zygomaticus

I like the aspects that are client-centred, but I always question the sincerity or plausibility of the kinds of sentiments stated in the article. For instance, the reaction of intrigue and excitement in the face of a client that he recognises as despising him. This is not a normal reaction, this is the response of the lab technician observing the lab rat. This is clearly turning the client into a subject. The kid despises you, yet you ignore that entirely and get excited by the challenge to 'get through'. What authenticity is there in such a response? What respect is there for the emotional output of the client? They've been objectified into a challenge, a puzzle, an opportunity for the therapist to show his quality and array of tools. When the therapist treats the client like a curiosity, this is not an equal, genuine, human-to-human dynamic. in actual fact, the client has been dehumanised. If this isn't stigma against those with mental health issues, I don't know what is. What's disturbing, too, is that people like this therapist in the article, is that he genuinely thinks he's connecting with people that he himself admits have rejected his help: And when his methods don't work, he says the kid isn't 'ready for counselling'. That's right, the methods aren't to blame, it's always the client. I suppose it's better than some of the explanations that are typical, that the client is difficult, rebellious, hostile, lazy or even, too unwell. It's never the model, never the training, never the toolbox. If it doesn't work, it's always the client that's to blame. Bloody zealots! The translation for this is that therapists need to be convincing in their simulations. It's the same for therapists as it is for those in sales and politics. Hide the agenda, polish the exterior. And yet, he talks about out-manoeuvring clients, letting their hurricanes blow out, being unmoved so that when the baring of teeth is done, he will still be there to out-last the opposition. It is an attritional stance, one of adhering methods once the client is in a state that's more vulnerable, all built on some contradictory notion of planned, methodological, theory-based 'sincere' acceptance. I've said it elsewhere: it is a simulation, a very practised, rehearsed, well-drilled act, with a lot of attention to detail in how to present it. It's the very definition of fake and contrived and the aim is to manifest a very convincing appearance, but these people say to themselves, 'oh, it must BE authentic. Let's go again, let's do a little theatre so we can practice sincerity until we nail it and if feels real... but IS real... one more time... not quite, let's try again... ten more reps and you'll seem authentic!' All the talk of rapport is typically artificial, using any interests or motivation that the client shows as a lever, a pretence of valuing it in-itself, when in truth it's only a stepping stone, a pace along a path the therapist has in mind. It gets them to trust, to open, to feel heard, when on the part of the therapist it is merely a strategy. It's false. Acquire trust, get the client believing you're in their corner, you WANT to listen, then you have the platform to do the real work and the client is more likely to want to please you, especially if they're vulnerable. Securing trust and rapport is only ever part of an overall agenda of control and influence. It's not a human connection, it's a con. Yes, therapists are in love with their techniques, with their toolboxes. In some models, they're told that there can be no deviation from the manual, a methodological bible replete with gospel interventions one must show unwavering faith in. In these cases, the client is very much made to fit the model, and a fit for them as an individual isn't on the agenda. I suspect most of the content of this article is coming from a more humanist perspective, insofar as there is talk of the client's values and meaning. That's something, at least. However, I think they are kidding themselves if they think they can have two dynamics at the same time that are incompatible. On one hand, they preach the value of a human connection, but on the other, it's all about finding ways of applying a raft of techniques that are concealed from the client under the veil of trust that something more meaningful and sincere is taking place. Essentially, the client is being fooled by appearances that are only ever functional in delivering the underlying methodological agenda. This ulterior agenda may not even match the client's expressed needs at all, it may end up being what the therapist or the philosophy the therapist's model(s) preach as manifesting 'health'.

I suppose my response would be that emotional reactions will often be the form of the kinds of harm done in therapy, and therefore there should be scope for their inclusion in any process of reviewing complaints. The trouble is, too often client emotions are dismissed by therapists, like it's an acting-out and if it pertains to the therapist, then it's 'transference'. It's difficult, because there is an intangible component to emotional harm that only the client knows the true extent of and those who care for the client know the harm because they listen and they believe (as well as see the effects more broadly). So, claims of emotional harm could be dismissed altogether depending on the terms of what's considered a valid complaint by the body responsible for processing them. I've read about clients going through a complaints process and then being told they have no evidence, and this is where the private nature of how therapy is conducted acts as a protective shield against practitioners. What are we, as clients, supposed to do? Bring hidden recording devices into sessions? Record meticulous accounts of each session as soon as we get back home? Even the latter would likely be dismissed, but I personally think it's a good idea (even if it only provides a reference so you can see the cumulative process over time yourself and know that your latest red flag corresponds to a series spanning many sessions). Many trades these days have ratings and reviews for services and those rendering them, why should therapy be any different? Any such system is open to abuse (positively or negatively), but you should expect some sort of reliable picture to emerge given enough numbers. Let's take it out of the hands of the industry, have an independent body host the reviews and ratings, and let the market say what they feel about practitioners and clinics. Let's at least have the debate. If therapy is a special case, why? Is it because us clients are deemed far too unreliable or unstable to provide trustworthy feedback? There is a caveat, of course, and that is that sometimes therapists can do such a number on you, that you end up saying what they want you to say. Not only are a lot of people eager to be the 'good client', they are rewarded when they say positive things and punished when they don't. This has certainly happened to me. So, any system would need to allow reviewers to return at a later date when they've had a chance to discover whether any gains are long-lasting or not - which is very important anyway - and if, upon reflection, they realise their initial impressions were inaccurate.

