What are therapists responsible for?

My therapists were caring as long as I participated in their role playing: them the sagacious healer/priests and me the feeble, imploring disciple. Once I called out the emperors, questioned their judgments, said I was feeling worse instead of better, the performance ended, and I was left with most normal wounded beings using everything in their arsenals to knock me to backward into my obsequious role.

You'd think a team of screaming, snide, insulting therapists violate professional ethics. WRONG! One professional board didn't even hear the case. The psychologist argued his admitted behavior was to "challenge" me, and the only reason I didn't drink this treatment up was due to my transference and distortion. In other words, he was brilliant but the patient just didn't appreciate him. And from their ruling, apparently the state psych board concurred.

So I began a reading expedition to understand this logic and found, yep, this is pretty much the way some/many? therapists are trained--to think "negative therapeutic reaction" is due to deep flaws in the wretched patient. If therapy is harmful, it's due to transference, projection, resistance, self-sabotage, "clinging to the disease," therapist as bad object etc.
Clinical Reflections On The Negative Therapeutic Reaction < European Psychoanalytical Federation
http://www.psychoterapiaptp.pl/uploa...apia2015i1.pdf

Freud really unloaded on dissenting patients, and much literature since has not been much nicer. In the vast ocean of psychological literature, almost none covers harm in therapy, and all of it speaks FOR the patient rather than with her. (My use of the word patient is deliberate here.) Literature on grievances sympathizes with the provider i.e. "take care of yourself," but not the client, save admonishment don't sleep with them.

As much I as "put into therapy" (and the scolds will have to take me at my word I did; it made me near crazy) the only thing I got out was self-absorption, a rabbit-hole reality view, and reinforcement of the authority figure as Great Guru.

There was absolutely no consequences for my therapists' behavior. With a very few exceptions, professionals don't want to hear my questions about the process. I've gotten into some might skirmishes with them, including a past APA president, on Amazon.

If this guy really does have that kind of attitude, then I would definitely have a problem with that. A therapist should at least show some interest in the emotional climate controls they set, if not assume responsibility.

It goes back to what I sort of referenced early, and that really points to transparency about the work and what, exactly, is afoot. I would ask if your therapist is intentionally bringing you to a boil and if so, why? I don't find that a useful tactic, but I would want to know if that's what's being done. Maybe he thinks you will bring yourself to stasis after the internal uproar, or learn to do that, which would get to whether or not this is something that's part of your work with him. You might think it's not, but he might think it is.

Either way, I would want to have it acknowledged as a thing that needs to be addressed.

Those are all good questions. We did have a bit of a conversation around it and he said I'm the type of person that if I knew exactly what he was doing it wouldn't work because I would think it was stupid. (And to be fair, he's probably right.)

I doubt he intended to irritate me last session, and I am pretty much back on my usual even keel now, so no serious harm done. But I'm still irritated at him.

If this is part of the work... well... I shall be very displeased. Greatly displeased.

I do see it make most people very self absorbed and self centered and selfish. It's sad. I am glad i got out of the pit of doom called therapy.

Wow, I am so sorry that it's considered professional for someone to snark and 'challenge' and think that's some way to treat a person and that you went through not only experiencing that, but having a professional board say that was acceptable. I think snark and confrontation is too easily done to be brilliant, or even close to therapeutic.

Therapy truly is the wild west, I think. Theories swing wildly, personality disorders are conjured out of the ether and disappear just as quickly, and somehow all this costs thousands of dollars.

I don't understand how Freud maintained any credence. I won't go into it here, and you're probably more than well aware of the nonsense he spouted.

I suppose I am somewhat fortunate in that I can walk away from therapy and lead an active life, that my issues are not so severe that I truly need support on a daily basis. If this therapist continues to (in my view) yank me around, then I'll just finish therapy, call it a failed experiment and continue on with my life.

What bothers me is that there are people who are kind of 'stuck' because therapy is the only place they can get the support they need. It almost seems like we might need an alternative to therapy, a profession whose job isn't to pretend to heal, but simply to help.

Like what? A guarantee we will improve? How would that be measured and enforced?

Well, he responded, so that's nice. I'm still not thrilled with things, but I think he's at least done his part in starting to make things better, so I guess I'll take that and see where it goes.

I appreciate all the responses, it's good to see various angles on this, and take them into account. It helps calm me down and get a bit more perspective.

Yes. A five year parts and service guarantee (to be voided if there turns out to be significant user error.)

Seriously though, what I meant was that though therapy might be an 'art', there's still a huge range in expertise of artists. You have your DaVinci's and you have your stick figure sketchers.

Some people pay Sistine Chapel prices for a dodgy sketch of a seven legged spider*.

(* Spider Reference.)

