Very Bad Therapy podcast

[Sylvester McMonkey McBean]

On 7/24/2019 at 6:03 AM, here today said:

Ben and Carrie still believe in the therapy model, though.  I don't.  So as instructive as some of our stories might be I wouldn't volunteer to go on it.  How about any of the rest of you?

i've had a few fleeting thoughts on perhaps contacting them and seeing if they would be interested in an aspect of one part of my story, but then i change my mind because i worry that they or any guest therapist they bring to the podcast would use it as a means to twist it into their own agenda to prop up the benefits of therapy instead of as a means to bring awareness that this is kind of shit is going on and throughout the profession, it actually is quite a taboo subject to even bring out into the light of day. 

through my wanderings on another forum, i recently have crossed paths with one of the guests from one of the podcasts.  they were telling a bit of their story and i was thinking i had heard this story before, so i asked them if they were on that podcast and, if so, how was the  overall experince for them. they said they thought the interview went well, they felt heard and not judged, but they were never able to bring themselves to listen to their actual interview that was played in the podcast. so, in the end, i don't really know if it was helpful or not for them to do, but i did give them credit for their courage to do it. 

Edited August 4, 2019 by Sylvester McMonkey McBean

[Eve B]

15 hours ago, Sylvester McMonkey McBean said:

but then i change my mind because i worry that they or any guest therapist they bring to the podcast would use it as a means to twist it into their own agenda to prop up the benefits of therapy...

I think the podcast hosts would reinforce support for therapy because it doesn't make sense for them to sabotage their livelihood, and they also seem to really believe that therapy can be helpful if practiced properly. Does the real evidence of therapy harm invalidate the cases where clients feel that they've been helped by it? It would be better if they could be a little more objective in presenting both sides of the therapy experience, but I would be more suspicious if they didn't defend their profession. 

[Eve B]

On 8/2/2019 at 10:18 PM, Mary S said:

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

Maybe we could email the very bad therapy podcast hosts and ask what "compassion training" is, if there is such a course in their school's program? 

[here today]

On 8/3/2019 at 10:41 PM, Sylvester McMonkey McBean said:

i've had a few fleeting thoughts on perhaps contacting them and seeing if they would be interested in an aspect of one part of my story, but then i change my mind because i worry that they or any guest therapist they bring to the podcast would use it as a means to twist it into their own agenda to prop up the benefits of therapy instead of as a means to bring awareness that this is kind of shit is going on and throughout the profession, it actually is quite a taboo subject to even bring out into the light of day. 

. . .

 

On 8/4/2019 at 2:58 PM, Eve B said:

I think the podcast hosts would reinforce support for therapy because it doesn't make sense for them to sabotage their livelihood, and they also seem to really believe that therapy can be helpful if practiced properly. Does the real evidence of therapy harm invalidate the cases where clients feel that they've been helped by it? . . .

I wonder if more specific data about the particularly harmful effects of bad therapy on clients might be useful information.  Yes, therapy can be helpful and useful for some people, and then very bad and very harmful for others. 

Right now, there are a bunch of horror stories here and there across the internet about the effects of bad therapy.  There are some commonalities in those those stories that bear witness, I think, to the almost predictable effects that some very bad practices and attitudes on the part of some therapists can have.  Maybe not on every client, but on susceptible ones.  

There are enough stories that a relatively extensive analysis could be done, seems like, but I don't know much about that kind of research.  It would only be a start, using available data.  But it could point to more specific kinds of questions and perhaps more rigorous research.  

Real evidence of therapy harm doesn't invalidate therapy that may have been helpful to somebody else.  But the helpfulness in some cases doesn't invalidate the harm in others, either.

I wonder if Ben and Carrie might be interested in something like that?

[Mary S]

1 hour ago, here today said:

I wonder if more specific data about the particularly harmful effects of bad therapy on clients might be useful information.  Yes, therapy can be helpful and useful for some people, and then very bad and very harmful for others.

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

[Eve B]

The podcast has a contact form that could be used to suggest topics for their future episodes. Anybody try it yet? I just sent an email to ask about compassion training, so let's see if my question was interesting enough for them to respond.

[Eve B]

Update: To his credit, Ben responded the same day I emailed my question about compassion training. I think his answer basically confirmed to me that therapy training isn't as adequate as it could be. I would recommend sending him other (maybe tougher) questions because he seems open and willing to give honest feedback.

" In my opinion (as supported by research), compassion is one piece of a bigger puzzle that also includes empathy, cultural humility, collaboration/collaborative goal setting, and unconditional positive regard for the client.  That's the approach from which a good therapeutic alliance can best be built, which is a necessary part of good therapy.  The natural corollary is that bad and/or harmful therapy is often the result of good intentions but a lack of those aspects of interpersonal relating.  These are large generalizations of course, but the most important thing for a therapist is to have these trans-theoretical qualities in their work, and from there general theory/technique/interventions/etc. can be applied as to best serve the client.  This kind of relational approach is becoming more common, but it can often get lost within the therapeutic relationship, especially if the therapist isn't taking steps to see how the client views their progress and the development of the alliance itself.

As for compassion training in graduate school and/or training facilities, the answer is yes and no.  No, in the sense that there are rarely classes to teach things like empathy skills, compassion skills, etc.  But much of learning to become a therapist includes self-reflection, authentic and vulnerable conversations with peers, feedback designed to help the student/trainee see their biases and defenses, and plenty more things of that nature.  In many ways, there is a "what you put in is what you get" approach to therapist development.  The vast majority of us are committed to becoming better therapists, better versions of ourselves, and better people as a whole.  Some are not, but they are the exception to the rule in my opinion.  If I'm being honest, I would love to see psychotherapy training have far less content around theory and far more content about exactly what you're asking about.  People can learn to become more compassionate, and while therapists are in large a compassionate bunch, we can all do better.  It's impossible not to have defenses and not to have biases; the work isn't to eliminate them entirely, it's to become more self-aware so that you have more room for compassion with clients."
 

