Differences btwn therapy & real relationships

I agree that many therapists try to impose a false image of themselves as being more self-aware, balanced and successful than the average human. Wasn't my experience at all and this was part of the reason why I never viewed them as authority figures - they did not demonstrate more competence than I felt myself or could see from many other more or less accomplished people. The false image especially irritated me with one of my Ts: he has a lot of public stuff about therapy on the internet, some of which sounds quite compelling, saying all the right things about therapy and the limitations of therapists. That was what drew me to him in the first place - just to find that what he does in reality is not even close to what he is preaching, rather the opposite in many ways. Also the way he handled our conflicts seemed more immature than I see from most people. There is no way for me to cultivate ideals about the integrity of someone like that long. My other T was much better at it, but still, never had the impression that he was particularly skilled at life than most other people who have generally successful professions and have the elements of a conventionally okay personal lives such as a family of high achievers, hobbies and many personal interests, ability to remain reasonably ethical, pleasant and engaging personalities, etc. I know many people like that and the T did not stand out among them at all. I do understand that they present such a "professional" image, otherwise why would people go to therapy if not to get help for all the issues in life? I just despise when it is overdone and obviously contrived or exaggerated.

From all my reading of this forum and the literature, it does not appear to me at all that therapy is very successful with "treating" attachment disorders. Often it makes them worse. And those people who seem to benefit this way are probably already reasonably secure, to start with. Of course there are exceptions like in everything, but this seems more the trend to me. Working with the T relationship is also something that Ts claim way too often to keep clients going for a long time, with the promise that eventually the client will "work through" it. Also, all the cases where clients get therapy for the things that went wrong in previous therapy... I personally dislike that premise, it can go on endlessly as there can always be something upsetting, even if not disastrous, especially for people who have self-esteem issues are are not confident about handling relationships and breakups. It can redirect the focus from improving everyday relationships to something rather artificial.

Agree, and this is one of my main rants. Hey, i took some courses in psychology, and now I'm qualified to interpret the thoughts and feelings of ANY person who walks through the door, and to counsel them on their life. It's a blatant conflation fallacy.

I would now consider any person (therapist or not) who makes such a claim to be psychologically unsound. Calling yourself a life coach or life expert puts you somewhere on the delusions-of-grandeur spectrum.

A therapist literally shrieked at me when I said that too her. She had tried the "you're running away and that's JUST what you do in relationships" shtick.

Personally, I'm not really a believer in therapy. I think it could be done right, usually it's not. I've always essentially felt that way.

One thing I don't get about these types of sentiments, though, is why blame everything on the therapy structure itself? Why not the individual therapist(s)?

I mean, anyone who is doing a job--they can do it well or they can do it badly. There is always going to be a more or less effective therapist out there. Even if you dislike the structure, in my mind the harm is still largely created by the incompetence of single individuals.

So then, in my mind, the problem with the structure (and the field as a whole) is its thusfar inability to weed out these individuals. Clearly a degree, a license, x years of experience--those things are not enough to certify the kind of skills that are really going to be needed to RELIABLY create good outcomes and RELIABLY avoid bad outcomes in clients. I think that therapy could work, but also it is much too frequently not working.

[QUOTE=BudFox;5772488]People say that therapy and real relationships are basically the same[\QUOTE]

I am going to go through and read people's responses but I wanted to say one thing immediately. I don't know anyone who says that. Therapy and real relationships are vastly different and I think that anyone who says otherwise is kidding themselves. I can see where it might be easy to blur the two because of the intimate and personal nature of the therapy relationship, but if you stop and think about it, even for a minute, it's easy to remember the vital differences between.

I have been through an experience where the therapist and friend line became very blurred and it just ended up hurting me in the long run.

For me, therapy should imitate real relationships, it will never be the same thing because of boundaries etc. It's just a specific relationship.
But also, because this relationship is pretty close and intimate we start to have similar emotions, desires, worries like in any other REAL relationship. Luckily in this relationship, we are with a specialized therapist and we can look deeply what's really going on here. We can start noticed feelings we had no idea we have, investigate why we feel this and then change it.
It's often not possible to discuss this with a friend (in a normal relationship) because they can be angry and offended. They also don't have skills to look at many things objectively (like T can do).

So for me - a therapeutic relationship is something really valuable. It can evoke similar feelings like any relationship in real life, but it can be also discussed in details and give me a lot of information how I'm functioning in life and what should be changed.
(which is not always easy because many different feelings appear, but that's what is it for).

