Mary S

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

2 hours ago, PsychoLogical said:

... When I read statistics on how many people are afflicted with depression and "the economic cost" of it being in the billions of dollars, and how there's so much "lost productivity" and job-related expenses lost to mental illnesses, it makes sense that they would ship people off to therapists or psychiatrists, oftentimes in conjunction, because both of those fields claim to be able to effectively treat mental afflictions. They want to get people back to work as quickly as possible. Once again, not because they genuinely care about improving people's lives, but because of the profit motive. Problem is, what if part, or even all of the cause of so much mental anguish and suffering is due to our very society itself? Well, since most people in power would rather die than willingly give up their money and their control, they would never want to fix the problems in society. Better to "fix" the millions of people who are depressed because of society's corruption. Of course, it's never a fix, but more like acclimating a slave to his cell and making him comfortable there and teaching him how to accept his lowly conditions and never hope for anything better, so that after a while he will believe that's the best life will ever get, and eventually he'll forget to even imagine breaking free and changing things, so that the masters can leave the cage door open and he will never think of leaving it, or if he does leave it, he'll be too scared to go far, or to run away at all. So what we have are so many suffering individuals, who are rightly hurting, who are not truly being helped by anyone, and the entire system continues chugging along, seemingly improving people's lives, while not transforming anything for the better. Why is it that now more than ever, we have access to a multitude of different therapists, and therapeutic techniques and methods, yet rates of depression and other mental illnesses are skyrocketing, not declining? If all the medications and therapists out there were really helping people as they claim, wouldn't we be seeing rates going down?...

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.

26 minutes ago, Eve B said:

How would it be possible to collect more accurate data regarding true positive and negative outcomes, then?

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

5 hours ago, zygomaticus said:

What isn't being tested in all of the research, from what I can tell, is just how much of a factor clients seeking to please their clinicians by reporting improvements is, or indeed if and why clients might feel pressured to report positive results. my pet hate is what I consider to be coercive and manipulative practices like operant conditioning: if you repeatedly get punished for reporting no improvements, isn't there a potential for ultimately telling the clinician what they want to hear, if only to get them off your back? I personally suspect these are meaningful factors that contribute to positive results and hence skew the figures. Without such misleading reporting, presumably the efficacy rates for clients getting better and staying better would be even more woeful than they already are.

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).

13 hours ago, Eve B said:

So this author is saying that psychotherapy is still effective despite flimsy evidence? Since psychology is really a pseudo-science anyway, I guess that kind of wishy-washiness is fitting.

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.

2 hours ago, Eve B said:

But wouldn't the general public assume that a PhD means the therapist should be more knowledgeable and effective simply because of the higher degree and fees of service? 

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.

21 hours ago, Eve B said:

Could it be the PhD education (not the therapy itself) that convince people therapists should be sufficiently knowledgeable to offer solutions? I think the public generally sees therapy as just talking to somebody who will listen to their problems and provide advice.

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

7 minutes ago, Eve B said:

Extroverted therapists would also be more likely to have arrogant personalities and violate client boundaries!

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.

On 2/18/2020 at 8:51 PM, Eve B said:

Let me try to play devil's advocate by asking how do we explain the people who say therapy has helped them? Are they just deceiving themselves too? Or, maybe, they've fallen under the influence of subconscious conditioning similar to Stockholm syndrome?

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. "

On 2/13/2020 at 10:18 AM, PsychoLogical said:

... I'm wondering if it's the type of people who are drawn to these professions, or if they actively teach them to abdicate and shirk any personal responsibility for their actions?

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.

On 2/13/2020 at 10:18 AM, PsychoLogical said:

At least with a prostitute you get what you pay for and you know what you're getting. Therapists are glorified prostitutes who can't even provide a "happy ending", literally and figuratively.

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.

2 hours ago, Eve B said:

 Showing interest usually means they're more motivated to be helpful

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.

7 hours ago, zygomaticus said:

I like the aspects that are client-centred, but I always question the sincerity or plausibility of the kinds of sentiments stated in the article. For instance, the reaction of intrigue and excitement in the face of a client that he recognises as despising him. This is not a normal reaction, this is the response of the lab technician observing the lab rat. This is clearly turning the client into a subject. The kid despises you, yet you ignore that entirely and get excited by the challenge to 'get through'. What authenticity is there in such a response?

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.

On 11/20/2019 at 5:21 PM, Eve B said:

"A small percentage of clients experience negative effects from therapy"-- I wonder where they got those statistics when the reality is probably more than a small percentage that aren't reported.

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

3 hours ago, Eve B said:

Yes, I wish this could be made mandatory and implemented! The concern, however, would be those unethical clients who would abuse it to get "revenge" against their therapist. It's easy for both sides to feel personally wronged in therapy because of miscommunication or poor communication. I suppose these evaluations would need to be carefully worded so that only facts are presented and not emotional reactions?

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.

9 hours ago, Eve B said:

What good are changing the training programs if how therapists practice behind closed doors can't really be monitored and enforced, though? The privacy of the therapy sessions ends up protecting the therapist more if the client feels too afraid to file a complaint. Even if these types of improved consent forms are made mandatory, it's unfair that the client would still be carrying the greater responsibility to recognize the therapist's violations and do something about it (terminate and/or report the misconduct). There are also many therapists who believe they're doing what's best for their clients no matter how much the client may insist otherwise.

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.

10 hours ago, Eve B said:

What's the most common reason why a therapist wouldn't do what the client tells them? Can we simply narrow it down to a controlling and arrogant personality? If that's the case, the psych schools should be filtering these types of people out of their programs as much as possible because those are obviously dangerous traits to have as professional caregivers.

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.

On 1/3/2020 at 11:17 AM, Eve B said:

Episode 33- Therapist Violating Client Boundaries

Another example of therapists believing they know better and not listening to what the client wants.

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.

10 hours ago, Eve B said:

Therapists seemed to pay more attention when I said, "I feel that..." even though I'm pretty sure that in the real world, people would usually say, "I think that...." I've noticed myself using "I feel that..." when talking about my emotions to a therapist but then I'd switched back to "I think that..." if the conversation was with anyone else outside of the session room. Maybe it's just part of the therapy language for clients if they want the therapist to be able to listen and connect with them better?

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".

6 hours ago, Eve B said:

Asking questions is helpful to clarify the problem and find solutions. Maybe it's not that therapists need to ask questions but that they're not asking sensible or useful questions appropriate for each client's issues?

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.