Thursday, December 2, 2010

In Treatment: What It's Really Like To Be A Therapist

Does anyone else follow HBO's In Treatment?

I love this show.

No, I hate this show.

Either way, I can't stop watching it.

See, I used to be a mental health therapist.  Have you ever wondered what that's like?

Let's pretend you are the therapist.  This is a typical day (all of these examples are actual cases):

First, you rush to work to finish up writing treatment plans and session notes from yesterday's patients because you were too exhausted the night before.  

The paperwork is never ending.

Patient #1: Your first patient is the surviving sibling of a 16-year-old who hanged herself from the high school bleachers.  She doesn't really want to talk about her sister, but her mother is hysterical.  You spend the session with both of them, calming the mother, hoping to have a chance to meet with your patient alone next time.

You have ten minutes to write the treatment plan and chart note.  

Your next patient is waiting.

Patient #2:  This patient is a 17-year-old girl who is so pissed off to be in therapy that she refuses to speak.  This is her second session.  Finally, after 30 minutes of silence, you say, 'do you play poker?'  She does, as it turns out, and you spend the next 30 minutes talking about her parents' fighting and impending divorce.

Patient #3:  Of course, you have favorite patients, and your next appointment is one of them.  She's a 9-year-old who is so anxious she can hardly function.  And she is so smart that no one knows what to do with her.  Her parents simply think she's a problem and they want you to 'fix' her.  As is often the case, she's not the one who needs fixing.

You're already behind on your paperwork. 

Stuff down your lunch before your next patient arrives.

Patient #4:  Now, a family session with a 16-year-old boy that constantly threatens his mother and siblings.  Both parents, and your patient, are in your office.  Dad appears to be...high.  Mom is talking about her son and scolding him for his misbehavior.  In the middle of the session, your patient stands up and yells, 'you fucking bitch!'  You're afraid he might attack his mother in your office.  You stand up and say 'stop!'  As if he couldn't kick your ass, too  He sits down, you establish ground rules and finish the session.

Your next patient is waiting.

Patient #5:  She is 15-years old and she has fallen in love with an 18-year-old girl.  Her family is very conservative and religious.  Her parents are convinced that, if she stops hanging out with this friend, she will begin dating boys and everything will be fine.  This is the family's second session.  You meet with the patient alone and then with the parents alone.  You gently explore the 'what ifs' around your patient's sexuality.  Parents get up, walk out and demand a therapist of their own faith.

Hurry up and do the chart note.

Last patient.  It's a light day.

Patient #6: This patient is a 16-year-old boy in state custody.  He has a terminal heart condition and is non-compliant with all of his treatment.  He won't take his medication, plus he drinks and does drugs.  The state has removed him from his unstable mother's care.  He is living with a foster family.  He needs a heart transplant.  With his current behavior, the doctors have refused.  Without help, he will die soon.

No more patients today.

You haven't left your office since you arrived at work.  

You need to pee.

You have paperwork. 

You're so emotionally spent you can hardly speak.

You'll come back tomorrow and do it all over again.

Sometimes, in the middle of an episode of In Treatment, I have to shut it off and return to it later because I remember how oppressive it is to be faced with people's pain all day, every day, again and again. 

But I can't stop watching.

Picture from

1 comment:

  1. This was the most beautiful, gut-wrenching post. Thank you for sharing it. Being a mama to four beautiful girls ages 7 to 17 and being in a unhappy marriage with a man I've known since 8th grade and all my life in between and around that I can relate to your feelings.
    It never stops.



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