Greetings! So glad I found this forum

[zygomaticus]

Hi everyone!

A little about me. I'm a long-term mental health service user and I've tried various therapeutic models, some privately and a few via the National Health Service (NHS) in the UK, where I'm based. I've become increasingly disillusioned by psychotherapy, and the more I've learned, the more I'm disturbed by many elements, some that belong to particular models, some that seem to pervade all of them. At the moment, I'm gradually informing myself more and more about the behavioural model, because that's what is primarily used in the NHS. I'm likely to post about that more than anything.

I did train as a counsellor, but didn't complete the training, for various reasons. That has given me a certain amount of insight (as a trainee in class, I never did any formal client work).

Also, I've had a couple of friends that have provided other insights, often inadvertently, one being an academic psychologist and the other a clinical psychologist who was, until recently, the clinical lead for adult mental health services in one of the most populated cities in Europe and also clinical lead for child and adolescent services in another big chunk of the country. Both of these friends took it upon themselves to effectively render their friendships with me into 'dual relationships', constantly delivering interventions, supposedly by stealth, without telling me this is what they were going to do or asking my permission. Since I've become aware of this and recognised the techniques they've employed, my sense of trust has taken a massive hit, irrespective of their undoubtedly caring intentions. This has caused me considerable distress and damaged one of the friendships irreparably, which I've recently ended. The other has been completely devalued, too. The paternalistic nature of this, and the complete disregard for the 'code of ethics' therapists are meant to abide by, has been revealing and is typical of how fast and loose practitioners are when it comes to ethics, particularly the notion of informed consent, from my experience. I have a very dim view of the ethical standards of psychotherapy in general, which definitely lean towards the consequentialist, 'the end justifies the means' variety.

I guess that's more than enough for now. I look forward to being part of the forum, and a special thank you to disequilibrium1, because it was her excellent blog post that led me here.

[Eve B]

Thanks for sharing your story, zygomaticus!  I've also learned that the trust issue is a biggie because that feeling of betrayal and damage is amplified inside a therapy relationship. After I researched on my own the various methods of what therapists try in order to get certain responses from their clients, I couldn't trust their kind as lightly as before. I felt like a guinea pig. Psychology is a subjective "science", and the power of confidentiality allows practitioners to be able to get away with and cover up a lot of the harm that happens.

You might want to check out the "Very Bad Therapy Podcast" topic thread in our Open Discussion forum and also let us know your opinion there since your training and personal experience with the profession would provide another perspective.  

[disequilibrium1]

zygomaticus, welcome. I've noticed therapists seemingly  more self-deluded as they go, believing themselves gifted with special knowledge and beyond the bounds of pedestrian ethical restrictions. They seem so convinced in their divine healing powers, it's easy to rope others into their folly.

[zygomaticus]

1 hour ago, Eve B said:

After I researched on my own the various methods of what therapists try in order to get certain responses from their clients, I couldn't trust their kind as lightly as before. I felt like a guinea pig. Psychology is a subjective "science", and the power of confidentiality allows practitioners to be able to get away with and cover up a lot of the harm that happens.

I feel the same way myself, and I think therapists want us to remain as in the dark as possible about their methods, because they can be quite unsavoury. I've definitely felt like a lab animal as a client getting prodded, provoked and endlessly manipulated. I think a lot of the claims of empirical evidence clinical psychologists claim are spurious, subject to all kind of biases, at best, and there seems to be a wilful blindness to factors that stack the odds in their favour that are embedded in their theory and practice.

I agree with the point you made about cover, and it's quite insidious to think that something that, in theory, is meant to be about creating a 'safe' and private space, the one-to-one setting of the counselling room, provides a convenient your-word-against-theirs unaccountability.

I'll check out the podcast, thanks for the tip.

[Mary S]

Welcome, zygomaticus. So sorry to hear that you had such unethical experiences with purported "friends" who just couldn't resist trying to "help" you. I think that people who have this kind of conceit are attracted to the field. I hope that cavorting with skeptic/critics such as we will be a positive experience -- it has been for me (Not that it's made life all wonderful -- but it at least is often a breath of fresh air.)

