To think she was a bit rude/not empathetic?

[UndertheCedartree]

I can't quite put my finger on it so said rude/not empathetic but could be something else.

I had a first appointment with a therapist today. Been in this position many times and know the first appointment is just an introduction/talk about practicalities/see if we can work together - it doesn't always work out which I find hard as well as I struggle with new people.

So I asked my support worker (PA) to come with me to this appointment. She has supported clients with therapy many times before so it was no problem.

Therapist comes into waiting room and calls me by the wrong first name...I corrected her and introduced her to my support worker. She then addressed the support worker and told her 'stay here, I'll take her in'. It made me feel uncomfortable that she didn't speak to me and made me feel like an object with 'I'll take her in'. So I said 'I would like SW to come in with me.' Therapist ummed and ahhed over it. I told her I was within my rights to have my SW with me. Eventually she let us leave the waiting room and go into a private room. There she called me by the same incorrect name and when I corrected her just told me she sees a lot of people.

She then proceeds to talk to my SW about why she shouldn't be there. That therapy isn't a 3 way thing. Questions the dynamic between us etc. My SW explains her role to the therapist and that I'd asked her for support in this sutation and that it was a situation she was very familiar with. I make some comments but the therapist ignores me in favour of talking to my SW!

I try to explain to the therapist why I have asked for support for this session and explain going forwards I will mainly seek support from her after our sessions and possibly for her to support me to go to the session and be with me for 5 minutes at the beginning until I start to feel comfortable with the therapist. I may therefore ask her to wait for me in reception for a couple of sessions. My SW asked if we could agree that if I wanted her with me for 5 minutes at the beginning of the next session that, that was ok (to try to prevent such an awkward start next time.) She wouldn't agree to this.

She spoke in so much jargon. She didn't have to think about something she had to 'have a thought.' She was constantly 'curious' about things. I was 'holding on' to the idea of therapy = I wanted therapy. Just so much it was hard to understand her. I explained to her how I felt and she just kept asking again and again and I had to repeat myself 3 times. She then left a massive pause and asked if I felt sad...which was not what I had said at all! She didn't understand my use of 'in the community' (I.e not in hospital) when that is a completey normal turn of phrase!

She was then 'curious' as to how I could cope with therapy if my SW was in the waiting room. I just replied the same as anyone. And then I asked what would happen if at the end of the timescale she had given me we hadn't finished the work necessary and her reply was we would have to 'have a thought' about it.

It felt like she was highly anxious. She obviously had a problem with me having my SW with me, but if she hadn't been with me I would have walked out because tbh the therapist was really pissing me off!

This is part rant and part - do you think that this sounded a bit 'off'?I want to go into the next session knowing how to make this work better and how to deal with these kind of difficult situations.

Rapport is crucial to getting patients to open up so they can do real, productive work together. The therapist got OP's name wrong and then dismissed her as one of many, not a big deal, stop making a fuss. She's indirectly dictating the meeting and abusing the discrepancy in the power dynamic. OP is in a vulnerable place, and subtly telling her that she's not even important enough to remember her name is really, really poor.

A somewhat lighthearted analogy, but if you turned up to a first date and the guy got your name wrong, and when you corrected him he shrugged and said, 'I date a lot of people', do you think it would be a good date? Would you see him again? Would you even bother finishing the date? It's obviously not the same as therapy but there are basic expectations of respect and courtesy and the therapist couldn't even manage that, so it doesn't exactly bode well for her empathy skills as she's immediately put a wall between them.

Anyone can make a mistake but it's the attitude that came with it, talking to the SW instead of OP, and becoming hostile at the possibility her shoddy professionalism might be being scrutinised.

I've done therapy, multiple times, multiple branches, for multiple reasons. Therapy 101 is make the patient feel comfortable. If you get the relationship off on the wrong foot when the patient is already apprehensive, there's a good chance it will never recover. Apologise profusely for the name mistake, allow transparency in the first meeting, see if you can find a compromise for the SW going forward and explain your reasons fully, and work with the patient.

I mean she’s not wrong about therapy not being a 3 way thing (though I would have cut a bit of slack if it was the first appointment). It’s not necessarily about accountability it just changes the dynamic.

Calling you by the wrong name (twice) is crap though. I think you’d have grounds for asking to swap therapists based on that alone.

Your instincts are saying no. Look at it like you are interviewing for a therapist and she didn't pass so doesn't get the job and you move on to the next person on the list. Maybe don't send her a rejection letter though.

So group therapy and couples therapy doesn't exist then?!

I honestly cannot understand posters thinking the OP is the one making things difficult here.

