We’ve all known that amazing mental health professional who just gets it. They can genuinely connect with their clients, and they’re able to accomplish powerful things within the therapeutic relationship. We’ve also met the one who just can’t seem to get it right. They may have lots of knowledge and great intentions, but leave the client feeling unheard and invalidated.
As a mental health nurse who lives with depression, I’ve encountered many of both types as colleagues and people who have treated me. This can really become an issue when it deters people from seeking out mental health care. Access to care is already hard enough without having to worry if the person treating you is just going to make you feel worse.
Based on my experience, bad care usually doesn’t come from a lack of knowledge base, but rather an attitude of clear separation between professional and patient. It’s as though there’s not only a desk that might be standing between the two, but also a much wider gulf.
I’ve put together this wish list of simple but incredibly important things that a mental health professional can do to make sure they’re helping rather than making things harder. There’s nothing particularly earth-shattering here, but it does require genuinely recognizing the full humanity of those of us living with mental illness, and maybe for some, that takes some conscious effort.
It had been a rough year, with one major stressor after another, but I’d managed not to have a relapse of my depression. When I learned that a workplace bully was making a valiant attempt to destroy my career, it was the straw that broke the camel’s back, plunging me into the depths of my illness.
When I went in to see my psychiatrist, I was so slowed down I could barely put coherent sentences together. His response was to question my coping skills, invalidating all of the really hard stuff I had made it through leading up to that point. That was the last time I ever went to see him. The next two physicians that I saw were equally invalidating, and I ended up stopping my medications because I couldn’t bear to have another doctor dismiss the challenges I was facing. It took months before I felt ready to take on another doctor so I could get my meds restarted.
This doesn’t mean kid glove treatment is needed. It doesn’t mean agreeing with what I’m saying, or ignoring any distorted ideas I might be expressing. It simply means validating that it’s okay for me to be feeling what I’m feeling, and recognizing whatever unmet needs I might have that are contributing to me feeling that way. It means acknowledging that my feelings count, and that I’m trying the best I can.
Don’t tell me what to do
I’ve always been highly independent, and that has really helped me to function in the world. I can also be extremely stubborn, and the combination of those two traits is a recipe for psychological resistance; when someone tells me what to do, I dig in my heels and fight back.
This has been a huge problem when I’ve been hospitalized involuntarily. If the treatment relationship becomes an adversarial one, no one wins. No matter how sick I might be, I need information, ideas, and options. I want to be treated like a partner in my treatment planning; after all, it is my mind and body.
This isn’t about allowing the refusal of much-needed treatment; it’s about being involved in figuring out what that treatment should look like. If you treat someone like a child, with rigid, arbitrary restrictions, chances are they will react like a child. That’s not pretty, and it’s not helpful for anyone.
Respect my knowledge
Mental health professionals have years of training and clinical experience, but they’re not the only ones bringing expertise into the therapeutic relationship. Those of us with mental illness have a wealth of knowledge, both about the effects of the illness and how we’ve responded to various treatments. That knowledge is no less valuable than what the clinician is bringing to the table and recognizing that knowledge can go a long way towards establishing a collaborative treatment relationship.
This subject can be particularly dicey for me because I’m a well educated and experienced mental health nurse. Chances are my knowledge base is comparable to that of whatever clinician might be treating me, and if they talk down to me rather than approaching me as an equal, they’ve lost me.
I have no patience for professionals who think they’re above me just because I happen to have an illness. Because it really conveys a lack of awareness and understanding on their part.
Don’t judge me
The sicker I get, the less access I have to my health-coping mechanisms. I can get irritable and downright mean. When I’m really unwell, I have what could probably be best described as hissy fits, complete with shrieking and swearing. That’s not who I am as a person, though, and I need my health care providers to see this.
When I feel disrespected I get even more irritable, which feeds into more judgments about my character, and it goes round and round in a vicious circle. I need care providers to take the time to ask how I feel and how I act when I’m well, so they can see that how I am when I’m ill is not who I am as a person.
This isn’t the sort of normalization that comes from that friend who tries to reassure you that “everyone gets depressed sometimes… kind of like I did when they stopped making my favorite lipstick color.”
Normalization is helpful when it takes the form of reassurance that I’m not the only person with depression who experiences these symptoms and has these thoughts and feelings. In the midst of depression, all the darkness and negativity floating around feels profoundly abnormal and skews our perception of everything around us. Mental illness is very isolating, and it can be easy to lose sight of the fact that we’re not alone in our struggles.
Depression can make it difficult to recognize hard work or progress. There’s also very little chance that people in my everyday life would ever think that brushing my teeth every day in a week is a feat worthy of praise.
Without having some sort of external feedback, it can be so easy to fall into the trap of focusing only on how difficult tasks are and how negative everything is. We’re too busy being overwhelmed by the mountain looming overhead to be able to recognize that we’re actually making progress up that mountain. This is where a mental health professional can really come in handy by pointing out progress, even if it's baby steps.
Help me to see more objectively
Depression creates blinders and rigid thinking. Memory goes flying out the window. My mood is often the last of my symptoms to improve when things do start getting better. That can make it hard to see and contextualize overall improvement. I also may not see whether the wellness activities that I’m pushing myself to do are having any benefit. Since it’s hard for me to see it, it really helps to get an objective perspective. It’s hard to get an objective view from friends and family since they’re in too close, but a mental health professional is a perfect person to provide that.
Of these seven wishlist items, the first four are the must-haves for a mental health professional to be therapeutic. They require a shift in mindset from a more traditional paternalistic approach and require some critical reflection on what the nature of a therapeutic relationship should be. The last three help to enrich that provider-client relationship, and are probably the easiest for the clinician to accomplish. While everyone with mental illness is unique and will have their own particular wishlist, what is probably universal is wishing that what we have to say will be treated as valuable. There’s nothing ground-breaking about that, but sometimes a bit of a reminder is a good thing.