Mary S

I've often read that therapists should be warm, or show warmth toward the client. But, to be honest, I don't really know what "warm" or "warmth" are in this context. When I've tried looking it up on the web, I've gotten things about body temperature, or once something about charisma. I don't consider charisma to be a good quality in a therapist -- I think of charisma as something that sucks you in -- a kind of manipulativeness. My own guess is that what some people call warmth (as a quality of a therapist or other person) I is what I might call cloying, or invasive, or disrespectful of boundaries. Can anyone tell me their definition/interpretation of "warmth" in the above quote?

I don't have any evidence of therapists' trying to invalidate my perspective, but I think they often de facto do this, typically in an automatic knee-jerk reaction. Also, I think it's more likely to be showing contempt or disdain for my perspective (or for what's important to me) rather than invalidating it -- more "I don't want to hear about this!" -- pretty childish; a kind of denial thing; a lack of open-mindedness. Doesn't earn my respect for them as professionals (sadly).

Thanks for the link.

I would guess that there are some therapists who consider themselves genuinely good, (or might be considered genuinely good by some clients and/or some other therapist) but might appear to be a manipulative pretender to some other people. And a therapist might be helpful for some clients but not for other clients. It's not a "one-size-fits-all" situation.

I think that one factor contributing to the problem of at-best-mediocre therapists is found at https://blog.prepscholar.com/easiest-majors-college-degrees, which identifies psychology as the easiest undergraduate major (i.e., having the highest average grade point average). This in itself might contribute to the "Lake Wobegon Effect" that has been noted among therapists by Lilienfeld and others.

I just listened to the latest podcast (Episode 18, with Scott Miller). It was very good -- he said a lot of things that make good sense to me. One thing in particular he mentioned was that he thinks that most of the "continuing education" for therapists is useless or worse (not sure if those are his exact words, but give the gist). He also pointed out how it is important for a therapist to listen to and respond to criticism from the client -- in fact, welcoming such feedback is essential for the therapist to make "course corrections" when therapy is going poorly (or even to help the therapist realize that it is going poorly). Another thing I recall is that he believes a big mistake therapists often make is to focus on things like "having a healing relationship" with the client (or other "theory driven" focus).

Hard to say -- partly because I don't recall many instances of this. But an important one I do remember was when a therapist presented me with a lengthy "informed consent" form to read and sign, and after reading it, I said I wasn't willing to sign it because it was essentially asking me to give up my right to informed consent. His initial reaction did seem defensive, saying "Where does it say that?!", and I responded that it didn't explicitly say that, but that signing it would be giving blanket consent to his asking me questions, and that would be giving up my right to truly informed consent, because informed consent would require knowing the reason for each question. He accepted that as legitimate, and I think I rewrote or amended the form to read as something I could rationally consent to. I suppose in some sense this was helpful, because it gave me evidence that he could "listen to reason," rather than give me the type of dismissive response most therapists gave. It was one of the best moments in my therapy experience -- it seemed professional, rational, and in touch with the real world -- things that were usually missing from what therapists did. It gave me a least a moment of hope.

Yes (sadly), "poor manners" all too often describes how therapists treat clients. There are a lot of things in life I'm not comfortable doing, but still do because I think they're important to do. I did sometimes offer criticisms of therapists. Mostly I got "lashing out" or defensive (e.g., "You can't expect me to ...!") responses, but a minority of therapists I tried seemed to at least try to respond to criticism professionally.

Following the link under Episode 18 to Scott Miller' website, I found this discussion (read the comments as well as the original post by Scott MIller) to be pretty interesting.

I think something stronger is warranted, namely: Few therapists have these qualities. Many don't even seem to care about cultivating them. But these would be a good list of things to have clients give feedback on.

