Very Bad Therapy podcast

[Mary S]

On 11/19/2019 at 2:18 AM, Eve B said:

Therapists upsell their product (therapy) because it's also a business.  If it sounds too good to be true, though, then it probably is. 

I don't really think the author (authors?) of the book I read were trying to "sell" therapy in the sense of promoting their business -- I think they were "selling" it like a religion that they fervently believed in -- they were promoting their beliefs, not their business.

[Mary S]

I listened to episode 26 a couple of days ago. The therapist involved sounds like a real scumbag. The client was a young therapist in training. Her therapy seemed to be going along fine, until one day the therapist (a man 20 or 30 years her senior) said, toward the end of the session, "I'm going to ask you a question. If you say yes, we'll have to end our therapeutic relationship," then proceeded to ask if she wanted to go out for coffee with him. She, of course, was shocked and decided to file a complaint. Later, she got an email from him saying something to the effect that the therapeutic relationship was terminated. She noticed something that said that the email would expire in a short amount of time, so she took a screenshot if it to support her complaint. I can well imagine that this type of behavior would have been even more devastating to a client who wasn't as familiar with the ethics of therapy. 

(I see that the next podcast is up -- the topic is "The Negative Effects of Therapy", which is something quite important to me.)

[Eve B]

2 hours ago, Mary S said:

 I think they were "selling" it like a religion that they fervently believed in -- they were promoting their beliefs, not their business.

I agree that therapists believe in what they do, but I see them selling therapy as a  more of a business because they're charging $200+/hr to basically brainwash their clients.

[Eve B]

"A small percentage of clients experience negative effects from therapy"-- I wonder where they got those statistics when the reality is probably more than a small percentage that aren't reported.

[Eve B]

2 hours ago, Mary S said:

I'm going to ask you a question. If you say yes, we'll have to end our therapeutic relationship," then proceeded to ask if she wanted to go out for coffee with him.

I don't understand why he didn't simply explain his boundaries to her instead of acting like an obnoxious jackass?

[Mary S]

4 hours ago, Eve B said:

I don't understand why he didn't simply explain his boundaries to her instead of acting like an obnoxious jackass?

I'd say he acted like an obnoxious jackass because he was an obnoxious jackass  or maybe even worse.

[Mary S]

I just listened to Podcast 27. The first part is discussion with a client who has had several instances of bad therapy. Around minute 30, there is discussion with (Danish?) therapist Jorgen Flor, who has written a book (not in English) about negative effects of therapy. He said that research finds that about 10% of clients get worse. Around minute 40, a discussion of "bad apple" in the profession begins. It points out that clients rarely have information that would allow them to avoid bad apples.  Carrie points out that therapists' evaluating colleagues is not currently part of therapist culture. Toward the end, someone says something like , "It's not the patient who fails the treatment; it's the treatment that fails the patient."

[Eve B]

It's the treatment that fails the patient, no kidding... And who's supposed to be responsible for recognizing this failure in time? It's also mentioned in episode 27 that therapists are assuming they're giving good treatment even when it actually may not be working. So why isn't client feedback a mandatory part of the sessions?? 

[zygomaticus]

42 minutes ago, Eve B said:

It's the treatment that fails the patient, no kidding... And who's supposed to be responsible for recognizing this failure in time? It's also mentioned in episode 27 that therapists are assuming they're giving good treatment even when it actually may not be working.

Exactly, and therapists are supposed to be trained to be perceptive and observant, yet strangely seem to have cognitive dissonance when it comes to the limitations of the treatment or their own capabilities. How can there be such a mismatch between what the therapist and client are respectively experiencing the treatment to be, as in the therapist can believe it's beneficial whilst the client is stuck, or worse, being harmed?

The easy way out when therapy isn't working is to blame the client, and there seems to be a culture of that from what I've read and heard.

49 minutes ago, Eve B said:

So why isn't client feedback a mandatory part of the sessions??

It's almost as if clients are expected to be active in some ways, passive in others. Vocal and yet, when it suits the therapist, voiceless. I believe the industry as a whole treats clients as there to be instructed, guided, prompted and educated. They're meant to follow, and they're never equals. The therapists and clinical psychologists seem to think that if the model is delivered, the client SHOULD get better, so if progress isn't happening, clients are made to fit the model, not the model to fit the client. I just don't believe they welcome feedback, it would empower the client more than they're comfortable with, being accustomed as they are to monopolising power in the dynamic. Plus, there seems to be a huge reluctance to allow the process itself to be discussed, with justifications like 'it's just not therapy' or that the process comprises 'tools of the trade', as if it's about protecting intellectual property or something, being unconvincing. Clients have a right to question the process, especially given that they're being subjected to it and are the true stakeholders when it comes to their life, mind and therapeutic goals.

[Mary S]

3 hours ago, zygomaticus said:

The easy way out when therapy isn't working is to blame the client, and there seems to be a culture of that from what I've read and heard.