Like most things I don't think there is any protection for us, if you spot an awful therapist you just have to bail ASAP. Hopefully you can spot them. Hopefully you can bail.

One time I saw a psychiatrist, he fired me on our second meeting after I had paid him $500 in fees saying he wasn't a fan of prescribing certain meds I had always been on... I was flabbergasted. How can you see a doctor, they refuse to do their job ( medicine) but you pay them hundreds?! Plus being fired touched my abandonment issues, and enforced my self talk that my depression was hopeless and that I am a weirdo no one wants to talk to even for money. $500 seeking help for depression and I got more depressed, wasted a month, and was back at square one. After the dust settled I demanded a refund. Fortunately I got one, otherwise I was up shits creek .

I'm really glad you got your money back, that's something at least. It really does seem like there needs to be a serious delineation between therapists who deal with people who are feeling mildly ticked off at their mother in laws and people with more serious issues and needs who need support. I don't think the two jobs really come tangential to one another, and the fact that they share the same title of 'therapist' is just unnecessarily confusing, plus it adds unnecessary trauma. It's like if there were two types of store both called a Flerbingen, but one sold party balloons and the other sold hot air balloons. It gets confusing really quickly.

In my experience, social workers tend to operate with the philosophy is more of a helping one. I know I'm generalizing but their training is a bit different than that of LMHCs and psychologists. I think LMHC Ts can go either way in philosophy, some lean toward social work tbinmjng an some get into the psychological theory a lot more. PhD level psychologists, to me appear to be the most caught up in theory and in pathologizing clients, rather than being an active helper. I think many think they are a lot smarter than they are, too. I don't know what your Ts discipline is, but if you ever looked for another one, I would take this into consideration.

Important question. One of the things I fear about doing any future therapy is the way it is dosed. Brief sessions often spaced far apart, with limited means for support between. I found it often destabilizing. And contact between sessions was possible but not encouraged, and always came with a certain guilt for bothering the master. Save it for the next session, she would often say. Quite frankly, this is not a great model for someone in distress.

Your question can also be extended to therapist responsibility for the client's well being following termination. Similar dynamic. See recent thread I started on this...

Both fortunately and unfortunately, I think my therapist's training and approach is pretty much as perfectly geared to me as is really possible. I do give him credit for a lot of things, but that doesn't mean he doesn't tick me off a lot sometimes, plus I have to factor in certain mood glitches I experience.

He's never made me feel pathologized, he's just irritated me, which I suppose, in terms of therapist transgressions, is on the low end. I just don't like it very much.

Discomfort is discomfortable!

I didn't like how long he took to get back to me, but to be fair, it was within 24 hours. So objectively, my feelings aside, he's not too bad about between session contact. However, when I'm in the grip of feelings, one hour might as well be a year.

I agree though, I couldn't do one session a week, no contact in between, it would do my head in pretty quickly.

As licensed professionals, therapists certainly are held responsible by the state that licenses them to practice in an ethical and professional way. Here's something I just found:

"In practice, the primary functional role of licensing is to ensure that a client who has been treated inappropriately by a practitioner has straightforward legal recourse against that practitioner."

From:Professional Licensing for Counsellors and Psychotherapists

You have the right to make a complaint to the licensing authority in your state. You can probably do that on line. They will investigate your complaint.

Therapists are not responsible for a client's well-being around the clock, at all times. However, if a therapist is reasonably persuaded that you are in imminent danger of harming yourself and/or others, then the therapist would have a right and an obligation to notify police to visit you and assess the need to transport you to an emergency room for a psych evaluation and possible detention.

A therapist doesn't have a duty to extend a couseling session past its scheduled time because a client has become upset. Therapists are supposed to wind down a session in a way that helps a client regain some composure, after discussing a matter that has proved upsetting. That may not always be possible. But, if counseling sessions are repeatedly leading to a client getting very agitated, then the therapist should be advising the client that they may need to find another source of treatment.

A licensed professional has to be careful not to "abandon" a client. But, sometimes, transfer of care to another professional is appropriate.

Whether a consumer of psych services can properly be treated on an out-patient basis depends on that client having sufficient stability to be generally responsible for their own safety. If the client lacks that basic stability and capacity to be largely responsible for their own safety, then the client can be involuntarily admitted to an in-patient setting.

It sure sounds like you don't have a very satisfying relationship with your therapist. Have you considered transferring to another provider? Would that be difficult to arrange? You might do better with a female therapist.

I've had therapists extend the session on occasions where I was unusually upset. I haven't had therapists that were very interested in communicating with me when I was at home, other than to make an appointment for me to come in ASAP.