PS: Thanks also for giving me a nudge to learn a little about facial physiology.

[zygomaticus]

1 hour ago, disequilibrium1 said:

zygomaticus, welcome. I've noticed therapists seemingly  more self-deluded as they go, believing themselves gifted with special knowledge and beyond the bounds of pedestrian ethical restrictions. They seem so convinced in their divine healing powers, it's easy to rope others into their folly.

Yeah, I think there is something very cult-like about the profession - they certainly have tactics in common - except some therapists seem to imbue themselves with God-like attributes. They think they're omniscient when it comes to the minds of their clients, they seem to think they're omnipotent and can skew the power dynamic as much as they can get away with whilst also having virtual impunity, and they act as if they are perfectly benevolent. Unfortunately, for us, they are 'interventionist' Gods *jazz hands*.

My experience of therapists, in general, is that the trainees often display better instincts than the experienced ones, and the latter probably are buying into their own mythology and that of their careers, and by this stage they have invested that much more, money on education and training, time (perhaps decades), identity and ego; with that much more to lose - status, reputation, good money -  should they have a crisis of conscience (fat chance) leading to either leaving the profession or trying to be some sort of iconoclast from within (which is why I respect Jeffrey Masson so much, he put ethics first).

I would wager that the vast majority of clients arrive in need of something to believe in, being prepared to hope, and as such are vulnerable to deferring to the therapist's claims of expertise, their authority, their supposed 'evidence base' and their boundaries (and even if they don't defer automatically, certain models have methods of both establishing practitioner dominance and engineering client compliance).

Plus, any dissenting voices are marginalised in any mainstream forum. The profession has successfully marketed itself as being nigh-on beyond reproach. It is a 'caring' profession. Some marry that with 'scientific'. Most journalists, who really should know better, do next to no research, or are simply too perplexed by the dense jargon of the field, and are presumably beguiled by the notion that surely such compassionate people could do no harm, accept all the PR they are served and in effect provide free advertising with the spoon-fed bunkum they publish. There is no balance in how the field is covered in the media whatsoever, and the infidels have no voice.

[zygomaticus]

45 minutes ago, Mary S said:

Welcome, zygomaticus. So sorry to hear that you had such unethical experiences with purported "friends" who just couldn't resist trying to "help" you. I think that people who have this kind of conceit are attracted to the field. I hope that cavorting with skeptic/critics such as we will be a positive experience -- it has been for me (Not that it's made life all wonderful -- but it at least is often a breath of fresh air.)

PS: Thanks also for giving me a nudge to learn a little about facial physiology.

Thanks, Mary! Yes, it's been really upsetting, especially the nature of it: predominantly, but not exclusively, being the disingenuous rewards and stinging punishments of operant conditioning, like I'm some kind of pigeon in a Skinner box - it's so dehumanising. Ironically, the guy I severed ties with actually published a paper on mental health stigma and dehumanisation. Oh, the bitter irony. The behaviour modification can be hard enough to see for what it is when therapists use it, because it's meant to fly under the radar and blend into the verbal and non-verbal communication, but in a friendship, where it's obviously a more informal interpersonal setting and you're more at ease, not even expecting interventions (although, with hindsight, I should've known better than to trust psychologists to resist when they probably felt all along they could go undetected and have impunity), your trust for them and the friendship itself becomes both a smokescreen and a kind of leverage. It's so condescending and paternalistic when someone tries to tweak and calibrate multiple facets of your lifestyle, personality and belief system. Man, I think I've been stressed about it every day since the realisation dawned on me just how far-reaching it was. Quite simply, that belongs nowhere near a friendship, that's a controlling relationship, and those are generally considered to be abusive.

It will absolutely be refreshing to be amidst fellow dissenting voices!

