The Failure(s) of Therapy - What needs to change and why?

I DO have a light switch, though it's not instantaneous, and I can behave well -- suppressing the (invalidated) little girl. But, in therapy, I thought -- it's therapy, learn how not to turn the feelings off. But when I did NOT do that, when I allowed the switch "ON", I did act out some -- and the therapists shamed me. Since the acting out little girl had had little experience in the real world, the adult me was clueless.

I had cognitive control of the on/off switch, but not so much what I did if I allowed my feelings ON. Seems like a clinical psychologist with 2 years post-doc training in trauma and dissociation should have understood that? Been able to deal and even help with that? But NO, she didn't. Shamed me and then terminated me because she "didn't have the emotional resources" to deal with me. Re-enacting what was similar to my early life, which I had cut off and suppressed and learned to behave like a "good girl".

What a horrible and disruptive experience to retrace back to that. Thanks so much, therapy! Lead me back to that and then dump me. Gee golly whiz. It may be important, but. . .to do the psychological "surgery", locate the source of the toxicity, expose it, and then leave the original and additional wound open and oozing goo, and . . . "Go find another therapist." The goo is unpleasant, and the therapist doesn't have "the emotional resources" to deal with it? And, so far as I can tell, that is "ethical", according to the code they have written for themselves.

Too many of them don't know what they are doing and the devastating effects that can have on the people they have agreed and taken money to "help", and that needs to change.

@Xynesthesia2

I am so sorry that you were sometimes misunderstood here (or perhaps elsewhere) - I will re-read what you wrote later, after I return from my meeting today - but I wanted to say that it takes a lot of courage for your to say what you just said to me, and your statement about feeling .

Your statement, "...I have been grossly misunderstood on this forum by some before..." stood out to me.

You being in the mental health field is important, and your opinion matters! I can understand not wanting to go outside that, nor would I want any mental health professional to do that (unless they are grossly negligent of their duties, of course, but most are not, and most "slights" or ruptures in therapy are correctable or resolvable, whereas other more serious "slights" are fixable with assistance). Like another person here said, "You cannot throw the baby out with the bathwater." I agree with that statement.

I'm not against therapy or therapists at all, but I am in a position to say something because I'm not a professional and currently not a student. I have a feeling, however, that I might be limited on what I can say when I become a graduate student - or not.

That said, I think it is important for everyone to have room to be authentic in their opinions - yours included. What I would like to hear more dialogue on outside of the clinical room is what therapists, psychiatrists, etc. think about some of the abuses done in therapy, or even perceived abuses. It would be good to not have a one-sided argument, as that does not solve the issue.

Most of the people I studied with during undergrad are probably licensed mental health professionals by now (I took a five year break after undergrad), and I honestly wish them all the best. I wouldn't want to attack their careers. I also have a really nice neighbor who is a social worker, and it feels great to know someone who is not MY therapist but who is just a neighbor. She's so busy, but when we do get five minutes to chat, I ask her about her day. She maintains confidence, but she tells me how her day has went very vaguely, and when she has a rough day, which is all she says, I can only imagine. She will say something like, "I've had a really rough day, so I'm going to walk my dog and relax for the rest of the night." My replies are always, "I hope you feel better," and "I'm sorry you had a rough day!" I do know that compassion fatigue and secondary/vicarious trauma are hard to deal with, so I have compassion right back at therapists who deal with that when they hear difficult things from their clients. I think it's great for therapists to have a supportive network, too, such as therapists helping therapists.

Anyway, I thought I'd reply to you this morning before I got ready. I will reply again once I've slowly read your response. I liked what you said!

