#most of which arein California but not exclusively

[librarycards]

hey there cav. this is sort of a fraught question but. how do I engage with psychiatry when I'm antipsych? I need treatment but I have so much distrust and I feel like it's all bullshit. I don't really have a support system and there's few peer support resources in my area. I can't do this myself but I cant trust this system. soooo... tips for finding therapists that don't suck & getting the most of it? really appreciate your blog and posts, thanks

thank you for entrusting this message to me, I appreciate it! I have answered questions like this a few times before (they're buried somewhere, if you can't find them in my "ask" tag, lmk and i'll try to dig them up!). it's definitely fraught inasmuch as we're never (as people who hate psych but need specific, urgent support that communities aren't by default set up to provide) going to get an answer that we 100% want, but also very not-fraught inasmuch as most of us agree that surviving in this sea of partiality is something we can do together, with love and nonjudgement.

so, for context: i was in therapy - first behaviorist OT as a toddler and elementary school child, and, beginning at 7, talk therapy - nonconsensually basically from the time I could remember until adulthood. i likely would never have tried it again, except for the small hiccup of needing letters for Transing Genders. so, this was when i first sought out "trans affirming care," as it were, and i didn't expect much. i went to my college's health center and got a list of possible providers, and ended up getting an excellent PCP, as well as a therapist who was a genuine cis accomplice: she wrote letters for Mad/psych disabled clients whose genders wouldn't typically qualify us for surgery/hormones in the eyes of the M/PsyIC. i did not share with her the things i "ought" to have shared, but she knew I had survived abusive therapy / forced institutionalization, and accepted that, and accepted my cynicism along with it. i was also first genuinely understanding foucault at this time, so rest assured i was quite a little shit (affectionate).

when she left to practice elsewhere, i went to a therapist at the same practice she recommended. she was fine, but not what i needed. by this time, I'd gotten the requisite procedures, so my therapy attendance wasn't required. i basically just ghosted this new therapist around the time covid hit.

when i came to grad school, i initially wasn't looking for therapy, though i had idly considered something for OCD, which I was (and am) managing in part through medication. after getting outright rejected for, essentially, being too crazy for normie OCD therapy, i directed my search specifically for Mad/abolitionist providers. i began by going through some of the archives of places like the National Queer and Trans Therapists of Color Network, and some people who have posted guest articles on Mad in America / The Fireweed Collective -- many are providers seeking to disrupt/abolish the system. That provided some leads, though no openings (there are very few of them, and they are, understandably, in high demand).

I then turned to my community connections: over the years, I've amassed a large number of Mad colleagues in various fields. Many are a half-step from radical/antipsych circles, so I asked them. This time, I asked specifically about a possible therapist who was interested in critiques of "eating disorders" as a category, who had an abolitionist, harm-reductionist, and anti-"health" approach to care, and who, accordingly, refused to cooperate with institutions of psychiatric confinement. I was directed to a list of people, of whom my current and beloved therapist / colleague / comrade was the first to respond.

my trajectory with her has been a steady building of trust through a shared ebbing and flowing of closeness, frustration, enlightenment, and curiosity. it has been close to a year and a half now, and we only began speaking frankly about more "dangerous"/"risky" topics a few months ago. early in our relationship, i did a great deal of boundary-testing, and reacted with anger and shutdown the first time she asked a question that proved risky/activating for me. my biggest recommendation when engaging with ANY provider is to ask them explicitly, repeatedly, and critically about their relationships with your own risk/harm level, their ongoing history wrt patient institutionalization / "referrals" to "higher levels of care". take note about the way they reference past patient situations, as well as their own past experience. take note of how they respond when you choose not to provide the information they seek.

also take note of what info they're willing to provide upfront, including at a consult: what methodologies do they work with, what was their training, how do they feel about said training? what are their politics? ask whoever recommended them to you, too. look at reviews. this is obvious -- what might not be is looking up their work on google scholar. who do they cite? what do they advocate, who do they associate themself with?

i think that it's also a good idea to ask them explicitly about their experience in other/"higher" levels of care - most therapists have done some kind of rotation during their education, often in a hospital, group home, halfway house, similar. if you have ever been institutionalized, you may have even spotted / been abused by some! observe how they discuss these experiences. take note.

if and when you've established this person as someone you want to continue working with, trust notwithstanding, think personally about what you are actually looking for. they will ask you about your goals, surely, but it's a good idea first to think about your own personal goals outside of the verbalized relationship between you two. do you need a confidante, and of what kind? what sort of accountability do you need, and what are you willing to try to figure that out? *what are you paying this person for that you feel others cannot or will not do*? what part of this person's expertise can be of use to you, and for how long?

i think one interesting approach to therapy is to regard the provider as a teacher - they're there to share knowledge with you, and you're free to accept or reject it. they have some kind of training/experience you don't have, and you seek them out because you think it may be of use in your own life, and perhaps even to redistribute that knowledge if and when you gain it. at the same time, you also have knowledge to share with them - not to be extracted, but to be incorporated in their own work and practice. the biggest insight on the practice of good therapy i've gleaned is that, ideally, you're both teaching and learning forever. this is true of all good relationships. there is an exchange of knowledge based on shared trust - values - priorities. once you are in a space where you know that this person shares your general relational orientation (aka, doesn't want to institutionalize, etc. you and people like you) it's possible to begin sharing knowledge in a way that benefits from this imposed structure. the benefit, imo, is that it's okay that you "monopolize" the convo and direct the knowledge-production toward your needs, because that's the service you're paying for!

i guess, to close, i'll return to the classic Mad Pride framing of us as "psych users/consumers." this isn't the perfect term, but i think it's enlightening, as we can and should be able to seek out services that work for us. just like i go to a person who knows wtf they're doing when, say, i need my nails done or my car fixed, so too do i go to an expert interlocutor when i am interested in developing my self-/relational knowledge and/or am seeking support in times of emotional tumult. this doesn't confer them a status as superior to me, just like someone isn't superior to someone else by being a nail tech or mechanic. it simply means that we are entering into a relationship where my needs and their expertise meet. seek a therapist who understands this, and understands themself as someone who can learn from you, too. this approach to therapy, and to care, mean that you can't just throw someone away or lock them up when they say things you don't like. it means that, even in those moments, there is something to be learned, and that the relationship will grow in that process of edification.