Gee, I've been reading these kinds of articles in the NYT and other sources which make recommendations as to what to try in therapy but they never seem to live in the real world.
I've been around the therapy world for most of my life since my mentally ill mother dragged me to therapy with her starting when I was 16 years old. No therapist I have met meets any of these descriptions. Once, after reading a suggestion in a NYT article to ask my therapist what her treatment plan was for me, I asked did and was told "We'll get there". I've tried asking others. They seem to have no idea what I'm talking about. We never seem to get "anywhere". It is nice to have someone to talk to sometimes, and every now and then they make a helpful suggestion. Fortunately, I have insurance now but wish I could get back all the money spent talking in vain.
For those in need of help after an abusive therapy expeience please see www.advocateweb.org
There’s a private discussion board for clients to explore therapy harm and relationships from client viewpoint-- The Reality of (Bad) Therapy-The Client's Side (TTCS) Forum. Consumers appear to delve into topics and angles I never see approached by practitioners.
2
@Susan
There also is help at www.advocateweb.org and Therapy Abuse (formerly TELL) https://www.therapyabuse.org/
These organizations have helped people since the 1980s
Joyce S,ith, LICSW
I have found individual therapy helpful at times but supplemented it with twelve step recovery meetings. I found the structure of the twelve steps and the engagement with people who were suffering from painful patterns similar to my own, to lead to actual change. For example, for years I escaped the suffering of my personal sorrows by in quotes, falling madly in love. This pattern worked until it didn’t work, until it led to despair. In finding a recovery program from so-called love addiction, I finally recognized the pattern by hearing the stories of others and experiencing those ah-ha moments of recognition that finally enabled me to extricate myself from this unbearable series of painful relationships.
1
@LoveNotWar Twelve-step programs are religious in origin and have dismal documented success rates. Failures are blamed on the patients and not the methodology--heads we win, tails you lose.
It is a profession, period. Professional handling of vexatious matters, whims and fancies plus fantasies, like cleaning laundry, may not result in colorful outcome. Stark reality meets the world of make believe. There is a trade off. Therapist cannot and will not make decisions or solve problems. Then why am I going there? Thoughts precede speech which precedes action. Why lent your ear to an incoherent line of thoughts. There are better things to do.
I can't related to this essay’s conclusions: “What feedback offers is an opportunity for realness and deeper intimacy with one’s therapist. When this happens, patients can feel seen and heard, which can be a turning point in treatment, as well as in life.”
First, I never found how a one-sided, regimented, time-limited relationship is “real,” much less intimate. If a friend/partner dealt me mostly silence, in a prescribed format, with his rules and limited time frame, I’d call that relationship remote, possibly abusive, and far from model.
Then I find the treatment “turning point,” assumption, so inspiring in the now- discredited Sybil story, far murkier in real life. Some practitioners present the fictional construct of “catharsis,” as fact—that some consulting room epiphany enchantedly will “heal” a life. Perhaps patients would be less disappointed if theory wasn’t so uncritically offered as truth.
5
I appreciate the comments to this post, which point out how difficult it is to find a good therapist. "Talk to a therapist" is our standard advice for suffering people, and yet how many therapists fail to help or actually do harm to their clients? And in that suffering state, how does one identify a good therapist? And that's leaving aside the expense. I thought I had a good therapist after talking to her for a few years off and on, but she put me in a group with a guy who encapsulated so many triggers for me that I began to reexperience symptoms of the stress-related illness that I had struggled for years to overcome. And yet the only way to address this with her was to spend more money on private sessions in which she failed to show any empathy and essentially denied that the group placement was problematic for me. I began to feel that group therapy was just an income-maximizing tool for her. I ended up having a humiliating crisis in a group session and left therapy at that point. Six months later I tried to get closure on this by emailing her, first to ask if she wanted feedback and then to give her that feedback. After spelling out what a painful setback that experience had been for me, I had hoped for at least some kind of acknowledgment of my pain or even an apology that she had however unintentionally caused it. But all I got was a bland invitation to pay some more money to sit in her office again and be gaslighted some more. No more talk therapy for me.
4
@Cathy I sometimes tell clients, if they're in a non-precarious state and casual mood, that psychotherapy is like religion. "There are over four thousand religions in the world, and everyone thinks they have the right one." There are different -- and conflicting -- paradigms of what goes right and what goes wrong with people. That's problematic enough, in my opinion. But what's worse is that there is no good way to capture which therapists will have a very problematic "belief system" and personality, and which won't. Jacquelyn Small, in her excellent book Becoming Naturally Therapeutic, points out that 'regular people' can be better therapists than those who fill their heads with theories, often to distance themselves from their own heart and the heart of their client. So you are right: Beware.
3
My partner recently decided to try therapy. His psychopharmacologist did not have anyone to recommend, which I thought was strange. Instead he asked him to send him a list of the therapists who are in his insurance network.
We cut and pasted the names into a word doc, which was quite an undertaking, and sent it over. The doctor chose four out of the list. My partner called all four. Only two retuned his calls.
The first one said he is taking new patients but he’s 71-years old and travels a lot. But my partner made an appt anyway. But he also wanted to meet the second therapist to see which one would be the best fit. However, when told that my partner was “shopping around”, he said, “If you don’t have specific goals and are only looking for an open-ended relationship, I don’t think we are a good fit.”
How many paid sessions should it take for a patient to know they’ve chosethebest match? Why didn’t the other therapists at least return my partner’s call, if only to say they can’t take new patients right now?
My partner saw the first therapist this week and is not sure he’s the right person. His next appt is not for two weeks. Considering what he’s dealing with emotionally right now, that’s too far away.
Yesterday, as the result of a Google search, we found a therapist who offers a free discovery call. Fingers crossed. The bottom line: finding a therapist is an arduous process, particularly for people in crisis. Improvements are critically needed
8
As a therapist myself, I have heard many stories from colleagues, friends, and clients about therapists who operate in a manner that suggests they might be truly clueless about human beings. It still shocks me when I hear about them, even though I have heard this kind of story many times.
For the client, challenging the therapist (in a polite way, as the article suggests) can be a great litmus test for the therapeutic relationship. If the therapist is defensive, it might be time to move on. If the therapist is curious and gracious, you might be in a really good relationship.
6
Yes! I’m very grateful for articles like these, which discuss such important topics, erm dilemmas, that so many of us struggle with alone in our heads and have no idea how to navigate.
Our therapists should most definitely be checking in on us, regularly, because literally our challenge in bringing up issues, as others here have said, is a HUGE reason why many of us are in therapy to begin with. If I could expertly confront and address issues I’m having in therapy with my therapist, with such confidence and ease, I wouldn’t need therapy.
L
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6
Long ago, I saw a therapist who at one point clearly veered way off base in her understanding of me; it’s almost as though she thought I was someone else. I went to a session and told her it would be my last, and when she asked why, I told her the truth. She was stunned and said I was right and that she had recently gotten into a new relationship that was distracting her. She asked if I would give her a chance and come to one additional session. I agreed, and starting with the next session, she was back on track and helpful.
5
@Annie
That's a good story. I sometimes wonder how therapists seeing many clients a week can keep track of all our stories. Maybe she had literally confused you with someone else, or at least, partially mixed up your story with someone else's. I would certainly cut a therapist a break for a simple error like this.
