the Right Therapist can be a life changer for the Better

Elio, wow, great to have someone here who knows about this stuff. Unfortunately, I've recently had to teach myself a lot due to need to advocate for myself.

I was also upset to find out about the portal notes. I can understand needing them to be a legal part of the patient's record, but there should be a law that patients can access the record 100% and even enter their own notes for appointments. I've recently had to read my medical notes from the hospital and they are about 75% wrong. It's amazing how irrelevant the patient rights are. Everything seems to be set up to benefit the providers. It's egregious how much they get away with and harm people, not all mischievous of course, but in the course of practicing defensively i suppose for those who do care about patients. I see doctors using the notes to disparage me, dismiss me, obstruct my treatment, and blame medical health issues on mental health. It seems like no one monitors or supervises what they do after their residency.

Ok, I'll stop now. This has just been making me so mad lately. Injustices of those in 'authority' positions, etc. (And 'working thru' myself as I'm not currently in therapy.)

I just wanted to reiterate, if oprah sends a scathing email to her t, its not covered by hipaa. Yahoo or gmail or whoever actually owns it, and putin will probably publish it in 2020! Just to put things in perspective. Email or the general internet is not private or confidential. Email doesnt have to be hacked, it can be gotten at legally. Hipaa stuff, yes it IS illegal, if you are not oprahs doctor or on her medical team (however that is defined), to be reading her records.

Eta - anne, thanks for the treatise on "i care!"! Seriously! One time my brother used a variation of that on me, saying, "im your brother!" I was like, i dont know what that means. I later learned what it meant for a gf - she moved house, and her brother showed up to help!

Right. One issue is just about the lack of confidentiality of emails. The other is about how provider systems share communications. People might think an email is risky because there is no privacy on the internet, but not actually know that their provider is not the first to read their emails (if they are in a system). One is a risk. The other is a policy. Both leave the person exposed.

Hi Una-I believe that is not true but would be interested in your source if you are interesting in sharing as you seem so sure about it...From what I understand, they still have to protect the information (PHI) exchanged in the email if they are a entity covered by HIPAA. The law is more lenient for accidental disclosure when it comes to emails, I noticed, but it seems to me that they are still responsible for intentional disclosure of the information in the emails.

Really interested, and it seems to apply to so many people here.

edit: is there a lawyer here?

Don't take legal advice off the internet from a group of anonymous strangers.

(I am a lawyer)

Okay, i may have overstated about oprah and hipaa. What i know for sure - my t at a public (state) university told me my emails are not private and confidential, period, so i will want to "watch" what i send to her.

Im not, but i like playing one on PC! i coulda been a contender!

A big issue about finding a good therapist, IMO, is that it will most likely take a while to feel a truly positive effect that is due to changes occurring in the client's life (inner and outer), beyond the possible initial excitement and "placebo effect". People also often report that they only really realized the positive effects of therapy with quite some delay. And while I believe it is possible to filter out majorly incompetent/unsuitable therapists quickly just like we can have an intuitive sense about the qualities of anyone we meet, I think the features that can be truly harmful in a deep sense more often surface after a while, in part because the therapist personal presented is often not very transparent and direct and clients are often desperate for help. I do think it is a trial and error thing even if a client has good antennae for BS and is generally compliant. I definitely think that experience and hearing about a great variety of stories such as those discussed on this forum helps.

For example, I do consider myself someone with fairly good instincts and quite BS resistant, and I like to trust my impressions, but having accurate perceptions and insights requires an interaction with reality and more complex experience. Therapist famously don't tend to present a complex and very realistic image of themselves to clients at least initially, plus some modalities encourage mental perceptions which, by definition, can only be distorted at least somewhat. A therapists' true qualities are really not something easy to see through. I had one that still puzzles me at times when I think back, how I was even willing to interact with such a person, how I bought into his maneuvers for a while - not very long, but long enough for me. And when I look at it in more depth, it's not only that he is a gigantic manipulator and has very low sense of responsibility/stability - I actually wanted it to work and be interesting myself, he was my first T, and I think I intentionally overlooked many things. I wanted to trust it/him and not scrutinize for a good while, I did not even ask many questions, until something big and serious came up for me and I saw how he mistreated it royally, how self absorbed he really was etc. Then there was the other T who was really accepting and non-judgmental, letting me do whatever, a pleasant, careful and intelligent man, but the therapy was without much direction and challenge.

