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I like the idea of therapy in theory - psychology is certainly important to understanding ourselves and the world around us - but I'm left with some nagging questions based on my own (limited) experience with therapy and therapy patients I've known:

  • How do therapists know the information they are getting from the patient is accurate?
  • Why do therapy patients seem to make the same life mistakes over and over?
  • Why do therapy patients tend to go through so many different therapists?
  • Why do the competency and techniques of therapists vary so wildly?

One qualification I often hear from patients is that one has to find a "good therapist." If therapy is anything resembling a science, shouldn't all therapists share a basic competency, like we expect from medical doctors? Why do there seem to be so many useless therapists out there, and how can one know if a therapist is good before investing a lot of time and money?

When I saw a therapist in college because I was feeling depressed about my social environment, one of her first questions for me was if I "ever fantasized about hurting other people." "Yes," I said, "but that's normal to some extent for all men." "No, it isn't," she answered quickly, and wrote some notes down in her notepad. The remainder of the session didn't go much better, and that was our last.

My first girlfriend used to see a therapist weekly for depression and anxiety, but she never seemed to get any valuable life skills out of it. Her therapist exclusively focused on her childhood and all the ways her parents had supposedly failed her. Meanwhile, she was making all manner of destructive life choices and her panic episodes worsened over time. She would often characterize events and people differently than I would have - very self-servingly in my opinion - so I always wondered how the therapist would be able to separate the fiction from reality. If therapy is a serious discipline intended to help people discover important truths, why don't therapists regularly speak with a person's acquaintances to get a fuller picture of what's going on?

There are other examples - all negative - but they're admittedly anecdotal.

Has anyone here had a positive experience with a therapist and benefited from it? If so, why do you feel the therapist was effective?

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I saw a therapist twice, and she was great. I would not have gone there, except she was free as a "sorry we fired you" sop to the 10% of a payroll axed by a well-planned and totally unexpected downsizing by the company I worked for. I don't know what kind of therapist she was, and apart from praising the creativity of my resume (which indeed got me tons of interviews) she didn't help me get another job, but after talking to her I definitely felt better - actually physical lighter. Not that the feeling lasted long.

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If there is consistent value in therapy (I'm not yet convinced there is, but I could be convinced), I'm wondering if it's because the field offers legitimate insights into human behavior, or whether it's little more than a socially acceptable way to discuss one's feelings and have somebody actively listen. In other words, is there consistent value in discussing one's problems with a therapist above discussing one's problems.with your average reasonable person?

The impetus of this thread is my wife attended a therapy session today. We figured "hey, what's the harm" because she's been dealing with some major life changes recently. The therapist was totally incompetent, rattled off some moronic quick fixes to complicated issues, and was very judgmental - making her feel worse than when she arrived. It's easy to write it off by saying she just got a "bad therapist," but based on everything I've heard and experienced, I'm beginning to wonder if the entire field is just so much hokum to milk the vulnerable and their insurance companies of their money.

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I am sorry to hear you are having problems. Have you both had a thorough physical exam, to make sure there is not a medical issue buried somewhere?

Ba'al Chatzaf

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It has nothing to do with our relationship or health. The main issue is she's starting a new job and is anxious about it. But this isn't really a thread about us; it's about whether the therapy profession is offering real value to people or whether the experiences I've described are typical.

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Robert B -- how did you choose the therapist and what were the credentials offered?

By credentials I mean the achievement of some line of study. Some therapists may be Marriage and Family Counsellors, others may have a BA or MA or more in Social Work. Some therapists may be 'psychotherapists' without a particular school of thought and without a particular 'line.' Others may be doctors of Psychology or masters of Psychology. Some may be simply accredited in some skills (say, with cognitive-behavioural therapy, etc). Still others maybe educated in a particular modality -- from the NLP practitioner to the utter bounds of woo-woo (i.e., 'sensitives').

Sometimes a therapist may publish -- from case studies to chapters to books. Some may have websites and publication arms.

It's a nice mess.

The only thing I could suggest is a form of interrogation from your side. I think it pays to ask a lot of questions about the particular therapist's client-base, formal training, licenses, accreditation, etcetera.

The best part of psychotherapy is as you suggest: a private, confidential conversation with an empathetic and intelligent interlocutor, whose sole focus for the fifty-minute hour is you/your wife and the presenting problem.

In my province (BC) there are no laws or regulations covering the practice of psychotherapy. Thus, anyone may put up a shingle saying "Psychotherapist" and get to business. In your state it may be the same. Generally speaking, a good psychotherapist is an excellent communicator with broad experience talking to folks with common problems and issues -- and with some kind of a track record, or at the very least some evidence that they have achieved something above the baseline of opening an office with a box of kleenex and a billing system.

