zygomaticus

Well, it might seem crude to reduce therapists to two groupings... but I'm going to do it anyway. There are the more process based or experiential models, that might have more of their roots in, say, new-age movements, a more spiritual basis, more abstract sources, notions of medical science from some time ago (like Freud), or simply originate outside, initially, from academia, and they will, most likely, have less in the way of academic studies to point to in order to legitimise themselves in the face of scrutiny. However, this is not always the case. Some of this ilk do originate within academia. For instance, Carl Rogers was meticulous in his approach regarding gathering data with the aim of making the client-centred approach empirical (in theory). Lacking this academic interest doesn't mean they are less worthy than other models, I would contend. I'd say it's much more arbitrary than this, and a big factor is who is founding the model in the first place. A careerist psychologist with a standing in the field has a much better chance of gaining approval and funding for studies, for obvious reasons, also with a better prospect of other academics attempting to replicate those studies, than someone on the outside looking in. Also, health insurance companies just might have an interest in funding studies of limited session models, but I cannot think why *extracts tongue from cheek*. Of course, notoriously, L. Ron Hubbard was someone on the outside looking in, and he - thank the heavens - didn't gain mainstream approval for his 'model', not that it prevented him from getting rich off of it, but, frankly, his methods are arguably no less arbitrary than the so-called empirical ones. Meanwhile, there are the 'evidence-based' models, which are embraced to the bosom of academic clinical psychology, and trumpet their empirical credentials directly into the eardrums of not only to the afflicted, but to their loved-ones, to multiple government departments worldwide, and, I believe, they have transmissions making their way to the outer reaches of our solar system as I type, just in case those intergalactic denizens are feeling stressed by their travels. The trouble is that claims of proof don't always come with credibility, and this is arguably the case with even the most vociferous of flag-bearing empiricist clinicians. In the NHS, here in the UK, not only is there such downward managerial pressure that numbers are fudged on the way upwards to appease the paymasters, but the very models themselves, by design, punish the clients (through interpersonal means) that don't display improvement, and reward them when they display even a modicum of compliance, which means that the validity of any self-reporting is highly questionable. If someone was clearly unpleasant towards any of us when we displayed one behaviour, but nice as pie when we did the opposite, but all in a subtle and sneaky enough fashion to mask the agenda, the vast majority of us would be vulnerable towards complying, and trying to please the individual, even if we didn't know we were doing so. This, actually, I would contend, forms much of the basis of contemporary clinical psychology. It's not so much the science of helping as the science of compliance-gaining. This, much of the time, is less about the outcome - long-term - for the client, and more about a statement upon discharge that can be used as evidence on behalf of the clinician, agency/institution, and model itself. I've done this myself, as a client, and shortly afterwards, in confusion, wondered why the hell I did, as it dawned on me that I was no better off for the treatment. The bulk of these types of models consists of Milgram, Bandura, Skinner et al. distilled into a methodology of interpersonal skills that are meant to be imperceptible as skills, as methodology. The first group, the more experiential tribe, also have 'clinical skills'. You are trained like a parrot. I know, I've done it. The second group also are trained in workshops, with role-plays most prominent in BOTH settings (only with more precise technical tinkering in the second group). You are trained to be fluid, to be reflexive, for it to blend and seem 'natural'. Indeed, psychologists will even use terms like 'authentic' (without irony), which basically means that it SEEMS authentic to the client, even if it is highly rehearsed and hence simulated. Also, regardless of the model, therapists are notoriously evasive of questions about their methods, themselves, or, well, anything other than you, the client. They feel entitled to be the interrogator and to extract all the data not by torture (arguably), but through (manufactured) 'trust'. We all know how therapists answer questions with questions. Turning the tables in this way is so standard, it's really a cliché and satire fodder. 'Socratic Questioning' is a standard method in clinical psychology which really is less about the name it's branded with and his dialectical method, and more about being a disruption technique that apes the junior that repeats 'why?' ad nauseam until mental exasperation means we have no answers left, dagnammit. These are slippery fish indeed. My point is this (after my typical lack of brevity): even with a science denier, they might at least engage in a discourse. Therapists are incredibly hard to engage or pin down. Try hard enough, you'll probably be ejected from the 'alliance'. Also, clinicians of certain tribes will make claims of empiricism that, in practice, are highly questionable. To be fair, they are far from being in the only industry that do this. The pharmaceutical industry, for instance, are serial offenders in this respect. The link provided in the original post references the tobacco industry. With money, a PR company (which essentially consists of professionals trained in influence psychology) and the open palms of university departments starved of funding, 'science' can effectively be bought as easily as a chimp with a bag of bananas. In the discourse about science and any counterpoint, it probably is also relevant that some claims are either dubious, disputable, or downright fraudulent even if they have been published in a 'prestigious' journal. It doesn't make one a moron to question the quality of all published studies, or to point out factors such as the file-drawer effect, institutional or journal bias, or the very human elements of pressure to not only publish, but publish certain kinds of studies that fall upon academics. Sadly, academia isn't operating in a sheltered, objective environment, devoid of the human politics that undermine all other institutions. Some fields are, admittedly, more objective. Psychology isn't one of them, in my opinion. Obviously, science deniers can be devoid of logic and be spouting baseless rhetoric. They can be somewhat easy to expose, even if they then retreat to the choir that has previously been preached to. However, it can be social anathema to question the source of scientific assertions, as if it renders the sceptic into the bracket of backwards, time-warped, Cro-Magnon twit simply for asking. Perhaps, we should question both the denier and the believer in equal measure. Therapists can, essentially, be both.

