Very Bad Therapy podcast

[Eve B]

What I find ironic when therapists react defensively to client criticism is that they're really making it all about themselves with their "I'm only human too" or "bad fit" excuses instead of trying to understand the client's point of view and working to mend the impasse. Therapists claim to learn from their failed outcomes, but I think they tend to forget or negate those mistakes if their treatment techniques are successful with other clients.  

[Mary S]

On 10/1/2019 at 12:32 PM, Eve B said:

... Therapists claim to learn from their failed outcomes, but I think they tend to forget or negate those mistakes if their treatment techniques are successful with other clients.  

I think this may be confusing what "many" do with what "some" do. In other words, I think that there are some therapists who really do learn from their failed outcomes (part of this learning being that they need to treat each client as an individual)  -- but they are not the majority of therapists.

[Eve B]

14 hours ago, Mary S said:

I think this may be confusing what "many" do with what "some" do. In other words, I think that there are some therapists who really do learn from their failed outcomes (part of this learning being that they need to treat each client as an individual)  -- but they are not the majority of therapists.

There doesn't seem to be much in the way of accurate data on therapy failures being voluntarily reported, so I don't expect the majority of therapists to honestly admit their mistakes because their business depends on their reputation.  I also wonder if it's only "some" or a "many" clients who would give their therapist who screwed up another chance? The only way to know if the therapist learned to correct their mistakes would be for the client to risk continuing with the sessions. Should clients give their therapist the benefit of the doubt, and how many chances should a therapist deserve?

[Mary S]

1 hour ago, Eve B said:

... The only way to know if the therapist learned to correct their mistakes would be for the client to risk continuing with the sessions. Should clients give their therapist the benefit of the doubt, and how many chances should a therapist deserve?

I don't think it's (in practice)  a matter of "Should clients give their therapist the benefit of the doubt", but rather, "Do clients give their therapists the benefit of the doubt?" I know I did until the side-effects of a therapist got really bad, and I suspect many clients do as well. However, this may have changed since I last tried  therapy, because now internet discussion and searching gives more possibilities of finding out information about therapists and therapy.

However, my understanding is that what Miller is talking about is therapists who do measure outcomes and client ratings routinely, and I think his statements are based on such therapists -- so the real question is how to get more therapists doing this routine requesting of feedback. I think that he is trying to get more therapists to practice routinely asking for feedback and adjusting what they do accordingly -- and he is talking about what such therapists (and their clients) have found the results of this practice to be, in order to persuade more therapists to follow these practices which seem to give better results.

[Mary S]

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!

Here's a website I just came across that discusses gaslighting, including a somewhat sarcastic but somewhat amusing  video, and in some sense seems consistent with my suspicion that people who put a high priority on "winning" arguments tend to engage in gaslighting (in a possibly not deliberate, but more behavioral "positive reinforcement" learned way -- because it often leads to "winning" or at least getting the last word, or shutting the other person up): https://www.psychologytoday.com/gb/blog/ambigamy/201910/new-tool-getting-better-spotting-gaslighters

 

[Eve B]

On 10/5/2019 at 3:27 PM, Mary S said:

However, my understanding is that what Miller is talking about is therapists who do measure outcomes and client ratings routinely, and I think his statements are based on such therapists -- so the real question is how to get more therapists doing this routine requesting of feedback.

Unless the APA makes it mandatory, I doubt many therapists would want to request regular feedback, especially if it's in a written format that could be used to question their professional competence. The problem I see is that many therapists just have too much pride to be able to take honest criticism from their clients without overreacting in a defensive manner. Maybe there needs to be a better filtering of the types of personalities who enter the field, but that's not going to happen either.

[Mary S]

4 hours ago, Eve B said:

Unless the APA makes it mandatory, I doubt many therapists would want to request regular feedback, especially if it's in a written format that could be used to question their professional competence. The problem I see is that many therapists just have too much pride to be able to take honest criticism from their clients without overreacting in a defensive manner. Maybe there needs to be a better filtering of the types of personalities who enter the field, but that's not going to happen either.

There is the possibility that clients may start to "vote with their feet", if the benefits of feedback informed therapy become more widely known (either by word of mouth or just searching on the web).

Also, I don't think that APA has any official capacity to make anything mandatory in therapist practice -- it is the individual state (etc.) boards that license therapists.

Also, insurance programs probably have some clout, since they can restrict insurance for therapy to therapists who meet their own requirements. So, for example, research that shows that feedback informed therapy is more effective than "treatment as usual" might convince insurance programs to only cover treatment by therapists  who use feedback informed therapy.

