Bamboozled, hornswoggled and hoodwinked?

On the contrary: they would not be in the news.

Why deprive us of the ancient, time-tested, always reliable, utterly human, self-soothing method of generalizations without sufficient basis in fact? Ninety-nine percent of PC members would be forced to express themselves solely using emoticons. You MUST be fully aware that outside of peer-reviewed academic articles baseless generalization is the way the world works. If that weren't true, the amount of political and economic misery in the world would be reduced by 85%! (No citation) And no, Pach, you can read about truly functional people in The Christian Science Monitor and www.happynews.com. Take care!

FoolZero's question about my selection of therapists and therapy modalities got me thinking about the haphazard manner I employed. My general practitioner referred me to a the first therapist I had. I had no idea about the types of mental health professionals to choose from or the importance of a good fit:

The key to choosing which one of these professionals is right for you is to determine what kinds of things are important to you and finding a professional that seems to fit with your needs and personality. Often times, finding the right therapist or mental health professional takes more than one try. You may need to “try on” a few professionals before finding one that feels right to you. Don’t be afraid to do this, as it is your well-being and treatment you’re investing in. http://psychcentral.com/lib/2006/typ...professionals/

The importance of a good relationship with your therapist cannot be overstated:

Choosing a Therapist

Research on psychotherapy outcomes tells us that the most powerful factor to assist healing is the quality of the relationship you have with your therapist. [1] Addressing sensitive personal issues with a therapist can be difficult, bringing up intense feelings, thoughts and memories. When you choose a therapist, your ability to disclose sensitive material and work on it openly is greatly enhanced if you feel comfortable with the therapist and can establish a trusting relationship with him or her. You also want to feel secure in the therapist’s skills, competence, and approach to your needs — a nice person without these qualifications won’t get you the best results.

For these reasons, I recommend that you don’t settle for the first therapist you meet if you don’t feel the potential to form a strong healing alliance. As you get into the work, feel free to ask your therapist about your treatment plan and progress. If you aren’t happy with her or his approach or with the results you’re getting, voice your concerns early, as discussed below.
http://psychcentral.com/lib/2009/get...therapy/all/1/

DocJohn has assembled a lot of useful information about psychotherapy here: http://psychcentral.com/lib/2009/get...therapy/all/1/

He tells us:

Most psychotherapy tends to focus on problem solving and is goal-oriented. That means at the onset of treatment, you and your therapist decide upon which specific changes you would like to make in your life. These goals will often be broken down into smaller attainable objectives and put into a formal treatment plan. Most psychotherapists today work on and focus on helping you to achieve those goals. This is done simply through talking and discussing techniques that the therapist can suggest that may help you better navigate those difficult areas within your life. Often psychotherapy will help teach people about their disorder, too, and suggest additional coping mechanisms that the person may find more effective.

The most effective therapy for me included a treatment plan that established goals, formulated the means to attain them and included homework. Therapy without some structure was much less beneficial. Here is another article that touches on the subject: http://www.wellsphere.com/mental-hea...therapy/782440

Dr. Jacqueline Simon Gunn wrote a book entitled, In the Therapist's Chair.

Her approach is one of therapist/client equality – both affect each other and self-awareness on the part of the therapist is crucial to success. She says, “In order to be open and receptive to each patient’s particular uniqueness we need to be sufficiently accepting of ourselves. We need to be aware of our own unique traits, whether they elevate our feelings of self-worth or make us uncomfortable. Self-awareness, empathy and acceptance of both our strengths and inadequacies are all vitally important to our work with our patients.” http://psychcentral.com/lib/2010/in-...rapists-chair/

This quote reminds me therapists are not superhumans to be placed on a pedestal. They have a very difficult job. A good therapist is invaluable.

Most of the therapists I saw did not design a treatment plan or tell me the type of therapy they intended to employ or state what was expected of me. Many talked about getting paid. When I started with therapy I was so unknowing of what I wanted from therapy. I was too ignorant to ask intelligent questions. I just knew I did not like what was going on and could not change it for the better alone.

