T terminated me

So the AMA has an online reporting/cancelling system? Just wondering since this all transpired Friday and it was a long holiday weekend so I would think it would have been hard to do otherwise.

Many therapists, including my ex, need to read and understand this. Well put as I have felt this way. It is the strangest feeling to be an adult with a mature mind and have feelings of a kid.

AMA sends patients to local licensing boards. Filing is rather complex, unless some states have it easier. I can't imagine to go through the annoying process just to cancel few days later. It's so much work! Hopealways why did you cancel?

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I did not even know it was possible to withdraw a complaint against a physician - the state already has all the information necessary to investigate and a vested interest in pursuing the matter.

Some states do have online reporting systems, but even that requires a great deal of virtual paperwork.

when i filed my complaint i had to print out forms and mail them to the state board office. they then came to interview me (investigate me) 2 or 3 times as well as taking my computer hard drive. im sure it's different in each state though.

That was an awesome post! Thanks for reposting it! I missed that one!

I cant comprehend that there are Ts who don't already understand attachment theory, developmental trauma, and how this might manifest in therapy. It's like performing surgery without having fully studied anatomy & physiology.

Seems Ts also need basic training in neurobiology. If a client has regressed the way Seahorse is describing or is in the grip of overwhelming emotions, it would helpful if the T knew that trying to work through this rationally (boundaries, termination, intellectual insight) might be completely wrongheaded. Couple quotes on this (Bessel van der Kolk MD):

"When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it."

"For a hundred years or more, every textbook of psychology and psychotherapy has advised that some method of talking about distressing feelings can resolve them. However the experience of trauma itself gets in the way of being able to do that. No matter how much insight and understanding we develop, the rational brain is basically impotent to talk the emotional brain out of its reality."

Great quotes!

I hope it doesn't seem we've highjacked your thread.

Another point to make is that if you look at the work in therapy in terms of Outer Child and Inner Child, it makes complete sense. If my ex-T. had viewed it that way, I could have done some awesome work. Fortunately, my current T. is the one who brought these up (and we've read books on it).

I know you feel crushed but it will get better. It's been about 9 months for me. I can now see how much better I am without ex-T. I am happier and others have commented on it. However, there are still painful times. This week has been an emotional rollercoaster because I "get" to see my co-worker get all sorts of extra sessions/phone calls/texts due to her rebellious daughter. It is so painful to watch.

My current therapist is a big believer that you have experiences or meet people who are supposed to teach you something. She keeps asking for the meaning of my time with ex-T. If I had not entered therapy, I would have stuffed all my emotions about my deceased mother and would not have changed. Perhaps ex-T. was just like my mom so I could recreate some drama and recognize that I had needs and most were not met. Then, you could argue that my time was done with that person and I was meant to meet my current T who is helping me process it all, is completely opposite of my mom and is meeting some of my needs.

I hope that you can find a good new T. who can help you through this difficult time. There is no easy way to do it except to let time help. Also, you might consider journaling. I did a lot of that to at least get the emotions out and somewhat organized.

This is what I discovered a long time ago. I can't understand how come real research data gets completely bypassed by the professional community and how come speculative theories become more important than empirical data.

Why on earth the works of Van der Kolk, the research conducted by Dan Siegal, Alan Shore, Peter Levine, the works of John Bowlby and many others who were truly dedicated to putting psychotherapy practice on the scientific ground, the discoveries of neuroscience aren't a REQUIRED coursework in the psychology curriculum in every graduate school? This is the material upon which the whole practice of psychotherapy should be built because this is real factual information.

There are many prominent researchers and educators in the field who have been telling their professional community that talking about one's pain, especially using the pscyhobabble terminology is not nearly enough to address the core issue of trauma because the major traumatic information is coded into implicit memory and is stored in the body, therefore, the body has to be addressed directly and talking could be a supplemental component of therapy which could help to process information that comes out as a result of working with the body.

Shamefully, most therapists, as well-intended as they may be, don't have even basic knowledge of how trauma works. The whole professional education and training system needs an overhaul.

I can see how it might happen. I am sure most Ts do learn about attachment theory, developmental trauma etc during study. But if they haven't experienced those things personally (and many wouldn't have) I can see how it would be quite one thing to know about them in theory but be completely thrown by their intensity and management in practise. Experience in the field can only come from experience in the field... which means that most Ts would spend a good deal of time doing things wrong as they 'feel their way through' before they manage to 'get it right' more consistently. I think there would be a certain amount of learning 'what not to do' involved. I don't know if there is any other way of 'learning to T'.
I also think there would be Ts who are better at learning on the way than others. Some people can learn from and admit their mistakes, and others can't. That would be a crucial characteristic for a 'good T' I reckon.

Everyone seems to take your side, I don't know your story and I don't know you. Here's what I can gather: your T felt that you were abusing his or her privacy and felt so strongly that they decided to write off your bill.

This may be a great learning opportunity. Put the tone of the letter aside (which does seem a bit harsh.) Were you calling/texting this person incessantly? Were you mailing them letters after they blocked calls?

