A Shrink Screwed Me Over - July 16, 2008

Recently a Psychologist came in to my office for treatment. He was a late 40's gentleman who had been diagnosed with Bipolar Disorder. While medicine is generally a first-line approach, treatment is often augmented with Cognitive-Behavioral therapy to help decrease impulsivity and irritability as well as helping clients to manage mood swings.

For me working with colleagues is generally a positive experience. We share a common bond because we've been through the same years of training and share a similar mindset about people and their problems. Clients who are shrinks themselves know the lingo; they know the format. It usually flows well. Many theorists believe that psychotherapy has an inherent power differential that isn't always comfortable: I am the expert, you are not. I am healthy, you are sick. My life is exactly the way I want it to be, yours is not. If you've read more than two words of this site you know that thought process is skewed, but many people enter a therapeutic relationship with this dynamic intact. I make every attempt to minimize this power differential by making therapy a collaborative relationship where we each share thoughts and ideas. Doing this with colleagues is often quite easy.

Conversely, the potential problem for me with a "pro to pro" relationship is a certain, self-induced pressure. Does she know more about therapy than I do? What if I make a mistake? Will she call me out on it? Is his practice more successful than mine? His Armani suit is much nicer than my Banana Republic khakis and Gap button-down polo shirt. I'll bet he makes more money. He's wearing a ring too...why is he married and I'm old and alone??

Another difficulty is the inherent strangeness that often comes with two shrinks interacting. Because mental health people tend to be highly analytical, bizarre moments of circular logic can develop:

Dr. Rob: So you can see, then, how this type of thinking is leading to your negative mood?

Dr. Non-Rob: Hmm...interesting. That's not how I would have handled it though.

Dr. Rob: How would you have handled it?

Dr. Non-Rob: I'd probably have asked about the origins of this type of thinking. Did it come from my mother?

Dr. Rob: Did it?

Dr. Non-Rob: Did it what?

Dr. Rob: Come from your mother?

Dr. Non-Rob: I don't know. I think if you had asked me earlier my answer might have been more spontaneous and emotional.

Dr. Rob: Would you like me to ask you that now?

Dr. Non-Rob: I'm not sure. Do you think that's the best course of action?

Dr. Rob: No, otherwise I would have asked you that to begin with.

And so on.

The Psychologist with Bipolar Disorder and I used the first appointment to design a possible treatment plan. When the time was up I asked him if he would like to return for another appointment. "Oh yes, absolutely," he said. "I just need to check my schedule so can I call you?"

"Of course. Here is your receipt. Will you be paying by check for this session?"

"Oh...could I just pay you next time?"

This isn't unheard of as some clients assume that I will bill them at a later date. However, most Psychologists know that the most common approach is to "pay as you go." I looked at him a bit suspiciously.

"I suppose so. As a general rule I prefer if clients pay for their sessions as they occur because I'm a solo practitioner and don't have an elaborate billing system. But I probably didn't explain that over the phone, so it's fine."

"Great. I'll be in touch to set up something."

A week went by and I didn't hear from the Psychologist. After about ten days I called him to find out if he was still interested in working together. If he wasn't then I'd close his chart. I left a message on his voicemail.

After another week I called again. Voicemail. A few days later I mailed him a bill. No response. Another phone call followed, but this one had more edge. "Dr. ___________, please return my call as soon as possible to resolve your bill for the therapeutic services that were delivered." Those are pretty intimidating words so I assumed that I would hear from him immediately.

No return call. The proper clinical term for this is "being screwed over."

More harassing phone calls, collection agencies, small claims court. All of these are options that practitioners take to obtain payment for services rendered. I haven't decided if I will pursue any of these or simply let it go. Regardless of the outcome, however, I feel betrayed. Other shrinks are supposed to know what it's like. They are supposed to know how hard it can be to build a practice, to have to deal with clients who are demanding or unappreciative or complain about fees or refuse to pay you if they don't like something you say. They're supposed to know that you're not rich simply because your name starts with "Dr." And they're definitely not supposed to take advantage of you. Apparently, though, some do. And that's just wrong.

Posted by Rob Dobrenski at 8:19 PM

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Comments

Obviously the best recourse is to get him to listen to you for 45 minutes, and take off without paying.

Posted by: Ilan Bouchard at July 16, 2008 09:30 PM

Ilan has a good point.

Posted by: Jason at July 16, 2008 10:52 PM

Maybe I should send Dr. John or Dr. Pete for an appointment and have him not pay.

Posted by: Dr. Rob at July 16, 2008 11:09 PM

Yeah, send John and Pete as a "gay couple" who want counseling.

Posted by: Wayland at July 17, 2008 12:15 AM

I vote Dr. Pete! I agree as well, I mean are you even going to get the money if you take this guy to small claims or send creditors after him? And if you do, would it cover your costs to go after him? And you're not old! Quit that!

Posted by: Amber at July 17, 2008 07:03 AM

That guy treated you with disrespect during the session. He wasn't mentoring you, but he sounded like he thought he should be. He obviously has some control issues. Payment is still due for services rendered, whatever his issues are.
I do think the inherent power differential is a given - even with "pro-to-pro" therapy - or, Especially then. You guys are equals up to the point he becomes your patient. Then the differential is in effect. Apparently, this guy couldn't deal so well with this reality. You also worried about not measuring up to him, which goes to show that you're aware of these inherent power dynamics. That's only natural and to be expected. Had this guy given you half a chance, I think you would have been able to help him.
It might be that he wanted something different than cognitive therapy. Even so, he is probably just a pain in the butt to Anyone he interacts with in Any way. If I were so unfortunate as to be his patient, I'd surely hate him with great, undying fervor. With each wretched session, I'd do my best to lance him into slivers of oozing, emotional pain, utilizing my rampant, always-on-tap hostility. (He'd probably respond with sarcasm, but a patient Always has the upper hand with That, so long as there is even a *modicum* of ethical restraint on the part of the therapist.:)

Posted by: Borderline Betty at July 17, 2008 07:12 AM

what a fucker.

I bet he has no idea how close he came to getting the smack-down Dr Rob style.

Do you reckon he knows about your website?

Posted by: Jackmo at July 17, 2008 07:47 AM

Ah yes the screw over. Sorry you pay now. I've been all the routes and it's never pretty or fruitful. For one patient that owed me thousands of dollars I ended up auctioning his car off to make a dent in the debt.

Posted by: Mike at July 17, 2008 10:17 AM

Bring some strong men to his house and COLLECT.

Posted by: Jenna at July 18, 2008 08:28 AM

Well if he's bi-polar he might not have any money because he probably had a manic fit and bought 500 lbs of lumber because he decided his apartment needed a new deck.

Posted by: not a doktor at July 19, 2008 03:48 PM

Power....struggle.

I'm curious how the dynamics differ between 2 pro's from contrasting orientations, vs. 2 pro's that work within the same orientation. I'd think insight would be harder to have if they are working in their "comfort" zone, because they can rationalize and intellectualize their situation, never really getting to a point to allow for insight.

Posted by: Therapeutic Ramblings at August 12, 2008 12:32 PM