She went for an introductory/admin type appointment. Easy enough for the therapist to explain the importance of therapy being one-to-one, gently probe a bit to see OP's reaction. At which point OP could have explained she planned to attend without her support worker in future, and just had her in there for this first appointment. Job done. All clear and no frustration on either side. Except the therapist chose to make it strange and awkward instead.

Her support worker waiting outside is surely ok though? Seems odd that that's objected to. OP may need help getting home, especially after an emotional session (I struggled with this when I had therapy - having to navigate journey home in public when I just wanted to be alone quietly). If she struggled to attend sessions due to this, would they hold that against her too? ("Unwilling to engage", "Not committed", etc!)

It doesn't surprise me that it's NHS, and the posters criticising the OP remind me of that kind of rigid awkward thinking that seems to penetrate mental health services. It's like they get an idea into their heads about how the person is and the cause of their problems, and forget to actually explore the person in front of them or adjust their view at all. I don't know how much info is shared beforehand - do they have the patient's full notes? Referral letters full of opinions, leading to pre-judgement rather than actually exploring what's going on for the person? Up until the point of therapy, the person has interacted with mental health staff who are not trained in psychology or therapy, and who may only ever have seen the person in crisis - their viewpoint will be skewed. Unfortunately this sticks.

(To the NHS therapist who posted upthread - no criticism towards you! Please stay, the NHS needs good therapists!)

It's intriguing that a PP referenced OP's previous threads, in assuming she's being unreasonable about this. As if she's "just one of those people", she must be making a fuss about nothing because she's always in these apparently unreasonable situations... Whilst those of us seeing this situation in isolation think OP has a point.

I think this shows the sort of vicious circle that can happen in MH services - patient gets treated badly, next person judges them as potentially "difficult" due to this incident, leading to them misinterpreting the patient or acting in a slightly hostile manner towards them, so the patient has another difficult interaction, and the whole thing escalates. Until you have a patient with a long history of attempting to get help, but who is increasingly treated as a difficult nuisance and with hostility by staff, making interactions fraught and sort of anti-therapeutic.

(God forbid the patient be allowed to feel the staff are the ones being difficult, though!)

@Sparklfairy
Rapport is crucial to getting patients to open up so they can do real, productive work together. The therapist got OP's name wrong and then dismissed her as one of many, not a big deal, stop making a fuss. She's indirectly dictating the meeting and abusing the discrepancy in the power dynamic. OP is in a vulnerable place, and subtly telling her that she's not even important enough to remember her name is really, really poor.
...
Anyone can make a mistake but it's the attitude that came with it, talking to the SW instead of OP, and becoming hostile at the possibility her shoddy professionalism might be being scrutinised.

^This!!

It's this sort of attitude and power control that permeates MH services and makes things worse.

@UndertheCedartree : I think this is why it's going around in my head so much. It just felt so wrong.

This is probably all you need to go on.

I've had questionable dealings with therapists before. Took one of my children to CAHMS once. On the first session the therapist asked my child then aged 17 what 'idiosyncrasies' they had and also used a whole bunch of other language that was not at all appropriate for the audience.

On top of that they asked me a lot of detailed questions about their childhood that I just couldn't answer off the top of my head (but could have if I'd had some time to think about it). Anyway, the whole thing was just awful and we both came out of there feeling, probably, like you did.

While they may have had the appropriate training, it doesn't mean a therapist has people skills, that you will feel at ease with them or that they can meet you at your level.

It's intriguing that a PP referenced OP's previous threads, in assuming she's being unreasonable about this. As if she's "just one of those people", she must be making a fuss about nothing because she's always in these apparently unreasonable situations... Whilst those of us seeing this situation in isolation think OP has a point.

Or, PPs have observed repeating patterns of behaviour which might be valuable for both the OP and other contributors to recognise and try to understand.

You are so spot on. Some people just seem to see people with mental illnesses as morally wrong in some way. As you say a nuisance, the cause of their problems, perhaps. They just need to try a bit harder.

I'm sorry to hear about your difficult experience and I hope your child got the help they needed with someone else.

I am quite curious about your theory here. Do you have a qualification in psychology or similar? On what basis are you suggesting it?

The repeating pattern you claim to observe is on threads about my mental health many people are 'cheerleaders' while the couple of 'clear thinking' people don't get favourable replies from me.

My interpretation - I get lots of really supportive comments that help me enormously in dealing with the situation from people who have direct experience. There are always a couple of negative people that detract from the thread and just make a nuisance of themselves with their unfounded claims. These people have no experience but still think they know best.

She sounds insufferable. Abd nit a good fit for you. Apart from all the other stuff she doesn't get you, and you can't understand the way she speaks. I wouldn't bother going back.

You might have to go back on the.waiting list but there is zero point seeing a therapist that you don't click with. I've seen a lot of therapists!!

