Psychotherapy inherently flawed?

If it works for you like that great. It is not how it works for me, why I go to see one or why I ever started going to see one. I don't believe in the Wax on Wax off school of therapy for me.
And while therapy or how it was supposed to help did not for why I first went, I did find a use for it. And that use, when I remind her what it is (or when she is thick enough to ask) annoys the therapist (but not enough she won't take my money - and for all I know she may be lying or ACTING). So there is that somewhat satisfying result.

Over 400,000 people a year die from medical mistakes, that more than 1,000 people a day. I don'tknow if these numbers include the mental health field, but I cringe when I hear therapy being compared to Western medicine as practiced in the US. IMHO, so many more are lead astray and maimed or killed by surgeons, etc., and for me they are a lot more dangerous than any one putting up a shingle saying: The Therapist IS IN.

How interestingly different we all are. I am just the opposite in that it won't work for me if the t tells me regularly what is supposed to be happening and why. I have a great t and have actually stopped him several times or tuned him out when he starts to explain the how's and why's.

For me, all I hear is what I am supposed to do IF I DO THIS RIGHT and my brain immediately goes to focus on how I should respond, react, think, etc. . Nothing true to myself would exist if he kept me in the loop on what he is looking for asks why he is saying things. In the very beginning of therapy with this t, I told him that I had 'spoken' to a couple of others, but never talked to any of them. I even remember saying that the couple other T's that I had spoken to were like playing with wind up dolls, I knew what to say and do each step of the way and often felt like I should be the one helping them because they couldn't seem to figure anything out on their own or tell me anything I didn't already know. I did try to get all that control information up front and he did the withholding stuff with a slight smile when I told him that I couldn't do it right if he didn't tell me what we were doing. He just kept saying things like 'right is whatever happens' and i would all but yell at him because I would panic from not being able to 'play correctly' because he wouldn't tell me the rules of the game. .. (I used that exact analogy one time) ....... a couple years into this process now and I realized that he stood firm and I finally gave in to trying to just respond and act in there according to 'me' and not expectations. ... I am still full of many battles, but because he very kindly refused to explain so many things in the beginning, I now have the only place on earth and only time I can recall, where I am not masked with 'here are the rules, now play the game by them and if you do good enough, you might win. .. but if you don't win, it is because you failed and I had told you stay to do'.... for better and worse, I am still battling how to play by the therapeutic rules to make sure I do things right, but now I'm having to deal with a much bigger problem regarding how to live in an environment where I don't know what I am supposed to be but am just supposed to be, which would never have happened if he had given in to my begging for direction to this process in the beginning... This feels like torture now, but I know it's because it's the first time I've been forced to just try to be since he won't give me the guidebook so that I know what the expectations are for me.

Again, just interesting how what works for one person can be the completely opposite need for another. I do feel for the therapists in general regarding figuring out what will help or harm each individual.

That's a really interesting perspective, confusedbyself! Thanks for that. It is amazing how different people are and how we need such different things.

It is good that we have these statistics on western medicine, but I don't think it's any more dangerous than mental health treatment. The fact that we don't know how many die or or harmed by therapy mistakes is deeply troubling.

I am all for people doing whatever works for them. For me, the woman standing firm is nothing but big disaster and when I tried to tell her that she didn't listen so I found another one who would tell me what is going on. So now I tell the first how much her way failed. And that her attempts to thwart me failed too. I never feel sorry for therapist for any reason, at any time, anywhere. Sometimes the first one will assume something has changed and then acts surprised when I tell her it has not or when she gleans she was incorrect. When she gleans it on her own, she says "I am surprised at X" and I ask why she would have thought X would have changed without asking me if had. One time the woman said she thought I had "softened" my stance on something (that she had majorly screwed up) and I asked why she would think that without checking with me - why did she think I had softened? And she could not or would not answer. What had I done to lead her to that incorrect assumption so I could avoid inadvertantly misleading her again. No answer. Every so often the woman mentions something and I have to correct her and she says she is surprised because I haven't said it in a while. And for some unknown reason, the woman acts surprised again when I tell her the reason I have not mentioned it is not because it has gone away but because talking to her about it was so completely useless I simply gave up -not because in her infinite wisdom of messing with me I decided to agree or whatever with her. Good lord - does the woman expect me to spend the first half hour going through the list of things she has been useless for?