I'm not sure when you were in therapy but I do notice that therapy seems to have come a long way since I last was.
I think a major problem for me was that I assumed there was something wrong with me that my therapists would see (since they were the experts) that I couldn't (since I was the patient), and that for the same reasons, they'd be able to tell me what to do whereas I'd never find the right direction by myself.

Since I was already used to hearing that whatever difficulties I was having were my fault (although for a different reason each time ), I was wary of stumbling into a situation where my therapist could possibly tell me I wasn't trying, or I misunderstood, or I was doing it wrong. The result was that I'd try to anticipate what they expected and give it to them, even if it meant saying things that I wasn't quite sure were true or sometimes not saying things that might make me sound like (my idea of) a bad patient. I'd present with those problems in particular that I thought would be easiest and most rewarding to recover from and least likely to confuse or freak out my therapist. Then, once we'd established that their methods worked for me and I was a good enough patient for them, we could go on to the hard stuff if we had time.

I was in my early 20s at the time, and accustomed to unequal relationships with authority figures. I figured the therapists would be deciding how the therapy was going, whether to keep me as a patient, and what to try next. I didn't trust them to do the right thing or make the right decision every time, but I wasn't going to be in a position to argue or appeal. I needed to keep looking like the kind of patient they'd want to keep working with, and hope that whatever they decided to do did me some good.

I later came across several authors who did seem to show a good understanding both of therapy itself and of my experiences with it. The first few I think of are Carl Rogers, Irvin Yalom, and Steven Hayes. I have to admit that they, and therapy, make a lot more sense to me in retrospect. I'm not sure how useful I'd have found them if I'd read them before starting therapy.

---------------------
edited to add: While looking for some of those other links, I also found this collection.

Thanks for your comments and links, Fool Zero. Thanks to all commenters, for that matter. While in hindsight it may seem ridiculous for me to have thought all I had to do was show up and the therapist would fix me, I am not embarrassed for thinking so.

At the time I was trying to overcome a chronic illness. I was seriously struggling, Even then, it took a lot of will for me to accept I could not get through this myself and needed help. Once I made the decision, I thought I had taken the biggest step to getting better. After all, therapists were the experts. My therapist would rid me of my malaise and have me smiling in no time. All I had to do was respond to the therapist's questions, listen carefully, follow instructions and live happily ever after.

Frankly, I do not understand how I could have been expected to think otherwise. I had no idea about the various types of therapy or what qualifications I should be looking for. I should have interviewed potential therapists? News to me. Etc., etc.

Even if I had known more I doubt it would have made a lot of difference. For me, the experience of therapy was my teacher.

There's no way anyone can know what to expect and even once going through it, it is still a maze. The mind in of itself is a mystery, how can anyone expect to know?!

I too had higher hopes than I initially started with and at times have lost it along the way. I continue to hope for more knowledge, insight, understanding, and compassion as time goes on. It is more gradual than would like but it has become better than times past on one hand and less in some respects on the other.

Everyone's posts have been so valuable into the nature of the treatment and the profession. It has been considerate, thought provoking, beneficial, and at times very difficult, yet important. I just wanted to thank everyone for posting. Thank you TheB for sharing and for starting it. This has meant more than I can say.

There is nothing to be ashamed of at all; for a long time, that "come in and be fixed" attitude was, perversely in a way, encouraged by the culture of the times. The the professional would pathologize the attitude that you had that said "fix me" instead of trying bravely to fix yourself Catch 22 all over again.

For a long time, the goal was that we were al supposed to be "happy". I don't know, I find it hard to define what would be "happy" for me especially if it was supposed to last my whole life. For me, the meds HAVE made the difference between having to be on a form of disability and being able to work and manage myself. All the insight in the world wouldn't have been able to save me.

But no, nothing has reached the old time therapy goals of making me HAPPY, and the more I have accepted that nothing can make me that way, the better I feel. Wierd, I know, but like, with Christmas, I ´'m much happier if I manage to make the kids really get into it than if I try to recapture the feelings I had as a kid, because well, I'm not a kid anymore. But this Christmas I found myself darned close watching the kids with each other, not even with the darned gifts, with each other and the tree we cut under the power line. I'm not making much sense, but...