When it comes to manualised therapy models, like CBT, one major reason is that therapists have 'fidelity to the model' seared into their consciousness, the course of therapy tightly binds to a step-by-step approach and they are taught to deal with deviations by trying to get back on script. Also, anything behavioural - crudely put - is sourced in a 'learning theory' basis that treats the client as having a 'skills deficit', in other words, their ability to know what is 'good' for them is diminished. If the client says no to something, it will likely be punished in some way, probably ignored (negative punishment) or the therapist will circumvent it, for instance, if the client reacts badly to the use of a typical positive punisher like sarcasm, or punishers in general, the therapist may look to find something inconsistent with the 'undesired' complaining behaviour or just the overall target behaviour and reinforce that instead: differential reinforcement (the idea being that the behaviour being lavished with approving rewards will get strengthened whilst the inconsistent 'undesirable' behaviour gets left behind). The main point, as I see it, is that these models don't really value client insight. In fact, I've had referrals to bypass my insight, with someone I had an assessment with saying it was because I had 'a tendency to intellectualise' before referring me for pure behavioural therapy (she didn't tell me it was behavioural, it was vaguely called 'short-term focused therapy'). It was as if my insight, rather than being a resource, was a hindrance. The therapy itself was something I wasn't suited to in the slightest, it was mostly me being heckled until I showed her something that might alleviate the suffocating pressure. I didn't complete it. In CAT, meanwhile, whenever I deviated from the standard circular diagram to say, 'it's not really like that for me,' the therapist repeated verbatim, with some accusatory intonation and narrowing of the eyes, 'you're disagreeing... in a subtle way.' This was designed to build my self-consciousness to the point at which I abandoned having a voice on the matter and simply became compliant. It was an attritional method to make me feel unreasonable simply for having ideas that differed from the standard formula about *gasp* my own mind and my own life (oh, and incidentally, it turned out that, on a previous placement, my friend had been his supervisor when he was a trainee... figures). These models also don't value the client's agency, so it's no surprise that they don't welcome input regarding client preferences. When I say they don't value the client's agency, I mean that it is all designed to CIRCUMVENT your agency, with you being led left or right via interventions you aren't supposed to be aware of as being interventions, because they're deliberately embedded in interpersonal communication - verbal and non-verbal. There is a huge scope, therefore, to deviate from the client's original stated goals and implement what the therapist sees as of more benefit. Indeed, in the literature, there is a clear component of adjusting the client to social norms (whether this is relevant to the client's presenting problem and the client's aims or not). Here's a quote from a book I'm reading currently, Behavior Analysis and Treatment, "... as a member of society at large, an individual has a right to services that will assist in the development of behavior beneficial to that society." The section concerns the 'rights' that clients of behaviour analysis have, a discourse that they have no voice in and is determined on their behalf, by the industry, and kept internal to the industry. Clearly, in these instances, therapy has deviated from a transaction concerning a specific problem and a desired outcome to being something, well, ideological. If there is no discourse with the client, then they don't even get a say in what is 'beneficial to society' and are kept in the dark that they are being adjusted on the sly towards some hidden agenda concerning social norms regardless of the nebulous meaning of such matters, which are perhaps best left to philosophers and social commentators to debate, not therapists to dictate, and for clients to use their agency to determine their own political choices. Goodness knows there is enough bias out there already acting to influence any individual, without a covert campaign being waged in the clinic. With these models, I would say the bulk of the methodologies constitute boundary violations. Clients have no idea what they're being subjected to, there is no transparency, no informed consent and the very pact of trust itself is leveraged to maximise the covert influence the therapist has over the unsuspecting client. Behaviourists like to claim what they do is simply an extension of a law of nature, something that proliferates in society anyway. Skinner said as much, too. My response is that if one is looking for an analogue of the manner by which reinforcement and punishment is used to covertly influence and control someone out in wider society, well, it is what can reasonably be labelled as a controlling, abusive relationship, one characterised by heavy doses of manipulation. These are the people that cause harm.

Exactly, and therapists are supposed to be trained to be perceptive and observant, yet strangely seem to have cognitive dissonance when it comes to the limitations of the treatment or their own capabilities. How can there be such a mismatch between what the therapist and client are respectively experiencing the treatment to be, as in the therapist can believe it's beneficial whilst the client is stuck, or worse, being harmed? The easy way out when therapy isn't working is to blame the client, and there seems to be a culture of that from what I've read and heard. It's almost as if clients are expected to be active in some ways, passive in others. Vocal and yet, when it suits the therapist, voiceless. I believe the industry as a whole treats clients as there to be instructed, guided, prompted and educated. They're meant to follow, and they're never equals. The therapists and clinical psychologists seem to think that if the model is delivered, the client SHOULD get better, so if progress isn't happening, clients are made to fit the model, not the model to fit the client. I just don't believe they welcome feedback, it would empower the client more than they're comfortable with, being accustomed as they are to monopolising power in the dynamic. Plus, there seems to be a huge reluctance to allow the process itself to be discussed, with justifications like 'it's just not therapy' or that the process comprises 'tools of the trade', as if it's about protecting intellectual property or something, being unconvincing. Clients have a right to question the process, especially given that they're being subjected to it and are the true stakeholders when it comes to their life, mind and therapeutic goals.

This coheres with what I've read. It's a nice snap-shot of the systemic problems that litter what ends up being promoted as 'empirical'. The biases are varied and significant. To this I would add the comparative studies that hamper the (clearly unfavoured by the researchers) model by restricting it by the protocols of the other model. For example, I recall this presentation about a comparative study concerning trauma therapy in which there was a cognitive-behavioural group and a psychodynamic group. In the latter, the novices being trained in the method received less training time than their counterparts and were instructed to change the subject every time the client mentioned the trauma, kind of like being tasked with tying your shoe-laces with your teeth being compared to Shiva having a crack with all six of her hands! In Behaviour modification a practitioner is told that being attentive to a client's pain would be to 'reinforce' the problem and hence be unhelpful. They would either look for incompatible alternatives as 'differential reinforcers' or ignore the client's feelings regarding the trauma and swiftly move on to signpost to diagrams of how healthy thinking works. Other models, however, do not take this perspective, and although the psychodynamic model in no way guarantees an empathic therapist, and some are most certainly detached and try to present the whole 'blank screen' neutrality, they certainly shouldn't change the subject. They're most likely to probe deeper, and there certainly isn't any prohibition against displaying compassion (at least not from what I've read or from the training I received). In this scenario, unless one knows the respective tenets of the comparative models, biases may not be evident to the casual observer, or, for instance, the media, that seem to tend to accept what they're told by academic sources without barely anything in the way of fact-checking (and certainly buy into the notion that only someone with a PhD is qualified to comment, which excludes all clients that don't also have a doctorate in the discipline). Before you know it, with a powerful enough confluence of promoting factors - all of the biases, and say the pharmaceutical industry aligning themselves to the formula of CBT + anti-depressants, the 'truth' becomes: this works; that doesn't. By the way, I am no advocate of the psychodynamic model, it's just an example. The reverse could just as easily happen, depending on the bias of the researchers. I have no allegiance whatsoever in terms of models - I am, like Masson, an abolitionist - but I do believe some models are more harmful and pernicious than others. In terms of research, there is a MASSIVE skew demographically in terms of most subjects in most studies being undergraduates that are mugged on campus, with a substantial portion of them likely to be psychology majors from what I've heard (because the researchers have the most access to them). This means that these are young people predominantly who either choose prohibitive levels of debt or have parents that can afford to finance their further education - this is NOT a cross-section of society. Obviously, given the limits of social mobility, certain sections of society are very likely to be under-represented. Certain nations are also going to be over-represented, and yet there appears to be a culture of extrapolating results as if they apply to humanity as a whole, from what I've seen. Journal bias is a HUGE issue across the sciences. Positive research is much more likely to be reported. Journals are heavily influenced by commercial interests: advertisers. This influence transfers across to the institutions, predictably, as well as individual academics who are restrained by the entire culture (as are department heads) whilst being under pressure to publish SOMETHING. There is a selection process in research that doesn't translate to real-world factors. Subjects are typically screened prior to being allowed into studies so that there is greater scope for a successful outcome, more complex cases being excluded. And, although research is typically limited in duration, so is the selling-point of models like CBT. Any therapist in private practice being so parsimonious in their choice of clients must either be independently wealthy and hell-bent on proving their healing excellence or on a collision course with bankruptcy. In reality, therapists are likely to take on clients without such checks and balances, even if they stay solvent without much gain for the client.