[Sylvester McMonkey McBean]

hi zygomaticus,

welcome to the group! 

1 hour ago, zygomaticus said:

any dissenting voices are marginalised in any mainstream forum. 

that has been my observation and experince, and is exactly why it is nice having this forum.  although, the further i have come from de-attaching myself from my ex-T and climbing out from the deep enmeshment trap of the therapeutic relationship, the thicker my skin has become and my fear of being vocal and speaking up about the truth of what happened to me has  lessened.  i am noticing that on some of the public forums i go to, there seems to be more and more clients who are willing to speak up and share or who are starting to really question and doubt the therapeutic process, especially when there are others, like us, who believe those clients and are willing to help support them. 

[Eve B]

1 hour ago, zygomaticus said:

My experience of therapists, in general, is that the trainees often display better instincts than the experienced ones...

This is a good point that the psych profession probably wouldn't want widely advertised to the public because if extra degrees and decades of experience can't guarantee or at least greatly improve the chances of a successful client outcome, then how can they justify their exorbitant fees?

[zygomaticus]

9 hours ago, Sylvester McMonkey McBean said:

i am noticing that on some of the public forums i go to, there seems to be more and more clients who are willing to speak up and share or who are starting to really question and doubt the therapeutic process, especially when there are others, like us, who believe those clients and are willing to help support them.

Hi, Sylvester! I think that's really important, to have clients feeling able to speak up because they're in a supportive climate. Feeling isolated when you've found therapy destructive can almost compound the damage. It almost does take someone who's been through a difficult experience in therapy to understand, especially when the dynamic was more like a drip, drip, drip of poison rather than dramatic examples of abuse. The most similar comparison, perhaps, would be a relationship with a manipulative person. People on the outside say stuff like, 'why are you still with them?' or 'why did you stay so long?' but there is a fog in these situation that flows from the manipulator. Therapists are very good at keeping you on the hook, even when you express doubts or misgivings they somehow keep you there, as if glued to that damned chair. It can be hard to verbalise this stuff to others, especially when they have the positive PR of the industry bouncing around their brains because they've never heard it criticised before.

8 hours ago, Eve B said:

This is a good point that the psych profession probably wouldn't want widely advertised to the public because if extra degrees and decades of experience can't guarantee or at least greatly improve the chances of a successful client outcome, then how can they justify their exorbitant fees?

Exactly, Eve. I'm pretty sure there was some large-scale study that looked into outcomes to try to identify the factors that correlated most with good results. I wish I could remember the names or provide a link, but it was a while ago and before I began recording noteworthy stuff. Anyway, to my recollection there was no particular correlation with level of experience or with a particular model. The clients involved identified the quality of the therapeutic relationship as being a significant factor of a good outcome. I think the model used accounted for 1%.

[Mary S]

10 hours ago, zygomaticus said:

...I think that's really important, to have clients feeling able to speak up because they're in a supportive climate. Feeling isolated when you've found therapy destructive can almost compound the damage. It almost does take someone who's been through a difficult experience in therapy to understand, especially when the dynamic was more like a drip, drip, drip of poison rather than dramatic examples of abuse. The most similar comparison, perhaps, would be a relationship with a manipulative person. People on the outside say stuff like, 'why are you still with them?' or 'why did you stay so long?' but there is a fog in these situation that flows from the manipulator. Therapists are very good at keeping you on the hook, even when you express doubts or misgivings they somehow keep you there, as if glued to that damned chair. It can be hard to verbalise this stuff to others, especially when they have the positive PR of the industry bouncing around their brains because they've never heard it criticised before.

Yes! The "Why did you stay so long?" question when you've had bad therapy  can prompt feelings of shame (Why in heavens name did I stay so long?), but part of the "bad therapy" experience is the crazy-making fog/shocked/gobsmacked experiences that interfere with rational behavior. It's a catch-22 experience -- you go to therapy in large part because you don't have enough confidence in yourself, and therapy just erodes the little that you do have.

