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

 ... 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.

I'm not sure I would welcome everything that could make a therapist "more human". Some therapists' "human" qualities can be pretty undesirable ones (e.g., a tendency to lash out when they are criticized or challenged).   But the "emergent" vs "contrived" point is a good one.

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On 8/26/2019 at 7:09 AM, Mary S said:

I'm not sure I would welcome everything that could make a therapist "more human". Some therapists' "human" qualities can be pretty undesirable ones (e.g., a tendency to lash out when they are criticized or challenged).

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.

On 8/26/2019 at 7:01 AM, Mary S said:

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.)

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!

On 8/26/2019 at 6:49 AM, Mary S said:

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.

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.

On 8/26/2019 at 6:17 AM, Mary S said:

"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.)

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!

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8 hours ago, zygomaticus said:

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!

Thanks for mentioning Theo Dorpat -- I hadn't heard of him or his book (In case anyone else is interested: https://www.amazon.com/Gaslighting-Interrogation-Methods-Psychotherapy-Analysis/dp/1568218281). The book sounds like something I should get and read.

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8 hours ago, zygomaticus said:

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).

I recall reading about a study where the therapists in the comparison group were forbidden from professional behavior such as answering clients' questions about what they were doing and why. (Although my worst therapist, even though I wasn't in a clinical trial, essentially refused to answer questions about what she was doing and why -- instead, she responded with things like, "Are you sure you're not second guessing me?", "Do you realize that you're asking me to give up my control?", and "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.") Aargh! Sure sounds unprofessional to me.)

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On 8/27/2019 at 3:37 PM, zygomaticus said:

... 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 just found a therapist's blog post that discusses therapists gaslighting clients, and tells therapists what they can do when they or their client catches them gaslighting:

"If your client calls you out you can gaslight them and say, “No I’m not mad!” When in actuality you are frustrated, confused, and have a boatload of countertransference going on. Another option would be to say, “Yes, I have some frustration arising because I have an agenda with you to move through this pain and I think I have the answer for you. And I realize that my agenda is causing some struggle in me, and seems to be disrespectful of your own journey and choices. How is that to hear from me?” If you are willing to really share the truth about your experience then there is an option for repair, deepening of relationship, trust, and love.

 

If your client does not call you out, but you notice what’s going on, call yourself out!"
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An excerpt from another post (http://www.karolinawalsh.com/blog/2017/9/14/046-being-a-therapist-is-about-letting-go ) in the same blog as above:

"Every day that I work with clients, at least once, I try to control the direction of the session. This can look like having a brilliant insight and I want to share it with them. I notice something and I am sure that it is the missing piece of the problem they have been working with for so long. They want to go in one direction and I want to go in another. Some problem I have “overcome” is presenting in my client and I want to tell them what to do so they can have the same insight and healing as me. While all these insights and desire to help can be used in a skillful way to support my client, without a lot of awareness we as therapists can really delay their healing via this meddling.

As therapists we all do this. Mentors of mine who have been practicing for decades do this, new therapists do it (but sometimes less because they are more humble!), and of course midlife therapists do this so much because we really think we know what’s best! This is part of the journey of moving from the identity of “healer” to a more fluid state of allowing healing to flow through us. The difference is one of nuance, of subtly. And the means to allow this subtle state is through letting go. ... We are not there to add techniques, but to help in navigating through the landscape of their internal organization. ...we might as helping professionals take a more humble stance and move towards trusting the healing already inside our clients rather than our idea of what needs to happen for them. Also, being willing to tell your clients when you were trying to control, or meddle in their process is extremely healing!"

 

 

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

... then there's always the 'transference' get out clause that seems to get used regardless of the model. ..

Brings to mind the time my worst therapist said, "Transference has occurred without my intending it to."

Duh ... I don't think she had a clue as to how out-of-it she sounded. She seemed to be clueless that she was clueless.

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I've listened to parts of Episode 15. It's mostly about child therapy, but it starts with a discussion of ethics -- focused on a question that Ben asks Carrie: What would she do if Richard Spencer (a Neo-Nazi and white supremacist)  wanted to engage her services as a therapist. He (or maybe Carrie? or both?) seemed to think that there is a principle that therapists should not deny services to a prospective client just because the prospective client's beliefs or behavior conflict with the therapist's values; that the therapist should be willing and able to work with clients not sharing their values. (For example, a therapist should not turn away a gay client if homosexuality is contrary to the therapist's values). Carrie seemed to be inclined to say no -- which is what I would hope a therapist would do if they had strong values that conflicted with my values (because I sincerely doubt that any but a truly exceptional therapist could do a good job of helping me if they had values seriously in conflict with mine; indeed, I think that such value conflicts were big contributors to my "bad therapy" experiences.)

What do others here think about this?

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  • 2 weeks later...

Episode 18: "The need to feel effective is so big that, on average, therapists overestimate their effectiveness by about 65%. Think about that. So we create an illusion of effectiveness to make up for what we know is true the minute you're in a room with clients. It's a struggle. It's a struggle to figure out what to say, what to do. And maybe you're good for the first two hours of the day,  but by 4 PM (at least for me), I'm hoping to put two thoughts together that are useful. The whole process augurs against good outcomes, and we fill in the gap with our fantasy about how effective we are in order to maintain our ability to practice and confront clients on a day-to-day basis."

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In this link ("Why More People Are Choosing Tarot Readers Over Psych Therapy"), Miller says that “despite what therapists believe, there is no evidence that the methods we [clinical therapists] use uniquely contribute to the outcomes we measure.”  He even points out that the effectiveness of psychotherapists aren't any better than consultations by psychics and fortune tellers.

