Scammed

In a recent article posted posted on the "Interesting Psychotherapy Articles" thread, a therapist likened her profession to stockbrokers.

A apt analogy. While there are many clients who like their brokers and feel they have gotten good financial advice from them, there are others who feel their brokers, and by extension, the whole job is basically a scam.

In going to a stockbroker, I felt I understood the risks and likely complex motivations of the broker. And when I felt that the cost was more than the value to me, I went to a low cost brokerage and managed things myself.

In going to therapists I feel I did NOT understand the risks and I was not there in therapy observing the therapist for signs of complex and mixed motivations. My bad, of course. But it was a risk that I did not understand I was taking, in part because of issues I went into therapy with.

I was looking at therapists more as what is known in the financial business as a "fiduciary", someone who is legally bound to act in my best interest. Stockbrokers, on the other hand, are primarily salespeople.

What does anybody else think? Contrary opinions and disagreements are welcome.

I think one of the many problems is how many therapists themselves don't recognize a risk to the client. They may see malpractice/licensing risks to themselves (which is usually for only the most egregious sorts of behavior on their part) but I think an alarming number of them see therapy as risk free for the client. I have seen them write that in their blogs - therapy has no risk- no downsides - no pesky side effects and so on. And sadly, I think some of them actually believe it. I don't know if it is because they are clueless morons or because they are true believers or what - but I do think it is a scary situation when they can't see how harmful they/it can be. For me, probably the only reason I did not feel scammed was because I never believed in what they said they were selling in the first place. That annoyed the woman a great deal.

If you were going to write an "informed consent form" to let new clients know the potential risks of going to psychotherapy, what would you put on it? Do you think that there is a good way to quantify those risks? As in percentage of people who are harmed vs. helped?

I don't know that they want to do that...if only because I read somewhere recently that studies show that only about 50% of clients get benefit from therapy. (I will try to find it.) Studies also show that clients who have actually made only modest gains in therapy often believe they have made enormous strides. (Another difference from stockbrokers is you can actually assess a broker's performance, by how much you have gained, or by ratings by financial publications.)

The informed consent forms I have signed do say that therapy can cause things like uncomfortable feelings, but they also make it sound like these are temporary side-effects, when they may very well not be. And that's before you even touch the competence or lack thereof of the therapist.

They don't keep statistics on how many are harmed versus helped. They don't know. when they hear about it, they downplay their role in it and blame the client. Certainly people have reported self harm and suicidal ideation from therapy/interacting with a therapist - and those guys don't warn about that. At least anti-depressants have it on their warning sheet now.

You probably would have to have some kind of placebo control to figure it out what benefit/harm was actually due to the therapy vs. change over time. And then you'd have to control for things like what type of therapy you are getting CBT vs. Psychodynamic vs. DBT etc. And male vs. female therapist/client. And other client characteristics...like belief in the process, diagnosis, cooperation, intelligence, age. And other therapist traits...like age, experience, empathy, personality, etc.

Pills are much easier to research.

I could write about the bad effects I have had but it would only be my experience. There are some researchers in the UK who have been studying harm and risks in therapy from multiple respondents and hopefully they may have some useful data in the future.

What particularly bothers me now is that I trusted, maybe much too blindly and naively, my therapists and the institution of therapy. I thought they should be trustworthy, and therefore I treated them as if they were, and I thought that if I did not trust them it was an issue of mine, not theirs.

However, I think that more about the responsibilities of the client in the "relationship" could be spelled out and may have helped to prevent or reduce the harm that happened to me.

I think that is true. I think most of the harm that happened to me in my first therapy relationship would have been avoided if I had realized that she wasn't a good fit for me. I thought it was all me. It wasn't. I should have fired her a year before I did. But at the same time going in expecting the therapist to "fix" you isn't likely to work. You have to be able to communicate with the therapist about what is and is not working in therapy. Because they can't read minds.

They can't read minds? Tell that to some of them.

If the professionals have expectations about clients, including what they need communicated to them, it could help a lot if they would make that explicit. I'm not at all sure that it's a client's responsibility to know in advance of starting therapy that expecting the therapist to "fix" them, or even read their minds, is unreasonable, from their uninformed perspective.

Very true. It should be explicitly spelled out that therapy is not magic. It's mostly a ton of work...assuming what you want from therapy is real change in emotions or behavior. And some people don't want that. Some people just want someone to listen to them or someone to accept them. I'm not saying that is bad either. It's just not why I go to therapy.