Welcome to the forum, I really hope you find it helpful. With a background in ABA, I can't help but wonder what sort of interventions found their way into her counselling 'repertoire'. All of what you mentioned sounds awful and violating. I feel for you having to go through all that. I often think that the coercive nature of medicating patients and over-medicating them is punitive in nature rather than 'protective' and is a genuine human rights issue at heart. The power these mental health professionals have is scary, to say the least.

Greetings! Welcome to the forum! Sadly, yes, I have very much had this experience, and the impact it has had on me is massive. I had two psychologists as friends, one an academic psychologist teaching clinical skills and with some clinical experience himself in an agency contracted by local government. The other was a clinical psychologist that careered her way to the top of the NHS pay-grade and oversaw MH services for adults in my city and for children and adolescents for a big chunk of the country. In the end it wasn't friendship at all, in fact, I realised it barely ever was, and my naive trust in them regarding my MH issues and general openness regarding feelings (I like being open about emotional matters and, for me, it is a pillar of a meaningful relationship) was only ever really seen through their clinical lenses. They used my friendship as leverage to try to bend me to their will and mould me into the kind of person that they - and the supposed 'empirical' science - defines as a healthy individual. This included attacking my introversion and trying to convert me into an extrovert, amongst many very intrusive and duplicitous measures, all without consent, all under the radar until I educated myself about their methods. They even screwed with the relationship I had with my first love, trying to reinforce her critical feelings towards me, presumably to weaponise her into a source of punishers (they were and are VERY Skinnerian). Third parties were used against me and my ex at other times. I get the distinct feeling that they felt they had an ethical justification to dip into their 'toolbox' of psychology influence tactics whenever they wanted, but often the notional (and erroneous) idea of furtive tinkering being permissible ethically was just a ruse, I would say, for a pretty pathological need to CONTROL. I got away. Way too late, but I got away. I am still, on a daily basis, working my way through the trauma of what was akin to something cult-like (given that cults use many of the same tactics!). I continue to learn more, incrementally, about the methods of clinical psychology. I'm also learning more about the system, as it is, and the frankly dubious claims made regarding the 'evidence-based' nature of what they do, not to mention how policy-makers have been swayed by extremely poor science. If psychologists are good at anything, it's spin, PR and influence, What they have no regard for, is the side effects of systematically subjugating another human being to their will, no matter what 'good intentions' they might claim. I'm so sorry those friendships turned out to be toxic. I can 100% empathise! There is a cumulative element, I find, with relationships like that. It's not a few dramatic episodes, generally, but a drip-drip-drip of poison over time, death by a thousand cuts, like being the lobster in the boiling water that isn't aware of the heat until it's scalding. By then, the damage can really eat away at you. I know my own recovery from 'friends' like these will take some time. I hope you know you aren't alone, there are others out there. My own 'platinum rule' is basically the old adage of avoiding twots! When I sniff out a manipulator, I'm gone! Don't engage with manipulators, that's my rule. Avoidance is generally pathologised (by the professionals), but it certainly has its place when it comes to protecting yourself.

Welcome Happynow! I really hope you find this forum useful and supportive. It certainly has been for me.

Impossible? Of course not. What it does mean is a very uphill battle. From the insight I've been given, practitioners are subject to action, but it generally is due to multiple complaints before a serious investigation. Look at it this way, if a client might threaten to bring a practitioner/clinic into disrepute, they are likely to be frozen out of any meaningful response. If a therapist causes multiple complaints that aren't easy to dismiss across various clients (which can't be routinely blamed on the clients), then it may, MAY be a case that they will be sanctioned, even if it is the proverbial wrist slap to satiate a client's desire for some sort of action to be taken. From what I can make out, it is often a game of assessing what a client will be satisfied with in a kind of low-balling fashion, which might just be a third party to pretend to empathise and hear them, or it might be a short suspension if the client isn't so pliable. Jeez, even practitioners guilty of serious ethical violations can end up practising again following a bit of disingenuous 'mea culpa' (diluted into language that can't result in litigation). They are very aware of the legal parameters of their profession and what protection the private nature of the therapy space brings them. It's a bitch to prove anything in court if nothing is public. My NHS source said that the team involved with complaints are tasked with making them go away, meaning: use any tactics that will make the complainants feel they've had their day in court (even though it's an internal process and nothing of the sort has taken place). This is standard PR psychology, issue disingenuous statements, pay lip service to the problem until it swiftly goes away. Often, if people are given the IMPRESSION they had a say, they will not pursue the matter further. It is a similar principle with 'consultation periods' by councils/local authorities with some planning issue or policy when, in truth, a decision has already been made. The British government did plenty of this in the 80s concerning mine closures that devastated communities that relied upon these jobs. It was about the illusion that a fair process had taken place, simply by the appearance of a review. Those that would oppose it are more likely to accept a final decision they don't like IF they feel they at least got to voice their opinion. Cynical? Yes, it is, and it is a typical example of how psychology is weaponised by those that are schooled against the general population. Let's not fool ourselves in thinking that therapists, most of whom are educated to some, perhaps an advanced level, in psychology, aren't very well versed in the means of compliance-gaining, including dealing with those that complain. So, yes, not impossible, of course I wasn't saying that, but yes, it is a difficult and arduous process for most, and if you're lucky enough to have more ethically-balanced clinics involved, then that's an almighty relief.

