Psychotherapy inherently flawed?

I don't believe therapy is for everyone, and I don't believe being a therapist is for everyone. A proper match is also critical.

By my reasoning, a life changing positive outcome in therapy is highly unlikely. Statistically, let's say 75% of clients are suited for therapy while 25% are not. Let's also assume 75% of therapists are competent while 25% are incompetent. This equates to a little more than 50% of clients who have the potential get any benefit at all from therapy. The remaining % of clients are doomed from the start because of either their own limitations or an incompetent or dangerous therapist. Of the 50+% of clients who are suited for therapy and are with a competent therapist, a significant number may have personality conflicts with their therapist or are with someone practicing the wrong modality for their need. I'll be generous and say half of all client/therapists matches are adequate. This equates to a little more than 25% of clients who will have positive therapy outcomes. Of that, I'm estimating only 10% will have life changing positive outcomes while the other 15% have only mildly positive outcomes. IMO clients in the in between range are better off saving their money and doing something else with their time. The doomed % will lose more than time and money.

Therapy is a gamble, and therefore very flawed. Odds improve when people are willing to change therapists mid way. I hope I'm in the favorable 10%.

I suggest that therapists, despite their training, are as prone to "triggers" as we are. Yes, their profession is marketed just like that of any doctor, they promote their ability to "heal" our psychic ailments much like my GP can sell me on antibiotics for strep.

Somehow, I triggered something within him. I possess no extraordinary or superior qualities, but I am undoubtedly "different", which is fine by me but, looking back, he was in heavy transference very early on and way before I was.

I had also been referred to him by a female friend who had been through several therapists but found him to be the first who she didn't feel was coming on to her. I am very intuitive but I ignored the increasingly obvious seduction, eventually just playing dumb, for a couple of years until the elephant in the room was suffocating. I have to credit him with honesty - at that time - but my faith in his truthfulness quickly unraveled.

Point is, I believe he caught himself eventually, either through peer consultation or a showdown with his wife. I, who was the one to shut down the idea of sexual consummation, became the enemy.

There began the roller coaster of love and rage that lasted until finally I could not do it anymore. Too much harm done to ever go back.

I would love to have his side of the story....but I am resigned to the fact that even if I reported him I would never get that.

Hopelesspoppy - I am so sorry for what happened to you! A fatal flaw with therapy includes the illusion of therapists being able to control all feelings. Your therapist behaved badly, regardless.

Yes, agree. In fact, I don't really know what the product is at all. I have found that most therapists are inscrutable and opaque, both with regard to their methodology and their product, AND who they are as human beings.

With my last T, I did not discover who she really was, what she was offering, and whether it was legit (seemingly not) until the train had already wrecked. She turned out to be as flawed as I (or nearly so) after all. Looking back, I don't even know what the transaction was supposed to be.

Therapy betrayal or abandonment can be a sort of doubling down on original trauma. Given the above pitfalls, seems crazy to trust another one -- or even one in the first place -- with my psychological and emotional well being.

The replies to this thread that I have read are incredibly well thought out, useful, and honest. I rely on writing, writing, writing down my feelings. I may burn the notebook or pages from it, but it has helped me so much more that having to talk to a therapist.

And what is the DSM? Convenient, money making fiction in my humble opinion only. But there are no facts that support the DSM. At least not scientific facts. It is all conjecture.

I trust no therapist to help me. I have to help myself. And that is what someone who sees a therapist does anyway.

I think the oat valuable lesson I have learned from therapy and training to be a t is that ts are extremely flawed, wounded and injured. It's when they don't recognise those wounds and act out of them defensively, that's were the damage gets done.
I think a good t will be aware of when they are being triggered enough to know they can't help a client and should refer before the damage is done.


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I wonder if the part that I bolded ^ could/"should" be included as part of the disclaimer Ts give to clients initially going into therapy?

Many of us here have had bad experiences, that's why we're here. If the Ts I had seen had been aware of how they were being triggered -- even if they could have just said "I'm being triggered. Can we take some time out here?" that would have helped a lot, I think.

I was so dissociated going into therapy initially I didn't even understand triggering very well. I mostly just froze when sensitive areas were "touched". So a lot of my therapy has been to get unfrozen. But then, when the long-dead, paralyzed, frozen parts came back to "life" they were very intense and . . . I guess from what I have learned now . . . triggered the T's and I ended up feeling guilty, shamed, or otherwise unacceptable. The very results that led me to dissociating in the first place, it seems.

