We want a patient to build an open and trustful relationship with his doctor. Yet, we pay little attention to the fact that a relationship is a mutual thing, and thus we excuse the doctor from actively participating in it. Now, have you ever tried to build a trustful relationship with someone who you address by title and last name, who sees you for five minutes a day on weekdays, who meets with you only because it’s his job, and whom you completely depend upon? It is obviously impossible. Moreover, it is harmful. We ourselves, put in the same shoes, would try as hard as possible to manipulate this person in order to get out, rather then be open and try to befriend him! But we still demand that the patiens do it.

––skpsycho.wordpress.com

This essay is for those who gain no benefit, and may even be harmed, by talk therapy in its many forms. Occasionally, people are forced to go to therapy, even though they know it does nothing for them. Admitting this, however, often prolongs this person’s “treatment,” thus making the problem worse.

This essay impugns no one who benefits from therapy. It does criticize therapy, but if therapy is scientifically and medically sound it should withstand this criticism. It is written from the perspective of a patient and uses no jargon, save in examples.

Throughout the essay, therapy is used to refer to talk therapy in general, i.e. the practice of treating mental problems by talking about them. Therapist refers to any of many credentialed psychiatrists, psychologists, social workers, psychotherapists and so on. Group therapies are not discussed, but these lessons are applicable, to some extent, in most therapeutic contexts.

This essay is divided into four parts, not counting this introduction: “Assessing the Situation,” “Practical Tips,” “The Narrative” and “Finding Help.” Patients looking at a short-term (< 5 sessions) of forced therapy should jump to the second section, for tips that can help them immediately. Those looking for alternatives to therapy should browse the last section. Others should read from the beginning, scanning what isn’t relevant to them and perusing what is.

Let’s begin.

I. Assessing the Situation

Who is coercing or forcing you to go to therapy? Here are the most common answers:

1. Doctor or hospital
2. A court of law
3. Family
4. Employer

In many cases, the consequences for not attending therapy can be dire. A judge might send you to jail. A doctor could get you hospitalized, even committed to an institution. Your family may withhold funds or possessions of yours if you don’t comply, especially if you are a teenager. You may be denied access to your children, even if you don’t drink, use drugs or hurt others. Take these consequences seriously.

Just because the alternative is worse doesn’t mean that therapy is good for you. Just because someone wants to help you doesn’t mean they can. Many therapists are trained to see any aberration as a disorder, even if it has no negative effect on your life. If you want to leave therapy as quickly as possible, you must deceive the therapist.

The main way to lie in therapy is to outwardly conform to the therapist’s directives, get better in spite of the “treatment” offered, and make them believe that they are the cause of your improvements. Make the therapist feel good about him or herself, and half of your work is done. The other half is knowing when to cut and run, when you can leave without incurring legal, financial, judicial or other penalties.

Always say you are taking your medication. Research common side effects and complain about them for the first two weeks. Then they will disappear and you will start feeling so much better.

On your own time, learn about alternative treatments which can actually help you. For example, if you have a drinking problem, there are many A.A. alternatives, such as Secular Organization for Sobriety, Women for Sobriety or Rational Recovery. But, above all, don’t mention this research to your therapist(s), nurses, other group members et cetera. You run the risk of wounding their egos and making them question your “commitment” and “resistance” to the program. You might be able to mention it to your attorney, because of attorney-client privilege, but make it clear that you are conforming to the court’s directives and, though you dislike it, have no plans to deviate from orders.

In many cases, it is possible to stop therapy before you’re supposed to. Sometimes all it takes is a note from your therapist saying that you’re fit to return to work/school/home. Take and deliver this note, if at all possible. Open it and read it. If it recommends you continue therapy, print out another note, identical save that sentence, and forge the therapist’s signature. There’s a chance this could backfire, but it’s not as large as you think.

Know the answers to these questions:

1. Who is ordering me to go to therapy? What authority do they have over me?
2. If I don’t go to therapy, what will happen?
3. What is the minimum possible time I will have to go to therapy without incurring a serious penalty, such as jail time?
4. How am I going to get better in spite of this “treatment” that, at best, will do me no harm?

You may not know the answer to #4 yet. That’s okay. If you are a psychopath or a narcissist, unfortunately there is no cure, but then again you probably don’t think of yourself as sick.

