Did it Ever Occur to You That You Might Just Suck as a Therapist?

Depending on where you get your numbers, roughly 1/3 of all patients will not benefit from psychotherapy. Why this is so isn’t entirely clear and could be due to multiple factors: intractable diagnoses, poor compliance/follow-through, an inadequate match between client and therapist, negative changes in the patient’s life circumstances, etc. Any and all of these can easily make therapy a failed endeavor.

When clients leave an unsuccessful therapeutic experience, shrinks often provide explanations couched in jargon, usually pointing to the patient’s “pathology” as a reason for the lack of follow-through:

“Clearly, the transference issues were far too intense for the patient to tolerate.”

“The Jungian archetype that emerged in session created a too startling response in the client’s collective subconscious.”

“Without question the patient’s defense mechanisms wouldn’t allow for the necessary vulnerability to facilitate the required psychological mindedness that makes the analysis flourish in its decided glory. How do I know this, you ask? I’m the expert, that’s how.”

However, what you will rarely hear, if ever, is a therapist assume actual responsibility for the failed treatment. Although it’s important that clients feel confident in their providers’ abilities, to see your therapist as without fault is naive. Most readers of this site don’t spend a lot of personal time with shrinks, but if they did they would hardly ever hear the professionals lament their mistakes or short-comings:

“I wasn’t empathic enough and left him feeling misunderstood.”

“I should have challenged the patient more, gotten her to think more about one particular issue.”

“I jumped in too quickly, I should have given him more space to get comfortable.”

“I was too cocksure and that made me appear cold and uncaring.”

“I just wasn’t good enough to help him.”

In short, it’s never the therapist’s fault. We always do our jobs correctly, so if therapy doesn’t work, it’s either due to the psychological problem or the patient. Why would we think this way? Part of it is our required role as promoting confidence in the therapeutic process. Patients need to believe that we know what we’re doing in order to invest the time, energy and finances into treatment. We are also greatly rewarded for our successes; the rush of pleasure and pride we feel when clients say “Oh, Dr. So and So, you’ve changed my life!” is like a drug. To think that your words and actions altered the landscape of a person’s life is something you hold onto forever. Add in a human being’s natural urge and ability to avoid blame and suddenly you’ve got a recipe for an overly confident shrink. But there’s another piece as well.

Consider a shrink’s training. During my graduate studies, I had a supervisor tell me that because therapy is an inexact science, one can never say that what you’ve done was wrong. “Anything you say might actually be correct, accurate and helpful, so don’t let anyone tell you that you might have erred.” He actually extended this line of thinking to never apologize for “mistakes,” such as being late for a session or forgetting an important piece of information about the patient’s history.

But ineptitude is, in fact, a viable factor for consideration. While gaining acceptance into a doctoral program for practicing Psychology is quite difficult, once you’re there, it’s not all that hard to navigate through the program*. Others will tell you differently, but as long as you are capable of reasonably structuring your time to read the textbooks and attend class, graduating is very easy (read about the real difficulties of being a Psychologist here). Those who do not finish their program rarely leave due to academic demands; rather, they realize that this line of work is not for them or they simply don’t complete their dissertations and thus can’t have their degree conferred upon them.

That said, graduation does not translate to success in real world psychology. While a licensing exam is required, there is simply no adequate way to predict what students will excel as practicing psychologists. And while many programs will point to intensive supervision and feedback about a student’s clinical work throughout graduate training, the reality is that unless you engage in some grave ethical violation or consistently drool on yourself in session, your odds of passing are quite high.

But even the well-qualified practitioners are going to make their share of mistakes. This site is constantly dissecting the “human” element of shrinks, which includes our foibles, idiosyncrasies and professional limitations. Shrinks need to work on what I’m calling Humble Skills (HS) and recognize our errors and failures (just peruse the archives to see the countless blunders I’ve made and, make no mistake, my clients have often correctly pointed out when I’ve fumbled the ball). Psychology is often an inexact science and thus mistakes will be made. We need to own up to that, acknowledging that we have said things to our patients that have not been beneficial or perhaps even hurtful. In graduate school I worked with a severely mentally ill man who told me that a former doctor of his admonished him about his lack of progress. “If you don’t get your act together you’ll be walking the floors of an insane asylum for the rest of your life.” Of course selective memory could easily have been in play here, and perhaps the doctor was using warning as a possible motivator, but the reality is that the patient’s interpretation of what was said created a deep psychological scar.

