Article: Clients that Didn't Get Better

I have only seen two therapists and both are/were fully trained analysts and both were great. Maybe I was just extremely lucky but to me it also seems that it is not just random - I think with someone who has "only" trained as a psychodynamic therapist, the risk of meeting someone who doesn't fully have their s... together is larger. Sure, I would rule out old-school conservative non-relational freudian analysts but these, I hope, are exceedingly rare nowadays anyway.

As from where I found these therapist - first was just luck because back then I did not know anything about analysis/analysts yet. For finding the second one I asked for a referral from the closest analytic institute.

It's odd you ask that. I found my therapist by googling [my area] therapy. I felt absolutely no connection to most ads I read.

But I felt an immediately strong connection to what my therapist had written on his website - - it made no assumptions at all (no "We all feel sad at times."), and everything he'd written was so calm and measured. It also struck me that his website was the opposite to the marketing stuff I work all day long at.

His picture was him squinting into the sun, the first page spoke about the ample parking outside his office. There was a picture of berries for no reason. Then, at the bottom of one of the pages, against the backdrop of carefully chosen words, there was a mention of how he found Jung's ideas useful when working. I remember thinking, "Who the f*** is this guy?"

He didn't have any spots when I first called him. I called him six weeks later to ask him if anything had opened up. He told me no and said perhaps I should look for someone else. I was actually confused - - I felt very strongly that this person had the ability to help me.

A couple weeks later he texted me to ask if Wednesday evenings worked for me. I am really happy he did.

But I think part of my success is that after a while with him, I felt OK enough to put my brain away. I intellectualized a lot the first couple months, but he didn't get sucked into that - - he realised emotions are where I struggle, and has taken a lot of pains to steer sessions away from my strengths (intellectualizing).

He has his faults (he's a bit rigid sometimes) but I feel like I'm working with someone who really knows what he's doing. I got very, very lucky.

I'm enjoying all the posts here.

So, how do you actually put your brain away?

I'm struggling with that a lot. I mean, I do put my brain away because I've understood for long that the intellectualization is really bad and I refuse to engage with intellectual talk. But then what happens is that I don't have anything to say - I have no words for things that happen inside me. It feels like I'm floating in the vast see of something and first of all, I don't know how to describe it and secondly, when I would try to describe it then it would vanish and I would find myself intellectualizing. Thus, the only reasonable thing to do is not to say anything at all but this is also bad. I haven't really figured out how to solve this conundrum.

This post resonates for me so much, and speaks for my experience too. Thank you.

My current T is a psychoanalyst as well, but she's very unorthodox. I've met/interviewed psychoanalysts whose blank slate approach threw me into states of panic. So I knew that blank slate therapists are not for me. I guess what's helpful with psychoanalytical training is that it trains the Ts perception to pick up on the undercurrents. To be aware of their own (counter)transference... What I don't like about psychoanalysis is that it tends to be fairly hierarchical, at least where I am living. Current T deflects this power hierarchy by being much more transparent than a "normal" psychoanalyst would be. But then she's a trauma therapist as well, so I suppose this plays strongly into her way of working as well... [/QUOTE]

Her insisting on this anger thing was actually really scary. It kind of messed with my brain, because she got extremely frustrated and agitated because I wouldn't 'admit' this anger of mine (which I didn't feel) and because her reactions were so strong I kept questioning myself and my own perception more and more. In the end I was convinced that I must be "wrong" or "bad" for not having access to my aggressions, which was a scary re-enactment of my christian fundamentalist upbringing... Because I doubted my own perceptions it took me incredibly long to get up and leave this situation. Because I was 'convinced' that I have to pull through this, that there is no way around this, but right through the middle. Bit sad really.

Maybe it's not so much surprising but two sides of the same medal?

As a psychodynamic T (correct me if I'm wrong) she's on the 'lookout' for emotional gravity. So she will notice that you get annoyed. Which is a good thing and you got every right to get annoyed when she interrupts you. Do you express your annoyance as well? or do you just talk about like, like you'd talk about the weather?