 

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I just listened to the latest podcast (Episode 18, with Scott Miller). It was very good -- he said a lot of things that make good sense to me.

One thing in particular he mentioned was that he thinks that most of the "continuing education" for therapists is useless or worse (not sure if those are his exact words, but give the gist).

He also pointed out how it is important for a therapist to listen to and respond to criticism from the client -- in fact, welcoming such feedback is essential for the therapist to make "course corrections" when therapy is going poorly (or even to help the therapist realize that it is going poorly).

Another thing I recall is that he believes a big mistake therapists often make is to focus on things like "having a healing relationship" with the client (or other "theory driven" focus).

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On 9/21/2019 at 2:22 PM, Mary S said:

He also pointed out how it is important for a therapist to listen to and respond to criticism from the client -- in fact, welcoming such feedback is essential for the therapist to make "course corrections" when therapy is going poorly (or even to help the therapist realize that it is going poorly).

It would be easy for therapists to agree with this point when the criticism is against other therapists, but I have yet to meet any therapist who can accept negative feedback from their own clients without becoming defensive or denying it. They will often try to invalidate the client's side by emphasizing their professional expert credentials or implying that clients should feel more grateful for their efforts.

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5 hours ago, Eve B said:

... They will often try to invalidate the client's side by emphasizing their professional expert credentials or implying that clients should feel more grateful for their efforts.

I  don't have any evidence of therapists' trying to invalidate my perspective, but I think they often de facto do this, typically in an automatic knee-jerk reaction. Also, I think it's more likely to be showing contempt or disdain for my perspective (or for what's important to me) rather than invalidating it -- more "I don't want to hear about this!" -- pretty childish;  a kind of denial thing; a lack of open-mindedness. Doesn't earn my respect for them as professionals (sadly).

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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).

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18 hours ago, zygomaticus said:

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.

This makes sense to me

18 hours ago, zygomaticus said:

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.

I'm not convinced that it necessarily attempts  to inject doubt into the client's assertions. It may be in some cases, but I think that in many cases, therapists  do it just because it's what they've been taught, and in some sense gets them results that seem positive to them -- so I'd classify it (in many cases) as inadvertent rather than deliberate gaslighting.

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One thing I found interesting that Miller said in the podcast with him was that his experience was that most therapists who were trained/taught that their job was to provide a "healing relationship" tended to get burned out easily -- that trying to maintain that "healing relationship" was extremely demanding. But when these therapists tried what he promotes (feedback informed and measuring outcomes), they didn't get burned out: the feedback gave them a means to adjust the relationship to fit the client, and that lead to progress toward the desired outcomes, and that was "positive reinforcement"/rewarding  for the therapist. It does seem to make sense to me.

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On 9/26/2019 at 1:40 AM, zygomaticus said:

They then get to evade being accountable, deny the validity of your feelings by positing a more 'viable' alternative explanation... 

It irritates me a lot when they do this as though their perspective should be the more accurate one and that my critical point of view should suddenly mean little if it's something that they feel is questioning or threatening their professional and personal credibility.  

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22 hours ago, Mary S said:

But when these therapists tried what he promotes (feedback informed and measuring outcomes), they didn't get burned out: the feedback gave them a means to adjust the relationship to fit the client, and that lead to progress toward the desired outcomes, and that was "positive reinforcement"/rewarding  for the therapist. 

I still don't understand why the APA doesn't require therapists to use mandatory feedback forms as part of the therapy, especially if outcome depends more on the cooperation of the client.

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Following some links from one of the websites listed with Episode 19, I got to this one https://www.scottdmiller.com/three-free-evidence-based-resources-for-improving-individual-therapist-effectiveness/ , that says that the only factors that have been documented as influencing development of individual therapist effectiveness are "(1) measure your results; and (2) focus on your mistakes." This sure makes sense to me! Yet so few therapists seem to do these things-- especially (2)!  But intuitively (to me at least), (2) seems really important, if for no other reason than setting a good example for clients to learn to help themselves.

 

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On 9/28/2019 at 9:14 PM, Mary S said:

https://www.scottdmiller.com/three-free-evidence-based-resources-for-improving-individual-therapist-effectiveness/ , that says that the only factors that have been documented as influencing development of individual therapist effectiveness are "(1) measure your results; and (2) focus on your mistakes." 

Focus on their mistakes? Divert from and/or deny their mistakes is more like it. How are results accurately measured other than by outcome, though?

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27 minutes ago, Eve B said:

Focus on their mistakes? Divert from and/or deny their mistakes is more like it. How are results accurately measured other than by outcome, though?

"Divert from and/or deny their mistakes" is what (in your and my experience) therapists all too often do. What I understand Miller to be saying by "focus on your mistakes" is the opposite of "divert from and/or deny" them -- instead, focus on doing better, on not repeating the same mistakes (and maybe even focusing on undoing any harm that the therapist's mistakes may have caused).

I assume that what he means by "measure results" is indeed by looking at outcomes -- and, in my experience at least, just as therapists typically divert from and/or deny their mistakes, they typically also don't pay attention to outcomes -- or at least, not the outcomes that the client is seeking, or that have been agreed on by therapist and client as what they're working to achieve. Instead, the therapist all too often has "goals" for the client that the client hasn't agreed upon and often isn't even told until the therapist scolds the client for not making progress toward the therapist's (previously unstated) goals for the client.

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