Let’s end with this: if you’re a shrink, sit back and really reflect on your own “psychological mindedness,” wonder if you’ve simply dropped the ball at times in the therapy room. Really consider viable mistakes you’ve made and instances where you were simply not equipped to do the best work possible, especially those times when it was easy to point the finger at the client or the disorder. I mean this not for the purposes of punishing yourself, but to be more humble, open and simply better at the job. And if you are a client, don’t use this post as a mechanism to abdicate all responsibility for your treatment. Rather, view it as an invitation to consider your shrink as someone who might have said or done things that didn’t benefit you and, therefore, what might have been more helpful.

* An exception to this would be a small number of “diploma mills,” or programs that accept a colossal number of students (in exchange for very high tuition rates). A small number of these programs alone actually produce more than 50% of the United States’ Psychologists each year.

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39 Responses to “Did it Ever Occur to You That You Might Just Suck as a Therapist?”

  1. Beth says:

    Soon after my mother was diagnosed as bipolar my younger brother and myself went to counseling to try and come up with some skills of how to deal with her illness. She’d had a complete nervous breakdown and when she came home had some problems. Some OCD to the point where if anyone put dishes on the counter away she’d rage that she needed to be able to see everything in the kitchen, or a panic attack if someone came home 15 min late from a movie, not to mention copying my hair color every time I dyed it (I was about 19).

    I remember we went to Dr. Eric who basically just sat there and listened to us bitch about her behavior. Every once in a while he’d agree her behavior was unacceptable, but that’s about it. I think the most we got out of seeing him was he referred us to a Movie/Videogame exchange where you could trade in used merchandise–which we used for years. But he certainly never told me any good ways to deal with a parent which such serious problems.

    Still, I’m smart enough to know it was him that was the problem. Not therapists in general.

  2. BL1Y says:

    I want to punch your supervisor in the nose.

    Let me know when there’s an app for that.

  3. Kevin says:

    I’m a graduate student training to become a therapist. I’m in the middle of my first practicum and if anything I think I’m the opposite. I’m probably too hard on myself and am always going over less successful closed cases in my head wondering what I could have done differently. “Oh, I wasn’t assertive enough with that client…”, “Oh, I pushed that client too hard…”

    Do you think different schools of training are more likely to instill the over confident attitude in therapists. From the examples you gave it almost sounds like the traditional analysts are the worst about it.

    Also, it’d be interesting to hear your take on diploma mills more. Why are they still running? What are the big ones? How do people with “Ph.D’s” from the Correspondence College of Tampa get away with practicing?

  4. Rob Dobrenski says:

    @Kevin: I think most students share your experience, but the majority seem to lose that fear and lack of confidence once they are out of school and practicing for a living.

    I do give the analysts a very hard time, mainly because their way of thinking lends itself most easily to the arguments in this post. They are also the most annoying. But that doesn’t mean other orientations aren’t guilty as well.

    The diploma mills still run because they make money. It’s not entirely familiar with the accredidation process, but I suppose the schools offer enough supervision and follow the suggested curriculum, which might be enough. I won’t name names here, but a quick google search could tell you the programs with the largest number of students.

  5. Attachment Girl says:

    I loved this article! I’ve been working for the last several years with a really gifted therapist who has helped me make amazing changes in my life and if I had to pick out one quality to describe him it would be humility. His approach to healing is to be totally open to the patient and just be with them, then see where that takes you. He takes non-defensiveness to a high art, yet apologizes very clearly if he knows he messed up. Even better, he’s more than willing to listen to my feelings about something he did, even when he didn’t mess up. And he doesn’t apologize in those cases, which has modeled boundaries for me in such a way that I now really understand them and how to have healthy ones. The other thing I really appreciate is his willingness to learn no matter where it comes from. I do a lot of reading in order to understand both my issues and how therapy works, and my therapist and I at times have been reading the same books. I’ve NEVER gotten the sense that he felt like he needed to know more than me or that he was threatened by my having knowledge of the process. Actually, he’s been quite complementary about it at times as well as willing to read and incorporate into his practice books I have recommended to him.

    Just in case this sounds like I’m doing all the work, I also want to add that his focus and attunement are used to gather the facts about my internal landscape, at which point he applies his considerable knowledge and experience in order to both understand me and help me understand myself. And he’s a master of the timely confrontation (I call it “velvet bulldozer” mode). He brings an absolutely necessary expertise to the process.

    I’m on a support forum for people in therapy, and considering the stuff I hear from other people about their therapists, I think what you have written would make excellent reading for a lot of therapists out there.

    Thanks so much! I’ve been reading for a while and always enjoy your stuff. And I love your sense of humor!

  6. GregC says:

    Not to be a naysayer for a thoughtful and worthwhile article, but doesn’t this create the possibility for dangerous taking of responsibility?