Are we and our therapists working for the same thing? Are we defining our terms the same way? Is what I want and what the therapist would want in my place the same thing? If not, whose definition should win out? what do you think, Byz? I have my druthers both as a prof and a pat. I'm kind of interested in hearing if I'm the only one who has wondered this as as well.

Our pharma television advertising promotes this expectation even now, it seems to me!

Hello, lonegael. Your question is one I have pursued with vigor in "discussions" with more than one professional. I want to make clear my answer is subjective and is not intended to be persuasive. The thread on inability to change comes to mind.

Happiness for me is a slippery concept that I find rather unhelpful. My goal is to increase functionality. This definition of recovery by William Anthony is my exemplar for enhancing my ability to function at a higher level:

" a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness."
http://www.mhrecovery.com/definition.htm

As the years passed, I became more assertive in expressing what I wanted and expected from therapy. I felt some of the professionals needed to be reminded it was I who had hired them; I was not one of their experiments and definitely expected to have a voice in my treatment.

This quote from an article entitled A New Model of Recovery from Mental Illness is one I would like to incorporate into my treatment plan: "Self-Direction: … By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals."

One of my therapists asked me to envision standing in front of a door. On the other side of the door was the life I wanted for myself. He asked me what that life would entail. He further stated my life would always be changing to some degree. He wanted to know about the core values I admired and the requisites I needed to make my life more fulfilling. The exercise was very thought-provoking.

If my recovery (increased functionality) is going to be self-directed, what is the role of the professional? The professional is the one that helps me get well enough to sell-direct. He/she tells me when I am grandiose, intellectualizing or short-sighted and narrow-minded. She/he helps me formulate a treatment plan to get better and reach my goals. The plan must have micro goals and a macro goal. The plan should be revisited frequently for updating and accountability. In short, the professional is my brain trust, my cohort and my sounding board.

At the onset of the relationship, it is important that the professional familiarize the client with the Patients Bill of Rights, informed consent, client autonomy and the professional's expectations of the client.

APA's Ethical Principles of Psychologists and Code of Conduct sets forth the core values of our profession. The title of the document conveys that the Ethics Code consists of two central aspects: a set of principles and a code of conduct. While the code tells us that the principles are aspirational in nature and that the ethical standards are enforceable rules for conduct, much more can be said about this subtle and rich relationship.

Principle E of the code's General Principles, "Respect for People's Rights and Dignity," begins by stating "Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality and self-determination." Throughout the code are examples of how psychologists respect their clients' right to self-determination. Respecting a client's right to self-determination both manifests a core value of our profession and plays a helpful and important role in providing services that will benefit clients.

Perhaps the most apparent way in which the new code supports a client's right to self-determination is found in four ethical standards with "informed consent" in their title: Standard 3.10, "Informed Consent"; Standard 8.02, "Informed Consent to Research"; Standard 9.03, "Informed Consent in Assessments"; and Standard 10.01, "Informed Consent to Therapy." Obtaining informed consent respects a client's right to self-determination by informing the client about central aspects of the relationship and obtaining from the client consent to proceed. Through the process of becoming informed, the client receives information on which to base a considered decision; through the process of obtaining consent, the psychologist ensures that the decision to proceed belongs to the client and is not the product of coercion.

The process of obtaining informed consent also holds important clinical meanings. Through informed consent, the client is made a collaborator in the work. Research has shown that when clients experience themselves to be true partners in the therapeutic process, the likelihood of a beneficial outcome increases. Here is an excellent example of how good ethics can promote good clinical care.

The Ethics Code emphasizes and elaborates the centrality of informed consent in a variety of ways. Standard 3.10, in the "Human Relations" section, provides that psychologists obtain informed consent when they "conduct research or provide assessment, therapy, counseling or consulting services," while other standards take this general language and apply it to specific circumstances: Standard 8.02 to research, Standard 9.03 to assessments, and Standard 10.01 to therapy. Numerous other standards that do not make explicit mention of "informed consent" nonetheless promote self-determination and autonomy, as well as excellent client care. http://www.apa.org/monitor/jun04/ethics.aspx

http://www.healthyminds.org/Main-Top...of-Rights.aspx
http://blogs.psychcentral.com/therap...ill-of-rights/

The premise of autonomous decision-making fits well with my preference for self-direction. It also lessens over-reliance on the professional while curtailing client finger-pointing.