I guess the point of the paragraphs above is that there is no single profession, but a multitude, no single body to supervise the casework (as in internships), and no single body that holds a particular therapist to a standard of care. Buyer, be wary. Ask a lot of questions and ... know what you want from the encounter, if only to be told that you cannot have it.

-- what were the moronic 'quick fixes' and judgments made?

Edited by william.scherk

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In both my case and my wife's case, the therapist was assigned. I believe the bad therapist today had a masters in social work. There is some sort of licensing process for therapists in the U.S., but I'm not familiar with the details.

I think my main objection is that therapy is being presented as a scientific and reproducible practice - a chapter of medical study - where it may really be more of a soft skill and vary widely from practitioner to practitioner.

I'm mainly interested in hearing about the specifics of successful cases at this point, because most of the patients I know don't seem to significantly benefit from their sessions.

To take a hypothetical example, if I suffer from depression or anxiety and go to see a therapist, is my condition likely to improve as a result or will it more likely just be a waste of time and money?

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It depends on if the depression is situational or clinical. IMO "talk therapy" only works for CD in conjunction with antidepressant meds. Based on experience as I had it descend on me twice out of nowhere, at points of success and happiness in my life, before I found out that it was physically based.

If Moralist is reading this, he will be glad to know that I certainly blamed myself for my misery both times, and did not assign blame or anger to outside agents.

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I wish I was able to offer more help, RB. You yourself are probably going to be the best therapist to your wife.

To take a hypothetical example, if I suffer from depression or anxiety and go to see a therapist, is my condition likely to improve as a result or will it more likely just be a waste of time and money?

Serious depression can be and is addressed as a medical issue, so I would first bring it to the attention of your doctor. At the very least he can assess you and lay out the options for treatment. Among them may indeed be a focused adjunct psychotherapy for depression via CBT. The only quick fix is likely to be a late-model antidepressant medication. For a more protracted or disabling depression he would likely also set you up with a psychiatric consult.

Therapy is the add-on here.

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About depression.

If a case of depression is a mental/emotional manifestation of a physical health problem, then the focus should be on the physical health problem. Maybe some sunshine or some exercise or more sleep or quit some bad habits or avoid some poisons or whatever else you gotta do to repair the physical health problem. Someone said you can beat the blues with greens.

If a case of depression is a purely mental/emotional thing, not connected to a physical health problem, I would expect Objectivism to remedy it.

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dupe

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It has nothing to do with our relationship or health. The main issue is she's starting a new job and is anxious about it. But this isn't really a thread about us; it's about whether the therapy profession is offering real value to people or whether the experiences I've described are typical.

There is no "therapy profession."

There is no science whatsoever in psychology or psychiatry.

Psychologists have clients, psychiatrists have patients. Psychiatrists can be extremely dangerous combining pill pushing with legal authority over some patients.

Short-term anxiety might be dealt with simply by breathing deeply and exclaiming on the exhale, "Boy!--do I feel anxious!" This is owning how you feel.

One good way to deal with psychological problems is to talk about them with your significant other--if he'll let you. Is he listening or interrupting?

Structured use of sentence completions can help get right into the heart of what is bugging you. Branden: The Six Pillars of Self Esteem.

Psycho-therapy is a crap shoot and what you make of it.

It isn't what the psychologist knows about you, it's what the psychologist learns about you from you when you tell her consequent to the work you do with her. This refers to what you find out about yourself in the therapeutic context, not what you blab coming in the door for the first time. That info may be needed to establish context and to start things going, but abreactive exercises and use of altered states of consciousness come before things are really figured out--by you, not her. If she figures it out first, telling you what she thinks she knows will not help you much for it'll be just verbiage you can't connect to. Therapy that is just talk is just talk. Changes nothing, costs a lot.

If your therapist gives you bad vibes, leave, get out, go home, don't come back. I'm talking about what you are feeling, not what you are thinking.

Therapy should be relatively short-term. Usually long-term therapy is therapist incompetence.

Hope some of this helps.

--Brant

talk with people who have gotten help from a therapist--pick your therapist don't be assigned one: if assigned make a quick evaluation, yes or no. If insurance pays for it that's very dangerous; it encourages incompetence and sticking around a bad therapeutic situation--insist that no records, especially electronic records, be kept--you don't want other people learning about your therapy and what your supposed problem is--pay for your own therapy if you can and keep it private

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If everybody could adjust their brain chemistry just by using their brains, there would be no need for discussions like this.

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  • How do therapists know the information they are getting from the patient is accurate?

They don't. But they can't do much about that, especially not in one or two visits, and maybe not even in 10 or 20 visits. A therapist, like anyone else, has to work with the information in front of him. In this case, a therapist must accept that the information could be totally false. If the patient is a liar, that pathology will come out in time. Think about it, though. Even when a patient is being truthful, a human being's thoughts and feelings and even memories are filtered. Your first girlfriend interpreted events in a different way than you did. Her interpretation of life events was based on her own life experiences, her own physical biology, her own nature. The therapist has to examine all of that if he's to help her develop strategies to live successfully. Keep in mind that her definition of living successfully doesn't have to be the same as yours.

