TRANSCRIPT
I get asked all the time, “Why did you quit being a therapist?” I was a therapist for a little bit over ten years, with a job that I’d loved. I was so passionate about it. I gave my heart and my soul to it, and it was something I did in a lot of different contexts. I did it in different clinic situations, and I ended up working the last six, six and a half years just in private practice. I worked with a full range of types of people, except for children. I didn’t work with children. I didn’t want to do that because I didn’t believe children belonged in therapy. But I worked with all sorts of adults. I did couples therapy, and mostly individual therapy. I did some family therapy also, and it was something that totally consumed me in terms of just my passion, my intellect, my emotions. I was really, really, really into it. I loved it, and yet I quit.
So I think it can be hard sometimes for people to get why I quit. I actually haven’t been a therapist now for almost eight years, and so I’ve had a lot of time to think about it. Here are my reasons.
The first reason that I quit being a therapist is it was such a struggle for me to be a therapist in a system that was so messed up. The mental health system was not a healthy system, and that’s the irony. It’s a system that’s supposed to help bring people who have mental health problems back toward mental health, yet the system itself is totally mixed up and screwed up. The system presents itself as science, but it’s not science. It’s not even really social science. A lot of it’s antisocial, anti-science, or maybe antisocial pseudoscience.
For starters, therapists are supposed to diagnose everyone. I was a therapist in New York State, a licensed clinical social worker with my LCSW letter, meaning I had six years of supervision, which allowed me to have the highest level of billing to insurance companies. Now social workers in New York have to diagnose everybody. They have to diagnose every client they see in therapy, and diagnosing people is incredibly stigmatizing. It can really actually cause people a lot of harm. And when you’re in a field where you don’t want to do any harm, why do you want to do something that’s an intrinsic part of the field but actually so often harms people?
Also, these diagnostic categories are quite arbitrary. Basically, you can stick most people in any number of these categories at any given time. So really what that does is it gives the therapists a lot of power to label someone with something that really doesn’t have a lot of meaning. But that’s just one thing that I found ridiculous.
Another thing is this whole thing about medication. Psychiatric drugs—supposedly we’re supposed to push people. Therapists are supposed to push people into taking psychiatric drugs. “If you have this problem, you’re supposed to take this drug. This problem, you’re supposed to take this drug. Oh, you have sleep problems? You can take this drug. And oh, you have this kind of mood problem or this kind of mood problem? Well, you’re supposed to take this drug or this drug. And if you have a side effect of this drug, you’re supposed to take this drug.”
And it becomes really ridiculous, especially when we consider how unhelpful and downright dangerous so many of these drugs are and how difficult it is to get off these drugs.
Now, there was another problem in being a therapist. Being a social worker, being a psychotherapist, was that we were trained to help people get on these drugs, to refer them to psychiatrists or medical doctors whenever they were having any sort of problem considered outside the bounds of what we were able to help them with. Now that really could be interpreted very broadly, such that therapists could, and often do, refer people to psychiatrists for basically just about every problem. There’s lots of therapists that refer lots and lots of, not most, of their clients to psychiatrists for medication. And medication is supposed to be very helpful in tandem with psychotherapy.
Now, I don’t agree with that. That was not my observation. And certainly from listening to tons of clients and tons of people in my life, I see that a lot of times the medications weren’t helpful at all. But therapists, we were supposed to, according to our education, get people to go to psychiatrists. We’re supposed to up-talk medication. Like, you know how waiters, to make more money, they up-talk selling alcohol? Because that’s how they make a lot of money. Well, therapists are supposed to up-talk medication, and they never, ever, never get in trouble when you up-talk medication.
When you suggested to people, “Well, maybe you have some sort of chemical imbalance,” or “Maybe you have some sort of biological problem that requires some sort of medication adjustment,” it sounds very scientific, and so many people buy into it. But the truth is, what really was our education in terms of medication for social workers, psychologists? It’s ridiculous. It’s so unscientific.
The bottom line is what therapists are trained is when you can’t deal with someone’s problems, when it’s too stressful, that’s when you send them to a psychiatrist to get evaluated for medication. But you never get in trouble. It’s considered totally within the bounds of our competency of practice, within our sphere of practice, to send people for medication evaluation.