You have an opportunity, sulk or learn. You can adapt or stay the same. I wish you the best of luck.

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Umm..no. I hate to break the reality to you, but, as a therapist, I know what happens inside the field a little better than outsiders. As a therapist, I can tell you that what happens in training is nothing like what you assume, sorry if it disappoints you.

" I am sure most Ts do learn about attachment theory, developmental trauma etc during study."

Very superficially. In my training we have been told ABOUT the concepts but never really spent time studying those things.

"But if they haven't experienced those things personally (and many wouldn't have) I can see how it would be quite one thing to know about them in theory but be completely thrown by their intensity and management in practise"

Yes and no. While having lived through trauma and having mastered life skills, put together the broken pieces and restored one's wholeness, at least to some extend, is a MUST to truly understand the somatic nature of trauma and to appreciate the power it can have over a person, it is NOT enough. While there are similarities in traumatic dynamics, there are also distinct differences in how trauma operates in different people.

The traumatic circumstances are never identical, no matter how similar they may be. The capacity for resilience is never the same for different people. The social support varies from person to person. Some people suffer in isolation, others have the support system that helps them heal. The commitment and the capacity to do the healing work is not the same for everyone. The cultural influences are different as well as socio-economic situations (people with means usually have better conditions for healing and could afford better treatment options) and so on and so forth.

The list of various factors that play important role in how trauma manifests itself and how healing can happen will never end. This makes every individual case unique, which means that a therapist cannot automatically apply their own life experience and their experience with recovery to their patients. If a T tries to understand a patient exclusively through the lenses of their own experience, a patient is in trouble. It's a sheer projection and is a very unprofessional thing to do. It'd be contrary to what Ts are supposed to do, which is to SEPARATE their own "stuff" as they call it from a client's "stuff".

Personal experience with trauma and recovering from trauma is crucial, no questions about it. But that experience should only be used as some information to consider and not as a go-to template or criteria when trying to understand a client. Other information should include the one that comes through rigorous studying all the available research data, through direct experience with clients during which a therapist observes, listens and uses both critical thinking and intuition to analyze the information that came through observation and listening. In order to do all this work, a therapist has to distance themselves from their personal experience enough to be able to use it as information to consider instead of projecting it directly onto a client.

"Experience in the field can only come from experience in the field... which means that most Ts would spend a good deal of time doing things wrong as they 'feel their way through' before they manage to 'get it right' more consistently"

I've known so many therapists with 20-30-40 years of experience in the field who were utterly ignorant of attachment theory, developmental theories and many aspects of trauma and who screwed up all the time IMO. They, however, thought very highly of themselves. It's not so much the experience itself but what exactly you are learning from it. If you are told that certain theories and assumptions are facts and you blindly believed it, then you will fail to observe and to listen objectively and to register a lot of important information. When new information doesn't fit the "established" theory, it gets dismissed in order to keep the theory intact, to never challenge or question it. This, by the way, is the psychological fact that has been discovered through many social experiments.

So, one can have many years of professional experience and still fail to learn. Happens all the time.

All in all, psychotherapy is not a craft similar to plumbing, carpentry, engineering and such, where one can learn precisely what to do in cases A, B, C etc. by deconstructing the devices and looking at how different parts are connected and how they move together. In psychotherapy such precision will never be achieved no matter how much we learn about human brain, human body and human spirit, which goes into the field of quantum physics and quantum mechanics. There is always going to be unknowns about humans which means that the only attitude a "good" therapist can take is that of humbleness and appreciation of their human limitations.

Actually, on my course there is huge emphasis on attachment theory and its impact on the client. It's hardly sweeping over the concepts, we have undergone in-depth experiential workshops examining our own attachment styles and their impact on our work as well as a focus on attachment and MI.
I agree that relying on personal experience alone is dangerous, but personal experience to inform empathy is useful to say the least. My T suggested my past will be 'simultaneously one of my greatest strengths and most significant vulnerabilities' as a practitioner, and I agree completely, so it is my duty to keep that in my awareness.
In my experience of working with therapists, I have found more experienced Ts more beneficial, however it stands to reason that that's not a universal truth, and the individual is a crucial factor in what makes a competent therapist.

You are in the UK, right? That may explain the difference.

Absolutely. I never argued that. If you read my post carefully you'll see me say that personal experience is crucial in understanding somatic nature or trauma, where by "understanding" I certainly meant empathy because empathy IS understanding through feeling what the other person is feeling.

It's important, however, to know the difference between empathy and projective identification, a useful concept from psychoanalysis that suggests that oftentimes we may believe that we are feeling the other person's pain and experiencing genuine empathy when, in fact, we are feeling our own pain. This happens when we mistakenly believe that the other person's traumatic experience is identical to what ours has been when this may not be so. In this case, we are not really feeling empathy, we are simply projecting our own pain on the other person. It's called projective identification and it's very often confused with empathy. You may recall situations in which you tried to be supportive and empathetic and to let someone know that you understand what they are going through only to hear from them that you are wrong and that their experience is totally different. Don't you feel like an idiot when that happens? I do.