[Mary S]

10 hours ago, zygomaticus said:

Exactly, Eve. I'm pretty sure there was some large-scale study that looked into outcomes to try to identify the factors that correlated most with good results. I wish I could remember the names or provide a link, but it was a while ago and before I began recording noteworthy stuff. Anyway, to my recollection there was no particular correlation with level of experience or with a particular model. The clients involved identified the quality of the therapeutic relationship as being a significant factor of a good outcome. I think the model used accounted for 1%.

I  believe there have been a lot of such studies. Here is a 2011 paper that discusses studies on the therapeutic alliance up to that point:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198542/

(I looked a little for more recent articles, but was not able to find any that are not behind a paywall.)

[Eve B]

Excerpt highlights from So You Want to Be a Better Therapist :

"And although the need and value of training seem obvious, it has long been known that professional training and discipline are not related to positive outcomes (Beutler et al., 2004). A more recent study only confirmed this conclusion. Nyman, Nafziger, and Smith (2010) reported that, as strange as it seems, it didn’t matter to outcome if the client was seen by a licensed doctoral level counselor, a predoctoral intern, or a practicum student; all levels of training achieved about the same outcomes. As for continuing professional education,  despite its requirement in nearly every state, there is no evidence that therapists learn anything from such experiences or that their participation translates to better outcomes (Neimeyer, Taylor, & Philip, 2009)... More bad news here: Experience just doesn’t seem to matter much (Beutler et al., 2004). Results are mixed at best, with recent studies suggesting no effects on outcome of experience (Hill & Knox, 2013). In large measure, generic experience does not improve outcomes—experienced and inexperienced therapists achieve about the same outcomes." (page 7)

"And the ugly: Explaining part of the volatile results, variability among therapists is the rule rather than the exception. Not surprising, although rarely discussed, some therapists are much better at securing positive results than others. Moreover, even very effective clinicians seem to be poor at identifying deteriorating clients." (page 9)

"When services are provided without intimate connection to those  receiving them and to their responses and preferences, clients become cardboard cutouts, the object of our professional deliberations and subject to our whims. Valuing clients as credible sources of their own experiences allows us to critically examine our assumptions and practices—to support what is working and challenge what is not—and allows clients to teach us how we can be the most effective with them."  (page 13)

"Even if you are one of the la crème de la crème now (my looks at many data sets reveal that the best therapists are effective about two-thirds of the time), for every cycle of 10 clients you see, three will go home without benefit...  Unfortunately, up to now, therapeutic outcomes have been hard to define and even harder  to actually measure in everyday practice, leaving us to our own devices and  judgment—which aren’t so good. Consider a study (Dew & Riemer, 2003) that  asked 143 clinicians to rate their job performance from A+ to F. Two thirds considered themselves A or better; not one therapist rated him- or herself as below average.  More recently, Walfish, McAlister, O’Donnell, and Lambert  (2012) surveyed practitioners and found that therapists likely inflate their  effectiveness, reporting that 85% of their clients improve and seeing themselves as above average in effectiveness (90% saw themselves as above the 75th percentile)." (page 16-17)

"They conducted minute-by-minute analyses of 120 sessions involving 30 clients treated for a range of psychological problems. They found that unsuccessful therapists focused more on problems while neglecting client strengths. Successful therapists attended more to identifying client resources and channeling them toward achieving client goals." (page 22)

"And the absolute certainty: The client’s view of the alliance is not only a robust predictor of therapy outcomes, but also is the best avenue to understand therapist differences. Marcus et al. (2009) noted: High levels of consensus in client ratings of their therapist indicate that clients of the same therapist tend to agree about the traits or characteristics of their therapist, suggesting that there is something about the therapist’s manner or behavior that evokes similar response from all of his or her clients. (p. 538)' " (page 23)

"Bottom Line: The alliance makes significant contributions to psychotherapy outcome and therefore should be actively monitored and tailored to the individual client." (page 24)

"Feedback significantly improves outcome regardless of the model practiced—the feedback process does not dictate what technique is used but, rather, is a vehicle to modify any delivered treatment for client benefit." (page 26)

"Soliciting systematic feedback is a living, ongoing process that engages clients in the collaborative monitoring of outcome, heightens hope for improvement, fits client preferences, maximizes alliance quality and client participation, and is itself a core feature of therapeutic change." (page 27)

 

[Mary S]

Thanks for this! 