Enough. I am so windy!

Very good points, both of you!

I mentioned Steven Hayes a few replies ago; well, he also wrote the foreword to a book by Russ Harris called The Happiness Trap. <--- Google Books (partial copy online) A month or so ago another member posted a link to a worksheet (pdf) taken, as I understand it, from that book.

I just tried to download a promising-sounding video, Steven Hayes on Happiness, but it doesn't seem to work well with my browser. I'll let anyone else interested pursue it further.

Years ago, the pursuit of happiness actually felt like a big breakthrough for me. My family of origin had been pushing me to choose a suitable career, get the right training for it, and set up my circumstances so that I could (eventually) be happy; if I failed to do that, they warned me, I was sure to end up unhappy. It bothered me no end that in order to (theoretically) be happy I'd quite likely end up working in some field that I didn't really enjoy that much and giving up most of what I was really interested in.

I was 17 or 18 when it dawned on me that happiness wasn't some place that I needed to get to by doing all the right things but (apparently) a natural consequence of doing what I enjoyed. Of course this brought its own complications: if I were to find I enjoyed reading poetry or getting drunk or skipping school or dating unsuitable girls, wasn't that likely to cost me in the long run? How could I tell, though, if it was going to cost me more or less than persevering with an education for some career I didn't expect to enjoy? In retrospect, of course, I was lumping together lots of dissimilar and perhaps incompatible experiences to represent "happiness" but I had no way of figuring that out at the time. I don't know if my therapists would have been able to explain it to me (or how well I would've followed their explanation if they'd tried), but in any case I didn't ask. I was probably expecting to be told that it was all up to me, that I had to study the alternatives, make the best decisions available, follow through, and find out much later if I'd chosen well or not. It seems to me, though, that I was in therapy precisely because I was having difficulty with every step of that. Probably my therapists did the best they could to help me back off from whatever immediate crises I felt stuck in and start exploring how I actually felt about my choices. It was a long way from enough but it was definitely a step or three in the right direction. I did end up changing my major in school (from math to psychology! ) just a few months after starting therapy.

Byz, I guess this is where the problem arises for me: at certain points in my life, autonomous choices and self direction were what were killing me. No metaphoric speech intended. At some point many of us patients go through periods where we aren't really in a position to make decisions for ourselves, or even to see when we have reached that point. This does not mean that we atay in that stage, or that we all have to go through it, but there are those of us who go to get help and find ourselves given istead plenty of rope and lots of questions about "now, what do you think you can do with this+ What else? can you describe that further?" with all that help, I got a couple of lovely nooses knotted in those ropes... What I had needed was someone who said "you need to sit here and not move while I call an ambulance and your husband to take the baby, it's going to be OK, but you are going to need some help to get back on your feet. It's not normal for a new mother to feel this way and hear what you are hearing."

There is also another problem. Even ethical therapists influence their patients. There were studies dne where even Carl Rogers was seen to influence what his patients brought up in therapy and how they "developed" just from the subtle ways that he sat, nodded, and looked up at the patient in sessions. Rogers was not trying to unduly influence his patient. He was very against such things, but even as well train as he was, he was human, and humans communicate our views, emotions and expectations through more complicated ways than those we learn to recognize in training as psychologists, but which we as members of the species use and read none the less.

One of my professors used to say: "ethics are a fine place to start, but they are by no means sufficient when it comes to how you should treat a patient or how honest you should be with yourself." Soemtimes, you even have to go against eithics codes to do the right thing, but those things are not really related to what we are talking about.
Thanks for this thread, Byz! I do LOVE them mental gymnastics! HUGGGGSSSS!

Hello, lonegael. Yes, I totally agree with you. There have been quite a few times when I did not have the capacity to make even informed choices. My incapacity was both a function of my illness and my ignorance.

For years, I did not even understand I had a say in my treatment. The therapist that helped me the most talked about getting better as a requisite to more autonomy. He worked very hard to reverse the burnout that had consumed me so I could resume practicing law. When I told him I would no longer be a lawyer, he was very disappointed.

