When Shrinks Go Wrong

This morning I read an article in the New York Times that really upset me. Titled, "My Shrink is my Co-Author" the author, Susan Shapiro, describes the ups and downs of writing a book with her longtime psychotherapist "Dr. W."

The good doctor, it seems, is an expert on addictions who helped Ms. Shapiro quit "cigarettes, alcohol, marijuana, gum and bread" several years and somehow they decided to write a book on addiction together. (The article is unclear as to whether Ms. Shapiro or Dr. W suggested writing the book in the first place.) Ms. Shapiro goes onto write that Dr. W's sessions cost $200 a pop so, in return for her writing the book, he would treat her for free. Uh-oh.

As she engages in this process, Ms. Shapiro discovers that her relationship with Dr. W has changed. "As a therapist, he was perceptive, sensitive, caring," she writes. "As a coauthor, not so much." She also learns personal details about him, like he had an abusive alcoholic mother, and starts dispensing advice to him. When Dr. W. flubs a biography detail in a magazine article designed to pitch the book to prospective publishers, Ms. Shapiro tells him, "Afraid of success, you subconsciously took the title off the bio that would get us the publishing deal…..Perfect sabotage, the kind of thing you taught me not to do. How does that make you feel?"

Realizing the situation is not working, Ms. Shapiro laments that Dr. W has rescheduled her appointments to the daytime, leaving his evenings free for higher paying clients. Upset and hoping to unravel the situation, she leaves voice mails and sends "twenty-emails" with no reply. She eventually has to arrange a paid session with Dr. W to work things out. So they come to a compromise. She will keep the entire advance for the book in exchange for paying Dr. W his regular fee. But when she finds out that Dr. W jacked up his fee 25 dollars without telling her, Ms. Shapiro is again upset, thinking it's retaliation. When she goes to another psychotherapist for advice she's told that the "boundary crossing" Dr. W was doing was 'unethical." The article wraps up with Ms. Shapiro finishing the book and comparing the writing process, in self-deprecating neurotic New Yorker fashion, as an addiction unto itself.

When I finished the article I wanted to throw my iPad against the wall. The reason I was so pissed? Because Ms. Shapiro's piece just reinforced something I've known for years.

A great many therapists are flat fucking crazy.

I have friends who are therapists. I also worked in the mental health industry for ten years. In that that time I learned that wackjobs populate the mental health world. We had a saying in the psychiatric hospital, "How do you know the difference between the patients and the staff? The staff has keys!" And there was many a time I wanted to throw the healers into a straight jacket. I knew a psychiatrist who married one of his patients and another who talked to himself on a regular basis. I worked with a hygienically challenged child social worker that wore the same clothes and ate the same food everyday. (The resultant smells thrilled the parents.) I also dealt with; nymphomaniacal manipulative psych nurses, active anorexics treating anorexics, drinkers treating drunks, people sexually acting out all over the place and dozens of depressed, anxiety-ridden and bi-polar therapists refusing to take meds or seek treatment. Sad to say, there are lots of therapists who should never get near a patient.

However, the biggest gripe I have with field is the same ones all my therapist friends have: that the therapeutic community is filled with badly trained clinicians and those with poor boundaries. I am not qualified to talk about how therapists are trained but, as one retired psychoanalyst with four decades of experience told me, "It's gone downhill over the past twenty years." But I can talk about the whole fucked up boundary thing.

A few years ago, a friend of mine started seeing a therapist. Excited about her quest for self-improvement, she told me to take a look at her West Side shrink's website. My first reaction was, aren't therapists supposed to be a kind of blank slate? What the hell is she doing with a website? And when I looked at the site I was seriously aggravated. It was basically an ad for the books the therapist had written about "putting the zing back into your sex life." Worse, at the bottom of the webpage, there was a notice that she had been a signatory to a petition to end the ear in Iraq. When I told my therapist friends this, they were aghast.

This is just one example of poor boundaries. This therapist has a right to express a political opinion of any stripe, just not in her professional space. Imagine going to a therapist's office and seeing Tea Party or Occupy Wall Street literature on the coffee table? What if a depressed conservative came in for help and saw a Che Guevara poster hanging on the wall? How would a liberal neurotic feel discovering an NRA magazine in the waiting room? The less the patient knows about the therapist's personal life, the better.

But the therapeutic boundary slippage usually isn't political. It's mostly personal. Just last week a therapist I know was bemoaning how a colleague of hers was socializing with his patients. Going with them to bars and concerts! When I did a catering gig as a waiter I was shocked to see that the host's therapist was in attendance at the party! Another friend of mine saw a therapist for an initial interview and told me that the guy spent the time griping about his own problems. Nuts. And don't even get me started about the therapists who've slept with former patients.

In her article, Ms. Shapiro's describes a therapist with a terrible sense of professional boundaries and ethics. It is unethical for a clinician to work with a patient on a project for financial gain. It's a no brainier. The reason you go to a therapist is to talk to an impartial observer who will advocate for your mental health. In order for this process to work the clinician, unlike your friends, family, coworkers, or spouse, can have no vested personal interest in you. Sure, you pay a shrink, but that's part of the process. It tells you that you're not just gabbing into a friendly ear but making an investment in your well-being. But it's not a barter system. You can't clean your clinician's house in exchange for free analysis! And when a clinician does what Dr. W. did, he commits a gross violation that makes you wonder about his own emotional health and ability to treat patients. Keeping your shit together is a necessary discipline for a therapist. If you can't do it, quit.

For sake of comparison, let me tell you about my old psychoanalyst. He was very different from Dr.W. Well trained, highly experienced, and compassionate, he was also rigorously ethical. Once, when it looked I might have inadvertently started dating a relation of his, he told me that we'd have to end our sessions. They weren't related and we got over that hump, but the episode spoke volumes about my analyst's professionalism. Can you imagine what would have happened if I asked him to go in on a business project with me? And in all the time I saw him, unlike Dr. W, my analyst returned every phone call I made. He never left me hanging. When it came to money my analyst wasn't greedy either. I paid him very little in the beginning. It was only when I finally started making real money that he gradually raised his fee to the regular rate. After a while "digging in the dirt" I got my issues resolved my analyst told me, "You don't need me anymore." He didn't treat me as a cash cow. He knew I was an author and didn't ask me to help him write a book. He didn't tell me about his problems. He helped me. And because of him I am in much better shape than I would be otherwise. Sadly, Dr W. is not a good therapist.

I feel sorry for Ms. Shapiro. She got used, And even though she was complicit in the process, she got exploited by the very person who was supposed to be looking out for her well-being. Dr. W should have said no. In no way should she have been privy to his personal life, much less feel compelled to give him psychological advice of her own. And if Dr. W committed this kind of boundary violation with her, you have to wonder if he's done it with his other patients. If so, the damage could incalculable. Dr. W. should stop seeing patients and get his head in order. If not he should have his license revoked or, at the very least, be seriously sanctioned. And, obviously, Ms. Shapiro should find a new therapist – one that doesn't want to write books with her. To paraphrase a line from her article, Let the writer write. Let the healer heal.

Sorry to get off on a rant here. I just feel very strongly on the subject. And here's a word of advice – if you start seeing a therapist and get the slightest inkling that they want to get something out of you – run for the door.