With regard to the scheduling: Maybe her uncertainty stems from the fact that she doesn't or cannot feel the "emotional pull" in this area. I find quite often that I felt I was very upfront and direct and clear in my communication. And it doesn't "reach" my T. Because yes, my words might have been clear, but my facial and/or body expressions might actually have told her the opposite story, or nothing at all, flatline. It doesn't reflect at all on you not being good enough. It might be more of an observation of her perceptions, could be. If it bugs you, you should bring it up and discuss it with her, might bring some interesting insights. Otherwise you'll start your own theories about this and eventually act on this theroy, which is never good...

Anyway, what I 'm trying to say, not all things that seem to be contradictory must necessarily be contradictions... It does help to talk about it. To bring up YOUR perceptions, and ask her for hers.

Agreed, I think a lot of people who work (or claim to work) psychodynamically are undertrained and don't really fully have their s*** together to use the modality responsibly and well, without letting their countertransference run amok.

But I also hesitate to recommend psychoanalysts as a group, because there are some issues/situations around gender and sexuality where it can be very difficult to find a psychoanalyst who's equipped to deal with them in a non-pathologizing way. And because (relatedly) a fair number of psychoanalysts do seem to harbor some tendencies towards rigidity of theoretical approach, even ones who aren't extremely old-school in the strictest sense.

yup i don't believe that my ex-psychodynamic T had his s#*t together and his countertransference lead to many unhelpful issues in therapy and the relationship.

Yep, I agree (although perhaps not entirely for the same reasons), I would also hesitate to recommend psychoanalysts as a group. However, for myself, this is certainly a filtering criterion.

My ex psychoanalyst is one of the most manipulative, self-centered people I have ever met. He had many long years of training and various degrees, yet in the end my interactions with him had little else but his intense countertransference reactions and turning it onto me. He completely refused to take responsibility for his acts and also could not tolerate challenge and criticism at all. I also know a couple other analysts who seem to be similar, even if to a lesser extent. Of course I am not trying to expand this opinion to all psychoanalysts, just saying that, in my own limited encounter with this brand of Ts and their conceptual framework was pretty negative. And I was suggested to be the ideal psychoanalytic client by quite a few people, based on being very analytical myself and interested in deep introspection.

Just to add something I thought of reading/posting on another thread about having two therapists and treatments. I really do think that therapy is not for everyone, just like often a relatively standard medical treatment will not help everyone, based on a complex set of factors and underlying variations.

I believe that my ex psychodynamic T did not have his sh.t together. His countertransference was very unhelpful to me.

Thanks everyone!

Stafishing - oh wow. That's really cool that you had such an intense sense from the start that your current therapist would be helpful! And, what great luck in finding him! It's funny, I had a feeling about my last therapist - not exactly like yours - but I had a moment early on where I felt this weird sense of resignation/acceptance where I went from trying to see if we were a good fit and I should continue, to this feeling of: "OK, so I guess I have a therapist! I'm officially in therapy!" LOL. Actually, lots of little signs/feelings that made me think he was going to be the person I'd stick with... so I'm still a bit sad about that one.

I really, really wish it weren't so incredibly hard to find somebody who is a good match.

Maybe this T will end up being that person though. Maybe. She's willing to read books with me and discuss, and I actually brought in a book about psychoanalysis that has a LOT of interesting things that I relate to, and she was so excited - told me she has it (and pulled it off her bookshelf) and that it's actually a favorite of hers. So, maybe we'll get there.

I love what you wrote about how previous therapists took your resistance personally, but your current therapist is working with you to figure out where it comes from and only brings it up when it's therapeutically significant. That sounds... so professional, and yet so hard to find! You're right, that IS their job. Yet so few seem to be able to manage that (which again, gets back to therapists needing to do their own work, keep a certain level of "objectivity", and work with the counter-transference, rather than getting sucked in and personalizing it.) It's still crazy to me that my first T thought I didn't like him... I didn't feel that at all... I was *scared*, I was practically cowering behind a pillow, and he made it about him. *Argh*.