  • Why do therapy patients seem to make the same life mistakes over and over?

For the same reason that non-therapy patients make the same life mistakes over and over.

  • Why do therapy patients tend to go through so many different therapists?

For the same reason that some people go through several dentists, or several gynecologists, or several plumbers, or several auto mechanics, or several barbers, or several [fill in other specialist here]. Also, see below re: relationships.

  • Why do the competency and techniques of therapists vary so wildly?

It's a huge field, and as you say, a great deal of it is soft skills. Also, see below re: relationships. One therapist may be perfectly competent in working with Patient A, but total crap when working with Patient B.

Thing is, we're talking about an actual relationship here. It's a person, who by definition of being human is imperfect, digging into the life, experiences, values, philosophy, religion, neuroses, fears, etc etc etc of another person who, by definition of being in therapy, is damaged. Under the best of circumstances, relationships are hard. The therapuetic relationship is rarely the best of circumstances.

I think many people go into therapy with unrealistic expectations. Very few people are going to feel better after the first visit. It just doesn't work that way. Whatever the patient is suffering from didn't manifest itself in an hour, so it certainly can't be alleviated in an hour by a person the patient just met. Many people also go into therapy unprepared. The patient needs a goal, and part of the therapist's job is to establish that goal early on in therapy and then re-examine it periodically as therapy progresses.

I think your wife's therapy experience might have been a better one had she:

  1. Chosen her own therapist after some research. There are therapists out there who specialize in job-related problems and in coaching people through professional challenges. Dr. Henry Cloud is a well-known one among executive leadership circles. Who's your wife's monkey? I'm guessing it's you. (You'll have to look up Dr. Cloud to get that one.)
  2. Communicated to the therapist when she made the appointment that her therapy goal is to get past this situational anxiety. If indeed that was her goal.
  3. Understood that therapy is a process, not one encounter.

Edited to add: Just another thought. Some people are never going to get anything out of therapy either because they are willfully resistant to it (in the case of people required by law to attend), subconsciously resitant to it, don't believe in it, or any number of other reasons. That's okay, I think. It doesn't work for everyone.

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According to Gregory House, MD patients lie.

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To clarify - I'm not questioning whether there is a potential for a therapist to help a patient. I'm sure sometimes the process offers value. What I'm questioning is whether the therapist's claim (explicit or implicit) of possessing special problem-solving skills and insight into the human experience is a legitimate one, or whether it's really just a smokescreen for the true value of having another human being - any human being - actively listen in a socially acceptable setting.

Approaching this scientifically - if we took 100 professional therapists and matched them one-on-one with patients; then took 100 people from random professions, placed them in the therapist role, and matched them one-on-one with patients; would there by any significant difference in outcomes between the two groups? Could the therapists group actually perform worse because they've deluded themselves into believing they possess skills and expertise they don't actually have? For example, I'd be perfectly comfortable telling someone I don't know a solution to their problem, but a therapist might be less likely to give such a candid response.

We can't perform the experiment I described, but I am interested in hearing about personal experiences to determine what specifically it is that makes the successful cases successful. I also want to learn how common successful outcomes actually are compared with the therapist's confidence that they are offering value to their patients most of the time - a claim of which I am skeptical at this point.

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I gave you my experience, |Robert, skimpy as it was I considered it successful. If Brant wanted to I think he could amplify on his own experience, as I understand it he was in therapy with Nathaniel Branden, which he has often indicated was highly beneficial to him.

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There is also the (unquantifiable) negative benefit expressed by therapy clients, roughly, "I know I'm a neurotic mess but without Dr X I would be way, way worse."

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Forgot one thing, the genetic factor. Serious (clinical) depression is highly heritable. If any family members have suffered from mental illness or displayed observable symptoms of psych disorders, an individual's potential for developing problems is unfortunately multiplied. Take these into consideration when trying to get to the root of depression /anxiety.

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To clarify - I'm not questioning whether there is a potential for a therapist to help a patient. I'm sure sometimes the process offers value. What I'm questioning is whether the therapist's claim (explicit or implicit) of possessing special problem-solving skills and insight into the human experience is a legitimate one, or whether it's really just a smokescreen for the true value of having another human being - any human being - actively listen in a socially acceptable setting.

Approaching this scientifically - if we took 100 professional therapists and matched them one-on-one with patients; then took 100 people from random professions, placed them in the therapist role, and matched them one-on-one with patients; would there by any significant difference in outcomes between the two groups? Could the therapists group actually perform worse because they've deluded themselves into believing they possess skills and expertise they don't actually have? For example, I'd be perfectly comfortable telling someone I don't know a solution to their problem, but a therapist might be less likely to give such a candid response.

