Four Things they don't Tell You

Actually, this is about 100% what my therapist said and continues to say to this day.

My t gave me pretty accurate prediction how things will go and what are my prospects are when it comes to therapy.

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There's no way a therapist could accurately predict any of these questions. That said, where I work, if a client asks if treatment will be successful, most people answer something like- "Hopefully therapy will help, but we really don't know. We can just do the best we can". I have never been told in my own treatment that I will be cured or that everything will be fine. If a therapist tells you that, it's a red flag as far as I'm concerned. There isn't much concrete evidence on the effectiveness of therapy, so Ts can only base it on experience. And that's subjective since once clients leave, a therapist has no idea what happens (unless they come back). The most honest thing a therapist can say is that they want to help you and will do their best. As for the pain, I think that's subjective, since therapy isn't necessarily painful for everyone, at least not in the context that I read about here. For a therapist to tell a client they know how they'll feel is presumptuous.

There are a lot of surgeries and treatments that promise to be successful and curative but aren't dor a lot of people. Granted success is still easier to measure, but there are an awful lot of people who've had back surgery who ultimately weren't cured the way they had hoped. Lots of treatments are a gamble and can even be risky. As consumers we need to be aware of that- and providers need to be more honest.

I have never touched a mac. PC DOS all the way. Blackberries rule!!

How did you know?!

Una & SD - keeping psychocentral safe from psychomonopolies since 2011

Mine has said some of these things, but I had to ask. I do think there should be a warning label, in addition to operating instructions.

(unaluna...you realize you align with a dysfunctional operating system, right?)

I'm pretty sure unaluna is not only using Windows 8, but loves it.

Right. Somewhere between "it's impossible to predict" and "here's exactly what will happen" is a middle ground. And that middle ground should be some sort of honest accounting of general outcomes and possibilities, based on the T's experience and on the published literature.

It's called informed consent, and to leave this out entirely is unethical.

Wow that is my experience almost to the letter. Cruelest thing I ever went through. It would better not to have ever started the process at all, because I only feel the lack and deprivation more now. Sorry you went through this too.

Cruel is about right. I'm so sorry you went through this as well. I'm going through this for the second time

I think it depends what client is in therapy for.

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My T told me repeatedly for the first few months that I will feel worse before I will feel better. I bet if I asked her if she could really help, she'd be honest and tell me that she doesn't know, but we could try.

I think it's perfectly reasonable to expect a psych practitioner to share at least broad expectations around prognosis with their clients, just as anyone else in the medical field would be expected to do. Unfortunately no one usually holds them to such standards, including themselves. If a general practitioner told you to keep coming in without giving you any idea of why or for how long and to just have faith in the process, would you go?

I get the lightbulb analogy, but isn't that only half the battle? You can want to change until the cows come home, but if you're with a therapist who isn't genuinely well equipped to help you, if your particular diagnostic profile is not genuinely in their wheelhouse, it won't be likely to make much difference.

If the therapist doesn't set expectations, both for their own and for the client's benefit, I don't see how anyone in the situation can remain effectively motivated to achieve.

I might still be on 6...

A lot of patients never return after appointment 1 so I don't know why a T would say this up front when they want to get a client. Also I would have a frank conversation with T, I know I did. I've always been honest at how long I expect things to take and T was honest about the process. But no one has the same time frame or process I do. So it's hard to tell.

I would go back into therapy if I could get rid of all my anxiety about whether T likes me or not. Doc John's article which mentinoed therapists wanting patients to get better and countertransference makes me wonder if maybe T did genuinely care about my progress.

Therein is part of the problem with any kind of statistics that some say should be available. How many clients go for one or two appointments and stop because they decide it isn't for them? Do they count in the statistic? No real therapy even got started? How many stop therapy because of financial concerns? Do their statistics count if they left therapy without it coming to any sort of close? What is the length difference for clients with X type of situational issue as opposed to clients with Y type of more involved issued as opposed to clients with Z serious mental illness diagnoses such as schizophrenia as opposed to clients with some combination of the above that defy any sort of predictability because of the issue of variance with comorbid issues? What is the length difference for different modalities of therapy? What about clients with therapists who don't fit neatly into any particular modality? How any sort of reliable statistics could be the least bit useful to an individual I have no idea except in what is probably the rare circumstance of someone with a very clearly defined disorder in a very specific kind of therapy modality conducted to the letter and by the book. Most of us, quite frankly, don't fit into that neat, statistically traceable category.

It is going to take time for a therapist to have any sort of clear handle on what a client needs, how long it is going to take, what modalities might be best suited, how the client is going to respond to treatment along the way. That is individual. This is particularly a problem in therapy where clients often either do not really know what they want from their own therapy to start with and/or they are not completely open from the beginning and/or they are not completely honest from the beginning and/or other problems occur during the course of therapy that create additional fodder for assistance; none of these are unusual or even particularly wrong, but they highlight the problem of expecting a therapist to make prediction and give warnings to a client about themselves based on virtually no information to start with. No blanket statement could be remotely accurate to the individual or even really particularly helpful or predictive. Personally, I would run from a therapist who started making warnings and predictions early on about how long they thought it would take, what they thought my chances of success/failure were, etc.