I remember reading something about manipulative and controlling types being drawn to the 'caring professions', with the rationale being both the vulnerable nature of the clients/patients and the almost military like hierarchical culture in a profession like medicine (so when you rise up, you can domineer those underneath you). When it comes to institutions, it can be highly competitive to even become a trainee. I can certainly see narcissists finding the idea of status combined with the potential to have power over patients and subordinates very appealing, all whilst getting the extra kudos from the reputation of being someone that supposedly helps or cares for others. Yep, there's certainly indoctrination that takes place. And the shame of this is that those trainees that were more inclined to want to help and care and show some compassion are being conditioned to believe there are only particular 'valid' ways of doing so, and even if they don't feel or seem caring, it doesn't matter so long as the methods garner results. Of course, the truth heresy is that the 'proven' methods aren't nearly as effective as advertised, despite an awful lot of mind games, manipulation, obfuscation, verbal chicanery, dirty tricks and, I would argue, coercion taking place (not to mention academic bias and fraud). Once committed to the role, and thoroughly indoctrinated, it must be so hard for therapists that have invested so much time, money, effort and personal identity into the notion of being a helper to have to admit that they're not really helping that much at all. That's a recipe for cognitive dissonance if I ever I heard one. Meanwhile, for all the narcissists and controlling types, they at least still have the pleasure of being the puppet-masters to their clients, controlling, shaping, deceiving and STILL having everyone they meet assume they must be good people because they're in a caring profession. I suspect most trainees are closer to any ideals (if they had any) that brought them into the profession in the first place than any seasoned practitioner. My sense is that this gets displaced over time as the sense of mastery kicks in and they've had multiple clients dance to their tune by their grasp of method and skill in its delivery. Again, the greater the personal investment, the harder it must be to then disavow what you've been doing. The boot-camp/religious indoctrination has not only been completed, but continuously reinforced by a variety of forces acting upon you as a practitioner, including, but not limited to supervision, peers, the stress on 'continuous professional development', requirements of professional bodies, dubious claims in the field of empiricism (and the wish to be aligned with science), and, I hate to say it, but dominance over clients, too. If those on the podcasts are genuine, my money would be that they're the exceptions of their generation, not the norm and who knows what shape that humility will be in several years down the line. Are there any models currently being practiced where the power dynamic isn't tilted heavily in favour of the therapist? Simply entering into that as a practitioner is a tacit acceptance that this is ethically reasonable. In secondary mental health services here in the UK, and I'm sure this is the case elsewhere, practitioners are trained to establish dominance from the outset, mostly non-verbally. This is done to subliminally insert the message that they are the boss and to make the client more likely to submit and be compliant. It really is a case of 'you WILL take your medicine' except, perhaps, it's more like us clients being dogs and having the pills we'd otherwise refuse mixed in with our food, because we'll also get some scooby snacks when we're good doggies and do as we're told. It reminds me of the dynamic in abusive relationships or 'traumatic bonding'. People on the outside can't understand why anyone stays with the abuser, but when it's bad and then there's a switch to affection, it's like the oasis that quenches the awful thirst for love. Similarly, the switch to social rewards from social punishers can feel like such a relief to a client (even if they're not fully aware of what's going on), that they want to continue to please the therapist to keep the punishment at bay and become compliant and submissive in the process. There's a study showing that when one person fixes another with a dominant glare and the other submits, the dominant person gets a boost of dopamine and a lowering of stress hormones like cortisol. The opposite is the case for the submissive one. So, when practitioners - who have been told this is an important step in helping clients - act dominantly it literally will feel great. For the client, chances are they want the discomfort to stop by pleasing the dominant figure, and they will be given opportunities to do just that by following instructions and reporting improvements, receiving social rewards when they do (and maybe some sort of token economy, too). Now, whether clients report improvements because they're real or simply to make the domineering and often punitive treatment stop is another matter. It's my personal opinion that such methods are coercive and coercion is never a reliable or trustworthy means of securing credible information. And even without such methods, simply sitting opposite someone and acting as the arbiter of meaning and purpose when it comes to the other person's life (whilst this other knows nothing about you) is such an empowered position comparatively. There is such a risk of assuming that some sort of special sight accompanies training, simply because everything has been categorised and validated by seemingly impressive instructors speaking with authority like the theory is truth and not totally arbitrary.

Do you know what would've worked for you, zygomaticus? I was referring to the kind of flow-charts and questionnaires typical of CBT, CAT and the like where all you can do as a client really is say how much it applies, you know, strongly agree, agree, don't know etc. There's such a narrow and set range of expression of symptoms based on what they deem to be a pattern of data and the cyclic diagrams and questionnaires stem from that. Rather than allow individuals to define and describe their own experiences when they differ from the manualised stuff, my experience is that they try to carve out those parts of your square peg that won't fit into their system. So, when I've tried to say that the ways in which they describe anxiety or depression don't resonate with my own, rather than listen, I've had operant conditioning used on me to make me concur. I've quite literally been punished for disagreeing, even though the subject on the table was my own experience and I'm the only insider, so to speak. In terms of what would have worked as a therapeutic approach (am I right in thinking that's what you were asking?), a model that allowed me to express my issues in my own terms would have been a start. However, there are pitfalls in models that are too lacking in structure, too, from my experience. I've felt a little lost doing psychodynamic and person-centred counselling because of the sense of no direction. Which means that I'm not sure that there is a form of therapy that I'm suited to. In humanistic models there can at least be the sense of empathy, which matters to me, but even then I'm no longer sure that it's the kind of true emergent empathy that is therapeutic (to me, at least) in and of itself. It won't provide solutions, but it is a salve, at least. However, in that professional context, I'm not convinced that it isn't simply someone going through the motions and - whether they're aware of it or not - simulating it. I suspect that genuinely empathic people would be hindered by most therapy models from making that human connection, not enabled to do it. Even in person-centred counselling boundaries are hammered into you so much that you're led to believe a level of detachment is essential. Hence, it's a case of what measure of empathy can make the leap across that divide intact. In all honesty, I'm an abolitionist. I don't think there is any therapy I know of that's fit for purpose. For me, it's a matter of (some) noble intent and a woefully inadequate - to the point of being counter-productive and potentially dangerous - reality.

