Mary S

Thanks for posting this -- I didn't notice it when it first appeared. It's good to know there are at least some written guidelines, but I suspect that they are, sadly, often not followed. Here's a link to a 2014 Guardian story about how therapy can be harmful: https://www.theguardian.com/society/2014/may/26/misjudged-counselling-psychological-therapy-harmful-study-reveals. Sadly, I haven't been able to locate any signs that the results of the study discussed in the link have been published anywhere, but did find another web article at https://www.sheffield.ac.uk/news/nr/preventing-adverse-effects-of-psychological-therapies-1.376074 I had previously come across the website http://www.supportingsafetherapy.org/ linked in the post. It sounds like something that everyone considering therapy should read. Not perfect, but at least there are some people out there aware of the possibility of harmful therapy and trying to help prevent it

Sadly, some therapists are so into "mind over matter" that they are not open to other possibilities -- and may even go so far as to carry out and publish research that is chock full of holes. A couple of examples that have been critiqued on the web: https://www.theguardian.com/science/sifting-the-evidence/2014/apr/02/has-cognitive-behavioural-therapy-for-psychosis-been-oversold (supposed treatments for psychosis/schizophrenia) https://www.statnews.com/2016/09/21/chronic-fatigue-syndrome-pace-trial/ (supposed treatment for chronic fatigue syndrome)

Yes, that is the most scary part of the article. But I think the danger of not considering hebephilia as a disorder is much greater than the possibility of psychiatrists taking advantage of vulnerable children; it is the danger of promoting leniency for non-psychiatrist sexual predators of children on the grounds of normality.

From carefully reading the linked article, it seems that your statement "According to the APA it's supposedly normal for full grown men to be attracted to children" is not an official APA position, but is promoted by some. Still, there seems to be enough pressure from the latter contingent to raise some serious concern that this view may be common enough to be very concerned about. (Also, the article is from 2014, so there may have been more recent developments since then.)

I recall once reading (in a novel, I think) "wounds heal; scars don't hurt". That metaphor sounds like it is appropriate for your situation: right now you are wounded and hurting, but you can expect that the "wound" will heal with time. It might leave a "scar", but that's much easier to live with than the hurting of a still fresh wound.

One of the subtopics in Zur’s discussion “How Psychotherapists Create Power Advantage: Rituals, professional posturing and meta-communications” is “the Misuse of the Term Resistance”. I encountered this misuse not directly in therapy, but in reading to try to make sense of my therapy that seemed more counterproductive than helpful. I read one book that had two checklists to help decide whether a client’s problems in therapy were due to incompatibility or resistance. I checked an equal number of items on each list, but there was one on the “incompatibility” list that said something like, “You are giving in to the therapist’s personality rather than to the process.” I had no idea how to answer that – so I was left with the possibility that maybe I was engaging in “resistance” (whatever that was – the checklist seemed to be the closest I could find to a definition). But I was troubled by the use of the word “resistance” as something that seemed to indicate something negative -- that the client wasn’t cooperating or otherwise was to blame for lack of progress in therapy. In my experience prior to therapy, “resistance” had primarily been used in a positive way – eg., the French resistance in WWII; resisting peer pressure; resisting negative influences; resisting temptation. So it was good to see Zur’s acknowledgement that the term is often misused by therapists to “lay the blame for lack of therapeutic progress at the feet of their clients,” and points out that professionals in many fields face some kind of resistance, but they “do not seem to use it as an excuse to be paid without performing their duties effectively.” (Follow the link above for a more complete discussion.)

Things may have changed since I have tried therapy, but the following were common when I tried it: 1. More often than not the therapist would not tell the client the diagnosis. 2. If using insurance for therapy, the insurance company wouldn't pay for two therapists unless there was a different diagnosis -- so if a client was dissatisfied with the diagnosis and tried another therapist to get a second opinion, and the opinion turned out to be the same, the insurance would not pay for the second opinion. 3. Many therapists had standard diagnoses that they gave most clients -- then what they actually did was to engage in what seemed to be snap judgments (not backed up by evidence, even if I asked or disagreed). Also, in my case, since coping with personal attention was the problem I was going to therapy for help with, the idea of seeing another therapist was really a big deal -- being asked lots of questions for a second opinion would be a real ordeal for me.

