Eve B

Aren't there people in other professions who pretend to be nice to their customers too, though? And don't more therapists nowadays believe that a certain amount of reciprocal self-disclosure is beneficial to earning their clients' trust?

I think therapists who like their clients probably don't fake their relationship with the client? It's when confronted with resistance that therapist posturing can feel like tricks being pulled from their training manual. Why would a therapist believe that a passive model is helpful other than they're not trying to make decisions for their clients?

With all these model variations, how can clients reduce their risk of choosing a harmful therapist? To me, it doesn't seem like the treatment models really matter as much as the personality of the practitioner. I think therapists would want to apply integrative/eclectic approaches to help improve client outcome, but I can't see them being adequately skilled at many kinds of treatment methods.

But therapists seem to always emphasize the importance of feeling over thinking, right? Consideration is about being polite and respectful, so that quality should be given first before clients can trust the therapist's show of compassion. Do therapists tend to be less considerate the higher up they are in the academic and credentials hierarchy?

Maybe it's not that therapists don't want to take client feedback seriously but that many therapists (who claim that they're in the profession because they care and want to help people) don't want to put in that much extra effort and time, especially, if they weren't being paid for it? How many therapists would've helped find a way to get those bike parts for Peter if he couldn't afford to buy it himself? And what does it mean when there is such a huge salary gap between the public service social workers (who are assigned their case loads) versus the inflated fees of private practitioners (who can pick and choose)? Therapists juggle multiple clients on a daily basis, and the quality of care isn't even consistent no matter the years of experience or fancy credentials.

I've also noticed a lot of divided camps within the profession. Therapists don't even really listen to each other because they have their own ideas on how to practice, and who's to tell them they're doing it wrong (when treatment is confidential) other than their clients who aren't supposed to know any better.

Excerpt highlights from So You Want to Be a Better Therapist : "And although the need and value of training seem obvious, it has long been known that professional training and discipline are not related to positive outcomes (Beutler et al., 2004). A more recent study only confirmed this conclusion. Nyman, Nafziger, and Smith (2010) reported that, as strange as it seems, it didn’t matter to outcome if the client was seen by a licensed doctoral level counselor, a predoctoral intern, or a practicum student; all levels of training achieved about the same outcomes. As for continuing professional education, despite its requirement in nearly every state, there is no evidence that therapists learn anything from such experiences or that their participation translates to better outcomes (Neimeyer, Taylor, & Philip, 2009)... More bad news here: Experience just doesn’t seem to matter much (Beutler et al., 2004). Results are mixed at best, with recent studies suggesting no effects on outcome of experience (Hill & Knox, 2013). In large measure, generic experience does not improve outcomes—experienced and inexperienced therapists achieve about the same outcomes." (page 7) "And the ugly: Explaining part of the volatile results, variability among therapists is the rule rather than the exception. Not surprising, although rarely discussed, some therapists are much better at securing positive results than others. Moreover, even very effective clinicians seem to be poor at identifying deteriorating clients." (page 9) "When services are provided without intimate connection to those receiving them and to their responses and preferences, clients become cardboard cutouts, the object of our professional deliberations and subject to our whims. Valuing clients as credible sources of their own experiences allows us to critically examine our assumptions and practices—to support what is working and challenge what is not—and allows clients to teach us how we can be the most effective with them." (page 13) "Even if you are one of the la crème de la crème now (my looks at many data sets reveal that the best therapists are effective about two-thirds of the time), for every cycle of 10 clients you see, three will go home without benefit... Unfortunately, up to now, therapeutic outcomes have been hard to define and even harder to actually measure in everyday practice, leaving us to our own devices and judgment—which aren’t so good. Consider a study (Dew & Riemer, 2003) that asked 143 clinicians to rate their job performance from A+ to F. Two thirds considered themselves A or better; not one therapist rated him- or herself as below average. More recently, Walfish, McAlister, O’Donnell, and Lambert (2012) surveyed practitioners and found that therapists likely inflate their effectiveness, reporting that 85% of their clients improve and seeing themselves as above average in effectiveness (90% saw themselves as above the 75th percentile)." (page 16-17) "They conducted minute-by-minute analyses of 120 sessions involving 30 clients treated for a range of psychological problems. They found that unsuccessful therapists focused more on problems while neglecting client strengths. Successful therapists attended more to identifying client resources and channeling them toward achieving client goals." (page 22) "And the absolute certainty: The client’s view of the alliance is not only a robust predictor of therapy outcomes, but also is the best avenue to understand therapist differences. Marcus et al. (2009) noted: High levels of consensus in client ratings of their therapist indicate that clients of the same therapist tend to agree about the traits or characteristics of their therapist, suggesting that there is something about the therapist’s manner or behavior that evokes similar response from all of his or her clients. (p. 538)' " (page 23) "Bottom Line: The alliance makes significant contributions to psychotherapy outcome and therefore should be actively monitored and tailored to the individual client." (page 24) "Feedback significantly improves outcome regardless of the model practiced—the feedback process does not dictate what technique is used but, rather, is a vehicle to modify any delivered treatment for client benefit." (page 26) "Soliciting systematic feedback is a living, ongoing process that engages clients in the collaborative monitoring of outcome, heightens hope for improvement, fits client preferences, maximizes alliance quality and client participation, and is itself a core feature of therapeutic change." (page 27)

This is a good point that the psych profession probably wouldn't want widely advertised to the public because if extra degrees and decades of experience can't guarantee or at least greatly improve the chances of a successful client outcome, then how can they justify their exorbitant fees?

