Mary S

Yes! (Which brings to mind once when a therapist said I needed to be more tolerant -- when I was trying very hard to be tolerant of her.)

Thanks! Lots of good points here. So sad that they have gotten little if any attention by those who practice the "profession". Some of the most harmful things in therapy were comments like the following from therapists: "You'll never get better if you keep seeking the perfect therapist", "You expect too much; that's your problem", "I can't help you if you take everything I say as criticism". It was so rare for a therapist to acknowledge their part in a problem. (I do remember a therapist once saying, "I take responsibility for that distortion" when I called him on his claim that I said something I hadn't said). I naively expected that therapists would set good examples. They sure didn't -- just the opposite. I would feel ashamed if I treated other people the way they often treated me.

Good point. Telling it to the therapist is usually like talking into a black hole. Trying to file a complain can (in my experience) result in just getting a run-around -- this agency says you need to report it to that agency, etc.

I looked at the Very Bad Therapy website again today. Episode 65 (When Treatment Fails (with Henk Spierings, who has written a book, Becoming Compliant ) is really good -- I recommend it highly. An overarching theme is that therapists need to ask clients questions like, "Is this working for you?". I remember that in my therapy experience, therapists never seemed to ask, "Does this make sense to me?" And, more often that not, what they did didn't make sense to me. They just seemed to be off in a fairly tale world, disconnected from the real world that I live in.

Yes, therapists tend to take advantage of our naivete and how the strength of our hope to change for the better can blind us to their questionable practices.

I think the therapist's behavior was extremely unethical. I'm so sorry that you (and, sadly, so many other people as well) have had to put up with such behavior. I wish that we, as a society, could somehow prevent these things from happening in the future. Unfortunately, I think therapy might always remain a "buyer beware" situation. But at least now, with the internet, we can at least to some extent publicize instances of therapist misconduct, which hopefully can help at least some clients experiencing such therapist misconduct to quit before too much harm has been done. I appreciate your effort to make your case public. I hope that posting the link to your website on this site can help more people to find it and help them (and others) to act at the first sign of therapist malfeasance to at least try to prevent future harm by their harmful therapist.

Today I did some more browsing on informed consent in therapy. One side I found (http://www.drlaurabrown.com/media/PsychotherapyConsentForm.pdf ) had something that I don't think I ever saw in therapist informed consent forms before, but that sounds like something that should be included: "IV. Other Rights You have the right to ask questions about anything that happens in therapy. I'm always willing to discuss how and why I've decided to do what I'm doing, and to look at alternatives that might work better. You can feel free to ask me to try something that you think will be helpful. You can ask me about my training for working with your concerns, and can request that I refer you to someone else if you decide I'm not the right therapist for you. You are free to leave therapy at any time. " This seems to express a therapist perspective that is unlike most of my experience with therapy (as described in my preceding post in this thread.)

Yes. Some quotes from that section that show this (with my comments in square brackets): "One suggestion is to Choose wisely: I would say ask for recommendations if you can, and if the person's not right for you, say so, and ask if there's someone else you can see (Service User Testimony 9)." [This needs more detail to be helpful. For example: "Ask for recommendations if you can" is not helpful if the person has no idea where, whom, or how to ask for recommendations. So to be helpful, this suggestion needs information on whom to ask, how to find out who to ask, and how to decide if the person is right or not.] "Stop Therapy, or Tell someone" [The client quote for this starts, "I am lucky to have had a good support network. My husband has been a safe haven of love and support." Not everyone has a good support network, nor a loving spouse. So for the "suggestion" to be helpful for such a person, it needs to go into some detail about how to find someone suitable to tell or otherwise be supportive] [This suggestion also says, "This theme also includes the client telling the therapist about their experiences of therapy." Unless the therapist is very open-minded, this may be counterproductive. When I've tried telling therapist that I thought I was getting worse in response to therapy, I've gotten replies such as, "You expect too much; that's Your Problem", or "You'll never get better if you keep seeking the perfect therapist. ] I could give more examples, but am too tired now.

I haven't been following the Very Bad Therapy podcasts lately, but I just listened to a recent one which is very interesting/good: : https://www.verybadtherapy.com/episodes/episode-60-vbt-in-history It discusses recent developments in evaluating research quality, which shows that a lot of research in psychotherapy makes claims that are not sound. (A heads up: The podcast is close to an hour -- I think earlier ones were around 1/2 hour)

To continue: Client-directed, outcome informed therapy does seem to take this approach. For more information, see https://www.slideshare.net/scottdmiller/what-is-client-directed-outcome-informed

I agree with most of what you say, but take issue with this: " What they need to do first and foremost, before allowing anyone to start practicing anything, is to understand mental illnesses, the etiology of them, and how to objectively diagnose them without fuzzy and mostly subjective questionnaires. " My problem with this is that I think what you describe is most likely impossible, simply because there is so much variation between individual human beings. So I think that one thing therapists need to do is to refrain from the believe that they "understand" people or mental illnesses. Instead, therapists need work with the client to work toward goals that the client thinks are worthwhile (unless, of course, the client's goals are unethical, in which case the therapist needs to tell the client that.)

I just came across a website with the title above. Scrolling down a bit, I came to the sentence, "Male or female, therapists do not judge you. They want you to feel free to be yourself and say what’s on your mind without mincing words." This does not at all describe my therapy experience. So often, in my experience, when I tried to express myself honestly, I was met with disapproval, or a shocking reply. The thread https://therapytheclientside.invisionzone.com/topic/246-client-therapist-relationship/ has a number of examples of therapist behavior that doesn't fit with the quote above.