I first encountered the phrase “the power to name” about ten years ago when reading (the then-current edition of) Poe and Vasquez, Ethics in psychotherapy and counseling: A practical guide. My recollection from that book was that “the power to name” seemed like something rather mystical. So I was glad to find an elaboration in Zur’s article (under item #3. Professionalism Power: Societal Respect For The Healer’s Role in the section types of Power in Psychotherapy). He describes this as follows: “Power to name: The authority to label, name and diagnose is another form of power that therapists have over their clients. This also involves the power to suggest or interpret unconscious or conscious motivations. As part of the therapists' authority to name or label mental illnesses is the enormous power to define that which is normal and that which is not. As will be articulated below, the power to define what is normal gives therapists social power and control and is reserved to very few others in our society.” He elaborates under the heading “The power to name” in the section How Therapists Create Power Advantage, which I recommend reading. I’d like to add an additional perspective. Namely, I became aware many years ago (I can’t find a reference, but I know this is not original to me) that all too often when we have a name for something, we feel we understand it but don’t really understand it. So the power to name brings with it the power to feel we understand when we don’t. And this is in turn the power to close doors to understanding. It can also be the power of denial (that we don’t understand). It can be the power to stuff into boxes. It can easily be applied unintentionally. This occurs in therapy in diagnosing clients (as “labeling” them, as Zur points out), but also in labeling clients’ feelings or motivations. Thus therapists (and also clients) need to be very, very cautious in using the power to name.

As long as I can remember, I have considered any kind of power as something that can be misused. I’m not alone in this, as the old phrase “power corrupts” suggests. Uncle Ben’s advice (“With great power comes great responsibility”) to Spiderman reflects the caution ethically required in using power. So when I told a therapist I was somewhat shy, and she responded, “You gave up your power,” I expressed some reservations about power. She then said, “We’ll have to redefine it for you.” As a result of that conversation and the rest of my experience with her, I developed a strong association of the word “power” with that therapist (and the negativity I associated with her) that became a roadblock to my thinking of power in any way except the association with her. But, to my surprise, when I recently came across the website Zur, O. (2015). Power in Psychotherapy and Counseling (Online Publication by the Zur Institute. Retrieved 1/23/2017 from http://www.zurinstitute.com/power_in_therapy.html ) , I managed to read most of it as I would read anything else. The “breaking down” and careful discussion of the topic of power helped me at least begin to think of it as I would any other concept, rather than as something that was so laden with negative associations. It helped me begin to get some sense of what the word “power” means (at least to some people) in psychotherapy and begin to talk (or at least write) about it. I recommend the website to anyone interested in the topic of power in psychotherapy. However, it is a slog. One way to proceed if you don’t care to read the whole thing in order is to start with the table of contents (toward the top) and start with topics that interest you. Or you might start with the Summary Points ( http://www.zurinstitute.com/power_in_therapy.html#summary ) and then go back to read more about points of interest to you. Some points that were most important for me: 1. In the section What is Power , Zur says, “In the context of this paper, power refers to any ability to effect, direct, influence, change, or exert control over self, people, situations, or courses of events. It can be viewed as people's capacity or ability to affect, control, or manipulate their environment, including the attitudes, emotions, and behavior of other people or themselves. Power, obviously, can be just or unjust, fair or unfair, direct or indirect, or it can be referred to as holy or evil. It may or may not involve force or threat of force and can be employed consciously or unconsciously, overtly or covertly, and the recipients may be aware or unaware of the impact of power on them.” OK, Zur presents “power” as a complex subject, which makes more sense to me than the mystical, unitary thing that my therapist seemed to be talking about. (But it does seem strange to me that his definition doesn’t come until about two-thirds of the way down the page.) 2. Types of Power in Psychotherapy was also helpful for me. For each of these types, Zur lists aspects of that type that therapists have, and then aspects of that type that clients have. One thing that I wish he had emphasized more is that these are potential types of power – a given therapist or client might or might not have developed the skill to implement a particular type of power. In fact, a client may come to therapy in part because they lack such skill (as was my situation). If therapy does not address that lack and focus on improving it, then therapy is likely to do more harm than good. Also, I can think of a couple of types of power that Zur has omitted: The power of setting an example, and the power of laughter. I (naively) expected therapists to help partly by setting a good example; they did not (at least not according to my values, although at least some of them may have thought they were setting a good example according to their values.) I did experience the power of laughter used once in a very negative way (when the therapist laughed when I tried to explain what shame was), but I can see it being used helpfully – e.g., if a therapist laughs at themself when they make a silly mistake. 3. How Psychotherapists Create Power Advantage This is a particularly meaty section, with lots of subsections. If if you only read one section, I recommend this one. 4. Power in Psychotherapy and Counseling This ends with a list of Seldom Discussed Issues, that I think clients need to be especially aware of. 5. The Ethical Way provides a list of ethical precepts for therapy, but I wish Zur had given more specific examples of how therapists’ (mis)use of power can be unethical. One thing that I (at least initially) found strange was that so much of the article seemed to be arguing against the proposition that there is an inherent power differential between therapist and client (with the therapist having greater power). Yet Zur gives lots of quotes showing that many therapists believe this. (Personally, I can’t help but wonder if many of the therapists who adamantly believe that the therapist necessarily has more power than the client are people who crave power over others – which I think makes their fitness to be a therapist questionable.)