I soooo understand and that is why I find your posts so interesting to read because you are probably about as opposite as I am in many, many ways and especially in the most successful methodology for us. It is in part to your posts over the years that I have been able to work past some of the 'mishaps' with my t when I have thought he should have 'gotten' it, or should be doing something else, or missed the boat completely. I have actually thought about how hard it would be for him if he was trying to work what is best for me in one session and you were to walk in the following seeding with needs and wants that were completely opposite of what he had just dealt with regarding me. It must be A therapeutic roller coaster for therapists to determine what is the best help for each client. If it were only as easy as asking the client and then taking direct answer, it might be much easier. I can testify that had my t done that method with me in the beginning we would not be where we are today. So, maybe not for everybody, but many of us, would be and are demanding and wanting the exact opposite of what is in our long-term best interest.

Wow, can you imagine the internal struggle that a truly caring therapist goes through in trying to best help the client even and when it appears to go against that clients outward claims. I wonder if this has much to do with the problems that exist today with the way psychotherapy is viewed. I am sure there are many therapist out there that simply do what is easiest for themselves, or use there status to meet their own needs regardless of the client's needs, and there are simply bad therapist also; but I wonder how many are truly trying to do what they feel is in the best interest of the client and because we are all so different, they make mistakes like the rest of us that ultimately become detrimental because of our already fragile states. I don't know, just how my crazy brain works.

I would never, ever, let a therapist determine what is in my long term or short term best interest. I don't think their job is all that hard and really if they would just ask me I will tell them. And I do think it is that easy. And when they don't listen to me, I don't go along with them. It is no big deal to the therapist one way or the other - but I am not going to roll over and submit. I am not looking for them to explain what they are doing at me so I know what I should do correctly. I want to know what they are doing at me so I can decide if it is what I want done or is going to lead to the result I want and not them. I don't want just any willy nilly thing the therapist may decide for me. And honestly I may want X but if the price of X is Y - Y is not what I am willing to do to get X. I need to know what the Y is and if it is blindly submitting to a therapist - I can live without X quite easily.

I am becoming a huge believer in combining insight oriented psychodynamic techniques with action oriented cognitive behavioral techniques. Basically, we have to see where our fears originated and what inner and interpersonal dynamics they are causing - how are we currently dealing with these learned fears, painfully reduced expectations, and other "baggage" that comes from actual experiences?

In addition, we have to come to an understanding of how to fix these issues in the here and now - how do we get our needs met and reduce our fears by seeking situations and acting in ways that will more likely get the results we have always wanted? I think both "traditional" CBT and "third wave" style CBT can be useful here. A more psychodynamic approach can also be helpful. The more tools in the toolbox, the better off we are.

You cannot hope for a better past, as the saying goes, but we can certainly hope for a better future by understanding how WE can be empowered to improve things for ourselves. An important part of this is trust and transparency between therapist and client, going both ways. A therapist can't help too much when we don't open up, and this is a factor that therapy needs to address as needed. At the same time, a therapist whose approach is vague and opaque to the client doesn't engender much trust or sense of direction.

I guess one of the reasons some of this is not my cup of tea is that I have never thought like I was not able to improve things for myself. I don't look at the therapist as someone who has the ability to empower me in any way. I don't look to them for that sort of thing.

Where does the idea that psychotherapy is inherently flawed come from? Personal experiences or research? A real question, not rhetorical.

The evidence shows that people benefit from therapy overall regardless. It is simply better to go than not.

People go for different reasons, go to different kinds of Ts, have different expectations, have different backgrounds.

Modern approaches do not assume that the T is in charge or an expert. So many of the newer ways put the client first as the expert, work with positive aspects (strengths, resources, abilities).

I personally have seen a number of Ts, all different in approaches, personality, level of experience, but I have had overall good results even with difficulties within the therapy. There is a concept of rupture and repair, pretty standard now. Ts are human, make mistakes. All my Ts have been open in either seeing the mistakes themselves or listening to me when I point them out. That has led to a strengthening rather than a problem.

Therapy is about getting stronger. The job of a T is to make themselves obsolete, a weird goal in a profession, but that is really what they have to do. The job of the T is to empower the client to function in a way that makes their own personal situation better so that they do not need to go to therapy any longer.