This is the rub. We want to find something meaningful, something 'real', a relationship within which we can bare all in a climate of trust. However, when this is put into motion by a painting-by-numbers theory driven methodology, how any given human prompts another given human to open up, to trust, to feel 'intimacy', well, it might not feel so real or trustworthy, so the act becomes a means of persuasion, a method of convincing a mark that the 'intimacy' is actually real. From this foundation, the idea is that behavioural change and cognitive change can flow, all BECAUSE the client BELIEVES in the fiction they've been presented with. Yes, most likely, but they will also be likely to employ methods of persuasion. Perhaps, if they feel they have sufficient access, they will gaslight the client in question. If not, and the relationship is irreparable, I would expect that the clinician will attack the client's state of mind, ability to be rational, to perceive accurately, etc, all in a climate of there being third parties to appeal to. It's all too easy, in this scenario, to place the 'irrational' client against the decorated, certificated professional, with societal institutions that baselessly are biased towards therapists as if they possess a truth that they surely don't! It appals and disturbs me that society gives psychologists a platform of authority that they've done nothing, credibly, to deserve, empirically. Also, complaint processes, as far as I can tell, are carried out within a professional body that is in no way unbiased. It is not independent and clients have no say concerning the ethics and professional procedures, it is a code written by clinicians FOR clinicians. Clients have no say whatsoever.

Your instincts and experience of him are telling you his influence is at play. I believe you. It is dreadful that you should be going through all of this, all because of a therapist who abused your trust and continues to impact your life in profound ways. I understand why you are feeling desperate. Please hang in there. I hope you have someone you can turn to in your support network, I realise that not everyone has a support network to speak of (I don't). I know this is obvious, because in the UK they are so well known, but in the past I've had to turn to The Samaritans, and they've generally been a comfort. A break up years ago left me feeling broken and desperate, and they definitely played a part in getting me through that time. I also want to apologise, I missed your previous post above when it was posted months ago. I'm not surprised the gargantuan stress of a situation like yours has triggered a breakdown. I can't even begin to imagine the pain it must have caused. So, for what it's worth, I empathise, and I truly hope you get through this awful time.

That example also makes me think of the word 'paternalistic', which I think is probably a bit on the mild side in this context. Of course, a mould for a brick is standardised, so all the bricks are the same, so there is a conformism about this, too, which is typical of most therapy, which is generally dealing with manualised standards in theory and methodology. For individuals, however, one size most certainly does not fit all, and yet, as clients, we pretty much get crammed into these moulds regardless of whether we feel they are appropriate for us. Pathological is a good word, too, to me, it makes me think that there is a malady at the heart of the practice of therapy, that to think that clients should be moulded, or, perhaps, corralled or herded into the 'correct' pen, is, in-itself, evidence of psychological, or perhaps, ideological, disturbance. There is a term in behaviourism called 'shaping', which is kind of appropriate, given the process. A word that resonates for me in relation to what I have experienced and learned about clinical psychology is 'disturbing'. The more I learn, the more disturbed I feel. 'Violating' is another that springs to mind, and it is a sense of violation that is at the heart of the damage that I personally feel from the fall-out of my treatment.

Welcome back! I agree, there are great resources here, and it's definitely nice not to be alone!

Hello Sapphire Blue, a warm welcome to the forum. Happy to have you here!

When you say officer, you mean you had a visit from the police? So he made a complaint but didn't seek to bring charges against you? I wonder what the legal definition of distress is here in the UK! I see what you mean about it being open to abuse, and the horrible irony of that is that the complaint of harassment can in itself effectively prove to be harassment against the individual being accused, if that makes sense. After all, there are other rights in play here, like the right to your free speech to articulate an account that you can also back up with documentation. Clearly, the person in this whole situation that's been caused the greatest distress is you. In terms of the pressure arriving, in what form did it take other than the visit of the officer? Were you threatened legally at all, only without that being acted upon (because, like you say, he didn't seek a prosecution), so a kind of bluff? Did the therapist's boss email or call demanding that the site must be taken down? It kind of sounds like they are trying to silence you, to censor you, and that seems much more like harassment to me. However, like you say, over 200 people read your account and will have been given some insight into the character and ethics of this individual. For what it's worth, I won't forget your story, and I applaud you for putting it out there and telling it.

In that case you'd know way better than me about such matters, and that's reassuring to know you're highly unlikely to be exposed in any way. The Google search result is encouraging, because it must be a very rare situation indeed where a therapist's online marketing and an extensive and thorough client review get an equal footing on a search engine. Mostly, clients don't even have the recourse to write reviews, well, not unless they go down the route that you did, and publish their own site. I applaud you, frankly.