II. Practical Tips

However you answer the four questions above, it is important to deny your therapist any ammunition. If you say you are feeling stressed, it is like putting your finger in a shark tank and wiggling it around. If you explain why you’re feeling stressed, it is like sticking your whole hand in. You may have an innocuous reason, but the therapist’s training is to take anything you give them, however tiny, and pathologize it.

Keep a neutral emotional affect. Pretend you are giving a press conference to one journalist. Be polite and professional, and answer what you can, but don’t encourage speculation.

Make eye contact. Never look at the clock. Take off your watch and “turn off” (i.e. silence) your cell phone during a session. Keep your legs uncrossed and your back straight.

Always give your therapist slightly higher status than you, but not much higher. Do this by breaking eye contact, then quickly looking back; leaning forward in your chair; smiling widely; crossing your legs and fidgeting. Like policemen, therapists take their job in part because it gives them the opportunity to dominate other. If you try to bring your status up to their level, nine times out of ten you will be subtly slapped down without the therapist even being aware of it. So always keep a slightly lower status, but only slightly; this is far more discomfiting than someone who tries to usurp their status or remains firmly subservient to them.

Never start a sentence unbidden. Wait for the question and answer it. Answer as many questions as you can with “Yes,” “No,” “Sure” and “Fine.” Not “Yes, I understand because…”, not “Fine, but I think…” just each word by itself.

If you want to stall for time, repeat the last word (or last key word) of your therapist’s sentence as a question. Examples:

Therapist: You look tired today.

Patient: Tired?

Therapist: Yes. How much sleep are you getting?

Patient: How much?

Therapist: Just on average. Like, four hours, six hours, eight hours…

Patient: Eight hours?

Pay attention to your therapist’s eyes and tone of voice. Listen to what your gut tells you about him or her. If your gut tells you that this person is seriously bad news, listen to it. Ask yourself if the consequences of not going are so severe you’d rather undergo psychological torture than face them. It is almost always possible to find a new therapist, so long as you don’t make excuses for yourself. If someone asks for an explanation, simply say “I want to comply with the court/hospital/insurer’s directive. I can’t do that with this therapist.” Repeat ad nauseam.

Make your therapist uncomfortable. Make sure they’re relieved when you leave; that way, he or she is likely to speed up your treatment.
Above all, be pleasant, professional and polite. Never direct a negative emotion at the therapist; this may seriously set back your “recovery.” Appear to improve.

III. The Narrative

If you are in therapy for more than five sessions, you will need to create a narrative. The purpose of this narrative is to make the therapist believe you are getting better and that they are the cause. Read the last sentence again; it is very important. Most professional-class people are emotionally stupid; they will believe anything if it appeals to their ego, balms their neuroses and reinforces their feeling of superiority.
Your narrative must involve some one issue, preferably ongoing or, at most, a month old. If something serious has happened to you, such as a traumatic event, do not mention it unless it is the reason you are forced to go to therapy. Never go into your background, your childhood, et cetera. Again: never delve into your past. Don’t answer questions about anything that happened more than a month earlier, if even that.

Here are some example issues to “work out” in therapy:

  • A bad job. If it really does suck, quit the job. Then, tell the therapist it’s because of therapy that you quit. In a way it’s true.
  • A drug problem. Sober up and say that therapy helped you initially. Admit your struggles and cravings. This is actually an easy thing to fake, even if you never touch drugs. Simply go to one or two AA meetings, listen to the jargon and repeat it as best you can.
  • Unemployment. Find a job, any job, start a business, work for a friend, then tell your therapist it’s because of therapy that you were able to do it.
  • Lack of a social life. Tell your therapist you are making friends, through AA/work/dance club and so on.

If you have recently experienced a trauma and have to attend therapy or face institutionalization, you have a tough row to hoe. You must simultaneously find treatment for a serious condition and endure “treatment” that can make you worse by dredging up and reliving the incident. On top of that, you have the threat of institutionalization hanging over your head like the sword of Damocles. I do not envy you. The good news is, there are support groups which deal with PTSD, survivors of sexual abuse, domestic violence sufferers and more.

