Quote:
Originally Posted by Xynesthesia
I so agree with this! I've heard many therapists conclude that the effectiveness of their work has increased when they realized that they cannot, or should not attempt to, save anyone. I think it can also elevate the client's sense of responsibility, not expecting magic change from an external source but accepting that, ultimately, we are alone in choosing and executing how we lead our lives. Part of the problem is probably the codependency (or call it whatever) that many Ts struggle with themselves and cannot really get out stably. And, in the case of unethical therapy, if neither the client nor the T takes responsibility - how on Earth could anything happen but chaos and destruction? I think that a therapist's responsibility should concern their own actions and discipline - this is what many of them forget. That, by the nature of the practice, they can be sources of information and some limited support, maybe guides, and nothing else. I do think that many of the Ts who act unethically mean well, but they get trapped in an illusion of power/influence and pull the client into an imaginary world instead of encouraging them to remain realistic and proactive.
The "comfortable swamp" analogy is extremely appropriate to mental health issues of course - a main reason why they are so stubborn. There are good reasons behind it - we are wired to seek familiarity and the excitement of novelty typically peaks and dissipates quickly. It is very challenging to maintain steady change and it requires hardcore everyday action, not merely talking about it and feeling supported. In general, the more serious/ingrained the issue the harder. Therapists claiming that they, or the therapy itself, will make that happen are either ridiculously ignorant or manipulative/unethical. Sadly, these realizations most typically come once the harm has already been done and it adds yet another layer of trauma: that even the figure/activity that promised healing will not, cannot provide really.
Of course it is complicated for the profession, because if they are not supposed to promise healing and change, what should they sell clients then? Especially for the high cost many Ts charge for their services? This goes back to the whole informed consent thing that has been discussed on PC many times. I really think that many Ts would not even know what to put in such an informed consent as they are not knowledgeable about the reality and limitations of their field. One thing I appreciated in my last therapist was that he was very open about the limitations and had a realistic perspective - in principle, in speech. He would still charge $200 for ~50 mins of mere conversation - why not after all, if a client pay him for it? I think most professionals who sell services are primarily business-minded. That's not a problem IMO, the problem is when ambition and the salesman mentality takes over reality, and when they do not care about the quality of the service the provide, they don't make an effort to educate themselves and advance with modern knowledge/technology. I easily understand being business-minded (am am that in my own way also), but there should be a better balance and realism on it than what can often be seen with therapists.
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I wrote you a long reply to a previous message but it was lost in a paper shuffle, I guess. Here you have (or not) my second attempt.
Before I begin I should note that my therapists, from January 1985 through July 2011 were MD psychiatrists or MD psychiatric residents. I had a PhD psychologist clinician for a little over six years and now I’m back with an MD psychiatrist.
I agree with some of what you write in your opening paragraph. I think that all who’ve treated me have been pessimists — or realists — as no one has ever promised to save me from my disorders. The goals were always an increase in functionality, across symptomatic spectrums, various levels of maintenance, and finding ways to increase my quality of life. When I was sick but functioning I recognized that I was naturally interested and responsible for participating in meeting these goals. I don’t think that we’re alone in determining our behavior, though. I think that we’ve internal and external reference points (too many to name but the latter includes people) that inform our actions. And I think this true of everyone. When alone with my lover my behavior is going to differ from my behavior when alone with my mechanic. As idealistically individualistic as we’d like to think ourselves — that there is the ego/I that alone guides our behavior — our actions are extraordinarily the results of external references. I included internal references because I know that my behaviors are heavily influenced by my symptomatic mental disorders. I impulsively spend money foolishly. I can have that sentence tattooed on my forearms but I will do it again, time after time.
With mental disorders the question of responsibility always lurks. That’s one question that continues to puzzle me. It’s not something that I can address just now.
I’m not sure what you mean when you write that many therapists are codependent? I’m also not clear on what you mean when you write of neither the unethical therapist or the client taking responsibility for… what?
Of course therapists should practice ethical responsibility. I accept that a small percentage of therapists are unethical just as I accept that a larger percentage of the U.S. population are criminals. I think that your dismissal of the efficacy of psychotherapy needs some fact-based data to support or disprove your claim, though.
I’ve never had a shrink try to ensnare me into an imaginary world. I have had shrinks try to free me from the imaginary worlds of my delusions, however.
[A note about delusions: I’m cognizant of the ‘fact’ that I’m delusional. That recognition, though, doesn’t mean that I believe any less in my perception of reality. I believe that there exists a cabal trying — and succeeding — to silence me. I think that there is an effort being made to discard/abandon me for reasons that elude me. I believe that this effort has directly awakened dormant symptoms that negatively impact my well-being. I can’t say any more.]
I can’t find any cohesive matter in your second paragraph so I’ll not comment on it.
No, an ethical shrink doesn’t promise cures but can offer, I think, possibilities of healings (even if that only means hurting less) and very realistic goals of changes away from destructive behaviors.
You wouldn’t pay a patent attorney $1,200 per hour as if you were purchasing a commodity. I’m always a little surprised at those who are surprised that doctors who may have to finance twelve years of school actually charge money for their services. There seems to be an “if they really cared” sentiment that precludes payment. We generally don’t speak as if those in service industries are “selling” themselves but rather what they “charge” for their services. You write of selling in one sentence and services in the next and while I’ve no problem acknowledging that professionals sell services ‘selling’ could be misconstrued as synonymous with commodities rather than services. I don’t speak of my mechanic selling me labor to repair my car but rather speak of what she’s charging me for labor.
Why would you think that a therapist would be able to write an informed consent form? Or a real estate contract? Forms and contracts can avoid legal entanglements when drafted by attorneys. I completely agree “that many Ts would not even know what to put in such an informed consent” form. I would also posit that my thoracic surgeon wouldn’t “know what to put in” a writ of certiorari to be delivered to the SCOTUS.
I’m unclear as to how you are able to deduce that “many” therapists are ignorant about the realities and the limitations of their particular areas of expertise, i.e., psychotherapy? Do you know of polls or research to substantiate the claim? Or is it a gut feeling or intuition?
I have to ask why you would pay $200 for 50-minutes of mere conversation? You seem to find other clients gullible all the while you were doing the same. That seems very strange.
I doubt that my mechanic is primarily interested in business. She’s primarily interested in repairing cars and can repair ’57 Chevys and ’18 Jaguars. She is very concerned about the quality of service that she provides as her reputation for providing exceptional service has a direct impact on her income.
Obviously what is true of my mechanic is true of my therapist.
I have asked too many questions and I don’t expect answers to each. My primary concern is that you’ve provided portraits of ‘many’ therapists as stupid, lazy, unrealistic boogeymen based upon — I don’t know what? The climates that you create inspire others to go further and proclaim all doctorin’ nothing but nonsense since the patient is going to, after all, die in the end. And then all sciences are fair game. And I know that Shakespeare never wrote no plays or poems. I suppose that, at the end, we’re left with the least knowledgeable amongst us holding Jack’s magic beans.
I’m drawn to these threads because I’m a real-life product of psychiatric care. I don’t want anyone to be afraid of therapy because of salacious subject lines or posts that paint a skewed portrait of therapists and therapy. Conversely, I would want to engage anyone who came here proclaiming that therapy can cure all mental disorders and prevent boils from forming.
I’m so very, very tired.