[guilloche]

I saw this the other day, and it really resonated with me (so much so that I immediately forwarded the links to my T and talked with her about it later that day.)

They talk about people (with a very small sample size, I think it was only ~8 people) who either didn't get better, or who got worse in therapy, and what traits they shared.

Some of the traits (of the clients!) were:

- smart, with good defenses, which seemed to confuse/distract the therapist

- The client may look more functional/well than they feel, and the therapist initially misjudges the amount of dysfunction.

- Similarly, the therapist initially connects with the more competent part, and doesn't really interact with or relate to the part that actually needs therapy.

- The therapists reported feeling like there was only "half a person" in the room with them, and feeling like they were treated more like an object or piece of furniture.

I very much relate to most of this. These were people who spent 2-3 years with their therapist before dropping out of treatment... which I've done, with several therapists, and felt not helped.

I've been trying to talk about this stuff with my current therapist... and she's been really great about being willing to talk about it and not take it personally, although I think it's frustrating for her. (Note: I've been seeing her for about a year so far. And, we're still trying to figure out this whole thing of "how can therapy actually be helpful to me?")

I don't know. I don't quite know what to do with all this yet. I wanted to share the links though, and to see if anyone else related. I did think it was kind of nuts that the therapists interviewed still felt that they had been helpful, because my experience is that the therapists I've seen previously really were not... and didn't realize that they weren't.

Here's a short summary of the article:
https://digest.bps.org.uk/2018/05/25...ven-got-worse/

And here's the longer write-up with lots more details:
https://www.tandfonline.com/doi/full...7.2018.1453621

Thanks!

[CantExplain]

I'm smart with good defences.

But I stuck it out for ten years, and I did get a lot better. I'm less angry and less fearful.

[CantExplain]

The therapists described how trying more actively to wrest back control led to “fruitless battles”, and the process terminated with the therapist in an emotional state, overwhelmed by the client’s energy.

There was a lot of this between me and Madame T.

It would appear that the Ts failed to see that this wasn't working and failed to switch to a less controlling strategy.

[CantExplain]

I notice no one asked the patients what they thought went wrong.

[CantExplain]

The summary paper doesn't accurately reflect the contents of the full paper. The full paper reveals that there were things the patient just refused to talk about. That wasn't my problem at all.

[CantExplain]

Originally Posted by CantExplain

I notice no one asked the patients what they thought went wrong.

My bad. The full article has some patient feedback.

"However, the theme of the patient’s aversion for closeness was absent in the patients’ narratives; instead they described the relationship as artificial, attributing this to the therapist."

I can relate to that.

But they should go further and interview therapist and patient together (after interviewing them separately.) That, to me, seems the best way to get to the bottom of what went wrong.

[CantExplain]

"Thus, there is a marked difference between the patients’ and the therapists’ experiences of the therapeutic process in cases of nonimprovement. We interpreted experiences of nonimproved patients as an unbalanced therapeutic alliance, with a good-enough emotional bond, but not enough agreement concerning therapy goals and tasks (Werbart et al., 2015 Werbart, A., von Below, C., Brun, J., & Gunnarsdottir, H. (2015). “Spinning one’s wheels”: nonimproved patients view their psychotherapy. Psychotherapy Research, 25(5), 546–564. doi: 10.1080/10503307.2014.989291
[Taylor & Francis Online], [Web of Science ®], [Google Scholar]
). Conversely, the present study showed that the therapists experienced deficiencies in the emotional bond. However, both patients and therapists shared an experience of remaining core problems and that therapy was insufficient. The results from the two studies taken together indeed imply that therapists and patients did not find a common idea of what should be focused in therapy: the therapists tried to bring up countertransference as a means to address relational problems, but the patients did not mention this as helpful and wished for focus on concrete life matters. Thus, neither the goals and tasks in therapy seemed shared nor did they develop a trusting emotional bond."

Put simply, patient and therapist wanted to talk about different things.

That's not long enough to make a real judgement.
2-3 yrs. Some stuff takes that long or longer to reveal itself.

I'm not saying. That therapy is for everyone. Just that 2-3yrs is a blink in therapy time lines.

[ShadowGX]

I've had a mix of all of it said to me, most common being the first one. The problem with therapy is you have to buy into some things that don't quite make sense realistically and so when I point that out or otherwise defeat these thing I get told things like "you're too smart for your own good". I just don't get why it's so hard to come up with something believable. I've even pointed out how some techniques could be more realistic at times... It's frustrating and makes it hard to feel like I will ever get better when the thing that is supposed to help just makes me feel bad because I can't dumb myself down.