I understand that there is uncertainty about the exact nature of how matters unfolded, especially as, no doubt, concealment on their part was going on, but there are clear ethical guidelines about dual relationships (which, it seems, some clinicians don't take seriously whatsoever, I also know this through personal experience) and this guy definitely crossed those. What the hell is he doing going with her to pick up your kids from school? His remit was counselling in the context of your marriage, right? Then he was her personal therapist? So, he did a house visit once, for observation purposes, is that correct? Even though he'd become your ex-wife's therapist at this point, didn't he need your consent in addition to hers? Anything beyond that is contravening professional boundaries. It's unethical. Then, therapy sessions consisting of what, to any casual observer, would look like a DATE, like taking her to a restaurant or on a country walk? What is this supposed to be, exposure therapy? Did she have phobias of eating out and the countryside? Then she's meant to send him PHOTOS of herself for therapeutic purposes? What exactly is his treatment plan in regard to this, he deems her to have body dysmorphic disorder, and he's using compliments as reinforcement? Sorry for my outraged tone, and the sarcasm, but this is so unprofessional, unethical and manipulative that it beggars belief. Except, I suspect this kind of thing isn't nearly as uncommon as people might think. Your ex-wife's complicity in the deceit must have hurt, too, and if she developed any kind of feelings for him - Platonic or romantic - that is a personal matter for her (which obviously has ramifications for your marriage and family), however, where he is concerned, there is a professional code of ethics involved that forbids dual relationships for very good reasons, and when they are discarded real harm to individuals, to relationships, and to families can accrue. He should never have pursued anything other than a strictly professional relationship with her, regardless of his or her personal feelings. So, the nightmare continues. How much salt do they intend to pour into the wounds? What's been done to you is a travesty. My goodness, it must have taken a lot of strength and fortitude for you to just get through all of it, so far, to reach this point. I truly hope it gets easier, but you have every right in the world to tell your story. Just beware, if this guy is trying to inflict damage, of the possibility he might explore bringing a libel case against you. So long as you have everything documented, you should be fine in that regard, I just know if it were me I'd want to be absolutely sure I wasn't leaving myself open to that. Did you get any legal advice on this?

I agree that it's under-reported. Also, the 50-60% claim is very dubious. When negative studies are included (which typically go unpublished due to institutional and journal bias) the percentage of positive outcomes gets reduced by about a third. My friend has said a number of times 'psychotherapy only works 30% of the time', but I didn't ask whether this figure was adjusted to account for the negative studies. Presumably, there are more unpublished negative studies in file drawers out there. Then, what is the percentage of clients whose symptoms improve and stay improved? I think it's claimed to be somewhere around 15%, but as Shedler points out, the screening out of large percentages of real-world clients presenting for participation in these studies casts doubt on the applicability of data to actual clinical reality. Ben talks towards the end of this episode about the placebo effect and how the busy clinic and lack of parking spaces Henk mentioned enhanced his expectations. I think he referenced Caroline considering marketing of services to virtually be a clinical intervention, even! It seems they see placebo as a significant element of therapy. A Cambridge University meta-analysis states this: If this is the case, then for genuine clients out in the real world, outcomes are likely to be nothing other than placebo effects. The technical aspects, irrespective of the model, only matter insofar as they lend credence to the expectations of expertise clients have with regard to the services and their providers. Since outcomes are the name of the game, does this matter? Well, with the significant expense of sessions, when the level of training, accreditation, experience etc of the service-provider is essentially meaningless (a volunteer counsellor can be just as effective if they seem credible), and an academic estimation of a 15% chance of long-term benefits - itself a dubious figure likely to be far lower - I think there are probably other placebos out there that could be just as effective (or just as ineffective) that cost far less in terms of money, time and emotional upheaval. Plus, the placebo effect is usually short-lived. It also matters when there is also a risk attached that the therapy could cause harm. In a way, therapists are claiming placebo effects as due to their skills and clinical theory, which makes it all the more irksome when they also claim that failures in therapy are broadly due to client attitudes.

Reading your account, OM, I would have to agree that the therapist's behaviour was utterly unethical, and not only from a professional standpoint, but on the level of personal character, too, as the timing of the 'bumping into' your ex-wife certainly suggests that it was a bid to only bring the dual-relationship into the light once the timeframe for a BACP complaint had expired. Have I understood that properly? He was having a covert relationship with her prior to that, which was kept quiet in order to prevent you from having the recourse to make a complaint to the BACP? This is clearly a very devious and cynical plan, which, I imagine, could feel like an additional slap in the face on top of the other serious breaches of trust that he was responsible for. It sounds like he wanted to protect himself professionally whilst also pursuing a romantic dual relationship that he knew all along contravened the code of ethics he was duty bound to adhere to. The apology he wrote certainly sounds disingenuous, especially when considering his subsequent behaviour. It sounds like a tactic to placate, it reads a bit like one of those 'expedient' apologies written by PR companies hired when a corporation has been caught out publicly! The action taken by the clinic seems inadequate, again, especially in light of subsequent developments. Too often, complaints procedures are white-washes or simply no more than trying to mollify clients into agreeing no more needs to be done. My friend, who worked at a very high level as a clinical lead in multiple NHS trusts once said to me that when a complaint was made, those running services were told to 'make it go away', in other words, make the client feel like they've had their day in court and are satisfied by the lip service being paid to them. Typically, the privacy of the therapy room, and the 'my word against yours' situation would act as grounds for dropping any further action, but obviously in this case there are actions taking place beyond the clinic that demonstrably violate boundaries. This should never happen. In my opinion, if the BACP or the clinic in question were serious about good practice, therapists like him should face more severe penalties, including the option of being struck off as BACP accredited practitioners. Any contrition he may have shown to them, in his apology, perhaps in supervision and personal therapy, is somewhat undermined by the behaviour he continued to engage in and the duplicitous nature of how he seems to have handled the whole situation. I really feel for you having had to endure this experience. I can only imagine the magnitude of the distress it must have caused you.

