Mary S

In my experience, "empathy' is a word that can mean very different things to different people, which is why I have skepticism about its value -- whether or not empathy is helpful depends on what kind of "empathy" a therapist shows -- and different clients may need different types of empathy.

A couple of days ago I listened to the latest Very Bad Therapy Podcast (#28). It featured Chris Hoff, (who has his own website called The Radical Therapist, including some podcasts and UTube videos). The impression I got of Hoff from the VBT podcast was mixed. On the one hand, his general demeanor gave the impression that he was basically a nice guy. On the other hand, some of the things he said were disturbing. In particular, I recall him saying something like "95% of what a therapist does should be asking questions." (I'm not sure this is the exact quote.) That sounded like a one-size-fits-all prescription, that I doubt would work well with me. Indeed, my general experience with therapy is that therapists too often ask questions that seem out of the blue, without giving reasons, or giving unsubstantial reasons (like, "Because there's something I want to know"). That comes across to me as being very authoritarian, and not caring about informed consent. Today I looked over Hoff's website and some of his videos. Most of them turned me off or seemed not of interest to me, but there was one that seemed worthwhile: https://www.youtube.com/watch?time_continue=101&v=gNFnWGamNfM&feature=emb_logo It essentially debunks "attachment theory". My impression (including from Psych Central postings) is that Attachment Theory seems pretty bad, so I'm glad to hear that it has been debunked. (Hoff believes that focusing on resiliency is better -- which makes sense to me.)

I think it's an overreach to say that "they won't ever see eye to eye with their clients?" I think the milder assertion, "It' may be inevitable that there are some clients that they won't see eye to eye with" fits reality better. I'd say that listening respectfully (respecting individual differences) rather than "listening empathetically", because what a therapist considers "empathetic" behavior might in fact show strong misunderstanding of the client's perspective.

I think that for many therapists, "to help people" means "to be appreciated" or to "change people to be what the therapist wants them to be," which might be very different from what the client wants to be, or from being psychologically healthy.

Examples from my experience: "You expect too much. That's Your Problem!" "Are you sure you're not trying to second guess me?" "Do you realize you're asking me to give up my control? "You make things too complex." "You'll never get better if you keep seeking the perfect therapist."

I'd say it's something more like "anybody who works in the therapy profession can't avoid behaving like Freud the Fraud to some degree at some point in their practice because of the nature of their reasons for becoming a therapist and their training".

I just listened to Podcast 27. The first part is discussion with a client who has had several instances of bad therapy. Around minute 30, there is discussion with (Danish?) therapist Jorgen Flor, who has written a book (not in English) about negative effects of therapy. He said that research finds that about 10% of clients get worse. Around minute 40, a discussion of "bad apple" in the profession begins. It points out that clients rarely have information that would allow them to avoid bad apples. Carrie points out that therapists' evaluating colleagues is not currently part of therapist culture. Toward the end, someone says something like , "It's not the patient who fails the treatment; it's the treatment that fails the patient."

Things from this list that fit my therapy experience: "following wild hunches, willfully descending into pseudoscience, covering up his mistakes" '"He made things up as he went along, constantly changing his theories and methods but not making any actual progress towards a successful treatment." " "often worked backward, finding “scientific” excuses for various behaviors and then working to “prove” those theories"

Aargh! Unethical and unscientific. Yes, that's my impression as well. Unfortunately, when I first tried therapy, although I was well-educated in a STEM field and used to critiquing research in my field, I was ignorant of just how sloppy the standards were in psychology. However, I was often appalled by the unwillingness of therapists to give me their reasons for what they were doing -- and also appalled by the reasons they did give on the rare occasions when they did give reasons. It just didn't make sense to me. This is something I was not aware of. I was in my forties when I first tried therapy, so twenty or so years older than the typical reasearch subjects. (Although I'm not sure much if any of what therapists tried on me was claimed to be "empirically supported" -- all too often, it just seemed like their whim. They almost never offered reasons for what they were doing, and when I asked for reasons, they gave responses like, "I have my reasons," "Because I want to know," "Are you sure you're not second-guessing me?", "Do you realize you're asking me to give up my control?", "Consider me to be something like a computer; what you say goes in, mixes around with my training and experience," or "I get the feeling that you think this should be an intellectual discussion" -- with a tone of disdain on the word "Intellectual". They acted as if I was supposed to leave my brain and education outside their office door. My therapy experiences motivated me to learn more about shoddy research practices in a number of fields. This goes beyond the things you have mentioned, including what is sometimes known as "the replication crisis", which pervades the social sciences and is also all too common in the natural sciences. A large part of it is inappropriate understanding of statistical procedures and of when they are or are not appropriate. The Wikipedia article at https://en.wikipedia.org/wiki/Replication_crisis can give some idea of the problem (although there is lots of technical detail left out).