Today i came across the following that I wrote a couple of years ago and had forgotten about, so thought it might be good to post here. I'm wondering how much on this list is just me, and how much fits with other clients' experience. REASONS I DON’T TRUST THERAPISTS Please note: This is a list of things that (at least, if I am behaving rationally) prompt me not to trust a therapist who does them. I am not claiming that all therapists do all the things on the list. However, in my experience (based on my personal efforts at therapy and also on my reading about therapists), most therapists do at least some of these. Also note that these reasons are a matter of being misguided or of lacking adequate competence, rather than having ill intentions. (I am aware that some of these reasons are correlated, overlap, or are different facets of a broader classification. Still, I think it's worthwhile to articulate these different facets.) 1. They don’t seem to care very much about informed consent – or else are not very good at translating their caring into behavior. 2. They don’t seem to care much about giving reasons for what they do – or else just give vague reasons such as, “because I think it will help you,” or “I’m interested in …,” or “I’m trying to understand you.” 3. They seem to think in coarse-grained terms (e.g., control, power, warmth, healing, anxiety, depression), which shuts out people such as myself who see the world in finer-grained terms. 4. They seem to have some agenda of their own that interferes with their ability to help. (Examples: Satisfying their need for intimacy; gratifying their interest or curiosity; seeing the client as raw material to mold or shape; being appreciated for their self-perceived warmth, insight, etc.; being confrontational; emphasizing similarities, to the neglect of differences; being “creative”; having fun, even if it’s at the client’s expense) 5. They often think (or at least express their thoughts) in black-and-white terms, thereby shutting out clients such as myself who see things in shades of gray. 6. They often jump to conclusions with little or no evidence. 7. They seem to attribute something to a single cause, rather than considering possible interacting factors, or possible alternate causes. 8. They look for, and then ascribe significance to, patterns – without considering that we humans often see patterns that aren’t there, or that patterns can occur simply due to chance. 9. They seem overconfident. 10. They focus too much on “want,” “like,” and “feel,” to the exclusion of thinking (e.g., weighing pros and cons, considering alternative explanations, considering consequences), questioning their assumptions, accepting uncertainty, and accepting not knowing. 11. They seem to see you as a stereotype or other creature of their imagination. (e.g., they give you permission for the opposite of what you are trying to give yourself permission for, or try to reassure you about the opposite of what you are concerned about; or tell you that you feel, want, or think something other than what you feel, want, or think.) 12. They assume the liberties of a friend without having earned a friendship. 13. They seem dismissive of what is important to you. 14. They don’t seem to care about helping you with the problems you came to therapy to work on, but seem to regard those problems as nuisances that you are uncooperatively injecting into therapy. 15. They seem to give you the message to leave important parts of yourself outside of their office when you come in the door. 16. Instead of acknowledging and respecting individual differences, they seem to think these are something to either deny or hide or change. 17. They regard something claimed in a professional journal as proven, without giving any thought to the quality or adequacy of the evidence backing up the claim.