Sure, they can have you read and sign a form about all the possible horrible things that might possibly be a problem for you in therapy. Have you ever had to sign one of those forms for a medical procedure? They are CYA documents about generally obscure possibilities that never apply to everybody and in fact apply in only rare instances. Personally, I've never backed out of a medical procedure based on informed consent and I've never had one of those rare scenarios actually happen. My sister did have one of those rare scenarios happen, but she would not have backed out of the treatment if you had put a gun to her head because the treatment was her only chance at life. Yes, people could choose to back out of therapy right then and there and I suppose that is what the OP is looking for? I don't know. Of course, the only danger of backing out of therapy due to informed consent, I suppose, is that a person continue to live their life in mental and emotional instability or pain or whatever it is that brought them in (but of course, continued self-harm or successful suicides could certainly be a tragic outcome of someone running from treatment based on such predictions . . . )

I am not saying any therapist should tell any client it will all be better and turn out roses -- not in the least. But these conversations have to happen over time in the context of the individual as the therapist gets to know the client and the client's needs more closely. It's not like antibiotic B is going to cure infection B; it's just not anywhere near that statistically predictable. How soon can a therapist have a better idea for an individual client? Again, that would vary with the client. The best a therapist could do might be very broad statements that would not be particularly individual at all. I prefer to be treated as the individual I am rather than be given some CYA statement early on that probably wouldn't apply to me anyway.

Yes, of course all clients are individuals and therapy - if it's any good - will end up being tailored to their needs. But:

1) as pointed out by a number of posters, therapy does need to come with some warnings. Clients with unrealistic expectations are going to struggle more. It's simply good practice.

2) statistics does not mean hard and fast numbers. One can easily say, "the average amount of time a client [not talking about the ones who don't come to a second appointment, no one ever was] spends in therapy is 4 years, but your mileage may vary." This at least gives a time frame to a client.

The more transparent the process and the therapist, the better it will go, and with any luck the less heartbreak clients might experience.

A lot of people go for the 12 sessions of cbt, T wants the business, why would T say "oh it could be x years"? I would never go back

I asked T up front if she had a time frame in mind and that I was not interested in short term therapy. When I'm done, I'm done. If T had told me "ok but with your issues it might take 3 yrs" I would have left and never come back.

Not every client goes for the intense therapy we go for and I don't see any T duty to discuss consequences. Do marriage T's start out saying "well I might not help and you might divorce, but maybe not"??

Actually, my T's intake form specifically states that it might take a long time, might be painful (or at least very emotional) and is not a guarantee. As a new client I even had to sign that I'd read the document.

I agree that there is no way a therapist can know certain things. When I started therapy again with my T (there was a 3 year break) she had me sign this paper saying that therapy is a risk, I could end up worse than I was before, its going to be painful ect. I am glad she had me sign that and talked with me about it so I knew the risks of therapy before I started again.

If I were a therapist, I'd point every client to a list of books and online resources that discuss therapy outcomes in a honest way. Or create handout with some basic disclosures and cautions. How hard is that?

The main issue to me is whether the profession is churning out victims at a high rate. If so, better start asking tough questions. Not just about informed consent, but about T training and qualifications, lack of audits and checks & balances, lack of reporting, and whether some of the basic assumptions are unsound.

If the profession wants to be taken seriously, there needs to be some data available on outcomes. For example, what percentage of clients leave therapy feeling harmed. Pretty straightforward.

Unfortunately when one is depressed, anxious, not functioning well, therapy seems like a good option. It's what society has to offer people who are depressed, anxious, and not functioning well. But when therapy does harm, who knows or cares? Who is there to do the outcome follow-ups?

Seems simple enough, psychologists have a science of doing surveys, etc., but they certainly seem not to use it to find problems with their services and try to improve them.

Other parts of society do, though. I recently flew across the country and the airline sent me a survey 2 days later. They also included a space where I could write in any suggestions that I felt could have made my experience better.

So many lost opportunities, so much client experience never inquired about. . . but . . . Who cares?

I think this is one of the reasons why this forum is so active. Many of the posts (including this one) can be rooted in this premise.

I shall only speak from experience, then.

My life has changed for the better since I've been in therapy in very clear and distinct ways. So yes, therapy has helped me. There is no doubt.

I think it is often the therapists and their profession who encourage unrealistic expectations from cloents. Certainly they do very little to clearly state what can be realistically expected from paying a therapist thousands of dollars and much of it is very ephemeral and nebulous.