When practicing law, I would not tell clients what I thought they should do. I gave them alternatives. Of course, as you mention in the case of therapy, there are ways of influencing the decision-making process in the practice of law too.

Again, I want to stress my response is subjective and based upon my experience in therapy. As a consequence of being a lawyer I was used to dealing with alternatives. In a more general sense, I wish all of my therapists had talked about the role of clients in therapy. Frequently, I was perplexed when my therapist would not tell me my diagnosis, or why she/he was focusing on a particular subject, and did not involve me in decisions about treatment.

Therapy was very challenging for me. I really, really disliked being told I did not understand. I expect it was a bit challenging for the therapists too.

Current one has prescribed a low dose of a med 40-80 mgs that normally is 120-180 for most with my disorder but I react just fine on this lower range. \\yes... thanks for describing this

Hello, Wallowa, Glad you are doing well.

During the course of this thread, I have poked fun at those who treated me. Nonetheless, it does take two to make therapy work. When it became apparent I was not making progress during therapy, I became disillusioned.

This thread has been quite an adventure for me. Like Keynes, I have changed my mind about some things. In particular, I regret not having been a better client. By saying that, I do not mean to say I had to capacity to be one. After so many failed therapies, my expectations diminished and so did my will.

Thanks to Fool Zero and Kiya for these links that address a client's responsibility in therapy:

10 Qualities a Therapist Recognizes in a Good Client, part 1
10 Qualities Therapists Recognize in Good Clients, part 2
Protecting Your Therapeutic Relationship and the Therapeutic Community

After reading these articles, I have a better understanding of why I was told I did not have a personality that was conducive to therapy. I did not plot to be a difficult client, just as I did not set out to be mentally ill.

This Kathy Brody comment I found interesting:

These qualities, in my opinion, have nothing to do with mental illness. I have worked with some very disturbed people with huge issues, and yet, they possessed these qualities, and they made huge progess in their healing. I’ve also seen some folks who appeared to be rather high-functioning, and yet, they did not, or could not grasp some of these basic ideas. http://discussingdissociation.wordpr...lients-part-2/

The highlighted part seems to speak to me about why so often I was told I did not understand. Oh well, I am doing okay these days.

http://mentalhealthce.com/courses/co...B/secCB29.html

Despite being Bamboozled, hornswoggled and hoodwinked? You've come out the other side pretty darn good! ((((((( TheByzantine ))))))))

Pachy, you are right. A person can not re-cover something they never had. Would that mean we "covered?"

There's a saying I heard in group once that I've taken to using. "Normal" is a setting on the dryer." To me "good mental health" means being able to function on a daily basis. It means I experience a full range of emotions that are related to the world around me.

TheB, thank you for starting this thread. And thanks to everyone who responded. It's been an enlightening read.

Byzantine,

Glad you were able to get a bit (well more than a bit) more out. I'm sending you another just plain 'ole hug' but well intended.

My observation is that you don't give any of us anything that you haven't thought through (as much as you could/can) and I really like that.

“Science without religion is lame.
Religion without science is blind.”
Albert Einstein

lonegael's comment about autonomy and self-direction got me thinking. On more than one occasion, I was without the ability to function. Twice I lived in what I will describe as a structured home. My psychiatrist would come to the home to see. I thrived at the structured home. I had the most restful steep there. Doing what I was told was my only responsibility. The morning did not bring to bear the stress, anxiety and fear I was used to. The recovery model would have been folly for me.

As lonegael stated, ethics and patient rights at times may be problematical. There must be some flexibility to allow treatment that is in the best interest of the client.

There are many articles discussing the merits of the recovery model. Here are some of them:

http://stopthrashingaround.wordpress...ecovery-model/
http://www.cmha.ca/data/1/rec_docs/7...al_illness.pdf
http://en.wikipedia.org/wiki/Recover...l#cite_note-17
http://www.psychologytoday.com/blog/...-part-the-cure
http://www.empowermentcouncil.ca/PDF...ay%2014-03.pdf
http://psychservices.psychiatryonlin...ull/52/11/1462
http://ps.psychiatryonline.org/cgi/c.../full/52/4/486