Mary S

See also https://www.cbc.ca/news/business/business-climate-strike-1.5293916

The combination of craving power and using "metrics" (such as monetary gain) just fosters a dominant/submissive relationship, whether boss/employee or therapist/client. Economists and therapists are both off in fairy tale worlds.

The first step is for the researcher to care about negative outcomes, ask about them, and respect clients' negative feedback.

Good point. I also suspect that "getting worse" is not tested for (or at least only a limited type of "getting worse" is recorded, while the client might be getting worse in other ways that are consequences of the therapy but not asked about, and dismissed if the client brings them up).

He is criticizing the types of therapy that are called "evidence based" (e.g., cognitive-behavioral). However, he seems to be an advocate of psychodynamic therapy. Note that he does use the word "efficacy" in promoting it, which seems to be a waffle-word. I did glance at his paper on it, but haven't read it thoroughly. I might get back to it at some point, but the glance was not inviting.

I just case across this paper in the Show Notes for Very Pad Therapy podcast #41: https://jonathanshedler.com/wp-content/uploads/2018/05/Shedler-2018-Where-is-the-evidence-for-evidence-based-therapy.pdf . It seems very good. However, it may need to be taken with a grain of salt, since the author has also written an article called The Efficacy of Psychodynamic Psychotherapy , which I have not yet read.

That may be. Working under the assumption that more education was better, I first tried two therapists with Ph.D.'s, then one with an M.D.. They were all pretty bad. At some point I tried one with just a master's degree, and she was really, really bad. Of all the therapists I tried over the years, the two best had Ph.D.s. Possibly if one of them had been the first therapist I tried, they might have been helpful. But after a few really bad therapists, I was in so much worse shape than I was initially, that although I appreciated (and still appreciate) some of what they did, it still didn't undo the craziness/damage from the earlier therapists.

I don't think it's the Ph. D. education. A lot of therapists don't have Ph.D.'s. Here's a website discussing considerations as to which type of degree someone wanting to be a therapist might consider: https://www.psychologytoday.com/us/blog/careers-in-psych/201606/masters-vs-doctorate-in-clinical-psychology

It sounds prejudiced, but I am inclined to agree with you. Also, this reminds me of a phrase, "push back" that I have noticed in some of the Very Bad Therapy podcasts -- as when the therapist "pushes" and Ben or Carrie asks if the client "pushed back". Maybe "pushing back" doesn't come naturally to introverts, and perhaps extroverts just assume that if they push, the pushee will push back.

People vary tremendously. It makes sense, just by luck of the draw, that some people are helped by some therapists. Part of why I tried therapy to begin with was that two friends of mine had found therapy very helpful. I think there needs to be some serious study of what type of people are and are not helped by therapy. One possibility that comes to my mind is that extroverts are more likely than introverts to find therapy helpful. This is just speculation, but is partly based on the following two observations: 1. The two friends of mine who found therapy helpful were extroverts, but I am an introverts. 2. It seems that a lot of the participants in this forum have described themselves as introverts. Of course, there might be something more complex going on: For example, it might be the case that introverts are more likely to be helped by an introverted therapist -- but since introverts are in the minority in the general population, I would guess that they are also under-represented in the therapy profession, which would imply that the chances of an introverted client having an introverted therapist are lower than the chances of an extroverted client having an extroverted therapist.

I just posted a comment at https://therapytheclientside.invisionzone.com/topic/250-respect-focused-therapy/?tab=comments#comment-5584 that seems relevant to this thread.

oops -- "to be play a part in the therapist's fantasy." should be "to play a part in the therapist's fantasy. "

I think it's some of each -- or, to look at it another way, it is a "culture" that attracts people who crave power, people who crave intimacy, people who are off in their own fantasy worlds (or "in denial"), and people who not willing to take responsibility for their part in a problem. And the culture seems to be self-perpetuating. It is all too often parasitic rather than helpful to clients. There are some therapists who ask for client feedback and take it seriously, but they seem to be a small minority. It really is caveat emptor, sadly. I sometimes think of some therapists (especially those who crave power and/or intimacy or have other fantasies) as people who expect the client to pay them so that they (the therapist) can use the client as a prostitute to be play a part in the therapist's fantasy.

I"m skeptical of this. It may be the case with some therapists, but I think a lot of therapists focus on what they are interested in, which sometimes coincides with what the client is hoping for help with, but which often does not. When the latter is the case, the therapist's pursuit of their interest is just using the client to pursue the therapist's agenda/whim/whatever, and perhaps failing to even try to help the client with what they came to therapy for -- and that is a boundary violation! The client has a right to informed consent/refusal -- in particular, the client has a right to refuse to answer questions that aren't relevant for helping them, and the therapist has the responsibility to respect the client's boundaries. In my case, I went to therapy largely to learn to cope better with intrusive thoughts of people behaving intrusively toward me. Therapists' asking me questions because they were interested or curious (along with their tendency to tell me what I liked, wanted, felt, or thought) made the problem worse, not better. My problem (and big part of me) just wasn't on their radar; I was de facto just an object for them to do whatever they chose with me.

I think excitement toward a client can indeed be authentic for some therapists -- I see it as a type of voyeurism. I remember one "phone interview" with a prospective therapist. I said that I didn't like being treated as an object of interest, and he replied (with a snarky tone of voice), "Why do you think I went into this pr0fession?" I didn't find it as shocking as I would have if he were the first therapist I tried, but it still seemed shocking to me.