I agree with Mary, therapists often act as if there is a high degree of certainty. In fact, the so-called 'evidence-based' models operate in a highly categorical manner, formalising symptoms into causal diagrammatic cycles and pushing this at clients as if it's the only option. This is so inflexible that client expression falling outside of these limited statements is treated as a matter of getting sidetracked. I've tried saying it doesn't work like X for me only to be told, authoritatively, that yes, it does. Proponents of most models seem to reify their theories, judging from what I've read over the years, like various faiths all claiming to revere the one true god. Therapists make sweeping statements about clients as if they are statements of fact rather than conjecture. I've been corrected many times by therapists, who claim to know my mind or situation better than I do, even on matters they didn't know existed five minutes previously. Therapy needs certainty to be a part of how it operates, because without it the house of cards collapses. It's predicated on faith, not fact, and often those with the least evidence will act as if they have the most certainty. In theory, there are supposed to be systems in place to prevent negative consequences for clients, but I think the reality is that they're ineffective because a) they rely upon the honesty of the therapist when discussing cases with supervisors, and b) the client has no access to the supervision system to put across their side of the story. Yes, there are complaints procedures with professional bodies, but as has been pointed out above, the private nature of the therapy room means the client is empty-handed when it comes to proof. Plus, from what I can gather from the professionals I've spoken to, as well as the accounts of those that have tried complaining through official channels, there is a culture of stigmatising the client with a reputation as a trouble-maker. This climate amounts to little more than lip-service when it comes to professional standards, codes of ethics and any notion of accountability. Yes, sometimes there is disciplinary action from what I've been told, but only when there are repeated complaints from multiple clients over time that can't be ignored. The culture of disdain towards client complaints was even evident during the introductory 'Welcome Group' at the mental health service in my area when the facilitator scoffed at clients in the service who said they were being bullied (by therapists) just after he ominously told us that following the group the mental health professionals would be applying pressure to us (and for context, to get onto this level your case had to be complex and severe, and from what I observed the others in the group seemed like they were a vulnerable bunch, for sure). Personally, it was the last thing I needed to hear at the time as I myself was in a bad place, very vulnerable and in need of some gentle, graded support, not a Drill Sergeant. Then there is my biggest bugbear, the fact that clients are deliberately punished, which, according to the 'certainty' of behaviour modification theory ('it's like the law of gravity') cannot possibly result in anything other than the clients' problems being diminished. This also applies to when you voice negative experiences of therapy, like when I spoke of my experience of the previous psychodynamic therapy during an assessment following a subsequent referral to the service and I received a punisher, and later, during that same assessment, I said that as a result I had trust issues with the service and I got punished again. When you can reason - with a sense of certainty - that to help the client's trust issues disappear, all you need to do is punish their expression until they are rendered 'extinct', it's as if you've squared the circle, helping is harming, harming is helping, listening is indulging. For me, though, it had taken such courage to speak up at all and be honest about my experience that her punitive and dismissive response only served to demoralise me. Similarly, if a client has their own ideas or disagrees with yours or the theory or voices their frustration at the process, punish them until they shut up and it goes away. Or, perhaps, use your box of tricks, use the language game, use sophistry - whatever it takes - to make it go away. Maybe, if a client is difficult assertive enough to stick to their guns, you can take the alternative course of feigning understanding, using de-escalation tactics if they seem angry or other fake means of tricking a client into thinking they have a voice, before resetting and employing more covert and subtle forms of directing the whole process again. I hear you. I've had the same issues. One of my main goals, which has been repeatedly ignored by clinicians, has long been to be more assertive in my relationships (I can do it in writing - sometimes - but not in person or over the phone). In treatment, therapists seem to be much more interested in my compliance, and so me being assertive would be unwelcome and incompatible with their interest in bossing the whole process. Similarly, I've wanted to make myself more resilient to controlling relationships and manipulative people, who have typically targeted me, presumably because, in person, I come across as submissive, compliant and non-threatening. But the therapeutic relationship typically is very controlling, and many techniques could easily be deemed to be manipulative, regardless of whether the therapist has 'a sense of wanting to help others'. And, of course, should you raise this perception of being controlled or manipulated, it gets dismissed as 'transference', which also happened in that same assessment, appears in my therapy notes and has been thrown at me by psychologist friends. It's a nice bit of theory to wheel out whenever it's convenient for the therapist or another member of their 'guild', but, for the client, it's not productive. Personally, it just makes me feel unheard. So, I would say that a problem I've had in the wider world has been replicated in the therapy room, only in the latter instance opposite a professional well schooled in the craft of eliciting responses with a repertoire of techniques, a professional whose main skill-set is all about influencing the largely unsuspecting and trusting client in the other chair. In that sense, I think the problems have been exacerbated by the very people I turned to for answers and hoped, needed and trusted (initially) to hear me.

I remember reading about these psychologists training rapport, mostly via role-plays, and insisting that it had to be 'authentic'. Of course, the true meaning is that it has to seem authentic. The context was training police for interrogations, by the way, with the theory being that suspects open up more readily under such conditions (there was more to it than that, but I'd be delving off-topic). If the rapport seems genuine, but the reason behind it is ulterior; how is that authentic? The nonverbal stuff is used a lot in therapy, but if it's rehearsed or someone has to think about it mechanically before using it, then it isn't genuine, in my opinion. It's a simulation of what authenticity might look like. Giving feedback in the moment, rather than later is something emphasised in behaviour modification: the stimulus should follow the target behaviour as soon as possible, so that it is linked in the doggie/lab rat/horse's client's mind (even if they're not cognizant of exactly what happened, the idea is that an association will be registered at least unconsciously). For the theory, it's that warmth seems helpful in terms of outcomes for clients because it makes them feel more accepted, at least this is what Rogers and others have concluded. For me, it again comes down to whether the warmth is authentic or the result of someone demonstrating their grasp of method, the results of their training to the point that it's so drilled it almost appears to be natural. I personally would find warmth, acceptance and empathy helpful, but if I felt it was no more than a therapist going through the motions of applying theory, and thus authenticity is questionable, then I'd feel perturbed, frankly, by being dealt a counterfeit. I suppose there is this idealistic, humanistic notion that these two people are brought together and a natural empathy, warmth and acceptance will flow, but in reality people clash an awful lot and dislike one another, and in such cases where a therapist dislikes a client in client-centred counselling or a similar model, the therapist has to either find it in themselves to have unconditional positive regard for them anyway - like some sort of Buddha-like figure - or they put on a pretence. If they do the latter, then they're not 'congruent', one of the three 'core conditions' for Rogers. When warmth is faked, and the client knows it, the danger is always that it devalues the therapeutic relationship and possibly undermines their trust in those they encounter in general that superficially appear to display warmth.

Or they just deny that your criticism is even about them by using theory evasively. Typically, across a whole range of models, this will be the classic 'it's not about me, it's transference' denial of responsibility. They then get to evade being accountable, deny the validity of your feelings by positing a more 'viable' alternative explanation (without the therapist being so wise, you'd have no idea that what you thought was your opinion of him or her as an individual was actually some sort of playing out of a pivotal dynamic with your absent parent), and can hence divert you into delving into this other dynamic. I call it gaslighting. It attempts to inject doubt into the client's assertions, especially when done authoritatively, so that the client then loses trust in their grasp on reality in the matter. I think it's popular across models - even amongst those who don't seem to care for any other element of psychodynamic theory - precisely because it supposedly is a theoretically valid way to puncture criticism coming from the client by interpreting it as something else entirely, a phenomenon that turns the tables and places the lens of scrutiny back upon the client. Personally, I think it's abusive. The risk is that the client not only has the legitimacy of their feelings quashed and going unheard, but they end up disempowered insofar as they may lose trust in their ability to perceive relationships clearly, something that could spill over into their relationships in general, which leaves someone wide-open to continued abuse (if you don't think it is abuse, but you misinterpreting it as such, maybe you let it pass and think you need more work to be done on your phantom relationship with your dead mother).