    Obviously it’s important to evaluate your own performance, but it will probably always be possible to find problems – like you said, shrinks are human. But did this cause the patient to truly be unable to benefit from therapy is another question entirely.

    There’s a fine line between taking responsibility and putting the weight of the world on your shoulders. You will screw up. It will happen. Some people really can’t be helped though.

    I think most often, you’ll find the problem somewhere in the middle. The patient was unusually resistant, the doctor made a small error, and that synergy was more devastating than either problem would’ve been on it’s own.

    I say this only because I’ve met so darn many people who just weren’t willing to get better. I’m not a shrink, nor a shrink in training, but it doesn’t take a shrink to meet someone who clearly has a problem that they aren’t interested in fixing, even when they ask for your help or your sympathy. I’ve seen too many people trying to help others start to go crazy because they can’t help these incorrigible idiots who want sympathy and advice, but refuse to take any actual action.

    None of this, of course, invalidates anything you’ve said above. I just feel that there has to be really careful balance in that their fault/my fault dichotomy, because tipping the scales either way ends poorly.

  7. VWoodard says:

    GregC: I definitely agree with what you’re saying in the first bit of your post – the combination of small things on both sides meets in the middle to form the big issues.

    Having never had therapy but always having had a listening ear to my friend’s problems, I definitely have the lack of confidence Kevin talks about. “Oh, I should have pressed this issue.” “I should have ratcheted it back a notch here.” “We should have talked about this instead.”

    It’s all about balance, I suppose. The most difficult part of anything.

  8. katie says:

    My old therapist (MD with psychoanalytic training) once suggested that I might not ever benefit from that kind of talk therapy. When I asked her what, then, she might suggest, she had no suggestions. The following week, I suggested to her that laying the full responsibility at making a treatment work at the feet of the patient was arrogant at best, and overall, just wrong. I said that without doubt the majority of the responsibility was mine, the client, but that it wasn’t 100% up to me, because therapy happens between two people, and one person can’t be solely responsible for what happens a relationship, even of the therapeutic kind. I pointed out most of the reasons you suggested. She more or less rolled her eyes.
    I’d like to hope she heard some truth is what I was saying. Not at all sure that is the case, unfortunately.

  9. Wayland says:

    I liked reading the comments so far as much as I liked reading the article. Get it published. Hurry up. Snap to it Rob you’re not getting any younger… And so on and so forth until you do it. Haha. This was great man. I’ve got about 2 months left of massage therapy school and then I’ll be getting ready to enter the Athletic Training Ed. Program in the Fall…sweet.

  10. throughthemotions says:

    Awesome post. I think that a therapist’s humility is what makes the whole interaction between therapist and patient a more human kind of exchange. I know that I can’t deal with people that I have friendships or relationships with that refuse to acknowledge any mistakes they have made; why should I have to deal with that from my therapist? It seems like that should be the one place where acknowledging mistakes is one of the primary criteria. And if it’s a mistake to acknowledge a mistake, then you can look at why it was an incorrect decision. I wholeheartedly agree with everything in this article.

  11. cici says:

    I’ve only been in therapy a bit, and I was fortunate to have a fairly modest therapist. A lot of our sessions were brainstorming for what could make things better (was in a difficult situation), so we didn’t exactly do all that much therapy. It was really very helpful at the end when my own therapist admitted that some of the things we did helped (life-changing, really), and some of the things we did really didn’t (irritating, overanalyzed, overly assertive in wrong directions and occasionally mildly insulting).

    It also helped that I read your blog beforehand, so I expected only a human and not a dispense-o-matic of advice. Mostly though, reading your blog helped humanise the profession for me, which made it easier for me to be less distrusting of therapists in general by seeing them as one of our species instead of as, well, creepy people with odd social skills who stare at you a bit too intensely and talk too much about Freudian analytics. Made it easier to understand why a person would go into the profession and do the things they do, I guess, which felt as if I’d have common ground with whomever I was seeing before going in.

    Perhaps you could give this glowing recommendation to your publishers, or maybe a psychologists’ association as good press for the profession and have them foot the bill for publishing? Your blog does seem like something that would make for good reading in the waiting room before an appointment – better than the glossy family-friendly home-related magazines, children’s picture books, and scientific article-focused psychology magazines, at any rate.

  12. Shay says:

    I don’t know how I feel about this. Using an analogy, I’m sucking wind right now to keep up as it’s finals time and I just got my 2 hours of sleep for the night.

    Maybe I do suck more then I considered.

    Cross Posted as Usual, Dr. Rob

  13. BL1Y says:

    I think maybe the issue is that people are too focused on results. With therapy (and a zillion other things), the results are not entirely in your control.