Hello April! Welcome aboard. Say as much or as little as you like, that's absolutely fine. I feel for you with regard to the decade of disastrous therapy. I really hope you find your way forward when it comes to recovering from that.

I suppose the concept of harm differs from therapist to client, especially when there are methodologies designed to inflict short-term pain with a view to it being a 'corrective' stimulus. The practitioner may see this as healing pain, the client may simply experience it as pain, but the client's views are typically subordinated when it comes to the limited checks and balances that feed back into the professional practice and their dubious ethics. After all, clients allegedly have wonky, unreliable minds in the first place, they are one of the easiest groups in society to cast doubt upon, and, of course, therapists are well-trained in injecting doubt directly into the client if they do dare to voice discontent about how they're being treated by their therapist. So much so, that they can be spun into blaming themselves, instead. Physical harm and negligence is so much easier to prove. In the privacy of a counselling room, a client is very much cut adrift from any grasp at advocacy or legal back-up. One person is adorned with certificates, the other is, by definition in the eyes of most, floundering and unreliable, psychologically speaking. Who has the upper hand? It's hard to prove psychological harm when the one making the claim can have their credibility undermined by the very person that caused it, and all in a social climate that, to a greater or lesser extent, contains a measure of taboo towards those seeking help rather than stoically coping without (obvious) crutches. Plus, it appears that in popular culture, mental states are typically treated as somewhat transitory, amorphous, impermanent and under the alleged executive control of a perfectly rational controller, the self... so long as it's someone else we're discussing. The individual, however, even if they won't admit it, knows how entrenched and deeply-rooted emotional woes and individual traits are. It's hard to acknowledge how daunting change truly is, but we want to have hope, and in its simplification and marketing of fool-proof systems, the therapy and self-help industry will endlessly exploit this need for hope. The disclaimer, routinely, is that it only works if the client makes it work. Faulty appliances get replaced. Faulty therapies come with no refunds, blame apportioned to clients, and a fat wedge of punishment, judgement and harm as a risk factor. In terms of AI therapists, I recall speaking to someone working in AI who insisted that popular conceptions of it are distorted, that programming is ultimately the fulcrum and the AI is basically doing what the programmer wants it to do, albeit with a certain capacity for functional learning. If human therapists are drilled continuously to show 'fidelity to the model', which they very much are, both in training and supervision, why would we expect AI therapists to deviate from their programming when they have even less scope for creative or empathic thinking? They may not have the considerations of careerist individuals, or egos, but their programmers do. Do the venture capitalists behind the start-ups have any greater desire to be exposed to liability? Do the developers want to admit such flaws? Will concepts of 'personal responsibility', 'transference', 'resistance', 'lack of commitment/engagement' or 'non-compliance' not be abused in this techno-psychotherapeutic field? It's hard to imagine that it will. There will always be markets to administer products in relation to our human ills, but they will always, ultimately, be self-serving, profit-making, and highly reluctant to admit liability for their failings. Those in need, desperate for a solution, will either be temporarily spell-bound, but ultimately disappointed, or stuck in an endless pursuit for the Baby Bear's porridge of a system perfectly attuned to their needs. When one 'fool-proof' system doesn't work, we're back perusing the shelves and listings for the next, because we're already hooked and conditioned. Given the choice, though, at this point I'd probably pick AI over a human if I was forced to choose between the two. I might need to learn how to hack it, however. How's that for resistance?

I couldn't agree more. There is a woeful culture of minimising or excluding social factors from therapy, instead, it's largely about placing all the responsibility on the client's shoulders to adapt to and accept society as it is. Perhaps, though, it is well-adjusted to be anxious and depressed and bereft of purpose, but instead of having these responses acknowledged and respected, clients are told to not only suck it up but to be positive about the very society that damaged them personally and that is chronically sick itself in a very moral and systemic manner. Those that were truly concerned with the psychological fall-out of society should campaign for a better world, not profit from it and compound it in a way, because, if successfully brainwashed into the cult of positivity, there are less potential voices of dissent. But just as therapists will seek to profit from a global pandemic, the systemic ills of society also provide them with ongoing market niches to exploit. Far from wanting to build a better world, if others did so effectively, therapists would largely be out of a job. They're no more interested in cures than the pharmaceutical industry are: they're simply not profitable.