No disagreement here, again, depending on how you use your past experiences.

I've only worked with those who had 20+ years of experience, and IMHO they still had so much to learn...

It's hard to believe that the US would be so lax in their training across the board. There are differences in quality across universities in the UK (I happen to be at a very good one) but to skirt over attachment theory in general in the US sounds really odd. I thought the American system was more stringent than the UK (we don't have licensing here).
Thanks for clarifying on other points.

It's not odd at all given the fact that the whole healthcare system here is a multi-billion for-profit industry that strives for short-terms solutions, quick "fixes" and immediate profits. In this system, deep understanding of the problem doesn't pay off monetarily. Medical insurances only pay for limited number of sessions and so the whole system is incentivized to focus on managing the symptoms rather than to deal with root causes. Many clients are constrained with their financial resources and, understandably, aren't necessarily excited about doing deep work that requires a lot of time and money. They often just can't afford this type of work. And many therapists spend much more time filling out insurance papers than actually doing the work they are meant to do.

As far as I know, the big chunk of UK healthcare is still under NHS which allows practirioners to actually practice instead of spending most of their time building marketing and administrative skills. Here, nationalized medical care has never even been in political proposals until Bernie Sanders came out with this "radical" idea this election cycle.

It's stringent in terms of formalities that have nothing to do with how good you are as a practitioner. It is true that you have to go through years of internship (during which you are NOT PAID) and take and pass a couple of exams in order to get licensed but information you are required to memorize has virtually ZERO information about attachment theory and all trauma-related material and 90% of information about which DSM label you should give in which case and how you should act in different situations in order not to get sued. So, all that stringent "training" is aimed at making you good at filling out documentation and avoiding legal troubles. There is so many BS forms therapists have to fill out here when they work for agencies that there is no time for learning how to do the work they are supposed to do. Which makes the whole system a sheer fraud.

People like myself, who really want to deepen their knowledge and sharpen their skills have to do a lot of self-education and self-training here. And enormous amount of personal work that consists of much MORE that just talk therapy. There is no other way to do it if one truly wants to be a real deal.

Ididitmyway, you are bursting no bubbles, I completely agree with everything you are saying (mostly - in my own country Ts also learn more about trauma and attachment than in the US, it seems).

When I said "if they haven't experienced those things personally (and many wouldn't have) I can see how it would be quite one thing to know about them in theory but be completely thrown by their intensity and management in practise" I did not also mean by omission that those who *have* experienced trauma will be better at, and I am absolutely not suggesting that anybody use their personal experience as a therapy template. I don't even know how you extrapolated that from my post. I only meant that those who haven't experienced trauma are not going to 'get' the complexity of trauma and attachment issues at all, and that learning about trauma responses in theory is a whole different kettle of fish to effectively supporting a human being through those issues in a therapy situation.
I certainly agree with alllll your other points about the complexities of human experience, response and a multitude of other factors making work with each individual a very unique experience. Right down to the social experiments about people not challenging long-held beliefs to maintain the status quo. You are preaching to the choir.

Ok. Thanks for clarifying.

There was/is someone here on pc training to be a therapist who said her program would take anyone who could pay. There didn't seem to be much quality control. It might go a long way if schools could do some weeding out before these people are unleashed on live clients.

I think for-profit universities are a growing problem in the medical field, at least in the US. Not just in mental health but in physical health as well. They graduate plenty of good people, but also some bad ones I've run into.

I've found it weird that in my area at least, T's who graduated from crappy for-profit-y places charge the same rates as those who graduated from decent programs (even after accounting for experience, approach etc). Clearly, there's enough of a demand for them or people are not looking at educational qualifications in choosing a T.

I did not really bother with educational qualifications. First, I don't think it really matters when talking about a therapist - there is no consistency with those guys. Second, the one Phd I saw was batshit crazy (And she was in charge of the clinical psychology program at a prestigious university here). Third - I have had psychologists and lcsw's as parties in family matters and they are all just as batshit crazy as anyone else - those who have degrees from prestigious universities are no better at their own lives than anyone else and, in my experience, often worse.

My point wasn't about prestigious vs. non-prestigious universities -- I basically draw the line between what I see are for-profit type places vs. other schools. But, yeah I guess one could argue that in theory, good therapists can come from for-profit type places except I'd personally be very wary of going to one of them.

As for degrees, sure I can see how it may not play a big role depending on what the client is looking for.

Personally, I wouldn't look at those without a Ph.D because in the absence of really solid information about their competence (which I don't think I can assess even in the first few sessions), the Ph.D acts as a signaling device for me.

But, to each her / his own.

Oh yeah you are right. I remember she was having difficulties at school and said they take anybody who pays and wouldn't kick anyone out as they aren't selective at all. It is a shame. I would hope there is some selective process when in internship. Maybe?

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