Signs of a bad therapist

WOW Moxie....just wow. Unflippinbelievable!

We are, all, of course, aware that events in one's life can cause biological changes in the brain, right?

It all becomes chicken and egg quite quickly as to whether or not problems are biological in origin or originally caused by an inadequate environment during the developmental phase (or thereafter, plenty of people become depressed due to events which happen in their adulthood.)

People who live under a great deal of stress for protracted periods of time have biological changes which are observable in various hormone levels, and sometimes I believe, in physical changes in the brain. In the same way, people who meditate a lot apparently also experience physiological changes in the brain.

Saying 'it's biological' is essentially saying nothing at all. Everything is biological. Even if the trauma were caused by being beaten daily, the ongoing pain would still be biological, because it would be a physical response to environmental stress. I guess you could maybe mean genetic instead? As in, you were always going to feel depressed regardless of how your life went?

I don't think it really much matters what the cause is as long as people find solutions that work for them. Funny how people like to hold on to certain causes while dismissing others. I think there's a lot of evidence for both genetic causes of depression, and for lifestyle factors to be at play. It's probably a mix of both for most people.

Genetic disposition could very well mean that some people are unable to tolerate everyday life as well as others. There's also the fact that 'everyday life' in a modern context is pretty ****ed up in a variety of ways, which would certainly account for a lot of depression.

Does it really matter, as long as people find something that works for them?

I mostly agree with you, particularly the bolded part.

I don't know if she was speaking genetically or not, but I do agree with her that for some of us, there is a point where our depression, etc. can become so pronounced and debilitating that it can very definitely become an issue that has to be worked out medically to some degree before we can really get to the psychological work that we can do in therapy. And having been in the position of having medical interventions become absolutely necessary to even begin to budge the symptoms and have any progress even become a remote possibly through therapy, I completely understand what Nowhere is saying.

Does everyone need medical intervention for their symptoms? Absolutely not, and that is very fortunate; however, when we personally do need medical intervention and it has proven to be quite helpful, life-saving, and progressive in our quality of life, then having anyone take our very personal and individual experience and success in that kind of intervention and treatment and call it simply a matter of a doctor who "does not know what is going on" is extremely invalidating and inaccurate. In my personal case, it was the fact that my doctor absolutely DID know what was going on and was able to find the right medical interventions that I am alive and very healthy today.

Yes, it is a bit of a chicken or the egg question, but the bottom line is that what has to be dealt with is what a person's current functioning and current needs are in the present, particularly when the symptoms are so severe that they are impeding a person's quality of life significantly.

As you said, what really matters is that whatever route of treatment a person takes, it is effective and moves them forward in their healing.

I think the genetic component is usually referred to as temperament. Some people who are put in certain environmental conditions will be more prone to depression than others. And like skyscraper said, along with that you'll get changes in the brain that happen along the way. Plus, at a certain point in life the root cause of depression could be like finding a needle in a haystack. Either that or it's been talked to death but the depression is still there. For these people symptom resolution is the top priority along with learning the skills to deal with the here and now and increase functioning.

I think that's what the therapist may have meant when he came to the conclusion that it's biological. To push a client to uncover the many layers of their past when they've been there done that, can be quite harmful. Not everyone needs to go there - they just want to live their life now. To invalidate a clients wishes because it's not what the T wants to do, is bad therapy in my opinion. Clients are often more educated on the effects of medication than they are given credit for. If the psychiatrist is a good one, then a decision is often made with a careful weighing of the risks and benefits. Sometines the risks of dealing too far into someone's past is riskier than going the medication route. If that's the case, I think a responsible therapist will respect the clients wishes. I had a T once tell me she didn't believe in psych medication and didn't wouldn't talk to me about my meds or hear anything about my pdoc. I liked her but when I heard that I couldn't relate to her in the same way anymore - she basically was saying what I knew about myself was so wrong she wasn't even willing to have a discussion about it. I couldn't work with s person like that and never did again.

Why is it that nearly any thread on any topic on PC is liable to be invaded by people proselytizing about psych drugs? This is a thread about signs of a bad therapist.

Sorry if I have offended, but when I see someone stating in a public forum that because their doc has them on some mind altering drug that makes them feel better, this proves their depression is biological and that the drug is actually fixing some known problem, I have to say something.

What if I downed a bottle of whiskey and I felt less depressed, and then claimed that it fixed some imbalance in my brain.

Part of the reason I opened my big mouth is that in another thread where the same issue is being discussed, Nowhere did use language that implications for everyone -- "The reality is that a brain under stress *does* undergo chemical changes and a medication can help right those changes".

No one here has either "invaded" (we have as much right to state our personal experience as anyone else here), nor have we "proselytized" (we have not tried to convert anyone to our own beliefs) about meds. We have simply stated our experiences in very personal terms. You do NOT "have to say something" every time someone tells their personal experience with success with medications; you have a choice.