This therapist will, most likely, have been able to keep a lot of clients by moving appointments to the phone/VOIP, instead. Sure, some will cancel, it is a luxury expense (that therapists try to convince clients is a necessity, nonetheless), particularly those that have lost their jobs. Therapists, though, have so much more flexibility than most workers out there in the current situation. If this person is truly earnest about helping, it's simple: volunteer. Outside of normal appointment hours they can allocate time to provide their 'skills' for free. Instead, they try to make a buck. Also I note the wording 'Through this discussion resources and next steps may be identified.' That sure sounds like a consultation to me, as opposed to the claim it is mainly to offload. The advertised premise makes it sound like it isn't therapy, but there's already a charge for something - listening to someone's need to externalise - that a friend or loved one can do without any training and for free. The next steps, no doubt, would be full sessions with the therapist. Call my a cynic, but this reads like a therapist using a ruse of a support-like conversation as a way to market, perhaps also to those not looking for therapy but still needing to offload. Perhaps, once the relief of getting what they needed to off their chests, they'll begin to believe regular session might be in order and will be convinced, in private, of just that.

Yes, and perhaps there should be dedicated parts of the research team that have nothing to do with the therapy component and who remain as independent as possible, both so they can have a clear objective of collecting feedback and screening for any sign that the client may have felt obliged or pressured to respond a certain way to those conducting the therapy and the client/subject identifies them as independent. Ideally, there should be someone different when it comes to the longer term feedback, and the client/subject should have it stressed to them that all feedback they give won't be identifiable to them, in case they worry about seeming critical or their later feedback being at odds with anything they said at the time they took part in the trial. I can't see this being done with any integrity or commitment, however if it's simply not in the team's career oriented interests to do so. Better still, an entirely independent body should be responsible for collecting feedback. When one team under one supervisor conduct research of this nature, there is always the risk of data being manipulated, but this is sadly part of a flawed system of institutional biases. Journals also have to be more open to publishing studies that show negative results.

I can understand the point he's trying to make, but only insofar as I think the 'evidence-based' badge of honour is a baseless piece of self-promotion and as far as evidence goes all models are much of a muchness - roughly they are equally ineffective. Patients' choices and informed consent are pretty much non-existent in most settings, but I agree that it's even worse with the manualised stuff, because the script is basically seen as the only valid method, so if a patient/client veers away, the practitioner must get them back on script, and that's when the dirty tricks are employed. Clients aren't given options, they are corralled down a set path with very few variables at play in how anything gets expressed. At least psychodynamic therapy can be somewhat explorative, so that the client has more of a voice. Flexibility in how a clinician applies 'evidence-based' models is extremely limited, they will literally repeat the same script, the same phrases, the same rewards and punishments over and over again, regardless of what variety may exist in how the client tries to present their problems. Not that psychodynamic practitioners have as much freedom as proponents of that model might claim, they still have the theory drilled into them as trainees, they still have supervisors applying course-correction, they also have practice demonstrated to them by their own mandatory therapy. With psychoanalysis, the compulsory analysis may have to come from a narrow range of experienced analysts and be voluminous, all before accreditation is achieved. Also, there is a very real dependency upon referrals within these circles, meaning an economic imperative to stick to an orthodoxy is present. I like the paper in the link, it actually echoes much of what I've heard and read before, but there is an elephant in the room, if the author is arguing that psychodynamic therapy should be considered to have the same level of efficacy as the so-called evidence-based models, and he does this after outlining just how ineffective those models are, well, it's not exactly the best endorsement. 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.

I think there are various answers, one being that, at the time, they genuinely believe it. I tend to think in many cases there is a temporal bubble that's been inflated around them, which could be a matter of being led to believe that the world is more benign than it really is or that they can have more control over their feelings and lives than is realistically the case. Even if this belief and confidence is taken with them at therapy's conclusion, maintaining it over time becomes less and less viable. It was never going to last. Effectiveness rates of therapy decline notably over even relatively short periods of time, like six months to a year, and will drop off a cliff given a long enough time-line, and that's with the clients that report being helped at all. Plus, there is some evidence from controls that the simple passage of time can rival therapy effectiveness, which might mean that what a client attributed to therapy might have been incidental entirely. Time could also explain the decline, sure, but if the point of therapy is to enable a client to develop what the clinical psychologists call 'resilience', the tools and know-how to maintain good psychological health and cope with life's sling-shots to the guts, then it's reasonable to expect that, once sufficiently augmented, that it should be lasting. Of course, therapists like to explain it more along the lines of 'I gave them the tools, but they needed to continue to use them' or 'without continued practice, skills decline and neural pathways atrophy'. I also think that when a therapist rewards compliance and punishes deviations it is a recipe for conditioning clients into saying what the therapist wants to hear, and above all else it is: you've helped. I mean, you can genuinely believe it at the time. I've been there, wanting to please therapists but not knowing precisely why, only to realise, as soon as that pressure is taken away, that I was in no better position, and only much later that the dynamic itself conditioned me to act in that unwittingly ingratiating fashion. So, in a way, there can be some self-deception, but a lot more deceit coming from the therapist in how they manipulate you into compliance. Also, there is a kind of situational deception, if you can call it that, insofar as you'll never know if you would have been in the same position, or better, had you not entered into therapy and spent your time, energy and money differently. But if you think therapy has helped you, you're likely to believe that you would have been worse off without it. If the gain was on the basis of something interpersonal (but most likely the therapist going through the motions, as with rehearsed acceptance signifiers and textbook rapport) and you trusted it to be authentic, who is to say you couldn't have had equal or better gains of an interpersonal nature by making a friend that you achieved an understanding with? And, as stated above, the fact that one relationship is predicated on (hopefully) reciprocity and the other is contingent upon remuneration by the hour, raises questions about whether it's something you should have to pay for and if it's likely to be sincere when you do. Again, the alternate situation is you feeling worse off and attributing it to therapy rather than other factors in your life, to which I would say, aren't you, supposedly, in the perfect place then? Because if therapy helps people deal with all the crap they have to contend with, and they have difficult challenges emerge whilst they're in treatment, then they have the opportunity to make use of the theoretical boons that therapy offers. I suppose some may simply lack the insight to know that they feel worse not because of therapy but due to unrelated elements. Also, if the client chose to engage, attended with commitment, completed any 'homework' and was an active part of the process, but felt worse at the end, it certainly wouldn't be fair of a therapist to claim that the client 'didn't work hard enough', which is a typical accountability hurdle (and I also think it's reasonable to leave before a set point if no gains are apparent or visible, and feeling worse cannot be explained by a 'feel worse before you feel better' rationale). Also, people need hope, they want to believe, and often therapy can feel like the only or last throw of the dice. So, even when therapy hasn't helped, many clients still go back looking for different forms or new practitioners in the hope that next time will be the charm because all other alternatives have been exhausted or feel untenable. Like I said above, there's always another self-help book on the shelf. It's also a disturbing thought that the person you've been trusting with all your innermost hopes, fears and vulnerabilities was never more than a hired ear, with no special insight, and who might not have even particularly cared for or liked you, or worse, was actively manipulating you all along. That's an especially coarse pill to swallow. Many will choose the comforting lie over the unsettling truth. Or it could be that I'm a terrible cynic, heh heh.