I just came across this article discussing what makes therapy work [when it does] and what types of further research are needed. https://www.researchgate.net/publication/318242080_Common_versus_specific_factors_in_psychotherapy_Opening_the_black_box

I'd say he acted like an obnoxious jackass because he was an obnoxious jackass or maybe even worse.

I listened to episode 26 a couple of days ago. The therapist involved sounds like a real scumbag. The client was a young therapist in training. Her therapy seemed to be going along fine, until one day the therapist (a man 20 or 30 years her senior) said, toward the end of the session, "I'm going to ask you a question. If you say yes, we'll have to end our therapeutic relationship," then proceeded to ask if she wanted to go out for coffee with him. She, of course, was shocked and decided to file a complaint. Later, she got an email from him saying something to the effect that the therapeutic relationship was terminated. She noticed something that said that the email would expire in a short amount of time, so she took a screenshot if it to support her complaint. I can well imagine that this type of behavior would have been even more devastating to a client who wasn't as familiar with the ethics of therapy. (I see that the next podcast is up -- the topic is "The Negative Effects of Therapy", which is something quite important to me.)

I don't really think the author (authors?) of the book I read were trying to "sell" therapy in the sense of promoting their business -- I think they were "selling" it like a religion that they fervently believed in -- they were promoting their beliefs, not their business.

Yes, communication was a real problem in my attempts at therapy. I had trouble putting my (often complicated) thoughts (let alone emotions) into words orally on the spur of the moment. (With writing, I can look at what I've "said", think about whether or not it is what I am trying to (or need to) say, and revise.) But the therapists sure didn't set a good example of good communication, nor did they do anything to help me communicate. They were so quick to criticize -- but not constructive criticism, just "lashing out" type criticism. Or maybe it wasn't criticism so much as a knee-jerk "wanting to win" response. Whichever it was, it sure wasn't helpful. (Actually, that's an understatement; it essentially sabotaged any possibility of helping me.) Therapy was harder to cope with than the situations that I came to therapy for help in coping with.

Yes, I gave the therapists too much benefit of the doubt. I had read a book on therapy and naively thought it was an accurate description of what therapy was. (It described therapy as "a nurturing experience" -- but there wasn't anything in my therapy experiences that I could call "nurturing". Yes, my experience was also that therapists didn't explain what they were doing or why, or ask permission. Saying "I'm going to try something different on you today" really sounds like he sees you as an object or a toy to play with. That attitude was very common in my therapy experience.

When you go to therapy in large part to learn to cope better with personal attention, having unnecessary personal attention tossed at you at the therapist's whim doesn't seem like an appropriate form of treatment . When I told my worst therapist I was somewhat shy, she said, "You gave up your power." Not appropriate, in my opinion. My experience was that therapists didn't ask for feedback, and slapped me down when I tried to give it on my own initiative. The idea of asking for feedback is fine with me, but I don't see why it has to be in the form of asking the client about how they are feeling. To me, that approach is very (and unnecessarily) intrusive; the opposite of user friendly for me. I would be glad to give feedback if it were framed as giving my perspective, or my evaluation, or my assessment, or my opinion. They also react with resistance (Defensively? Perhaps with the attitude "The best defense is a good offense) when the client takes the initiative to offer feedback or (especially) ask why they are doing what they are doing. Examples of such resistance: "Are you sure you're not trying to second guessing me?" "Do you realize you're asking me to give up my control?" "I resent that" "You'll never get better if you keep seeking the perfect therapist." Yes, students preparing to be therapists need to be taught these things. But it needs to be emphasized that these are things to apply to themselves. I have had some instances of a therapist telling me I have used faulty logic when in fact the therapist is saying I said something that I didn't say. So careful listening and not jumping quickly to conclusions are also things therapists need to learn.

My point in the original post was that the later therapists might have been able to help me if they had been the first ones I had tried -- but that after my experiences with the ones that I did try before them, I was in far worse condition than when I first tried therapy, so my experiences with the earlier therapists made me a more difficult client to help than I was when I first tried therapy -- for example, I wasn't as trusting, and went to the later therapists with a greater fear of therapists -- and had all this extra baggage (from the counterproductive therapy experiences) on top of the original stuff I went to therapy for -- in fact, I think the "extra baggage" was a bigger problem than the original problems I went to therapy with. I don't have any criticisms of them for not listening to me or not knowing how to communicate effectively with me. But I think that most therapy training doesn't help therapists deal with clients with the "extra baggage" from extremely bad previous therapy. Possibly the therapists trained in "feedback informed therapy" might have had a better chance of helping me.