Thanks for the link. Also of interest: http://www.vox.com/2015/12/29/10654056/ben-goldacre-compare-trials. The shenanigans described in it (which result in approving drugs that show no evidence of doing good and may show evidence of doing harm) may be part of the problem described in the link you provided.

I'm tempted to say "Good for you!" But not knowing just what went on, I am not sure whether I would approve or not. I often have a problem with getting angry -- I get very self-conscious and ashamed of myself. But sometimes when I do get angry, I say something that really needs to be said. So I am wondering if what you did was indeed saying something that needed to be said, but it seemed like bullying to you. Therapy is often so strange (for me, at least). It's not like anything normal (for me, at least).

This site is at https://www.psychologytoday.com/topics/therapy. All the blogs that I have read there allow comments. The list of blogs in this site does not overwhelm me with things I would find helpful, but there were a couple that I came across that seemed worthwhile: Does Psychology Work, by Romeo Vitelli (https://www.psychologytoday.com/blog/media-spotlight/201305/does-psychotherapy-work ) Does Your Therapist Bully You? by Eric R. Maisel (https://www.psychologytoday.com/comment/869924 ) This shows a bit of arrogance from the author at one point, but a couple of commenters pointed it out. It also provided an opportunity to be supportive to other clients having bad therapy.

The GoodTherapy therapist’s blog site is at http://www.goodtherapy.org/blog/. Currently, there seem to be about two posts each weekday. The site does allow comments on blogs. There are a number of bloggers; topics range widely. The quality also seems to vary. One blog post that is unusually client-friendly is 50 Warning Signs of Questionable Therapy and Counseling ( http://www.goodtherapy.org/blog/warning-signs-of-bad-therapy/ ), posted February 12, 2008 by Noah Rubenstein. It still gets comments. It’s a good place to look at now and then to be supportive of therapy clients who have had bad experiences. It’s easy to find by searching on 50 questionable therapy. Most comments on the 50-warning-signs post are by clients, but some therapists have chimed in, too. One (Kelly Crossing) seemed to me to be willing to listen to clients and try to see their point of view more than most therapists I have encountered. She spoke from the point of view of someone who found therapy extremely helpful herself. However, after awhile, she dropped out of the discussion and posted a blog entry 50 Signs of Good Therapy ( http://www.goodtherapy.org/blog/50-signs-good-therapy-0110119/ ), which may be worth reading (and perhaps leaving a comment on). Another therapist who commented on the 50-warning-signs blog was Darren Haber. On his Good Therapy profile (http://www.goodtherapy.org/therapists/profile/darren-haber-20091204 ), he says, “I am not a cookie-cutter, one size fits all therapist. I respect the intelligence and sensitivity of each client.” Yet in a comment (April 23rd, 2012 at 11:06 AM ) on the 50-warning-signs blog ), he says one thing a prospective client should ask themself about a prospective therapist is, “Does this person seem attentive, empathic, CURIOUS? (Curiousity is key, the therapist I think has to be interested in you and what’s going on, not sit there like a statue, who wants that.)” I agree with the attentive, empathic, not sitting there like a statue parts . However “curious” sounds to me like a one-size-fits-all cookie cutter approach -- one that doesn’t fit me, in particular. I would certainly hope that a therapist would be open minded and listen carefully to (and respect) the client’s perspective, but for me personally, pursuing curiosity shows a lack of empathy for me (although it might show empathy for someone else – people are not all made from the same cookie cutter!). In fact, my experience in therapy is that therapists often push aside things that are important to me, in favor of pursuing their interest. At the other extreme is a Good Therapy blog I saw a few years ago with title something like “Introverts Are Relationship Breakers”. As the title suggests, it was very prejudiced against introverts. I can’t find it now, so hope it was taken down. Another example that strikes me as good but not as good as it could be is One Size Doesn’t Fit All When It Comes to Treatment, at http://www.goodtherapy.org/blog/treatment-approach-cbt-depression-0703125#comment-429150