Consequently it's been a very long time that I've been in (failed after failed) therapy. I think it would have helped if I could have been cognitively warned ahead of time. I didn't know enough in the beginning to research this a lot, plus I started over 50 years ago in a hospital with a (life-threatening) eating disorder. In my experience, most therapists I've seen have NOT been aware when they were triggered. And I didn't understand that's what was happening either. So I had no defense from the (repeated) shame, blame, guilt.

What I experienced with a wounded/flawed T becoming triggered and acting out was systemic denial. She could not acknowledge what was going on, and other Ts could not either. It was as if the whole system was triggered, lost its collective mind, and could not respond appropriately when it mattered most. Most of the Ts doused me in a cloud of confusing equivocations, like a squid squirting ink when threatened.

It's not just that Ts are flawed but also that clients are in no position to properly assess the T's mental health. The one-sided honesty and disclosure means the client is always groping in the dark. Trust me says the T, but then withholds the very information that the client needs to feel safe.

This is so true. And the client might not be in a position to evaluate how their own therapy is going. People say "it gets worse before it gets better." It's crazy. How are you supposed to know what is better?

My sense is that your compent-incompetent therapist ratio should be flipped -- 75% are incompetent . And even that might be too generous.

And if competence is defined by things such as solid grasp of psych theory, ability to run a practice smoothly, sufficient clinical experience, sufficient psychological and emotional health, sufficient self awareness... then i guess that means ability on the level of first do no harm. Within that group, the subset of therapists who possess some ability to actually help clients, in a significant and lasting way and with regularity, would seem to be relatively small. Starts to sound like a lottery.

The first statement is true about any professional, or really anyone in general. I don't know how to assess anyone's mental health, including my physician, my dentist, my lawyer, my acupuncturist, my accountant, etc. I am not trained in mental health evaluation or therapy, just like I'm not trained in any of those other professions.

What I am able to do is figure out whether the professional is helping me. I've experienced a T as not helpful and quit after 6 months, and about 4 others as helpful and had longish term relationships with them-- one that ended prematurely with the T's job change, and the others that I ended at a point where I was done with whatever I was done with. Last T relationship going on 6 years and it's still very helpful to me. I've had more mixed helpfulness from physicians (I have liked about 1 out of every 3 and have switched docs when that happens), both good and bad experiences with lawyers and dentists. Have only had 2 accountants but they've both been good. Had a number of acupuncturists and loved them all.

Point is, clients don't need to be trained to evaluate mental health symptoms in order to have a positive T experience. Just like with selecting any other helping professionals, clients are empowered to decide for themselves whether that person is helping them or not or what kind of treatment works for them. I don't believe that it's impossible for T clients to know what works and doesn't work for them. I think that all of us have an inner wisdom about what's right and what's not for us. There's no reason why choosing a T has to be cloaked with some kind of brush that makes it impossible to determine the bad from the good professionals.

It hasn't been my experience that therapy is completely one-sided, but I prefer somewhat limited self disclosure by therapists. I have learned from them when they do self disclose but I prefer to have the focus on myself. It has also been my experience that my therapists have been honest and straightforward with me, even when we have disagreed.

I've never had a T say "trust me," rather the opposite, where they acknowledge that it's smart not to trust them at whatever junction I've been. They have always made it seem rational to be suspicious or tentative or unwilling to disclose some things at some times. I have always felt in control of how much honesty I'm sharing at any given time, and I've been free to be dishonest and to later disclose that dishonesty or not. My current T has said more than once that the only person it's important to be honest with is myself.

I have no idea what you mean about T's "withholding" information that a client "needs to feel safe." If you are referencing the T's lack of personal disclosure, then I disagree that personal disclosure makes everyone feel safe as some kind of universal truth. That hasn't been my experience at all. Self disclosure by T doesn't relate to safety at all for me, and I've known people for whom too-disclosing T's have felt unsafe by said disclosure.

I have felt safe in T because my T's have listened, have demonstrated that they've heard me, have allowed me to develop my own sense of what I want and what I need, in and out of therapy. They've shown up for me when they said they would (timely and keep appointments except in emergencies), have remembered what I've told them often better than I do, are willing to discuss conflicts in a sane and open manner, and have treated me with kindness and respect. No darkness, just light opening up inside myself.

