What would therapy look like if therapist followed this protocol?

Yes, that would be a poor therapist. I've never had a therapist do that. I HAVE had therapists talk to me about why they would like to proceed the way they are planning to proceed and hear me out about my questions and concerns, letting me make the decision about whether I am comfortable with that plan, etc. I've never had a therapist behave dictatorially, even when I was in crisis. I realize it happens but, like you, if a therapist, doctor, or any service provider dictated rather than discussed, I'd be out of there. That's really not what I was talking about. That was your take on what I was talking about.

You are misinterpreting me. I said nothing about dictatorial. I meant what I said earlier. You and I will never agree on this.

I agree with pretty much everything that Artley has taken time to spell out here.

Although I can understand from where the idea of a comprehensive informed consent comes from, I highly doubt it would accomplish anything close to what people seem to hope here. A good therapist will lay all the necessary information out in due time anyway. For the not so good therapist, the informed consent would provide just a very convenient cover that will help to officially roll the responsibility on the patient's shoulders - you were informed and you consented, so why are you complaining?

If I think back abut myself in my first therapy session then the most important thing for me was the vibe I was getting from the therapist - does he seem to understand the problems I'm presenting that I don't understand myself and no one else ever before understood about me? And yes, he immediately saw something in me that rang true and is quite obvious in retrospect but that no one else had seen before. I did not know anything about the therapy at that time and if he would have started to go through some very elaborated informed consent that definitely would have been very hypothetical for me at the time then I probably would have figured that no, he cannot help me and thus I simply wouldn't have found the help I have actually received.

Also, I believe many things have happened in my therapy that my therapist had never experienced before in his work and thus he himself has had to learn and adapt considerably in the course of my therapy, too. That means that he possibly even couldn't have given me informed consent about those things because he simply did not even know that things can go that way.

I generally don't believe in strict protocols in psychotherapy, except perhaps when it is in fact skills teaching. Psychotherapy is based on a relationship between two people and this just cannot be standardized into protocols. Yes, one might try to do that but those therapists, who understand the underlying processes, don't need these protocols and for others, who actually do not understand the underlying processes - the protocols do not help them to start understanding them and thus it's useless and perhaps rather even harmful.

Then they shouldn't try to sell it as a science or part of western medicine. If they want to admit they are just stabbing and guessing and messing with people - I am all for that.

I have never thought that psychotherapy is part of science or western medicine. Sure, some parts of psychotherapy perhaps can be studies scientifically but all these studies seem to be in their infancy still because the subject matter is just so complex.

At the same time I don't think it means that therapists (at least not all of them) are randomly guessing and messing with people. A solid accumulated body of clinical knowledge and experience also goes a long way.

I think it's fine for those of you for whom psychotherapy-as-usual has worked to say that it has worked for you and you like it the way it is.

But are you not hearing how it has hurt others? Sometimes very badly? If heard at all, there seem to be several responses to that.

1. It's the client's fault.

2. It's the therapist's fault -- they are poorly trained, incompetent, or even unethical -- but that doesn't affect the overall view that psychotherapy-as-usual is fine. There are incompetent people in every profession.

3. I just don't believe that people who claim to have been harmed by therapy actually have been. They just need more therapy.

Anything else?

HT, but right now it's not about not hearing how things have hurt others.

It's about whether such protocol with such informed consents would help to avoid hurting people. I don't believe it. I just see no way how adopting such rules would help anything substantially. It's not related at all to the points you brought out.

But, I have been harmed by psychotherapy-as-usual and I do believe it is worth a try.

When I was a "Therapy Virgin" if on the first meeting he went through the warnings of transference I would have thought in my head.."Dude...your are not even my type nor would I want you for a parent. Ewww you wont have to worry about that happening to me." I would not have believed it.

I do like the weekly check ins regarding any feelings of transference coming up so the client does not feel shame and aguish trying to bring it up themselves leaving it to fester until exploding point.

Then we can just agree to disagree. I don't believe it's worth it and I would probably filter out any therapist who would try to do that because for me that would signal those who are just following some kind of protocol and to me that signals incompetence.

Please guys do not get this threat shut down.

I keep reading things on transference on Quora. They keep saying it is normal and that no one wants to leave therapy because the void it fills.

How normal is it to feel like you are going to die and want to claw your throat out and you can not function normally when you lost your therapist?

That is just not normal.

Moxie, I suppose the thing is that transferences are all sorts of kind - from barely noticeable to extremely stormy. I think what you are experiencing is something that many people are not even able to imagine but because you are using the same words - transference - then you and they are just talking with the same words about a phenomenon in completely different magnitudes.

I think what you are experiencing is totally normal too, considering the circumstances. I've felt it few times when I thought I will lose my therapist. For me it was like a sudden storm came up in an instant that clouded all ability to think and all I was experiencing was a total loss of all meaning. I did not lose my therapist (and who knows, maybe you did not lose yours either) but the feeling was definitely very raw and overpowering. I felt I could die. I find it quite likely that most people who talk about transference have much milder experiences in mind.

http://https://www.psychologytoday.c...e-transference

Even psychology today does not have an answer to resolve transference.

This is where free association can be helpful, IME. What you describe sounds like a very hungry infant. Your task now is to re-feel those bad feelings, but in the better, more controlled, adult environment you now inhabit, so you can integrate the bad feelings - that is, dont leave them floating out there, unattached, waiting to jump out at you at any time - but as your t says, use your adult self to wrap a scarf around your neck. Actually my t DID often wrap my winter scarf around my neck as he helped me on with my coat. My parents NEVER did, so yes, it was a reparenting ritual. Maybe you need a t willing to do such things, rather than one who tells you to look to yourself to do them.

Yes, I agree to that.

For a long time, I started sobbing every time I thought of losing my former marriage counselor. Like even the thought of "At some point, we'll end therapy" made me feel like I couldn't survive without him. So I get the feeling. And when we had the big rupture at the end, I thought that maybe I wouldn't get through it, but T and PC helped me. And I got through it. And now it's been over a year since I've seen him, and it's OK (we did communicate over email some during that time, but I haven't contacted him since April). You're stronger than you think you are. But I think having another T who you can see in person (vs. online) can help immensely in getting through it.

Have you seen this discussion of transference on Jeffery Smith’s blog? I think it’s kind of interesting: Attachment to Therapist: A Primer

Good Discussion. I always get transference and attachment confused though. I got attached to my former T but I don't know if I had transference towards her. If she would have told me in the beginning that I would get attached to her though, I would have thought she was crazy. I wouldn't have believed her and I probably would have shrugged it off. Only now that I have been through it, if a T told me I would get attached, now I would believe them. But not when I was new to therapy.

I did not even realize there was a difference. I jus thought it was the same. So am I attached or do I have transference or both?