Once you know your main issue, know how you are going to “work it out” in the amount of time that you must go to therapy. It might help to make a rough calendar of how your mood is going to fluctuate at every meeting. Here is an example graph:

The mood is measured on the Y-Axis from a scale of one to ten. There is steady improvement but it is gradual. At the end of session 11 you are doing well, well enough to leave anyway. Notice that there is no ten; there is a good reason for that, covered in the next paragraph. 

Most therapists are not very happy people. Think about it. If you lead a fulfilling life, do you spend it listening to the problems of strangers? Most therapists do not want to see patients happier than they are. Because of this, do not go above a seven out of ten for more than one or two sessions. You want to flatter the therapist’s ego, to make them believe that you are doing well; you do not want to produce feelings of resentment or envy.

If your therapist is financially dependent on administering therapy to survive, there will be a very strong pull for them to keep you there indefinitely. You must resist it politely, but firmly. This is easier said than done, since most people want to make money. But whether or not they make money is not your problem. Whether or not you go to jail, to the hospital or to the dumps is your problem. Your therapist is merely a means to an end, i.e. keeping you out of a place where you don’t want to be.

Know and understand your therapist’s reasons for sitting in the room with you. You may not know exactly, but take an educated guess and play into these reasons. Here are some common ones:

  1. Love of comfort.
  2. Love of power.
  3. Fear of life.
  4. Laziness.
  5. Desire to help.
  6. Desire to save.
  7. Need for prestige, superiority, status.
  8. Arrested development.
  9. Inertia.

If this person is lazy, comfortable or afraid, make them uncomfortable, but do not get emotional or hysterical. Be easy to work with, and don’t express too much “resistance,” but always be “off” in some way that makes them dislike working with you. If they view this as a challenge, change tactics: be friendly and professional, but deny them any intimacy. If they mention it, explain that you’re just doing this because you have to, otherwise x will happen.

One friend of mine sat and stared at her therapist, unspeaking, for the entire hour. When the therapist said “We have to stop now,” she smiled. She wasn’t invited back.

If this person wants to save other people, flatter them. Make them think and feel that they are the cause of your recovery. Make a note of any advice they give you and remind them of it next session; say it really worked for you, even if you spent the week doing something else. Give them an emotional high, until you get the letter of recommendation or the paperwork signed that you need to be signed. After that, you have no obligation to them.

If this person wants status and superiority, flatter them. Appeal to their intellect. Ask for their opinion on complex matters, and listen to their responses while maintaining eye contact and leaning forward in your chair. Tell them they’re smart, admire their watch, or something they have on their desk. These little details can make a big difference.

If this person is an egotist, and talks about him or herself nonstop, just listen. Don’t act interested, but listen; if you act interested they make keep you in therapy indefinitely so as to always have a receptive audience. Empathize but remain professional. Listen but make them uneasy; if they feel uneasy around you they won’t want to put you in indefinite treatment.

Above all else, be patient. Steadily improve in mood and in mind. Direct your anger to some harmless channel, like painting or drawing or working out. Obey so absolutely that you strike fear in the heart of authority. This is how you can escape.

IV. Finding Help

If you have a problem with yourself, or with interacting with others, you will probably need some outside help. This doesn’t make you a weak person or a crazy person. It just makes you a person, a sub-robot, if you will.

Often, a change in diet and exercise can do half of the work for you. Go running and go vegetarian or vegan. Stop eating processed foods, watching tv and surfing the web. For many people, this alone can create an improvement, though even a drastic one.

Some other changes you can make:

  • Taking up a physical discipline, e.g. yoga, karate, kendo, fencing, etc.
  • Writing in a journal.
  • Giving yourself permission to not be perfect.
  • Volunteering for an organization.
  • Bibliotherapy–reading self-improvement blogs and books.
  • Meditation.
  • Finding a life coach, although if therapy doesn’t work for you, a life coach may not either.
  • Joining a non-cult-affilliated support group.
  • Change of sex partner.
  • Self-hypnosis.
  • Dropping bad friends and keeping the old ones.

If you want to join a support group, try to research it beforehand to find any questionable ties it might have to a cult, a GRQ scheme or some other craziness. Scientology is particularly notorious for starting front groups and then trying to push Dianetics on its captive audience. When looking at groups, be cautious.

I am not competent to tell you how to run your life. Nor is any therapist. I hope, however, that this article has given you some survival strategies, as well as ideas for starting a path of real recovery.