I'm sorry you didn't have a good experience in therapy. I believe it's possible that you can, if you want to try. Perfectly acceptable to stay off the therapy wagon, that is a valid choice for yourself. Not everyone wants to do so, however.

The first one I see now always seems surprised when she asks me if I trust her and I same about some things and that it is that she will usually stay back, she is there when she says she will be and for the amount of time contracted for. She seems to think it should be more because she will then ask me what about X, or Y or Z and when I remind her I have found her distinctly non-trustworthy in those areas, she always says she thought I had started to - but then will give no specifics as to how she was so grossly misled.

I don't think it is often obvious about what they are doing that is useful or supposed to be useful or not - certainly they have not been, in my experience, open about it or clear - if they say anything it is in such nebulous wishy washy language as to not give any real information. I liken them to weather people and their predictions where if the world does not end, they are accurate because there was weather regardless of them predicting rain and only sunshine was forthcoming. I do not believe in blaming clients for being confused as to whether therapy is doing anything for them or not let alone anything useful. Certainly for me it has not been useful in how the woman seems to think it would be. I am much clearer about what is actively harmful for me (CBT) than what is useful other than the woman staying back and not actively trying to impose empathy upon me.

I find it so odd that she would ask you that overtly. Isn't "Do you trust me?" usually followed by a request to put blind faith in a very, very stupid plan to get past movie zombies?

I'd be creeped out if my T said that.

Psychotherapy is inherently flawed--for me. I wanted to feel more competent, more adult, more autonomous, more socially fluid. Instead therapy lured me to a parental, submissive, relationship in which I felt accountable to them and looked to them for interpretations and wisdom. Any "insight" from therapy was merely speculative and certainly not emotionally freeing. And it instructed me how to be pessimistic and self-involved. I found it only regressive and feel vulnerable I was so fooled. (Please note, I'm not stating its effectiveness universally.)

I was not creeped out - just more surprised at her surprise I do not in any way other than those few ways. I have never seen a zombie movie.

I am not sure that just because some therapists don't directly say "Trust me", they don't expect one to do it all the same.

My therapist was totally cool, expansive even, and willing to be very kind and compassionate about my trust issues when I directly said that I didn't trust her. She in fact responded saying "But, why would you trust me?" etc. So, that was the 'direct' part.

Fast forward a week or two -- I mentioned a couple of changes in my life (not at all related to why I was in therapy) and I immediately got told that I was "dropping things" on her; that I was being "guarded" and "wanting to keep things to myself" and so on.

This last part (my "guarded-ness") has come up more than a few times (even at the very beginning of therapy) -- all of it has been related to stuff that I'd said I expressly did not want to discuss in therapy.

Would I say my therapist is a truly crappy one? No, she has helped me a fair bit but yeah, I do consider switching to a non-trivial extent.

But, would I use the metric of her being okay with my saying that I don't trust her as a way of assessing her 'quality' as a therapist? Nope, I've found that to be utterly useless.

And, here's my guess as to why -- therapists are trained to deal with standard situations rather well. They have canned (okay, internalized) responses down pat. Stuff like clients saying that they don't trust (or, for e.g., want to quit or are overwhelmed or are missing them etc) are all rather par for the course and so, they likely know (or should know at any rate) how to handle it.

It's the non-standard stuff -- the very client-specific stuff (our unique madness, so to speak) -- which throws them seriously off their game (or not).

That's when the rubber hits the road so to speak and the good ones get separated from the not-so-good ones. And, so when we talk about not being able to deal with therapy, I think we usually end up assessing how they failed us when it came to these one-of-a-kind will-not-work-with-a-standard-response kind of situations.

I'm not sure if this makes a lot of sense. To be honest, I think I agree with a bunch of points on both (or rather multiple, at this point!) sides of the argument. So, I guess I just leave it as to each her / his own.

I'm talking about the normal give and take that occurs in other close personal relationships. Trust is established through reciprocal disclosure and shared vulnerability. If there was a support group or social group where one person rarely discussed their true feelings or their private life or their personal struggles, the group would view that person with suspicion. My last therapist, even though she disclosed more to me than her other clients, withheld all sorts of things that later emerged and caused a lot of harm.

The other info that is consistently withheld, in my experience, is detail about the risks involved. This is deliberate and is antithetical to building trust. Almost every therapist I have seen has skipped this. In the first session I was expected to just start divulging personal material while they silently consumed it. I would wager that most therapy clients sense a distinct unease somewhere in their body when doing this, and yet override the feeling because the structure of therapy demands it.