I just came across this web site:from 2011: Psychotherapy is effective and here’s why It starts out, "Psychotherapy works, and the science and research are there to back it up, said Bruce E. Wampold, PhD, at the APA 2011 Annual Convention symposium, "Psychotherapy Effectiveness: What Makes it Work?". Then there is a list of qualities of a good therapist. Here are some of them, together with my comments on how well therapists I have tried displauyed these qualities: "Has a sophisticated set of interpersonal skills."" My impression is that the interpersonal skills of therapists I have tried ranged from extremely naive to downright poor." "Builds trust, understanding and belief from the client." Very rare in my experience. Therapists I have tried seem to expect the client to see them as some kind of authority, but seem to have such shallow and narrow views that I can't rationally accept them as authorities. Has an alliance with client. Oh, I wish! But we seemed to be on different wavelengths so much of the time. Often it seemed as though we were from different planets. Has an acceptable and adaptive explanation of the client's condition. Not in my experience! Explanations were few and far between, and typically were either shallow or seemed off in a fairy tale world. Has a treatment plan and allows it to be flexible. No therapist I tried ever mentioned having a treatment plan. Some were a little flexible, but some were anything but. Is influential, persuasive and convincing. Maybe some tried to persuade me, but their attempts were not persuasive --they typically seemed either shallow or out in left field. Monitors patient progress. Not that I was aware of. Offers hope and optimism (realistic optimism, not Pollyanna-ish). Nope. Is aware of a client's characteristics in context.What therapists "reflected back" to me about my characteristics had little or no relationship with what other people I interacted with "reflected back" to me. Is reflective. Some (a minority) were a little reflective; most were all too often like, "My mind is made up; don't confuse me with the facts"

I've listened to parts of Episode 15. It's mostly about child therapy, but it starts with a discussion of ethics -- focused on a question that Ben asks Carrie: What would she do if Richard Spencer (a Neo-Nazi and white supremacist) wanted to engage her services as a therapist. He (or maybe Carrie? or both?) seemed to think that there is a principle that therapists should not deny services to a prospective client just because the prospective client's beliefs or behavior conflict with the therapist's values; that the therapist should be willing and able to work with clients not sharing their values. (For example, a therapist should not turn away a gay client if homosexuality is contrary to the therapist's values). Carrie seemed to be inclined to say no -- which is what I would hope a therapist would do if they had strong values that conflicted with my values (because I sincerely doubt that any but a truly exceptional therapist could do a good job of helping me if they had values seriously in conflict with mine; indeed, I think that such value conflicts were big contributors to my "bad therapy" experiences.) What do others here think about this?

Brings to mind the time my worst therapist said, "Transference has occurred without my intending it to." Duh ... I don't think she had a clue as to how out-of-it she sounded. She seemed to be clueless that she was clueless.

An excerpt from another post (http://www.karolinawalsh.com/blog/2017/9/14/046-being-a-therapist-is-about-letting-go ) in the same blog as above: "Every day that I work with clients, at least once, I try to control the direction of the session. This can look like having a brilliant insight and I want to share it with them. I notice something and I am sure that it is the missing piece of the problem they have been working with for so long. They want to go in one direction and I want to go in another. Some problem I have “overcome” is presenting in my client and I want to tell them what to do so they can have the same insight and healing as me. While all these insights and desire to help can be used in a skillful way to support my client, without a lot of awareness we as therapists can really delay their healing via this meddling. As therapists we all do this. Mentors of mine who have been practicing for decades do this, new therapists do it (but sometimes less because they are more humble!), and of course midlife therapists do this so much because we really think we know what’s best! This is part of the journey of moving from the identity of “healer” to a more fluid state of allowing healing to flow through us. The difference is one of nuance, of subtly. And the means to allow this subtle state is through letting go. ... We are not there to add techniques, but to help in navigating through the landscape of their internal organization. ...we might as helping professionals take a more humble stance and move towards trusting the healing already inside our clients rather than our idea of what needs to happen for them. Also, being willing to tell your clients when you were trying to control, or meddle in their process is extremely healing!"

I just found a therapist's blog post that discusses therapists gaslighting clients, and tells therapists what they can do when they or their client catches them gaslighting: "If your client calls you out you can gaslight them and say, “No I’m not mad!” When in actuality you are frustrated, confused, and have a boatload of countertransference going on. Another option would be to say, “Yes, I have some frustration arising because I have an agenda with you to move through this pain and I think I have the answer for you. And I realize that my agenda is causing some struggle in me, and seems to be disrespectful of your own journey and choices. How is that to hear from me?” If you are willing to really share the truth about your experience then there is an option for repair, deepening of relationship, trust, and love. If your client does not call you out, but you notice what’s going on, call yourself out!"