Thanks for sharing your story, zygomaticus! I've also learned that the trust issue is a biggie because that feeling of betrayal and damage is amplified inside a therapy relationship. After I researched on my own the various methods of what therapists try in order to get certain responses from their clients, I couldn't trust their kind as lightly as before. I felt like a guinea pig. Psychology is a subjective "science", and the power of confidentiality allows practitioners to be able to get away with and cover up a lot of the harm that happens. You might want to check out the "Very Bad Therapy Podcast" topic thread in our Open Discussion forum and also let us know your opinion there since your training and personal experience with the profession would provide another perspective.

Glad to see here, zygomaticus! I hope you're finding our topic threads to be informative and thought-provoking. I don't know if the mental health services are better or worse in the UK than the US, but the psych profession, as a whole, really needs to improve their standards of care if they're serious about helping people.

It could be worthwhile writing them and then posting the response here? I wouldn't be surprised if they're having difficulty finding people who have suffered therapy harm to want to participate in a live talk with them. I've only listened to some of the episodes, but I've been checking to see if/how their topics evolve.

Update: To his credit, Ben responded the same day I emailed my question about compassion training. I think his answer basically confirmed to me that therapy training isn't as adequate as it could be. I would recommend sending him other (maybe tougher) questions because he seems open and willing to give honest feedback. " In my opinion (as supported by research), compassion is one piece of a bigger puzzle that also includes empathy, cultural humility, collaboration/collaborative goal setting, and unconditional positive regard for the client. That's the approach from which a good therapeutic alliance can best be built, which is a necessary part of good therapy. The natural corollary is that bad and/or harmful therapy is often the result of good intentions but a lack of those aspects of interpersonal relating. These are large generalizations of course, but the most important thing for a therapist is to have these trans-theoretical qualities in their work, and from there general theory/technique/interventions/etc. can be applied as to best serve the client. This kind of relational approach is becoming more common, but it can often get lost within the therapeutic relationship, especially if the therapist isn't taking steps to see how the client views their progress and the development of the alliance itself. As for compassion training in graduate school and/or training facilities, the answer is yes and no. No, in the sense that there are rarely classes to teach things like empathy skills, compassion skills, etc. But much of learning to become a therapist includes self-reflection, authentic and vulnerable conversations with peers, feedback designed to help the student/trainee see their biases and defenses, and plenty more things of that nature. In many ways, there is a "what you put in is what you get" approach to therapist development. 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. If I'm being honest, I would love to see psychotherapy training have far less content around theory and far more content about exactly what you're asking about. People can learn to become more compassionate, and while therapists are in large a compassionate bunch, we can all do better. It's impossible not to have defenses and not to have biases; the work isn't to eliminate them entirely, it's to become more self-aware so that you have more room for compassion with clients."

The podcast has a contact form that could be used to suggest topics for their future episodes. Anybody try it yet? I just sent an email to ask about compassion training, so let's see if my question was interesting enough for them to respond.

Maybe we could email the very bad therapy podcast hosts and ask what "compassion training" is, if there is such a course in their school's program?

I think the podcast hosts would reinforce support for therapy because it doesn't make sense for them to sabotage their livelihood, and they also seem to really believe that therapy can be helpful if practiced properly. Does the real evidence of therapy harm invalidate the cases where clients feel that they've been helped by it? It would be better if they could be a little more objective in presenting both sides of the therapy experience, but I would be more suspicious if they didn't defend their profession.

Could these therapists be less biased and narrow if they had better compassion training?

Do clients also have some obligation to help their therapist with this?

If empathy is biased and narrow, then maybe clients should expect many therapists to personally rub them the wrong way more often than not?

"I’m sorry. I’ve let you down today. Again, it’s tough to hear this, but thanks for telling me.” (from Mary's Daryl Chow website link) How many therapists would really have the guts to admit this after offending their clients, and how many therapists would a client have to try before they finally get one who could even come close? Episode 11 acknowledges that psych research data often can't be replicated, and I also wonder about the real honesty of feedback from therapist trainees who may disagree with their supervisors.

I would have trouble trusting them because they laugh too much. I had a therapist who chuckled at something I said that wasn't funny to me or he tried to joke around to lighten my mood, but it just made me shut down.

There's some truth to the observation that doctors often make the worst patients, so therapists who undergo their own therapy and challenge their treatment could also be seen as not behaving like good clients.

After having been through enough of my own bad experiences, many of those stories would be very easy to believe. Not sure, though, how people who have never had bad therapy or any therapy experience would take it. I don't think clients can really understand the shock and confusion of that moment until it actually happens to them for the first time.

Episode 9: "Real therapy is anything that helps the client."

Maybe the only way to avoid this uncomfortable being interviewed-center of attention feeling would be to have a therapist who is easy to get along with?

Would people affected by very bad therapy experiences trust these trainees enough to want to publicly share their stories on this podcast, though?