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  #1  
Old Feb 03, 2015, 08:13 AM
PaulaS PaulaS is offline
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I´ve been abandoned by my T some months ago and since then I´ve read a lot about termination and clients feeling abandoned, here at PC amongst other places.

There´s nothing much about how a T reacts when therapy doesn´t end at a positive note. When there´s no real closure. Sometimes it seems like if the T can motivate a termination by for example the methods not being sufficient, they also tell this to themselves, they just move on and forget about a therapy not working. Are they as coldhearted as they seem or is this just to protect themselves? To distance themselves? If anyone has a good article or book on this to recommend, I´d be interested.

Last edited by PaulaS; Feb 03, 2015 at 08:14 AM. Reason: spelling
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  #2  
Old Feb 03, 2015, 08:23 AM
RedSun RedSun is offline
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As a t in training, a big part of this is how and when to terminate. At T's and clients are all (mostly) human, there will always, always be instances of a 'bad fit', often no more than a personality clash, or a client needing a different treatment modality than that offered by the t.
As with anyone who provides a service, this is part of the job. I guess that all driving instructors, music teachers, personal trainers etc etc have had clients move on, or have had to finish with clients. There are training books on how to best manage a termination, but often it happens very suddenly, so there is not good time for closure.
I think it's so important to remember that T's are human beings, doing a job, probably because they like the work, and they care about their clients, but also for the same reasons that everyone else gets up and goes to work each day. And yes, failing is hard because it affects another, potentially vulnerable, person, but it's inevitable sometimes.
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Old Feb 03, 2015, 08:27 AM
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I think they are used to putting everything off on the client. The last one I saw apologized for disappointing me, but I hadn't felt disappointed at all. It wasn't until after she moved and I found out that she'd misled me that I realized she'd disappointed herself and shoved that off on to me.

Maybe some will admit it when it's their fault, but I think that's rare. The one I see now did something that was not a terribly bad thing, but she was quick to take responsibility for it and meant it. It was almost worth going through the whole thing just to have that experience of a therapist who owns up to making a mistake.
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Old Feb 03, 2015, 08:54 AM
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my T seems to admit she was wrong or could have handled something very differently all to often. sometimes i think she isn't wrong and she will even explain how she could have been better. it makes me uncomfortable when she tries to say she was wrong
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Old Feb 03, 2015, 09:06 AM
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I've had therapists and pdocs (and medical doctors) accept responsibility when they've fallen short in some way and honestly admit they aren't sure how to proceed. I've had them encourage me to get 2nd opinions to double check that they were on the right track. I respect that a great deal.
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Old Feb 03, 2015, 09:17 AM
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feralkittymom feralkittymom is offline
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The reality statistically is that clients quit therapy, sometimes prematurely, far, far more often than T's terminate them. There's a lot of literature out there about termination and how all variations of it effect both client and T. The experiences related on this board I don't find to be reflective of the majority of therapy experiences.
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Old Feb 03, 2015, 09:56 AM
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I bet they are used to "failing." I would just guess that they mostly have failures, and only a few true success cases. I suppose the degree of "failure" is probably relevant... but what I mean is I doubt the average person goes in and continues with therapy until a healthy termination. I bet most by in large quit very early on, and some the T terminates later on or they get frustrated with the process and quit, and then only a very few stick around for any kind of duration.

Of course maybe we aren't the typical kind of client either? Who knows, maybe a lot of people come in with short term kind of problems to fix? All I know is I've seen maybe 8-10therapists, and around 7 of them were for one visit only before I "quit" and then 1 was for a couple months, and 1 was for 4 months, and then my current one for 2 years. So you could say I've left 9 "failed" therapists in my wake in some respects because I'm still depressed, and that I have 1 in progress now. I doubt any of those 9 feel like failures. The two I saw more than once did help me a bit.
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  #8  
Old Feb 03, 2015, 09:58 AM
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They fail daily - they just are trained to blame the client for it.
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  #9  
Old Feb 03, 2015, 11:00 AM
boredporcupine boredporcupine is offline
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Quote:
they just are trained to blame the client for it.
Some probably are trained this way. I am in my 2nd year of school and so far nobody has told me to blame things on the client. I hope that when (not if, because I will fail a client sometime no matter how hard I try not to) I fail a client then I will be able to freely admit it.

