Mary S

Thanks for this link and the excerpts! There's something else that I found really interesting in the link - namely, the part from pp.31 - 33. It describes the author's experience with one of his first clients, when he interned at an aftercare facility working with clients who were classified as severely mentally ill. His jjob was to try to help his clients function well enough to keep them out of the mental hospital. One client, Peter, engaged in bizarre behaviors in an attempt to distract himself from the "voices" that told him scary things, but these behaviors led to his being periodically re-confined to the psychiatric hospital, where he was heavily medicated, and suffered the side effects of the meds. The author didn't really know how to help Peter deal with the voices, but in desperation he asked Peter what might help him deal with his condition better. Peter responded that he thought it would help if he could resume riding his bike (he had been a competitive cyclist in college) -- but it needed parts, and he was afraid to go to the bike shop to get the parts, because he was afraid that if he went out alone, he might engage in behavior that other people found threatening, and so end up back in the hospital. So he asked the author to go with him. The author consulted with his supervisor, who gave the OK for the unusual request, and at the bike shop bought himself a bike, and thereafter had his sessions with Peter while they rode their bikes together. Peter improved to the point where he could live on his own and not need periodic hospitalization. This example shows me what a true therapeutic alliance can be: where the therapist asks for the client's opinion and takes it seriously to create a relationship and treatment that really helps the client. (But how many therapists have the willingness to listen to the client, and to take the client's perspective seriously?)

Reminds me of when my worst therapist once said, "I get the feeling that you think this should be an intellectual discussion," with a tone and expression of disdain on the word "intellectual". Much to my surprise and delight (since, like you, I usually have great difficulty asserting myself orally and "in real time"), I responded with, "I think it should be in part an intellectual discussion, because I"m in part an intellectual person." (Actually, part of what I hoped for in therapy -- but didn't get -- was acceptance and affirmation that it's OK for a woman to be an intellectual person.)

Thanks for this! One thing that I think a lot of therapists could learn from is "unsuccessful therapists focused more on problems while neglecting client strengths. Successful therapists attended more to identifying client resources and channeling them toward achieving client goals." And maybe this says that good advice for therapy clients would be: "If the therapist focuses more on problems while neglecting your strengths, you're probably better off without them." And adding my personal experience: It seemed that when I tried working from my strengths (for example, asking a good question, or pointing out important points that the therapist was neglecting), the therapist responded in a negative way (Examples: "You expect too much; that's your problem", or "Are you sure you're not second guessing me?", or "Do you realize you're asking me to give up my control?", or "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"", or laughing and saying, "Oh, you make things so complex!" or saying, "You'll never get better if you keep seeking the perfect therapist.") .

I believe there have been a lot of such studies. Here is a 2011 paper that discusses studies on the therapeutic alliance up to that point: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198542/ (I looked a little for more recent articles, but was not able to find any that are not behind a paywall.)

Yes! The "Why did you stay so long?" question when you've had bad therapy can prompt feelings of shame (Why in heavens name did I stay so long?), but part of the "bad therapy" experience is the crazy-making fog/shocked/gobsmacked experiences that interfere with rational behavior. It's a catch-22 experience -- you go to therapy in large part because you don't have enough confidence in yourself, and therapy just erodes the little that you do have.

Welcome, zygomaticus. So sorry to hear that you had such unethical experiences with purported "friends" who just couldn't resist trying to "help" you. I think that people who have this kind of conceit are attracted to the field. I hope that cavorting with skeptic/critics such as we will be a positive experience -- it has been for me (Not that it's made life all wonderful -- but it at least is often a breath of fresh air.) PS: Thanks also for giving me a nudge to learn a little about facial physiology.

Thanks for taking the initiative to try this out. I may very well send in some comments/suggestions sometime in the next few days. (I need to think a little more about it.)

