Eve B

Ask anyone in the field what their reasons are for becoming a therapist, and isn't their usual response to "help" people? The power dynamic of therapy's relationship structure seems to be what they're taking advantage of and claiming that it's for the client's benefit.

Maybe anybody who works in the therapy profession can't avoid behaving like Freud the Fraud to some degree at some point in their practice because of the nature of the relationship structure?

It's the treatment that fails the patient, no kidding... And who's supposed to be responsible for recognizing this failure in time? It's also mentioned in episode 27 that therapists are assuming they're giving good treatment even when it actually may not be working. So why isn't client feedback a mandatory part of the sessions??

So can we say that the evolution of therapy and the psychology profession has worsened or improved since Freud's time? Freud Was a Fraud: A Triumph of Pseudoscience: "Freud was trained as a scientist, but he went astray, following wild hunches, willfully descending into pseudoscience, covering up his mistakes, and establishing a cult of personality that long outlived him." "His advocacy of cocaine was irrational. He wanted to justify his own use of the drug, which he took for migraines, indigestion, depression, fatigue, and many other complaints; and he presented it as a panacea. He claimed it was harmless, refusing to see clear evidence that it was addictive." "He came to specialize in a 'disease of the rich,' hysteria, which could never be cured and which generated a continuing stream of income." "He made things up as he went along, constantly changing his theories and methods but not making any actual progress towards a successful treatment." "He was preoccupied by sex, presumably because of his own problems in that area." "He claimed that his critics weren’t entitled to pass judgment on psychoanalysis because they didn’t understand it." Untangling the Complicated, Cotroversial Legacy of Sigmund Freud: "Freud often worked backward, finding “scientific” excuses for various behaviors and then working to “prove” those theories. This logic is also a typical argument against psychoanalysis’s efficacy — that it works mostly by placebo effect, with people responding simply because they feel like they’re being listened to, not because of any more scientific explanation."

From Mary's link: "Limitations of the Existing Evidence Base" "Trials typically enroll study populations that are un-representative of people attending for treatment in clinical environments, and often their findings are not generalizable across different ethnicities and cultures. Second, the intervention tested differs substantially from how it might be provided in other contexts: therapists are trained in manuals tailored to the study’s population, typically monitored for compliance, and often employed by a research group with an allegiance to the positive outcomes for their brand." "Additionally, the dissemination of findings leads to further bias. Negative trials are less likely to be reported, thereby inflating effect sizes."

I don't understand why he didn't simply explain his boundaries to her instead of acting like an obnoxious jackass?

"A small percentage of clients experience negative effects from therapy"-- I wonder where they got those statistics when the reality is probably more than a small percentage that aren't reported.

I agree that therapists believe in what they do, but I see them selling therapy as a more of a business because they're charging $200+/hr to basically brainwash their clients.

Therapists upsell their product (therapy) because it's also a business. If it sounds too good to be true, though, then it probably is.

I felt the same way by the time I reached a therapist who wasn't as bad as my first one. I gave the first one all of my trust and benefit of the doubt because I didn't really understand what therapy was at the time or the effects he was having on me. He didn't explain his treatment or ask my permission. The most he said during that session was, "I'm going to try something different on you today," and he just went ahead and did it. The dissatisfaction and frustration I felt as I tried different therapists only increased my suspicion, disrespect, and animosity towards them. I need them to be able to effectively communicate with me because I don't speak well. I have a hard time syncing my complex thoughts to speech, and it's worse when complex emotions also jumble themselves into the mix. I was more angry than afraid, and I kept thinking that most of them are just overpaid (oxy-)morons. I would feel somewhat sorry (and maybe some admiration) for any therapist with the guts to try working with me at this point because of my heightened emotional sensitivities and accumulated psychological baggage. I don't believe it's too late to be helped by a "good enough" therapist, but I'd have to really weigh the risk versus the possible worst/best case results.

Most therapists wouldn't see the harm in showing excitement and enthusiasm towards their clients because to them, it means they genuinely want to be of help. In a real world social setting, a person's excitement and curiosity in conversation wouldn't usually be received as offensive, but therapists shouldn't be assuming their clients' feelings regardless. Encouraging client feedback still seems to be the best solution to minimize these kinds of misunderstandings. Below are excerpts from When Therapy Causes Harm: " ‘There are things that therapists just don’t do…,’ Fonagy continues. ‘You’re looking at two different animals when you look at an RCT [randomized controlled trials] and when you look at practice as it really is. I think there is a disconnect between the two.’ " "For the last 16 years Michael Lambert, professor of psychology at Brigham Young University in America, has been studying the use of client feedback to improve outcomes in psychotherapy. The principle is simple – before each session, ask clients a few brief questions about how they are feeling and how they feel the course of therapy is going. Part of the reason client feedback has such a dramatic effect is that, as we saw earlier, without this information, therapists seldom expect their clients to get worse. In one striking study conducted by Michael Lambert and colleagues, 40 clinicians were asked to predict which of over 500 of their patients would be worse off at the end of treatment. ‘Even though we told them the deterioration base rate for all patients is about 8 per cent, they predicted that virtually no patients would be any worse off. Our algorithms and stats methods picked up 85 to 90 per cent of the 40 cases who deteriorated, the therapists picked up like 3 per cent.’ Clinicians generally react with resistance to client feedback systems. Lambert quips: ‘If you think you’re a superior clinician, as all clinicians do, then why would you feel you need it? Why collect data that can only bring you down?’ " "Lilienfeld believes the answer lies with spending as much time teaching students critical thinking skills as teaching them the facts about conditions like schizophrenia and depression. Students need to be taught how to think about the evidence, he says, ‘to understand the basic biases and heuristics that can impact our judgment and lead us to believe that certain techniques or treatments work even when they don’t.’ "