Therapy is not set up as "normal give and take," in fact it's the opposite, where disclosure is not supposed to be reciprocal. I'm unaware of any legitimate school of therapy that suggests equal disclosure between therapist and client. In my experience, my T's have disclosed quite a lot, but certainly not to where it equaled mine. Nor would I want that. If my current T disclosed more than the small tidbit once or twice a session, I'd be please shut up, I want to talk more about myself. Focus is on the client, not the therapist. Not equal sharing. What you were or are expecting in therapy isn't how it's built. If you need reciprocal disclosure, talk to your friends.

Perhaps you don't intend your statement to be as the universal truth that your words suggest, but trust is a whole lot more complex than just reciprocal disclosure or shared vulnerability. I've been in two different therapy groups and was in a support group for five years. Not only did people differ in how much they disclosed (assuming this is even possible to quantify over some period of time), but one of the functions of all these groups was to be accepting of whatever level of disclosure people were comfortable with. Some people became more open over time and some stayed the same, but nobody was looked upon with suspicion.

In my long term therapy with multiple T's, trust was established over time, with me poking my toe into the water at time, sometimes diving in, sometimes pulling back, sometimes running away. It was never linear and I was never told I had to disclose something or everything at any given time, and my choices to trust my T's or not was always supported as normal for therapy clients and, moreover, as an intelligent choice. I was never asked or expected to just spit out information without any connection or feedback or relating back to me. Trust in therapy has been different than with my marriage or close friends, although it has been useful to consider in therapy if the way I move forward or backward in trust bears any resemblance to my relationships outside of therapy. It usually does, and it's been helpful to me to observe the way I feel about trust in therapy as a microcosm of how I trust people outside the room. For me, at times when I felt distrust of my T, it was really about how I couldn't trust other people. Or when I felt like I didn't get enough back from my T, I told her I needed her to not let the silence go on as long, and now she jumps in quicker than she used to. Or I told her I wanted her to ask me more questions, be more directive, and she did that until I told her to stop.

So I'm curious, if you want to share, is this sense that therapy didn't give enough back to you something that you experience in life in general? Do you feel like you always end up in relationships with people who take but don't give back what you give?

I don't think that "normal give and take" implies equal at all. A good relationship is not one where its members concern themselves with exactly equal contributions, only that there is productive exchange.

One example of a particularly influential school of therapy which does advocate for therapists' self-disclosure is that of Rogerian therapy, a.k.a. person-centered therapy, which has been around since the 1950's, and which refers to it as a core element of the six "necessary and sufficient conditions required for therapeutic change":
Most contemporary critical psychoanalysts also advocate for it; maybe some of the old textbooks need to get caught up.. probably most of all though, a large majority of individual therapists just need to work harder not to fall into seemingly convenient but unproductive habits of so wholly cloaking themselves from the process.

One important delineation is that therapists are obligated to protect clients' confidentiality, while clients are not obligated to protect therapists' confidentiality. This makes equal disclosure problematic.

I am on the side of Rogers that it's advantageous for therapists to work from their own experience, and ride a happy medium. I don't want to be burdened with my therapist's deepest darkest issues, nor do I want her to waste our sessions detailing her weekend. However I do want to know enough about her to feel comfortable trusting her. I don't agree with therapists that don't disclose last names, marital status, professional background, opinions, and so on. I wouldn't feel like I were talking to a person.

I don't see where I'm disagreeing with you, or where you're disagreeing with me.

Yes of course. I am saying that this lack of reciprocity is a core flaw because in general it is not conducive to building trust and emotional and psychological safety. I realize that this is a standard feature of therapy, but that doesnt make it healthy necessarily. I understand that some people have a good relationship with their therapist.

I don't follow the line of questioning. This thread is about therapy flaws, and I contend that a massive one is the way in which the therapist conceals so much while the client reveals so much, and that this creates a shaky foundation for authentic interaction and trust. I am not arguing for a new way of doing therapy where disclosure is handled differently.

Super! I was only looking to add to the dialogue with the perspective I shared, not to disagree.

I've heard plenty of clients complain that their therapists had self disclosed, either too much/too often or that they self disclosed at all. Every situation requires a unique approach and should serve the needs of the client, not the therapist.