My impression is that even when particular types of therapy are studied in clinical trials, there is usually no recording of harmful effects. That is not really different from clinical trials for drugs -- the drug side effects that get "published" are typically reported by physicians who observe them in their patients after the drug has been approved. Still, there is some effort to collect and announce such reports for drugs, but no analogous procedure (as far as I know) for therapy techniques. Still, there has been some reporting of harmful effects -- see here, for example.

I don't know how to answer this. Do therapists indeed have "compassion training"? If so, what does it consist of? (The phrase "compassion training" could mean very different things to different people.)

The client can try, but the therapist has to be willing to listen. If talking to the therapist is like talking to a brick wall, there is little if anything the client can do to get through to the therapist. Therapist training should include learning to really listen -- and probably trying to refrain from "interpretations" (regrettably, a lot of therapists seem to think they have some direct line to reality, and don't even consider the possibility that they're wrong). Therapist training should also include learning to say (routinely) things like, "Am I correct in assuming ____, or am I off base on that?"

Thinking more about this: Different people have different definitions of "empathy". Bloom's article is really opposing what I consider the most extreme definition of empathy: the "I feel your pain" type, where the empathizer actually feels the emotion that the other person is experiencing. I have encountered a couple of other definitions. One is being aware of and taking into account other people's feelings. Still another is being aware of and taking into account other people's thinking and feelings. But it's also important to distinguish between what I call "perceived" and "accurate" empathy. For example, if someone believes they know how someone else is feeling, that is what I would call perceived empathy (perceived by the empathizer), but the person having the feeling is the only one who can judge whether the purported empathy is accurate or not. To me, the important kind of empathy (especially for a therapist to have) is accurate empathy in the wider sense of understanding and talking into account the client's thinking as well as their feelings. As an example, to me someone who says, "I feel your pain" to me would be expressing perceived empathy, but their statement would (for me) be expressing inaccurate empathy because it would show that they did not understand (or did not take into account) how offensive it is for someone to say "I feel your pain" to me -- in fact, saying, "I feel your pain" would come across (especially if said by a therapist to me) as a boundary violation: using me to pursue their own agenda that I haven't consented to. I think accurate empathy (empathy in the sense of understanding both thoughts and feelings and taking that understanding into account in working with the person) is an important quality for a therapist -- it is the means to giving individualized (rather than one-size-fits-all) treatment. But it seems like a rare therapist who has it -- or even who tries to develop it. Also relevant: I think the kind of empathy I describe as an important quality for a therapist may be what Yalom was trying to get at when he said, “Look out the other’s window. Try to see the world as your patient sees it.”"

I suspect that very few would have the guts to admit this. I haven't found a therapist who ever said anything like this. But I did have one who listened when I questioned his diagnosis, and was willing to change it to something that made more sense to me. I think he was something like the 13th therapist I tried, over a period of several years. There was a lot I did respect about him -- especially his willingness to listen to my perspective and try to take it into account. I ended up saying, "You're a nice guy, and I like you, but I don't see what you have to give." He did show potential, but it wasn't yet developed enough to give me much more than the experience of being willing to listen to me and take my perspective seriously -- I don't want to knock that, because it was so much better than most previous therapists had given (there was one exception, who actually seemed to have some modicum of accurate empathy). Possibly, if one of those two had been my first therapist, they might have been able to help me. But by the time I got to them, the problem was more the experience with the previous therapists than the original problem I went to therapy for help with.

Is it the problem that empathy is biased and narrow, or that the therapists are biased and narrow? I suspect that latter.