Why else go? why pay or have insurance pay? Doesn't make sense to go if you actually think it is "inherently flawed" across the board or that your money and time are for nothing. Basic trust and belief in the process is undermined by such ideas. And I still don't understand where they come from.

I totally agree with those who posted that more transparency would go a long way in helping with issues like the OP's original question.

I guess if we were to unpack what 'love' consisted of in therapy and / or the conditions of it, my guess is that the lack of transparency would have a lot to do with the intensity of attachment. If the T were to -- from the get-go (once therapy has started in earnest) -- let one know what the process will generally look like (given that there's more than enough literature on transference and attachment stuff, this shouldn't be hard), what progress will broadly look like and so on, I'd think it would help manage a lot of stuff.

This idea that somehow one is to totally trust this mysterious process with little or no questioning of the person 'administering' the process is what I'd say contributes to a seeming severe return to child-like states of always needing stuff from a caregiver (T in this case) and never actually getting it. And, somehow feeling like something is wrong with one to even need it (which of course will lead to an utterly useless and patronizing reassurance from the T that of course there's nothing wrong with those needs blah blah blah).

So, I'd think that if T's were to treat clients like cogent adults who can acknowledge and work with those child-like states and be totally transparent about the process, a lot of the intensity could be managed. But, instead, I'd say that this idea that one needs to allow oneself to feel all those deep, intense needs in depending on the T but then manage those needs and show them only to the extent that the T allows is what ends up being painful.

You know, honestly, looking back at my original post, I now think I was just tantruming over the fact my therapist won't gratify my desire to hear him say he loves me. Do I really think therapy is inherently flawed? I don't know, I hope to find out. I think it is shocking how dangerous it feels. I am a reasonable together person, but this feels like it could unhinge me. It's dangerous to care about another person, when they can hurt you, and because I care so much that makes him and the whole situation dangerous.

That's an entirely unsupportable claim.

There is also the concept, and reality, of rupture and failure to repair, leading to retraumatizing.

My trust and belief in the process were undermined by the process itself, and by my exT's betrayal of that trust. And also by reading too many direct accounts from people online who went through nightmarish ordeals.

I just quit therapy after 6 straight years of it. I also had several prior episodes that just sort of ended.

I wouldn't go as far to say it is fundamentally "flawed", but it is HUGELY an art. Research informs us in a limited way as elements of good therapy just can't be controlled and quantified adequately to arrive at strong conclusions.

After experiencing multiple modalities--CBT, psychodynamic, relational psychoanalysis, humanistic, Jungian...multiple therapists, I really do think it is rare to find a relatively good therapist.

How many people do you know who have the talent to be a true artist? Well, I think it's exactly the same with therapists. I read Mouse's posts, and I am just wowed by things her therapist says. My T doesn't sound like that at all! Neither did the 6 before him!

Second to natural artistic talent, I think the therapist's character, his/her own mental state and sense of self, is the 2nd most important thing. They have to really have a good head on their shoulders. Overall, the healing experience I had, which was unfortunately cut short, was with a therapist who mastered the art of attunement. Just small bits of 'feeling warm inside', repeated over and over, and the rupture and repair of someone attuned who is generally fond of me and who generally cares about me, was the main thing that promoted a positive effect.

In the end, for me, the true test is--how is my life outside of therapy? Well, it's been worse for me lately so I quit. No, not the therapists fault, but I do think he was not attuned enough to me but he also wasn't artistic/creative enough to understand how to help me. But it wasn't my fault either. And in terms with his character, I know what I need to get better, but my T insisted my issues were all transference. I didn't agree. And if I am well, I certainly wouldn't be here seeking support or even visiting this forum if therapy was "working" for my life. So if it wasn't his fault, and it wasn't my fault, who is at fault? Hmm. Maybe the therapy is flawed.

The best times in my life were the times I was most active, not in my head, and certainly not thinking or obsessing about my therapist. Difficult to do when I am depressed. But I definitely have learned that therapy, in my view, is effective only when it transfers to life outside of the T room. It may take a while to get there, but it shouldn't last forever. It's unfortunate that many don't realize this when going in, and for many of us trauma survivors-not until we are hit with feeling all of our emotions again (aka pain), often for the first time as an adult.