We can't perform the experiment I described, but I am interested in hearing about personal experiences to determine what specifically it is that makes the successful cases successful. I also want to learn how common successful outcomes actually are compared with the therapist's confidence that they are offering value to their patients most of the time - a claim of which I am skeptical at this point.

Too much human variation for your study. When you apply science to interactive human beings the science goes off the tracks. No matter the study's outcome, there would be so many caveats it would be revealed as only moderately valuable at best and not at all at worse and not scientific at all.

Where you get your data about therapeutic confidence, I've no idea. If you already told us I missed or forgot it.

I've estimated Nathaniel Branden saw about 10,000 clients--individual therapy in group settings--in his career. As far as I know he accumulated no data nor did he ever make any explicit claim about how effective he was overall. Sentence completion was his primary tool, at least until he got into energy therapy, about which I've no idea. He was effective with me because I was effective with him. We meshed. I cannot speak to anyone else. Once he did badly hurt me, but even then I was extremely tough so it didn't last, thanks to both that toughness and, ironically, him. I do know that many of the issues I dealt with I would have outgrown with greater maturity, but he made it easier and quicker and cleaner leaving me with only one particular issue I kept around as a keepsake, which I shouldn't have. My psychology used to be very complicated and confused. Not now, except for trying to live beyond my natural testosterone level. No, that's not about sex, but wasting time doing lesser things than I think I should, or energy deployment.

--Brant

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I do not think any therapist should intentionally hurt a client, however tough.

But oh hell, Brant, up off your feet and let's do the Semantica ... they're playing our ....! (Complete this sentence)

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  • How do therapists know the information they are getting from the patient is accurate?

They don't. But they can't do much about that, especially not in one or two visits, and maybe not even in 10 or 20 visits. A therapist, like anyone else, has to work with the information in front of him. In this case, a therapist must accept that the information could be totally false. If the patient is a liar, that pathology will come out in time. Think about it, though. Even when a patient is being truthful, a human being's thoughts and feelings and even memories are filtered. Your first girlfriend interpreted events in a different way than you did. Her interpretation of life events was based on her own life experiences, her own physical biology, her own nature. The therapist has to examine all of that if he's to help her develop strategies to live successfully. Keep in mind that her definition of living successfully doesn't have to be the same as yours.

  • Why do therapy patients seem to make the same life mistakes over and over?

For the same reason that non-therapy patients make the same life mistakes over and over.

  • Why do therapy patients tend to go through so many different therapists?

For the same reason that some people go through several dentists, or several gynecologists, or several plumbers, or several auto mechanics, or several barbers, or several [fill in other specialist here]. Also, see below re: relationships.

  • Why do the competency and techniques of therapists vary so wildly?

It's a huge field, and as you say, a great deal of it is soft skills. Also, see below re: relationships. One therapist may be perfectly competent in working with Patient A, but total crap when working with Patient B.

Thing is, we're talking about an actual relationship here. It's a person, who by definition of being human is imperfect, digging into the life, experiences, values, philosophy, religion, neuroses, fears, etc etc etc of another person who, by definition of being in therapy, is damaged. Under the best of circumstances, relationships are hard. The therapuetic relationship is rarely the best of circumstances.

I think many people go into therapy with unrealistic expectations. Very few people are going to feel better after the first visit. It just doesn't work that way. Whatever the patient is suffering from didn't manifest itself in an hour, so it certainly can't be alleviated in an hour by a person the patient just met. Many people also go into therapy unprepared. The patient needs a goal, and part of the therapist's job is to establish that goal early on in therapy and then re-examine it periodically as therapy progresses.

I think your wife's therapy experience might have been a better one had she:

  1. Chosen her own therapist after some research. There are therapists out there who specialize in job-related problems and in coaching people through professional challenges. Dr. Henry Cloud is a well-known one among executive leadership circles. Who's your wife's monkey? I'm guessing it's you. (You'll have to look up Dr. Cloud to get that one.)
  2. Communicated to the therapist when she made the appointment that her therapy goal is to get past this situational anxiety. If indeed that was her goal.
  3. Understood that therapy is a process, not one encounter.

Edited to add: Just another thought. Some people are never going to get anything out of therapy either because they are willfully resistant to it (in the case of people required by law to attend), subconsciously resitant to it, don't believe in it, or any number of other reasons. That's okay, I think. It doesn't work for everyone.

I think there is a great deal of wisdom in this response. But I have never had therapy of any kind, so...

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I do not think any therapist should intentionally hurt a client, however tough.

But oh hell, Brant, up off your feet and let's do the Semantica ... they're playing our ....! (Complete this sentence)

Intentionally? Did I say that? Nope.

--Brant

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