I have an ex-T who hasn't really been able to admit she failed me. Instead she talked about how therapy is an "imperfect art" and nothing could be guaranteed. Which is somewhat valid except there were very concrete things she could have done better. Her inability to take responsibility for those things really pisses me off as a client and even more as a future T. But if she were better able to pay attention to the areas where she fell short, and take responsibility for them, then she probably wouldn't have had to refer me in the first place.
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  #10  
Old Feb 03, 2015, 11:17 AM
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I don't think of it as a zero sum game. My T has admitted he can't help me because my issue is biological and I know it took a lot out of him for a while because he had to accept that he couldn't fix it. At the same time, I never felt like I had failed at therapy. We both recognized that we were bound by certain biological limitations.
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  #11  
Old Feb 03, 2015, 12:15 PM
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Ididitmyway Ididitmyway is offline
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I don't know about actual failing, but I understand what you are trying to say. Basically, I think, you are asking if therapists honestly admit when they didn't do a good job with the client. In most cases, the answer is, unfortunately, no. There is a lack of honesty in the profession, but there is a lack of honesty in many societal institutions and structures, so therapists, by no means, are the only ones who often don't take responsibility for their screw ups. This has nothing to do with being coldhearted but rather with the fear of hurting their egos by admitting the mistakes.

It is also and mostly a structural or systemic problem. Many psychotherapy methods are based on myths instead of scientific research, and those myths have been perpetuated for decades and have turned into a dogma. This is another vulnerable spot of the profession that many therapists don't want to address and get very defensive about it. So, yes, I see your point and the point is valid.
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  #12  
Old Feb 04, 2015, 04:56 AM
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Just to respond to the above, that's a very valid point.also, where I am training in the UK, I have met so many T's and tutors (who are also, or have been, T's) who are inherently honest and committed. I have only met one, I think, who showed any dishonesty in admitting to their own process with clients. I'm not sure which psychotherapy methods are based on myth, I guess if you are in the US I've understood that there is still a lot more Freudian based psychoanalytic work than in the UK now. But I would say that person-centred and psychodynamic work has empirical evidence for its ability to allow clients to use therapy as a vehicle of change.
So, I of course agree that some T's are dishonest and ethically flawed, as you say, same as all professions. But I would not agree that there is a lack of honesty in the profession, it has not been my experience. Clinical psychology, particularly cbt, has often been called to question because of lack of follow up evidence, but that's a different category.
And, as ever, a t cannot change how we feel, or behave, or cope. They can 'only' provide a safe, held space, and guidance as to how we can make those changes ourselves. It is inevitably an issue of personality and skills matching, cos we are all so unique.
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  #13  
Old Feb 05, 2015, 04:04 PM
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When I became very suicidal during a bad depressive episode last year, my Psychiatrist told me about losing one of his other patients to suicide and how the news just hit him like a tonne of bricks - it was clearly something that effected him deeply. I asked how long he'd been seeing this patient, and he just replied "not as long as you", so I kind of got the impression that losing me that way would probably have been pretty devastating for him. Apart from that, although he never gives out any sort of detail that might lead to the patients being identified, I am aware there are a couple of patients he's treating who aren't doing so well. One of them is a patient with a severe eating disorder, and because I've managed to achieve a fair degree of recovery myself after having anorexia for over 20 years at one stage he was trying to see if there was anyway he could bring me in as a support person, or just to have someone his patient could talk to, who'd been where she was, without breaking any sort of confidentiality rules (unfortunately he couldn't - and before anyone says anything about my Pdoc trying to put responsibilities on me that aren't my own, this would have been part of my therapy as well). Anyway I do know when patients are struggling like this, or if therapy doesn't go well for a particular patient, he constantly asks himself things like 'Where did I go wrong? What could I have done differently? How could I have helped his person better?' He's said sometimes he does need to step back and allow himself some perspective, or else the failures can end up seeming like a personal failing of his own (he's 'not good enough', he's a 'bad doctor') and if he allows ideas like that to take hold too much and knock his confidence then he can't effectively treat his other patients.

Edited to add: My point amidst that rambling was that I think it depends on the individual practitioner, some are fully prepared to exam their own failings (potential or otherwise) with a view to improving future client care, whilst others will most likely point the finger at everyone but themselves, including blaming the client. Classic example of the latter was a well known Eating Disorders treatment hospital and clinic that once admitted a 100% treatment failure rate, but went on to blame the patients for "usually needing 5 or 6 go's before they 'got it'".
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Do you think T:s admit and think of having failed some clients?

Last edited by willowbrook; Feb 05, 2015 at 06:06 PM.
  #14  
Old Feb 05, 2015, 05:20 PM
missbella missbella is offline
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At least one provider thinks there's a lot of patient-blaming:
http://www.nytimes.com/2008/10/21/health/21mind.html

And how many times have clients been accused, including by other clients here, of not committing wanting to change or failing to look hard enough for the right therapist? In my opinion these rebukes directly imitate of what the therapy industry tells clients.

A book published in 2013 about ethics complaints, Red Flags in Psychotherapy, revives decades-old material from James Groves about the four types of "hateful patients." The book then presents a number of composite case studies of complaining clients, depicting them, particularly the women, as low-IQ cartoonish bimbos (in my opinion.) Worse is Lawrence Hedges's "Facing the Challenges of Liability in Psychotherapy," comparing a psych plaintiff both to a witch and Nazi gestapo.