[Mary S]

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

[Eve B]

It could be worthwhile writing them and then posting the response here? I wouldn't be surprised if they're having difficulty finding people who have suffered therapy harm to want to participate in a live talk with them.  I've only listened to some of the episodes, but I've been checking to see if/how their topics evolve.

[Mary S]

Thinking more about the empathy/compassion thing, I’ve come to the conclusion that what I would prefer to either the empathy or compassion perspective is the perspective of being considerate. My reasons are:

1.     “Empathy” and “compassion” are both something that a person has, whereas “being considerate” is something a person does. This puts an emphasis on the personal qualities of the therapist (tending to make the therapist something like a guru with magical powers), whereas I think it’s the therapist’s behavior that makes or breaks therapy.

2.     Both “empathy” and “compassion” (which literally means “with passion” or “with feeling”) are both upfront (and often in-your-face) about emotions. This emphasis seems likely to promote the snap judgments that I have found so counterproductive in therapy.

3.     By contrast, “being considerate” involves considering alternatives, options, perspectives, pros and cons, combinations of factors. It involves more thought, more caution, and more taking complexities (including uncertainties) into account. It involves deliberation. This to me is strongly preferable (more in touch with the real world in all its complexity and uncertainty) to the “snap judgment” behavior that has been so counterproductive and so limiting in my therapy experience.

[Eve B]

But therapists seem to always emphasize the importance of feeling over thinking, right? Consideration is about being polite and respectful, so that quality should be given first before clients can trust the therapist's show of compassion. Do therapists tend to be less considerate the higher up they are in the academic and credentials hierarchy?

[Mary S]

9 hours ago, Eve B said:

... Consideration is about being polite and respectful, so that quality should be given first before clients can trust the therapist's show of compassion. ...

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

[zygomaticus]

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.

Edited August 18, 2019 by zygomaticus
poor proof-reading ability! (dyslexia)

[Mary S]

6 hours ago, zygomaticus said:

.... 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.

Sad.

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

[Eve B]

With all these model variations, how can clients reduce their risk of choosing a harmful therapist? To me, it doesn't seem like the treatment models really matter as much as the personality of the practitioner. I think therapists would want to apply  integrative/eclectic  approaches to help improve client outcome, but I can't see them being adequately skilled at many kinds of treatment methods.

[zygomaticus]

16 hours ago, Mary S said:

Another problem I have with rigid behavioral methods is that practitioners may assume a  "One-size-fits-all" approach to what is positive and what is negative.

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.

5 hours ago, Eve B said:

With all these model variations, how can clients reduce their risk of choosing a harmful therapist? To me, it doesn't seem like the treatment models really matter as much as the personality of the practitioner. I think therapists would want to apply  integrative/eclectic  approaches to help improve client outcome, but I can't see them being adequately skilled at many kinds of treatment methods.

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.

[Eve B]

20 hours ago, zygomaticus said:

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).

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.

I think therapists who like their clients probably don't fake their relationship with the client? It's when confronted with resistance that therapist posturing can feel like tricks being pulled from their training manual.

Why would a therapist believe that a passive model is helpful other than they're not trying to make decisions for their clients?

[zygomaticus]

On 8/20/2019 at 9:06 PM, Eve B said:

I think therapists who like their clients probably don't fake their relationship with the client? It's when confronted with resistance that therapist posturing can feel like tricks being pulled from their training manual.

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.

On 8/20/2019 at 9:06 PM, Eve B said:

Why would a therapist believe that a passive model is helpful other than they're not trying to make decisions for their clients?

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).

[Eve B]

12 hours ago, zygomaticus said:

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.

Clients makes themselves vulnerable, therapists say next to nothing in the way of self-disclosure. 

Aren't there people in other professions who pretend to be nice to their customers too, though? And don't more therapists nowadays believe that a certain amount of reciprocal self-disclosure is beneficial to earning their clients' trust?

[zygomaticus]

3 hours ago, Eve B said:

Aren't there people in other professions who pretend to be nice to their customers too, though? And don't more therapists nowadays believe that a certain amount of reciprocal self-disclosure is beneficial to earning their clients' trust?

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.

[Eve B]

On 8/23/2019 at 2:19 AM, zygomaticus said:

 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. 

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's sickening how a therapist would emphasize trust in the process and the relationship and then betray it when it serves his purpose. Clients have every right to feel contemptuous towards the profession long afterwards. It's easier for therapists to deal with being the ones dumped because they have other clients to validate them. With most other businesses, it's not wise to mix the personal with the professional, but in therapy, that's what it is. So when things go wrong, more destructive consequences are left behind than just hurt feelings.

Maybe this self-disclosure issue wouldn't become such a problem if the expectations between therapist and client were made clear in the first session?

[Mary S]

On 8/19/2019 at 6:00 PM, zygomaticus said:

... 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'.

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

[Mary S]

On 8/19/2019 at 12:35 PM, Eve B said:

...I think therapists would want to apply  integrative/eclectic  approaches to help improve client outcome, but I can't see them being adequately skilled at many kinds of treatment methods.

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

* By "Correctly" here I mean in part that the client agrees with the "diagnosis".

[Mary S]

On 8/22/2019 at 6:05 AM, zygomaticus said:

... 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.

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

[Mary S]

On 8/23/2019 at 4:19 AM, zygomaticus said:

... 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. ...

I think that incompatibility in terms of values is at least as important as incompatibility in terms of personality (although the two may overlap.)

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