Examples from my experience:

"You expect too much. That's Your Problem!"

"Are you sure you're not trying to second guess me?"

"Do you realize you're asking me to give up my control?

"You make things too complex."

"You'll never get better if you keep seeking the perfect therapist."

 

[Mary S]

A couple of days ago I listened to the latest Very Bad Therapy  Podcast (#28). It featured Chris Hoff, (who has his own website called The Radical Therapist, including some podcasts and UTube videos). The impression I got of Hoff from the VBT podcast was mixed. On the one hand, his general demeanor gave the impression that he was basically a nice guy. On the other hand, some of the things he said were disturbing. In particular, I recall him saying something like "95% of what a therapist  does should be asking questions." (I'm not sure this is the exact quote.) That sounded like a one-size-fits-all prescription, that I doubt would work well with me. Indeed, my general experience with therapy is that therapists too often ask questions that seem out of the blue, without giving reasons, or giving unsubstantial reasons (like, "Because there's something I want to know"). That comes across to me as being very authoritarian, and not caring about informed consent.

Today I looked over Hoff's website and some of his videos. Most of them turned me off or seemed not of interest to me, but there was  one that seemed worthwhile: https://www.youtube.com/watch?time_continue=101&v=gNFnWGamNfM&feature=emb_logo  It essentially debunks "attachment theory". My impression (including from Psych Central postings) is that Attachment Theory seems pretty bad, so I'm glad to hear that it has been debunked. (Hoff believes that focusing on resiliency is better -- which makes sense to me.)

[Eve B]

Asking questions is helpful to clarify the problem and find solutions. Maybe it's not that therapists need to ask questions but that they're not asking sensible or useful questions appropriate for each client's issues?

[Mary S]

6 hours ago, Eve B said:

Asking questions is helpful to clarify the problem and find solutions. Maybe it's not that therapists need to ask questions but that they're not asking sensible or useful questions appropriate for each client's issues?

Yes, I agree that asking questions *can* be helpful in clarifying the problem (or  other relevant things) and in finding solutions -- as well as in increasing understanding. I agree that questions need to be appropriate for each client's issues and background. But so often, in my experiences with therapy, therapists' questions seem off the wall. For example, being treated as an object of interest really turns me off -- so a therapist who says "I'm interested in [something about me]" really turns me off. -- that is a form of using me to gratify their interest, a boundary violation. But, for example, if they ask for a clarification of something I have said (e.g., if I've used a word that has two different meanings), that can be helpful.

[Mary S]

I listened to #30. It was in some sense interesting -- Ben and Carrie seemed to be genuinely trying to be objective (non-partisan? Or something like that?). But I still really have that sense of being in a different culture. Things like "I feel that" just aren't normal, natural, or everyday for me. They sometimes talk about the importance of a "therapeutic alliance," but I find it hard to imagine having a therapeutic alliance with someone who says things like, "I feel that". That just  doesn't speak to me, and it's not a language that I fit into (or that fits me?).

[Eve B]

Therapists seemed to pay more attention when I said, "I feel that..." even though I'm pretty sure that in the real world, people would usually say, "I think that...." I've noticed myself using "I feel that..." when talking about my emotions to a therapist but then I'd switched back to "I think that..." if the conversation was with anyone else outside of the session room. Maybe it's just part of the therapy language for clients if they want the therapist to be able to listen and connect with them better?

Episode 30 also discussed the money aspect of the profession and the question of whether the process works better when clients pay (more) for it versus being a free service or a lower rate. From my experience with various therapists ranging from intern level to the PhDs, it's not the price of the therapists that influenced me to want to cooperate with them as how they communicated their personality, knowledge, and skills.

[Mary S]

10 hours ago, Eve B said:

Therapists seemed to pay more attention when I said, "I feel that..." even though I'm pretty sure that in the real world, people would usually say, "I think that...." I've noticed myself using "I feel that..." when talking about my emotions to a therapist but then I'd switched back to "I think that..." if the conversation was with anyone else outside of the session room. Maybe it's just part of the therapy language for clients if they want the therapist to be able to listen and connect with them better?

I sometimes think of therapists as "feelings vultures".

Once my worst therapist said, "I get the feeling you think this should be an intellectual discussion," with an expression and tone of disdain or disgust on the word "intellectual". I was shocked, but managed to reply, "I think it should be in part, because I'm in part an intellectual person." That was actually an understatement -- her comment really seemed sexist to me ("Women are supposed to feel, not think", but I happened to be a thinking woman and thought that that should be considered OK, rather than something to be viewed with contempt or considered inappropriate. She claimed to be feminist, but this comment seemed very unfeminist to me.) 

I sometimes think of therapists as "feelings vultures" -- the word "feel" seems to turn then on, something they seem to crave. It's pretty disgusting to be on the receiving end of -- somewhat like a guy who only cares about your body. It often seems like a boundary violation to me.

