Article: Psychotherapy as a Cult

Here's where I have questions...You know, I'd agree that a lot of therapy CLIENTS have trouble with criticism of therapy, but does it follow that talk therapy as an institution is afraid of criticism? I know that there are some specific therapists out there who can't take criticism from specific clients, but is there some sort of institutional authority suppressing dissent?

I agree that "Legitimate groups have nothing to fear from their members reading critical information about them." That makes total sense to me. And, yeah, I'd be icked out if there was some sort of therapy lobby quieting the critics and controlling some wider cultural narrative, but I just don't see that.

In fact, the only potentially creepy cultic narrative I see around mental health is that pharmaceuticals will fix your life and to heck with anyone who suggests otherwise. And this is a narrative that undermines talk therapy rather than supports it.

I don't know. Thoughts?

Exactly wbar I wanted to say but couldn't get into words

Funny you mention that. There is extremely slim literature about harmful or useless therapy or even why a significant percentage of clients end treatment "prematurely." Try finding reading if you're a consumer harmed in therapy. I find the professionals' stumbling attempts mostly is self-serving, condescending and unperceptive. It's almost like the profession has barely moved on from Freud,who bent in contortions to blame "negative therapeutic reaction" squarely where it belongs--on the patient.

When I criticized an ethics book on Amazon - using polite language, backing my arguments-- three professionals jumped in in condescending reprisals and ad hominem attacks. One was a past APA president. It was ironic how these providers behave like one of their own's writing was immune from review on Amazon.

Another example is Linda Martin's review of Anna Sand 's very insightful critique, Falling For Therapy. Again a therapist lacks any real substance to criticize a book that bothers her, so she hurls the ad hominem thing, criticizing a total stranger's emotional fitness.

Greenvalues Ltd - Opinion: A Response to Anna Sands? Falling for Therapy

This is similar to psych critics like Dineen and Smail who reported vicious personal attacks. In my own travels I've seen numerous examples of practioners using so-called diagnosis as weaponry when someone says something they apparently didn't like.

I get the strong impression the mental health profession as a whole is resistant to scrutiny. An exception is the vitriol they aim at practitioners of "rival" modalities. The scientific cloak looks very thin to me.

Funny, I've just never gotten that impression. I'll grant you that what I've read concerning premature termination has seemed unperceptive at times, but I don't know that I've stumbled across anything self-serving or condescending. They (the authorities) have always seemed more than willing to take the lion's share of responsibility for premature termination, therapeutic ruptures, failures to form alliance, etc. Ackerman & Hilsenroth talk a lot about this (lest I look like I'm talking out my ***).

I would disagree vehemently that the profession has barely moved on from Freud.

That said, I've never been in a position of having been harmed in therapy or searching for answers to validate and explain what went wrong. I've never researched with the purpose of finding therapy criticism, or with an eye to how criticism was handled. You've obviously done your research and I'm dreadfully sorry you've had negative experiences to the point of being attacked by so-called authorities on an Amazon review. I struggle to take any professional seriously who has the time to get into internet arguments.

The opinion article linked here does highlight a troubling phenomena--I'll admit that there's always the possibility that anyone critical of therapy will be dismissed as a nutjob. Since, you know, only nutjobs go to therapy. I've seen that attitude in blogs and editorials and other casual reading, but never in anything peer-reviewed or, you know, scientific enough to make my brain hurt.

I may have been filtering--again, my research (such as it is--haha) has always been focused on other aspects of therapy and my view of the institution's ability to take criticism is only a retrospective observation.

So, thank you very much for your viewpoint. I'll read with a sharper eye in the future.

Whats wrong with Linda Martin's critique? I agree, t is about not being perfect and being able to accept and forgive that in ourselves and others. Aka the t process of rupture, repair, rejoin. Did she not fairly represent the subject book?.

I confess to not clarifying my thoughts on Freud. I was considering specifically about the scalding he gave unsuccessful patients--negative therapeutic reaction. Therapy failed? The patients are nuts, high agenda, want to punish the therapist etc. Freud got the ball rolling in the respect department by calling his patients "rabble." Not a good beginning for a helping profession.

