I don't want to prolong trying to make my point, maybe we just disagree. But I was in and out of therapy for over 50 years -- yes there have been a lot of improvements, and dis-improvements, along the way. I've been in therapy almost continuously for 20 years -- it didn't prevent me from having a terrible breakdown and may have contributed to it, although I am better now. I've known two people with long-term mental health issues who took their own lives, one in his 50's, one in his 60's. They never got the realizations that could help them live healthier, happier lives.

Based on my long experience, though, the two goals that the authors proposed COULD, I believe, help a lot of other clients with trauma backgrounds and complex issues:

1. The therapist and patient form a shared understanding of what is happening and find a way of working together.

2. This way must be found to be beneficial for the patient and sufficiently tolerable for the therapist so that the therapist does not avoid it.

Because of the issues I entered therapy with, I did not have an understanding of the world of social relationships that matched what others did very well. That's the nature of what I presented with. But the therapist couldn't have known how I experienced the world any more than I could know how they did. So, having the development of a shared understanding as an explicit goal sounds to me like something that could have helped a lot.

Similarly, because I had numbed out my emotional reactions to my mother's anger, I could not understand that anger and angry outbursts felt threatening to the therapist. It was in therapy and I was proud of myself for getting in touch with my feelings and expressing it. I had previously understood that anger was "bad" and I could usually control anger by dissociation or self-shaming it internally. But then I couldn't talk about it either. And I expect there were other characteristics of me that were hard for the therapist to tolerate in me sometimes, and I didn't know it, or why, because she didn't tell me. I knew how to behave politely, at least as I had been taught, but to me that was a matter of being "good" or "bad". There was a lot of social nuance I didn't pick up on (still don't, I find out sometimes the hard way, others not at all). So some intellectual understanding by the therapist that that was the case could help a lot, I believe. She/he could develop a way ahead of time to tell the client if they were having a hard time with some of their behavior, or something, without being shaming, blaming, or belittling, which are things which therapists have definitely done to me.

Because of the numbing, I had no idea what a "good fit" was either. I kinda do now, but after . . .well, again, all those years. That's something that it might help to discuss up front, directly, with clients with complex issues at the beginning, too.

I'm putting this out there, here, because I have no confidence at all that any one in the profession is interested. But who knows? Maybe there are some out there who decide to take a look at the client forums as a lark. And certainly the authors of those articles seem to understand the problems and are trying to make a difference. Who knows how many folks will listen to them. Still, very interesting and thanks again, Skies.