Here are my responses to the supposed existence of these traits from my own perspective: "Has a sophisticated set of interpersonal skills." They've probably been schooled in rapport-building, meaning that they have a repertoire of contrived techniques. However, a lot of the interpersonal skills will be utilised to establish dominance, authority and impose their ideas and theory. "Builds trust, understanding and belief from the client." Uses the aforementioned role-play drills in rapport-building, which may include feigned empathy at apposite moments. Reflects back the client's feelings, which is often little more than an exercise in paraphrasing in a sympathetic tone (but will be absent in certain models). Belief is cultured perhaps from presenting themselves as professional, using their jargon, using interpersonal techniques to demonstrate authority and probably welcoming (and rewarding) clients that defer to the therapist from the outset. "Has an alliance with client." Perhaps, so long as the client is compliant, but expect it to be more adversarial so long as the client has the temerity to have their own differing opinions and insights regarding their own processes. Behavioural therapists will reward and reinforce compliance, which might seem like an alliance, but switch to punishers the moment the client strays, including changing the subject and ignoring expressions of the client's pain because to empathise is considered to be reinforcing the problem. "Has an acceptable and adaptive explanation of the client's condition." There's an explanation that's acceptable to the theory they work with (fidelity to the model) and acceptable to the therapist's supervisor, and such explanations might not be remotely acceptable to the client. In such cases, it is likely that the client will be subjected to compliance-gaining tactics until they agree or will end up falling foul of the 'difficult client' culture that pervades the therapy industry, meaning they don't have to be accountable for their shortcomings. The explanation of the client's condition will almost certainly be adapted to fit with the theory of the model being used (or the easiest one to fit it with, should it be an integrative approach). "Has a treatment plan and allows it to be flexible." The plan is likely to be concealed from the client, with only a vague notion being conveyed. The client is not likely to have much input, so there is little flexibility from that standpoint. If the model is 'evidence-based' then 'fidelity to the model' means there will be VERY LITTLE flexibility whatsoever. It is the client that will be made to fit the model, largely through operant conditioning and general compliance-gaining tactics. "Is influential, persuasive and convincing." Therapy is largely a language game, and therapists, like those working from telesales scripts, are schooled in how to gain the upper hand. Forgive me for being repetitive, but again the influence will be attained through establishing dominance, using compliance-gaining tactics, dismantling objections through punishers, cognitive reframing, Socratic questioning etc - basically a truck-load of sophistry - and being prepared to push as hard and persistently as it takes to impose their views. "Offers hope and optimism (realistic optimism, not Pollyanna-ish)." This might be a matter of inflating a comfortable - yet temporary - bubble during the course of therapy that provides a false sense of control, which I believe is prevalent in various models, but I will single out the cognitive model as a particular offender. It ignores external psychosocial factors to an absurd degree and makes symptoms seem like a matter of cognitive errors that can be reliably corrected through following formulas, thus making it seem manageable. Also, doubts concerning the formula are firmly pushed out of the picture as the practitioner repeatedly refocuses upon the principles, diagrams and cognitive drills, a lot of which are generic and contrived within absurdly simplistic circular flow-charts. "Is aware of a client's characteristics in context." I'm not sure what this is supposed to mean, but an appropriate context would be rooted in the social circumstances, including factors such as poverty, and would require a level of active listening that few models allow for, because most therapists are conditioned to feed everything a client says through their arbitrary theoretical filters rather than attempt to understand a client's experience from the client's history, perspective, socio-economic status, environment and relationships. "Is reflective." In my opinion therapists are far more likely to be reflexive and blinkered by theory, so any reflection will most likely have to fit into those parameters and hence be limited.

That's actually a really good point! I suppose I'm using the far-fetched idealistic notion of what a decent human being would be like in my rosier dreams! I suppose what I meant was a therapist tapping into (if they have it) a more natural pool of empathy and compassion versus robotically following theory-driven protocols, and from my experience, it can seem very mechanistic, which in turn makes me feel like I'm an engine getting a tune-up. Yes, I agree, a fit in terms of values certainly helps. As I mentioned above somewhere, even practitioners of supposedly non-directive models were shown to end up influencing clients by how they related to them and responded. There is ALWAYS a power-mismatch in the dynamic, in my opinion, regardless of the model, and I think it's so easy for the client to defer to the therapist, to see them as an expert, as someone with answers and knowledge - especially when clients are lost, vulnerable, and desperate for anything to hold on to - and even a practitioner that doesn't wish to be in that position or intend to be anything approaching a guru, they can influence a receptive client with even a simple facial gesture or vocal intonation... I would NEVER discount the power of that. It sounds so simple and insignificant, but we're responding to these signals all the time, and psychologists are VERY aware of this and use it deliberately. Those not doing so deliberately can still do it inadvertently! As much as therapists might want to be neutral, they are human and YES, you're right, that can include undesirable traits and many of those elements can be reflexive and either not be ruled out by theory or simply be a departure from any training that says not to do it. The psychodynamic theory of the 'blank screen' is baseless nonsense, in my opinion. And yes, I was understating the effects of gaslighting, thank you for pointing that out. It can be massively damaging. I know from personal experience. That alone signalled the death knell of my friendship with the academic psychologist I mentioned elsewhere. Trying to inject doubt into someone so they don't trust their own instincts is dangerous, undermining and no-one has the requisite crystal ball to know that any utilitarian ethical reasoning for using it will ever pan out. There is a massive risk that it could seriously undermine either the target's trust in themselves or the person doing the gaslighting. There HAS to be a better way than manipulating the hell out of someone. Be straight with them! Give them a voice! Don't try to pass under the radar so you can influence them in such a way! Gaslighting is PURE MANIPULATION. I don't think it's ever justified therapeutically, no way. The fact that, as Theo Dorpat suggests, it can happen unwittingly by therapists, suggests to me that there can't be enough checks, balances and safeguards (including supervision) to prevent therapy from descending into a dynamic of sheer uncontrolled influence from one with greater power over someone with significantly less, all with no immutable guiding force behind it because a therapist (or their supervisor) isn't bloody omniscient! I hear you, Mary. It's alarming how dismissive therapists can be about values they don't share or personal experiences that don't neatly fit into their narrow theoretical parameters. Those are two huge barriers to being HEARD and accepted for your own, for want of a better phrase, point of reference experientially, which includes your values, your emotional experience, how you relate to society and others. I would also add that I think there is a wide range of human experiences that routinely either get disregarded, pathologized or agitated against. Often, therapists consider themselves the SOLE arbiters of what constitutes 'legitimate' exploration, answers or direction for any given client - which to me is the height of arrogance - based on a very narrow theoretical range which is inevitably combined with their own prejudices and predispositions. I'm going to reference the 'Hearing Voices Network'. Who is to say that this element of human experience is deviant, in need of correction and worthy of rendering anyone who expresses such an experience as being - in the existential sense - such an 'other' that they are almost some sort of sub-human, as if, should they say they share their mind in a sense, that this renders anything they say as contaminated, as if the voices mean that they can't be lucid at all, that all their expressed experiences are now dubious. From what I've read, this is a common experience, but, of course, it's not mutually exclusive to both experience mental diversity in this way and be completely intellectually lucid. Sadly, should you express anything that would be deemed hallucinatory to a mental health professional, I fear you'll never be taken seriously again. In a mental health service, this could be extremely risky, should you need to advocate for yourself in any way. It also risks loss of liberty, both in terms of coerced medication and institutionalisation. This mental diversity could include both positive and negative elements, and the risk is that heavy-handed medication could effectively dumb-down out of existence BOTH, on top of severely limiting the range of your own (as the original occupant of your mind) mental range and capacity. Medication-induced zombification is very much a loss of liberty that even most mass-murderers won't have to endure. Psychiatric abuse, for sure. I'm just putting that out there. My fear is that most that hear voices are at risk of such measures should they be honest about such 'symptoms'. The only meaningful distinction is what is harmful versus what is innocuous or friendly/helpful and integral to the unified experience that mind has. I like to think of it as the body and brain being the software and the various entities residing there as being software making use of the hardware. The old Shakespeare quote of 'There are more things in heaven and earth ... than are dreamt of in your philosophy. ' springs to mind. Who is to say that one person's experience of their world is erroneous, invalid, worthy of scorn, prejudice, psychiatric classification, risible or ontologically redundant? Psychiatry/psychology/therapy theories do not have a monopoly on reality. There are no definites in philosophy that rule out the more intangible or transcendent experiences. Pretty much, it's all up for grabs, I would say. Society tends to socialise us towards a pool of more collective and conformist ideas about the world, each other and our own mental experiences. Some have religious experiences that conform heavily with doctrine. These are likely to be accepted by psychologists. Others, will have a kind of communion with entities that are comparative in their presence to those that say they have a personal relationship with, for instance, God, Jesus or whoever is a significant figure in the socially-validated belief system they subscribe to. Those with the experiences that don't have a basis in organised religion of any kind are likely to be pathologized, probably medicated and quite possibly (dependent on availability) institutionalised, and all because they don't fit into the socially-accepted forms of diverse experience one might deem spiritual or transcendent. The points you raise here are very important, Mary. I agree completely. I think trainees are basically told that the interventions based on this flawed research is something akin to immutable truth. Graduates training as clinical psychologists like to think of themselves as scientists, it's competitive just to get onto training programmes, it certainly is here in the UK, and there's a considerable amount of time, money and commitment that goes into getting to that point (this is the kind of point Fancher makes). Once there, as a trainee, you are being told, matter-of-factly, by senior figures in an organisation, that this is fact, these are protocols based on empirical, reliable scientific research. They are also preached 'fidelity to the model' on this basis. Stick to it, even if, for instance, punishing a meandering client might seem unkind or harsh, because the model says punishment can be corrective... science says so. Of course, science says no such thing. My friend, the one who was the clinical lead for the whole of London's adult mental health service, told me that therapy 'only' helped around 30% of clients. Personally, this sounds like a dubiously high figure. Typically, many subjects are screened out of being part of studies if their issues are complex. The demographics are generally VERY narrow in these studies. Often, they are psychology undergraduates being dragged off of campus and incentivised with renumaration. Those getting better and, crucially, STAYING that way, reduce the figures in a long-term sense. Then, there are the studies concerning the number of client that lie to therapists, saying they've been helped when they haven't, citing reasons like worrying about displeasing the practitioner or hurting their feelings, and these are just those that are AWARE that this is what they are doing. I know that, several times, I've been this kind of client, wanting to be the 'good client', the people-pleasing type, even when I've not had any true gains, and perhaps only being able to admit to myself subsequently, long after I've given false positive feedback, bolstering a dubious 'evidence base' despite wasting my own time and perverting, without meaning to, the foundation for the continuation of potentially ineffective interventions. My hunch is that this happens all the time, regardless of the model, but especially when there are interpersonal pressures applied, as in behavioural models. I've heard of comparative studies where the alternative model is hampered by the theory of the one that, in reality, is being rigged to show as superior, such as a trial comparing a behavioural approach to a psychodynamic approach which forbid the psychodynamic 'therapists' (utter novices that had received less training than their behavioural peers) from discussing any trauma with the subjects. Given that the subjects' traumatic symptoms were the subject of the research, and the psychodynamic 'therapists' were instructed to CHANGE THE SUBJECT if the client mentioned their trauma, this was like sprinting 100m with one leg tied behind your back and periodically having to hop backwards. Most comparative studies showing the 'superiority' of one model over another tends to be undertaken by proponents of the theory, apparently (again, my apologies for having no reference, but this is what I've read). The fact is that there are major factors influencing what gets published and then taken to be 'fact'. Institutional bias, publication bias, P hacking, the pressures of the progressive measures of an academic career, crappy sample sizes, peer review within effective cabals, outright fabrication and fraud, I'm sure it's all there, and yes, what's deemed as 'statistically significant' is widely misunderstood and misrepresented, in my view. The remainder is also SIGNIFICANT, especially those that aren't helped or actually HARMED. In the end, that remainder end up getting maligned once protocols are drawn up, these are the poor souls that end up being classed as 'difficult clients' because they don't fit into the experience of the 'statistically significant''. *sigh* Sorry this post has ended up being so long! I hope it's not high on quantity and low on quality!