My reading excursion began in response to losing my complaint. The therapist rejected all my attempts at feedback and contradictorily painted me as untethered to reality. I wondered why the disciplinary board didn't see through the smokescreen. So I embarked to question if my arrogant, incognizant therapist might be product of a larger system.

Admittedly, most writing I see on harmful therapy isn't peer reviewed.There's the blogger here and there who scolds wounded clients not to generalize that all therapists are bad, to assume Therapist-Knows-Best, to jump right back in the saddle. The writing is not so much help as promotional copy for the therapy industry. I've run across an occasional clinician/blogger who strikes out at a client who left him, criticized him, resisted his program. The APA themed their Jan 2010 journal around iatrogenesis (in my opinion) in such a basic "gee whiz" way, you'd think no one in the profession considered the possibility before. I've seen so little about harmful therapy, and what I do read seems to talk about the client rather than with him.

I didn't feel pummeled when my Amazon review created controversy; I thought it an hilarious and exquisite demonstration of my point. The review concerned a new ethics book which I felt ridiculed clients. Beginning with the APA prez, three of them jumped in attempt to invalidate my opinion. This is a book about ethics, but someone with a negative experience is unentitled to be in the discussion. No irony there.

Tana Dineen, who wrote the thoughtful Manufacturing Victims had to defend her license from colleagues apparently trying to silence her criticisms. The recently deceased David Smail said he found it flattering that critical colleagues would bother to analyze him in public. I've had my own adventures on my blog from professionals who attempted to analyze and make other assumptions about me. I expect it; it's the price of criticizing a profession accustomed to the power seat.

Ofer Zur, whose power article you cite, has his own agenda. He's been campaigning to loosen boundaries around dual relationships, so his article on power seems as an attempted paradigm shift on this topic. Of course, we likely have many ideas and definitions of power in life and in therapy.

Just reading PC, I've seen many shades of heartbreak I haven't seen covered by therapists. Members here have been seduced (actually and emotionally) traumatically bonded, frozen out, confronted, bullied, controlled and abandoned, to name a few dynamics. Only the most egregious offenses seem to be part of professional ethics discussions. It's one thing to label these events from a remote, clinical perch. Understanding how they affect a mind and heart and how it can be so magnified in therapy is another matter.

I thought the "review" an ad hominem criticism of the author, rather than discussion about the book.

For those who like curling up with some nice psych literature, I pasted a link to Richard House's thoughts on the book below. I thought Sands' book extremely thoughtful. In any event, I don't respect Martin's tactic of discrediting a book by diagnosing its author. Mind you, the book is not for everyone, but may be of comfort to consumers who had a negative therapy experience.
http://tinyurl.com/nzck9vk

And an exert from it:
http://tinyurl.com/hfrqkee

I'm not aware of any formal means of suppressing criticism or dissent. Seems to me it's more of a de facto doctrine, necessary for self preservation. How can T's sell themselves as more evolved than the rest of us and at the same time admit mistakes or acknowledge systemic problems? If you blame the client, the whole thing stays afloat. My T carried out this doctrine to a "T". She let me walk away with all the blame and all the responsibility. Not sure how much was conscious. When I circled back and began asking questiions, she got defensive and hostile. Eventually she caved a little and admitted some things, but at the very end she switched back to denial.

I then did something of an informal study. I talked to 12 different T's or consultants over the next several months. Anywhere from a single consult to four visits. The majority exhibited defensiveness and reflexive blaming in response to my story. With some it was oh so subtle, with a couple it was blatant. A few were netural, and maybe two were forthright. It's not as if it was an organized conspiracy, but it was a conspiracy nonetheless. The overriding message was clear -- you dear client are defective and that is the reason for the problems.

Agree the pharma narrative around psych drugs is the most creepy, and the most dangerous to challenge. My take is that biological psychiatray and talk therapy are rivals for the same customers, and often attack the other as quackery.

So important what you said here. A bunch of what was so devastating for me falls outside the typical list of therapy woes. A big part of it was just the nature of the relationship independent of specific incidents. Forming dependency on a near stranger and then finding out she was not what she appeared, and was not "dependable" at all, was uniquely destructive.