Now, where it gets ridiculous is the opposite. What about when people want to come off medication? Because lots and lots and lots and lots of clients really do want to taper down off their medication or just stop them entirely. So how do therapists help them? Well, what we’re told is, “Oh no, no, that’s not within your area of competency. You don’t even talk about that. That’s very risky. You can get a lot of trouble for that.” And who wants to work in a field like that?
And there’s so many other ridiculous things. I can go on and on and on, but I think of one. I think of someone I worked with, and this happened multiple times, but I think I’ll keep it kind of general and anonymous, and I’ll even blend it a little.
So someone who had been hospitalized multiple times—I was working with this person two, I think three times a week—and the person had been stayed out of the hospital for about six months, which was the longest in their adult life they’d ever stayed out of a hospital.
Well, I got a call from their insurance company: “You’re not authorized to see this person two to three times a week. That’s considered completely unacceptable. We’ll only authorize once a week.” And I was like, “Yeah, but it’s actually considering how much it costs to go into the hospital for this person. It’s like a thousand dollars a night to go into the hospital, and this person was going into the hospital all the time, using it basically as a sort of therapeutic help, even though it wasn’t helpful.”
Now, how much was I getting paid for a 45-minute session? I think I was getting paid thirty-seven dollars a session, thirty-eight dollars. So basically, one night in the hospital was the equivalent of about what? What’s that? What’s about 28 psychotherapy sessions with me? And so I was only seeing the person two to three times a week.
Now, the insurance company didn’t agree with that. They said, “Well, no, we can’t pay for that.” And then fine, I kept arguing. I said, “You gotta do it. Come on, this is actually helping this person.” And they said, “Well, what’s your treatment plan?”
Now, I know the mental health field loves confidentiality, except when it comes to insurance companies, who don’t want any confidentiality at all. They want to totally intrude into the therapy, and they want to know everything that’s going on. So for people who already have some sort of fears and paranoia about people knowing what their business is, it’s not very comforting to know that the insurance companies can dig right in and basically legally, before they pay, get all the information.
The insurance company asked me, “Well, what’s their treatment plan?” I said, “Well, their treatment plan is actually very simple: keep them out of the hospital.” And they said, “Well, that’s not a sufficient treatment plan.” I was like, “Well, how about the treatment plan is doing all the things that hospitalization should have done but didn’t do because it wasn’t effective?” Well, if funny thing…
Is the insurance company after about two months of arguing, and I think not even paying for some sessions, finally agreed to give two to three times a week therapy to help this person stay out of the hospital? Because they realized actually they were saving tens and tens and tens of thousands of dollars just by helping this person come to therapy and actually get better help to stay out of the hospital. Because what did this person really need? The person needed somebody to talk to.
It wasn’t like genius. I think actually the irony is so much of psychotherapy is made into this mysterious world of, “Wow, the therapists, sir, what they do is such brilliant stuff, and there’s so much insight involved.” Well, actually, I think a lot of people can do exactly what psychotherapists do and do it much, much better if they just have a gift for being able to have a comfortable, caring, respectful conversation with another person. And lots of people can do this.
The second reason that I quit being a therapist: there was a lot of pressure on me to make money and to run my business. The last six years I was paying for a place to see clients. It was expensive. I wasn’t working in a clinic; I was working in New York City. And when you consider some of those insurance companies were really paying very little—thirty-five, forty dollars a session—and a little bit more sometimes, and that’s if people could afford the copay. Sometimes I’d have to write down they just couldn’t afford the copay. And so it was like it wasn’t a lot of money.
And then also, with a lot of the people that fee paid, I worked on a sliding scale. It wasn’t a very high sliding scale. I could understand why some therapists would charge a hundred, hundred and fifty, or more dollars a session just to survive in New York City. I just felt that was ethically wrong. I had a lot of clients who were paying more in the thirty to forty to fifty dollar per session range, but there was a lot of pressure on me therefore to see quite a lot of clients. That was exhausting.