How many patients see therapists for years without any major changes in the circumstances of their lives that brought them to therapy in the first place? Doesn't this mean that "therapy" is little more than a fireside chat for such patients? If no discernible change is occurring I believe it is the therapist's ethical responsibility to "call it".
Feeling warm and cozy for 50 minutes is all well and good but should not be confused with real change.
3
I’ve met a person socially who I’ve learned is a therapist (not the unlicensed, uneducated type, this is someone with degrees). I not only wouldn’t I trust this person to help me as a therapist, I would not confide in her as a friend. She is so obviously self centered and obtuse that I think there is an ethical problem with her charging money for therapeutic services it is bordering on criminal.
I am all for the benefits of therapy, unfortunately like any industry, there are problems that can occur.
Unfortunately, patients in need of therapeutic services are not in the best position to judge if a therapist is qualified.
10
The behavioral therapist I have seen for a couple of years is a rock star in my eyes -- and he would welcome the sharing of dissatisfaction even if it secretly stung a bit. And I have told him on certain occasions "No, that's not what I' saying at all." His response is to listen. MY issues with ALL therapists is trust. Once In the past in the social company of a therapist , she started to say enough about a client to make them identifiable. I asked that person to stop talking about the topic. Do therapists share with their spouses? Some may. I hold back on some things because there is no way to be sure of the parameters of sharing outside the private office. I wish we could all say for certain that we know but the fact is, we have no way to be sure. So, yes, I hold some things back, especially when they concern someone else who wouldn't want their information divulged. But I take responsibility for this. It is not my therapist's issue. He has been nothing by probing, kind, astute, pointed and perceptive.. I just don't certain privacies shared with anyone. What I have always felt, however, is a rapport between us that is precious. I feel accepted just the way I am, and appropriately challenged. Yet I do absolutely know there are therapists reading this who will recognize themselves as "sharers" of private information.
5
I NEVER comment on articles. In fact, this is my first time....SO PLEASE BE KIND. I am an occupational therapist. And I start the therapeutic relationship by establishing the foundation of care, which includes a FOCAL tenet of open, collaborative communication. I HOPE that clients will give me feedback. That is the only way they can benefit form the process. I want to make everyone's commitment worthwhile. It makes me sad that client's don't feel comfortable to share feedback with their therapist. I mean, then....what's the point of therapy?
2
It should be like end of semester evals by students of their professors: written and anonymous. Then the therapist gets the joy of trying to figure out which patient said what.
5
as a former adjunct professor of Law and Ethics and a clinical supervisor and director ,I taught about and explored my students' and interns countertransference issues; and urged them to ALWAYS obtain consultation, not work in a bubble and maintain a balanced life and their own mental health support.
there are many troubled,damaged and damaging people who work as therapists..
yes we are all wounded healers, the ethical path means NOT dripping our wounds on our clients but getting our own help,knowing when we need it,and always seeking to do no harm.
5
It is very important that frustrations and disappointments in therapy be expressed and explored. Is that the same thing as “ feedback”?
But equally clients should be careful of therapists who never challenge and who always agree. Being “ heard” should not mean always being agreed with. Therapists who encourage self-pity are also ones to be wary of. Empathy is something different.
3
@Jill Reddan Self-pity can be fine, if it's compassion for oneself. It would be a transitional place -- the real feeling -- before some inner strength was able to transform it into productive action. Self-pity is only harmful if there is no adult scaffold over the self-pitying "inner child." I've seen adults, typically the personality disordered, who cannot do therapy because they have never ascended beyond the hurt child.
1
'Many clients come to therapy to feel better, not to get better' (from the Masterson Approach). That this is NOT a truism is one of the big problems in psychotherapy today. Many clients and therapists confuse the two goals -- palliative versus enduring change -- or more accurately, they do not know the difference. Of course we should listen to the client. If we overtalk or inappropriately disclose, we should be told. But if a client fears "facing painful experiences," while these experiences are intrinsic to the effective approach to their problem, then he or she should be told this. The customer is not always right in therapy.
4
I have got tremendous benefit from therapy but it took a long time to find the right ones, 'shopping around' was exhausting and I almost gave up. There really is a mixed bag out there, some people study Clinical Psychology/Psychotherapy for the wrong reasons and it shows. I quit or didn't make another appointment with some therapists because my gut told me we weren't the right fit. To me, there was no point in persisting or giving feedback because it was simply a chemistry thing. I think that it is an incredibly difficult and draining job, clinicians would need a lot of peer support having to hear all the awful trauma stories in the community, I think burn out would be very common. I thought that if I had done individual therapy that I may get some benefit from group therapy also, but I found this not to be the case. People are at different stages of their journeys and I discovered that group therapy is not for me. I think the alliance deepens most with your therapist when you start to genuinely feel in your heart that they really care about you. It takes time to build that bond. If your early life was desolate that can have a big impact on your current health and well being.
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While real world dissonance can need addressing in a psychotherapy- most skilled attentive psychotherapists recognize that the relationship that is unfolding including all the bumps & crashes that seem small, concrete, transactional, pragmatic, ordinary (like feeling uneasy being honest) are the heart of the work together. Instead of imagining there are purely logistical dissatisfactions (reasonably expressed by the patient)- both must be ready to seek more useful meaning in any sense of conflict, betrayal, poor attunement, selfishness or failure to generate anything new. Most therapies other than CBT & 'bodywork' are relational- that is the petri dish of psychological experience to decipher with greater awareness & language. Reflection on icky feelings which initially seem like petty glitches leads to talking in a new way about them- mentalizing emotional sensations so there can be 2nd thoughts ad an expanded capacity to unravel past and present dilemmas. This is not simply about achieving 'intimacy' as in a romantic coupling. It is a different kind of collaboration where both parties look at a shared event and cultivate meaning.
It is certainly not feedback like 3 stars for an Uber ride or a Yelp review.
5
@Sara
May I suggest that the benefit attained from (good) relational therapy is akin to the mood-elevation that arises when say, a lonely wife finally finds a girlfriend to chat to.
The "psychological experience(s) to decipher" are the conversation topics.
BTW, My bias is that these experiences/interpretations are like the "just so" constructs of psychodynamics, unfalsifiable and devoid of empirical content.
@Canwespeakyet : Subjective reality - obvious to all humans- defies concrete reproducible lab science methodology. The only way to honor the study of domains that cannot be so verified is to devise a method of observation & reflection that builds a consensus, resonates and proves helpful.
We have no empirical way to measure smell- there are no odor' photons' - yet we agree it is worth acknowledging this experience.
I’m fortunate to have great therapist whom I’ve been seeing for many years. It can take a long time to build a trusting relationship. It helps to refer to us as “clients” not “patients.”
4
@Catalpa
And I prefer consumers.
1
If a person doesn't feel there is any improvement in a few months, not a cure but improvement, change therapists. It is in the therapist's best interest to have their customers drag out therapy for as long as possible. There are many articles in this newspaper about people describing their problems after being in therapy for five years without feeling better. That is throwing good money after bad. How many times do you need to rehash the same problem? You would not accept bad service from any other business, so speak up sooner than later. If you are not happy with your slow to no progress, find someone else. You are not beholden to your therapist.
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Wow. “…customers…”? That’s a pretty raw, transactional term. I’d be pretty chaffed if my therapist referred to me by that word.