Thanks for sharing your story!

Feileacan - I do feel like you're on to something, with people who are "just trained in psychodynamic" not having their stuff together. Thanks for mentioning the referrals from the local psychoanalytic institute. I've looked in to that, and will keep it in mind. I'm not quite ready to bail yet on my current T, since she IS working hard to try to figure this out (and is the first one to really try to engage with me about this). Thanks!

Tomatenoir - Very nice! I hate the ads like you describe (i.e. "we all feel sad at times") too. But, I think for me it's because they all sound the same... like all the therapists just copied their descriptions from each other . I am not impressed with that.

I'm really glad that he got back in touch with you and had a slot open up! What a stroke of luck, right? Very cool.

The "putting your brain away" - I can't even imagine. But, I also feel like I *need* a good understanding of things... how things work, how my brain is set up, what the patterns are. I don't know though, I can see how that could be seen as a defense. I do think it would be nice to feel safe/comfortable enough to really just feel like yourself in therapy... like I said, I've got one person in my life who does that for me, and it amazes me how hard it is to find. I think the key with my friend is that he's just SO incredibly non-judgmental and accepting of whatever crazy thing I bring to him, that it's made it much much easier to feel like I can just be me, and not worry about his reactions.

I don't get why this seems natural to my friend, but so incredibly hard for therapists to do! You'd think it would be therapy 101?

Your therapist sounds awesome though, like an intelligent, competent professional that is able to provide some sense of... stability? Calmness? It sounds great! Thanks.

Cinnamon_Roll - OMG, I couldn't do the blank slate. I think though, for some people, even in psychoanalysis it's not recommended? (Something I saw in the book I'm reading, but I don't remember the details now). My current T tried to imitate a psychoanalytic approach when we started talking about, and refused to say anything to me... just remained calm, tried to look interested and supportive, and nodded a bunch. And it freaked me out. Ugh, I hated it. So, I definitely would not want that and totally understand your state of panic!

Can I ask, what do you mean about psychoanalysis being fairly hierarchical? I haven't experienced it... do you mean that the T is definitely seen as "the expert", so that the client's perception of what's going on might be invalidated? (IE "The T knows best!")

I'm so sorry about ex-T. But very glad that you did eventually get away!

Ooh! And thanks, you've given me some more to think about. I don't think I'm expressing the emotions well, but I think it may be something like, I wasn't allowed to express emotions (particularly negative ones) growing up. There wasn't room for that, and it wasn't accepted in my family. So, I've learned to not show them... I've touched on this with her before, telling her how the first time I tried to leave ex-T, I was *so* sad... I sobbed about it at home, and when I went to my appointment and tried to tell him... I could barely talk, because I was trying to not cry. And, I succeeded in not crying. I don't know if he could tell (he didn't mention it), but on the inside, I was such a mess! And she wanted to know why I didn't tell him any of that!

Anyway, I think there's something there.. it's not quite fully formed in my head, but it's a good point. Thanks for bringing it up! (Although part of me thinks that this gets back to comfort/safety! Like - I'm still not comfortable enough to actually get "in" to my emotions with her. I don't know what I need to get there though - it feels like a very right brain, unconscious type of thing!)

And, thanks, that's a good point about discussing perceptions with her. I appreciate it!

It seems like therapy fails a lot with clients who have a background of parentification. The therapist brings too many assumptions about what it means to be a “client” and the client is apparently the opposite of all those assumptions just like parentification is the opposite of how a child is supposed to be raised. Then you get role reversals, power struggles, and so on. The client never really learns to let go of control and preconceptions and be spontaneous. I think those therapists could probably learn to spot these issues if they just paid attention to what they are actually experiencing in the presence of such a client, rather than making so many optimistic normalizing assumptions and rationalizations to hold onto some notion that everything is going just fine and according to their plan and their training and to defend against feeling disarmed of their own expertise/essentially “lost.” Because the truth is often that they are dealing with a client and a human being who presents an appearance of having everything together yet internally is actually lost.