    Instead, the focus should be on the process. Did you show up on time? Did you pay attention and take notes? Did you really try to understand what the patient was telling you? Did you secretly have a sudoku puzzle on your note pad?

    It’s like playing blackjack. The right move has nothing to with whether you actually won or lost, but rather whether you gave yourself the best chance at winning. If you’re dealt a pair of kings and split, and the next two cards are aces, you still made the wrong play, even though it worked out. Contrariwise, you can make the right play and still lose.

    This is what irritates me about your supervisor. He’s basically saying that since you never see what cards the dealer had, you might as well assume you always played right. That’s bullshit. Even if you never see the outcome, you still have to take the actions that make a good outcome as likely as possible. Then, at the end of the day, even if you end up losing, you can still rest easy knowing you did the best you could.

  14. Susan Kramss says:

    I was suffering from what was later dx’d as BPD which blew through the roof during my first pregnancy which began our honeymoon night. The first therapist we saw was a nightmare. But what did we know; we had been raised to trust doctors.

    After talking to us for fifteen minutes he declared we should forget therapy and get divorced. We had a strong relationship. That wasn’t going to cut it. He then wanted to meet with us separately. This led to bigger problems. We were always open and honest with each other, however, what we were told never matched up. Finally as things began to reach a head we started wondering “what if neither one of us is the problem and he is.” We confronted him.

    He admitted to using an “unorthodox” form of therapy; separately blaming the other for all our troubles and demanding we keep it secret. When we explained how angry this made us because we never would lie to each other he became extremely angry, blamed both of us of being uncooperative and difficult and “fired” us as patients.

    He was divorced six months later. We are celebrating our 28th anniversary. I am fully recovered. And believe it ort not – he is still in practice. We call him Dr. Divorce. Heaven forbid anyone not follow his example.

  15. Kris says:

    *stands and applauds* How wonderful to see a shrink accepting accountability! I went through a roughly decade-long cycle of hospitalizations, meds, and sporadic therapy before finding someone I was compatible with. In that period, I was accused of:

    Not being willing to change
    Not wanting to get better
    Being too stubborn
    Being lazy/not doing my homework
    Not being “committed enough” to the program
    Showing up physically but not really engaging the therapist

    There’s probably more, but those are the ones I heard most. Thing is, I could easily turn those same accusations back on those who said them. (Discounting C, with whom I found great success and still adore) most of the mental health workers I encountered…

    Were not willing to change, even when something was patently not working
    Insisted that I should be “fixed” within a certain time frame (which, oddly enough, almost always was the same as how long my insurance would pay)
    Just showed up and were not fully engaged in my sessions.

    I quit working with a few because I couldn’t afford them, a few decided that I did not want to improve and quit seeing me. The vast majority of them, though, I left because for whatever reason, it just wasn’t working out. We didn’t gel.

    There really was no fault in those cases. Not every therapist is a good match for every patient. I’m sure that harsh and demanding Dr. L.’s style was exactly right for some folks. I’m sure that some patients C is assigned ask to be transferred to someone else ’cause they don’t mesh well. At the end of the day, you’ve got two people talking to each other, and neither one will benefit if the whole time is spent butting heads.

    I applaud you, Dr. D., for acknowledging your humanity and being willing to admit to mistakes. Every long-term psych patient has a few not-gels with therapists; it’s nice to know that the feeling can be mutual!

  16. 1. I am a huge supporter of peer groups/consultation groups because it provides a space for discussion and also some reflection.

    2. It seems much more common for therapists in training to be harder on themselves than not hard enough. I think as experience is gained, some bad habits can form around “expertise”.

    The other day I was talking to my supervisor and she came right out and admitted fault about a clinical decision. It was really helpful to see a seasoned clinician (20+ yrs) own up to not only being human, but also being willing to solicit feedback from a much less experienced clinician (6 years). I later had to own up to a flaw in my logic about another case, and it was easier knowing that judgment wasn’t waiting for me from across the room.

  17. misanthropope says:

    is there any scientific evidence that alleged “therapy” has any merit at all?

  18. Rob Dobrenski says:

    @ misanthrope: of course. You think managed care would pay for something without a track record?

  19. Thanks Rob – I enjoyed this article.

    I am a Counsellor from the UK and find I can become complacent about my decisions and tend to be harder on myself regarding not taking the time to reflect upon sessions and given directions, than upon those actual directions.

    As keeping a business alive and well also takes a significant amount of time, it seems to be the time due to reflection that is sacrificed. I wondered if others shared my view and if anyone had a system that put reflection into their working day.