Look no further than the body of literature on iatrogenesis (harm), to see the overall attitude toward dissatisfied therapy patients. The writing and research scarcely exists, and so-called ethics discussions lean more toward defensive practice –avoiding lawsuits—rather than avoiding actual harm.
Freud and disciples twisted pretzels conjecturing causes of “negative therapeutic reaction”: resistance, fear of fusion with the therapist, envy, avoidance of success, protesting the disturbance of status quo, megalomania, hostility to the therapist, treatment resistance, "flight into health," "flight into illness" unconscious guilt, need for self-punishment, secondary gain from illness" and more. Does today’s clinician now respect his disgruntled customer, or is scientifically-cloaked defensiveness (arrogance) deeply embedded?
Feedback might lead to the “deeper intimacy” this article carols. Or criticism might wound the infallible bull elephant, who now weaponizes the patient’s flaws and diagnoses to inflict maximum damage. The patient carries the risk if therapy heads off rails.
5
I would hope that any ethical therapist wouldn’t charge a patient for the time associated with this type of feedback. This shouldn’t be on the patient’s dime.
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As a therapist, I would suggest that this kind of feedback is exactly what we hope for. This is the kind of conversation that can really change a person’s perspective on themselves and their interactions. So yes, it is part of the fee.
1
I had a therapist tell me “I knew you would not me sophisticated enough to understand that!” and “I can tell you have NO compassion”.
She also encouraged me to quit my job and become a barista (I had a bachelor’s and master’s degree I wanted to use) and to be financially dependent on my controlling husband.
I said I wanted more stability than my grant-driven nonprofit, and she told me that stability is an illusion anyway.
She also charged the insurance company for my appointments a copay a bit extra (I think that’s fraud?). I called the insurance company because I genuinely didn’t understand what was going on.
At the time, I sought therapy because was really broken and struggled to know what I felt and that I wasn’t worthless — despite the abuse I’d been through.
Ultimately, she was able to give me a diagnosis and push me to do things like exercise and sleep enough (that matters!). I also started writing out my trauma history.
I read up on all the research related to my diagnosis and found my own way to healing. Writing and peer support were key. There’s a lot of research, and much of positive psychology is presented in compelling, easy-to-understand, evidence-based ways.
I feel that I’ve successfully managed complex trauma / complex PTSD, but therapy wasn’t a key part of getting there despite my trying to make that work.
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a profession that was dragged denying, stonewalling, and treating trauma with trauma into the truths of what trauma does.. Needs a lot of feed back.
4
Lovely article. I'm a psychiatric nurse practitioner and have many clients confide in me that they're afraid to give feedback to their therapists. Everyone who works in mental health should be open to feedback and eager to discuss and problem-solve. While the topic of prescriptions may be less flexible than psychotherapy, there should also be as much collaboration as possible. If you're not experiencing this with a mental health professional, move on.
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I'm glad the article addresses angry, judgmental therapists who claim patients are engaging in resistance - and how people should leave them. One therapist I saw became defensive, angry, and judgmental about even my most innocent statements. She forgot things I had told her - then accused me angrily of not opening up to her. She often accused me of being resistant. Toward the end of our time together she began using expletives and saying things like "you're just agreeing with me because you think it's what I want to hear" (often after odd and unsolicited advice). This reminded me of things that happened in some very dysfunctional and destructive relationships I'd had. The last straw occurred when I heard her having a screaming argument w/ someone on her phone through her door before our session and I finally cut off the therapy. I'm ashamed to admit that I told her I was moving rather than giving feedback. I was too scared of her reaction if I gave her accurate feedback - there were too many books and heavy objects in the room within her reach that could be thrown!
10
I'm a therapist, and one of the first things I tell a new client is that you need to tell me when I'm wrong. The therapist as expert is based on the medical model in which clients are seen as "patients" and is a holdover from old style Freudian analysis. Newer therapeutic approaches such as narrative therapy and the recovery movement have de-emphasized the role of therapist as expert. The people seeking help are the experts on their own lives.
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A therapist should never be angry, defensive or judgmental, but denying the presence of resistance or underlying unconscious contributions is rewriting something very core to therapy and is unhelpful
14
Carl Rogers, Ph.D, explicitly stated that if he could not find anything to honestly like about a client, he felt it was better to refer a patient elsewhere than to fake an empathy he didn't feel. Humanistic therapy, encountering another is not in fashion these days--it certainly won't get you insurance coverage. But it is the best--clients--not patients, not consumers. Encounter--not one up, one down. And hang the insurance.
Like Rogers said--congruence, unconditional positive regard, empathy. No one did it like he.
9
@drshar90 Yes, but think of all the commonly unlikeable clients being incessantly referred to the next therapist based on “I didn’t/couldn’t like them”.
What you’re speaking to is an idealistic and privileged approach to giving therapy, and for most in the field, we have to at times (frequently?) let go of that ideal and help for the sake of helping.
After reading most of these mostly helpful exchanges, I'd like to summarise my impressions. It is critical to have a collaborative, trusting relationship between therapist and client. To support this, the therapist should be asking for feedback from the client on a regular basis. The therapist should have an objective, professional stance with clear boundaries, inviting open expression of feelings and expectations. What I always found to be helpful as a therapist was presenting cases in a peer support group, to gain some perspective on my approach and ideas on how to not "get stuck" or "do harm".
11
There are SO many bad therapists out there with unresolved issues and they project them onto their clients. The relationship is formed by connection and the therapist providing a safe container. It is still a business relationship complicated as it seems. Good therapists should have their own supervision to deal with their own triggers. That is on them. You aren’t responsible for your therapist’s feelings. I feel sorry for people in relationships with their therapists who feel awkward & don’t just showing up and be themselves. It is not our job to take care of our therapists! That is what most of did in our families of origins. That is called co-dependence.
47
@ML Mine did exactly that: projected HIS issues onto ME. Of course, he had to be right. Etc. It was infuriating. A year after quitting "therapy" with him, I'm doing better than all the years I spent dragging myself to his office weekly for what I now consider to be his abuse.
13
@ML I supervise interns and people working towards licensure, and one thing I am finding is that schools of counseling and social work are not emphasizing the role of transference and countertransference in the therapeuitic relationship. A couple of years ago one of my supervisees working towards licensure was not familiar the concepts at all. Online learning (scalable, great for profits) and the increased presence of for profit schools are, I fear, increasing the number of incompetent therapists.
17
@ML Looking back on my younger years when I tried many therapists compared to now where I have someone I am very happy with & have had for years, I realised something. The best therapists have done therapy themselves. It's amazing how many have not. I think this changes the dynamic because they have had the courage to face themselves and have experienced the process for themselves. People have an energy about them and you can sense the ones that have undergone the therapeutic process and looked inside. For one it shows your therapist has humility and doesn't look down on their clients/patients.
Sometimes it takes many years for a patient to acknowledge and come to terms with problems they had with a therapist. I had one who talked excessively about his own family about matters having nothing to do with my life. When I tried telling him that I needed to talk about my own issues during my hour with him, instead of hearing about his life, he got angry and claimed he "didn't do that." It took years for me to realize the flaws in the therapy. Years.
25
@Ellen: I'm sorry you had such a incompetent therapist, one who clearly had some big issues of his own he needed to work on.
But not sure why you would continue with that for years, in sessions that you were (presumably) paying for.