Agree that individual therapists are accountable. Disagree that so called "good" therapists can reliably transcend a dysfunctional framework. Purchased caring is a problematic construct, even if the therapist is super special and has magical powers.

Also seems most therapists are perpetuating therapy orthodoxy unthinkingly, according to their indoctrination. One of the best descriptions of therapists I've come across is... "naive followers of a faith".

I do think therapists ought to get a real job and stop humiliating people, and for that they are absolutely responsible.

But if, as you say, therapy “could be done right, usually it’s not,” then why wouldn’t the problem be the structure?

These people receive similar training, have similar codes of conduct and ethical standards...so either the profession attracts a lot of incompetents (the problem is with individual therapists), or it doesn’t prepare its practitioners with proper training and doesn’t maintain standards (the problem is structural). Close to what you say in your last paragraph.

Generally the simpler solution is better to me—that means questioning the single factor, the structure, in its various aspects, rather than the multiple factors (incompetent therapists).

I think it is becoming increasingly established that attachment disorders are a developmental dis-order of the brain, where the lack of adequate emotional attachment to a caregiving figure has a life-long impact on the neurological formation and structure of the brain. Attachment disorders are not a behavioral or an emotional disorder as they were once thought to be. The observable impact of an attachment "disorder" is the result of a brain that has formed differently to the norm due to inadequate support during a critical period of development.
So in a very real sense therapy can't "treat" attachment disorders, anymore than therapy can "treat" physical ailments. Therapy can inform and support, it can help people recognize patterns of behavior an adapt different responses, and some forms of therapy (EMDR and brainspotting) can create alternative neural pathways that override ones that cause distress, but talk therapy itself simply can't "fix" attachment disorders. the relationship between a therapist and client can't "fix" attachment disorders. I think therapy for people with attachment disorders went very wrong for many years because they just didn't know what they didn't know then.
I think the future of therapy for people who have experienced developmental trauma including attachment trauma is exciting. They more they know about the neurology behind it the more they can find ways to adequately support people with these experiences. We can't regrow our brains "to be normal" but we can discover ways to optimize the functioning of the brains we have.

Some of the most interesting and cutting edge research being done indicates that the brain is neuroplastic throughout the lifespan, that the neural pathways can be altered.

Yes that is true, and that is why trauma informed therapy can do a lot to help. What it can't do is get the brain to a point where it was as if it had developed normally from the start.

I guess what I'm saying is, therapy fails primarily when the wrong person is sitting in the therapist's chair, and it is failing often because the licensing organizations are frequently putting the wrong people in that chair, people who simply do not possess the skills that are required of them.

But then I could definitely see the argument that the framework being so dependent on the performance of the individual therapist is actually an issue with the framework itself. There aren't really any failsafes, that's what I see as being the major problem. If the therapist is 100% bad, then they are doing harm to 100% of their clients, 100% of the time. And these situations are actually being enabled to persist. So I guess I essentially agree with you. The therapy structure in my mind can work, but also it needs more measures of accountability, maybe as a framework right now it is simply too idealistic and not realistic enough. It kind of has a "wild west" type of thing going on to this very day, you cannot reliably anticipate what kind of service you'll receive from any given therapist, and that's a big problem...

So I'll concede to your point here, I think you are totally right, that is a systemic problem and the system itself needs a change in order to address it. What I was trying to get at is that the basic therapy framework has value WHEN it is used correctly, though not necessarily as a rule.

Purchased caring hasn't ever been the point of the therapy framework, the whole structure is designed to identify and bring awareness to inappropriate psychological defense mechanisms. Caring is not even supposed to be what is healing about therapy: awareness and insight are. However so many therapists have arrived at the notion that they are supposed to demonstrate caring, due to a one-dimensional understanding of this structure and their own training.

The problem here is that the structure also equally brings out the psychological defense mechanisms of the therapist, and its effectiveness is thus entirely reliant on the mental health level of the therapist.

Anyway, it is completely natural for one human being to care about another. This is the "just like any relationship" part. For someone to perceive that as UNnatural is the whole problem. Any physically healthy human being will experience involuntary empathy for others. Usually when this empathy is not functioning appropriately it's purely because that person is distracted by a perceived threat to their own survival. A therapist shouldn't be saying to their clients, "here, I will prove your PTSD wrong by demonstrating that I care about you," they should be trying to answer the question of, "what would lead you to assume that I don't care about you in the first place?"