I think many (most?) professionals see the concept of Ego outdated now, why it is not being used in research studies much. Surely some psychologists and psychotherapists, especially the analytic kinds, still work with it some but mostly the older generations, in my experience. There are many exciting theories and approaches regarding the "self" though in modern neuroscience and neuropsychology in the area of consciousness. It is not my area of expertise but something I am very interested in and, actually, that was the area I wanted to do research on ~10 years ago when I decided to shift my scientific interest to the neurosciences, it was my first interest back then. I just choose not to pursue it professionally because I did not have the training required (I wanted to do experimental, not just theory) and I had already built a great chunk of my career/expertise on other areas that could be applied immediately to other fields of neuroscience and, actually I had some pretty unique background at the time that provided a very smooth transition and lots of interests from the scientific community, tons of opportunities for innovation. It was a complex decision. Oh, and another factor was that research on consciousness was (and still is) very much in its infancy - I thought the concepts and tools would never develop enough in my lifetime, for me to really be able to do work that satisfies me and that makes significant discoveries and progress. There were also financial concerns, i.e. it would not be easy to get continued funding for such research, because the areas of application are not so direct in our era. Hell, it is not even easy to get funding for studying straight, conventional, abundant psychiatric disorders! Maybe some of this is a bit my cowardice and exaggerated self-doubt, but I don't regret my decision anyway.

I think few therapists, who are not affiliated with some academic institution, teaching or research collaboration, are really interested in the deeper sciences and/or would make the efforts to educate themselves. My second T started out as a neuroscientist (part of the reason I chose him, hoping that we would have similar views) but decided to leave academia completely when still young and runs a private practice 100%, he does not really do anything else. He does work mostly with high achieving, more powerful kinds of people - he actually advertises himself to target that population (and makes good $ because those people, of course, can pay more). He is still very interested in science but does not follow the modern developments so much, more like a curious explorer and reader than a scientist at this point. I also think it is hard for someone like him to follow the important research very effectively, because they don't have access to many of the scientific journals, forums, professional networks - it would cost money and a lot of time besides their practices to get into that and maintain it. It is also part of the reason I don't quit my academic position and focus 100% on my private business - I would really fall out of the loop. I think psychotherapists/psychiatrists who also teach and/or do research academically are in much better positions to be highly informed, yet many of them are not (my first hand experience with colleagues). One thing I do regularly is to participate in educational forums for such clinicians - this is something I highly enjoy and find rewarding. But when they go back to their work, what they do in their practices, is another thing. This is what I said before, that often they behave in a seemingly very open-minded way, open to new knowledge, perspectives, contrasts - but it is not that easy for them to get out of their old familiar ways in practice. I think it is a lot like why/how it is not easy to break old habits, relationship patterns, etc.

I definitely think that using contrasts and studying opposing forces in the mind and behavior is extremely interesting and relevant - after all, a lot of the biological processes in the brain operate that way as well, via seemingly opposing but complementary and balancing molecular and physiological processes. Many mental disorders arise when these different types and levels of balance (of contrasting forces) get out of control and become overly hijacked in one direction. I could mention many examples, but the topic of our current discussion, how social dominance vs submissiveness works, is a good one. These things are definitely formed by early life (or whatever life) experiences, but not only that - there are many inborn factors as well. I definitely believe that part of the reason I am not so vulnerable to manipulation and power games is due to some kind of biological wiring. My father was the same way, only much more - he actually really liked having power and was a very dominant person. He dominated my mother big time, because she was clearly a very vulnerable, submissive individual. But he never dominated me - never actually tried, but he would not have succeeded even I am sure. I likely would have just rejected his efforts (unless it was severe physical abuse), like my mom's, to influence me. Instead, he treated me as an equal for the most part, and we had a great relationship. Similar trends have been abundant in most of my social relationships throughout my life, both personal and professional. What I think about it is that people, including those who are very power-hungry, usually detect (sooner or later) who can be used to feed their ego, dominance, and self-directed goals - who are the ones that are wiser to be "used" as equal associates, allies, behind-the-scenes advisors - and who to just avoid or fight with as enemies. I think I generally fall in the middle category relative to most people and it does not even take conscious effort, usually it's more natural development of relationships and social connections. I do have a life-long tendency to be drawn to (at least somewhat) powerful people, but not as a subordinate, and never experienced abuse other that some bullying by peers in childhood (but armored myself from even that pretty well). Of course I do not regret being this way, it makes life easier in many ways. What I am much more prone to, instead, is self-destructive behaviors and excess (and resistance to get help for it), but that is another topic...