Comparing drinking whiskey and taking prescribed medications under the supervision and management of a doctor are not at all comparable; that again is condescending and insulting. I do not understand why you do not recognize it when you do this.

I am sure this will be be pulled, but I am going to say it anyway.

I know. My friends are always telling me I should write a book, but who's got the time?

The political thing was the most astonishing to me. I mean, other things that happened have represented bad judgment and perhaps some misplaced affections, but to try to force someone whom you're treating for mental health to vote in a certain way is just completely sinister. To quote, "if you vote for (presidential candidate X) don't bother coming back here", and I kept looking them in the eye waiting for a laugh to break out followed by "just kidding" but instead I was stared down for what was a remarkably long amount of time. Because I really couldn't believe there was no "just kidding" coming.

The world is full of all kinds of people, and so is the psych profession.

Yes, I think that other thread did get carried into this, if only by association, and I understood that to be a recommendation for others. I completely understand your point about meds and the alcohol distinction (and I agree); however, I can also see how someone who's been struggling for years and found relief through meds would be hurt by that notion. Meds are the only thing that have had a stabilizing effect on me, but because I'm more in alignment with your thoughts on the issue, I refuse to go there any more. And it is hell. I feel fortunate to have a therapist who's willing to help me explore as many other avenues as possible that are not pharma. At the same time, I'm glad for any relief or way out someone else can find, even if it's meds. I just hope more research is done to identify other methods.

But, back to signs of a bad therapist: one is a therapist who will only see me if I take medication. I'm glad the one I see now does not refuse me on that basis.

There is a world of difference between:

"I take drug XYZ and it makes me feel better/different/normal".
"Drug XYZ fixes an imbalance in the brain".

The second statement perpetuates what I see is an extremely dangerous myth, one that is forced on people from every corner of modern society. It leads people to believe that psych drugs are medicine used to treat disease, and they fix some simple glitch in the brain. It is not so. Please just stop with this. This is a public forum, people can land here via google search, and if I see someone making these claims in a forceful way, I'm gonna counter it, even it gets me kicked off the forum. There are myriad ways to respond to depression, but drugs take up 90% of the conversation. It's madness, especially if you look at the long term data. It's really upsetting to me, and I should not post when I am like this...

People tend to be biased toward what has worked for them, whether it is medication or a certain brand of therapy. So I wonder why this is so upsetting to you. I've had interactions with people on all ends of the treatment spectrum - meds short term, no meds, meds long term, meds with therapy, just therapy....the individuals who have the most improvement in their quality of life are the ones who do what works best for them, and what works is very subjective. So I think this does relate to the "what is a bad therapist" question, because a bad therapist, in my opinion, is one who pushes their own agenda without regard to the clients' wishes. In my case it was with an anti medication T, but it can also be with a T that pushes meds on someone who doesn't want them. Plus people are equally as dogmatic about the effectiveness of certain types of therapies and certain types of therapists. So long as everything is ethical, isn't what works for the individual the most important thing? I think doctors should listen to clients who report negative experiences with meds and I don't think they should push them on anyone. But I also think it's true that people (at least adults) who choose to stick with taking meds do so after much consideration and for good reason. Given that, I don't think any myths are being perpetuated on in these posts, I think people are just sharing experiences. Regardless, overall I think you'll see an even split between the positive and negative posts, so I doubt many people are swayed much in either direction by posts on a forum like this.

Maybe a good therapist is the one who finds the treatment that works best for the *individual* patient. This is what my recent experiences have led me to think. If I am the perosn who would feel better and believes in a combination of meds and psychotherapy, then it will be likely that the confidence helps the healing process. If I am the type that is sceptical towards pills and there is no proven need for them, then I should see someone who respects and hears my wishes. Any professional should work with the client, not against her/him.

That's fine. But if you say that depression is a disease caused by some simple defect in the brain, you are no longer talking about your experience, you are initiating a debate.

I have done a lot of reading on this topic. I feel fairly confident in saying that the chemical imbalance thing is entirely unsupported by evidence. It's not even a controversial thing to say; many high profile psychiatrists, researchers, docs have admitted this.

However, I am not an authority just because i have done a bunch of reading, and I am not automatically right. I do not like dogma or certainty, and I sometimes lapse into it on this topic. I am just an idiot behind a computer.

Still, the message that all "mental illness" is caused by brain defects is to me an awful one. It tells people they have little or no control and must submit to long term or life long drug use. It's also apparently not true. And meanwhile true underlying issues (physiological, emotional, social, etc) are potentially ignored and the patient could be propelled onto a path of increasing disease and disability.