Good points. For sure there are plenty of professions where that is the case, particularly customer-facing roles. I suppose being disingenuous towards the kind of customer that's putting enormous amounts of trust in you by potentially baring a vulnerable side they may well have never trusted anyone with before, well, it feels like it's that much more significant. In client-centred counselling, there's the core conditions that a counsellor is meant to be faithful to in practice: empathy, congruence and unconditional positive regard. Of course, how can the counsellor both show unconditional positive regard AND be congruent if they really dislike the client? For me, thinking as a client, I would rather know as soon as possible that there is incompatibility in terms of personality, so I could move on and find a better fit. I believe that, no matter how much the counsellor may try to hide it, any potent dislike will leak out here and there, then it's a matter of whether the client notices and identifies it. If they were to do so and bring it to the practitioner's attention, then there's always the 'transference' get out clause that seems to get used regardless of the model. Getting a therapist to be accountable for anything when they can simply say it's all in your mind is not only invariably a futile exercise, but it can also be highly stressful when you're getting gaslighting coming your way. For the second point, I honestly don't know. Perhaps with those that do they're exercising discretion and getting the okay from their supervisor, but there was nothing in my training (client-centred and psychodynamic) encouraging that and I've not experienced it as a client when I've had behavioural, CBT, psychodynamic, client-centred, NLP or integrative therapy. Certainly in psychodynamic theory you're encouraged more to be a 'blank screen', to not only refrain from personal disclosures but to not give much away at all. As a client, being sat across from someone who simply sits in silence whilst giving you an unbroken poker face, it's all rather unnerving! I think reciprocal self-disclosure would certainly be an improvement, however. Yes, the focus needs to be on the client, but anything that makes the therapist less robotic and more human is welcome. It could also help to make them seem more 'on the level', reduce that power mismatch a tad, and help with trust and relationship building. What I would say, is that it would be better to allow it to be discretionary and emergent, because that's how genuine relationships unfold in the real world, and also because anything contrived carries the danger of being used as a confidence-gaining device with no sincerity attached. If a client sees through that, it's likely to damage trust.

From what I've experienced and read about training, it turns the idea of rapport into a very mechanical process. One training program insisted that rapport must be authentic, but then used artificial role-plays to practice the mechanics of it. Role-plays formed the bulk of skills training on the courses I did, and it was a matter of carrying that artificiality across to client work without it seeming artificial. We then had these group supervision sessions which I found galling because typically trainees would be bitching about their clients, how frustrating they were, how annoying, how boring, but also saying they were sticking to their rehearsed skills practice and not letting any of this show. Even if the therapist does like the client, and the rapport is a closer approximation of something genuine, there is still the entrenched, skewed power dynamic, even in humanistic models. Clients makes themselves vulnerable, therapists say next to nothing in the way of self-disclosure. Clients express feelings, therapists take those disclosures, pass them through theoretical filters, apply conceptual labels and most probably say next to nothing, if anything, to the client about how they are categorising them. I would say that there are always tricks, because every facet of a therapist's presence in the counselling room is based on theory and training, and rapport itself is mostly only a means to an end, theoretically speaking, contrived in its various markers (because if you have to think about showing 'minimal encouragers', then they're not happening spontaneously and naturally) and with a purpose in mind that, first and foremost, is self-serving. I see it as no more authentic than when people in sales use faux-friendliness to make you receptive. And therapists are selling something, they're selling themselves as providers of a service and they're selling the validity of the models they use. The idea is that the therapist will never know enough about the client's situation to justify being didactic or paternalistic, something I actually agree with in principle. The therapist is always likely to be missing something, so respect for the client's experience of the world is central (at least it is in the client-centred model). I'm pretty sure there was some study that concluded, however, that even most therapists that use models like client-centred counselling still managed to influence clients in line with the therapist's values and beliefs, even if they didn't mean to. In theory, though, by being directive you might simply be imposing your own values, preferences and meaning, and thus impinging upon the client's autonomy and agency. The danger is that the therapist's sense of health and purpose might reflect a value system that the client doesn't share and doesn't have to, and that by influencing the client in this way, you might be taking them further away from truly matters to them. It's very common for clients to be deferential towards their therapists, to see them as the one with the answers, a non-directive model, in theory, should be about helping a client to explore what constitutes healthy meaning and purpose for them. It might take longer, but the idea is that the client can find answers for themselves, given a supportive space for exploration. The risk is, however, that a client might simply be so lost in the fog of depression or in the dark about how to move forward, that therapy begins to feel little more than an exercise in futility. Worse, dredging up painful experiences could possibly be reliving them without being about to arrive at a resolution. The sense of being empathised with - should that be real or appear real - can still be powerful, though, and is better than being all alone with trauma for the rest of your life, I would venture. Of course, behavioural psychologists believe that such attention towards those expressing trauma will reinforce it, so they would divert from it, believing it will help make it extinct (more likely is that the person with the trauma will stop talking about it because being blanked when you're brave enough to broach such a sensitive subject feels awful, thus the behaviour of trusting someone with disclosure in the hope they'll give a shit goes someway towards extinction).