I would say to anyone--hang in there, but not for too long. If you aren't going anywhere, switch therapists. Or switch healing modes--join some Meetup groups, a drum circle, or take up a new hobby. Don't stay stuck (in ineffective therapy) for so long that one day, when you are 60 some years old, you wake up and think--what happened to my life...full of regrets.

i was wondering where all of this was coming from, because i wasn't sure if i ever saw what actually happened that made you do a 180 in your beliefs of therapy/your therapist. You always seemed to have a good relationship, and did you ask him to say he loves you?

i avoid these threads, because i don't quite know what to say. I feel that people who are saying that therapy as a whole is fundamentally flawed are basing this on their personal experience, which i don't think is fair or accurate to then paint the whole system as flawed because one individual was hurt by their T's.

what i do believe is that T's CAN and DO eff up their clients by not being consistent, or not explaining things clearly enough, or a million other ways. I believe people do get hurt, and i also believe there are T's who "blame" their clients when things go wrong, and they don't own their own ess h i tee.

unlike SD and some others, i don't need to know all the reasons why my T does what she does, but i do know that if I did question her methodology, she would be up front with me. She also said in her first session with me that she likes to tell people that there are two garbage cans outside; one for parent mistakes, and one for past T mistakes. So, she knows that Ts can mess up clients.

I also think that it is good to question things, that is how progress happens, but i think by saying that all T's will hurt their clients is putting a personal view on a whole system.

this thread reminded me of a friend who recently told me of a story of how he got arrested, and the laywer he called. this lawyer apparently treated him awfully; but based on his one personal experience, he thinks of female lawyers as "man-hating *insert derogatory term here*..." I was blown away as he is usually open-minded. I said that i believe his experience was terrible, and she should not have treated him that way, but to base his experience that she hates ALL men seems a little ludicrous.

i do agree with this!

But in therapy is totally asymmetrical in terms of vulnerability, disclosure, honesty, and power. It's as of the T is hidden in partial shadow while the client is under a bright light. Often the client is exposing deeply personal and sometimes very painful and even shameful stories and feelings, while the T observes and interprets. Seems to me all sorts of questions are considered inappropriate to ask of a T, in a way that is not true in other relationships.

Surprised you would say that. I completely disagree. The T relationship is like no other. It is set up to be hugely disproportionate. It's part of the basic model, defined as such in the literature. And its basic nature evokes all sorts of infant-caretaker dynamics and patterns, which is pretty unique and potentially explosive and risky and destabizling. I have no problem with Ts being human and responding in sometimes imperfect ways. It's when they fail to acknowledge it and deflect back to the client reflexively that it begins to look dishonest.

Probably so. Depends on your level of self awareness and self honesty. I can see how my neuroses distorted my perceptions but I can still see with sufficient objectivity to know my last T failed quite badly. She claimed otherwise for a while, I figured out the truth, and then she indirectly acknowledged it later on the phone in brief moments of weakness or guilt.

I have tried not to use the world blame. The point for me is accountability. The paid professional and person entrusted with the client's vulnerability needs to be prepared to admit mistakes and facilitate repair, or they should find another line of work. True lots of people can fail you, but as someone write therapy relationships can be paradigmatic and the outcome can have long term consequences. And sometimes people show up in therapy in a fairly desperate place where betrayal or exploitation might just exceed their ability to cope.

I have to respectfully disagree with you BufFox.

Vulnerability-Therapists also have to risk being vulnerable It's a hazard of the job. How can any person 100% of the time, day after day, client after client, not empathize with some of the people and some of the things they hear. Are they expected to manage it? Most definitely. Usually, one puts up defenses when they are feeling vulnerable. And, most likely she felt vulnerable at times working with you before the rupture. Maybe, you would not be railing continuously if your therapist hadn't put up defenses when things went south between the two of you. There are articles written and bodies of research being compiled on therapist's vulnerability.

Honesty - that's a toss up. I suspect clients lie more to therapist. But , we clients have our psychological reasons.

Disclosure- Some therapist disclose more than others, and for them to even trust a client with some of the things they reveal about FOO, spouses, divorce, kids, substance abuse...can be used against them by any irate client. I was able to ask whatever I wanted, including things of an intimate nature. She answered all, but I also realized that was not me. It was more testing the limits of the relationship, her willingness to be VULNERABLE and HONEST with me. She passed with flying colors. Did not need to ask anymore and would never ask a close friend. I respect their right to share private things in their time table, if at all.