But the problem is, especially after I made my first movie—and actually it was even before that—once I started getting popular at getting a reputation for being able to work with people who were in that state known as psychosis or diagnosed with schizophrenia or bipolar one with mania, stuff like that. People who were considered by the system— that I hated the word—but the system that considered them mentally ill. Well, what I found is a lot of those people discovered, “Ooh, here’s the therapist that we could talk to.” And they told people about me. And even in clinics, I got a reputation as someone who, “This guy can work with people who have those more serious problems. He’s willing to listen to them. He has the tolerance. He can sit with them. He’s curious about them. They get along with him. They keep coming. They don’t skip their sessions all the time.” So I started working with a lot of those people.
And in private practice, especially when I had much more pressure on me to make money and run a business because I had a lot more expenses, the problem is the people who had the most pain, the most problems, and the most need, the most trauma, the most difficulties in life, the most stress that it would cause a therapist were the people who could actually afford it the least. And that just always troubled me. And I really fought to work against that. I was like, “You know, I’m not going to turn people away because of their ability to pay.” The consequence, though, was I ended up having a practice that was very weighted toward people who could pay a lot less money. Also, because I was willing to charge a lot less money, I ended up getting people who the therapists didn’t want.
A lot of therapists work with a kind of a simple system. And if you’re psychologically clever, even in the first telephone call when people call up, you can kind of figure out who this person probably has some more problems going on, often because people directly say it. And you can kind of get a lot of them. Well, you know, actually this person doesn’t have much money to pay. And sometimes therapists just right away over the telephone tell what their fee is, and, “Oh, I can’t afford that.” And so what therapists do is, it’s actually a very good business strategy. They weed out the people who can pay less. They weed out the people who have insurances that can pay less, and they weed in—they filter in the people who can pay more. That felt unethical to me. I hated working in that kind of system.
So another reason that I quit being a therapist: it actually was just an utterly exhausting job. I was fried at the end of ten years, really fried. There’s a word we learned; we learned it actually in Social Work school, and it’s written throughout the literature, but they really don’t emphasize it that much: vicarious traumatization. I worked with tons and tons of people who had horrible, horrible traumas from their life, from their adulthoods, but mostly from their childhoods, from their early childhood in their family of origin. And I was on the front line of listening to them and feeling what they were going through along with them, empathizing, listening to their pain, looking, listening to them cry, watching this, also crying along with people. I was crying a lot.
I cried every day. It sounds kind of ridiculous eight years later for me to imagine that I sat with people and I cried in therapy with people every day. It almost sounds like it’s not even believable, but it actually was true. I wrote it down. I talked about it all the time back then. And I remember a lot of therapists really didn’t relate to me because they were distant from people. They kept people at a distance. They kept all those therapeutic boundaries, which in my experience really don’t help people very much, but they do help protect the therapists from the pain.
So what I went through, yeah, was a huge amount of pain just listening to it, listening to the horror. Although it’s like, did I get tainted as a person just listening to too many horrible things? I thought about that. I thought when I was a think before I became a therapist, if I had been a parent, I think I would have been much less protective of my children after all those years of listening to horrible, horrible things that happen to people in their childhood. And the range of the horrible things were quite beyond anything I could have previously imagined. It’s kind of amazing when I realized what people went through.
So often I wondered, and I even asked people, “After hearing your story, after hearing what you went through on an ongoing horrible basis—the rapes and the horrible molestations and the brutality and the beatings and the abandonments and all this stuff—how is it that you didn’t kill yourself?” I asked people that. And that’s again and again when I heard people give me the answer to that. It’s that they love their life. People are incredibly strong, incredibly resilient. And also, people do have defenses to keep their pain at bay. And that’s part of what’s so horrible about being a therapist is that therapy is the place where people do let down their defenses, and their pain can come out. The confidentiality, the safety, the privacy, the intimacy of the therapy relationship does allow that pain to come out if it’s a good therapy relationship.
So often what I’ve heard from people, my own experience also being, having been in therapy, was that therapy relationships were not a safe place for me to feel my feelings. Therapists just wanted to get rid of me. They were threatened by me. I kicked up their own defenses because I was more vulnerable, more open, more honest than they were. But what I found is if I was able to be with people in their pain, wow, people really felt safe in a relationship with someone else to feel their feelings when they were mirrored for who they really were as people and not criticized and attacked and put down and re-traumatized for it—not pushed to go on medications or called crazy or labeled all sorts of horrible things that the mental health field labels people.