Their training is meant to help them answer this question, however too frequently they themselves are distracted by their own defense mechanisms to even see what the client is actually experiencing, and in that case their training is rendered useless.

Their training is useless by default. The whole idea that a therapist can be trained to untangle the neurosis of another person they barely know, better than that person can, doesn't hold up to critical thinking. Awareness and insight can be discovered on one's own, through living life, mindfulness practice, general cultivation of self-awareness, and so on. Paying someone to furnish this like a vending machine is, in my view, a terrible proposition, since it comes with so much wretched baggage, and lacks logical basis. A trusted friend is much more likely to "get" you than some babbling therapist loaded down with dubious theories and convoluted thinking, and whose identity is wrapped up in demonstrating their exquisite insight and guru status.

Also I get that people go to therapy to get help with difficulties rather than to purchase caring, but in my observation the relationship drama and the longing for attunement and acceptance is what ends up driving many people, and once they get into that mode, they are forever chasing those needs. And it's the residue of having been dragged through this degrading pursuit that sticks around in their psyche.

I would propose that there is a sense, in which just about anyone can see you more objectively than you can ever see yourself. I still don't see where that translates into an ability to help you change into how you would rather be.

I recently "interviewed" two therapists. I just wanted feedback about how I came across to them. OK, it wasn't "therapy" that I wanted, just some straightforward feedback, and -- the important part -- I could decide if I wanted to do anything about that on my own time.

Would you believe they were clueless? And didn't understand what I was asking for?

So. . .where am I going to get that? In the real world, if I affect people adversely, they will -- attack me, shun me, etc.

So, I remain pretty clueless. Because people in general aren't "straight" with me, and neither are therapists.

I mean I think the fundamental idea is, someone who has become specialized in understanding these things would ideally have a better shot at understanding people than someone who has not become specialized in that.

If you believe that the workings of the psyche are completely intangible, then I would see why you would not believe there could be any benefit to psychology/therapy/etc as a vocation. However if you do believe that the mind, and feelings, and sensations and beliefs all work in a somewhat knowable way with some kind of knowable underlying structure that is not entirely random, then I think a natural conclusion of that is that there is theoretically some benefit to having people around who specialize in understanding those workings and bringing about some kind of change/solution in them.

I mean, are we actually in disagreement on that? This feels extreme.

Personally, I don't see this as being a question of categorically whether or not therapy could theoretically be effective, just a problem of it currently not being as effective as it should be.

Most of the insight or advice supplied to me by therapists has been banal stuff, dressed up to look special. Seems the client pays dearly for the occasional insight. And in between is a whole lotta pointless (and expensive) nothingness or pointless and painful drama, that mainly serves therapist needs.

Their training fills their heads with delusions of belonging to a special caste of saviors and savants, when in fact they are just commoners with at best a marginally better understanding of human nature than the rest of us, and at worst a seriously distorted way of relating to the struggles of others.

Right, these kinds of issues are what would need improvement. The fact that your experiences with therapy left you feeling this way is more evidence of that.

One interesting thing I've noticed in life, is that the biggest and most successful companies and organizations are the ones that ALWAYS try to reasonably accommodate the feedback they receive from their customers/clients/members/what have you. I think therapy as a "business model" (since it is a business) is still in its infancy in many ways and in the future should look to places like this and voices like yours to really understand how to create a better experience. There is a hell of a lot of money to be made by the first major mental health organization that learns to operate with that mindset. Because that's a need people have that is really just not being fulfilled regularly enough. I imagine that there are a few therapists out there who can provide that kind of service right now, there's just no sense as a consumer of therapy that it can be reliably expected to be that way, it's hard to know what you'll get from any individual provider and it's hard to get rid of the bad ones since there aren't enough objective measures of their performance. At the very least, for now I think online reviews for therapists should become a bigger thing, I think that would be really nice.

I maintain that the basic model is designed to make therapists feel better, and clients feel worse. Training will not change that. The newest flavor-of-the-month approach will not change that. Feedback will not change that, because it's precisely the systematic suppression of the client's true voice that enables the system. Too much honesty is poison to the process.

This plays out in one dyad after another based on my observation. Therapists appear to lash out at their victims on a routine basis when confronted with failure.

If therapists collectively said they merely are paid listeners, nothing more, then it would be honest. But they have a built a monstrous and freakish edifice on top of that, and it needs to be blown to bits, and most of them need to find another line of work and stop playing games with lives.

My opinion.