I once had a therapist who, during my session, would ALWAYS answer her phone if it rang (even though she had an answering machine), and who would repeatedly stand up to open/close the window behind her chair (4-6 times per session). I quit seeing her after about 2 months. I don't think she cared why I left - but I knew this woman was NOT going to be of any genuine help to me.
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@L
I wasn't really clear enough. When I say it took years, I mean that it took years AFTER ending the therapy to realize how incompetent it was. When I quit, I only realized that it wasn't working for me, without quite understanding why.
After the fact, (sometimes years after), things seem much more obvious.
18
@Ellen: Thank you for clarifying! It certainly would have been unfortunate if you'd wasted your time, money, and mental health by to continue seeing that not-good therapist.
Sometimes we know to get out, even if we can't put our finger on the "why" of it - but I consider it very important to listen to one's gut at a moment like that.
I absolutely agree with you that it sometimes takes years for things to become obvious. I've had that experience myself, including with a very competent therapist who helped me a great deal, but who got stuck on "encouraging" me to believe I'd be good at something I knew I would be bored by. I could never understand why the therapist did that.
It was only MANY years after the fact that I realized that this therapist, in a sincere effort to be "supportive" of me, had inadvertently reproduced a singularly unhappy dynamic from my family of origin. The therapist didn't realize it. And I knew the therapist was "barking up the wrong tree" BUT I couldn't clearly explain why to anyone at the time.
8
As someone who has practiced and helped train other psychotherapists for many years, I must say I appreciated this wonderful article. Any reasonable therapist should be more than open to receiving feedback. As a matter of fact - a client's feelings (good and bad) towards their therapist is often crucial to explore on numerous levels. Sometimes it enables the therapist to correct deficiencies or problems in how they have been approaching things. Sometimes it allows clients to explore complex struggles in their own past relationship with key authority figures (but in a safe space). I would urge anyone wrestling with strong feelings towards their therapist to find ways to bring it up.
22
Without even reading this article, I will say as a therapist, I encourage my clients to criticize and express their distaste, disagreement or anger with me.
19
@Listening All I understand about therapists is that for a couple of hundred bucks hard cash per session, they will listen to things you cannot talk about in any other way and tell you what you already know about them.
1
no, a skilled therapist will help clients heal from trauma, learn better object relations both within themselves and with others, and find meaning in their spiritual journey on the planet.
I’m so happy to see this article. I’m a psychologist with the Feeling Good Institute in NYC. We practice TEAM-CBT, developed by Dr. David Burns, and one of the key tenets is assessment of the therapeutic relationship. The clients we see rate us as therapists following each session, giving a consistent opportunity to provide feedback in a relatively easy way (clients often find it easier to provide written, multiple choice feedback rather than verbal feedback initially). Frequent feedback for therapists is so crucial to monitoring client progress and it’s great to see this idea being promoted!
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@Annie Mykyta, PsyD
Wow. David Burns' book "Feeling Good" is itself a fantastic resource for a motivated person.
Sometimes all we need from a therapist is someone to show us a different way way to treat ourselves and our world (instead of what I call The Squirrel Cage of Frustration-- where we try and try but can only come up with the solutions we always come up with.)
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@Annie Mykyta, PsyD
I Provide my own feedback to myself by writing about session afterwards, and occasionally share with therapist.
I find multiple choice "feedback" forms demeaning and idiotic and would refuse to participate.
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@Annie Mykyta, PsyD
After EVERY session? That would seriously put me off. It feels like part of the 24/7 "rate this and fill out a form" "provide your feedback for other users!" thing going on after everything we do these days, and it sounds like "data collection" rather than meaningful feedback. I'd have privacy concerns, too. Of course you will tell me it's all anonymous. But no thanks.
Yes, the relationship is important -- I believe it can at some level be a corrective recapitulation of failed critical bonds in childhood. But only if childhood is faced fairly deep and long. And that means pain. The greatest therapist might lose a client because the client should not, cannot or will not go to the dark places. The kind of relationships in therapy that are often considered most healing are simply palliative: One feels warm and "heard" in sessions, and there is some limited afterglow following the session or the therapy. These sessions are the most suspect: Only the surface person is being heard, while her roots remain buried.
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@Fred
After years of the same old stuff, palliative can be good.
8
@Fred: I would argue that feeling "heard" in sessions is pretty much the entire basis of effective therapy for many people, and for good reason.
17
In the article and comments, we see two possibilities: There are the few "good" therapists, earnest and concrete, who check their ratings and adjust accordingly, seemingly closing off all access to the rich worlds of metaphor and complexity in the process, and then there are the "bad" therapists who refuse to listen and even worse, who retaliate in florid and disturbing ways.
Where is the world in which the patient can say ANYTHING and be heard on many and evolving levels, where the therapist can appreciate explicit "feedback" without this interfering with the ability to make use of it in other ways on the patient's behalf, where the space between what is said explicitly and what is meant is recognized without devaluing conscious expression, and where therapists are both dogged and humble in their ongoing efforts to develop their own self-reflective capacities?
What this article points to is that your average mental health training program is doing a grossly inadequate job of actually training people to do treatment. The article might have elicited a skewed subset of comments, but the collective rage expressed and the succession of stories told throw a klieg light on the need to re-think radically and urgently the "evidence-based," Boulder (i.e., research-focused) model of cultivating mature clinicians . I hope people will join psian.org since it doesn't even cost anything and help speak up for psychotherapies of depth, insight and relationship.
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@nbur
where are these ratings? I keep hearing about them and can never find them:)
3
@meriboo. I was referring to those tell-me-about-me simplistic forms that many therapists use to talk pts out of difficult feelings rather than open them out and work through them. Somehow the whole concept is ripe for a Monty Python sketch!
4
Deaf ears!!!!
If people were so good at saying what troubles them to the person causing the issue, they would not be in therapy.
I left few therapists and ironically only when I initiated the termination did they open up about their experience of me in open and transparent way!.
As a client and therapy student, it is much easier for therapist to say I think you do not like me or you do not like my suggestions etc than fantasizing a person with interpersonal issue to become open all of sudden.
If the therapist is wrong to make an assumption that is a good and human way to teach...... See even a therapist gets wrong on things!!! Sorry but please tell me if that assumption annoyed you or made you see me differently.
But therapists want to appear all perfect and that is the resistance to patients learning it is OK to complain and not get whatever.
7
@dog girl Don’t understand this
9
One way of avoiding an unhappy therapist/patient relationship is to be selective. An important criteria to have is that the therapist has been in their own therapy/analysis. In my opinion, another way is to pick the right therapy for yourself; usually analytic/dynamic or CBT. If the therapy is unstructured, determine to say everything and anything that comes to mind in the therapy room, without censoring it no matter how silly, irrelevant, insulting, outrageous or otherwise it may seem. If the therapist has successfully worked through his/her own conflicts for the most part and is trying to be helpful, their sensitivity will mostly show in their understanding. When there are negative feelings or perceptions, a good therapist apologizes, holds the feelings thoughtfully without comment, or reflects on the evident disconnection. After 45 years I have found that successful therapies leading to profound life changes involve the working through of both negative and positive feeling toward the therapist. Too many people leave therapy precipitously because they feel angry and misunderstood. But inevitably, we feel the same way toward our therapist that we have toward others. This is the very impetus for change. There were times I wanted to rip my therapist to shreds. So glad I said so and stuck it out. I learned to tolerate him, myself and eventually others and a lifting of my spirit with a more sustained and sustaining love occurred. The other side is sweet.