What I experienced, yeah, was swallowing a lot of trauma. It went into my body, it went into my mind. I can’t became jumpy. I would notice a car horn would go on the street, and I’d jump. And it was like, what’s happening to me? And it’s like, yeah, I’m sitting around and interfacing with intense trauma all day long. It affected me. I got sick. I think it was how many, six years into being a therapist that I got ulcerative colitis. My gut, my inner gut, my intestines went crazy. And yeah, I’ve since learned it. The gut is like the second brain, the second mind. There’s so many, you know, receptors for some of these same chemicals that go in our brain, serotonin and whatnot, are also in our intestines. Well, God, my intestines were profoundly affected by being a therapist.
It’s like I was on a lot of medication toward the end for all that ulcerative colitis. It seems ridiculous to me that I was so, like, skeptical and critical of the psychiatric medication, yet I was taking medication for my gut to soothe it. And you know what? It didn’t help. And I got hooked on it, and it was very hard to get off. It took me six months to get off my medication, which actually, considering how long it takes a lot of people to get off their psych drugs, actually isn’t that long. But I was able to get off of it, and being away from being a therapist, you know, unlike exactly what the doctor said, the doctors, plural, said, I got better.
So another reason that I quit being a therapist is I had very little collegial support. I kind of mentioned this already, but basically, I was not well supported at all. Yeah, I did supervision. I did years and years of supervision as a psychotherapist, but that wasn’t supportive. Mostly, it was like, it was really good training to learn how to play the game, to learn how to say, “Mmm, if I tell the supervisor this, they’re gonna punish me or punish my clients or harm me or harm my clients in this way.” So I had to learn what I could share and what I couldn’t share, and that was a very unpleasant, frustrating process. It was disgusting, basically.
But learning how to play the game was actually very, very useful to me. It translated directly in me being able to help my clients learn how to play the game, especially clients that were getting sucked into the deeper mental health system, into psychiatry, into mental hospitals. And basically, for those clients to learn how to function outside of psychiatry, how to get out of the mental hospitals, out of the hooks of their psychiatrist, they had to learn how to play the game. And often, the skills that I learned were very, very useful to them.
A lot of it, yeah, people who’ve been in the mental health system a lot as clients learn these things. Don’t say trigger things. Like, if you tell people you’re suicidal, maybe, okay, maybe you don’t really want to follow through to kill yourself. But even if you start talking about suicidality, a lot of therapists and psychiatrists, plumbing, they’re trigger-happy. They’ll send someone right to the hospital. Well, I learned the same thing for my supervisors. If I was really open with them, like I was supposed to be, like I was trained to be about what was going on with my clients, they were less supportive of me, less supportive of my clients. They wanted to just do to my clients what they did to their own clients, which was send them to the hospital, force them to get on medication evaluations, kick them out of clinics, say you need a higher standard of care, basically be incredibly untherapeutic.
And so what I learned is that I couldn’t talk openly with my colleagues about what was going on. I could, yeah, I could be friendly with my colleagues. It was always a good idea, especially when I was working at clinics, to get along with them. And well, even with a little bit that I did tell my colleagues, a lot of them figured out, “Oh, this guy actually can work with really troubled people,” and they didn’t want to work with really troubled people. Most people wanted to get rid of the really troubled people, so they would send them to me. So yeah, I had good relationships with colleagues, but I was very unsupported. The end result with that was that professionally, I was very isolated.
Now, I know I shared this. At times, I’d feel in more intimate moments, I would share this with colleagues, and often I was burned when I shared. They said, “Oh, you’re professionally isolated, that’s your problem,” as if there was something wrong with me, and I was being pathologized in many ways, the same way my clients were being pathologized by the mental health system. There were a lot of parallel processes going on, but what I learned is, mmm, I really can’t share with them.
Now, where did I get my support? I got my support, I would say, from four different places. One, I got my support from my friends. I had a few friends who I could really talk about what was going on with. I couldn’t really talk so much in specific detail about what was going on with my clients because of confidentiality, but I could talk about my feelings, and I could talk about certain things as long as it wouldn’t come back to my clients in any way. And I found that very helpful.
What I found also is that a lot of my friends who were not therapists at all actually had a lot more common sense. I think the mental health system burned the common sense out of people. It ripped it away from them, and it made people have a lot less common sense. I’ve also seen that with some people who really had a natural gift for being a therapist, and they went through all the training to become therapists, and the end result is they became worse therapists as the result of all their professional training once they got their license.