When I searched writings about the negative effects of psychotherapy I found almost nothing, even less for consumers. (Terms would include iatrogenesis, adverse outcome, deterioration effect.) Much discussion I saw blamed clients, albeit in a high-toned, clinical way with terms like resistance, projection, non-compliance, negative transference and narcissism.

I've seen therapists so enmeshed in theory that they overlook the simple reality of their own absolute, autocratic behavior. If the lack of literature about harm is any indication, there appears of a trend by psychotherapists to avoid considering their mistakes.
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Old Feb 05, 2015, 06:00 PM
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Originally Posted by missbella View Post
At least one provider thinks there's a lot of patient-blaming:
http://www.nytimes.com/2008/10/21/health/21mind.html

And how many times have clients been accused, including by other clients here, of not committing wanting to change or failing to look hard enough for the right therapist? In my opinion these rebukes directly imitate of what the therapy industry tells clients.

A book published in 2013 about ethics complaints, Red Flags in Psychotherapy, revives decades-old material from James Groves about the four types of "hateful patients." The book then presents a number of composite case studies of complaining clients, depicting them, particularly the women, as low-IQ cartoonish bimbos (in my opinion.) Worse is Lawrence Hedges's "Facing the Challenges of Liability in Psychotherapy," comparing a psych plaintiff both to a witch and Nazi gestapo.

When I searched writings about the negative effects of psychotherapy I found almost nothing, even less for consumers. (Terms would include iatrogenesis, adverse outcome, deterioration effect.) Much discussion I saw blamed clients, albeit in a high-toned, clinical way with terms like resistance, projection, non-compliance, negative transference and narcissism.

I've seen therapists so enmeshed in theory that they overlook the simple reality of their own absolute, autocratic behavior. If the lack of literature about harm is any indication, there appears of a trend by psychotherapists to avoid considering their mistakes.
Many therapists are "sicker" than their clients. And almost every time I have posted here about my awful termination experience I have gotten blaming comments that it must have been something I did or didn't do. It's very confusing.
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Old Feb 05, 2015, 07:11 PM
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Lauliza Lauliza is offline
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Quote:
Originally Posted by PaulaS View Post
I´ve been abandoned by my T some months ago and since then I´ve read a lot about termination and clients feeling abandoned, here at PC amongst other places.

There´s nothing much about how a T reacts when therapy doesn´t end at a positive note. When there´s no real closure. Sometimes it seems like if the T can motivate a termination by for example the methods not being sufficient, they also tell this to themselves, they just move on and forget about a therapy not working. Are they as coldhearted as they seem or is this just to protect themselves? To distance themselves? If anyone has a good article or book on this to recommend, I´d be interested.
Personally, as a T in training I'd want to know what went wrong in therapy before terminating and try to address the issue. A lot of the time there may just not be a good connection and the therapy doesn't go anywhere. From what I know clients terminate therapy (or more likely just stop going) far more often than therapists terminate clients. Therapist screw ups may still be the reason therapy ended, but it's hard to really know. When I've encountered it it's been in the context of partial hospitalizations or structured program settings where the terms of the program are violated.

When outpatient Ts terminate, I think there should be a very well defined explanation and a discussion if possible. It's too bad because it does seem like in these situations that just doesn't happen and clients suffer a lot of pain.

Last edited by Lauliza; Feb 05, 2015 at 07:34 PM.
  #17  
Old Feb 08, 2015, 03:53 AM
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SubliminalThoughts SubliminalThoughts is offline
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Originally Posted by stopdog View Post
They fail daily - they just are trained to blame the client for it.
I think most CBT Ts are like this. They will always have an excuse as to why the client didn't progress.
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  #18  
Old Feb 08, 2015, 06:31 AM
The_little_didgee The_little_didgee is offline
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Originally Posted by stopdog View Post
They fail daily - they just are trained to blame the client for it.

This is especially true for almost all psychiatrists and gastroenterologists. I find this kind of behavior revealing so I avoid clinicians that show warning signs. Why help people if one cannot admit their errors?

I think most therapists think about where they went wrong. Unfortunately most won't admit it and try to repair the harm they have caused. I know some will, because a psychiatrist admitted her failure to meet my needs. She explained how she felt so confused with my presentation and the diagnosis previous clinicians have given me. Even though nothing added up she ignored her intuition, because my presentation didn't match the stereotype. She didn't diagnose me with the same disorder but a similar disorder that didn't come any closer to explaining my suffering. As a result it didn't improve my situation and alleviate my despair.

I left an impression on that psychiatrist. She admitted she would think about me and where she went wrong since we parted ways.

Clinicians assumed I was a lady who came from a dysfunctional family and was sexually abused. Apparently those assumptions come with a BPD diagnosis. It was also assumed that I would manipulate every therapist I met so nobody wanted to take me on as a patient. BPD was used as a garbage can diagnosis that prevented access to appropriate care. I was left with very deep wounds and I'm still hurting 20 years later.

Iatrogenic harm is brutal and everything possible should be done to avoid it.
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