  20. Disequilibrium says:

    Thanks for this article. I’ve had nothing but lousy experiences in therapy, and surveyed literature trying to understand why. I found predominantly a condescending, blame-the-patient, they’re-sick-and-we’re-the-authority attitude among therapists. I wrote this out in a blog, A DISGRUNTLED EX-PSYCHOTHERAPY CLIENT SPEAKS HER PIECE, but feel like a tiny voice in the wind on the subject.

  21. Addison says:

    Honestly, therapy has made me worse. I did much better without it and I find myself doing much better when she’s on vacation. Why do I continue to go, you ask? Two words: Attachment issues.

  22. Sheila says:

    “And if you are a client, don’t use this post as a mechanism to abdicate all responsibility for your treatment.”
    —————————————————————-
    Wow, quite an admonition. Responsibility for our treatment? Are you Big Daddy to the world? Why are you reinforcing an authoritarian construct when the goal is autonomy?

    Seriously, good you opened the issue of practitioner competence. But iwith therapists everywhere, the supercilious contempt creeps in, and that’s the problem.

  23. Amy Cloud says:

    I had therapy for a period of six months. It was following a depressive episode that lasted for three months. I never had depression before, it just happened, and it seemed to happen at an odd time in my life – I was on holiday and everything was fine. The psychiatrist put me onto antidepressants, they worked in a few weeks and he advised me that he didn’t think it was necessary for me go through talk therapy … but I already met my therapist and I thought this couldn’t hurt. The therapist I had to me seemed a little bit inexperienced or maybe burnt out, I think the former is more correct. We did DBT for three months and every week she asked me if there was anything else I wanted to talk about. Sometimes I’d reply ‘yes’ and all she would do was validate and say ‘ohhh that must be hard’ and reiterate what I just said “so you said you’re upset over what he said” and then change the topic. I never felt like I gained any new insights, any new ways to approach my problems … I felt like therapy did nothing. The skills in DBT were helpful to a certain degree but most of the time I didn’t like committing to it every week … it five hours of week (including travel time) just didn’t feel like it was worth it.

    I don’t know if I should have been more vocal about what I thought. In the field I work in, if I am unhappy with somebody I am receiving services from, I will leave discreetly because it’s a small world and I don’t want to create any friction. Having said that, sometimes I will voice a complaint, I’d do it professionally often not in a critical manner … often it would be in a more suggestive manner.

    Do you just leave the crappy therapist or do you tell him/her that you have a problem with the way they treat or talk to you?

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  26. Fran says:

    I have seen a number of therapists over the years. I have seen enough of their own antics now to realize that they typically do not know what they are doing. I did like one of them who ended up dying. Therapists are, from my experience, the least self aware people on the planet. I have come to realize that as much as medications are harmful they are the only thing that will ever help me. Therapy makes you worse. Therapists tell you that it has to get worse before it gets better. It never gets better.

  27. A says:

    I am grateful to read all these replies. Therapy for me was a great negative lesson. Mine was verbally abusive in an overt way. It was unnecessary, unprovoked, and completely insane. The “process” truly felt like a violation and it will take me a while to un-internalize all his projections. He seemed to not like the fact that I expressed myself as a separate person.

    I had come in for depression as I was going through a hard time. I did not have a “disorder” that needed “changing” via another person outside of myself, but I did need someone to just listen. How hard could that be? Seriously? Life was, and still is, changing me. I am not the same person I was even a year ago, and I do not linger for long in my comfort zone. I push myself, and use life, study, and self-reflection to raise my own self-awareness. I admit my faults when I feel it is safe to do so, but I certainly don’t feel that way when therapists think that they have an obligation to “challenge” me. I know better now… and was fortunate to find a therapist who understands that nobody knows me better than I know myself. TO think otherwise is the epitome of arrogance. (This comes not from me, but the more aware therapist I see from time to time)

    I have come to the realization that the old “therapist” is not only incompetent but is far less aware than I am. If I had stayed, I would have gone “crazy”… meaning that I would have doubted my own self-perceptions and/or learned that it is ok to verbally abuse another.

    Do therapists literally “train” their clients to become co-dependents of verbal abuse? I have to ask this, because I have seen the dynamics of this on several blogs. Women that have been abused all their lives are repeating the same dynamics with their therapists, with the therapists actively contributing to the “I am the authority and you are a child that is incapable of thinking on your own and are in need of re-parenting” mindset. Treat someone like a child, and they will probably act like one, unless they are strong enough to “resist” (and resistance is a GOOD thing most of the time… it means that one is wise enough not to believe everything they hear, and practice trusting their own judgement!)