But yeah, I got support. I got a lot more emotional support from friends. That was the first thing. The second is, it’s sad to say, but it’s the truth, is in my therapy with clients, a lot of my clients gave me support back, though I didn’t ask for it. But what they gave me was mirroring. When they realized that I was actually helping them, when they realized that I was actually listening to them, caring about them, and really being useful to them, often in ways that no one had ever been useful to them before, they turned around and they were like, “Thank you! My God, you’re helping me!” They were so appreciative, and they mirrored me back. They said often, I couldn’t believe how many clients told me, “How do you do this all day? This has got to be horrible to sit in, to listen to my stuff. I feel so bad. Should I come less?” People, like, even though it was helping them, they wanted to come less because they knew it was really painful to listen to. And I tried to be tough, and I said, “No, no, no, no, no, of course not! I can handle it!” But the truth is, it was difficult. But I really still did appreciate the mirroring, and it was intuitive mirroring that the clients gave me. They mirrored me as I was mirroring them, so it really was a two-way relationship in a way that I never learned about that in training. Nobody ever taught me that was true.
The third place that I got a lot of support was, and this is more early on, later I got less, but I got it through reading about psychology. I also got it by reading about novels. But I remember it, like Alice Miller, the psychologist Alice Miller, she gave me a lot of support. I also got support by reading about other, you know, critical psychiatry therapists and different parts of critical psychiatry, or reading Peter Breggin’s stuff like that. That actually really helped me to get support. But, but again, it’s not like day-to-day support I could get from reading, but it did definitely give me a foundation of some support. Wait a second, I’m not crazy! This stuff is actually what I’m going through is actually healthy and good and strong.
And the fourth way that I got support, and I think…
This was actually the main way that I got support, was through supporting myself, through doing my own self-therapeutic process, my own self-supervision process. I did a huge amount of writing, a journal. I wrote about what I was feeling. I wrote in my notes what I was going through with my clients. I would read the notes. I would read about what they were going through, and separately, I would write about my feelings, what was coming up for me. I did a huge amount of dream analysis. I found my self-therapeutic, my self-supervision process to be vital for me to be able to function as a therapist, to keep my sanity, to not lose my mind. I mean, yeah, you could say my colitis lost my mind for me, but pretty much I kept it together in terms of being able to function as a therapist to the best of my ability. But man, it was hard. It was a struggle. I journaled every day for years.
I also had to really, really simplify my life. I couldn’t go out and drink. I couldn’t go out and smoke cigarettes. I wasn’t using drugs at all. I couldn’t even be in a relationship when I was a therapist. It was just like I really had to treat it as a holy dedication, and that’s really how I felt.
So a fifth reason that I quit being a therapist was the responsibility. I think people don’t talk about this too much in the mental health field, and for me, that was something that was one of the hardest things about being a therapist, especially a therapist with people who had a lot of really serious stuff going on in their lives. But what it is in terms of responsibility, what is it that’s so hard? Okay, first, there’s just the responsibility of being the point person in that person’s life, being the one who is the recipient for hearing the horror of what they’ve gone through. That’s an incredible responsibility because you know that person, when they leave the therapy session and they go home and they think about it for a week, I’m on their mind a lot. And that’s an incredible responsibility. It’s like I had to be really careful about what I said. People, especially people who have been horribly harmed by their childhoods, by life in their adulthood, and by the mental health field and by therapists, they can be pretty harmed by a wrongly used word, an inadvertent phrase, a lack of sensitivity, or my mind would wander for a minute, and they would catch it. People would catch it, and it was like I felt an incredible responsibility to be focused, to be present, to not drift, to not be thinking about, “Hmm, I don’t want to go see a movie.” It’s like, no, be there.
Then also, at the end of the day, it’s not like, oh, therapists say, I hear this commonly, “Oh, you know, you’re supposed to leave therapy at home. You’re supposed to leave what happens with your clients at home. You’re supposed to have your own freedom afterward at night. You’re supposed to have your own evening.” Yeah, right. It’s like, come on. When people share about horrible things, you really think you’re supposed to be able to leave it behind? Ridiculous. It’s just ridiculous. I don’t think you can leave it behind. Some of the stuff that I heard, lots of it, it’s like you don’t just leave that behind. It would come out in my dreams. It would come out sometimes first thing in the morning, or I just think about it, painful stuff.