One thing that I think a lot of therapists could learn from is "unsuccessful therapists focused more on problems while neglecting client strengths. Successful therapists attended more to identifying client resources and channeling them toward achieving client goals."

And maybe this says that good advice for therapy clients would be: "If the therapist focuses more on problems while neglecting your strengths, you're probably better off without them."

And adding my personal experience: It seemed that when I tried working from my strengths (for example, asking a good question, or pointing out important points that the therapist was neglecting), the therapist responded in a negative way (Examples:  "You expect too much; that's your problem", or "Are you sure you're not second guessing me?", or "Do you realize you're asking me to give up my control?", or "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"", or laughing and saying, "Oh, you make things so complex!" or saying, "You'll never get better if you keep seeking the perfect therapist.") .

[zygomaticus]

Thanks for the info, Mary and Eve! I think there's something of a wilful blindness to studies of this nature, because the 'professional development' is a part of the industry, too, and it's not cheap, but it's drummed into practitioners that a core part of the ethics of their practice is to continuously update their credentials (which is a bit like the fashion industry telling us to update our wardrobes). If it's accepted that it makes little difference in terms of outcome, where is the imperative to do it? More broadly, it's an existential threat to the industry if factors that, arguably, a student could learn in a very short course turn out to be better predictors of a good outcome than all the theory and jargon-laden ongoing professional development. Some would say the key elements don't even need to be taught, necessarily. After all, if you don't know how to behave in an empathic way and rapport isn't something emergent and authentic, then the practitioner is basically simulating something that doesn't come naturally.

5 hours ago, Mary S said:

It seemed that when I tried working from my strengths (for example, asking a good question, or pointing out important points that the therapist was neglecting), the therapist responded in a negative way (Examples:  "You expect too much; that's your problem", or "Are you sure you're not second guessing me?", or "Do you realize you're asking me to give up my control?", or "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"", or laughing and saying, "Oh, you make things so complex!" or saying, "You'll never get better if you keep seeking the perfect therapist.")

It seems to me that therapists generally want to be the boss and are threatened by clients who show insight into their own processes or want to know more about the therapeutic process itself. It's as if the client is meant to a passive sponge, soaking up the 'wisdom' and direction offered by the practitioner. To that end, they invalidate anything of that nature by dipping into their box of dirty tricks. In all of those examples, the therapist is being evasive and using diversion. It's either dismissive, accusatory or vague, but all of those responses are offensive and undermining. Practitioners should treat client insight as an asset, not an inconvenience! It makes me angry that you were treated this way, Mary!

I've had similar experiences. One assessment, in which I believe I showed some reasonable insight into my condition, concluded with the practitioner writing and saying 'you have a tendency to intellectualise' and making a referral to a model that would circumvent this, because it was basically an in-your-face behavioural approach that barely gave me space to think during the sessions as it was endlessly provocative (by the way, I wasn't told it was behavioural, it was vaguely titled 'short-term focused-therapy', and it was only later, after educating myself and learning to recognise the techniques that I realised what the model was). It was a disastrous recommendation, and I didn't complete it because it was so harsh, critical and confrontational. She taunted me constantly for my shy and quiet demeanour, which I now realised was meant to punish it until it went 'extinct'. When I wrote (I can only assert myself in writing) and explained my reasons for withdrawing, she did some gaslighting which didn't even make any sense, saying that it wasn't the therapy or her that was harsh, but my own inner critical voice. This was the kind of unaccountability and client-blaming that's typical of the therapy industry.