I wonder also how many cases there are of unrequited love (in various forms) that are written off as mere transference, but that leave the client emotionally wrecked. The client is urged to see this as "normal" because it happens a lot in therapy, and perhaps they even tell themselves it's all about them and would not report it as problematic.

If the biz counts the the number of documented abuse cases, and then declares that to be an acceptable minority, seems to me that is so incomplete as to be meaningless.

I saw two therapists after the horrible one and that is also the message I got at least for awhile. The second one I saw though had actually heard some pretty bad stuff about my horrible ex therapist so she believed me. But there does seem to be a distrust of clients who have bad experiences. We are the "crazy" ones.

It appears to me that inherent in the therapeutic relationship is the possibility that the client will experience intense positive feelings towards the therapist. Psychotherapy therefore should be set up to accept this and I would expect there to be a thought out and therapeutic response to these feelings. This thought out response seems to often be lacking. Also I think that clients should be informed about the possible effects of therapy before they start like one is with medication.

It seems that there IS a thought out therapeutic response to those feelings. My T uses it. Its written about in books.

I think there are several problems there though. Especially when it comes to.emotions there is a world of difference between knowing what you ought to do and being able to do.it. I have watched the mental/emotional effort my T puts into managing her self care.
The therapy profession seems to attract people with their own.issues and they may not have the training to control their feelings or with some people the insight to even recognize the damage they can do. Or are doing.
I don't know the answer to that issue because it seems beyond the scope of therapy consumers to be able to tell how well the therapist has dealt with their own stuff. We aren't psychic. I only know because my T has repeatedly shared "x is my problem and I need to.keep working on it". So it seems I'm sure to people who are traumatized by it like a sort of trap--you don't see that the therapist won't be able to deal with your feelings til its too late.
I think there are very good theories on how to deal with transference but therapists may not be able to execute them. Just like I know the theory of how to teach my horse certain gymnastic moves, but I lack the feel, skill and timing to execute the theory. It might be an issue of training, personal bias. Previous experience, whatever.
In that respect therapy seems a bit of a crap shoot. I have had two awful therapists and two amazing ones. The awful ones were both LSWs so I am prejudiced towards PhD psychologists as both my awesome ones has PhDs and a lot of advanced training.
I don't know the answer. But it does seem that the failure is not so much in the theory as in the actual humans executing it. Although Also feelings about transference and how to handle it seem very different based on the type of therapy the therapist does.
I think maybe some of the new review sites for consumer reviews might ate least begin to give clients a place to start

My therapists were entrenched in the stage-craft of authority figure. They role-played priest/priestess who had Life Answers (and could instruct me) magically knew the road ahead and were strong enough the hold me up. That shared illusion at first seemed to work as long as I was duly obedient and intimidated.

But once I began to ask questions--I don't agree with you, or gee, all this ritual makes no difference in my life--the kind facade was discarded for contemptuous bullies who had their own pathetic neediness to control the relationship and the narrative.

I see no conspiracy so much as some therapists who desperately need to control, desperately must remain on their pedestals and seem terrified to subject their modality to the slightest bit of scrutiny. I've seen this same troll-like attitude on a number of therapists' public appearances, on internet blogs and skirmishes. To me, it all feels very cult-ish.

I agree, and just as concerning is that there are no failsafes to prevent such damage. The system seems to assume that T will either have things under control, or seek help when they don't. But they might fail to do both. No checks and balances.

This is one of the core issues I can't get past, not just with transference but all of therapy. I read the theoretical stuff with interest. But when it comes to translating theory into effective clinical practice, I rarely hear or read anything meaningful. When I have asked T's to explain their method they usually fall back on theory, or say something obscure. It seems highly improvised, and even precarious to the point where if you poke at it too much it will collapse.

The whole transference thing seems like more of the same. My main ex T applied the label in diagnosis fashion, which mainly served to confuse and pathologize normal feelings, while explaining nothing. It was obfuscation and sleight of hand. She didn't know what to do next. Any idiot can sit in a room and be opaque and mysterious and provoke strong feelings from someone in a vulnerable position.