21
@Dr. Diane
Selective at the beginning has nothing to do what happens months later or weeks later. The problem is about the therapist and clients first meet up to assess chemistry, it is about csn therpiast hear your method of work was not good for a particular issue and not shut down, retaliate or harm. And honestly another major issue is this, most therapist chose one method or theory and try to squeeze the client when most humans are too complex for o e theory fix.
So rather a therapist saying I am so sorry I may not have good experience helping you with this particular issue that I am not familolet us try something else, they take the stand the client is different or difficult or whatever and rupture the alliance.
It is truly more about how do teach therapists about being humble they do not know all life experiences but should be open to so so. You cannt tell a client see one therapist for anxiety, another for depression and another for childhood. That is the problem. Therapiowant boxes and human relationships are anything but that.
5
@Dr. Diane
Choice? What choice? Many clients have to go to therapy clinics, which have very few good therapists (and those who are can afford to be selective) The average therapist leaves the clinic within 6 months to one year. Look at the web site of the clinic--if every therapist is al smiling young female who looks like they are under 30--beware.
Clinics burn out their therapists. No raises, No promotions. No praise.
The industrial revolution in medicine neither benefits clients nor practitioners. It accelerates the descent into very expensive private practice, where the few, the rich, the narcissistic dwell.
4
After reading all these comments here, it gives me pause and causes me to wonder if there are any good therapists out there? I feel very lucky to have a therapist who is warm, caring, bright, and knowledgeable. We have an excellent rapport. I came to him in a state of great duress after harboring abuse I experienced as a teen from someone in a position of authority, and he quickly calmed me down and helped remove this awfulness from my brain. I will be forever grateful to him. He has taught me to stand-up to a toxic family member, and is helping me deal with my low self-esteem and anxiety. He is an excellent male role model for me when I did not have this in my early years. On occasion I have misconstrued something he may have said or did, which infuriated me, but instead of running away, I forced myself to talk to him about it, and he was never defensive, but was apologetic, kind and gentle with me. He even has had to deal with my gushing and romantic transference, and did not turn me away. He keeps excellent boundaries, is open to me, which has helped tamp down this whole transference thing. This paid professional is an important part of my life, and as someone who has had a very difficult upbringing, it is nice to know I have his support and knowledge. Therapy for me has been one of the highlights of my life.
68
@Polly Polly, it sounds like you have had a very positive and quite productive therapeutic experience. Count yourself fortunate for the therapist attributes you describe are absolutely essential and necessary for a true alliance and working relationship to occur. Sadly, a lot of therapists in this day of managed care don't have the personal or professional qualities and training necessary to perform this very difficult but also very gratifying work. Thank you for your wonderful testimony to your therapist. He must be quite a very fine person and clinician.
11
How about an article on how to tell your therapist you want to stop therapy? Took me a long time to work up the courage. It didn’t go well at all.
18
@Sheila
It's a problem when it's not well received and if it's not perhaps they arent good anyway?
7
Therapy is a two way street. Optimally the therapist learns from the patient/client as well.
This is easier said than done because many therapists go into the field to heal old traumas in themselves (ourselves). That is not per se a problem except when the emotional stakes become high and the waters become murky, and confused. Therapists need their own therapy, and someone with whom to process their own emotional reactions. Sometimes a patient will provoke or trigger unsolved or deep wounds, and we have to be able to stop, even if we have already overreactive.
Many people do not come from backgrounds where parents learn from children's criticism. The notion of being part of a learning and growing experience in a therapist can be very intimate, I suggest from both sides of the couch.
It can be terribly toxic when a therapist's narcissism depends on the worship of a patient, or much worse on a patient staying ill. One of the biggest problems in therapists is the need to be right.
Another is that there are not enough therapists prepared to go deep enough in their own self-work to be with a patient when there is a temporary crisis or meltdown.
We are all somewhat crazy and working on our own stuff allows us to tolerate a patient's journey, and the growing on both sides.
33
Maybe Netflix or Oprah or ? can do a docuseries on finding good therapists, educating clients, revealing red flags or dangers, various modalities... I've had to learn the hard way from bad therapists. Nobody is monitoring them. It would be great to empower the vulnerable.
22
@nyc
I would suggest that anyone looking for a good, non-pathologizing therapist capable of working collaboratively with you in a caring way, check out the site: good therapy.
Also, if you don't like something about the therapist, even at the very first meeting, please don't go back. When you're feeling vulnerable it's hard to trust your gut, but still crucial to taking the best care of yourself possible.
For those of you who can't get to therapy or want some extra help, please check out holistic divorce counseling. Despite the name, it offers 100% free support, resources and comfort for all life's issues and transitions, not just the cosmic hazing of divorce. No ads and nothing for sale.
5
@nyc
I agree.
There is a book I found on amazon called 'success in therapy' found useful for educating clients. A lot of useful detail
6
Clients (not patients) are the customer. Part of the problem is often that the customer doesn't understand how the service they are purchasing should work so are often unable to distinguish who is competent. Another aspect is how many therapists there are who are not good at the work. Most go into the field because they have (or had) issues themselves. You hope they work through them before getting to you.
Clients need to keep in mind that they are the decision-makers. What did they want from therapy and are they getting it? If not, why? Discussion and collaboration are key after their initial vetting process.
13
In my experience, psychologists/psychiatrists are a dime a dozen. I think 10% are gems, and the challenge is finding one of the gems. I went to several psychiatrists over the decades who simply prescribed anti-depressants trying one kind then another. I finally, much later in life, found a psychiatrist who is attentive and realized I have anxiety, and is now doing psychotherapy with me for childhood trauma that lead me to coping mechanisms throughout my adulthood that crippled my life. So much time lost, and not for lack of reaching out for help. This is a travesty in the psychiatric world and there sems to be no way to hold that profession accountable as one could if a doctor set a broken leg incorrectly. I am very frustrated and concerned with this problem.
25
@Lorraine There is no other way to utilize antidepressants other than trying one for a minimum of 8 weeks, seeing if it works, and if it doesn't, then trying another. All of psychopharmacology is like that. It's not like infectious disease where they take your blood, determine what microorganism is in your bloodstream, and give you an antibiotic that specifically targets that microorganism. The science is not there yet for psychiatry, though researchers are working on it. If a person does not respond to an antidepressant, it's not the clinician's fault; it's not like "they chose the wrong one and they don't know what they're doing." The only way to find the right med is through trial and error. The trial and error is one of the hardest parts. Then, when you've finally found the right med, the even harder work of psychotherapy begins!
Galit Sharon Marcus, NP
2
Although I wouldn't say I have considered any therapist I have had in the past ”all-knowing,” I am aware of that almost ”untouchable” ora that comes along with the title. I think it's interesting that they touched on this because a good amount of people who go to therapy go in order to seek professional help and guidance to help find solutions to problems or discuss important events in their lives. With that being said, I think it is easy to consider a therapist ”all-knowing” as you are receiving advice from them that you hope to benefit from. I am so happy I stumbled upon this article because I never would have thought about this if it weren't for this article.
5
The premise of this article "We often see our psychotherapists as 'all-knowing'" left me bemused. We do? Really?