Yes, I agree that narcissism is very misunderstood (and misused, overused) - unfortunately not only by the public but also often the psych professional community. And most of the so-called personality disorders. Then, of course, hard to help of the helper does not even get the basics and does not make efforts to understand better!

@ Xynesthesia2

Thank you! It's okay to respond when you have time. I'm still trying to catch up on all the responses to me, LOL. Thank you for identifying with what I shared.

There are so many good things that leaders, scientists, and mentors can do to help the suffering - whether it be in professional development, education, training, advocacy, or behind-the-scenes research. It's amazing how our perspectives change when we age, or when we experience more in life than we would have ever considered possible. When we were young, our worldviews were limited to only that which we found appealing, and that which we didn't and/or could tolerate. However, over time, we learn to appreciate or even like things we used to dislike or overlook in the past. It's great that you have enough self-awareness to know this! I'm discovering more things about myself than I ever thought possible, which is a good combo of life lessons and introspection.

Thanks for finding the topics on therapy harm interesting, even though you have other areas of interest that you're working on. I think your other areas of interest are highly beneficial, and will even indirectly address the issues of therapy harm, or iatrogenic effects of certain treatments we have today. If you could look for the etiologies of mental disorders at an organic level and implement innovative treatment alternatives to what we have now, that's awesome! When you say organic, do you mean neuroscience, epigenetics, etc.? Those things fascinated me when I was an undergrad and connected with a Neuroscience group, even though I couldn't afford to pay for another major. If I could take all the biology, chemistry, higher-level math, and neuroscience courses (after all those prerequisites were met), I would have. I was limited on funding, so I studied psychology and minored in a form of criminal justice. Nevertheless, I've always felt that etiology was important for not only detection of the source, but also for treatments/interventions/rehabilitation AND prevention (primary, secondary, and tertiary).

What you said is highly understandable, especially if you are an early- or mid-career scientist. Advocacy of this nature would need to be handled delicately, by those with clout in the psychological and psychiatric communities, and with great numbers (i.e., many professionals banding together with scientific or other evidence to demonstrate a need for change, innovation, reform, etc.). You are being authentic, as it relates to the person politic that is often discussed nowadays in the psychology of women courses, or how the person's identity and psychology is shaped a lot by our ecological systems and our interactions with those ecological systems. Given where you are at now, you are being as authentic as you can be, and are wise to know when and where you could share what you just said, etc.

That said, it is a compromise. Yet, I think you're taking strides to doing what you can in the work you are currently doing. Finding better treatments by looking at the organic etiologies of symptoms/behaviors/disorders/etc. is helping to improve the efficacy of treatments for clients and, by extension, their safety when reduction of harm is considered, or at least reduction of iatrogenic effects.

See what I mentioned above. I think you are absolutely correct!

There are a few things I want to respond to hear, in my humble opinion.

First, it sounds like your last T gaslit you, or undermined/misunderstood what you were sharing with him. That form of emotional abuse is a form of trauma! It may not be perceived by you as a form of trauma, and that is great, but perceptions aside, trauma can be defined as anything that threatens not only a person's life, but also a person's livelihood, including beliefs about the self. --That is how I define trauma - something that is threatening to life on many levels, not just physiological (yet they are connected - mind and body). I'm sorry you went through that! It may have been a form of psychopathy that I once learned about from one of my social worker/criminal justice mentors (there are four kinds of psychopathy, but I forgot what all of them are). I think there are ways to help those with psychopathy issues learn how to engage better with others, even if they cannot feel it for themselves, or even if their reward systems are wired to gratify the self when their manipulations/experiments are won; if they only knew the benefits of helping others, maybe that could help such persons with such radical stoic issues feel rewarded for actually helping someone, if manipulation is somewhat of an addiction for them. I don't know much about psychopathy, but to try to reduce stigma, I try to understand, even though I don't like many of the harms that those with psychopathy, or even those who are overly stoic in nature, do.

