Therapists do more harm than good

The recent "ethics" books and articles I've seen seem more centered around defensive practice--avoiding the appearance of violation which can open the therapist to legal liability. Unlike in a normal human relationship which might be mended with a simple "I'm sorry,"a therapist might see fault admission an opening to a law suit or official complaint. I do wonder if this sense of threat causes at least some of the therapists' difficulties I read on PC.

In reviewing my rupture, I sensed that my therapist was invested in concocting his legal defense rather helping me. I didn't bail quickly enough because the therapist used every tactic possible to stop my termination.

I agree. That is why I find any studies or research done in the area of psychology to be suspicious. There's no real science behind any of it and to me the studies dehumanize people.

I think generalizations like these do more harm than good.

Nuanced discussions, which can lead to truth, which is often ambiguous, are crippled with "nevers" and "always" and talk of completely incompetent clients and omnipotent therapists and other arbitrary thought-crushers.

I've found in my research there is a great deal of quantifiable data pertaining to different therapy practices and outcomes and that some of it is measured with concrete metrics as sound as in any science whether it be physics, medicine, geology, etc.

I mean, here's a random meta-analysis.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2773678/

It's evident to me that a great deal of time, thought and expertise went into the format and construction of this research which was in turn analyzing, distilling and building on findings from numerous other studies.

This isn't my 'city on a hill' study- it's not an ultimate document, just a handy one online among a vast number in a body of knowledge that was built during the past century-plus using the best scientific methods of all disciplines. You'll find the same processes in many of these studies as in those areas (and the same jargon).

There are certainly tens of thousands of studies on all types of therapy related topics, from mental illnesses like depression, bpd and numerous others to the efficacy of different types of therapy, to the role of other factors like relationship, to the challenges of therapy with constraints due to varying healthcare systems and other impediments.

I'm not sure what it really means "there is no real science behind it".

I do understand that in all disciplines, the findings can develop over time, not only in psychotherapy but in mathematics, astronomy, biology. So, the fact that there is scientific research surely doesn't mean we all have an easy way out of our mental health issues. I don't think we've found the all-purpose aspirin of psychic pain either in talk therapy or drug therapy. Nor do I believe science has all the answers, or that there isn't more of value in therapy than can be measured, just as I wouldn't care to have falling in love left only to a measure of how my heart rate increases or the labels of the hormones released when I feel it.

But it's not black and white.

P.S. I was in a study (about the PTSD), and I was not dehumanized. I appreciated getting to participate and I appreciated the respect with which the process was done.

Same here. It's called gaslighting. Seems that some Ts are totally incapable of honest self-reflection, or at least in their professional role since the client blaming is so ingrained. It's not an easy job and the ones who can come forward and admit mistakes and acknowledge when they have been triggered into vulnerabilities and neuroses, have my respect.

I can't get thru a single day without thinking of my T. I also miss her and am disgusted and horrified with her simultaneously. I thought my only hope was to find another T, but even that now seems unlikely to provide much relief. Feels like I have endured some sort of psychological torture and then got dumped on the roadside.

I have been sitting in on classes at the university where I teach.
I have found a good many of the students to be insufferable, a good many do not appear especially bright, and the teachings/classes to support my rather cynical view of them. I will say it is interesting.
I am more convinced than ever that before any of them are allowed to practice, they need to be subjected themselves to real therapy with several different of the approaches.

Problem as I see it, with studies in general, is that there is no guarantee that what was reported matches reality. Who paid for the study, what were the biases and objectives of those running the study, what data was omitted, what data was distorted, what powerful financial interests were involved, etc etc?

I also question anything that medicalizes mental health or tries to make it a measurable scientific enterprise. That sort of thinking is what led to the horrors of the DSM, biological psychiatry (it's a chemical imbalance in your brain, take this pill), and psych drugs.

Seems like our culture is obsessed with science. It's a bit like a religion with its own zealots and scary dogma.

Amen to that. I've always thought before anyone should be in a position of responsibility, they should experience the other side of the relationship, wish my boss did lol. I am glad that my therapist did longterm therapy and that she was an intern for years before beginning to practice more independently, also that there are ongoing education requirements to keep her licenses active.