[Eve B]

Episode 31- Confirming how therapists can overanalyze and try to oversell theories to their clients and that "psychotherapists don't improve with time" (00:21:53). Hmm, I wonder why that could be... Maybe something to do with therapists (over-)reacting to honest client feedback instead of really listening to it? 

[Mary S]

The interviewee's experience in Episode 31 is a good example of a therapist who takes the attitude, "My mind is made up; don't confuse me with the facts" (that I so often encountered in therapy):

The interviewee went to therapy when he was fifteen, shortly after his grandfather died, at the urging of his grandmother, who thought it might help him get over the grandfather's death. The therapist noticed that the client had a tremor, and seemed to think that he was in therapy because of the tremor. The client explained that he had had the tremor from birth and that it was neurological in origin. However, the therapist seemed to keep coming back to the tremor, for example, saying that psychotherapy might be able to reduce the severity of a tremor.

[Eve B]

Episode 33- Therapist Violating Client Boundaries

Another example of therapists believing they know better and not listening to what the client wants.

[Mary S]

On 1/3/2020 at 11:17 AM, Eve B said:

Episode 33- Therapist Violating Client Boundaries

Another example of therapists believing they know better and not listening to what the client wants.

It's worse than just "not listening to what the client wants"   -- it's doing things that the client has explicitly said, "No" to.

[Eve B]

10 hours ago, Mary S said:

 it's doing things that the client has explicitly said, "No" to.

What's the most common reason why a therapist wouldn't do what the client tells them? Can we simply narrow it down to a controlling and arrogant personality? If that's the case, the psych schools should be filtering these types of people out of their programs as much as possible because those are obviously dangerous traits to have as professional caregivers.

[Mary S]

10 hours ago, Eve B said:

What's the most common reason why a therapist wouldn't do what the client tells them? Can we simply narrow it down to a controlling and arrogant personality? If that's the case, the psych schools should be filtering these types of people out of their programs as much as possible because those are obviously dangerous traits to have as professional caregivers.

I'm very skeptical that speculating on causes (e.g., "a controlling and arrogant personality"), and then trying to filter people with these traits out of therapist training programs would do much good. First, the speculating about causes can be pretty iffy; second, being able to reliably detect things like "a controlling and arrogant personality" is also pretty iffy. 

I think a more effective solution to the problem would be to put a strong emphasis in training programs on the client's right to informed consent as an ongoing process. This  would include the following (and probably other things that I may have overlooked):

1. True informed consent involves the right to informed refusal as well as informed consent.

2. A good informed consent form does not just list a bunch of things and ask the client to sign it, thereby agreeing to all of the things listed. Instead, it needs to  provide both "yes" and "no" options (and perhaps an "It depends" option) for each item listed.

3. A good informed consent form gives reasons for each item listed.

4. A client has the right to change their mind on whether or not they consent to something.

5. A client has the right to add additional items that they do not consent to.

Edited January 6, 2020 by Mary S

[Eve B]

What good are changing the training programs if how therapists practice behind closed doors can't really be monitored and enforced, though? The privacy of the therapy sessions ends up protecting the therapist more if the client feels too afraid to file a complaint. Even if these types of improved consent forms are made mandatory, it's unfair that the client would still be carrying the greater responsibility to recognize the therapist's violations and do something about it (terminate and/or report the misconduct). There are also many therapists who believe they're doing what's best for their clients no matter how much the client may insist otherwise.

[Mary S]

9 hours ago, Eve B said:

What good are changing the training programs if how therapists practice behind closed doors can't really be monitored and enforced, though? The privacy of the therapy sessions ends up protecting the therapist more if the client feels too afraid to file a complaint. Even if these types of improved consent forms are made mandatory, it's unfair that the client would still be carrying the greater responsibility to recognize the therapist's violations and do something about it (terminate and/or report the misconduct). There are also many therapists who believe they're doing what's best for their clients no matter how much the client may insist otherwise.

Good point. I think changing the training program as I suggested might get through to some therapists, but there will always be some who don't care about accountability. So I think some measure of accountability is needed -- something like requiring clients to give therapist evaluations, which would be sent to a review board, which would have the power to discipline the therapist, or require further training or supervision -- kind of like how a college professor might be called on the carpet if their teaching evaluations are consistently bad.

But this would require a serious change in the profession itself -- which I think is needed, but is not likely to happen.

[Eve B]

18 hours ago, Mary S said:

 "something like requiring clients to give therapist evaluations, which would be sent to a review board, which would have the power to discipline the therapist, or require further training or supervision --"

Yes, I wish this could be made mandatory and implemented! The concern, however, would be those unethical clients who would abuse it to get "revenge" against their therapist. It's easy for both sides to feel personally wronged in therapy because of miscommunication or poor communication. I suppose these evaluations would need to be carefully worded so that only facts are presented and not emotional reactions?