Mental Health

What is Therapy Abuse?

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In the last couple of years some of the men in my practice have complained that their partners, generally women, but they could be men, aren't as physically demonstrative as they would like them to be.  They tell me they want kisses as much as sex, although sex would be nice, too.  You know the old joke:   

How do you cure a nymphomaniac? You marry her. 

We could talk about the joke forever, right?  But my editor tells me that I have to focus, so let's do that, focus on this problem, the disappearance of affection.  I'm thinking that if men are complaining, it means that they have finally caught up to women, feel more free to talk about their feelings in the twenty-first century.  And it's a good thing, not a gender issue so much as a windfall from the Women's Movement.

Women can ask for love and sex.  Men can ask for sex and love.  Just say something, please.

When it's brought to my attention in therapy that a partner in a committed relationship has become painfully avoidant, unaffectionate, emotionally distant and cold, I want to shout out, act like Nancy Grace of CNN fame, now the vigilante judge on the new daytime Fox TV show, Swift Justice. I want to verbally beat on the ostensibly withholding partner, glare at the poor, unsuspecting soul, and make harsh, judgmental faces while bellowing:

What were you thinking when you got married?  That you could let it go?  Do you think that just because you have a ring on your finger you don't have to show love anymore?  Do you believe that just because this person (I would point at the beleaguered spouse) signed up for life with you  that you can do your own thing, turn your mate into chopped liver?  What's wrong with you?@!@!?  Do you think people can go through life, day after day, week after week, with no kisses, no hugs?  Don't lie!  Don't lie to Swift Justice!


Men, women, doesn't matter which gender is the stingy party.  When it comes to affection, I (and Judge Nancy, we're thinking) take no prisoners.

But that's so judgmental!  So not therapeutic, ranting in this way.  It is what lawyers do, not therapists.  Most people don't see a therapist to be beaten up verbally and emotionally, what might be considered therapy abuse.  When we go to a mental health professional we're hoping for calm, relaxed, half-asleep doctors who explain the psycho-dynamics to us, the whys and wherefores.  We want to know why a partner is unwilling, unable to show affection, maybe.  Or we want to work on change, changing our partner, sure, but maybe changing ourselves.

Most of the time that's the case, and it is a slow, healing, sensitive process.  But some people are just dying for us to let loose, give them hell.  You can tell when they want someone to sober them up.  And quite honestly, when that happens with my patients, when I launch into a critical and judgmental tongue in cheek rant, for it had better be tongue in cheek, then that person is likely to love it, and will want to come back for more.

You could say, and you would be right, that this is dangerous water in which we tread at this moment.  A therapist on the Internet  probably should not be giving young, impressionable therapists the impression that it is fine to beat on patients.  Suggesting this, even whispering it, begs a lawsuit, screams professional suicide.

So don't do it without an amazing relationship with your patients, okay?  That would be unprofessional. And make sure they know you're kidding, or at least make the case so that they strongly suspect you are kidding

If you're lecturing a patient, no matter how badly he or she deserves it, make that delivery tongue in cheek, and act apologetic as the insults roll off your lips.

At this juncture it is best to reinforce what tongue in cheek really means.  Find a mirror, gaze at yourself in this.  Push against your cheek with your tongue.  Push that cheek way out. Go ahead. Do it right now.  We'll wait.

Could anyone possibly take you seriously if you look like this before, during, even after a rant?  Preferably during the whole show? 

Yes, it's possible, you say,? Your rendition of tongue in cheek in the bathroom mirror looks serious? Then that's bad.  Bad because the more concrete, the more literal among us take us at our word.  Best not to do this intervention with terribly concrete, literal patients.  And to be sure you are not misconceived, consider utilizing the other cheek, too, alternating the process:  Tongue in the right cheek, push.  Tongue in the left, push.

Return to the mirror and practice this, and for good measure, try raising your eyebrows up and down a few times.  If you are still worried that someone will feel abused when you rant in this fashion, be sure to tell them that you were being facetious. Confess, 

"I was just kidding. You have good reason, seriously, to withhold affection. Let's talk about it." 

Then go into it with the patient, find out what that good reason is. Because how should you know, otherwise?

We would call this giving somebody his day in court, presumably. Or just good therapy.