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In another thread (Older Clients), I wondered if some of the problems I have had with therapy stem from being an older client (in my forties when I first tried therapy; now in my sixties). I am aware that my problems with therapy in part came from me -- in particular, that my assertiveness and oral communication skills were not very good, and that I was easily intimidated and shamed. But those were in large part what I was seeking help with. It so often seemed as if the therapists tried to do things for me that I could do on my own, yet weren't willing to try to help where I was asking for help.
Has anyone else had this experience, of the therapists trying to do things for you that you can do on your own, yet not addressing what you're asking for help with? This seemed to be a consistent pattern with me. It often seemed as though the therapist and I might as well be from different planets.
I don't want to castigate individual therapists -- I think the problem is largely with the system. For example, training is often inadequate, too much one-size-fits-all and too much "therapist knows it all," with not enough emphasis on listening skills and flexibility. There are also not enough mechanisms for helping the client find a good client-therapist fit, and there are not adequate mechanisms for weeding out the bad eggs.
I do see improvements in the profession since I first tried therapy. In particular, at least some nod toward informed consent has become standard. However, it still seems to be in many cases only a nod, and more aimed at legal considerations rather than as an ongoing part of the process. Another promising sign is that some therapists are using feedback forms, and finding that it helps. Many of these are partly motivated by preventing harm, which I really appreciate. Also another promising sign is that some therapists are realizing that values are relevant in therapy. Still, so much of what I read seems one-size-fits-all, or perhaps is analogous to offering clothes in lots of heights, but for only one body shape.
There is a theoretical orientation called Client Directed Therapy that makes more sense to me than anything else, but it still seems to have some one-size-fits-all aspects. (The best source on this, in my opinion, is Psychotherapy with "Impossible" Cases, by Duncan, Hubble, and Miller. Their other books seem too polemical for my tastes.)
The Evidence Based Practice movement is a mixed bag. Some therapists seem to use it as an excuse to justify one-size-fits-all practices. Others advocate a form of it that makes more sense to me -- a form that emphasizes being careful not to extrapolate from the scientific evidence, and taking client preferences into account. (If anyone is interested in that, the book Clinician's Guide to Evidence Based Practices, by Norcross, Hogan, and Koocher, is a good source.)
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