[arkades]

> Who is this "we" you think you speak for? You may be right about what people are supposed to do, but people, even professional therapists aren't perfect.

I can't argue about the variation in quality of practitioners. However, in every state I know of / have practiced / have worked in, involuntary holds get a lot of scrutiny. Docs are given the benefit of the doubt, it's true, but it's a far cry short of "better to cover my ass, let's admit." People are, in general, careful when they know they're going to be getting second-guessed. Additionally, admitting psych patients is generally a losing proposition for hospitals, monetarily. They're expensive, and tend to take up a lot of square footage. Docs are getting second-guessed by hospital admin, too.

As a sidenote: your average therapist is a social worker, not a physician, or even a psychologist. They don't admit anyone anywhere, and in most states can't do involuntary holds. Unless you're about to slit your wrists in front of them, the most they can do is make a suggestion, or call your psychiatrist and make a suggestion. If they do think you're an immediate risk to yourself, they call 911 ... who will take you to the hospital, where a psych will give his opinion.

> It all depends on the individual therapist, how they interpret what they've been taught, what you say to them, and how worried they are that if they don't do something you may commit suicide, and how that will look on them.

The proportion of depressed patients to inpatient psych beds is "a gazillion to one," in particular since funding for inpatient psych got gutted a couple decades ago. If you think the average psychiatrist, never mind the average therapist (not the same thing), can land every patient into a ward because "well, what if they mean it?"... I don't know what to tell you. Even the psychs I know that are trigger-happy are the kind that don't admit the vast majority of the time.

I admit that there's more trigger happiness in pediatrics. Kids, IME, are more likely to harm when they don't want to, to prove that they're Really In Pain. Their attempts are less likely to be "genuine", so to speak, so folks tend to be less confident of saying "Well, this doesn't really seem like someone that wants to die."

> Some are very self centered just as everyone else, simply wanting more and more patients to earn a paycheck, so they will drudge up whatever they can to make you feel miserable, and get you hooked on psych drugs, all to try and get you to keep seeing them.

Psychiatrists don't want to chat with you often. They will diagnose, prescribe, recommend a therapist, and see you once every 3 months once you stabilize. They don't want you to keep seeing them and, given that demand >> supply, couldn't care less if you stopped. Ideally you stop because you've gotten better, but either way, they'll fill that slot in their schedule pretty quickly.

Therapists - again, usually social workers - can't write prescriptions. Their livelihood does depend on you coming back every week. They will not addict you to anything and, if you were on meds, it wouldn't tie you to them.

Yes, they are likely to make you miserable. You're there to talk about shit that makes you miserable. If they're good, that goes double - many personality disorders are essentially "my developed pattern of dealing with things that make me feel bad is ultimately self-destructive." Addressing that involves changing "my developed pattern of dealing with things that make me feel bad." That's short-term highly aversive - that's your tool for avoiding feeling bad!

Bad therapists still navel gaze about things that make you feel bad, only without therapeutic benefit.

There's a shit-ton of bad therapists. That's more due to the fact that, like we're doing in other realms of medicine, we've decided the best way to address the shortage is to put it into the hands of woefully under- or un-trained people. Good therapists are, as a consequence, rare and comparatively very expensive (cost of a doctor's time for an hour, vs. the four simple drug visits he could have made instead vs. the cost of a social worker for an hour - yah, it's expensive).

Any reasonably mediocre therapist would have told you to "develop interests in things outside of (your)self". Therapy is like coaching: good therapy is figuring out what you need to focus on, and showing you how. You still have to go out and do the exercise.