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Content note: discussion of serious illness, mental health, and patient rights

How many of you, if you went to a hospital for a serious and life-altering illness, would want to know what your treatment options are prior to receiving treatment?

How many of you would feel comfortable being treated with a medication that had not undergone any randomized, controlled clinical trials?

If the medication being prescribed to you had undergone such trials, and the evidence had shown that this medication was no more effective than a placebo, how many of you would want to spend a few thousand dollars to receive this medication?

Would your answers to any of these questions change if the doctor was very nice?  Would you stay with that doctor in order to avoid hurting their feelings?

David Tennant looking sad in the rain

How much of your health would you give up to avoid making a doctor sad?

For a medical doctor, most people would answer “Yes” to the first question and no to all the rest.  However, many people are unaware that these questions are equally important when seeking therapy.  The answers to these questions can mean the difference between healing and prolonged suffering.

Although it still has a long way to go, clinical psychology is crossing the bridge from groundless speculation to science.  Randomized, controlled trials have become the gold standard for evaluating different therapies, just like they are for evaluating medications.  There are many different therapies available, and it does matter which type you receive.  Unfortunately, many therapists do not give patients the information they need to make informed choices about their mental healthcare.

For example, I recently spoke with a clinical social worker who was treating a young patient with obsessive compulsive disorder.  This therapist had been working with her for over two years, but the patient’s dysfunction was becoming so severe that her parents were considering pulling her out of high school.  The therapist expressed her frustration that the patient was not improving.  She commented that this patient “has no motivation to improve.  She is just untreatable.”

First, it is bizarre to think that a patient who has been seeking treatment for two years does not want to get better.  Beyond this, it was painful to hear this patient labeled as “untreatable,” when there are multiple psychotherapy and medical treatments available for her condition.

When I asked the therapist if she had discussed other treatment options with her patient, since the current method was not working, she replied that she had not.  She said that she considered them to be ineffective.  The treatments she dismissed out of hand included Exposure and Response Prevention, a therapy that is highly effective for OCD.  When I asked if she had referred the patient to a psychiatrist for medication, she replied that she had not. “It would be no use,” she said.  “The patient won’t get better until she wants to get better, and she just does not want to get better.  Medication can’t help her with that.  Anyway, she probably wouldn’t take it.”

This therapist was unaware of her limitations and unwilling to consider that something else – or someone else – might be better for her patient.  Unfortunately, this therapist is not an anomaly.  For people with mental illness, the right to receive effective treatment is routinely violated by the hubris of those who are supposed to provide it.  Even if it stems from therapists’ sincere belief in the power of their training, patients pay the cost, both financially and in lost options for improved mental health.

A person stands at a crossroads holding a piggybank

Whether it is your first session or you have been working together for years, you have the right to the same standard of informed consent from your therapist that you have from medical doctors.  You have a right to ask your therapist questions about your treatment, and if your therapist is an ethical practitioner, they will be glad that you asked.

“What treatment options are available for the problems I’m dealing with?”

“What type of treatment do you provide?”

“What is the usual timeframe for this type of therapy?”

“Has research shown that this type of therapy works for treating my condition?”

“How do you define ‘working’?”

For some therapists, “working” means eliminating or reducing your symptoms.  For others, it means learning how to live a full and meaningful life even with your symptoms.  For others, it means helping you gain further insight into what your symptoms are, how they work, and how they affect you and your loved ones. Each of these approaches is highly valuable depending on what your goals are for getting better.

Speaking of goals, you have a right to know what your therapist’s goals are for your progress, and you have a right to participate in setting those goals.  You also have a right to discuss with your therapist if you are concerned that you are not making progress.  If your therapist does not share your goals, or is not helping you meet them, you have a right to be respectfully and kindly referred to someone who can provide the care you’re seeking.

Two children release a toy sailboat

Sometimes a therapist’s role will be to gently launch you in the right direction, even if they won’t be along for the ride.

To clarify something important, this is not to say that you should ditch a therapist if you aren’t getting better right away.  All recovery processes take time and hard work.  Like any relationship, you and your therapist will have challenging interactions to navigate and repair.  The point is that just like a patient receiving a medication, you have a right to know what treatment you are receiving, whether it has been proven to be helpful, and what your options are.

Some therapists might respond defensively to your questions; sometimes this just means that you surprised them.  However, if they continue to act offended, or if they dismiss your questions as unimportant, this could be a sign that your therapist does not value your right to make informed decisions about your mental healthcare.  Remember: an ethical therapist wants you to get better just as much as you do and will support you in learning more.

For more information about finding effective treatments, the website below is great.  It is run by Division 12, the much cooler name for the Society of Clinical Psychology, which is a subcommittee of the American Psychological Association devoted to evaluating and raising awareness about empirically supported treatments.  I love this site because it relies on available evidence, not ideologies.  For instance, under treatments for depression, the behaviorist “Behavior Activation” and the psychodynamic “Interpersonal Therapy” both receive ratings of “strong.”   They also explain their ratings system and list the studies that their ratings are based on.

To check it out, click here.  It is a great source of empowerment and reasons to hope.