ABSTRACT
Imagine a 49-year-old woman who lives with her husband and three teenage children in a small upper-midwest city. Her marriage has been bad for many years and is getting worse. She cannot sleep, concentrate, or focus. She cries easily, feels helpless, and wants to die. She is also having nightmares again about her father’s brutal beatings when she was a child. She does not know she is suffering from symptoms of posttraumatic stress disorder. But, she recognizes her symptoms of depression because she was hospitalized for depression several years ago. She consults her family physician, who prescribes some kind of psychotropic medication, but it causes dizziness, making it impossible to drive to work. She therefore stops taking the medication but doesn’t go back to her physician to tell him about the side effects. She doesn’t know that if she did consult him again, her doctor could refer her to a psychiatrist to explore other options. She feels desperate. She knows she needs help. Where can she find a therapist who will not immediately tell her to get a divorce? She wants to see if she can salvage her marriage. One afternoon while driving to her daughter’s volleyball game, she hears a psychologist on the car radio telling about her counseling approach with clients who sound like they have similar problems. She likes the therapist’s voice. She intuitively feels this therapist might be able to help her also. The next day she makes an appointment. She tells her new therapist details about all of her problems, including nightmares of her child abuse, unhappiness in her marriage, symptoms of depression, and medication side effects. The therapist says she is “against using medications” and recommends against them. The therapist does not provide the patient with any objective information on the benefits and risks of different courses of treatment. Since the client has no previous experience with psychotherapy, she does not know she is entitled to this information.