I've looked a little more at Daryl Chow's website. Another interesting page is at http://darylchow.com/Daryl_Chow/Blog/wordpress/blog/2015/01/19/why-our-self-assessment-might-be-a-delusion-of-reality/ Also, wandering outside Chow's site, I came upon an interesting article on empathy, at http://bostonreview.net/forum/paul-bloom-against-empathy

I looked at Episode 11. The client was a therapist trainee, and had a really bad time -- the t did an intake facing away from the client typing things into the computer, and things went downhill from there. Then the rest of the interview was with therapist Daryl Chow, who promotes Feedback Informed Therapy. I looked at his web sites. One page that is particularly worthwhile for a site for therapists is on how to receive feedback: http://darylchow.com/Daryl_Chow/Blog/wordpress/blog/2016/10/27/how-do-you-get-better-at-receiving-feedback/

Episode 10 is up. It says "Today's episode is a deep dive into the nuances of harm reduction therapy. " My first thought was that they were talking about therapy that tries not to cause harm. But I quickly realized that, no, they were talking about substance abuse therapy that focuses on harm reduction from substance abuse. I think the latter is something worthwhile -- but the former is also something that is needed!

Oh, how I wish I had had the ability to just chuckle at the "interpretations" my therapist made! Instead, they eventually pushed me into one night standing in a corner of my kitchen saying, "I don't exist; I"m figment of everyone's imagination." That was really scary. But at least it convinced me that I needed to quit that therapist. (Regrettably, the next one I tried wasn't a whole lot better -- she had a tendency to laugh at me at really inappropriate times, and was inconsistent in her willingness to tell me what she was doing and why -- she did it just enough to "seduce" me into going back, but then started saying things like, "I have my reasons" and going back on things she had said before.)

Or perhaps their “You would not believe what happened with my therapist.” should be replaced with "“You would not believe what happened with my therapist (unless you've had very bad therapy, too).”

Good point. Someone in the profession is more likely to be able to bring what they were taught in their training to back up their case that their therapist did something wrong, whereas clients who are not in the profession have no such backup. I wonder if my worst therapist would have been more likely to answer my questions if I were in her profession, rather than say things like, "Are you sure you're not trying to second guess me," or "Do you realize that you're asking me to give up my control?"

Based on my own experience, I think Ben and Carrie were getting at something, but their description was aimed at people who had not experienced "very bad therapy" (nor imagined it) themselves. It would probably be expressed better by saying something more like, "Very bad therapy is where the therapist says and does things that leave the client shocked and confused".

I noticed that Carrie and Ben actually say what they mean by "bad therapy" on the first page of their website: "What is very bad therapy? This podcast gives voice to the stories that begin with an exasperated “You would not believe what happened with my therapist.”

One thing that particularly hits home for me in this episode is something Carrie said to the effect that one thing that often leads to bad therapy is when the therapist says the client means something other than what the client means -- but that some therapists think that their job is to tell the client what the client means. I certainly found it bizarre for the therapist to tell me that I meant something different from what I said. It left me speechless, and seemed so arrogant. Another thing that I recall from the episode is that Carrie more than once brought up how important it is for the therapist to be transparent about what they are doing. That makes sense to me -- but therapists I have tried rarely if at all practiced what I would consider transparency. (However, perhaps the therapist who said, "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," thought that was being transparent? It sure doesn't sound like transparency to me -- especially since her analogy shows a lack of understanding of how computers work.)

My experience is that most therapists are difficult-to-get-along-with people for me. There seem to be so many conflicts of worldview and values. It so often seems like they have some agenda for me me that I haven't consented to (and that they haven't even asked if I consent to, let alone give any reason why they are pursuing that agenda). In fact, they so often seem not to care about giving reasons for what they do, or, in the rare instances that they do give a reason, they don't seem to care if it makes sense to me. Therapy never addressed the things I went to therapy hoping for help with. It so often seemed like a crazy place, like going down the rabbit hole.

Even if my therapy experiences were good, I wouldn't want to subject myself to having someone interview me about them. In fact, the "being interviewed" nature of therapy was a big part of what made it more harmful than helpful for me. I remember asking one of the first therapists I tried what therapy was. She said "it''s a safe place to work on your problems" (which sounded good to me) and then "You're the star" (which sounded horrible to me, not at all "safe"). I think I gasped when I said that, because she responded with, "You may not like it; you may not like the process," which was really demoralizing.