Terrifying podcast: The Shrink Next Door

[Mary S]

16 minutes ago, disequilibrium1 said:

Eve you’re probably right. However though this particular exploitation is extreme, I’d wager idolization and a therapist’s over-control are pretty common. Though I wonder how many practitioners would see the connection.

Over-control (or at least attempts at it, which can be really shocking/crazy-making) can occur without idolization. I never idolized a therapist, but so  much of what they did was shocking and left me dumbstruck. These were the types of things that could be "inadvertent gaslighting" -- or perhaps "automatic gaslighting" or "conditioned response gaslighting" rather than deliberate or conscious gaslighting.

[disequilibrium1]

I think much of what mine did was unconscious. Then too a therapist operates from the pseudo-world of “theory” which I believe distorts their interactions beyond human recognition.

[Mary S]

12 hours ago, disequilibrium1 said:

I think much of what mine did was unconscious. ...

When my worst therapist said, "Consider me to be something like a computer: What you say goes in, mixes around with my training and experience, and out comes a response" I suspect she was saying "Just trust my intuition" or "Just trust my unconscious" or something like that -- but I sincerely doubt that she cared about thinking; just her intuition.

12 hours ago, disequilibrium1 said:

... Then too a therapist operates from the pseudo-world of “theory” which I believe distorts their interactions beyond human recognition.

The theory includes the theories they have been taught, and also their own idiosyncratic theories. The former at least have some transparency, so can be criticized to some extent publicly, and possibly discounted on the basis of that criticism; the latter have no transparency, so are not open to criticism (let alone confirmation by evidence!) -- they are essentially just the therapist's whimsy, virtually completely in the therapist's head. The client might as well not exist except as a point of departure for the therapist's fantasy-making ; the therapist may make it up as they go along.

[Mary S]

16 hours ago, Eve B said:

When professionals are paid to perform a service, customers expect good results, but with therapy, there's no guarantee or refund if it doesn't work out. It's double jeopardy--mentally and financially-- but what client wouldn't hope that they'll be helped going into it, even if there's a disclaimer on the consent form?

When I first tried therapy, there was no consent form; the  first time there was a consent form, it had no disclaimer -- it was just about fees, appointment lengths, and cancellation policies. And later therapists mostly had no consent form.

[Eve B]

So is the therapist consent form a recent requirement? I wouldn't be surprised, then, if Freud didn't have any waivers for his patients to sign before he screwed them up. Not that these forms really affect a therapist's treatment style anyway because the confidentiality of the sessions can cover up a lot of their mistakes.

[disequilibrium1]

I only recall forms listing rules for clients, all to protect the therapist and assure he is paid. The psychoanalytic clinic mentioned a grievance process, at least.

[Mary S]

5 hours ago, Eve B said:

So is the therapist consent form a recent requirement? I wouldn't be surprised, then, if Freud didn't have any waivers for his patients to sign before he screwed them up. Not that these forms really affect a therapist's treatment style anyway because the confidentiality of the sessions can cover up a lot of their mistakes.

Here is a history of informed consent in medicine: https://www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/informed-consent-i-history-informed-consent

The first therapist I tried who had an informed consent form was a psychiatrist (I had tried two psychologists previously, so thought a psychiatrist might be better -- no such luck). This was in 1987, I believe. Since psychiatrists are M.D.'s, they presumably follow the medical requirements/policies for informed consent. So this suggests that psychologists started using informed consent sometime after 1987.

The psychiatrist's form only had policies about appointment lengths, fees, and cancellation policies. However, (if I remember correctly) when she said she thought I was depressed, she did give me a copy of the DSM description of "depression". And, if I remember correctly, when she wanted me to take anti-depressants (which I refused) she gave me a copy of the "package insert".

As I recall, it was much later than 1987 when I first encountered a psychologist with an informed consent form. In fact, the only one I remember was in around 1999. And the last one I tried (I think 2006) didn't have one. 

Ah! Here is Ken Pope's page on informed consent in therapy https://kspope.com/consent/

Edited June 22, 2019 by Mary S

[Eve B]

Below is from Mary's Ken Pope link:

"Informed Consent to Promote Patient-Centered Care" by Harlan M. Krumholz. Journal of the American Medical Association, vol. 303, #12, March 24/31, 2010.

Excerpt: "There is evidence that current efforts to inform patients are inadequate. In a review of 540 informed consent documents from 157 randomly selected US hospitals, the documents were shown to have limited educational value..."

"Informed Consent in Clinical Care: Practical Considerations in the Effort to Achieve Ethical Goals" by Yael Schenker &; Alan Meisel. Journal of the American Medical Association, 2011, vol. 305, #11, pages 1130-1131.

Excerpt: "Although practice varies widely, the current reality of informed consent...often falls far short of stated goals. In many settings clinical informed consent involves a laundry list of potential risks recited to a patient who has already committed to a procedure, followed by the requisite signatures on a form. It is not surprising that patient comprehension is often poor. In a recent study of patients who had just provided informed consent...88% had mistaken beliefs about the benefits of the procedure."

The quotes are from 2010 and 2011 findings. Almost 10 years later, and not much has changed. If patients/clients don't know enough to ask questions, the clinical providers aren't going to volunteer any extra information.  

[Eve B]

The quote below is from Mary's informed consent encyclopedia link, and I think this is what a lot of therapists still believe, too. 

"Withholding information and even outright deception were regularly justified as morally appropriate means of avoiding such harm."

[disequilibrium1]

Though ethics discussion covers a couple of basics, client information seems to fail to get specific about possible internal states that cause harm. They might talk about unequal power but not how a client relinquishes judgment, as Jan Wohlberg says, it’s the grooming that causes harm.

[disequilibrium1]

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