[koru_kiwi]

Originally Posted by CantExplain

The therapists described how trying more actively to wrest back control led to “fruitless battles”, and the process terminated with the therapist in an emotional state, overwhelmed by the client’s energy.

There was a lot of this between me and Madame T.

It would appear that the Ts failed to see that this wasn't working and failed to switch to a less controlling strategy.

i experienced similar in therapy too...

[koru_kiwi]

Originally Posted by CantExplain

"Thus, there is a marked difference between the patients’ and the therapists’ experiences of the therapeutic process in cases of nonimprovement. We interpreted experiences of nonimproved patients as an unbalanced therapeutic alliance, with a good-enough emotional bond, but not enough agreement concerning therapy goals and tasks (Werbart et al., 2015 Werbart, A., von Below, C., Brun, J., & Gunnarsdottir, H. (2015). “Spinning one’s wheels”: nonimproved patients view their psychotherapy. Psychotherapy Research, 25(5), 546–564. doi: 10.1080/10503307.2014.989291
[Taylor & Francis Online], [Web of Science ®], [Google Scholar]
). Conversely, the present study showed that the therapists experienced deficiencies in the emotional bond. However, both patients and therapists shared an experience of remaining core problems and that therapy was insufficient. The results from the two studies taken together indeed imply that therapists and patients did not find a common idea of what should be focused in therapy: the therapists tried to bring up countertransference as a means to address relational problems, but the patients did not mention this as helpful and wished for focus on concrete life matters. Thus, neither the goals and tasks in therapy seemed shared nor did they develop a trusting emotional bond."

Put simply, patient and therapist wanted to talk about different things.

and this too...

[ruh roh]

Originally Posted by ShadowGX

I've had a mix of all of it said to me, most common being the first one. The problem with therapy is you have to buy into some things that don't quite make sense realistically and so when I point that out or otherwise defeat these thing I get told things like "you're too smart for your own good". I just don't get why it's so hard to come up with something believable. I've even pointed out how some techniques could be more realistic at times... It's frustrating and makes it hard to feel like I will ever get better when the thing that is supposed to help just makes me feel bad because I can't dumb myself down.

I asked my therapist last week if a person has to suspend their disbelief in order for therapy to work and she said for some, like me, probably so, but then she said she would have to think about it some more, which meant it would not come up again unless I press it and even then she will probably ask me if this is how I want to spend my time in therapy. It's frustrating.

[Erebos]

Will go on and have a look but this sounds like my experience all over.
And why my pdoc no longer refers me to therapists.

[TeaVicar?]

Originally Posted by Mouse_62

That's not long enough to make a real judgement.
2-3 yrs. Some stuff takes that long or longer to reveal itself.

I'm not saying. That therapy is for everyone. Just that 2-3yrs is a blink in therapy time lines.

That's true Mouse but therapy still needs to feel as though some progress and attunement has been achieved in that time, in order for the client to stick with it.

[Fuzzybear]

Originally Posted by CantExplain

The therapists described how trying more actively to wrest back control led to “fruitless battles”, and the process terminated with the therapist in an emotional state, overwhelmed by the client’s energy.

There was a lot of this between me and Madame T.

It would appear that the Ts failed to see that this wasn't working and failed to switch to a less controlling strategy.

I can relate to this, particularly to the T’s failing to see that their controlling strategy wasn’t working.. and to “fruitless battles”

The therapist maybe became overwhelmed.. certainly not functioning at their “best” (why so many unhelpful, useless “interpretations” )

I also had “good” defences when I first went to therapy, I was labelled “intelligent” etc by the shrink. He actually took quite an “accurate history” in
one appointment (unlike a GP ). I would imagine he was experienced enough to know he couldn’t “get it all out” of the “patient” in one appointment ...

There was some progress and apparent attunement in therapy in 2 to 3 years.

But then.... not so much, a “bad fit” between “patient and therapist” to put it politely.

My experience and feelings were discounted. How the therapist felt was “more important” ...

[TeaVicar?]

Originally Posted by CantExplain

I'm smart with good defences.

But I stuck it out for ten years, and I did get a lot better. I'm less angry and less fearful.

