The psychotherapist came to the waiting room to get me. She was a tall, older, light-skinned Afro-American psychologist. She held the door as I maneuvered my wheelchair through it and we went into her office. She sat down and I slowly did a 360-degree turn in my wheelchair, checking out her office. I commented (favorably) on the university from which her diploma came and inquired with curiosity about one of her green plants.
When I had come full circle and was facing her, she uttered one sentence, the gist of which was “take off your clothes and tell me where it hurts.” I replied that we’d just met and weren’t there certain civilities that strangers engaged in before they got naked together? At which point she commented on the fact that I had come into the room and turned my back on her. Clearly, despite the careful language she used, she was criticizing me. Then we talked here and there about this and that. It is always necessary, when seeing a new care provider, to tell some truncated version of your story.
The following week, sitting at home an hour before my next appointment, I became aware that I was feeling nervous. Within the first five minutes of meeting this woman, she had judged me and found me unacceptable—and I had to go back and subject myself to this again. I considered canceling the appointment but I’m not a quitter, so I didn’t. I have had repeated episodes of great pain in recent months and I don’t know why. I am committed to figuring out the problem and need help to do so.
There was no space for my wheelchair in the waiting room. This is a constant problem in doctor’s offices. They fill the room with chairs and leave no place for their patients in wheelchairs. It is made clear to us that instead of being welcome, we’re in the way. Additionally, there was construction going on in the area where the waiting room abutted the therapist’s office. When the therapist showed me into her office, I inquired about the construction. She told me it was to bring her office into ADA (Americans with Disabilities Act) compliance. She did not say it was to make things easier for me; she said that the law required it. There was an undertone that it was my fault; I had caused the disruption.
Since we were talking about disability access, I brought up the constant problem of having no place to sit in the waiting room. I wondered aloud why, after talking to my previous therapist (who was out on sick leave) and various support staff people, no one had fixed the problem? Was it because people just didn’t care? Was I not worth taking time over? It was clear to me from the therapist’s demeanor and responses that she was not going to do anything about it. I was trying to advocate for people in my class—disabled people in wheelchairs—and she wasn’t going to work with me.
The therapist stated that I was bullying her. I replied that I’d felt judged and criticized by her in our first appointment. The therapist replied that it was rude of me to have turned my back on her. I sat there and reflected on that. Instead of accepting me, she was judging me according to her own value system. “Rude?” I said, and turned and left the office. If a therapist is judging your social behavior then she certainly isn’t open to working with you on the real problems. I went back to the waiting room and pondered why I had turned my face away from her the first time.
It was because I was afraid of her—afraid of what she might see in my face. I wasn’t turning my back on her; I was hiding my face from her. My behavior was about me, not about her, but she put her own needs ahead of her patient’s. Which brings us to the basic problem: is therapy to be conducted as a powerful action by the therapist or as a service to the patient?
If I was a therapist, after I’d introduced myself, I would invite the patient to tell me her story then I would sit quietly and listen. I would not judge the patient; I would get to know her. This is exactly what my regular therapist had done the first time I met her. If the beginning silence became oppressively long, then I would say—as an excellent therapist said to me decades ago—“Would you like me to wait until you’re ready to speak, or would it help you if I asked questions?” (I gasped with relief and replied “Oh, please! Ask questions!”) A good therapist, upon first meeting you, does not demand that you immediately reveal and discuss the source of your pain.
The therapeutic question is, is the therapist there to help herself and her own ego needs, or is she there to help you? Decades ago, a psychologist told me that he was taught at university that he was supposed to control the therapeutic relationship. Last year, a graduate student at the same university told me that therapy is now “patient-centered.” Between earning her master’s degree and taking her licensing exam, the young woman attended a “patient-centered” conference. When I asked her how many patients had attended, she looked shocked and said, “None.” We still have a lot to learn about what patient-centered means.
The interim therapist whom I had just seen demanded subservience. It is what most of the American psychiatric industry does. Maybe it’s what most Americans do, but is it right? If the goal of psychotherapy is to return a distressed patient to health and happiness then how is it to be done? Is it to be done by coercing the patient into what the therapist deems to be proper behavior, or is it to be done by listening to the patient? Is the therapist there to take power and control, or to listen and serve?
And what are you there for—to serve the therapist or to gain insight and power over your own problems?