So I think if I ever wanted to go to therapy again, I would ask them a series of solid questions in the first consultation and would reject those that deflect too much. Would also look for someone who asks me direct questions and challenges me right from beginning, I would not want a T who believes that we need to wait months to build rapport before tackling obvious issues head-on. I would also tell them at start that I am looking for respectful but solid challenge and focus, not distractions and useless tangents (even when I try to deviate myself as I tend to). I would want someone whose therapeutic philosophy is heavy on personal age-appropriate responsibility and discipline of both client and T, not someone who would shift most of it to someone's parents or life circumstances, even though of course those influence one's path very much. After all, for me if I seek out this kind of service, I do so because I am not happy with something and want change and solutions, not just a place to vent or to be accepted - those I easily find among friends, colleagues etc. I would want polite, respectful, but very direct challenge and someone to brainstorm with me on how to make the change happen in the present practical reality, outside of therapy, and to help me explore what gets in the way so that I can try to remove the roadblocks actively, but focus on past stuff only as far as it is useful and beneficial for the problem solving. So these needs and orientation is what I have learned from my therapy experiences, but it was experiential learning. Originally, when I first went to therapy, and even with the second T, I had quite different ideas of what I wanted and needed from therapy and had to do it before these conclusions came; even though now thinking back, I could have seen them earlier as the patterns pointing toward these needs and what usually works for me had been there for a very long time.

On caring, that is a frequently discussed topic here on PC. I never felt that my Ts did not care, they were clearly interested and motivated to work with me. What is more important to me is how that motivation manifests in their actions and interactions, what the outcome will be. There are plenty of people both in personal and professional life who have ambition and care, yet they make mistakes upon mistakes without correcting the approach, struggle with responsibility, and their acts remain largely ineffective in spite of all the care and intent. The thing though is that one has to engage and try in order to see if something is effective or not and be willing to adjust the approach if necessary. Both client and therapist.

Anyway, so even if we just focus on the possible upside ("good therapy"), there is the big question of how that can be measured, what are the parameters? I described above what, I think, would be mine, but personal goals and needs are very varied, it is really not trivial to find a client-therapist combo that is aligned well and is truly productive, so I think it is better to go into it with a good dose of skepticism and openness, even for disappointment.

Sorry my cryptic comment wasn't more clear. An unconscious/dissociated feeling that "nobody cares about me" was at the core of my difficulties, I now believe. I "transferred"(?) a feeling/wish/expectation that my last T DID care about me. Then "discovered" she "didn't" -- and that triggered a devastating feeling of rejection and abandonment that I didn't connect up with a (previously unconscious) feeling I had had in childhood until 6 months after the therapy terminated.

One perspective is that the therapist/surgeon did her job, clumsily and potentially disastrously, in eliciting this stuff. But because she did it reactively, not consciously/therapeutically, and said that she couldn't do therapy with me anymore "because she didn't have the emotional resources", it left me in a very bad way, having to try to find some way to make it through and find some emotional support until, hopefully, it healed up. Which may slowly be happening.

If you haven't had a deep core abandonment trauma like this, from early in your life, then I can understand if you don't understand its impact.

Now, yes, I can imagine a situation in which I would consult a therapist and not care whether or not she cared about me. And, for instance, I consulted two of them asked if they could just give me feedback about how I come across to them, but they seemed unable to understand that. If they had understood, then I would have gone to them and would not have cared or expected them to care about me. But since I'm doing OK now dealing with this deep core wound on my own (with a little help from support forums, etc.), I don't have anything now that I feel like I need or want a therapist for.

I think, far too often, the therapist expects the client to expect/want the therapist to care about them, and they "use" that. Perhaps ethically, perhaps not.

I have to say-this comes off a bit snarky to me. I didn't see anyone giving or asking for legal advice on this thread. I was kidding about a lawyer, a jab at the insane complexity of the information.

No legal advice intended from my end--I wanted to give information on the misconception that it's ok for everyone in the practice or system to have a free for all for your medical records without a good reason. It seems to be a common belief.

Pretty sure that makes him a sociopath.

No, I can detect them, at least after some time, and he's nowhere near!

It was in the context of our discussion about adverse ways the therapy was affecting me. It certainly was the most shocking thing he's ever said to me, but I wouldn't say that mentality defines his character. Hopefully he was just being defensive.

Dunno, unwillingness to take responsibility strikes me as an anti-social trait. Maybe some of these therapists are conditional sociopaths, trained to adopt dysfunctional behavior in their professional role.

I can't imagine another profession condoning this attitude.

Also, i gather most therapists with this attitude would take credit if a client improved.