Same. I'm coming up for 10 years too. I think it has been very helpful in lots of areas but it has also been a very painful process and I'm not convinced that the level of pain and suffering was really needed to achieve the end goal. Boundaries are rigid (for who's sake? Not mine.), and getting a small amount of additional support, which I desperately needed, took 9 months to negotiate. The whole thing feels very deceptive to me... either I've completely misunderstood what a therapy relationship should be or I have been encouraged to foster a dependency on someone who could have never met my needs in the first place and who has actually been pretty inconsistent and flaky with his idea of 'care' anyway.

Therapists who remain rigid in their beliefs and behaviours (in opposition to what the client is telling them/asking them) are, on some level pushing their clients away, so it's no wonder they leave.

[mcl6136]

I read some of the longer one and here is what struck me: Therapists could not accurately discern when the client was deteriorating.

Man, that says it for me. There have been so many times when I had to spell out that I was IN TROUBLE and a RISK TO MYSELF. And insist on it. I guess that says a lot about my defenses.

And yes, fruitless battles kind of summarizes my bad therapy of the past.

[here today]

Interesting articles, guilloche!

I could, and did, tell therapists that I felt "split". Mostly only the competent me showed up in therapy, why not, that's who could deal best, with therapists and with life -- and when the "bad me" did, they couldn't deal with it. :-(

I could keep the "bad me" away -- "I" (the more conscious and adapted me) actually worked very hard over a number of years to try to "get in touch" with the emotionally disconnected/dissociated part of myself.

Glad therapists are looking into this. Wish they would or could have years ago! Also wish they could or would ask some of us who have experienced bad and/or ineffective therapy over a long number of years -- 55 years for me on and off, 20 almost continuously until 2 years ago, 6 with the last who decided that she "did not have the emotional resources" to continue therapy with me.

Good luck, guilloche, hope your therapist can understand and can help! Please keep me/us posted.

[Fuzzybear]

Thanks for sharing ....

Originally Posted by here today

Interesting articles, guilloche!

I could, and did, tell therapists that I felt "split". Mostly only the competent me showed up in therapy, why not, that's who could deal best, with therapists and with life -- and when the "bad me" did, they couldn't deal with it. :-(

I could keep the "bad me" away -- "I" (the more conscious and adapted me) actually worked very hard over a number of years to try to "get in touch" with the emotionally disconnected/dissociated part of myself.

Glad therapists are looking into this. Wish they would or could have years ago! Also wish they could or would ask some of us who have experienced bad and/or ineffective therapy over a long number of years -- 55 years for me on and off, 20 almost continuously until 2 years ago, 6 with the last who decided that she "did not have the emotional resources" to continue therapy with me.

Good luck, guilloche, hope your therapist can understand and can help! Please keep me/us posted.

[unaluna]

Originally Posted by here today

Interesting articles, guilloche!

...(Of course, xxxxx won't see this because I am on her "ignore" list.)

Actually, if you are on someone's ignore list, they get like a title line showing them that you have posted, and they have the option of viewing that post, without removing you from their ignore list. So you can assume everyone can see your post.

Signed,
Obviously experienced in the mandatory ignore list!

[missbella]

My response to this article could be just as long as the article itself, but will stop myself. This is yet another piece full of subjective (self-protective?) observations, seeming to put most of the failure of therapy on the client's failures. Freudians were and sometimes still are far more fevered and furious in their patient bashing, so I'm glad this author toned it down.

Half a patient? That's an remote way to see another human being. I see the first omission is failing to view the transaction in everyday human terms and roles: the asymmetrical relationship, a seeker and the sage, the confessor and concealer, the sufferer and the authority. The structure doesn't work for everybody.

I was particularly struck by the ascription of the client's "aversion" to her defenses, assuming the entire transaction intrapsychic (in her head). I can envision other explanations why human beings might pull away from one another, but maybe I have a runaway imagination.

I wish mental health thinkers would ditch the theory momentarily and consider interactions in simple human terms. I experienced therapy as role play, an artificial construct. That pulls in a barge full of complications, potential hazards and impediments.

[here today]

Originally Posted by missbella

My response to this article could be just as long as the article itself, but will stop myself. This is yet another piece full of subjective (self-protective?) observations, seeming to put most of the failure of therapy on the client's failures. Freudians were and sometimes still are far more fevered and furious in their patient bashing, so I'm glad this author toned it down.

Half a patient? That's an remote way to see another human being. I see the first omission is failing to view the transaction in everyday human terms and roles: the asymmetrical relationship, a seeker and the sage, the confessor and concealer, the sufferer and the authority. The structure doesn't work for everybody.