Few thoughts about neuro-plasticity:

- Therapists imply in a vague way they can “use” NP to heal people. In other words they will engineer a healing relationship. The client must look the other way, when confronted with the possibility that their healing is supposed to come from the simulated emotions of the therapist.

- They also imply they can use NP in a controlled way. NP is a two way street. What can help can also harm. Psych biz avoids discussing that. At best, the therapist is experimenting in uncontrolled fashion with the client’s brain health.

- All social interactions involve power dynamics and social status that affect brain plasticity. Therapy, in my view, is heavily loaded in favor of therapist power and client powerlessness. The client faces an uphill battle, having entered into a pre-ordained hierachy. Seems more likely to recapitulate past social defeats than counter them.

- I can’t imagine any greater threat to brain health with respect to social status, than ostracization or rejection in the context of a power-driven and symbolic realtionship. And since therapy clients can easily be terminated if they don't conform, seems inordinately risky.

- Clients can experience loss of control once feelings of dependency set in. Loss of control, in relationships or in healthcare, correlates with higher stress levels, and increased stress correlates with deteriorating health and breakdown of the physical body (including the brain).

- The healthiest thing for me was to get away from an infantilizing guru-disciple, mommy-baby, superior-inferior arrangement and take back control. Taking back power and control is a reliable predictor of improved brain health.

I think that what you were asking for is entirely reasonable, would be very useful and is exactly what you are neeevvver going to get, until you pi$$ off a therapist who then decides to lay it on you in hostile fashion. That's what happened to me.

Ideally, a therapist would be able to offer unconditional positive regard, along with some candid feedback about what the therapist finds objectionable in the client's social/interactive manner. That's my humble opinion. But therapists seem to have a hard time holding both those thoughts in their head at the same time. In my experience, the T was either blowing smoke up my skirt about what a courageous, wonderful individual I was OR laying me out in lavendar over how distateful it was to have to deal with me.

They would tell me to not think in black and white and to grasp that people in my life are a mixture of virtue and vice, but they'ld fail to put that into practice themselves. "Splitting" is when you either over-idealize someone, or demonize a person as being totally defined by their faults. Therapists tell you not to do that, and then they go and do it to their clients big-time. And, yes, it's all about them using the imbalance of power to keep you from ever challenging them in a way that bruises their ego. Or they are retaliating because you managed to do just that. Therapists can be quite vindictive, in my experience. They feel entitled to the presumption that they only ever operate from the moral high ground. Well, sorry, but I don't presume that about any human being. Nor is that consistently true about any mere mortal.

At any rate, here_today, go offer a therapist some pointed criticism, and they'll hurl some right back at you.

I'm not saying therapists need tolerate being abused by their clients. Part of what therapy should be about is identifying and not tolerating abuse. But therapists can be a thin-skinned lot. They're supposed to be trained to avoid counter-transference, but they can take advantage of the client's not being trained to recognize that. They also can take advantage of there not being a third party witness to what transpires. This makes for real client vulnerability.

This thread has been about the most insightful conversation I've ever heard regarding the downside - and darkside - of therapy. I thank you for leading this discussion and for your cogent perspective. You're highlighting of the imbalance of power dynamics is edifying.

I've long been enthused about peer support among consumers of psych services, and I've wished there were more of it around. Your analysis of relative power imbalance helps me understand why peer support works differently. I was in a partial hospitalization that benefitted me more than had years of therapy. I give credit for that to my peers in the program. I've long wished that there were something like AA for persons with psych diagnoses. I guess that's what PsychCentral is, sort of, but it has the limitation of being an online venue. Someone above mentioned that there is "money to be made" by whoever could come up with an effective alternative paradigm for therapy. I suggest that might entail a bigger role for peer on peer participation. Though I think you almost have to get the so-called professionals out of the way, for a fellowship of consumers to evolve. I've been to meetings of the Depression Bipolar Support Alliance in the distant past and didn't find it quite what I was hoping for.

I realize criticism can be, and has been, made of the "12 Step" model. But it did a good job of upending the notion that possession of medical degrees somehow equipped doctors to turn around the lives of alcohol abusers. I think we need a similar paradigm shift in how we think about what persons with issues like mood and personality disorders can do to repair their damaged lives. "Getting treatment," IMHO, is grotesquely over-rated. Attendees at 12 step meetings aren't there to "get treatment." They may be getting some medical treatment of substance abuse, as an adjunct to their program of recovery, but their recovery isn't placed mainly in the hands of people with letters after their names. Maybe we with psych issues need to be thinking along the same lines.