This therapist just isn't the right fit for you. It's normal to need to "try out" a couple of different therapists before you find the right one for you.

Yes, that's true.

The Majority of your threads seem to be in AIBU though, rather than the Mental Health topic.

Would it help if you only posted about MH issues in the MH section and used AIBU/Chat for everything else?

Multiple professionals have replied before you wrote your post contradicting what you are saying.

This

I guess I fall into that trap of using AIBU as I usually get a good few really helpful replies immediately. When I'm feeling upset about something it helps to have that reply immediately and lots of support.

But maybe I should use the MH topic.

You're fine here OP, and don't let anyone police where you post. Enough people post in AIBU without even having an AIBU, and just say 'posting for traffic'. You do get more responses here!

I think for the majority of people they just read the post, not take note of the topic.

If you're referring to me, I'm not 'policing' anything.

The OP is saying some people don't understand mental health issues that's all.

She may (or may not) get more understanding in the topic.

It takes (at least) two for any interaction. Whilst it may be of great use to OP to examine patterns of behaviour, what I'm referring to is the tendency to place all the blame for an unsatisfactory interaction on one person. Perhaps the therapist should also be considering her own behaviour and emotional responses that have contributed to this particular unsatisfactory interaction. Hopefully she will be, in supervision, but the difference is this is OP's life whilst for the therapist it's just her occupation.

Another very crucial difference is that OP is the "troubled" one. One should reasonably expect/allow for a certain level of emotional dysregulation, perhaps oversensitivity in some areas, a difficulty managing things and interactions on a daily basis. The therapist is the one who should, for want of a better phrase, "rise above" that, be understanding and try to empathise with how reality feels to OP. Only then can she build a rapport, and the OP feel safe enough to open up and explore the really difficult stuff, the stuff that challenges her, or that she may feel too overwhelmed with difficult feelings like shame to face right now.

Unfortunately, for various reasons, too many working in mental health have a sort of suspicious, arms-length, "managing" patients approach that simply makes things worse. Particularly when you end up with, as I mentioned, a sort of vicious circle where the professional and the patient are reacting to each other and both becoming more mistrusting and reactive as a result.

To OP - I hope the above doesn't come across as patronising or unpleasant. It's just I've been there, done that, got all the T-shirts...

I've been through horrible stuff, surrounded by difficult situations where others (including MH staff) have decided it must all be me being a maniac as others apparently don't have these troubles, and the common factor in a those situations is me. It's ever so easy to scapegoat people who are struggling or different in some way, or not good at drawing the boundaries to stand up for themselves. Unfortunately this severely delayed my path to healing, as the answer turned out not to be "shut up and stop making a fuss" but more to do with self-respect, learning where to have strong boundaries, and basically keeping away from arseholes. MH services went completely the wrong way about helping me achieve that - in fact they seemed to want me to give up any self-worth and fight I had left in me to be reliant on their approval as a good little patient.

Oh no, not patronising at all.

I have come across some MH staff like that. Luckily, I have also come across the very opposite too.

It is like you say that a diagnosis can become a self fulfilling prophecy in the vicious circle you describe.

There is always a certain contingent on here that think 'put up and shut up' is the only course of action that you as a mentally unwell person should take. But I find they are very much in the minority and most people are helpful and supportive.

There does need to be trust between client and therapist before that challenging can even start.

Arbitrary reasons? I wouldn't say it's arbitrary for a vulnerable adult to need a SW there for the first session. It can be very daunting starting therapy when you have Complex needs. Trust is often difficult for us.

That said, I can understand why some therapists don't want that dynamic. It may be that it depends on the type of therapy.

@UndertheCedartree I am someone with complex needs, mostly around diagnosed complex trauma and BPD, and as yet undiagnosed possible autistic traits. I've had years of therapy both on NHS (DBT) and also charity and private based trauma therapies, so I 'm a bit of a veteran of the system, as it were. I never did take my SW actually into sessions but I can see why some may need or want one there. I certainly did a fair bit of debriefing with my SW about what went on in sessions. I can understand needing another set of ears and eyes there to assess if the therapist may or may not be a good fit for you too. I don't think YABU to have concerns . It does seem like she may not be the right fit for you, perhaps try next week, see how that goes? I understand the fear and frustrations around a long wait for therapy and being in the system long term, it's not an easy journey at all. I wish you all the best.

@Rachmorr57 I find your attitude a little rude. I don't wish to start a fight, it's late and I need to be in bed, but I don't like seeing the piling on @UndertheCedartree is getting. You appear to be making assumptions about Cedartree that are unkind and based on very little.

please be kind. There is a human being at the other side of the screen.

Well said, I relate a lot to this with my own experiences. I couldn't agree more with this. You've expressed it more articulately than I could, but you've said basically what I was trying to get across.