Wonderfully phrased and I agree completely. Behaviour typical of any industry is self-promotion and image management. Without being a global corporation (just a collection of professional bodies scattered around the world) therapy as an industry is remarkably good at providing its own PR, but I suppose that shouldn't be a surprise when much of what they do clinically is perception management. There is an aura in the public consciousness in a widespread fashion that therapy is the path to answers, solutions, and fulfilment, but the reality is that you're taking your problems to a stranger that has the same propensity for prejudice and flaws that we all do. This isn't someone with special insight, in fact, they don't know their clients in any other context, and despite the only access to the client's inner life being what the client directly discloses, they routinely ignore or carve off much of this by dispensing method, theory, empirical claims, or the need to demonstrate skill over the top of it. If a client disagrees with any conclusions about them that the therapist actually shares, then they are 'resistant', which is rather like saying that the therapist can never be wrong, and the client can never be right (unless they dutifully concur, which is only really affirming faith in the oracle's vision). I've often felt that there can be something of a God complex when it comes to therapists. One common theist definition in the philosophy of religion is that God is omnipotent, omniscient and benevolent, and when therapists act like all their intentions and applications are benign, that they know the client's mind better than the client does, what the client needs better than the client does, and routinely go about advancing such designs, typically by stealth, then they act as if they are all-benevolent and all-knowing. Meanwhile, when they skew the power dynamic as much as they can in their favour, monopolising it if they can, doing their utmost to bend the client to their will and manifest authority, then they act like they should be all-powerful, too. I actually think power is at the very heart of the systemic problems of therapy. I know of no model where this is even remotely close to being addressed, and some models exacerbate it further. This is one reason why I am, personally, an abolitionist. I honestly don't see therapy as viable when the process is so utterly skewed.