From Mary's link: “With everyone I counsel, no matter how much they despise me or how much they resist, I try to bring a spirit of excitement to the relationship,” he says. “[A spirit] that I can’t wait to come and have another session with them because there’s something about them that I find intriguing, something I want to learn and there’s something that I’m really excited to continue discussing with them.” “I just try to convey that element of acceptance, of excitement,” Martin says. “So no matter what behavior they are manifesting, there is something really worthwhile [about them]. … I doubt that the majority of therapists would be capable of consistently showing that much patience and tolerance. Easy to write how they should ideally (or rationally) respond to conflicts within the therapy relationship, but how often do therapists actually practice what they preach when a client's reaction offends them? I've been accused of taunting and inciting by my therapist when he takes the criticism personally, like voicing my anger and honesty should be condemned because he can't or won't see his own role in escalating the argument. I quickly lose respect for therapists who emotionally freak out on me in the heat of that moment.

Yes, the therapists who seemed open to differing opinions. Should those therapists have asked more questions or try to really understand your point of view? Were they unhelpful because they only appeared to be listening to your concerns, but they didn't know how to communicate effectively with you? A therapist can be open-minded, but they lack good communication skills, so therapy fails.

What didn't those more open-minded therapists say or do that could've helped you better? What qualities were they lacking that you really needed?

Therapists say they want to learn from their clients, but I've often found that they only want to learn if they aren't being criticized for their efforts. Ben admitted that some clients won't benefit from therapy because of how it's constructed, so what else could that basically imply other than clients need to play along with the therapist's game in order to see helpful results? Maybe therapists feel overly threatened by clients who act too smart and aware for their own good? I'd bet trainees who asked challenging, rock-the-boat types of questions to their professors probably wouldn't graduate through their programs either. Mary, what were those more open-minded therapists lacking that they failed you?

I suspect that Ben is being careful in his responses because he's under supervision and his schooling likely hasn't prepared him on how to answer these challenging, rock-the-boat types of questions. I think the academic setting is the worst place to expect any kind of changes for the psych profession because of the inherent politics, policies, and hierarchy. The pioneers who will most influence the field will need the greater freedom that comes from private practice. From Ben's email reply to my question regarding compassion training, he said: "The vast majority of us are committed to becoming better therapists, better versions of ourselves, and better people as a whole. Some are not, but they are the exception to the rule in my opinion." This assertion implies to me that he believes bad therapists/therapy are uncommon. Besides, therapists can't afford to be bashing their occupational cash cow, and it increases their chances of a better outcome if they can persuade people to believe that therapy/therapists are, more often than not, helpful.

I think the true test for the VBT podcast will be whether it's still continued after the hosts have graduated as licensed practitioners and how they apply what they're learning with their own clients. At least they're acknowledging and exposing the reality of bad therapy within their field, but they also say that the harmful experiences are uncommon.

I'd be more impressed if their publicity press was from someone they hadn't also plugged in their podcast.

And there are still some things that can't be trained for therapy to be "undeniably effective."

So basically, Ben is saying that if it wasn't for the inherent human flaws and biases of therapists, therapy itself is an undeniably effective tool towards helping clients with their emotional issues? Blame the therapist not the therapy?

What's funny to me is that there seems to be plenty of material for the podcast, and yet, they still claim that very bad therapy is an uncommon experience. Episode 23 highlights very bad graduate school education and ineffective curriculum, so what would that imply about the competency of the students who go on to practice on live clients after completing their programs? They even said in the podcast that they don't know what makes a good therapist? Ben's thesis on the impact of therapist bias on clients looked promising until he wrote "the effectiveness of psychotherapy is undeniable..." (pg 16).

From Mary's link to the article on narcissistic therapists: "anything that has real effectiveness, that has the transformative power to change your life, has also got the ability to make things worse if it is misapplied or it’s the wrong treatment or it’s not done correctly.” So I guess this implies that therapy is an effective tool in both helping and harming someone's life? Therapy is effective?

I can so relate to this! I still don't understand why the person-centered treatment expects the client to lead. If I knew how to fix my issues, I wouldn't be trying a therapist to help me! It's like there are more therapists whose styles fall on either extreme rather than meeting the client halfway. What irony that therapists are being brainwashed by their own institutions. If it's human flaws that are causing therapy harm, could there one day be therapy A.I. robots that are able to give better emotional support with less harmful consequences?

Do you think it could be changing somewhat with the newer generation of therapist graduates, though? The trainees hosting the very bad therapy podcast seem to show more open-mindedness and humility than many already practicing in the profession.

Do you know what would've worked for you, zygomaticus?