The other thing is I had this happen. I took very, very few vacations away from New York City when I was the therapist, mostly because I was so into the work. Also, it’s like I didn’t take a lot of time off, but when I did, I learned there was no such thing as a real vacation for me. It wasn’t a holiday. I’d be thinking about people. I’d be checking my mail, or even a few times I was out of range of being able to check my phone or check my voice messages. And it was like I worked with a lot of people who had suicidal feelings, sometimes suicidal actions, and it was like I felt like I bore a lot of responsibility. I feel a lot of the blame for that really is on the mental health system. There’s this idea that therapists somehow are supposed to totally be the catch-all that prevents people from killing themselves. Well, to me, that’s ridiculous. People have responsibility for their own lives, but the mental health system, with the rules of what it means to be a therapist, puts a lot of pressure on therapists. They can get in lots and lots of trouble with somebody if somebody tries to kill themselves or, heaven forbid, does kill themself, and the therapist hasn’t taken all appropriate actions to stop them. Therapists are supposed to use force to stop people from killing themselves. They’re supposed to call 911. They’re supposed to hospitalize people. They’re supposed to force people to go to psychiatrists to get meds. All these things that therapists are responsible to do, that to me, like actually, many of them are very irresponsible.
I, you know, in all those years I was a therapist, I never actually called 911. I never got somebody forcibly hospitalized. I did have some people voluntarily choose on their own volition to go to the hospital, to go to an emergency room if they felt really suicidal or had other things going on, but it was never me pushing them. And often it was like I would be the devil’s advocate, saying, “Well, why don’t you try something else? You haven’t tried this, this, this, and this before you go to the hospital?” There’s certainly lots of alternatives that you can try that haven’t been exploited. But some people wanted to go, and I feel like that’s certainly their right. And the same thing with medications. Some people wanted to take medication, and I feel totally that’s a person’s right. Though I feel it’s my responsibility to say, “Well, have you tried this? Have you tried this? Do you know the side effects? Do you know the dangers of this? Maybe you could try other things, blah, de blah, de blah.” But again, those are big responsibilities to take.
But I think the main one also is that it’s just that fear that if something goes wrong, if something goes wrong with one of my clients, I’m gonna get blamed for it. And I was like, when I quit being a therapist, man, that freedom that I got just to be away from that incredible responsibility.
So this brings me to my sixth and last reason that I quit being a therapist, and this actually may be as important as all the other ones put together. I became interested in other stuff. I wanted to move on with my life. I realized, you know, I have interest in other things aside from just sitting in an office, listening to trauma and helping people work through their trauma, helping people grieve. I started to want to make movies full-time. I started to want to travel. I started wanting to be, I wanted to go and hitchhike around the world again. I hadn’t done that in a long time. I wanted to learn other languages because the other thing was a lot of what I was helping people do was free up themselves to go forth and manifest, to be exactly who they wanted to be. And eventually, I realized, wait a second, I kind of want to do that too. I want to do more than just spend all my time dealing with healing and grieving and pain and trauma. I want to deal with beauty. I want to deal with all sorts of freedom to try new things and explore and experiment and be in other countries for a long period of time and go see parts of the world that I’ve never been, and I haven’t seen whole parts of the world, whole continents.
So I’ve gotten to do that. It’s been wonderful. It’s actually been a really beautiful thing to not be a therapist, and it’s also given me a lot of time to really have perspective on what I did. Sometimes I look back in it and I say, what is this world where certain people are designated to do this role of being therapists and to listen to people’s pain and trauma and to be healing conduits? Sometimes it seems a little bit ridiculous.
Seems better to me if everyone, or almost everyone, had some therapeutic skill and really could provide that for the people in their lives. It wasn’t put onto the role of people with titles and social workers and psychologists and therapists and psychiatrists and shrinks and all this stuff.
It just seems like, yeah, a more ideal world, it would be these helpful things, these helpful roles. The emotional support, the emotional insight would be more integrated into communities, into our regular life, and not into roles and diagnosis and this whole silly system.