It is well known that psychiatrists, for example, occupy the lowest rung of status for the specialisations within the medical profession - why is that? Because for many years it was considered the least scientifically based field of medical practice -- one where subjectivity rules. Substitute "know-it-alls" with "all knowing" and I may actually read to the end of the article!
In short, if you think your psychotherapist is omniscient, you really are crazy!
6
@Abraham
Unfortunately, massive idealization of other humans doesn't make you crazy. It makes you a co- owner of our very flawed human psyche. (Viz. the unquestioned following our current president enjoys.)
8
@Abraham
"for many years it was considered the least scientifically based field of medical practice"
Um, "for many years"? "Considered" less scientific? It is in fact the least scientifically based field of medicine.
Immediately, I was drawn to a particular therapist’s energy and intelligence when I’d see him greet his clients, so I soon met with him.
I have been in therapy for years and had yet to find someone who helped inspire me to improve. Well! Not long into our meetings, I noticed that he’d make issues - my issues - about himself. Por ejemplo, I said, through tears, “My life is over because I’m 50!”* To which he made a cross face and became serious and said, “I’m over fifty. You’re not saying MY life is over?!”
So, I started staying away after too much of this. But I was very angry. The psychiatrist suggested a letter and in that letter I told the therapist how dynamic he was, but that I did not feel heard. I know that must have stung a bit, but I figured maybe he’d learn to hear himself. I’m no longer angry and wish him well. The last great therapist was my latest, whom I lost because of insurance issues.
Be upfront. Be honest. It’s hard. It’s embarrassing, but do it, rather than waste one more minute.
(*Fifty as old! Boy, was I misguided then!)
8
For over 8 years I was in the clutches a horrible therapist and a horrible human being.
At various points in our unfortunate relationship I brought up instances in which she had offended and/or bullied me. Her response was always condescendingly dismissive. She would imply that if I were not so sensitive than maybe I could withstand her criticism more.
In the years since I’ve stopped seeing her I’ve discovered from talking to other therapists that her behavior was not only unprofessional it was unethical.
She constantly pressured me to stop using my insurance to cover our therapy sessions. When I refused to do this her response was nasty and petulant. I was in an abusive relationship at that time. And she would often cut me off from discussing this saying that my insurance company won’t justify these sessions if “that is all you want to talk about.”
She would complain that I had money to spend on vacations and a gym membership but I wasn’t willing to invest in a second session a week with her.
Obviously I should have left much sooner than I did. But the power therapists have is very real particularly if their patients are in crisis or have been through trauma.
If you don’t feel good about your therapy leave. Do it over the phone or via email. If you engage with them in person they will find a way to come you coming back.
42
@Katie Cox
Holy heck! Been in some odd therapeutic situations but this is horrible!
9
Yherapists can be immature and dishonest which leads to advice and feedback more harmful than good. Therapists can lie to clients which is fundamentally harmful.
1
Wow I just read all of these comments! I’m an LCSW and I’m going to once again encourage all of my patients/clients to share what’s on their minds with me if they are uncomfortable, unsure, confused, unhappy with the work we are doing together. Misunderstandings can so easily happen without talking them out... I must admit I’ve heard stories about therapists falling asleep or talking about their own grief or letting their counter transference get in the way of the clients issues,etc...we therapists need to practice our own self care ever so VIGILANTLY. Sometimes we need to get into our own therapy, so we never lose sight of what it’s like to sit in that other chair ...
47
How about the therapist who asks for feedback and says they appreciate the feedback but immediately grows defensive after receiving it and refers to the feedback as criticism?
It might be important for the patient to supply feedback but is equally important, if not more so, for the therapist to receive it well and when they don’t more harm than good generally occurs.
16
you must know my therapist
9
Clients enter therapy during a particularly vulnerable or painful time. Too often, the therapist is viewed as an all-knowing figure. Many therapists initiate treatment without any discussion of treatment goals or timeline. As the therapy progresses, many fail to solicit meaningful feedback. Some will become defensive and turn it back on the client if feedback is provided. Compared to other licensed health care providers, therapists practice with disturbingly little professional oversight. After licensure is achieved, supervision is limited. There is little to no accountability for outcomes. Many clients become very attached to their therapists, making the prospect of termination difficult. The therapist enjoys a stable revenue stream as long as the client remains in therapy.
Although I am willing to grant that most therapists enter the field with a sincere desire to help, I believe that the traditional structure of psychotherapy leaves a lot to be desired. The power imbalance is too great. Consumers (clients) need far more information about what constitutes effective, evidence-based mental health treatment. They also need tools to effectively evaluate the treatment they're receiving.
29
Having been a practicing therapist for over 20 years, I’ve seen the value in eliciting feedback. I explain to clients that it’s incumbent upon them to provide it, whether positive or not. By stating that the client is the expert on themself, the inherent power imbalance may dissolve. This paves the way for a collaborative, therapeutic alliance and restores agency to the client.
Merritt Stewart, LCSW
16
@Merritt Stewart, LCSW You're unusual in that. It's great that you ask for feedback. I've seen 3 therapists, one for close to two years, never got asked.
10
In my opinion, psycho-therapy is an art and extremely over-rated... Find two grandmothers or maybe even a trusted janitor to talk with for feedback... In the long or short run, it will most likely be a healthier and successful way of dealing with personal issues impacting your life....
14
Reminds me of the DirectTV Classic Narcissist commercial. Love it! If we can’t laugh at ourselves ....
1
Because I have seen many therapists over time I have concluded that most of them don’t have the wisdom necessary to help anyone. On one hand why would a therapist help a person get on the right track if it means that person will leave and cease being a source of income? On the other hand what if all the patient needs is a friend to sympathize with their problems? I think life is hard, empathy is needed, self reflection is a tool, and therapy should be VERY short term. In the end we have to figure out who we are and what we need.
13
Many years ago, I went back to my therapist after about 5 sessions to let her know that something she said in the previous session made me uncomfortable. The next time I saw her, she told me that I was "in stasis" and "not willing to make any changes", so she didn't think we had anything more to work on. It's a hard lesson to un-learn when your therapist fires you for daring to speak up.
37
I'm a therapist and frequently during the initial consultation, especially if the person hasn't been in treatment before, I will say that if they have a negative reaction to anything I say, I'd like to know about it, explaining that the relationship between us is paramount in the work we are doing together.
That said, I recently saw a patient who was excessively critical of everything I said and eventually left treatment. He had seen a therapist before for the same reason--relationship ending--and was critical of her approach as well. So, sometimes there's more that needs to be taken into account...
17
@L.K.
Well I was obvious as heck about why attacking therapist--evident to me --and just enjoyed doing so as it was a relieve from my presenting issue.
He was clueless BUT was helpful to me.
He was a nice guy and an excellent punching bag.
It did help me retrospectively but not him I gather.
And I was attacking his therapy method via lit I read, as a scientist I could wipe him out and enjoyed it.
2
I am a therapist and I ask my clients for feedback every 2-3 sessions at least. Sometimes they seem surprised, but I explain that it helps me to help them. IMHO more therapists should do it.
17
What about when the therapist is dishonest with the patient? I had suspicions that my therapist didn't believe me but I didn't have the courage to confront her. I didn't feel secure enough in the relationship to say a word. One reason was her habit of not wanting to discuss one of my major issues, cutting. She called it a red herring. I found out that she thought I was lying when I requested copies of the session notes.