Yes, I agree, and this is a major problem in the highly manualised models like CBT, both in the cognitive and behavioural elements. My opinion is that psychology studies yield data that psychologists consider to be statistically significant, then they extrapolate their findings until there's a standardised methodology as if it applies to all. They sacrifice flexibility in favour of creating a reference that all trainees must stick to, they call it 'fidelity to the model'. Of course, in the real world, no method will apply to everyone, but nonetheless, if you find something like CBT unhelpful or disagree with its theoretical assumptions, you'll probably get a reputation as a 'difficult client' if you say as much, as well as being on the receiving end of punishers until you either censor yourself or comply. There's also the notion of clients being 'CBT resistant'. Resistance... it's been used to blame clients for a lack of progress for such a long time. And I take your point about positive reinforcement. For me, if the standard social rewards of smiles, nods, nicey-wicey intonation etc seem disingenuous, then they hold no value. Something so artificial (and often patronising as hell), is not truly rewarding, even if I might initially get suckered in by it and it's the lesser evil compared to stinging punishers. With regard to the therapist's personality mattering, that's what the research says, but therapists can be a factional bunch and think their chosen faith is the one true religion. That said, there are those that do practice in an integrative way and I reckon you're right, they're unlikely to master any particular model. And with too much focus on methodology, they're liable to neglect the most important elements regarding the therapeutic alliance itself (although, the cynic in me suspects that in most cases it is more forced and feigned than genuine). As for the question about choice, it's a good one. In many ways, you'll have even less information if the therapist says they're integrative/eclectic, and even those that have one stated approach may be vague as hell about it during a consultation and incorporate other elements anyway, like 'compliance-gaining strategies'. I'd personally say that the directive models have the highest potential for harm, because the therapist is much more likely to take liberties, maximise control, be paternalistic and impose their values. On the flip side, in a non-directive model, simply feeling lost amidst the directionless limbo of it all could feel harmful, especially if painful stuff is dredged up without any gains to show for it.

In terms of compassion, it really depends on the model. More humanistic models, such as client-centred counselling, may emphasise both having compassion and acceptance for the client and the client's experience of the world, as well as allowing the client to be the one that directs the path the therapy takes. More directive models may see a focus on feelings as only necessary in the beginning in order to identify what needs to be corrected, like the 'cognitive errors' in the cognitive approach. I wrote in another post about compassion-focused therapy, and the therapist doesn't show compassion, they just direct the client, who it is assumed has problems like depression or anxiety because they lack compassion for themselves, towards identifying examples of compassionate behaviour and to think of applying it to themselves. It's utterly patronising, as if the client is a child being introduced to the concept, like you're a kid on Sesame Street, and, along with Elmo and Big Bird, you're being educated. Except you don't even get to hug Elmo at the end! Boo! Also, in the behavioural approach, there is the notion that, by showing sympathetic attention towards a client, the therapist, or someone else in the client's life, might actually reinforce a problem, so there tends to be diversion away from it, it gets ignored or it gets punished. Sometimes, the behavioural therapist will also seek to delve into the client's 'system', their family and friends, to instruct them how to respond to a client when something symptomatic happens. This could take the form of telling everyone to ignore the client, to actually refrain from showing compassion, only to switch to 'rewards' aka 'reinforcers' when they display alternative 'desired' behaviour, which might just be the absence of the 'unwanted' ones. The therapist will stress consistency to everyone in the system, and so the client may get starved of positive attention, or any kind of attention, until they change. Of course, a starving man may just tell anyone what he thinks they want to hear just to get their hands on a crust of bread. Behavioural therapists will claim that this is a kind of compassion on their part, because they are helping by applying evidence-based treatment, even if the methods themselves seem harsh or punitive. You might see it as a kind of tough love. It's all a bit Orwellian, if you ask me, and I don't think compassion is anywhere to be seen. It's also often used without anything even remotely approaching informed consent, because clinically it's generally delivered under the radar. It's highly unlikely you'll be told you're getting behaviour modification, and, if your goals aren't deemed sufficient by the therapist, they're likely to impose their own agenda which they'll choose paternalistically for you. Most of the interventions will be disguised within interpersonal behaviour on their part, and they'll likely establish dominance in the dynamic from the outset, because that makes it more likely that you'll be compliant. Ethically speaking, this is very much a matter of the end justifies the means.

Thanks for the info, Mary and Eve! I think there's something of a wilful blindness to studies of this nature, because the 'professional development' is a part of the industry, too, and it's not cheap, but it's drummed into practitioners that a core part of the ethics of their practice is to continuously update their credentials (which is a bit like the fashion industry telling us to update our wardrobes). If it's accepted that it makes little difference in terms of outcome, where is the imperative to do it? More broadly, it's an existential threat to the industry if factors that, arguably, a student could learn in a very short course turn out to be better predictors of a good outcome than all the theory and jargon-laden ongoing professional development. Some would say the key elements don't even need to be taught, necessarily. After all, if you don't know how to behave in an empathic way and rapport isn't something emergent and authentic, then the practitioner is basically simulating something that doesn't come naturally. It seems to me that therapists generally want to be the boss and are threatened by clients who show insight into their own processes or want to know more about the therapeutic process itself. It's as if the client is meant to a passive sponge, soaking up the 'wisdom' and direction offered by the practitioner. To that end, they invalidate anything of that nature by dipping into their box of dirty tricks. In all of those examples, the therapist is being evasive and using diversion. It's either dismissive, accusatory or vague, but all of those responses are offensive and undermining. Practitioners should treat client insight as an asset, not an inconvenience! It makes me angry that you were treated this way, Mary! I've had similar experiences. One assessment, in which I believe I showed some reasonable insight into my condition, concluded with the practitioner writing and saying 'you have a tendency to intellectualise' and making a referral to a model that would circumvent this, because it was basically an in-your-face behavioural approach that barely gave me space to think during the sessions as it was endlessly provocative (by the way, I wasn't told it was behavioural, it was vaguely titled 'short-term focused-therapy', and it was only later, after educating myself and learning to recognise the techniques that I realised what the model was). It was a disastrous recommendation, and I didn't complete it because it was so harsh, critical and confrontational. She taunted me constantly for my shy and quiet demeanour, which I now realised was meant to punish it until it went 'extinct'. When I wrote (I can only assert myself in writing) and explained my reasons for withdrawing, she did some gaslighting which didn't even make any sense, saying that it wasn't the therapy or her that was harsh, but my own inner critical voice. This was the kind of unaccountability and client-blaming that's typical of the therapy industry.