So maybe what therapists should do more of is set reasonable expectations.

I don't think the problem is that people believe therapy is going to be metric. I greatly greatly disagree with blaming the client when therapy doesn't help. Any number of people worked very very hard and still were injured by therapy

At this point, I think it would be wise for therapists to refer a client back to a primary care doctor in some cases or have a discussion about the risks of the process...but what often happens is that the therapist merely makes a referral to a nearly identical "professional" ensuring that the cycle of confusion and money wasting and insurance scam continues. I was caught in this hydraulic for years. Once I got a dog, my depression cleared enough to tackle change through a therapist who is basically a life coach who checks in on my goals and eases off the b.s. sorry for hijacking....

magic -not metric. dictation error

A therapist is like a stockbroker? I don’t understand how.

A stockbroker has expertise in investments and a license to sell them. They give expert advice, albeit motivated by their own personal gain, and they sell you an investment getting paid by commission. They do have a fiduciary responsibility not to do something unconscionable to the client.

How does a therapist compare to this???

I do understand what you are saying though about getting scammed by the therapist’s motivation for their own gain.

I think a couple of things need to made clear to a client when they begin therapy.

First, clients need to be informed that, in some cases (not all), the confidential sharing of information May lead to the client forming an emotional attachment to the therapist. This is often a normal part of therapy and can help the client develop trust in the therapist and the courage to disclose difficult or uncomfortable issues. However, too much attachment, if not managed properly, can result in an unhealthy dependency on the therapist. For these reasons, it is the therapist's responsibility to manage any attachment issues that arise in the therapy relationship to ensure that it remains balanced.

Also, I think therapists should give the client a brief overview of the types of therapy that are available and how they work. They should then let the client know which type of therapy they practice, so the client can think about whether it is the type of therapy they want to engage in.

For example, if a client comes to therapy with a problem that they want to tackle without delving into the gritty details of past traumatic experiences, they would probably prefer a therapist who does cognitive behavioral or other skills-building therapy, rather than psychodynamic therapy.

If the therapist doesn't inform them about what types of therapy are available and what style of therapy they practice, the client is left to blindly forge ahead, hoping it will bring relief. If, down the road, the client realizes that the type of therapy they are engaging in isn't working, they often find it hard to leave because they have already formed an emotional connection with them.

If therapists would provide such clear information at the first couple of sessions, a client would be more likely to obtain the sort of therapy they need, rather than feeling stuck in a therapy that doesn't work for them and wasn't what they wanted.

I don't think those things would make a difference for me. I read a lot about types before I tried therapy. I sue those guys and have had to learn about them. Until recently I saw two who both professed to do psychodynamic - but to me the two experiences were worlds apart. And neither of them could or would actually explain to me exactly what they were doing or what was supposed to be happening.

Stopdog,

It's too bad you've had to do all the research on your own to find things out. It seems like therapists should be able to give clear, solid explanations about things. The fact that each therapist seems to do things a different way, and have a different approach and orientation, makes it almost impossible to know what to expect.

Here's the link that stopdog posted in Interesting Psychotherapy Articles:

http://www.lianalowenstein.com/artic...ultClients.pdf

The part about the stockbroker is under 3) Retain.

This is really interesting because it was knowledge I had about the stock market from listening to my dad when I was a child that allowed me to understand and be careful about what stockbrokers were telling me and advising me to do after my late husband died, shortly before the dot com bubble burst. If I had listened to them, I would have been in deep you-know-what.

I didn't know better about therapy, having been introduced to it as something I could rely on as a teenager.

The article is by a therapist about dealing with the "educated consumer" of therapy.

I think, unfortunately, that's something that every client needs to be able to try to do these days. "Stockbrokers" is all we've got.

In the financial world, there are now registered investment advisors who are supposed to develop financial plans and act in the client's best interests. Of course, sometimes they don't -- and then it is recognized as unethical or incompetent, possibly criminal. Some people are able to make money but are not financial whizzes, so it's a service that is needed. Maybe someday there will be something like that in therapy. Seems like it may be needed there, too.

Well, it seems that I spent more than a year with the Bernie Madoff of therapy back in 2011 and it took me years to recover. Now I have someone who's getting me a decent return but at times I wonder if I could simply invest on my own and do as well.