[Eve B]

Therapists say that clients always have the choice to leave at any time, but they make it sound like it's so simple for clients to just break free from therapy when the experience is more emotional attachment than rational sensibility.

I think the majority of high-priced therapists don't accept insurance? New graduates may be willing to deal with insurance for awhile, but I'm pretty sure most will eventually ditch it once they're in private practice. 

Episode 20: When Therapists Have a Bad Day- Why should clients still pay for the service when the therapist isn't feeling at his/her best and so can't do a good job during session?

[Mary S]

I just sent this message to the VBT website in response to Episode 20:

Last night I read the VBT Podcast 20, and was appalled at the therapist’s behavior.

 

But this morning, it dawned on me that there might be a reason for the therapist’s impairment - namely, that she might have been undergoing chemotherapy that caused the impairment. In particular, I recall from a friend’s experience that chemotherapy can produce extreme nasal discharge. (Indeed, after his chemotherapy treatments, my friend carried plastic baggies in his pocket, since tissues were inadequate for the post-therapy nasal discharge). Chemotherapy side effects (particularly if the client's appointment is later on the day of a therapist's chemotherapy) could also account for some of the therapist’s other inappropriate behaviors (being late; having dirty dishes around; taking off her shoes, and generally seeming out of it).

 

This, of course, does not negate the negative effects for the client. But it does bring up the general question of therapist impairment (for whatever reason) and its effects on clients. When the impairment is the result of medical conditions or treatments, this is a societal problem. In particular regarding therapy, there need to be mechanisms to help ensure that a therapist’s medical condition and/or its treatment do not affect client’s treatment. I can well believe that a therapist impaired by medical conditions or treatments may be caught in a bind -- perhaps needing to work in order to pay for medical treatment, or to continue being qualified to receive medical insurance benefits. This is a societal problem that professional societies, agencies hiring therapists, and governmental bodies responsible for making and carrying out policies and regulations all need to play a part in addressing.   

[Eve B]

I don't think it would be safe or productive to be treated by any therapist who is feeling ill if that condition is affecting how they respond to their clients. The therapy relationship is sensitive, and a tired or moody therapist would likely make more traumatizing or triggering mistakes in their conduct. Here again, the client will be the one who suffers both emotionally and financially. I understand the therapist's need to work, but why at the expense of the client's mental well-being? The problem with enforcing regulations for this profession is that it will depend on the client to report the violations because there are no other witnesses in the session room. Therapists know the general rules that they're supposed to follow, but with confidentiality comes the power to bend or break those rules however and whatever they believe it's for their client's good. 

Episode 21: Harmful therapy supervision and the problematic glut of therapy graduates (so confirming that the quantity of therapists in the field is greater than the quality?)

[Mary S]

On 10/12/2019 at 4:40 PM, Eve B said:

... There problem with enforcing regulations for this profession is that it will depend on the client to report the violations because there are no other witnesses in the session room. Therapists know the general rules that they're supposed to follow, but with confidentiality comes the power to bend or break those rules however and whatever they believe it's for their client's good.

Yes, good point. This is something the professional societies and regulatory agencies really need to think about.

I got this reply from Ben Fineman:

"You make a lot of very valid points.  While I can't speak to what was happening with that therapist, it certainly fits with your idea.  I hadn't considered that possibility, and as you suggest, it brings up an important subject of therapist impairment and who is responsible for deciding when a therapist is no longer able to provide effective and ethical services.  I suppose the not-too-encouraging answer is that as professionals, we do our best in the face of circumstances which have lots of gray areas and uncertainty, but there are no systems in place to ensure the absence of negative consequences on clients.  Nearly all therapists are working out of a sense of wanting to help others (in my opinion), but that often is not good enough.  And so, we continue to do our best in an imperfect system."

[Eve B]

22 hours ago, Mary S said:

" lots of gray areas and uncertainty, but there are no systems in place to ensure the absence of negative consequences on clients.  Nearly all therapists are working out of a sense of wanting to help others (in my opinion), but that often is not good enough. "

This should be part of the disclaimer on therapy consent forms!

[Mary S]

On 10/13/2019 at 10:22 PM, Mary S said:

  I suppose the not-too-encouraging answer is that as professionals, we do our best in the face of circumstances which have lots of gray areas and uncertainty, but there are no systems in place to ensure the absence of negative consequences on clients.  Nearly all therapists are working out of a sense of wanting to help others (in my opinion), but that often is not good enough.  And so, we continue to do our best in an imperfect system."

The above are quotes from Ben Fineman's email response to me. Two  points in them that I would like to address:

1. "we do our best in the face of circumstances which have lots of gray areas and uncertainty"

Uncertainty is just  a normal, inevitable  part of life. One thing that often disturbs me in what therapists say is that they so often act as if things are (or at least should be) certain. Therapists need to learn to deal more realistically with uncertainty, rather than to go off in the fairy tale world where they believe things are (or should be) certain.