When my health problems first began, my GP's only advice was try SSRIs. Then I saw a Neurologist whose only advice was Xanax. This aint medicine. Not saying its wrong to take these drugs or that they cant help, but framing this as something other than drugging down symptoms is, in my opinion, irresponsible.

ps: This has to be the most egregious off-topic violation ever, and I am partly responsible, apologies to other posters.

I just wanted to bump this back up because I've been reading a LOT of bad therapy situations here lately. I just want people to beware and be careful.

Therapy is so individual, and what works for one customer won't necessarily work fo another. But, I do agree with you that there are a lot of bad therapist out there. I've had a few myself.

There are some things that are very clearly across-the-board unethical though.

I do agree with that. Nevertheless, what that looks like to you, me or another person may be very different.

This is so true. And people just tend to gloss over those types of unethical behaviors and blame the clients.

Ethics are very blurry in this profession and they can be open to interpretation. I find it amazing how many therapists are unethical and still practising.

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I totally and absolutely agree! And that goes for other professions too! I'm so sick of lousy physicians getting away with ridiculous mistakes (one of mine who outright lied and altered my medical file to cover her mistake) and I'd like to kick two of my sister's lawyers to the curb due to their incompetence. Professional organizations who "police" their own members are a total joke! All they do is duck, hide and put up smoke screens. It's disgusting.

Here's some of my own suggestions:

Signs of emotionally harmful themes in therapy:

-T has not explained the boundaries of this therapy to client
-T has not articulated expectations and limitations regarding contact, during and post termination
-T creates unrealistic expectations about future treatment ("I will never abandon you" "my door will always be open")
-T noticeably or significantly changes behavior that has previously been consistent, without explanation
-Sessions consistently end too early, run too long, or end at inconsistent times
-T is afraid to or avoids discussing feelings and emotions
-T is afraid or hesitant to set a boundary, feels pressured to comply with client's wishes
-T refuses to talk about any issue or deflects a topic without explanation
-T is uncomfortable when client disagrees, or expects or implores client to agree
-T acts in an emotional way rather than saying they are feeling an emotion
-T encourages, asks or suggests, without solicitation, that a client behave in a certain way
-T encourages, without solicitation, the client to feel a certain way
-T volunteers the opinion that T is trustworthy, capable, competent, skilled, informed
-T justifies T's behavior, perspectives or opinions because they are the T
-T questions the client's judgment, autonomy, responsibility
-T shares personal information that has no obvious relevance to the client's material
-T shares feelings that have no obvious relevance to the treatment
-T makes small talk
-T shares a personal experience intended to contradict a client's experience
-T shares information about another/other/most clients to contrast client's experience
-T debates; explains their own opinion in order to contradict a client's opinion
-T normalizes client's experience with the intent to question, minimize or invalidate it
-T reinterprets client's opinions, thoughts or feelings in a way that changes their substance ("so you think you ____ but really ____" "Though it may feel like ____, it's actually the case that _____")
-T makes judgments ("you are..." "that is..." "we can't...") without providing context ("I feel that..." "In my opinion..." "it seems like...")
-T changes the subject without explanation
-T goes blank/provides no response to client's topic/question
-T insists that therapy must focus on a specific subject or methodology that was not agreed upon within the first session
-T insists that therapy must be conducted in a specific way that was not agreed upon within the first session
-T tells client what client needs, thinks, or feels
-T provides ultimatums or warns client what will happen if client acts a certain way
-T challenges, questions or crosses client's personal boundaries
-T contacts client for reasons other than business
-T uses significant session time to discuss business matters

Just some that come to mind...

Policing their own members is a joke for sure. What bothers me is so many people seem to get hurt and are too afraid to speak up about it. Nothing gets done if you do speak up usually. No one really knows how much damage is done by unethical therapists (and other professionals).

My T debates me a lot.

" My body is disgusting. It deserves to be starved"

T: " no it doesn't. Give me one piece of information that proves that'

I come up with a reason

T: " no that's something your mother said. That's a reason you were abused. Try again"

Eventually we get to "so you have no proof which means you have to at least CONSIDER the idea that your body is normal"

And thus I have gone In a few years from starving myself to.having the start of a normal.relationship with.my body and food. I at least accept that my body biologically requires food which I used to deny. We debated that for a LONG time

Maybe its because I am a scientist and despite the power my past has over me on some level I recognize that my beliefs defy all logic...

Its hard to set such set in stone rules. We also make small talk
When we have done too much deep stuff and I need to catch my breath we discuss music, our favorite vacations, what other careers we each considered etc. Sometimes 30 minutes of deep trauma work.is all I have in me. Its that or sit there and stare at each other.....which means she'll ask "what are you thinking?"
And because I'm me and I'm maxed out on trauma I'm usually thinking something ridiculous like "if a unicorn and manticore had a fight, who do you think would win?"
Or " if you could talk to only one species of animal which would you pick?"

...If they tell you that having sex with them is going to be helpful to your mental health..

That would be a dead giveaway