I recall reading about a study where the therapists in the comparison group were forbidden from professional behavior such as answering clients' questions about what they were doing and why. (Although my worst therapist, even though I wasn't in a clinical trial, essentially refused to answer questions about what she was doing and why -- instead, she responded with things like, "Are you sure you're not second guessing me?", "Do you realize that 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.") Aargh! Sure sounds unprofessional to me.)

Thanks for mentioning Theo Dorpat -- I hadn't heard of him or his book (In case anyone else is interested: https://www.amazon.com/Gaslighting-Interrogation-Methods-Psychotherapy-Analysis/dp/1568218281). The book sounds like something I should get and read.

I'm not sure I would welcome everything that could make a therapist "more human". Some therapists' "human" qualities can be pretty undesirable ones (e.g., a tendency to lash out when they are criticized or challenged). But the "emergent" vs "contrived" point is a good one.

I think that incompatibility in terms of values is at least as important as incompatibility in terms of personality (although the two may overlap.) But, yes, the gaslighting (which I think a lot of therapists don't realize they are doing -- they may just see it as asserting their boundaries) is very counterproductive ("Very stressful" is not strong enough; therapists need to be aware of when they are gaslighting, and nip it in the bud -- or at least apologize for it when they do it.)

My experience was that I went into therapy with a good sense of what was "healthy meaning and purpose" for me, but the therapists didn't seem to care at all about that. I had hoped that therapy would help me be better at learning to live and behave in ways that were consistent with my values. But the therapists typically seemed not to give a damn about that; we had such strong conflicts in values. It wasn't a matter of "finding answers for myself," nor of "exploration" but of developing better skills and better habits. Therapy didn't seem to address this at all. And, by and large, therapy wasn't a supportive space -- it was more like a place where someone puts sand in the gears; the therapists were more obstacles to meaningful progress than facilitators of it.

My impression is that many therapists who say they are "eclectic" just use a small number of models, and may have their own "interpretations" of the models, and may draw from more than one model to make their own model -- which may not fit many. I think that a client-friendly type of eclectic model would involve the therapist first understanding and correctly* identifying the client's problem(s), then telling the client which models are aimed at/believed to be (at least somewhat effective ) for those problems, explaining what the pluses and minuses are for each option, then letting the client decide which the therapist should use (or perhaps collaboratively creating a composite model that the client finds better than any of the "existing" models.) * By "Correctly" here I mean in part that the client agrees with the "diagnosis".

"consider to be statistically significant," is part of the problem; and another part of the problem is that most practitioners don't really understand what "statistically significant" is -- it's a very technical definition which, if parsed carefully, has a lot of if's, and's, and but's. But most people take it to mean something like "proven" and, and you say, draw inferences of "one size fits all" when it may fits only a minority. (Somewhere on this site there was a quote to the effect that 40% to 60% of people in clinical trials improve. I wonder how many therapists tell this to clients. Also, how many get worse or develop other problems from therapy? My impression is that this data is rarely if ever reported.)

Sad. Another problem I have with rigid behavioral methods is that practitioners may assume a "One-size-fits-all" approach to what is positive and what is negative. For example, a lot of people think that what I call fussy personal attention is positive reinforcement. It may very well be for some people, but for me it's something negative if i"m on the receiving end of it. It makes me want not to engage in the behavior that prompted it.

This makes sense to me. (In contrast: Most things therapists said or did in my experience with therapy did not make sense to me -- and the therapists typically didn't seem to care whether or not what they did made sense to me.)

Thinking more about the empathy/compassion thing, I’ve come to the conclusion that what I would prefer to either the empathy or compassion perspective is the perspective of being considerate. My reasons are: 1. “Empathy” and “compassion” are both something that a person has, whereas “being considerate” is something a person does. This puts an emphasis on the personal qualities of the therapist (tending to make the therapist something like a guru with magical powers), whereas I think it’s the therapist’s behavior that makes or breaks therapy. 2. Both “empathy” and “compassion” (which literally means “with passion” or “with feeling”) are both upfront (and often in-your-face) about emotions. This emphasis seems likely to promote the snap judgments that I have found so counterproductive in therapy. 3. By contrast, “being considerate” involves considering alternatives, options, perspectives, pros and cons, combinations of factors. It involves more thought, more caution, and more taking complexities (including uncertainties) into account. It involves deliberation. This to me is strongly preferable (more in touch with the real world in all its complexity and uncertainty) to the “snap judgment” behavior that has been so counterproductive and so limiting in my therapy experience.