2. "Nearly all therapists are working out of a sense of wanting to help others (in my opinion), but that often is not good enough. "

I"m willing to assume that almost all therapists genuinely want to help others, but a big part of the problem is that they want to help others in ways and toward ends that they (the therapists) choose. That is treating the client as an object, unless the client freely  (without pressure) consents to both the ends and the means. However, many therapists seem to be very good at the art of persuasion, which can push the client to consent to things that they would not have consented to without the pressure of the persuasion. For example, one thing I hoped to get out of therapy was to be less vulnerable to persuasion, but I never got help toward that goal -- it was just swept under the rug by therapists. In other words, the problems I went to therapy for help with were bigger problems in therapy than in real life.

[zygomaticus]

On 10/14/2019 at 4:22 AM, Mary S said:

as professionals, we do our best in the face of circumstances which have lots of gray areas and uncertainty

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.

Quote

there are no systems in place to ensure the absence of negative consequences on clients.

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.

4 hours ago, Mary S said:

the problems I went to therapy for help with were bigger problems in therapy than in real life

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.

[Mary S]

11 hours ago, zygomaticus said:

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.

This pretty much describes my experience as well.

Edited October 15, 2019 by Mary S

[Eve B]

18 hours ago, Mary S said:

"they want to help others in ways and toward ends that they (the therapists) choose. "

Because they're paid to be the "experts," and many therapists assume that clients want them to take the lead?

[Eve B]

13 hours ago, zygomaticus said:

I've tried saying it doesn't work like X for me only to be told, authoritatively, that yes, it does.

Do you know what would've worked for you, zygomaticus?

[Mary S]

5 hours ago, Eve B said:

Because they're paid to be the "experts," and many therapists assume that clients want them to take the lead?

This might be part of the picture, but I don't think it's all. I think there are some other contributing factors, including:

A lot of therapists have pretty big egos and think they know it all and/or are "special".

A lot of therapists enter the profession precisely because they like to "mold" people (a power thing, I guess). 

Therapist training is often like a religious indoctrination.

[Eve B]

Do you think it could be changing somewhat with the newer generation of therapist graduates, though? The trainees hosting the very bad therapy podcast seem to show more open-mindedness and humility than many already practicing in the profession.

[Mary S]

12 hours ago, Eve B said:

Do you think it could be changing somewhat with the newer generation of therapist graduates, though? The trainees hosting the very bad therapy podcast seem to show more open-mindedness and humility than many already practicing in the profession.

I agree with your last sentence. Whether or not that reflects some change beyond their particular circumstances/training/whatever remains to be seen. I hope it augurs a change for the better -- but my impression is that the majority of therapists still stick to the "old ways".

[zygomaticus]

On 10/16/2019 at 1:21 AM, Eve B said:

On 10/15/2019 at 11:21 AM, zygomaticus said:

I've tried saying it doesn't work like X for me only to be told, authoritatively, that yes, it does.

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.

[zygomaticus]

On 10/16/2019 at 6:10 AM, Mary S said:

A lot of therapists have pretty big egos and think they know it all and/or are "special".

A lot of therapists enter the profession precisely because they like to "mold" people (a power thing, I guess). 

Therapist training is often like a religious indoctrination.

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.

On 10/16/2019 at 5:56 PM, Eve B said:

Do you think it could be changing somewhat with the newer generation of therapist graduates, though? The trainees hosting the very bad therapy podcast seem to show more open-mindedness and humility than many already practicing in the 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.

[Mary S]

5 hours ago, zygomaticus said:

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.

 

See here for some discussion of narcissistic therapists.

Edited October 18, 2019 by Mary S

[Eve B]

5 hours ago, zygomaticus said:

"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."

I can so relate to this! I still don't understand why the person-centered treatment expects the client to lead.  If I knew how to fix my issues, I wouldn't be trying a therapist to help me! 

It's like there are more therapists whose styles fall on either extreme rather than meeting the client halfway. What irony that therapists are being brainwashed by their own institutions. If it's human flaws that are causing therapy harm, could there one day be therapy A.I. robots that are able to give better emotional support with less harmful consequences?      

[Eve B]

From Mary's link to the article on narcissistic therapists: "anything that has real effectiveness, that has the transformative power to change your life, has also got the ability to make things worse if it is misapplied or it’s the wrong treatment or it’s not done correctly.” 

So I guess this implies that therapy is an effective tool in both helping and harming someone's life? Therapy is effective?