I was particularly struck by the ascription of the client's "aversion" to her defenses, assuming the entire transaction intrapsychic (in her head). I can envision other explanations why human beings might pull away from one another, but maybe I have a runaway imagination.

I wish mental health thinkers would ditch the theory momentarily and consider interactions in simple human terms. I experienced therapy as role play, an artificial construct. That pulls in a barge full of complications, potential hazards and impediments.

I can understand your reaction.

The article seems written in therapy-speak, for therapists.

But the conclusions and implications do seem to me to point to, or at least hint at, problems in the therapists' attitudes, and attitudes common in therapy literature that I have read. Almost tongue-in-cheek in the article, to avoid seeming outlandish?

To conclude, having half of the patient in therapy can be emotionally trying and evoke strong, contradictory countertransference reactions.

I found this particularly shocking, like a slap in the face. Imagine what it's like to BE half-people! But the article is written for therapists and hence some expression of empathy might be understood or at least excused. The authors then went on to say:

Throughout the treatment, the therapists experienced themselves as being particularly committed and active, strongly affected by the patient’s predicament. . .At termination, they additionally experienced the therapeutic relationship as marked by fruitless battles and loss of control of the process, feeling despaired, helpless, and frustrated.
. . .
In our study, the therapists’ unprocessed positive regard of the patient seems to have contributed to the therapist underestimating the patient’s problems. . . They do not attribute the limited progress in therapy to their own limited understanding of the patient’s problems, but rather to the patient’s lack of will to open up and try harder. Taken together, this resulted in an inability to adapt their technique and to address their interventions to the patients’ core problems

Several implications for clinical practice and psychotherapy training might be drawn from our findings. . .In such cases, when the patient does not participate with her whole emotional life, this might be the patient’s core problem.

All-in-all, conclusions that I can agree with as a possibility for some folks, based on my own internal experience of myself and my long experience with ineffective and sometimes harmful therapy. I certainly tried to participate with my whole emotional life. But maybe when the split is serious it needs some serious understanding -- something the therapists I saw, even supposed experts, seemed unable to do.

[missbella]

Originally Posted by here today

All-in-all, conclusions that I can agree with as a possibility for some folks, based on my own internal experience of myself and my long experience with ineffective and sometimes harmful therapy. I certainly tried to participate with my whole emotional life. But maybe when the split is serious it needs some serious understanding -- something the therapists I saw, even supposed experts, seemed unable to do.

I agree with you HT, that if this half-client creature exists, she needs serious understanding.

But I question the study's assumption that the failed client did so because she hid her weaknesses from the therapist.* Who goes to therapy to convince the therapist how strong she is? Isn't the point of therapy to talk about problems? I do feel it's impossible for a therapist to know much about the client's life, only experiencing her in one very specific setting. The rest of the picture is created by the client's description.

*That said, my therapists seemingly wanted to believe their magic worked and either denied some of my problems or painted a rosy interpretation to them. They were the ones who backed away.

[unaluna]

Heretoday - i thought the article was agreeing with you, saying that in effect the ts were blinded by the clients light. I guess i see that as the article saying it was the ts fault for not seeing past the brightness, not that it was the clients fault for being too shiny. Am i misunderstanding?

[here today]

Originally Posted by unaluna

Heretoday - i thought the article was agreeing with you, saying that in effect the ts were blinded by the clients light. I guess i see that as the article saying it was the ts fault for not seeing past the brightness, not that it was the clients fault for being too shiny. Am i misunderstanding?

I wasn't aware of trying to say that it was the clients fault for being too shiny. Although, maybe that came through somehow? I have a very dark side, that I can hide by by my brightness? Not sure I was really aware of it, but maybe I had found that it worked, in childhood not in therapy per se. But once it was there, it was a pattern that I used in the "outside world", even as I accepted that there was something different "down deep", and I tried very hard to see it, etc. I probably have done that now -- but nobody can stand me when I am in my "dark self"! I guess I see that as therapists' fault. Maybe it's like you don't want surgeons who faint at the sight of blood or something? I can't help the issues that I came into therapy with, any more than I could help by the ways I already had when I came into therapy. So shoot me, why don't you?

I can't stand me much, either, when I'm in that state. And, having tried to deal with it in therapy and failed, I pretty much keep it turned off. Sometimes I allow some bits and pieces out -- there is some in the post that you just responded to. And I had actually signed back on to edit that post and maybe eliminate it.

Thanks for asking.