Therapists and You

If you are a victim of domestic violence, then you may suffer from a number of mental health issues.  You may find yourself clinically depressed, or suffering from Post Traumatic Stress Disorder because of what you have been through. 

Although your mental health condition has been induced due to the horrors you have suffered, you may still find the mental health “system” stacked against you.

There are many cases where the abuser will try to use your mental health records against you.  Your ex may even attempt to state that you are unfit because you are depressed, or “unstable”.  They may try to use the fact that you are on anti-depressant medication against you – but it is far better that you seek treatment than avoid it.  I’ve put together my thoughts on this issue because there are a number of things that you may need to keep in mind if you find yourself in this situation.

First - there is no shortage of bad therapists.  There are far, far too many that are poorly trained, insensitive and downright abusive.  Anyone in need of counseling is at a decided disadvantage.  (I strongly believe that anyone who is mentally ill should have an advocate to protect them from abuse by "mental health professionals".  I have seen mental/emotional abuse from therapists first hand.  I have seen them pass judgments on people with an apparent disinterest in the consequences of their labels and without a shred of empathy for the individuals whose lives they wreck havoc upon.

This happens because many who go into this field do so, to understand themselves.  They are messed up emotionally themselves.  Keep in mind, that they are only human and therefore prone to foisting their own human biases upon you and your situation.  This is particularly damaging if the counselor has no experience or training in the area of domestic violence.  Your best bet is to check with your local police department or domestic violence agency to see if they have a program of counseling that you can participate in.  Counselors that are trained in domestic violence (regardless of their educational achievement) will view your behavior within the context of the domestic violence and frame it that way.  This means that while everyone else writes you off as “hysterical” they know that this is a normal reaction to what you have been through.

If you can’t get to a counselor that is well trained in the area of domestic violence, then you should know that all “counselors or therapists” are not created equal.

The absolute worst "therapists" are the social workers (horribly qualified, and prone to accepting the latest fad theory – many have their hearts in the right places – they mean no harm but they are the most dangerous), then psychologists (not as scientific as they should be), then psychiatrists (don't have a lot of time for you and will mostly use meds for treatment which is warranted at times) and finally nurse practitioners (the better of the lot - they have the training for medical care AND the TIME to talk to you).  From my perspective, the use of a more scientific medical model for treatment decisions has more credibility. 

Second - in terms of "talk" therapy - you may do just as well to have a good friend to talk to – “kitchen table therapy” can be just as good as care from "so-called" experts who can be VERY damaging to one's psyche and one’s court battle.  Just don’t wear your friends out - they can get burned out on your problems and start to resent and reject you - so be careful here.  If you need medication for depression – a very real medical condition – you must seek help from a qualified psychiatrist.  If at all possible, try to find care where you will not leave a paper trail that can be used against you in court.  This can be done by participating in a research study.  Ask questions about how your identity will be protected, and if in doubt – use a fake name.  The research records should be kept separate from all computer records and since the cost of your care is paid for by the pharmaceutical company (or NIH) you do not have to use your health care insurance and so, there should be no way to trace your participation in the study.  Ask if your records are entered into any computer system.  If they are, you are at risk of this information ending up in your computerized health record system.  The new HIPPA regulations which most people believe protect their private health information DO NOT.  All HIPPA does, is let you know that they will give your health information out to just about anyone.  In order for them to NOT give information out – YOU must write them and tell them.  HIPPA is the “Health Insurance Protection and Portability ACT” and it is pure Orwellian doublespeak because it implies that it is protecting you when it is NOT.

To find a research study, go online and search for research studies or call your local university (departments of both psychology and psychiatry) and ask for information about research studies for your condition.  Additionally, you may find care without the use of medical insurance through programs that train mental health professions – nursing schools (mental health nurse practitioners) or graduate schools in psychology.  Care through these programs is typically free or at a greatly reduced cost.  Granted, you will see a student – but these students are supervised carefully and frequently “know” that they don’t know the answers to everyone.  They consult with their supervisors on each case who guides them in your treatment.

I recommend that you weigh all your options carefully.  Any care you get that is traceable through your mental health records can and will be used against you.  It will take a good lawyer and perhaps medical experts to “spin” it back in your favor.  That can be done with skill and some luck because the fact is that if you have a serious mental health problem and that you need treatment.  If you can show that you did the responsible thing and sought treatment, then it should not weigh against you.   We know that mothers who have clinical depression AND get appropriate treatment are better mothers than those with depression who do NOT get treatment.  Never under any circumstances consider suicide or utter those words to anyone who can use them against you.  Don’t even think it.  It is not the solution for you, and would haunt your children for their lifetime.

Be warned - switching therapists a lot will work against you.  They will see you as "difficult to work with", "doctor shopping", and "manipulative".  There is no shortage of labels that they can put upon you - even if they are NOT warranted clinically. (There are very specific criteria for personality disorders - so even though you shouldn't get wrongly labeled, you most likely will.  This happens because few clinicians follow the criteria correctly by using an appropriate structured clinical interview.)

Third, don’t be surprised or disheartened if your therapist seems hell bent on making you “accept” the horrors you are experiencing at the hands of the court system and the batterer. It is true that most are trained to help you accept (so to speak) your life situation.  This is because no one can ever change the behavior of others.  The only real control that you have is to change how you "react" to what others do to you.  How you feel is something that you have control over and the therapist is supposed to help you arrive at a place where you are comfortable with things - where you feel like you have some mastery in your own life.  Let's face it - they really can't control the courts or your ex and neither can you.  That doesn't necessarily mean that you have to become a doormat.  They should help you find ways to react that are constructive for you - ways that make you feel like you are having some impact on the situation.  No one likes to feel helpless.  In fact feelings of helplessness can lead to depression if left unchecked.

Fourth - Many, many people who have never lived through all this crap - simply can't believe (don’t want to believe) it really happens.  To believe it as “real” is to shake up their own perspective on the world.  They would be forced to see things as unfair and cruel and that would cause them "cognitive dissonance" since it flies in the face of how they WANT to see the world.  I think this is also why so many judges refuse to believe women.  It is just easier to dismiss us as "histrionic" or "hysterical" or "vindictive liars".  Occasionally they do have someone who is essentially lying or over-reacting and they point to that case as representative of ALL cases.  They really can't sort out fact from fiction and many don't even try - preferring instead to dismiss all.  (you know that old "every story has two sides" crap, which I think is sometimes just evasion from the truth - because the truth has only one side - but that is a whole other essay for another day). 

A variation on this fourth item is the "ya, but I've seen far, far worse" so I am dismissing this woman's complaints because by comparison they aren't that important. (e.g., in my case my lawyer reminded me that judges see cases of people burning kids with cigarettes, etc, so beating them black and blue with a leather belt, leaving them unsupervised overnight, etc, etc, etc, and abuse against me in front of the kids - well that just doesn't compare - it's just not "that" bad.  Interesting how their yardsticks get skewed as to what counts as reprehensible and unacceptable behavior. ("Best" interests of the children is a joke - it really is best interests of the abuser, the judge and the therapist - all who don’t' want their own version of reality shaken up too much.)

Watch what you say to these people - because it can and will be used against you by the courts and the ex when they demand access to your medical records and get them.  Keep in mind that if you refuse them access to your records, you will be viewed as “having something” to hide.  I know this, from personal experience, and because I work in the field.

I truly wish everyone good luck because it can be very difficult to stay sane in this insane world.  Hope for a better tomorrow because sometimes hope is the only thing we have left to hang onto.

(Written by guest author Kay Hook 12/2004 and reprinted with full permission herein)