I was referring to credible research- the factors you noted would make the research not credible. Yes, indeed, they would be omitted from useful work on the topic, with carefully noted exceptions.

I'm not sure about the "horrors" of the DSM, again it seems like such an oversimplification. It's not perfect and it's had some downright neanderthal thinking in it, but it's helped me a lot, again, ambiguous. I do know others have been harmed by it. Books like that develop too. Once the world was flat, then round, and there was science in that decision- not all science leads to correct conclusions, but that doesn't mean I'd want to throw out baby with bathwater. (The earth is an imperfect oblate spheroid.) I like to think that in most human endeavors including therapy/psychology, we're evolving, like when homosexuality was removed from the DSM 40+ years ago. I don't imagine anything created by humans is likely to be flawless, nor even excellent, but that there are many many committed, thoughtful, scientific and artistic minded people working in that direction.

As someone who must satisfy ongoing education requirements for my license to practice law - if theirs is anything like the requirements we have - it is not rigorous nor useful in any real way. I have, based on my own profession, no faith that continuing education requirements do anything but provide licensing bodies and those who put on the events with some income.

Yep. I sensed this happening with my ex T. She did say I'm sorry eventually, so she deserves some credit, but then only after months and months of me asking for it, and then a 3rd party coercing her to talk to me. In the end she still avoided most of the acknowledgement and responsibility and she pushed me off a cliff to save herself. Not only to avoid self-incrimination and possible legal trouble, but to protect the fragile edifice that is her belief in what she is doing.

In my therapy, it's been helpful hearing about what my T has learned about PTSD, partly through continuing education and through her own ongoing professional interest for example. But no, I suppose if someone wants to be lousy at something, a periodic, mandatory, expensive series of classes won't make them great lol.

What constitutes "credible research" and how do you know when you see it?

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of the New England Journal of Medicine” *-- Dr. Marcia Angell MD

It does not, in my opinion, take someone wanting to be lousy necessarily - it just takes someone who is complacent, thinks they are experienced enough, arrogance, too many bad programs etc. And just sitting through them, even if a therapist is paying attention and even if the program or speaker does know, in some sense, what it is talking about, does not mean competence let alone mastery.

That's a really long answer to give, but as I noted, the factors you mentioned indicate unreliable, potentially biased research. In the absence of those and the presence of a properly applied, ethically administered scientific process, one gets good data.

There are certainly extensive, rigorous, lengthy standards for creating credible research, but entire courses are devoted to those. Some good reading on how to conduct and recognize it can be found online, and it's important to vet the research-

look for neutrality, appropriate funding sources, useful sample sizes or combination of smaller samples in solid meta-analyses, awareness of variables/controls, proper duration, subject choice, goodness, a long list, but indeed, it's not just a random abstract concept to brush away with concerns over imperfections.

Don't throw baby out with bath water.

"How do you know it when you see it?"

I personally know it when I see it because I devoted about 4 years to becoming a good secondary researcher and writing about my findings, and I suppose my studies in critical thinking, psychology and such helped.

I believe one can usually find some research to support almost any proposal.

Well stopdog, I'd say those things equate to being lousy in my book. If a practicioner doesn't care and doesn't practice and doesn't reflect, that's lousy to me.