This is one of my all time favorite threads. The posts are so useful to me in understanding what's wrong in my relationship with my psychologist- who is a big fan of highlighting how artificial therapy is and yet worries that the space doesn't always feel safe to me. I don't quite dare send him the article , bc he will dismiss it as me trying to speak without speaking in my own voice , but it still gives me a way of grasping what the dynamic is partially. My aversion to closeness definitely stems from the idea he doesn't take the relationship seriously enough in general ( not just with me, but how he defines his work). I am brokenhearted over therapy, and can't find my T in some important sense and feel like I am drowning in the process. I don't think he understands my world/ universe.

There are two concepts that I think may point to how I am drowning and brokenhearted, still. I'm not looking to therapy for help right now, but I have an IRL support group as well as PC and another one online. I guess maybe I'm trying to talk about or explain my universe in the hope that somebody might understand somehow. Ugh. So frustrating. So sad.

One is the concept of "psychache" which was referenced in a recent blog post on another forum in response, partially, to the recent high profile


Another concept is that of

which is a feeling or idea I came up with on my own (I think) and tried to describe to a therapist maybe 12 years ago. I also looked it up and found it online.

Together those two concepts make a lot of sense to me about what is still still "wrong" with me. But because the feelings/ideas are so painful and triggering, even to therapists apparently, it's hard to talk about them, to get "on land" so to speak, and not drown.

Maybe these concepts makes sense in your universe, too? Or not. Either way, I'd be interested in talking with you further if you want to PM me.

I wonder if maybe there isn't a need for a peer support group to help deal with these things, other people who kind of understand, even if we don't have any direct ways of helping? At least we could "sit with" each other, and that might be calming and help get some of these difficult feelings onto "land", or something? Maybe it takes building out some land, or a bridge, or something, IDK.

I am reading something quite different. I felt the article paid great attention to the failures of the clients to participate fully in the therapy.

"Yet the therapists also reported that from the very beginning there was a sense the clients were somehow removed. This was the first inkling of what Werbart’s team found to be a key theme, of “having half of the patient in therapy”."

I got a different picture. Yes, the therapists reported that there seemed to be just "half the patient" in therapy. Which in my view isn't the patient's fault. It's simply a description of their problems. And the therapists failed to notice the complexity of the patient's problems, which is clearly stated in the discussion section of the article:
To me the intent of the article seemed to try to paint a picture. of what is happening if a patient is not improving in therapy. It's not so much about putting blame on one side or the other. But more about trying to understand. And trying to find reasons behind those processes and to understand those reasons better. In order to create awareness for the dynamics in the therapy room. So that therapists (and patients...) might be able to navigate around those pitfalls.

Agreed, but a patient has absolutely got to do their part and that is to come ready and willing to the table, and to do the work involved as an active participant. CBT is a case in point. I realise this isn't so for every case but is seems often when I hear about failures in this form of therapy the client has not taken it seriously and not done the homework. When I read posts on the subject I find myself asking, but what has the individual done to make this work? I get the feeling at times too that there is an attitude that it is the therapist's job to fix the client. What I am trying to say and what I believe the article has in part pointed to is that there is a responsibility on the part of the patient to make a commitment to the process. Remember, the theme of the article was having "Half the patient in therapy."

Well, this article doesnt't talk about CBT and homework. It's about psychodynamic/psychoanalytical therapy, totally different approach.

Again: The therapists reporting that only "half" the patient is in the room doesn't necessarily reflect on the patients' commitment but the therapist picking up on the patients' emotional dissociation, which is probably part of the problem of what brought those patients into therapy in the first place.

I referenced CBT as a clear example in support of my supposition. It in fact IS relevant and to the point.

Yeah, that's part of it. But also T making assumptions, or interpreting things incorrectly. But they are so 1000% convinced of themselves, that the patients contradictions might be a sure sign of resistance (ie T is right).