A therapist who tried "to bring a spirit of excitement to the relationship, ... [A spirit] that I can’t wait to come and have another session with them because there’s something about them that I find intriguing, something I want to learn and there’s something that I’m really excited to continue discussing with them,”" would really turn me off. If a therapist shows excitement or finds me intriguing, that to me is a boundary violation -- a form of treating me as an object; of putting their interest or excitement above respecting my boundaries, of using me to gratify their greedy desires. I find it disconcerting that the author seems to put acceptance and excitement together. Acceptance (as long as it is acceptance as other, rather than acceptance into their world) is OK, whereas excitement is not -- it is using me.

I'm still not clear on what you're asking. By "those more open-minded therapists" are you referring to the couple of therapists in this quote: "I did find a couple of therapists that seemed open to differing opinions; possibly if I had gotten to them first, I would have gotten at least somewhat better rather than worse."? If so, I really don't know how to answer your questions about them.

This seems like a pretty good article on client-therapist relationships. Some encouraging excerpts: "one key to effectively addressing a client’s issues is to first understand those issues within the context of the client. “It’s critical for the counselor to learn the client’s worldview in order to enhance cooperation in the counseling process,” ... When counselors diagnose the problem and launch into a prescribed method of treatment without first discussing the client’s concerns and goals, they are likely to be met with resistance," “Meet the client where they are. ... This is true even if this means spending five minutes on topics that are important to the client that may not be directly related to the reasons they are coming into counseling.” "Hitting roadblocks But sometimes, despite attempts to offer respect, validation and space, client and counselor still don’t click. Is it time to throw in the towel when both the client and counselor are frustrated? Not necessarily, says Guterman, who reiterates the importance of first learning the client’s point of view. In such situations, he recommends that counselors again ask themselves if they have made their best effort at thoroughly understanding the client’s worldview. If that’s not the problem, Guterman suggests evaluating the pace of the counseling sessions’ progress. “Are you pacing with the client? All clients are different, and some clients prefer to go slow,” he says. “You [the counselor] may be solution focused, but if you go too fast, the client who is very problem focused may think that the problem is being stolen away from them.” Even counselors who have absorbed a client’s worldview may forget that it is the client who ultimately is in charge. The client will define the goals that he or she would like to achieve. “Let the client determine what is most important,” Ostrowski advises. “Sometimes what seems small to a counselor may be the most crucial element of what is happening in a client’s life right now.” "In cases in which a lack of therapeutic alliance exists, it is always tempting to look at the client as the source of the problem, but counselors should also look in the mirror, Guterman says. “We always tell our clients the only one you can change is yourself. This applies to us counselors too,” he asserts. “If we’re not connecting with our clients, what can we do differently?”

Eve, I'm not clear on what you're asking.

Sad to say: I think that one of the most important things for a therapist trainee to learn is how to answer challenging, rock-the-boat types of questions. I think a big part of my therapy being harmful was that I asked challenging, rock-the-boat types of questions (innocently not realizing that they would be so challenging and rocking-the-boat for the therapists) and was shocked at the responses I got. The therapists so often seemed authoritarian -- which I think is the opposite of what a good therapist should be Clients are very diverse, and an authoritarian approach assumes that "one size fits all". The therapy models often seem like fundamentalist religious beliefs to me. I guess in that metaphor, I was like an atheist. (I did find a couple of therapists that seemed open to differing opinions; possibly if I had gotten to them first, I would have gotten at least somewhat better rather than worse.)

Good points -- although I don't recall their saying explicitly that the harmful experiences are uncommon. And there is also the matter of considering both "How uncommon" and "how harmful" For example, if it's relatively easy for a client who has had very bad therapy to find a better therapist and relatively easy to get over the harm, that is not as bad as if the harm is serious (e.g., leads to suicide, when there had been no risk of that before therapy). So there needs to be a more detailed study of types of harm and seriousness of each type of harm. Actually, it is sad that graduate students are left to do this work -- more professors in universities should be doing more of it. (Some of them have -- e.g., Lilienfeld). I recently had an email discussion with Ben, (in response to his thesis) in which he said, "I believe that our field is constructed in a way that some clients simply won't benefit from what we have to offer" -- but he didn't really seem receptive to suggestions for changing the situation, nor did he offer any suggestions for how to improve the situation. (But he hasn't responded yet to my most recent email, so perhaps that will give some additional information.) Also, since he is hoping to extend this work with collaborators, he might be starting something that others do take up. We will see.

True -- but a small community is better than no community at all. I hope the community continues to grow.

The Vary Bad Therapy podcasts have gotten some press: http://www.scottdmiller.com/very-bad-therapy-and-how-it-can-make-you-a-more-effective-therapist/