I learned that she thought, without ever asking me, that I wanted to fix my brother. I may have said that his being autistic was hard but I couldn't imagine "fixing" him. She didn't believe my descriptions about the relationship with my parents.
Because of my past history I guess I overlooked the signs. But she was the one with the training, not I. I couldn't handle the rejection at that point. What does a person do when s/he suspects that the therapist isn't being "therapeutic", particularly if said person hasn't had good experiences with any relationships?
20
I just left my therapist. Too much harsh knee-jerk defensiveness from her whenever her ego was wounded or she felt overwhelmed. It has always hurt me. Even so, this has been a very difficult choice to let go. Time to trust my intuition and find the right fit. Intuition speaks. Listen.
16
I have found that psychiatrists don't want feedback. They just want compliance.
33
@dr. c.c. An attitude that too often comes w/the MD degree. Not always, definitely not always. I've had limited contact (treatment relationship) with D.O.'s but my impression from that contact and from chart notes I've read (I read alot of them for the work I do) is that D.O. training seems to train health care providers who listen better.
3
Years ago, I spent a brief time in therapy with someone with whom I never really connected --
I recall being at one session - around this time of year - when she mentioned early in the session that she would be going away for the entire month of August --
I just nodded and said Okay - and continued talking --
About twenty minutes later - after I had been expressing some pretty deep thoughts - the woam leaned forward towards me and - in a very thoughtful and concerned tone - said, "How do you feel about my going away for the month of August ?"
Without hesitation - I blurted out in reply -- "I wish *I* were going away for the whole month of August!!"
This caught her by surprise because she was trying to tap into my presumed separation anxieties about her leaving -- of which I had none --
Shortly after that session I stopped going to see her ...
16
I once had a therapist where I was the last patient of the evening. However many cups of coffee she drank she still had a tendency to nod off. The first time she did it I waited until she woke up and told her what she had done. She insisted she was listening the whole time. (Not. ). The second time I told her this was the last time u would be coming because I obviously bored her. To be honest I thought it was pretty amusing in a way but that still didn’t mean I was going to pay for her sleeping. Pretty constructive criticism but she didn’t take it kindly.
37
@Lisamugg. I knew a guy who regularly in business meetings. Once he fell asleep and the whole team sneaked out of the room and the last guy slammed the door loud enough to wake him up. Too funny, but not in therapy!
7
@Lisamugg.
I understand and can relate.
That's why sitting in the chair is not necessarily the best practice. While it is important for the client to be relaxed (hence, the origin of lying on a couch) it is important for the therapist to be paying attention. If the therapist has attentional problems which can be fixed by standing up and taking a few paces here and there--why be bound to a chair? Just explain that you want all the best brain cells to be actively charged with fresh oxygenated blood cells.
Wish bad, incompetent, defensive... therapists got fired. I have a few names to share.
7
There are too many therapists out there doing more harm than good with nobody monitoring them. Finding a great therapist is a true gift.
11
@Bill
They are monitored, there are licensing boards you can complain to, different depending on degree of practitioner.
@Ivy. Licensing boards don’t monitor the quality of a therapist’s work. You can complain about unethical or illegal practices, but that is not the same as just being a lousy therapist. There is no monitoring of outcomes, as there is to some extent in other branches of medicine.
5
I meant to add this link:
https://www.psychologytoday.com/us/blog/in-therapy/201209/how-give-feedback-your-therapist
It only took Swift and Greenberg 105 years to rediscover what Freud wrote in his case study of Dora. Back then the relationship was known as "transference" and now they pompously rebrand it the 'therapeutic alliance." And it took "numerous studies" to find out that Freud was right way back in 1905...
3
After appropriate feedback is given and received, is there no point in considering the transference and counter transaction of the interaction?
11
I think that as a patient you should be confident that the therapist is explicitly and reliably interested at all times in whatever you want to talk about, including your experience of the therapy -- not that you have to talk about it, but that you always can talk about it.
I think you should also be confident that the therapist will respond to anything you do say in a way that serves the therapy relationship, which almost always involves your experience of being understood by someone who wants to understand you.
28
@Virginia Kelley, PhD
And if not working, file them in "disposables" and find a new one.
And make a list of qualities you want, and expertise in areas you have problems with.
Screen professional background.
Interview on phone.
Take a shot and if not working out, discuss.
If that not working, find another.
This is not rocket science it is obvious.
[Although my rocket scientist brother would have benefited for years.]
3
Just curious how this should differ from patients' interactions with other healthcare professionals.
And fixing a broken bone may be straightforward but back pain and headaches aren't. I'm not sure why patients should be expected to take the recommendations of doctors without question for these problems but when it comes to mental health issues they shouldn't especially as psychological issues often play an important role in them.
11
"ultimately it's the emotional communication between patient and therapist that's curative".
These words should be told to every client ( and maybe some therapists) at every visit to remind them of what they are both really working towards.
28
I remember the moment when I got brave enough to have the "I'm not sure I'm getting X, Y and Z things I want out of therapy" conversation with my therapist. It felt like a breakthrough, and it was one -- she was very pleased to have me ask, and it led to a further conversation about me needing to have that same kind of conversation with other people in my life. It was about not being afraid to assert myself. That's a main reason many people go to therapy in the first place, to lose that fear, which is why it's so important to be able to ask your therapist, of all people, for what you want (and what you feel you're not getting).
65
@gmg22 ~
"""I'm not sure I'm getting X, Y and Z things I want out of therapy""
Your excellent comment reminded me of the time I worked up the nerve to ask my therapist not to take cell phone calls during our session. The minutes he used of 'my time' was not even added to the end of my session.
This therapist responded by telling me I was being confrontational and aggressive. It took a lot of nerve for me to bring up this issue, which I did in a non-confrontational tone of voice. More like a pleading tone. I ended up in tears from his response and ended therapy with him a few sessions later.
4
My most recent therapist grew frustrated with me because I couldn't see the joy in my life. Yeah, no kidding - that's why I'm here. I ended our relationship after that. I don't think any amount of feedback was going to solve that problem.
35
@Emily r
That frustration on the part of your therapist is your therapist's problem. She needed to analyze it and get help in overcoming that. Please don't negate therapy as the right therapist can enable you to find joy which is there. That joy is being obscured by a wall which can take hard work and an empathetic therapist to break though. I hope you have found that elusive joy.
3
I am a therapist, closer to retirement than to my training. Thank you for this. I am going to put it on my website.
I see several useful questions in the comment below mine. (I also see horrific tales of no ethics and no boundaries!) I'd like to add this one: "How will you know when your work here is done?" My clients like that one.
I will also add -- mostly for the younger psychotherapists out there -- that a non-defensive response on the therapist's part when they've made a mistake can be a critical turning point in therapy, adding powerful depth and humanness to the relationship and the work.
82
@Madison Minions Some years ago, being well-experienced as a patient, I went to see a Jungian analyst.
In thinking over our session, I realized I was very disappointed. So when I went back, I said that I wished that she had pushed me to explore XY more and that I thought she should have pursued the dream I reported. Instead of responding to what I thought were good leads, she became defensive and said that I should have taken the responsibility. So, after this session, I decided that if I was to be completely responsible for my therapy, I could just save my money. I cancelled by sending her a note. Too bad she couldn't listen. I could have taught her how to be a better therapist.
