My Long Journey to the Perfect Therapist

Finding a good therapist is hard enough for anyone. But finding a good therapist when you have schizophrenia? Well, for the first 4 years of my recovery, it felt impossible.

During that time, I cycled through four different therapists. Each of them wildly overestimated their infinitesimal understandings of the experience of living with schizophrenia.

Needing a therapist who understands schizophrenia

The therapist who questioned my diagnosis

There was Cheryl, who told me my diagnosis of schizoaffective disorder, bipolar type didn't exist. According to her, the two types of schizoaffective disorder were depressive and anxiety type, not depressive and bipolar type. For the record, "schizoaffective disorder, anxiety type" does not and has never existed as a diagnosis.

The therapist who questioned my treatment

There was Peter, who told me my 10-month bout of psychosis could have ended at any time had I been given an antipsychotic injection in a hospital. In reality, I was injected with antipsychotics 4 times during the months-long psychotic episode I experienced at my onset. None snapped me out of psychosis.

The therapist who questioned my personal experience

And then there was Heather, who once asked me, "What's ableism?" after I complained about its impact on my life. It irked me that she had never heard of the term for the oppression people with disabilities like schizophrenia face. It irked me even more that she insisted we work on strategies to prevent mania and psychosis despite her complete lack of experience and training in treating psychotic and mood disorders.

When a provider isn't open to learning or empathizing

Honestly, as long as a provider is open to learning about and empathizing with this experience, I can work with someone without specialized training in psychosis. What bothered me was that these therapists seemed to view themselves as authorities on my mental health, even more so than me.

The most hurtful way this manifested was the fact that these therapists felt entitled to determine the extent of the ableism I faced and how traumatized I was allowed to feel about it.

Cheryl, Heather, and my first therapist after coming out of psychosis, Megan, all excused my relatives’ assertions that they didn't believe in my ability to return to work at the same level I worked at before psychosis. These therapists made comments like, "They're just concerned," despite the fact that my relatives had been smiling when they said those hurtful things, as though the death of my career wasn't a tragedy.

Feeling like I have to defend myself

I experienced something similar with a therapist in an intensive outpatient program after a psychotic episode in my apartment complex. I complained to her that a neighbor who had witnessed my departure from reality acted angry and suspicious toward me later on.

The therapist asked me, "How do you know he was angry and suspicious?"

"He just... was," I said, caught off guard. I did not expect to have to defend my analysis of what felt like a pretty clear-cut situation.

Invalidating my experience

The worst example of a therapist invalidating my experience of ableism, though, was hands-down Peter. During the lead-up to the same episode, I told him, "I think I’m slipping into psychosis."

"You’re in psychosis?" he asked. "Good, we can finally talk about this sexual tension."

I was disgusted that he would take advantage of the altered state my disability created in order to sexually harass me. But he knew he could get away with it, because no one believes the accounts of people experiencing psychosis. (Sure enough, when I reported him to the government agency that oversees his license, they dismissed my complaint.)

But when I told him, "You’re taking horrible advantage of a disabled person," he replied, "Come on, you’re not really disabled," as though his behavior wasn't a perfect storm of sexism and ableism.

Finally feeling heard by a therapist

I was at my wit’s end by the time I met Alicia. She was the therapist assigned to me in my second intensive outpatient program, and she was surprised at first when I told her I wasn't sure if I wanted a therapist.

"You know how people of various marginalized identities tend to prefer therapists who are marginalized in the same way, because therapists who aren't minimize their experiences of marginalization?" I asked her. "Well, it's kind of like that. Except there are no therapists with schizophrenia."

"I know exactly what you mean," Alicia told me with a big nod.

Not being judged for my schizophrenia

Over the next several weeks, I had great conversations with Alicia about oppression and how to manage your mental health in light of it. When I told Alicia the same story about my neighbor, she told me she'd experienced similar encounters as a Black woman. She'd also experienced similar behavior from white therapists who told her she was overreacting, seeing racism where it didn't exist.

Unfortunately, the program has a policy against patients continuing with their program therapists after graduating. But thanks to Alicia, I knew exactly what to look for in my next therapist.

Finally finding the therapist I needed

I found Kristina through a friend who saw her at least weekly and thought she was worth every penny. In our intake, I explained the terrible experiences I'd had with my prior therapists. She told me, "Well, if your other therapists were all of privilege like you described, it would make sense they couldn't empathize with the experience of being marginalized."

Kristina hit the nail on the head. For me, it's not about how book smart a therapist is about the science of psychosis. After all, Megan specialized in psychosis, and she did more harm than good. Rather, it's about whether they understand what it means to be othered, stigmatized, looked down on, or even feared.

Having schizophrenia and deserving quality care

A good therapist will recognize that they can never understand the experience of living with schizophrenia as well as someone who has it. Especially if they lack formal training in psychosis, which nearly all therapists do, they will defer to their clients as the true experts on psychotic disorders and the ableism that comes with them.

We, as people living with schizophrenia, need competent, empowering healthcare. And I've finally found that through Alicia and Kristina. Good therapists are out there. Don't give up until you find the quality therapy you deserve.