Yeah, 'unconditional positive regard' is one of the 'core conditions' in client-centred aka person-centred or Rogerian counselling, along with empathy and congruence. Of course, how can a therapist be congruent if they're showing unconditional positive regard to a client they actually dislike or disapprove of? The notion of unconditional positive regard is a nice ideal, but I agree that it's unrealistic. A therapist may or may not have a sense of empathy for a client, but even when they do, it's suspended in rations of boundaried 50 minute appointments, and the continuation of its provision is contingent on payment. My contention is that it's an artificial relationship, regardless of the intent and humanity that a therapist might possess. In effect, that ideal is commodified and hence, the good stuff, if it's present, is somewhat cheapened, in my view. Mostly, it's probably feigned 'intimacy' for hire. I think there is something to be said for the need to be heard, understood and empathised with, it can be powerful, and although it might not solve any problems, it can mitigate the pain of them. Ideally, though, it's sincere, accessible and is situated in a reciprocal, personal relationship, like with a partner, good friend or family member. Perhaps, it's because it's in such short supply out there in the world that clients resort to paying a stranger for it. Sadly, it's a deep, profound need that is likely to go unfulfilled in a therapeutic relationship, too. It's a good point about the asymmetry. I think one part of that is that there are always two elements to what therapists do regardless of the model they employ: there is the client-facing communication and then there is the hidden applications of the theory. The therapist will take what you disclose, run it through their theoretical filters, jargonize and conceptualise it according to theory, and you won't, as the client, have access to that. Nor will you know the method, and there's an awful lot of duplicity in how therapists engage with clients, a hell of a lot of manipulation. In many ways, I personally see something like client-centred counselling as having less potential for harm and less unethical than many of the directive models, the likes of which generally contrast insincere feigning of rapport and 'social rewards' like smiles, nods, praise and attentive responses (reinforcement) with withdrawal of all of that and ignoring or changing the subject ('negative punishment') or confrontational body language and glaring, scolding, sarcasm, refusing to be civil like not saying goodbye and generally being disrespectful or provocative ('positive punishment'). Crudely put, this is the relational method in behavioural models (check out 'operant conditioning'), which are predicated on the therapist dominating and manipulating the client, and in such models there isn't much in the way of empathy because their theory is that to show empathy would be to reinforce the problem. So, when your symptoms express themselves, you get punished instead. So, in effect, it's all a simulation. I tend to think of it as the practitioner having two masks, the pleasant one and the unpleasant one, as most likely BOTH are simulations based on much rehearsal, though I would swear that some clinical psychologists that have used it on me have applied the punishment with particular relish, like they enjoy it. The 'process-based' models, like client-centred or psychodynamic counselling/therapy, of course can be harmful, too, and there's always a potential for both harm and poor ethics. Clients can be used as cash-cows and kept dependent because of the obvious financial incentive for the therapist. The lack of direction or focus can leave you feeling rudderless, and yet the models are such that the therapist has to refrain from providing anything approaching structure. Often, therapists in psychodynamic/psychoanalysis models do the whole 'blank screen' thing and are virtually silent, which can be a kind of intolerable limbo for a client. I see the whole concept of 'transference' to be a primary way that clients' direct feelings about the therapist get minimized and deflected, which is basically a kind of gaslighting so that the therapist doesn't have to be accountable. The justification for this is that the focus should be on the client, whilst also maintaining that 'the relationship is the therapy', meaning that how the client views the therapist isn't actually about the therapist at all, but some projection concerning other, probably historical, relationships from the client's life. The scope for abuse of this idea is obvious. Also, what kind of a relationship is it, really? One person becomes very vulnerable through personal disclosure, the other sits there almost impassively (psychodynamic), dons a sympathetic face and paraphrases what you just said (client-centred) or shows disinterest and changes the subject or perhaps even scolds and blames you (behavioural). These are not people worth trusting with my tender inner feelings, methinks! The realisation of the illusion and deception involved in therapy has the potential to do incredible harm. So much of what they administer is dependent on clients being kept in the dark about what's actually being done to them. Personally, it's been shocking and dismaying to end up being manipulated by the very people I trusted to help me recover from the abuse and damage manipulators in my life had already inflicted.

Hi PsychoLogical. Welcome to the forum! I share your feelings about the utter lack of responsibility therapists take for the failure of therapy. It is inherent in the entire industry and embedded in the theory. This is what happens when people get to write all the rules for themselves excluding other stakeholders. It's pure self-interest. I often think that part of the reason that concepts like 'resistance' and 'transference' exist is that, deep down, they know how flimsy what they offer is, how arbitrary and baseless much of the theory is, and they needed pre-emptive deflections to prevent challenges from clients threatening the whole house of cards. It's similar to self-help books, how the authors promise seductively easy to follow systems, with the only caveat being that the reader has to believe and commit because it's a matter of application. When readers are willing to accept this, probably because they really need something to believe in, maybe when the fool-proof system doesn't work *gasp*, readers blame themselves. Regardless of whether they do or not, the author dines out on book sales and sleeps soundly because that caveat exists as a conscience-cleanser, too, because THEY can blame the readers. And if these systems work so well, why is there such a broad market - whole sections of book stores - for so many of them? When they don't work, however, and the problem remains, maybe hope in the next book lingers, rather than that avenue seeming like a library of folly. Meanwhile, with therapy, if theory is designed to be impervious to revision because evidence it doesn't work isn't taken as such, only as evidence of the shortcomings of clients, then there are some seriously slippery fish concocting it. It's an interesting analogy about prostitution. What springs to mind is that prostitutes are forced by necessity (or, even worse, coercion) to pretend probably most of the time with punters that they don't find attractive (as well as the situation itself hardly being seductive). They have to fake an awful lot. I've written on here a few times I think about how I believe that an awful lot of what therapists do is basically a simulation. They pretend to like clients they actually dislike, they pretend to care in those instances when, in fact, they feel nothing of the sort. They get their rapport-building from textbooks and role-plays, they feign what domineering people do in order to assert authority over clients, they exaggerate in order to sugar-coat rewards or render punishments harsher and they pretend to ask innocuous questions when they're really mining for information on unspoken queries. They also make a lot of fake claims or are simply silent about the limitations on how effective therapy is. Hell, they even bias findings. I personally have no doubt that a lot of academic psychology pertaining to psychotherapy is flawed and I suspect that academic fraud is part of the mix. Sadly, CBT, ACT and all of the so-called evidence-based therapy models are subject to the same relational and systemic problems, the same manipulations. None of it is fit for purpose, in my personal opinion. I agree with Mary, it ends up with the clients fulfilling the therapist's fantasies, which probably include being a helper, a healer, someone applying something that has empirical validity maybe, having a certain professional status etc (not an exhaustive list!). I bet the therapists, too, have fantasies about intimacy and confuse textbook rapport with genuine rapport and fifty minute hours with a personal bond (so long as the cheques keep clearing). Those fantasies can't exist without clients, nor can their lifestyles.