Yes, I also encountered very little informed consent. I think it was the fourth therapist I tried who was the first to have an informed consent form. But it only covered fees, lengths of appointments, and cancellation policies. Nothing about the content, goals, processes, etc. IN addition, when I asked therapists why they were doing what they did (e.g., asking why they were asking a particular question), I got responses like, "I have my reasons," "Because that's what you need," "Are you sure you're not trying to second guess me?', "Do you realize you're asking me to give up my control? Those to me are all unprofessional responses. There was one who had a fairly lengthy informed consent form. I read it over, and said I wasn't willing to sign it, because it seemed to be signing away my right to informed consent. He lost his cool a little, and said, "Where does it say that?" and I replied with something like, "It doesn't say that explicitly -- but right here it says that you will ask a lot of questions, and I'm not willing to give blanket consent to your asking questions -- I only consent to your asking questions that you have a good reason to know the answer to, and that are accompanied by that reason-- and if you respect my right not to answer if I don't think your reason is good enough." To his credit, he accepted my objection, and I signed an altered form adding something like my right to be given reasons and to refuse to answer if I did not consider the reason good enough.

Yes, the jargon/lingo can be a real problem. Adding to the problem, in my experience, therapists often are not very good at defining their terms. I remember one occasion when I asked a therapist what she meant by a particular word, and she gave a response something like, "To me, it has connotations of X." Not very informative.

Today I came across a (fairly recent-- 2019) article called "How Does Therapy Harm?" It starts out with a lot of gobbledygook about theory and methodology, but the part following Figure 3 seems worth reading, since it includes a lot of quotes from clients or otherwise describing clients’ negative experiences.

Welcome! I hope this site can help you recover from your counterproductive therapy. No need to apologize for a short post.

To me, the idea of a "perfect" therapist just doesn't make sense. I find it hard to imagine a program where the selection of preferences to be input would result in a "good fit" for all clients -- the list of possibilities might be adequate for many clients to create a good enough fit, but a list that was adequate for all clients to create a good enough fit seems very unlikely. (It might conceivably be possible to create an "adaptive" program, which would start with a list of preferences set by the developers, but then have an "adaptive" capability to ask prospective clients to suggest preferences not on the list, and then to incorporate these for future potential clients -- but I think this would be a very difficult undertaking that at the very least would take years to "learn" to give a good enough fit for even a simple majority of clients.

The problem with this is how "virtual" therapists could be created to be specific to the needs of a client's issues. It's not just the human emotional flaws of therapists that cause client harm -- it's also therapists' ignorance and poor thinking skills. So no one but a perfect human would be able to create a good "virtual therapist". Virtual therapists would reflect the flaws of their creators.

Good point.

Repeating a quote from the article that Here Today' quoted upthread: " 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." Thinking about comparing and contrasting this with therapy: In the situation in the quote, the actual CAT scan was available to be double-checked. In psychotherapy, there is nothing as concrete or objective as a CAT scan that could be double-checked. So the possibility of having mistakes persist (rather than being corrected) is much less than in medical treatments. In other words, there is much less of a chance of discovering a "near miss" than in medical practice, and there is a greater chance of making serious mistakes that are not caught.

Here Today, Thanks for your comments. You make several good points. In particular, the following seems spot-on: "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. " This really summarizes something that should be an important part of therapists' training, but that I doubt is even brought up at all in that training.

I agree that strong client resistance should be considered a warning sign that therapy might be heading toward harm. But -- the reality seems to be that therapists use the concept of "resistance" as a method to deflect attention from the possibility that the therapy doesn't fit the client/problem, or that the therapist isn't doing a good job, etc.. Another possible (and perhaps frequent) complication: Therapists may label the client as "resistant" when the goals of the therapy are determined by the therapist, without the agreement of the client. It's irrational to push a treatment on the client that the client doesn't it makes sense. Therapists so often seem to think of themselves as gurus, insightful, etc.-- when they look like The Emperor Who Has No Clothes to the client. (I wonder how many therapists have even considered the possibility that they may appear to the client as The Emperor Who Has No Clothes, or a bull in the china shop, or as just out of it; not in touch with the real world the client lives in. I doubt that many ever even think of these possibilities.)

Today I happened to hear this radio program: https://www.npr.org/sections/health-shots/2020/06/30/885186438/a-doctor-confronts-medical-errors-and-flaws-in-the-system-that-create-mistakes , that discusses a book called When We Do Harm, talking about mistakes made in medical practice. I couldn't help comparing and contrasting with harm done in therapy. I appreciate the title, since it acknowledges that professionals can do harm. Among other things, the author points out that measures intended to reduce harm sometimes actually open the door to harm. (Note: I think the transcript in the link leaves out some things that I remember from listening to the program.)

You are asking a simple question -- but the reality is not simple, so I can't give a simple answer. In the current system, it is de facto the client's responsibility to find a suitable/good enough therapist. And de facto, there may not be (often is not) a good enough therapist for every person seeking therapy -- some prospective clients may easily find a therapist suitable for them, but for others, there may not be any suitable therapist (let alone one in area the prospective client lives in.) Put more bluntly, the current system is dysfunctional. (I won't say broken, because that assumes that it was at some time functional.) So perhaps another way of saying it is, "Buyer (client) beware." Therapy is not really a "service" industry; it purports to perform services, but (perhaps more often than not) does not provide those services, but just "attempts" at those services.

I see it as very much like religion -- religion can make life better for many people, but even people who find religion helpful may need to try different religions before finding one that helps them. (And, like therapy: religion can be harmful sometimes, even though it can be helpful sometimes.)