I'll try to continue tomorrow with Parts II and III, each discussing a different blog site.

(I've been having trouble creating this post. What is there is just the beginning, so I'll try to continue here.) I’ve only looked at a few of the blog entries there, but they do not give me a positive view of therapists. One concern is that the site doesn’t seem to allow comments: no discussion, just one therapist’s view in each blog. Another is that many of the posts (e.g., https://www.psychotherapy.net/blog/title/the-multiple-languages-of-therapy ) seem to talk about a particular client. That seems to be a violation of the client’s privacy (even if the name is changed, since so many particulars are often given). I found one post there ( https://www.psychotherapy.net/blog/title/the-socially-awkward-therapist, by Margaret Arnd-Caddigan) to be particularly disturbing. The author seems to include herself in a “socially-awkward-therapist” category, saying, “We’re not simply noticing, but carefully weighing, evaluating, and interpreting facial expression, tone of voice, body language, rhythm, inflection, and word choice, all in minute detail. We’re not diagnosing. We’re not pathologizing. We’re not judging. We are quite simply fascinated.” I seriously question her assertion of not judging – it looks to me like she is judging clients (and perhaps not just clients) to be objects subservient to the pursuit of her fascination. Perhaps some people like being the object of someone’s fascination. I don’t, and it would especially turn me off in a therapist. It’s an example of what I call a therapist agenda. I would really feel used if she were my therapist. Still, sites like this can be one resource for a prospective client to “research” perspectives of different therapists, and perhaps to research what a particular therapist is like before trying them.

More and more therapists seem to be blogging. Their blogs can give some insight into their view of therapy. Although some blog individually, some blog via therapist-oriented websites. I’ll comment on three of these, but put them in three different “topics,” in the hope that this will make any discussion flow more easily. One of these sites is https://www.psychotherapy.net/blog.

My worst therapist often reminded me of Elsa, the oldest ( 14 years old) child in the film Our Mother's House (https://en.wikipedia.org/wiki/Our_Mother's_House.) On one occasion she reminded me of one of the teen-aged characters in The Last Picture Show. In other words, she often seemed like an adolescent playing adult. (She was in her mid-thirties at the time; I was in my early forties.)

Eve said, "Clients coming into therapy should be aware of these risks, and it's also supposed to be mentioned in the consent forms. " When I first tried therapy, there were no consent forms. My third therapist was the first to have one -- but it only covered fees, length of sessions, and perhaps cancellation policies. I never had a consent form that mentioned risks, although the last time I considered therapy (but decided against it) the therapist sent me a draft of a consent form mentioning risks. I believe therapists have a professional obligation to try to mitigate risks ("First do no harm"), but my impression is that few of them do see that as part of their job.