Good question. I tried looking this up on the web, and did find one somewhat interesting article: https://www.madinamerica.com/2018/08/new-study-investigates-negative-side-effects-therapy/ Another at https://www.sciencedaily.com/releases/2017/02/170207092804.htm And https://thepsychologist.bps.org.uk/volume-21/edition-1/when-therapy-causes-harm

I'm not sure that evaluations could be worded "so that only facts are presented and not emotional reactions". Probably they would be best with some questions worded to focus on facts, but others worded to allow clients to express emotions. (I recall reading somewhere that this is often done in wording evaluation forms for professions where they are required, to be able to distinguish emotional reactions from facts). Also, if there are emotional reactions that result from miscommunication or poor communication, that in itself may indicate that the therapist needs more work on facilitating good communication.

Good point. I think changing the training program as I suggested might get through to some therapists, but there will always be some who don't care about accountability. So I think some measure of accountability is needed -- something like requiring clients to give therapist evaluations, which would be sent to a review board, which would have the power to discipline the therapist, or require further training or supervision -- kind of like how a college professor might be called on the carpet if their teaching evaluations are consistently bad. But this would require a serious change in the profession itself -- which I think is needed, but is not likely to happen.

I'm very skeptical that speculating on causes (e.g., "a controlling and arrogant personality"), and then trying to filter people with these traits out of therapist training programs would do much good. First, the speculating about causes can be pretty iffy; second, being able to reliably detect things like "a controlling and arrogant personality" is also pretty iffy. I think a more effective solution to the problem would be to put a strong emphasis in training programs on the client's right to informed consent as an ongoing process. This would include the following (and probably other things that I may have overlooked): 1. True informed consent involves the right to informed refusal as well as informed consent. 2. A good informed consent form does not just list a bunch of things and ask the client to sign it, thereby agreeing to all of the things listed. Instead, it needs to provide both "yes" and "no" options (and perhaps an "It depends" option) for each item listed. 3. A good informed consent form gives reasons for each item listed. 4. A client has the right to change their mind on whether or not they consent to something. 5. A client has the right to add additional items that they do not consent to.

It's worse than just "not listening to what the client wants" -- it's doing things that the client has explicitly said, "No" to.

The interviewee's experience in Episode 31 is a good example of a therapist who takes the attitude, "My mind is made up; don't confuse me with the facts" (that I so often encountered in therapy): The interviewee went to therapy when he was fifteen, shortly after his grandfather died, at the urging of his grandmother, who thought it might help him get over the grandfather's death. The therapist noticed that the client had a tremor, and seemed to think that he was in therapy because of the tremor. The client explained that he had had the tremor from birth and that it was neurological in origin. However, the therapist seemed to keep coming back to the tremor, for example, saying that psychotherapy might be able to reduce the severity of a tremor.

I sometimes think of therapists as "feelings vultures". Once my worst therapist said, "I get the feeling you think this should be an intellectual discussion," with an expression and tone of disdain or disgust on the word "intellectual". I was shocked, but managed to reply, "I think it should be in part, because I'm in part an intellectual person." That was actually an understatement -- her comment really seemed sexist to me ("Women are supposed to feel, not think", but I happened to be a thinking woman and thought that that should be considered OK, rather than something to be viewed with contempt or considered inappropriate. She claimed to be feminist, but this comment seemed very unfeminist to me.) I sometimes think of therapists as "feelings vultures" -- the word "feel" seems to turn then on, something they seem to crave. It's pretty disgusting to be on the receiving end of -- somewhat like a guy who only cares about your body. It often seems like a boundary violation to me.

I listened to #30. It was in some sense interesting -- Ben and Carrie seemed to be genuinely trying to be objective (non-partisan? Or something like that?). But I still really have that sense of being in a different culture. Things like "I feel that" just aren't normal, natural, or everyday for me. They sometimes talk about the importance of a "therapeutic alliance," but I find it hard to imagine having a therapeutic alliance with someone who says things like, "I feel that". That just doesn't speak to me, and it's not a language that I fit into (or that fits me?).

I looked at one of CHris Hoff's short videos, Cheerleading in Therapy. His position, is that cheerleading is often not a good thing in therapy, since it is judgmental. My own opinion is that I would not care to have a therapist assume a cheerleading role, because it seems pushy and/or intrusive to me. Hoff proposes as a better alternative being curious, and asking questions pursuing that curiosity. He gives examples such as "where are you now" or about "how they are making meaning at the present" I can't agree with him on this point. In general, I dislike being treated as an object of curiosity. -- to me, being asked questions from a position of curiosity is asking me to do the asker a personal favor. In ordinary life, we sometimes do personal favors for others, but I see a therapist asking a client to do a personal favor as a boundary violation. I think that a better alternative than either of these is remaining open-minded. There are some questions that are consistent with being open-minded, and that I probably would not mind a therapist asking, but the example questions Hoff gives do not seem open-minded to me -- they are too focused. Questions that fit this "open-minded" frame of mind include questions that give non-extreme options. For example, "Would it be helpful if I did X, or would that just introduce a complication that would be unhelpful right now?", or "Would it be better if I did A or B, or can you suggest an option better than either of those?" or "Please give me whatever information you can and are willing to give at this time that you think I need to know in order to help you".

Yes, I agree that asking questions *can* be helpful in clarifying the problem (or other relevant things) and in finding solutions -- as well as in increasing understanding. I agree that questions need to be appropriate for each client's issues and background. But so often, in my experiences with therapy, therapists' questions seem off the wall. For example, being treated as an object of interest really turns me off -- so a therapist who says "I'm interested in [something about me]" really turns me off. -- that is a form of using me to gratify their interest, a boundary violation. But, for example, if they ask for a clarification of something I have said (e.g., if I've used a word that has two different meanings), that can be helpful.