[Eve B]

I've also noticed a lot of divided camps within the profession. Therapists don't even really listen to each other because they have their own ideas on how to practice, and who's to tell them they're doing it wrong (when treatment is confidential) other than their clients who aren't supposed to know any better.  

[Mary S]

18 hours ago, zygomaticus said:

.. One assessment, in which I believe I showed some reasonable insight into my condition, concluded with the practitioner writing and saying 'you have a tendency to intellectualise' ...

Reminds me of when my worst therapist once said, "I get the feeling that you think this should be an intellectual discussion," with a tone and expression of disdain on the word "intellectual". Much to my surprise and delight (since, like you, I usually have great difficulty asserting myself orally and "in real time"), I responded with, "I think it should be in part an intellectual discussion, because I"m in part an intellectual person." (Actually, part of what I hoped for in therapy -- but didn't get -- was acceptance and affirmation that it's OK for a woman to be an intellectual person.)

[Mary S]

18 hours ago, zygomaticus said:

.. I think there's something of a wilful blindness to studies of this nature, because the 'professional development' is a part of the industry, too, and it's not cheap, but it's drummed into practitioners that a core part of the ethics of their practice is to continuously update their credentials (which is a bit like the fashion industry telling us to update our wardrobes). If it's accepted that it makes little difference in terms of outcome, where is the imperative to do it? More broadly, it's an existential threat to the industry if factors that, arguably, a student could learn in a very short course turn out to be better predictors of a good outcome than all the theory and jargon-laden ongoing professional development. "

In the U.S. (if I'm not mistaken), "continuing education credits" are required to keep a therapist's certification up to date. From what I've been able to find on the web, these courses often seem to be superficial. One thing both ironic and distressing is that my worst therapist (she who seemed not to give a damn about informed consent, even when I asked for it) seems to routinely teach such courses -- on ethics, no less!

 

[Mary S]

On 8/11/2019 at 10:00 PM, Eve B said:

Excerpt highlights from So You Want to Be a Better Therapist :...

Thanks for this link and the excerpts!

There's something else that I found really interesting in the link - namely, the part from pp.31 - 33. It describes the author's experience with one of his first clients,  when he interned at an aftercare facility working with clients who were classified as severely mentally ill. His jjob was to try to help his clients function well enough to keep them out of the mental hospital. One client, Peter, engaged in bizarre behaviors in an attempt to distract himself from the "voices"  that told him scary things, but these behaviors led to his being periodically re-confined to the psychiatric hospital, where he was heavily medicated, and suffered the side effects of the meds. The author didn't really know how to help Peter deal with the voices, but in desperation he asked  Peter what might help him deal with his condition better. Peter responded that he thought it would help if he could resume riding his bike (he had been a competitive cyclist in college) -- but it needed parts, and he was afraid to go to the bike shop to get the parts, because he was afraid that if he went out alone, he might engage in behavior that other people found threatening, and so end up back in the hospital. So he asked the author to go with him. The author consulted with his supervisor, who gave the OK for the unusual request, and at the bike shop bought himself a bike, and thereafter had his sessions with Peter while they rode their bikes together. Peter improved to the point where he could live on his own and not need periodic hospitalization. 

This example shows me what a true therapeutic alliance can be: where the therapist asks for the client's opinion and takes it seriously to create a relationship and treatment that really helps the client. (But how many therapists have the willingness to listen to the client, and to take the client's perspective seriously?) 

[Eve B]

Maybe it's not that therapists don't want to take client feedback seriously but that many therapists (who claim that they're in the profession because they care and want to help people) don't want to put in that much extra effort and time, especially, if they weren't being paid for it? How many therapists would've helped find a way to get those bike parts for Peter if he couldn't afford to buy it himself? And what does it mean when there is such a huge salary gap between the public service social workers (who are assigned their case loads) versus the inflated fees of private practitioners (who can pick and choose)?  Therapists juggle multiple clients on a daily basis, and the quality of care isn't even consistent no matter the years of experience or fancy credentials.