RealityCheque said, "You seem to have an inordinately bad therapist." I didn't have just one bad therapist. The first (not counting one that I didn't go back to after the first session, since she just seemed pretty blah) got off to a bad start when I asked her what therapy was and she said, "You're the star." I probably gulped (learning to cope better with personal attention was something I hoped for as an outcome of therapy), and she responded by, "You may not like it; you may not like the process." But I went back, with the attitude of "facing the music". I did decide to quit after the third session (there was so much she did that seemed poor quality), but made the mistake (not wanting to be "avoidant") of going back for a fourth session to tell her why I was quitting. She responded with, "You expect too much; that's Your Problem." I had a hard time coping with that, but tried a second therapist, albeit with a voice in my head telling me not to expect too much. The second therapist was perhaps the worst of the lot. In the first session she made pronouncements such as "You gave up your power (in response to my saying that I was somewhat shy) and "You have a problem with intimacy" (in response to my saying that a coworker with whom I had difficulty coping said something that was inappropriately intimate for the workplace). I gritted my teeth and came back. In the second session, she said that a metaphor for what I needed was something like a mold that a brick was made in, that would leave a shape when it was removed. Now I see that as appalling, but at the time, I found it shocking, claustrophobic, and extreme. Things just never got better -- her manner was very intimate (which seemed unprofessional to me), but when I tried to ask for something more professional, she said "Therapy is an intimate relationship". I tried asking questions when what she was doing didn't make sense to me, but got responses like "Are you sure you're not second guessing me?" and "Do you realize you're asking me to give up my control?" and "Consider me to be something like a computer: what you say goes in, mixes around with my training and experience, and out comes a response." Once she said, "I get the feeling you think this should be an intellectual discussion," with an expression and tone of voice of disgust or contempt on the word "intellectual". That seemed really prejudiced to me. Once she said, "I can't help you if you take everything I say as criticism," which fed into my tendency to blame and shame myself. I became kind of a basket case, but when I tried to tell her about it, she responded, "My clients' pain is precious to me," which sounded pretty sick to me. Finally I decided it was better to be a "quitter" than to continue. I tried a third therapist. She at first gave me hope that she would help me -- at least, help "recover" from my experience with the previous therapist. But as time went on, she did more and more things that didn't make sense, including saying "I have my reasons" when I tried asking questions to help me make sense of what she was doing. She also started teasing me at times that were especially inappropriate. Finally I decided to quit her. Thereafter I tried therapy off and on, with the hope that it would help me cope better with the flashbacks, etc. of therapy. I got a little better at not going back when the therapist seemed really out of it. Some seemed kind and well-intended, but not very in touch with the real world in all its complexity. The last time I tried therapy was about ten years ago. It actually was a little helpful, especially the practice in "speaking my voice" with some degree of acceptance on his part. But eventually he got into a weird agenda of how I was harming myself by focusing so much on how I was different that him, and that I should focus more on the similarities I had with him (which weren't many, and pretty superficial at that). So I quit.

RealityCheque said, "Some things are made much, much worse by talking about them, especially with a therapist. " I agree -- I had a lot of getting worse by taking about things to a therapist. But I didn't engage in "digging up trauma" and never wanted to get close to the therapist. In fact, to me a frequent problem was that the therapist tried to get closer to me than I consented to, and that resulted in claustrophobic nightmares and "daymares" that I still have thirty years later. I would have no objection to paying for the services of someone who actually helped me. But too often, it seemed that I was there to be used by the therapist, not to be helped in any way that I could see as helpful. It was analogous to paying someone so they could use me as a prostitute.

Here's what I said when I first posted the link on Psych News: "I recently came across this article giving advice to clients on setting boundaries in therapy: http://everydayfeminism.com/2015/08/6-strategies-for-setting-boundaries-with-your-therapist/ On the one hand I'm glad to see this advice on the web, because it is sorely needed. On the other hand, this addresses a large part of what I went to therapy to learn to do in ordinary life -- but therapy never addressed developing these skills, and I needed them in therapy even more than in ordinary life. Also, when I did try to assert my boundaries in therapy, I was likely to get responses like, "Do you realize you are asking me to give up my control?" -- not exactly positive reinforcement! " I think therapy could be (and maybe is already in some cases) helpful if the therapist is willing (and able) to listen to the client, see the client as an individual, and help with the things that the client is looking for help with. But there are too many in the profession who take the attitude that "therapy is what I say it is, and you shouldn't tell me how to do my job in any way, shape, or form." That attitude is likely to be more harmful than helpful. Therapists too often fail to see the client as an individual, but instead as raw material to stuff into the therapist's favorite theory, in other words, as an object to be acted on as the therapist chooses.