Eve B

Because they're paid to be the "experts," and many therapists assume that clients want them to take the lead?

This should be part of the disclaimer on therapy consent forms!

I don't think it would be safe or productive to be treated by any therapist who is feeling ill if that condition is affecting how they respond to their clients. The therapy relationship is sensitive, and a tired or moody therapist would likely make more traumatizing or triggering mistakes in their conduct. Here again, the client will be the one who suffers both emotionally and financially. I understand the therapist's need to work, but why at the expense of the client's mental well-being? The problem with enforcing regulations for this profession is that it will depend on the client to report the violations because there are no other witnesses in the session room. Therapists know the general rules that they're supposed to follow, but with confidentiality comes the power to bend or break those rules however and whatever they believe it's for their client's good. Episode 21: Harmful therapy supervision and the problematic glut of therapy graduates (so confirming that the quantity of therapists in the field is greater than the quality?)

Therapists say that clients always have the choice to leave at any time, but they make it sound like it's so simple for clients to just break free from therapy when the experience is more emotional attachment than rational sensibility. I think the majority of high-priced therapists don't accept insurance? New graduates may be willing to deal with insurance for awhile, but I'm pretty sure most will eventually ditch it once they're in private practice. Episode 20: When Therapists Have a Bad Day- Why should clients still pay for the service when the therapist isn't feeling at his/her best and so can't do a good job during session?

Unless the APA makes it mandatory, I doubt many therapists would want to request regular feedback, especially if it's in a written format that could be used to question their professional competence. The problem I see is that many therapists just have too much pride to be able to take honest criticism from their clients without overreacting in a defensive manner. Maybe there needs to be a better filtering of the types of personalities who enter the field, but that's not going to happen either.

There doesn't seem to be much in the way of accurate data on therapy failures being voluntarily reported, so I don't expect the majority of therapists to honestly admit their mistakes because their business depends on their reputation. I also wonder if it's only "some" or a "many" clients who would give their therapist who screwed up another chance? The only way to know if the therapist learned to correct their mistakes would be for the client to risk continuing with the sessions. Should clients give their therapist the benefit of the doubt, and how many chances should a therapist deserve?

What I find ironic when therapists react defensively to client criticism is that they're really making it all about themselves with their "I'm only human too" or "bad fit" excuses instead of trying to understand the client's point of view and working to mend the impasse. Therapists claim to learn from their failed outcomes, but I think they tend to forget or negate those mistakes if their treatment techniques are successful with other clients.

Focus on their mistakes? Divert from and/or deny their mistakes is more like it. How are results accurately measured other than by outcome, though?

I still don't understand why the APA doesn't require therapists to use mandatory feedback forms as part of the therapy, especially if outcome depends more on the cooperation of the client.

It irritates me a lot when they do this as though their perspective should be the more accurate one and that my critical point of view should suddenly mean little if it's something that they feel is questioning or threatening their professional and personal credibility.

I usually know what "warmth" is when I feel it. A "warm" person is inviting and welcoming, and you feel safe, relaxed, and comfortable in their company. Warm people are approachable and can more easily gain trust from strangers. Kindness, friendliness, and affection are part of behaving warmly. Warmth attracts closeness, but there can also be sincere warmth and fake warmth. People can pretend to be "warm" just as therapists can act like they care. I'm not sure why this thought was stuck in my head all day, but the therapy relationship reminds me of Cheez Whiz-- it's an imitation product that tries to mimic the real thing. I didn't know that Cheez Whiz wasn't even real cheese! https://www.thedailymeal.com/eat/what-cheez-whiz

I think this is the key. The therapist is trained to act in a certain way in order to try to get their clients to respond in a certain way, so the effectiveness of therapy is really based on pretense not authenticity. Therapists can't and won't admit this underlying deception because successful outcomes depend on trusting the process.

https://www.verywellmind.com/therapeutic-rapport-2671659 "Some of the ways the therapist can demonstrate genuineness is to: -Provide supportive nonverbal cues, including eye contact and nodding in agreement. -Give feedback in the moment, rather than in a later session. -Encourage you to be active and feel empowered in regards to your treatment plan." Does the above really qualify as genuineness? From an article on therapy rapport: "The two fundamental pillars that rapport is based on are trust and fluid communication. The therapist and client should understand each other’s verbal and non-verbal communication. -listening to the patient without interrupting or making value judgments -important to show warmth towards the client -see the world through their eyes. You must do this even if you don’t share their feelings or agree with their actions -appear credible -try to focus on things you have in common that will help you move towards the client’s therapeutic goal -Consistency between verbal and non-verbal language"

It would be easy for therapists to agree with this point when the criticism is against other therapists, but I have yet to meet any therapist who can accept negative feedback from their own clients without becoming defensive or denying it. They will often try to invalidate the client's side by emphasizing their professional expert credentials or implying that clients should feel more grateful for their efforts.

"Have We Overestimated the Effectiveness of Psychotherapy?": "the field of psychotherapy research needs to work harder to ensure that negative results are published as well as good news results, especially given the findings of another recent paper suggesting that the field has a problem with undeclared researcher allegiance to particular therapeutic approaches." The article also mentions how psychotherapy can negatively change personality along with other related consequences.

Then a "good" therapist is only about perception--how therapists see themselves and/or how clients see them? If these viewpoints clash, then the therapy fails?

So is there anything that can help distinguish a genuinely good therapist from a manipulative pretender?

Were their professional responses to the criticism helpful to you? It probably helped them understand your needs better, if nothing else.

Would just having a degree in psychology give them that kind of attitude, though? Maybe these know-it-all therapists already have grandiose personalities before they even enter the field? Or does the schooling bring that out in them?

I think it's easier for therapists to not care about cultivating better manners towards their clients because there's no third party oversight monitoring their unprofessional behavior in session. If few therapists have the good qualities listed, then I expect few would offer clients the opportunity to give honest feedback. How many clients would be comfortable criticizing their therapist, though?

In this link ("Why More People Are Choosing Tarot Readers Over Psych Therapy"), Miller says that “despite what therapists believe, there is no evidence that the methods we [clinical therapists] use uniquely contribute to the outcomes we measure.” He even points out that the effectiveness of psychotherapists aren't any better than consultations by psychics and fortune tellers.

Episode 18: "The need to feel effective is so big that, on average, therapists overestimate their effectiveness by about 65%. Think about that. So we create an illusion of effectiveness to make up for what we know is true the minute you're in a room with clients. It's a struggle. It's a struggle to figure out what to say, what to do. And maybe you're good for the first two hours of the day, but by 4 PM (at least for me), I'm hoping to put two thoughts together that are useful. The whole process augurs against good outcomes, and we fill in the gap with our fantasy about how effective we are in order to maintain our ability to practice and confront clients on a day-to-day basis."

The problem I see is that many of the above criteria aren't consistently followed by many therapists, so it would be more realistic to list why psychotherapy can be ineffective and why insurances usually won't cover for long-term, slow to no-improvement talk sessions.

I think therapists with strong personal belief systems wouldn't be able to remain objective with clients who hold contrary values. It may also depend on what kind of service the client is looking for and the sensitivity level of the therapist.

It's sickening how a therapist would emphasize trust in the process and the relationship and then betray it when it serves his purpose. Clients have every right to feel contemptuous towards the profession long afterwards. It's easier for therapists to deal with being the ones dumped because they have other clients to validate them. With most other businesses, it's not wise to mix the personal with the professional, but in therapy, that's what it is. So when things go wrong, more destructive consequences are left behind than just hurt feelings. Maybe this self-disclosure issue wouldn't become such a problem if the expectations between therapist and client were made clear in the first session?