Power- there was a thread a few months back on PC that beat that topic to death. I don't think of therapy in terms of power. But, if I had to take a side, I'd go with the client having the power. Sometimes, they just don't realize it. To me, all relationships are asymmetrical over time.

So BudFox, we will have to agree to disagree.

That's kind of where I've ended up. And since I've been doing my best, but I'm only a one-woman show, and I admittedly have issues, that's why I went to therapy -- AND I'm not the only one who has had difficulties, I wonder where is the much-larger-than-one-flawed-person mental health profession in all of this? Not their problem? Apparently. A flawed system, who cares? Just the ones who get hurt, it looks like from here.

I didn't mean to imply the client is responsible for confusion, it is just how some people respond to the dynamic. Many clients do not struggle with the relationship and its very common for clients to feel ambivalent about therapy/Ts.


[/QUOTE]Wow they are vastly different to me. Other relationships allow for shared intimacy and shared vulnerability. If you ask a question of a person with whom you have a real world relationship, you at least have a fair chance of an honest answer. With a therapist it is often unclear whether a question should be asked at all, let alone whether the answer will be genuine. Seems like many therapists are masters of evasion and obfuscation.[/QUOTE]

I dont think the relationship as a whole is the same, just that you never know how another person really thinks and feels. You can ask a partner and they might answer, but you dot know of if the answer is honest. I thinkhing what keeps the therapy relationship from becoming too confusing is the one-sidedness. For me it would be more troublesome if the exchange of information was mutual, since it would then feel like a paid friendship. That being said, I do think most therapists care about clients, and I can't imagine why they wouldn't. There would be very little basis for going into the field and even less job satisfaction. I know there are limits to that care, but I believe that is a fairly transparent part of the field. It is not common practice for Ts to fool clients. Many Ts are naive and misguided rather than deceitful and they are not good representatives of the profession as a whole.

I didn’t name this thread and I don’t know that “flawed” is the word I would have used to describe my unsatisfactory experiences with therapy. Nevertheless, my personal experience is that therapy is flawed. My trauma specialist therapist has also told me that she believes the system is dysfunctional. People tend to come to her by referral, generally not the first therapist people have seen, and I am not the only client she has treated who has been hurt by other therapists.

Unfortunately I see no research on that topic when I do internet searches. I had all the coursework done for a Ph.D. in cognitive – not clinical – psychology when my late husband was diagnosed with a terminal illness. So I understand how psychologists do research, and looking into the harm that psychotherapy can do is certainly something that a psychological researcher is capable of doing, if they thought it was an interesting question and could get support of the APA or other agency or university department to do the research.

For me the answer to the original question is yes and no. I am fairly convinced that therapy saved my life when I first started going. However I am not sure those deep wounds are resolved by therapy and I have certainly felt re-traumatisation in therapy.

I have to accept that T will never be what I want them to be. I totally know this in my head, but emotionally it is more difficult. It's on par with having to accept that my parents could never be what I wanted them to be.

In terms of caring, maybe that's about definition. I can care about a beautiful flower, I can care about a report I write at work and care about a meal that I am preparing. So I can understand that in the same way, T may care about me, about our work together.

But the "caring" is never going to go past this. T is not going to think of me in the way I think of them. How on earth would they live their life if that were the case.

So is it fundamentally flawed? I don't think so, as long as we're seeking the right answers and can be accepting of its constraints. It is what it is, not a perfect solution, but I do not see an alternative to it, it's the best that can be offered.

I think I see where you're coming from now. When I've read about therapy I've tended to focus on the positive, but now I think of it there is sometimes a blaming of clients as an explanation. My ex-T once said to me that 'some people can't manage therapy', which seemed to me to place the failure of therapy on the client. I told her that I was unsure whether clients should be blamed like that. (She didn't reply).

I also think I might not be happy with some of your T's answers like - 'I have a plan, but I can't explain it'. I know there are T's out there who are a bit more able to articulate things than your T seems to be. I wonder what you'd make of my T - she never shares a single personal thing (but I think she might if it seemed I needed that). She never says random things. We did seem to meander about a bit when I first started seeing her, but we seem to have grown into my therapy and it doesn't feel like that now.