here today

This isn't exactly about therapy per se, although the programs label themselves therapeutic.

https://www.bbc.com/news/world-us-canada-57442175

Thanks, Mary.  I'm going to quote a part of the article because I think there are some important implications for therapists:

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On Ofri's experience of making a "near-miss" medical error when she was a new doctor

 I had a patient admitted for so-called "altered mental status." There was an elderly patient from a nursing home and they were sent in because someone there thought they looked a little more demented today than they looked yesterday. And of course, we were really busy. ... And the labs were fine. The radiology was fine. And so I just basically thought, "Let me get this patient back to the nursing home. It's all fine."

So I sent the patient to kind of an intermediate holding area to just wait until their bed opened up back at the nursing home. Well, it turns out that the patient was actually bleeding into their brain, but I missed it because I hadn't looked at the CAT scan myself. Somebody said to me, "radiology, fine." And so I took that at their word and didn't look at the scan myself as I should have.

Now, luckily, someone else saw the scan. The patient was whisked straight to the [operating room], had the blood drained and the patient did fine. So in fact, this was a near-miss error because the patient didn't get harmed. Her medical care went just as it should have. But, of course, it was still an error. It was error because I didn't do what I should have done. And had the patient gone home, they could have died. But, of course, this error never got reported, because the patient did OK. So we don't know. It never got studied or tallied. So it was missed, kind of, in the greater scheme of how we improve things.

On the effect of having made that 'near-miss error' on Ofri's subsequent judgment

In the short run, I think I was actually much worse, because my mind was in a fog. My soul was in a fog. I'm sure that many errors were committed by me in the weeks that followed because I wasn't really all there. I'm sure I missed the subtle signs of a wound infection. Maybe I missed a lab value that was amiss because my brain really wasn't fully focused and my emotions were just a wreck [after that serious near miss]. I was ready to quit. And so I'm sure I harmed more patients because of that.

Now that it's been some time, it's given me some perspective. I have some empathy for my younger self. And I recognize that the emotional part of medicine is so critical because it wasn't science that kept me [from reporting that near miss]. It was shame. It was guilt. It was all the emotions.

 

1. The error wasn't reported because somebody else caught the problem and the patient did fine.  This is too bad, as Ofri would acknowledge now, because others did not therefore get to learn from her mistake.  The quality or potential of people  "blaming" her for her mistake took over in her mind.  And perhaps that in fact WOULD have been the attitude of some in hospital had the error been reported.

2. The effects of shame and guilt put her mind in a fog so she wasn't as effective as she might otherwise have been.  The shame and guilt did NOT help her perform better.  The simple knowledge that she made a mistake was not able, therefore, to make her more alert for the future, as it might have with a more experienced doctor or a more experienced Ofri herself.  Except that now, with some mistakes under her belt, she is also less likely to make them.

3. Shame and guilt can be problems for clients too.  It may be that they come into therapy and have problems dealing with those emotions.  They impact their sense of self, which is necessary in order to function in society.  But the sense of self is affected by more than just shame and guilt and can be damaged in other ways, too. 

I believe that I went into my last therapy with a damaged sense of self already.  There are no tests for this that I know of, but I think my last therapist's observations that I was "narcissistically wounded and fragmented" were apt.  If I hadn't already had the damage I went into therapy with, the way the therapist behaved with me may in fact not have been very damaging.  For one thing, I might have had the ability to feel her slights and self-absorption and disapproving looks without taking those things personally.  BUT I DIDN"T.  That's part of why I had felt the depression and anxiety that led me to therapy in the first place.  Of course, I imagine that it is very disorienting for a therapist to begin to realize, if they even allow the idea into their awareness, that they may in fact be damaging to the client's sense of self.  And to say that I was already damaged, so it didn't matter -- no that's not right, either.  If a patient has a condition that the doctor exacerbates and makes worse with "treatment", then that is an iatrogenic treatment effect.  And those need to be observed and documented.  So that some day, maybe, therapists can get some better ideas how NOT to do those kinds of things for future clients.  If there clients and therapists in the future -- which I kind of hope not.  I hope that something better than therapy can be found.  And people who have been hurt in therapy could provide lots of potentially useful information and ideas for alternatives -- if anybody was interested.  Which, of course, at this point in history, they are not.