BudFox - you appropriately lampooned, above, the notion that colleges can turn out professionals qualifed to be "life coaches." Claiming to have that expertise does indeed denote having "delusions of grandeur." Very aptly put. No doubt, you've seen the print advertisements that these folks out, wherein they list the issues they claim competence in treating. A single therapist's list may include "depression, anxiety, marital breakdown, social anxiety, parenting challenges, substance abuse, sexual concerns, career management, post trauma difficulties, gender identity dysphoria, compulsive gambling, bereavement and quest for spiritual meaning." Talk about range. We should have a few of these folks join up with Jared Kushner and get that Middle East thing straughtened out.

Yet - the preposterousness of what therapy purports to do goes barely noticed. We in the psych services consuming population have to accept part of the responsibility for this. We - just about all of us, at one time or another - have wanted to believe in this fraud. I drank my share of the Kool-Aid.

Getting back to power: the wanting to hold therapists more accountable is something I endorse. They get away with spinning wheels and getting nowhere, or worse (by harming people,) because they are just about immune from having any accountability whatsoever to anyone, or anything. You sit in that office and get handed whatever that T decides to hand you. Then what recourse do you have? Well, you can stop going there. That's about it. Something's wrong with this picture.

I've been involved in several peer support programs, including Emotions Anonymous which is a 12-step program which had some good aspects but leaned too much, in my view, on the 12-step format, which seems to work well for addictions but doesn't seem as good, to me, for just psych issues.

The thing I wanted there, as I have wanted from therapists and from PsychCentral from time to time, was the honest, social feedback, in a "safe" environment. I wanted to deal with my issues realistically, staring at them as straight in the eye as I could, but without shame. It seems like that's something a lot of folks might want, but I have not been able to find it anywhere.

Can you name some specific things that you would like in a peer support program?

In a word: Fellowship. I would like a format whereby we take turns talking about how we are managing. Then we could interact supportively. I would like some sponsors whom I could call to say, "I haven't been out of bed yet today." and they could, maybe, agree to meet me for coffee, if I get up. (I don't want to call just anyone with that problem. I want to have someone to call who knows what it's like to be too depressed to get up and get dressed.) Maybe we could call each other in the morning and offer mutual "wake-up calls."

We could have study groups with our own version of a Big Book, whereby one week we discuss the importance of getting up and getting dressed. Another week we discuss the chapter on hygiene and grooming. (My problem is depression, as you can tell by what topics interest me. Maybe not every person with psych issues could relate to those topics. Maybe groups would need a diagnosis-specific focus.)

What I'm not looking for is someone to be an audience for my tale of how much sorrow I've experienced. I've had sorrows. I assume everyone has. And some have experienced tragedy of the highest order. (I would not claim that for myself.) But I think that therapy, as it is typically done, infantilizes people. (When it's not brutalizing them.) Clients want some T to tell them that it was just terrible how their parents or siblings treated them. Yes, we are products of our rearing and a lot of that was pretty screwed up. Yeah, I'm in favor of sharing those stories. But therapy is me figuring out what I have to do now. In AA and in Al-Anon, they discourage "taking other people's inventory." Too much of current therapy is "Let's talk on and on and on about what a miserable guy my dad was, or what a narcissist my mom was . . . . and how my inadequacies are Not My Fault . . . . because just look at the abuse that I was subjected to." If I'm mainly talking about the faults of other people in my life, then I'm not working on ME.

I am fascinated by people's family histories. They have gone a long ways toward making us who we are. I envision a peer support group where we unveil that stuff and have compassion for each other's stories. But what was was. I believe we talk about what we're doing now that isn't working for us and how we are going to change that.

Psychotherapy, as much of it is practiced, seems based on the idea that the client has a riddle to be solved: "Let's examine how your unfolding of your potential was sabotaged by those lousy parents of yours, or that perverted brother of yours because that is how you work through it. Then, with that insight into how you were damaged, let's get you a whole new, better life." I say, yeah, let's definitely visit that stuff, but merely doing that will get you nothing. I conclude that this is how many therapists are wasting people's time by how many psych consumers I hear saying that "My T explained to me how victimized I was." And that's what they mainly want to dwell on.

I think we need to be "working a program" about how we are going to live in the here and now. A practical program. About what do we need to do today, and let's spur each other on. Let's lay out what a healthy life includes and look at what I need to do this week to have that in my life.

I'ld like to belong to some sort of group where we talk about that.