Difficult truth: some doctors are better than others.
You wouldn’t think this would be a hard concept to grasp. We are able to conceive an incompetent lawyer or an underprepared engineer without a problem. However, American society has a habit of putting medical professionals on an infallible pedestal. Thus, we’re sometimes blind to the ways that doctors can be abusive, neglectful, poorly trained or even just a bad fit for some of their patients. This is especially true in psychology and psychiatry, where the patients are sometimes (offensively) assumed to have a tenuous grasp on reality to begin with. Women and people of color are particularly susceptible to this kind of gaslighting and prejudice, and due to social conditioning, they may accept more unprofessional behavior from their doctors than they ought to.
You are not a passive observer in your role as “patient”, but an active collaborator. Repeat this to yourself as you move through the medical and mental health arenas, because often women, people of color, and LGBT+ individuals are taught the opposite message by the establishment. Your doctor’s worldview doesn’t always immediately translate to what’s best for your health.
Don’t let the clock run out—here are some behaviors and situations that signal it’s time to break up with your doctor or therapist.
They make overly friendly overtures.
Doctors and therapists see us at our most vulnerable, and because of this there need to be very distinct boundaries. Therapists are explicitly trained in how to avoid the therapeutic relationship developing unhealthy emotional bonds. Actions that cross these boundaries don’t have to be sexual, though sexual harassment of patients by doctors does happen and should be taken seriously. You shouldn’t be invited to golf or dinner with your mental health professional. They should keep abreast of your life as it pertains to your brain, but they should not try to be your parent, your buddy, or your partner. Ever.
On the other hand, if the person you’re seeing for any health issue doesn’t appear to care about your well-being at all, that’s a red flag too. Good doctors aren’t just in medicine for the insurance payouts--they have a genuine desire to help people. If your doctor interrupts you mid-sentence to tell you that your hour is up, you’re seeing a bad doctor. Ditto if they regularly struggle to remember even the most significant details about your life or medical history, they seem ill-prepared or rushed during appointments, or if they’re frequently late or absent. You don’t have to pay for time with an unprofessional “professional”.
They shame you.
For anything: weight, religion, sexuality, relationships (or lack thereof) with family, education, occupation, whatever.
Fat shaming in particular is a problem that’s often overlooked in mental health--you’d think they’d be on top of that in a profession that regularly treats eating disorders and body dysmorphia, but go figure. A body positive doctor may ask you about your diet and exercise routines, since vitamin intake and endorphins directly contribute to mental health, but they will not make comments about your appearance or attempt to “treat” your weight rather than your actual ailment. This goes for nurses in the office too. You’re not even required to know what your weight is if you don’t want to; more and more mental health offices, in particular those who serve women, have patients step backwards onto a scale and will not tell you what your number is unless you ask.
An appointment in a mental health office is not the place for moralization or prejudice. You don’t deserve for anyone to be condescending or rude to you, much less the people you’re paying to help you.
They react unprofessionally.
I have a friend who went to a therapist to discuss issues related to childhood sexual abuse. Once he was done relating his history, that therapist sat in silence with her mouth open for several minutes and was inconsolable for the rest of the appointment. My friend rightfully never went back to that therapist. Your mental health professional should be able to control their emotions and persona enough to react neutrally to anything that you tell them. Even if they do react, they should acknowledge their feelings and move on, not disrupt your session to deal with their own issues. As their mental health patient, it is your right to be the least-emotionally-controlled person in the room at all times.
They don’t have the degree you need.
When you’re looking for a mental health professional, the quickest way to tell if they can offer you the help you’re seeking is to look at the letters after their name. Google your doctor, just like you’d do with a first date or a contractor. Their website, if they have one, should have a detailed description of their degrees and work experience.
If you’re looking to start or manage medication, you need a psychiatrist who is a medical doctor (M.D.) or doctor of osteopathy (D.O.), the only kinds of health professionals who can write prescriptions in every state. Depending on the state you live in, mental health and psychiatric nurses may also be able to write prescriptions.
However, medical doctors are more focused on the physical than the emotional treatment of mental illness, so if you need talk therapy, you may want to look for a
doctor of psychology (Psy.D.), licensed clinical social worker (LCSW), licensed mental health counselor (LMHC), or a Licensed Marriage and Family Therapist (LMFT). Never be afraid to ask where your professional got their degree or where they are licensed. If you need something that they are not licensed to give you, don’t be afraid to seek treatment elsewhere.
They aren’t familiar enough with your problem to treat it.
Some mental health professionals specialize in treatment of certain illnesses. Others specialize in helping people through particular life transitions or in treating a certain group of patients (e.g. families, couples or college students). I promise there’s a specialist out there who can help with whatever you’re dealing with--you don’t have to stick with a doctor who isn’t prepared to meet your specific needs.
How can you find out if a doctor has the experience you need? Ask. If you have a diagnosis or suspect a particular issue is the problem, let them know. After they
run the necessary tests or review your medical records, ask point-blank if yours is a problem they can help with. Those being treated for depression and/or anxiety may have an easier time finding doctors familiar with their disorders than those with personality disorders, schizophrenia, or bipolar. Most doctors will be up-front
about whether they’ve dealt with a particular disorder in a patient before. If they can’t help you themselves, ask for a referral.
They don’t work with you financially.
If you’re financially vulnerable, as many people with mental illnesses are, you need mental health professionals who accept your insurance if you have it. If you are uninsured or underinsured, the therapists, counselors and/or doctors you work with should be willing to work with you on a payment plan or a sliding scale based on your income. A doctor who doesn’t care about your financial needs isn’t a doctor you need to be seeing.
It’s just… not working out.
If you’ve been seeing someone for a few months and nothing’s changing for the better, it’s time to leave. Some mental professionals will administer tests and inventories to measure your self-reported thoughts, feelings and levels of activity. If your scores on these tests aren’t going up, or worse, if they’re going down, you’re not getting what you need. Even if you’re not taking inventories every few weeks, if you don’t feel like you’re improving, you probably aren’t. Sometimes, just like in dating and friendships, doctor-patient personalities just don’t mesh, and that’s okay. (If you’re seeing a psychiatrist, lack of improvement could be due to being on the wrong medication or dosage; make sure you’re keeping them up to speed on your symptoms and feelings at every appointment.)
If you’re reading this, I’m sure you’re aware that not every moment of therapy is going to feel good--sometimes digging deep into emotional issues or trying to change damaging habits can be scary and overwhelming. However, your mental health professionals should be supportive guides through the process, not hands-off observers or pushy psychological stage moms. It’s important to remember that you have rights and freedoms as a patient, and that medicine is not a monolith. Not all doctors are right for all patients. However, armed with knowledge of what is
appropriate and what is not, you can find the one who’s right for you.