    Sadly, many clients continue to worship the therapists as if they are gods that have all the answers. I have even seen examples of therapists using simple reward/punishment techniques to manipulate clients, and it is sad that many clients do not pick up on it. If they did, and called the therapist on it, odds are good that a punitive dx would be slapped on the client, or worse..they would be “fired” for daring to defy the almighty therapist. It still blows my mind. I don’t know whether to be shocked or laugh. All I know is that it seems sick to me.

    Everything I have said above has been not only confirmed, but suggested by the new therapist. She understands the dynamics of verbal abuse, and that I actually did not contribute to it. The abuse IS the problem, and it scares me that the therapy profession provides a safe haven, even a livelihood, for abusers. I hope this helps, I sincerely don’t’ want to see anyone go through what I have gone through.

  28. A says:

    I am hoping that in the near future, there will be more therapists that are equipped to talk to real, intelligent adults who may be depressed for existential reasons, and a real, respectful conversation can take place without the need for the therapist to force their idea of “challenging” onto a client. I would go as far as to say that if the therapist is not specifically invited to “challenge” or if it is not on a mandatory disclosure form, it has no business in therapy. At least not mine.

  29. A says:

    edit to add at bottom of last post: Life itself is challenging enough.

  30. B says:

    Actually it does all the time. Occur to me, that is. I think I have Aspergers and I dread going to work. But the clients keep coming.

  31. Muse says:

    I am new to this site and, as a therapist (currently on disability) I certainly agree that we need to be more aware of our part in any failure regarding clients. Any therapeutic situation consists of my internal crap, the patient’s internal crap, and how those 2 interact. Most therapists I have known are woefully unaware of any issue THEY might have that impacts the therapist-client relationship. At my last job, my supervisor (a social worker, but don’t get me started on what I think of social workers doing therapy – my own arrogant prejudice, I admit) told me, “Our clients have to think of us as ‘having it all together’, otherwise we can’t do our jobs properly. We can’t admit to being wrong, or they won’t respect us.” This woman was also the same person who routinely violated boundaries by disclosing personal information to clients (“Sorry to hear about your day – let me tell you about mine!”), spent entire sessions discussing who was on the previous night’s American Idol, and called clients insulting names behind their backs in staff meetings. Unfortunately, this type of thing is all too common (and why I often get in trouble with employers for bringing these issues to light), and it’s only the client who suffers.
    Hopefully one day I can go back to school and get my PhD, and then work for myself so I don’t have to put up with this nonsense.
    Anyway, so far I am really enjoying your blog!

  32. aasshole says:

    i had a therapist flick me the bird mid conversation, she asked how i was then as i was saying good was like ohh my eye and showed me the bird, it was possably my fault i talked about drug use and prostitutes and i think she developed counter transferance issues with me, thing is i tried to accept i made her do it only after about 2 more sessions i couldnt even look her in the eye anymore and she had prettiest bule eyes one could see. i did call her out, last session i had i called her a liar and told her i didnt trust her and she was like we need to talk about that, but was to late i tried to talk about it several times she changed the subject every time, ruined 6 mo of therapy, i do not like her at all. i got better therapy from a prostitute then i ever did a therapist.

  33. dragonthor says:

    Wow. I am shocked that so many people have had terrible experiences while seeking therapy. Then again, this is the internet, and not many of those who are satisfied with their therapy will be reading an article about how therapists may just suck. ;D

    I am an exception in that over the last 4 years I have seen 4 different therapists, with varying levels of education and experience, and can say that I have disliked 1, and she only did my intake. Most of the clinicians I met truly wanted to help, and had varying levels of success with me based on mostly 1. how seasoned they were and 2. how well I personally liked their methodology. Of course the work is up to me; I’m the client; I’ve got the problem! It’s my problem to solve, and the therapist can only suggest, not reinforce.

    I liked this article and appreciate the advice to therapists to model humility and honesty with their patients, but I have got to defend therapy and therapists in general because they have helped me take proactive steps to enrich my own life. The key is however that I took those steps, not the therapist! I think a few patients on here could also benefit from some self-reflection, honesty, and humility–for their own sakes more than anything else. Therapy can be powerful with the right therapist AS WELL AS the right attitude.

  34. Muse says:

    I don’t think anyone is bashing therapists as a whole, only the ones who do damage. And, while self-reflection (insight) and honesty are important for the client to have, these are not things that most clients walk in the door with. Most are hurting, and pretty severely, and it would be a very foolish therapist indeed who would expect a client to sit right down and not only completely disclose, but understand why they have a problem. As for humility, that has never been an issue for me in terms of how the client is; it’s humbling enough for them to have to come see me in the first place. No, the humility issue, if there is one, lies completely at the feet of therapists who do not fully realize that what they do, or don’t do, has a huge impact on another person’s life.