Also, there are those "oldschool" psychoanalytic Ts around. Those of the "thou shalt have no gods beside me"-brand.
They expect you not to make any major life decision while in psychoanalysis.
They expect you to take your holidays when they do.
If you're ill too often, it might be resistance as well (in their opinion).
Seeing another T (maybe Trauma T or Art T) is blasphemy...
I've heard of huge power struggles surrounding lying down on the couch (instead of meeting the patient where they are at the moment... and taking things from there).

Luckily those "hardcore" psychoanalysts are getting fewer, the younger ones seem to be more flexible in their methods and in their approach. Which is good, I think.

The emotions. Current T is always coming back to the feeling and perceiving thing. Not so much talking about the emotions. But trying to get me to experience what's going on for me, right here and now. Which is terribly frightening for me, and also really exhausting.

And yes, talking about the perceptions. Again and again. I find this so useful because we give each other feedback about where we're at at this very moment. Which reduces the chances of missing each other in the process, esp if I'm at a point when I cannot feel myself (so she cannot really get in touch either....)

But for psychodynamic and trauma therapy it may NOT be relevant. Especially, if after working very hard for many years in "regular" therapy, one eventually gets a diagnosis of a dissociative disorder.

Earlier, non-specialist therapists did not diagnose -- may not have recognized -- the dissociative disorder. Some people may not understand or do not recognize or accept the validity or reality of a dissociative disorder. In that case it may seem to them that the person is not doing their part in therapy when, consciously, with everything they have with the most adaptive part of their personality, they may be.

Even in CBT, which I have never done although I have done other therapies with homework and had no problem doing the homework, if a person lacks the motivation to do the homework -- that seems more to me like something going on in the motivational system of the client that neither the therapy nor their existing coping skills are addressing. But the existing coping skills are what the client has, what they come to therapy with. Something which they are looking to a "therapy" to help with. If the therapy doesn't, then it's the therapy's failure, for that particular client, in my view.

I'm reading the longer version of the article, and holy crap, this is me. Therapists start out really intrigued and intellectually stimulated by me and my situation. They see me as a "special case," as the article describes. It's in no small part because, while I'm not a mental health worker, I am a very cerebral, academic-oriented person and tend naturally to have a lot in common with therapist types. We see the world through similar lenses and share similar interests. Then they realize just how tough my issues are to crack. If they were easy to crack with their usual methods, I would have already resolved them myself...I'm pretty familiar with psychological concepts after all and have successfully desensitized my own panic attacks using techniques I read about in an undergraduate psych course. And, thus, distance, tension, and frustration sets in. My defenses that I was able to, at least to some degree, let down in the beginning go back up because what's the point in letting this person incapable of helping me have access to me defenseless? I try to take them back down and give therapy a genuine chance, but every time I do, it becomes clearer that doing so in no way increases this person's ability to help me and just leads to me feeling ashamed by the vulnerability. Eventually, we both conclude we're getting nowhere. I leave with greater insights into my problems, as the article also discusses, but the problems themselves are still there...I just think about them a little more complexly, which I guess can be good or bad.

Therapy exaggerated my existing tendency to show my weakest side. I was meek, enthralled, deferential at my therapists' feet, though not quite that obeisant outside the consulting room. (I'd made some career progress and had a modest house.) My servility seemed red meat to therapists serving their most extreme savior fantasies. They convinced themselves about my divine improvement anointed with their celestial auras. One labeled a ill-advised romance as great progress; another deemed my cry about mean mommy a forever-more metamorphosis. She even sent me for a beauty make-over to signify my heavenly rebirth she created.

I gullibly trusted all of this. In fact, I needed less externalized authority, more self sufficiency. I needed less emphasis on my defects and unhappy past. Instead I got superparents, subordination and more self-deprecation.

It wasn't until much later I realized the folie à deux, the grand manipulation. I don't see the therapists as melodrama villains. I'm sure they thoroughly believed their own legends.