accept their poison as truth.

We Thank You for Your Support

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** Weekly Disclaimer**

Whoever you are, I’m not writing about you personally. I probably don’t even know you. So if anything you read here makes you think I’m talking about you personally, you need to consider what you’ve done to make you think this applies to you. And whatever it is, it’s your problem, not mine.

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It’s Thanksgiving week, and I’ve been thinking how grateful I am for some of the things in my life. I’m grateful that I’m able to work and that I have a job. I’m grateful for my apartment and the furnishing I’ve been able to afford and the homey way it feels. I’m grateful that I could have a holiday dinner tonight. And I’m grateful to have a therapist who understands dissociative disorders and has really been able to help me.

I am extremely grateful for my therapist. She has taught me about DID, she’s stuck with me through my hard times, she’s stuck with me when I took my hard times out on her, and she’s heard some of the things of which I’m most ashamed and still seems to like me. She’s dealt with my crises and given of her own time to do that. (Why don’t crises ever keep themselves to session time??) She’s borne with me when I was between jobs and couldn’t afford therapy, and she figuratively held my hand as I got back on my feet and started over again. I’m profoundly grateful to her and for her, and I don’t need a turkey dinner to make me remember that.

But much as I appreciate her — much as I in fact count on her to do all these things — at the same time, I also need to remember, she doesn’t have to do them. I pay her for one session a week, and that’s all she has to give me. It’s my good fortune that she’s also willing to do so much more — such as taking crisis calls, responding to e-mails, or still letting me see her for sessions even when I’m between jobs — but it would be a serious mistake to think that I have any right to these things. No matter how often she does them, no matter how much I think I need them — they are favors. Each and every time, they are favors, and she has the right at any time to NOT do them. I am not entitled to anything more from her than the one session a week that I pay for — and the world will not end if my crisis of the moment is not attended to as soon as I wish it could be.

One thing that has repeatedly astonished me (and angered me) about many of the other survivors I have met is the attitude of absolute entitlement that they express with regard to their therapy — and since therapy is a microcosm of a patient’s attitudes and interactions in the wider world, presumably this sense of entitlement is not confined to therapy alone.

Many patients seem to assume that, if a therapist takes a crisis call or manages to schedule an emergency appointment once, then they have the right to expect the same from then on. Any time they need it, it should be available — and if for any reason the therapist can’t accomodate them, they can turn manipulative, offensive, and really nasty in response.

Where’s the gratitude?? How can these people lose sight of the fact that they do not, under any circumstances, deserve to have their every need perfectly met at each and every moment? What happened to appreciating the fact that a therapist could ever accomodate a crisis call or emergency? Since when has one session fee also included unlimited e-mails of unlimited lengths with responses expected between sessions?? Since when have any of these things become rights and not favors??

(And this is even assuming that the patient is paying a regular session fee — although statistically speaking, the worst offenders of overentitlement are patients paying on a sliding scale, Medicare patients, habitual freeloaders, and patients diagnosed borderline. Which makes the offense even worse. But god forbid a borderline patient has some limits set on their behavior — therapist forums are rife with the proof of how well this usually turns out. Borderlines… can’t treat ‘em, can’t get rid rid of ‘em.)

And I have to wonder… what do the patients think that kind of response is going to accomplish? If I’ve done a favor for someone, and my reward is to have them assume that I now owe it to them to keep doing the same thing at their convenience or they’re going to get pissy with me about it… that’s really not going to increase my incentive to keep doing them that favor. Or any favor. In fact, it’s going to make me really sorry I ever did them a favor in the first place. So I’ve always kind of wondered how the nasty attitude is supposed to help.

I’ve also wondered where the entitlement comes from. If I’d acted that way when I was a kid, I would’ve gotten my ass kicked… and although I’m not a kid anymore, I still have a lot trouble working up any feeling of entitlement. I realize that all survivors have their own individual histories and perspectives, but the survivors I know or have spoken to online all seem to agree that “wanting” or “needing” was given a negative construction and they don’t feel like they “deserve” anything — do some survivors then flip this around to assume that they now deserve everything?

I don’t understand it, really — but whatever it is, it annoys the hell out of me.

We don’t deserve everything. We do not, for example, deserve to have our therapists take every call or answer every e-mail. We don’t deserve to have every need perfectly met by our therapists to make up for the needs our parents did not meet when we were young. We don’t have the right to insist that everyone around us inconvenience themselves to take care of us.

I mean seriously, as appealing as those concept are… how can anyone be stupid enough or selfish enough to think we deserve to have them fulfilled?

I’ve always been amused by the patients who terminate therapy and stomp off into the sunset, proclaiming their intention to find a therapist who will be as available as they “need”, who will never be unavailable when they want to talk, who will be Johnny-on-the-spot for every personal crisis, who will do things RIGHT (meaning, do things their way)…

Off they go, determined to find the shiny new therapist who will prove how their last therapist failed them, how wrong their last therapist was in not acceding to their every wish, and how their demands of absolute availability were well within the realm of reality — it wasn’t their demands that were unreasonable, it was their therapist’s refusal to do what they wanted that was unreasonable!

… only to discover that they had walked away from the best deal they were likely to get.

So sorry, Ungrateful One, but nobody is going to give five sessions a week for the price of one, nobody is going to schedule an emergency appointment for every crisis, nobody will take every call or answer every e-mail… plenty of therapists won’t do any of that at all, not even once.

So I always have to laugh when someone is whining endlessly about how their therapist took a few weeks off or didn’t answer an e-mail or a call quickly enough. They make a big stink about it, terminate their therapy, and then spend the next few months whining about how they can’t find another therapist who will do even as much as the therapist they just left. And eventually they settle with less than they had in the first place — less availability, less expertise, less latitude for their attitude. Some people don’t know a good thing when they have it!

People need to remember that it’s not their right to dictate how much time or attention a therapist gives them. Especially if they’re not paying for every second of the time and attention they’re demanding.

Crisis calls, emergency appointments, answering e-mails — these things are favors!

Be grateful for each and every time they happen, and don’t assume that they must and will happen every time they’re wanted forever after.

The fastest way to sour a person on doing favors is to take those favors for granted — and that’s true for therapists too.