    Regarding the elements needed to successfully address and deal with a client’s problem, liking or not liking the methods used is not so much an issue as does the method work and is the client willing to engage? A good therapist has many types of interventions at his/her disposal, and if one doesn’t work then another should be employed. It’s normal for a client to be hesitant to cooperate, and there has to be trust involved for any therapy to work. That’s on the therapist, not the client.

    Therapists carry the bulk of the responsibility for the success of the therapy, not the client. While it is true that no therapy will work if the client doesn’t “do his part”, if a therapist consistently sees that what happens in session isn’t working, it’s on them to figure out why. And yes, it is the therapist’s job to reinforce, otherwise who is going to give feedback to the client?

    Having been a therapist, I can sadly say I have known far more incompetent, uncaring people in this profession than decent ones. I have met clients who loved their former therapists, but never got better (so much for liking the methodology), and therapists who have worked for years in their jobs and didn’t know the first thing about therapeutic interventions (so much for the seasoned part). I think the point here is that therapists place blame on the client for their own failures, and that’s not only unprofessional, it’s heartless and perhaps a clue that someone needs to change fields.

    I’m glad that therapy helped you. But please try to understand that the clients who have posted here all have different issues, some of which were aggravated by incompetent therapists. Some are clearly still in the throes of mental illness. And some are just trolls. It doesn’t change the fact that there is a huge problem within the therapeutic community of blaming clients (and labeling them as “borderline personality disorder”), which causes great harm to clients – especially patients in mental health hospitals. Let’s not reinforce that, ok?

  35. dragonthor says:

    Muse,

    I’m not a therapist. I don’t know what goes on within the community of therapists, and I’ll just take your word for it that many therapists are uncaring or are just plain incompetent.

    I will also concede that it is the therapist’s job to use different methods when they see their current ones are not helping the client. I appreciate that you are a therapist who cares about what you do and your clients.

    What I do not agree with (and the main point I take issue with in the comments section of this article) is an attitude among a few posters that essentially reads: “I didn’t get better after therapy: must be the therapist’s fault.”

    Maybe it was. As you said, many people are not necessarily very self-aware when they walk into therapy, and a great number are suffering from…well…mental illness or emotional difficulties, which doesn’t usually lead to accurate self-reflection. That being said, it’s exactly a lack of being able to discern the “realities” of your own stuff that may prompt a person to blame their therapist, rather than something that hits closer to home, although that may be the real reason they did not have successful therapy sessions.

    I really am sorry to have implied that patients in mental hospitals, of which I have been one, are to blame for their negative experiences. I guarantee that is not the population I was referring to. Most people in there are suffering a great deal, and will always suffer a great deal because therapy does not cure mental illness–it hasn’t cured my clinical depression or my brother’s paranoid schizophrenia. It is only a tool that can promote a better quality of life, if one can and does use it wisely.

    My anecdote is the disparity between how therapy has influenced myself and my brother. I am well enough and able to see it’s value, and perhaps have a greater deal of self-awareness than many people I know. Therapy has helped me, as has hormonal regulation. On the other hand, my brother has gotten therapy for 6 years, and it has not helped one bit. Only medication has helped him cope better with life. He does not see the benefit of therapy and has never taken it seriously, and this is the reason it doesn’t help him. Is it his fault? Yes. However, does he have the capacity to engage in successful therapy? no, not at this time in his life. That is not his fault, and no therapist can breach a wall he does not want down.

    In essence, therapy works for most “regular” folks when they want it to, but will be unsuccessful if they are not willing to look at themselves honestly. My brother is not willing, but more importantly, can’t at this time. That is not a therapist’s fault.

    I understand this is a complex issue, which is why the writer put in a disclaimer about how this trend among therapists is not an excuse to automatically blame your therapist when things don’t pan out. My questions to posters who feel it was their therapist’s fault they did not have growth from therapy is how many therapists did you see after the inefficient one(s)? Did you tell your therapist directly how you felt or that you didn’t think therapy was going anywhere? Did you give them a chance to turn things around? Or did you stop showing up? This is not meant to judge those who didn’t speak up, but to maybe open eyes up to the possibility they weren’t ready for therapy at the time. Or maybe they genuinely got rotten therapists.

    My suspicion is that despite what you say, there are many good therapists out there to compensate for the stinky ones, and it is still on the client to find those ones and not give up on their mental health. After all, no one in this world can do your job for you, and your job is you.
    (Didn’t get that from therapy, but from support groups.) 🙂

    Either way, I firmly support therapy and trying it out if you are a reader who is unsure of its value. I also emphasize to those with negative experiences to try a different therapist or to talk to the one you have now. And to those, like Muse, who are professional therapists and really show up for the rest of us, thank you, and please keep showing up.