I discontinued therapy with one therapist (a psychiatrist) many years ago because I did not agree with his treatment plan. Later that same year he called me to have coffee "out" with him, and during this little -- what was it? -- a coffee date? -- he was suddenly very confirming and supportive of my personal path. At the time I was very confused by his actions, as he showed obvious displeasure when I terminated therapy -- then on this "outing" his every word seemed sugar-coated---- I was so confused I just shelved the memory -- but the memory resurfaced while reading this thread. I think perhaps he was just "covering his tracks" and placating me, so I wouldn't bad-mouth him in the community. I was so vulnerable at that time I never suspected such machiavellianism. Several years later a second therapist I went to described this first therapist (who she knew professionally) as narcissistic and authoritative. That I was so naive - and not a young woman at the time - is astonishing. I now believe, after some thought, that there are too many cases of psychological abuse to really see this as a viable way to get healthy. It seems to me that those in therapy are getting better, not because of therapy, but despite it. The way many people describe therapy it seems as if the therapist is some kind of "paid friend" who doesn't have to reciprocate friendship in a traditional and sane manner. How the heck is someone suppose to learn about healthy inter-personal relationships in such a warped setting???

I totally agree with this. I wish the abuse in therapy was something they would acknowledge and deal with in a meaningful way. It could be used to turn therapy into something not so damaging for so many.

Are you referring to "they" as therapists? I can't imagine they would come forward and offer this kind of information. They are also very busy with taking on as many clients as possible, and building their careers.

Accountability was something that was attempted in a spiritual community I belonged to. Some senior practitioners behaved inappropriately with new students. It took many, many years for the various incidents of abuse to surface because the victims were afraid, or too vulnerable to report the abuse. But finally it was reported, and some new measures were taken...such as an easy, confidential way to report abuse was put into place. Did this stop abusive situations? No. The problem was in the system. People were being appointed "senior" practitioners and given an authority many of them could not handle. In truth, there wasn't even a great need for such a hierarchy but it seems to naturally develop in cult settings. In may seem radical but perhaps one-one-one therapy isn't a good idea and it should be abolished in favor of group settings. No group should be allowed to have just one leader. It should always have as many leaders as possible, to insure proper checks and balances. I believe that DBT therapy groups always have several leaders. One-on-one therapy isn't sacred. Maybe it can't be fixed, and something new should take its place.

Sorry. Yes. I meant "they" as the therapist community. I agree though that they will never come forward and try to fix the problems. I think something new should take its place. Something with more accountability. What that would be I have no idea. I am just sick of the ones who are damaged being ignored and put down by the ones who say therapy helps.

I agree. It's classic blaming the victim stuff to be ignored, or to have the impact of one's experience diminished. Maybe short-term therapy with specific goals would help? What I see is that those going into one-on-one therapy are very vulnerable, and it is difficult to hold proper boundaries, because of the power differential. I have also read that for dependent personality types one-on-one therapy could actually be counter-intuitive. I have been surprised here in PC to learn that some people have been in therapy with the same therapist for years and years. I really wonder what is accomplished by this. People write that their therapist is the most important person in their life, they report weird behaviors such as driving by the therapist's house multiple times (which some therapist don't seem to think is abnormal) -- and even if the therapy was good there are also reports of people being traumatized when their therapist retires, as they if were just waking up to the fact that this was a professional arrangement, and not a friendship.

Mine wasn't so overt, but she did make a clear shift from kind and caring to defensive once her self-state and her practice were threatened by what I was saying and what I represented. She circled the wagons around what mattered to her -- her practice, her needs, her illusions and delusions -- and I was not in that circle. I was before, but only because I played the proper role in the narrative that she set. Once I tried to break out of that role, which could have been healing somewhat, she turned on me. Seems that once therapy goes bad and the client becomes a liability, the whole system turns against them and protects itself.

Feel same way about everything you said.

I was with my last therapist for somewhere in the neighborhood of ten years. What was accomplished for me was finally ultimate healing and stability. Excellent therapist -- right person at the right time. Why was I with him so long? Well, during those years, my bipolar and PTSD symptoms were very debilitating and I required a lot of support and intervention. In addition, during those years both of my sisters were diagnosed with breast cancer, one of whom ended up having a bone marrow transplant and eventually passing away. My husband's health was deteriorating to add to the stress. Sometimes life seems to just pour all of its crap on you all at once. Fortunately I had an excellent therapist and psychiatrist who were dedicated to helping me find my way through, and I was able to end therapy about two years ago and have remained quite stable and healthy due to the skills and support I was given during that time.