Counseling sessions can lead to emotional upset, but if you're walking out feeling worse than when you came in and that happens repeatedly, then it sure makes sense to ask, "What is the point?" Therapy isn't supposed to be a battle of wills. A therapist has no right to insist that you see everything his way. At the same time, a therapist can't guarantee to offer total affirmation of the client's point of view. Both sides need to be open and respectful of a differing point of view.

There actually is a duty to avoid harming clients. Go to this website and download a PDF document that will show you that, as one of the provisions of the code.
Ethics

It's at www.counseling.org

No offense, but much of this is rather condescending and infantilizing. Some therapy clients have serious wounding and problems, but are at the same time responsible and hard working and respectful. It's not a question of round the clock support; the issue is what the T can or should do if therapy or the therapist puts a client in greater distress.

The way you and others describe therapy seems a bit detached from reality. My experiences have never shown it to have the legitimacy and credibility that your words seem to suggest. The way the biz talks about itself, and the way it actually conducts itself, seem sometimes worlds apart. My ex T stuck to official language while the whole thing was crumbling around her. Therapy encourages clients to take an unflinching look at themselves in the mirror, but seems incapable of the same.

I haven't been able to read ALL the replies yet (I keep getting called away...sick kid!) but I wanted to say I do relate to this. My T and I had quite a disagreement, actually, about the thought of letting me leave in a bad place. This was happening.... and I would dissociate and once even ended up sitting in a snow bank in a neighboring parking lot with a frozen bum after session. NO idea how I got there. What would have happened if I had been driving?? So it took me awhile, but I finally told her about this, and that I needed to be in a good place when I left, and could we maybe spend the last 10 minutes of a session on a more light hearted topic. She thought I had issues with time boundaries, and wasn't wanting to leave at the end of a session. NOT the case. I didn't want to be upset or dissociated at the end of a session, for my safety! She did not believe me. It's as if she thought I was trying to milk her for more time at the end. So since then, i've been able to "stay present" by watching the clock....and now THIS drives her crazy, but I am out the door exactly when my session is to end. She hates that I watch the clock now.... but, I needed to take matters into my own hands and let her know it was NOT because I didn't want to leave. Watching the clock has given me something to focus on so I stay present.

I remember you mentioning this a while back actually, I thought at the time how scummy that was of her. I am glad you have managed to find a way to make it work for you, but also kind of sad you had to do that for yourself.

One thing that bothers me immensely about some therapists is they create this profession, offer a service, and then sort of check out of any responsibility past physically being in the chair. As if nothing that happens has anything to do with them. It's all transference, it couldn't possibly be that they're being kind of jerky about things.

Meanwhile, the rest of us are constantly adapting to, making allowances for, doing everything but dancing a jig through most social interactions because we realize we have some responsibility in them.

BudFox, if it sounded like I had some idealised view if therapy and therapists, that's not the case. I went for therapy for long intervals of time with a few different therapists. I thought they were, basically, well-intentioned people. However, I came to the conclusion that they really don't have as much to offer, as they seem to think they do. When, after being with a therapist for an extended amount of time, I would say that I felt I was not being helped significantly, the therapist would become very defensive and say I was not going about therapy correctly. (This happened to me twice.) I would have already gone to numerous sessions and never told I was not participating appropriately. Then, as soon as I voiced some dissatisfaction with what I was getting out of it, I'ld get lambasted for not doing my part. I think therapists tend to be extremely defensive - utterly unwilling to take hard looks at themselves.

It is a very unbalanced relationship. Every problem that arises tends to get seen as the client's fault, in my experience.

musinglizzy, I came to the same conclusion as you, and I employed the same strategy. I became a clock watcher and took it on myself to wind things down when the end time was approaching. It was just too upsetting for me to be in the midst of a troubling thought and then have the conversation aborted. In my experience, therapists don't do a good job of limiting the conversation to what can be reasonably dealt with in an hour.

SkyscraperMeow, I do agree that this is a profession where one can put a lot, or a little, into the encounter . . . and there's not really any recourse for the client, other than to stop going. It's my impression that therapists do spend a lot of time just occupying a space, or chair, as you say. A lot of what transpires doesn't really constitute therapy, IMHO.

SOOO true. I've always loved your posts...because you really get the down and dirty stuff into words that really mean something!

I'm probably a fairly demanding client, I guess. That could be part of the reason for my irritation. I genuinely expect a lot more than chair sitting, and frankly my therapist is obviously a smart guy. He can do it. Easily. So I guess I'm not letting him off the hook for not doing it. I guess we'll see how that works out long term.

That means a lot, especially coming from you. Because sometimes I've thought I've said too much concerning your therapist, but I really do mean to be helpful, even though I know things are never actually as simple as I would like them to be. It's something I should probably work on. I think my therapist would like me to anyway .

Ok maybe I read you wrong. Hard to know sometimes.