Human behavior all that goes with it is controlled by the brain, the organ scientist know the least about. That doesn't mean psychology and psychiatry isn't a science. It's been established that psychology is a behavioral science, not a medical one. Still the medical model can be beneficial to many clients, especially when the medical and behavioral overlap as is the case in addiction and eating disorders. If we don't see these as medical than people aren't going to get the help they need, or at least not enough of it. Mental health is also consistently linked to physical health. Stress affects health in so many negative ways that I can't see it as a separate issue. Of course there are other reasons to attend therapy that are purely for personal growth or simply as a plaw to vent, but that isn't why the majority of mental health consumers seek treatment. That is why research is so helpful in many cases - it shows what's worked for a certain number of people and what hasn't. You'll never have the black and white results you'd find in a blood test, but it's still giving information that is measurable. Are there a lot of bogus studies out there? Of course there are (the link between vaccines and autism is one of the better known ones and that author did jail time), but this is the case in all research; just because something is published doesn't mean it's any good. If multiple studies are done on the same topic yielding similar results, the odds are better that there may be something meaningful there. I have also been in a few studies and thought it was interesting and fun- nothing dehumanizing; years ago was a different story, but today you won't find such outrageousness. The truth is that human behavior is pretty consistent and the norms researchers have identified are useful when used as a guide and when used properly. I don't see how that is a negative thing - human nature is what it is, and humans are more similar than people like to believe sometimes. The flip side to this is that information is often misunderstood, misinterpreted and manipulated. That doesn't mean it isn't legitimate, or even scientific. If just means that psychology isn't an exact science and no one claims that it is.There is a lot of research that shows that bad therapy can be more harmful than no therapy but that isn't meant to generalize to all therapy. That's like saying being admitted to a hospital is bad because people sometimes die from complications that occurred while receiving treatment (which wouldn't have happened at home). Something can go wrong, a simple oversight or mistake on behalf of s nurse or doctor can cause complications that shouldn't have happened. Just like in therapy, unless it's a glaring mistake that you can't help but see, then for all purposes nothing happened and you're not going to find doctors and nurses admitting to any mistakes or other staff calling anyone out for mistakes either.. Gas lighting and covering ones ***** in order to avoid a lawsuit is not unique to the field of psychology, or even medicine for that matter. I guess my point is that I don't see how it's helpful to be dismissive or on the defensive about an entire discipline of "science", even if you don't believe it to be one. You may not agree with some theories or understand some and that's fine. Isn't it still better to approach therapy and psychology in general with a healthy degree of skepticism so one can advocate for themselves in the event that they do find themselves receiving bad treatment? If one doesn't have that ability, hopefully there is someone who can advocate for them.

I just did not see it as a conscious want to be lousy. It may result in lousiness as a practitioner, but does not, as I see it, require intent.

That's a popular cliche recently, but how about *good* research. Easy to find self-serving research, sure, not as much credible, multiple-source conclusions that would support "any" contradictory proposals in my experience.

I'm not talking about McDonald's paying to find out that we don't get obese from eating there or any other number of dubious findings from dubious processes and partnerships, but about something more serious and higher quality, imperfect but conscientiously, scientifically accomplished.

My sense, from my own reading, is that the bulk of Psychiatry and its bible the DSM is fraud and quackery and social engineering and marketing for the drug companies.

"Don't buy it, don't use it, don't teach it. Theres nothing official about it. [about DSM-V]" -- Dr Allen Francis, Chair of the DSM-IV committee, and one of the most powerful psychiatrists in the country according to the NY Times

""There is no definition of a mental disorder. It's bulls**t. I mean, you just can't define it." -- Dr Allen Francis, Chair of the DSM-IV committee, and one of the most powerful psychiatrists in the country according to the NY Times

“The ostensible validity of the DSM is reinforced by psychiatry’s claim that mental illnesses are brain diseases—a claim supposedly based on recent discoveries in neuroscience, made possible by imaging techniques for diagnosis and pharmacological agents for treatment. This is not true. There are no objective diagnostic tests to confirm or disconfirm the diagnosis of depression; the diagnosis can and must be made solely on the basis of the patient’s appearance and behavior and the reports of others about his behavior.” -- Thomas Szasz, Psychiatrist

“The problem with psychiatric diagnoses is not that they are meaningless, but that they may be, and often are, swung as semantic blackjacks: cracking the subject’s dignity and respectability destroys him just as effectively as cracking his skull. The difference is that the man who wields a blackjack is recognized by everyone as a thug, but one who wields a psychiatric diagnosis is not.” -- Thomas Szasz, Psychiatrist

That's a massive generalization. Too broad to really discuss fairly I believe. My own experience of using a diagnosis in DSM has been empowering and useful. Not pefect, but it's led to concrete improvements in my life. I don't happen to use any medications and none were recommended to me during the diagnosis-specific portion of my therapy treatment.

Good research used to teach that the world was flat and the shape of the skull could predict personality and that force feeding babies was a good thing.
Diabetics (and a lot of others) were (and still are) treated horribly by health care professionals in the name of treatment that they believed was backed by research.
I am not saying it is all bad --just that the belief it is mostly good is not borne out by history in my opinion.

Absolutely- it's funny you mention the flat world- I brought that up a page ago on this thread. Evidence that science is evolving.