That's why we're engaged.

Seriously, though, it sounds like you had a very traumatizing experience, and I am very sorry for that, especially because it seems you are not getting relief in telling your story, as well as failing to get your (ex) therapist to act in an accountable fashion for what transpired. Well, all of that on top of ...instead of healing, there was more harm done. We naturally want to trust our healers. At the very least, if they do not help us we expect they will "do no harm." I came on here to PC and got some very good information about why it is wrong for a primary care physician to prescribe an anti-depressant when anxiety is the main presenting problem. It can court mania. I really wonder if that's why so many people are now being diagnosed with bipolar. Since then I have found a lot more information on this. I was lucky I stopped the medication (I call it that loosely) in a short period of time. But I really couldn't figure out what happened until I came on this site and got a lot of feedback.

So I think that advocate sites like PC (well, I know of no other, I have only been on this site) serve a very important function.

Would it help, I wonder, if you started a thread with more specifics about what happened to you in your therapeutic setting? Or maybe...a thread about what people do after such a trauma happens in therapy? This thread started to address that.

In my case, I am done with therapy. I do enjoy peer advice such as is offered on this site. I read a lot, and I know you do, too. Right now I am working on two workbooks...one on CBT, the other DBT.

I think, for me, therapy promotes too much dependency, and I can ill-afford to give over that power to someone I barely know. In the case of taking the anti-depressant, the doctor kept saying "Trust me," and you know, I really wonder why I didn't say, "Why? I have met with you twice for a total of less than 30 minutes, and you are wanting me to take this anti-depressant which has over 20 potential side effects, some severe and dangerous, without question." I trusted her because she asked me to. And you know, BudFox, that was just stupid of me.

PS I confronted my doctor on the phone and in emails but she has that teflon skin that must be learned in medical school. I also saw (in my online medical records) that she put me down as "allergic" to the anti-depressant she gave me. (I don't think that was the problem. I think she treated depression instead of anxiety, although I was adamant that anxiety was my presenting problem.) I have since emailed her outlining my holistic health healing model, and told her I have become active on PC. She emailed back that she's "happy" for me. I hope I will never ever again go into any medical office as a dis-empowered patient. It's gambling with one's life...

That is a great analogy or allegory for therapy. How many T's are given authority -- just by virtue of being granted a license -- that they cannot handle? And then perhaps an incompetent or negligent T trains and supervises another, and the dysfunction is self perpetuating. My ex T's supervisor has a short intro video on her website, and it seems she has bought into her own publicity (to quote misbella, I think) in a most creepy way. And I imagine her indoctrinating my T, and what a mess they are potentially unleashing.

Totally agree about one-on-one not being sacred. It's so clearly a setup for abuse. No checks and balances... that is one of the core issues I have been screaming about.

Not all problems are amenable to quick fixes. If you consider that I spent 18;years with my abusers twisting up my soul, its not surprising that it might take a while to untwist it all. Plus I have a long history of disordered eating which is very refractory to intervention. So if it takes 10 years it will take 10 years. I just want to be free of the legacy of my childhood no matter how long it takes. I'm also an adult in adult situations and relationships. Since starting therapy I have had a threatened lawsuit, a heart attack that almost killed me, my wife had a cancerous tumor removed , my mother passed away, etc so that disrupts the work on the deep stuff

I don't think one-on-one or any thing else about therapy is sacred, but I do good work individually with my therapist. I have, however, been involved in a situation involving a toxic group led by a charismatic leader with insufficient oversight in an educational environment. Group dynamics can be as sick as one-on-one dynamics, and it was certainly unhealthier than anything I've ever personally experienced one-on-one. I would never do group therapy - I am extremely leery of the way people act in groups. Groups really can take on a power of their own, and for me it would add a whole complicating layer with real potential to traumatize.

And I wouldn't trust a group more just because it has more than one leader - if one of the leaders is more powerful (or sicker) than the other, there are no guarantees that the second will act as an effective check on the first.