On 8/3/2019 at 10:41 PM, Sylvester McMonkey McBean said:

i've had a few fleeting thoughts on perhaps contacting them and seeing if they would be interested in an aspect of one part of my story, but then i change my mind because i worry that they or any guest therapist they bring to the podcast would use it as a means to twist it into their own agenda to prop up the benefits of therapy instead of as a means to bring awareness that this is kind of shit is going on and throughout the profession, it actually is quite a taboo subject to even bring out into the light of day. 

. . .

On 8/4/2019 at 2:58 PM, Eve B said:

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? . . .

I wonder if more specific data about the particularly harmful effects of bad therapy on clients might be useful information.  Yes, therapy can be helpful and useful for some people, and then very bad and very harmful for others. 

Right now, there are a bunch of horror stories here and there across the internet about the effects of bad therapy.  There are some commonalities in those those stories that bear witness, I think, to the almost predictable effects that some very bad practices and attitudes on the part of some therapists can have.  Maybe not on every client, but on susceptible ones.  

There are enough stories that a relatively extensive analysis could be done, seems like, but I don't know much about that kind of research.  It would only be a start, using available data.  But it could point to more specific kinds of questions and perhaps more rigorous research.  

Real evidence of therapy harm doesn't invalidate therapy that may have been helpful to somebody else.  But the helpfulness in some cases doesn't invalidate the harm in others, either.

I wonder if Ben and Carrie might be interested in something like that?

Ben and Carrie still believe in the therapy model, though.  I don't.  So as instructive as some of our stories might be I wouldn't volunteer to go on it.  How about any of the rest of you?

Very interesting!  Sounds like they are learning something from real life, as opposed to consulting room life.

Yes, welcome Starling. 

I'm almost speechless about the "...Now that you have stopped volunteering for abuse ..." comment.

I don't understand that stuff -- I guess it's what I've heard referred to as passive, relational, or motivational aggression. And it definitely adds to my impression that the rest of that person's comments were primarily self-serving, whether she was aware of it or not.  Hence your comments, I guess, were experienced as an attack and she "had to" attack back?  A very unsafe therapist herself, therefore, is my impression, despite her previous appearance of support for you.  :-(

She never acknowledged the possibility that her comment was offensive, certainly didn't apologize, despite it being pointed out by the other person.  Maybe she didn't see how her comment could be seen as offensive?  But she didn't ask for clarification, either.  Then, later in reply to the person who pointed out her possible "mistake", she wrote:

Quote

I, too, seek feedback after each session and at termination. I also encourage it during each session so that there is felt safety and a collaborative approach.

Yikes!  How ironic, in a discussion of therapists' acknowledging mistakes.  Scary, too, to me.  

My general attitude toward therapy is so negative these days that the podcasters' happy, "Oh, my job is so wonderful!" just really made me feel sick.  For instance, I "felt safe" enough with therapists and the theoretical process of therapy and then ended up getting shamed by them, rupture without repair.  They just quit and left the job unfinished.  NOT safe.  (Stupid me!)

"Safety" in therapy?  How ridiculous and OPPOSITE to my experience with it.  Yes, I wanted and needed to get in touch with my gut -- but that's what I thought I was going to therapy for, not something which I needed as a prerequisite before I started.

Thanks for posting, though.  Interesting to see how deluded so many therapists still are.

Yes, and the ethics guidelines in my state about competency, among other things, seem more about protecting the therapist, too.  I've wondered if another way to approach the problem might be through the state legislature.  But, as of now, I'm the only one I know about in my state who might share my view.  And the "guild" most certainly has a large lobby.

I didn't ghost.  I confronted.  As best, and as cooperatively as I could.  And my therapist(s) couldn't handle it.