Hi, Sylvester! I think that's really important, to have clients feeling able to speak up because they're in a supportive climate. Feeling isolated when you've found therapy destructive can almost compound the damage. It almost does take someone who's been through a difficult experience in therapy to understand, especially when the dynamic was more like a drip, drip, drip of poison rather than dramatic examples of abuse. The most similar comparison, perhaps, would be a relationship with a manipulative person. People on the outside say stuff like, 'why are you still with them?' or 'why did you stay so long?' but there is a fog in these situation that flows from the manipulator. Therapists are very good at keeping you on the hook, even when you express doubts or misgivings they somehow keep you there, as if glued to that damned chair. It can be hard to verbalise this stuff to others, especially when they have the positive PR of the industry bouncing around their brains because they've never heard it criticised before. Exactly, Eve. I'm pretty sure there was some large-scale study that looked into outcomes to try to identify the factors that correlated most with good results. I wish I could remember the names or provide a link, but it was a while ago and before I began recording noteworthy stuff. Anyway, to my recollection there was no particular correlation with level of experience or with a particular model. The clients involved identified the quality of the therapeutic relationship as being a significant factor of a good outcome. I think the model used accounted for 1%.

Thanks, Mary! Yes, it's been really upsetting, especially the nature of it: predominantly, but not exclusively, being the disingenuous rewards and stinging punishments of operant conditioning, like I'm some kind of pigeon in a Skinner box - it's so dehumanising. Ironically, the guy I severed ties with actually published a paper on mental health stigma and dehumanisation. Oh, the bitter irony. The behaviour modification can be hard enough to see for what it is when therapists use it, because it's meant to fly under the radar and blend into the verbal and non-verbal communication, but in a friendship, where it's obviously a more informal interpersonal setting and you're more at ease, not even expecting interventions (although, with hindsight, I should've known better than to trust psychologists to resist when they probably felt all along they could go undetected and have impunity), your trust for them and the friendship itself becomes both a smokescreen and a kind of leverage. It's so condescending and paternalistic when someone tries to tweak and calibrate multiple facets of your lifestyle, personality and belief system. Man, I think I've been stressed about it every day since the realisation dawned on me just how far-reaching it was. Quite simply, that belongs nowhere near a friendship, that's a controlling relationship, and those are generally considered to be abusive. It will absolutely be refreshing to be amidst fellow dissenting voices!

Yeah, I think there is something very cult-like about the profession - they certainly have tactics in common - except some therapists seem to imbue themselves with God-like attributes. They think they're omniscient when it comes to the minds of their clients, they seem to think they're omnipotent and can skew the power dynamic as much as they can get away with whilst also having virtual impunity, and they act as if they are perfectly benevolent. Unfortunately, for us, they are 'interventionist' Gods *jazz hands*. My experience of therapists, in general, is that the trainees often display better instincts than the experienced ones, and the latter probably are buying into their own mythology and that of their careers, and by this stage they have invested that much more, money on education and training, time (perhaps decades), identity and ego; with that much more to lose - status, reputation, good money - should they have a crisis of conscience (fat chance) leading to either leaving the profession or trying to be some sort of iconoclast from within (which is why I respect Jeffrey Masson so much, he put ethics first). I would wager that the vast majority of clients arrive in need of something to believe in, being prepared to hope, and as such are vulnerable to deferring to the therapist's claims of expertise, their authority, their supposed 'evidence base' and their boundaries (and even if they don't defer automatically, certain models have methods of both establishing practitioner dominance and engineering client compliance). Plus, any dissenting voices are marginalised in any mainstream forum. The profession has successfully marketed itself as being nigh-on beyond reproach. It is a 'caring' profession. Some marry that with 'scientific'. Most journalists, who really should know better, do next to no research, or are simply too perplexed by the dense jargon of the field, and are presumably beguiled by the notion that surely such compassionate people could do no harm, accept all the PR they are served and in effect provide free advertising with the spoon-fed bunkum they publish. There is no balance in how the field is covered in the media whatsoever, and the infidels have no voice.

I feel the same way myself, and I think therapists want us to remain as in the dark as possible about their methods, because they can be quite unsavoury. I've definitely felt like a lab animal as a client getting prodded, provoked and endlessly manipulated. I think a lot of the claims of empirical evidence clinical psychologists claim are spurious, subject to all kind of biases, at best, and there seems to be a wilful blindness to factors that stack the odds in their favour that are embedded in their theory and practice. I agree with the point you made about cover, and it's quite insidious to think that something that, in theory, is meant to be about creating a 'safe' and private space, the one-to-one setting of the counselling room, provides a convenient your-word-against-theirs unaccountability. I'll check out the podcast, thanks for the tip.

Hi everyone! A little about me. I'm a long-term mental health service user and I've tried various therapeutic models, some privately and a few via the National Health Service (NHS) in the UK, where I'm based. I've become increasingly disillusioned by psychotherapy, and the more I've learned, the more I'm disturbed by many elements, some that belong to particular models, some that seem to pervade all of them. At the moment, I'm gradually informing myself more and more about the behavioural model, because that's what is primarily used in the NHS. I'm likely to post about that more than anything. I did train as a counsellor, but didn't complete the training, for various reasons. That has given me a certain amount of insight (as a trainee in class, I never did any formal client work). Also, I've had a couple of friends that have provided other insights, often inadvertently, one being an academic psychologist and the other a clinical psychologist who was, until recently, the clinical lead for adult mental health services in one of the most populated cities in Europe and also clinical lead for child and adolescent services in another big chunk of the country. Both of these friends took it upon themselves to effectively render their friendships with me into 'dual relationships', constantly delivering interventions, supposedly by stealth, without telling me this is what they were going to do or asking my permission. Since I've become aware of this and recognised the techniques they've employed, my sense of trust has taken a massive hit, irrespective of their undoubtedly caring intentions. This has caused me considerable distress and damaged one of the friendships irreparably, which I've recently ended. The other has been completely devalued, too. The paternalistic nature of this, and the complete disregard for the 'code of ethics' therapists are meant to abide by, has been revealing and is typical of how fast and loose practitioners are when it comes to ethics, particularly the notion of informed consent, from my experience. I have a very dim view of the ethical standards of psychotherapy in general, which definitely lean towards the consequentialist, 'the end justifies the means' variety. I guess that's more than enough for now. I look forward to being part of the forum, and a special thank you to disequilibrium1, because it was her excellent blog post that led me here.

Hello, I'm new, I hope to register after posting this and hopefully it'll work as I've been having a few problems. I just wanted to extend heartfelt thanks for the compilation of this list. It's a wonderful resource and I aim to work my way through it. It's the kind of endeavour I've wanted to focus on myself, with a particular focus on behaviour modification, as this is ubiquitous in mental health services here in the UK and it's something that I've found especially galling and ethically problematic.