Another issue is seeing "victimization" in the case of dominant-submissive dyads and potential biological protective factors against victimization. First, there are some persons who may be very dominant in nature, but they could still be victims in therapeutic settings and otherwise. It's important not to accidentally disempower those without the dominant traits, or accidentally invalidate those with the dominant traits who have been victims. Perhaps perception of control for a person with dominant traits (such as what you, I think, described yourself as) are internal strengths (like resilience, optimism, coping) that are protective against trauma or victimization, even if not perceived. But the lack of perception of trauma does NOT mean that a trauma has not occurred, as evidenced by many resilient persons who have experienced trauma but did not wind up getting PTSD. There are many of these persons in the child welfare system, the criminal justice system, and in high-powered positions. I don't want to be triggering or anything, but your last T who gaslit you did victimize you in his own way, which is a form of emotional trauma, and which may have been lawful (in the sense that there are no laws to demonstrate his misconduct, as emotional abuse/trauma is hard to detect and/or codify in law). Nevertheless, victimization can happen with anyone.

That said, you raise an excellent point about protective factors - both internal and biological. If there were ways to build protective factors in others, maybe PTSD and other trauma-related disorders could be reduced or ameliorated/prevented. --At least ethical in terms of internalized strengths, but I'm not sure if changing a person's biology would be ethical. On a "mad-scientist" level, I can see a highly controversial question arise in research: If changing a person's personality through DNA manipulation or other manipulation prevents some mental disorders and/or victimization experiences, as a form of "capable guardianship" (in my opinion), would it be ethical to do so?

I'd say that debate is part of communication, is part of sharing, is part of being authentic, is part of healing, is part of rational thinking, is part of what we often do with some of the CBT and other therapeutic tools we challenge ourselves with to heal, etc. Debate is supportive, but not in the traditional sense. Debate helps us to tolerate differences, understand others through exposure, desensitize from differences in personalities and cultures, etc. Debate is healthy as long as there are no blatant ad hominem attacks, though sometimes implicit ad hominem attacks could occur.

When I consider "narcissism" as a "negative" trait, I recall being victimized by a lot of people with that trait or who seem to have that trait. Yet, there is such a thing as "healthy narcissism," which is not harming others but upholding yourself as important as others. Healthy narcissism can look like this: I love myself enough to take care of myself and know when I'm hurt by others, and I love myself enough to go after my dreams no matter who my naysayers are. I do not want to harm others, but I want to be an integral part of life to help others or to affect positive change. Toxic narcissism looks like this: I want to be better than everyone else I come across, because I'm better, and because I don't want to feel or remember any of the self-esteem issues I have so I protect myself from those feelings that I don't need to acknowledge by being better than everyone else, and therefore earning others' respect that I never got when I was a child. Of course, it's hard for those who have biological or epigenetic flaws from early childhood trauma (including and most notably neglect), which is a known link to toxic narcissism and/or traits. That said, I see how hard it would be for such people who do inadvertently and directly harm people to see the pain in what they are doing and see the rewards and love they would receive if they would just learn to be vulnerable and truly apologize and truly see their worth beyond surface behaviors. I see the pain that is hidden and never felt with those who hold narcissistic traits, and even the frustrations in those who have psychopathic traits. Yes, they can harm us if we try to help them, and they really don't want help. Yes, they can manipulate certain persons easily, and yes many of us have been victimized by those with many traits or beliefs, irregardless of whether or not they have a mental disorder or personality disorder. People can hurt others with or without the presence of a serious mental illness, or even without the traits most commonly noted as narcissism and psychopathy. People can victimize others even without having a personality disorder. But people who have mental disorders or symptoms that don't meet the clinical definition of a disorder do need help. Debating all these issues - all controversies included - is what helps us to understand one another more, reduce biases, correct some of our wrongs, and get along better. It may take time, and its infancy stages may look somewhat like a verbal-emotional battle, but if done respectfully, it can help support and inform.