  36. Vance says:

    “In essence, therapy works for most “regular” folks when they want it to, but will be unsuccessful if they are not willing to look at themselves honestly.”

    Please. Nobody knows whether that is true or not. To blame the client for therapy failure is pathetic, unless the client is actively and overtly working against attempts to help them. Therapists as a group appear to be as or less self-aware than the average person, tend toward narcissism, and can’t handle criticism or admit mistakes. Whole thing is a setup for victim blaming and all sorts of abuse. I am quite self-aware but therapy for me was ruinous. The standard tropes about client didn’t try hard enough, wasn’t ready to “do the work” are tired and silly.

    “it is still on the client to find those ones and not give up on their mental health. After all, no one in this world can do your job for you, and your job is you.”

    Mental health is not contingent on therapy. Therapy is not a compulsory rite of passage. It is just one option for working out problems. There are many others, most of which do not carry so many risks and likelihood of adverse outcomes. As for your doing the job comment, you seem to have internalized the profession’s proclivity for preaching and condescension. Therapy is not medicine, it is not science. It is closer to religion or cultism. Methods are obscure and unproven, and it amounts to a large social experiment. Caveat emptor.

  37. Now I'm the Asshole says:

    Condescension. That would be 50% of what occurred. And disrespect. The therapist that was the worst was a narcissit too. six therapists in ten years, none mentioned a treatment plan. None wondered if I was slightly depressed. And in the end, I’m not sure if they cared about me. I was becoming happier when I started with the worst of them. I went from taking a class ad seeing the world through better eyes to disgusted and distrusting. How could someone call himself a therapist and paly those games he played. He spoke like a sex addict, and possibly a drug addict too. The time I wasted is as bad as the money. And I felt duped. Those who knew the whole story said report him.

  38. Seviah says:

    The diploma mill serves to certify practitioners. The scientific method can hardly be applied to individual therapy. How do you know–without a baseline–that you’ve failed?

    Well, fuck, if you refuse to see me…that’d do it.

  39. Reflected Bounce says:

    Glad this site is set, and wish there were more like it…..
    Kind of wondering why someone like dragonthor is even on here if they had such a good experience: “The key is however that I took those steps, not the therapist! I think a few patients on here could also benefit from some self-reflection, honesty, and humility–for their own sakes more than anything else. Therapy can be powerful with the right therapist AS WELL AS the right attitude.” PLEASE!!! It makes one think you are a shrink, or someone looking to get into it, who just can’t stand to see the profession challenged a little. Are you going to say that the shrink has NO RESPONSIBILITY?!!! If the shrink makes the choice to open for business, and accept patients, they are TAKING ON THE PATIENT’S problems too. If you want to speak for yourself, that is fine, but don’t try to speak for everyone else. The shrink CHOSE that, and should have chosen to do other work if they don’t want responsibility of working on a problem. Lastly, why would someone pay the money to see someone, admit a weakness, only to be worse off? At some point, that line that all this responsibility falls on the client just doesn’t work any more. The client is not the one getting paid. If they were getting their needs met, they would likely say that.
    I have long doubted that profession, and as someone who went to school to be a math teacher, I had to take some psychology. Let me tell you, that just about anyone could pass those courses. My easiest math course was harder than my hardest behavioral science course. It isn’t a difficult field to get a degree in, so many go in that direction. This article is very well put together, and exposes the likelihood that getting a degree in the area doesn’t make you successful. There is so much of this field that is subjective, and there are so many cliches like some of the quote above, that the truth often gets drown out. Part of that truth is many “diagnosis” are really just someone’s opinion. As Vance says above, therapy is closer to a cult or religion than it is to science.
    This leads me to one more closing thought on this: how well do these practitioners actually understand the real science behind many of their diagnosis? Knowing a bit about statistics, people fudge on statistical studies all the time. There aren’t enough auditors out there checking to make sure a study was conducted adequately. There is even disagreement in the profession themselves about various industry “disorders”. ADHD and ADD are well criticized for being over-diagnosed. Also, when these diagnosis are actually conducted, how often are there actual physical tests? One question I have had for a long time is whether some of this is actually perpetuated by the industry itself so that shrinks and people in behavioral science can make money. It is not hard to imagine, people in this field just piggy-backing on a study that was illegitimately conducted. That way they can expand all of their labels and “disorders” to a wider population, and make more money. They DO get paid after all…….

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