So the following is, frankly, still triggering for me:

Quote

 

I need to add one last piece, as a therapist: It’s hard when a client ghosts, not just for the lost business or the unanswered phone calls. Those sting, but only temporarily. It’s the unanswered questions that hurt most: “Why did you leave?” “What was going on that I didn’t know about?” And the iconic, “Was it something I said?” I come to care about my clients, even after just a session or two, and a disappearance makes an impact.

Why? We spend a lot of time in our training learning to help clients feel safe and comfortable, to help them say whatever they want. Ghosting tells us that something was wrong with our rapport. Even though it seemed like the relationship was functional, something else was going on underneath. Either there was no secure connection or the client didn’t feel safe enough to talk about their insecurities. That’s a problem we’d like to correct—but without contact we’ll never know. It’s like someone telling a surgeon: “Sorry, the heart transplant failed and we lost the patient. The body is gone now, though, so we’ll never know what happened. By the way, you have three more scheduled for this afternoon.”

What happened? What went wrong? How can I improve?

 

I tried to tell you.  I felt that was the "better way".  It hurt your feelings and you shamed me.  Your training was insufficient, no matter how much time you spent in it.

If a client wants to avoid that, I can certainly understand, and SO SHOULD YOU.

Perhaps, if you're really interested and want to take responsibility for meeting your own needs, you could sent them a questionnaire requesting customer feedback?

Professional vs. Guild ethics, a very interesting distinction.

On 7/4/2017 at 8:27 PM, Mary S said:

Professional ethics protect the public against abuse of professional power, expertise, and practice, and hold members accountable to values beyond self-interest. Guild ethics place members' interests above public interest, edge away from accountability, and tend to masquerade as professional ethics.

It's something good to be aware of.  Thanks, Mary

I don't entirely agree, RC, as you probably know.  My most critical "wound" was to my capacity to form my identity.  I had a solid relationship with my late husband but he died.  I had problems in my career because of issues, probably related to that of identify and how I fit into the larger whole.  I couldn't re-form my identity after my late husband died.

But certainly the way I identified myself primarily as a mental patient during the time I was needing and trying to find help didn't help.  It kept me out of life, not in it.  And since I felt ashamed, dysfunctional, etc., I kept myself out of other people's way as much as possible.

I felt/knew that what I needed was something "social", but couldn't find anything like that except a support group called Emotions Anonymous, which reinforced the "broken" identity.  Still, it was nice to feel I had some people who could accept me.  Nevertheless the time came when I felt I needed to move beyond that, and I have, meeting people with similar interests on Meetup.com.

The online forums have been a big help to me, too.

But I agree with WS74 that the way people with "mental illness" are viewed by others, especially those who are paid to try to "help" us,  can often create additional problems and exacerbate those related to how one sees oneself.

How would you approach helping people with issues like the ones you mentioned -- emotional problems, relationship difficulties, shame and low self esteem.  What about depression so deep someone tries to kill themselves, or anxiety so bad they can't leave the house, or seeing and hearing things that "aren't there", at least that other people in the same space can't see or hear?

Also, although I may speak sometime from a somewhat more moderate position, I believe ALL critiques of the MHS need to be put out there and explored.  Snuffing out the critiques without really looking at them is just really, really dumb.  Too bad that's what the system does but I believe like you that a site where people who have been hurt in therapy can be heard is needed.  And I'm thankful it is here.

Welcome Wounded Soul,

Hope you will feel comfortable here, as I have.

It seems to me these are some realistic reasons for caution from a client's perspective -- not just that I, or any client, has unrealistic expectations, "trust issues", paranoia, etc.  Something that could help clients new to therapy not to err on the other side of a "trust issue" -- blindness to the reality of the "authority", denial of their flaws and imperfections, etc.  These may be flaws or faults that I had going into therapy, but -- they were what I went into therapy with.  Seems like there could be another method to address those problems rather than the client getting trampled on -- "again", from a reenactment perspective.

I came across this online today:

http://www.salon.com/2017/01/02/inconvenient-truths-of-mental-illness-more-people-take-medication-but-progress-has-stalled_partner/

Interesting article, comments, and links.  I thought some others might enjoy it, too.