23
A significant amount of therapeutic breakthroughs happen when a patient completes an Evaluation of Therapy Session(ETS) after each session. This is required to be a TEAM CBT (David Burns MD) therapist and can be humbling at times, but my clients critical feedback has improved my skills immensely.
I wouldn’t go to a therapist who didn’t take feedback (on paper) for each session. Now that I see how my client relationships, and most importantly, outcomes, have improved because of it.
6
@Paul L.
The ETS sounds like a good idea; but for me at least, I need time to process what happened in the session. If the form is to be filled out and handed in immediately, it wouldn't work for me. If I could take it home and have at least a week on it, that would be useful. After a hospital stay, I was sent an email by the hospital wanting to know how I regarded my experience there. I filled it out as completely positive; and it was not until several weeks later that I came to understand it was anything but.
23
@Paul L.
What you describe is very useful when you are treating symptoms. Not so much when you are doing deeper healing.
Treatment versus healing. They are different.
31
You’re right about the hospital form. You needed a week to process. Much different than an ETS in terms of questions. Having an evaluation every session builds the exposure and ability to connect and practice assertiveness, self-determination instead of relying on the therapist. Turns the relationship into equals.
4
As a retired therapist and clinical consultant to other therapists, I’ve found the following questions helpful:
How is your therapy going?
How is the relationship between us?
Are there things you want more of?
Are there things you want less of?
This has often led to productive conversations including clients disclosing topics never previously discussed. There is plenty of research that shows therapist and clients differ in what they think produced a successful therapy.
77
I would also add that a really good, well-connected therapist should recognize when a client relationship isn't working well, and would refer the client to a better suited colleague. Client feedback may help a therapist see this so they can send the person to someone who many help them more appropriately.
35
I've had 3 therapists who probably need more therapy than me. Clients need to be educated and empowered. Great article.
116
@nyc Most people who choose therapy as a vocation were attracted to the field because THEY have/had issues themselves. You hope to find one who has worked effectively on them.
8
It’s unfortunate that patients are put in the position of having to stand up to their therapists.
Often people are in therapy in the first place because they have a lot of anxiety that impacts their lives enough that they can’t easily confront anyone or even have an awkward conversation, so they may find it difficult to leave a therapist who isn’t helping them.
Those patients may find it hard to get what they need from therapy because they can’t ask for it easily- if they could, then they wouldn’t need therapy!
71
@L Brown
No one is saying clients need to "stand up to" their therapists. We are encouraging clients to ask for what they need, to communicate clearly and bravely on their own behalf with the other person in the relationship. In so doing (and assuming the therapist responds well), they are learning a new behavior, getting stronger and more confident, and probably getting better and feeling happier. Bingo! Treatment goals and deeper healing achieved!
13
@Madison Minions
Read what he said again? You sounded defensive.
9
Unfortunately, in my experience therapists do not respond to any critical feedback well, no matter how tactfully or bluntly presented.
Its worst with those who refer to the people they see as “patients” rather than “clients”, and it usually boils down to feedback giver “having a bad day”, “resisting treatment” or committing a “thinking error”, or even “patient out of touch with reality and perhaps then requires a psychiatrist and prescription.”
37
Well said. I have offended every psychiatrist, doctor and therapist I have ever met by not being “Christian enough”, “religious enough” or “spiritual enough” for the therapists in question. This applies to the entire medical profession, not just psychiatrists. Until doctors quit making their judgemental natures obvious, and are trained to rigorously avoid such appearances, no one will get the help needed - which is science based treatment.
6
I was surprised that this article did not mention that therapists should also be asking clients for feedback. While it is important for clients to be their own advocates, therapists should be frequently checking in with their clients and asking for regular and consistent feedback. Feedback is a beneficial opportunity for all parties to ensure they are being heard and respected, and therapists must be sure to seek it out without only relying on their clients to bring it up.
I think therapists can be doing a better job of soliciting feedback in the first place. Soliciting feedback can empower the client to speak up, and it creates space for this type of conversation to happen in the first place. Therapists should then be using this feedback to help navigate treatment and ensure the client is making progress. This will ultimately serve to help clients and therapists alike in being able to achieve desired outcomes.
116
You are absolutely right. One of the reasons I love accelerated experiential dynamic psychotherapy (AEDP) is that feedback is built into the model. We call it metaprocessing. Check out Diana Fosha’s text the “Transforming Power of Affect” for more information.
13
@sca Totally agree. Seeking feedback is something every therapist should incorporate into their practice and asking clients to do this on their own, IMO, borders on unethical. For decades Yalom as been writing about the importance of feedback and more recently the work of Scott Miller and others has shown feedback is one of the most effective tools therapists can use to foster the therapeutic alliance. And decades of research have shown that alliance accounts for a far greater percentage of change in therapy than any of the so-called "evidence-based" therapies some out there are promoting. When training counselors and therapists, I insist they make feedback a fundamental part of their practice.
33
@sca
thank you for this comment.
Almost every therapy article I see talks about how a client or patient should do this or that.
In fact, I think as a therapist and a client, it is the therapist that is responsible for setting the healthy part of the relationship and the client is bringing things to work on not to show the therapist how to have healthy relationship.
It is quite jarring to expect a person who could not do this (speaking directly and healthy way) to speak directly and healthy way in therapy...then what is the therapy for?
Every now and then, I would make a comment to my clients to let me know what they do not like about the process. This is my job. My therapist never asks me how I am doing but because I do not have a problem in this area I can express freely.
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Although most therapists are focused on helping patients and would/should be receptive to feedback, if something is really distressing in a therapeutic relationship or feels creepy, it may be a sign of unscrupulous and unprofessional conduct on the part of the therapist. It can help to share such concerns with an outside trusted person as a check on whether the therapist seems out of line. If so, simply giving feedback to the therapist is likely to be insufficient.
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@NY MD Agreed. I worked with a therapist a few years ago who gave some borderline unethical advice and regularly became very agitated toward me during sessions. They would say that there "were no wrong answers" while we talked, but would go on angry rants about some of my ideas, feelings, and decisions. To be honest, they were sometimes on point, but their approach was counter-productive and even damaging. After almost a year of walking on eggshells with them, I finally left them after speaking to two therapist friends who said "get out of there - NOW". As you said, as w/ many things in life - if something doesn't feel right - get a second - or third - opinion.
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To express the feelings of unease or voice criticism of the therapist would require a high level of self-awareness from the patient. Often patients seek help because they lack this self-awareness it self-confidence needed to draw healthy boundaries. The therapy-client relationship may be no different. All of this said, I completely agree that patients should be able to give feedback to the therapist. I speak from painful personal experience here. When I was a child of 12 my mother was in therapy. From what I understood at the time, my father accompanied my mother a few times and it was revealed that the therapist (a man) and my dad shared the hobby of deer hunting. Soon my Mom's need for therapy was trumped by what became a friendship between my dad and the therapist (red flag!). Soon the therapist and his family would join my family on Sunday outings. To make matters worse this therapist would critisize me for my weight saying things like, "If you would lose your baby fat, you would look quite nice!". He would also say things along these lines to my Mom. This did not sit well with either of my parents but they did not dare to speak up and throw him out. Only last year (I am 40 now) did I discuss this gross ethical and professional transgression with my Mom for the first time. She was completely unaware of how inappropriate this whole thing was and how she as a patient did have the right to say no to all of this.
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