I've made the mistake of constantly using the word "narcissist" when I describe my abusers. It's easy to fall into that trap, and I'm sorry if I've offended anyone who is struggling with narcissism, or even psychopathy. They may not feel like they are "struggling," but there are some things in life that they may be struggling with because of their symptoms/traits, such as relationships.

It's hard to swallow it all.

I'd suck at therapy because I'd have a difficult time with transference, too. Thankfully, I know my limitations. Some people who have been licensed, however, may not be aware of their limitations or may not care. It's that phenomena that is problematic.

Maybe it needs something akin to the Nuremberg trials. I can hear my Ex T now " I knew it was wrong , but I was too weak to say anything.... And then I blamed you ". I think the saying " All it takes for evil to succeed is for good men to do nothing " applies here somewhat. Not that the systemic problems in the profession and the system as a whole are intrinsically evil as such , but certainty the good ones don't do very much , then everyone is horrified when it comes out. And still they insist they were right , ethical and principled.

@Out There

I didn't know whether you were being humorously sarcastic or serious regarding the Nuremberg trials. I would think the Nuremberg trials are a bit of a stretch. I was considering speaking the language that they speak - research.

The problem I see is the balance between what is fair and what is just, what is a widespread issue among certain populations versus what is plain out unlawful (e.g., having sex with clients, experiencing harassment or bullying during a session, malpractice within the legal limits), and what is truly a misunderstanding versus any microaggressions that take place during treatment.

Someone here had mentioned attachment being an issue that brings up strong emotions and letdowns when expectations aren't met, even if boundaries are clearly stated and understood at one point in time. I think that attachment-based treatments work for some, not all. I also think that being too stoic and detached is also problematic, though not necessarily abusive. Then there's the personality differences between patient and client, which could simply be unfit instead of abusive.

Whenever claims are made, they have to be fair and just, as well as rational - not simply predicated upon the fallacy of appeal to emotion. Although many were in fact emotionally harmed, the questions that ensue will likely sound like this: What diagnosis does the patient have, or what symptoms does the client have, and do those symptoms interfere in their interpretation of the treatment process? Was the therapist acting in the best interest of the client during x, y, or z treatments or relational dynamics, as indicated ethically by how they were trained with the methods they were using for particular diagnoses/symptoms?

Then again, it could be that if a certain population with attachment-based issues are largely perceiving therapy as harmful, it could be all of the above and then some - perhaps speaking not to the client as liable, but more to the treatments that are administered to such clients that are simply not helping certain clients. For instance, cold medicine may work for most individuals who fall within the normal curve, but for those outliers who comprise minority populations that eat different diets, believe in certain cultural practices, or simply dislike the taste of such medications, the issue shouldn't then be to simply blame the clients as being "abnormal minorities" or "those with sensitive taste buds." Instead, the focus should be on what about the cold medicine needs to change to meet the needs of others who suffer from similar symptoms but have other factors at play, such as comorbidity with other diagnoses, ongoing stress (including traumatic stress), cultural sensitivity and tolerance that must be acknowledged, etc. Perhaps a cold patch instead of cough medicine, or perhaps a different flavor of cough medicine, or perhaps holistic approaches (that may not be as beneficial as cough medicine if their beliefs don't allow for medicine, but still somewhat of a relief for some of their symptoms). If being stoic is the black-white extreme of having transference issues, then find something in-between that may work, such as continuous check-ins and evaluations on how the dyad is operating, or finding different treatment alternatives.

There are a lot of things to consider in terms of what is ethical, what is abusive, what are iatrogenic effects (non-abusive, not intentional), and what is malpractice. When it comes to emotional trauma, there's a lot of grey areas, which makes this really hard to detect and address. And, if a client feels that he or she was misdiagnosed, then what about a few different opinions, like they allow in medicine? Therapy is like surgery; there are a lot of risks involved, most notably, emotional risks that can permeate through other areas of life. What are those risks? Are those risks not addressed because the non-disclosure up front would impact the treatment itself, or the evaluations based on the reactions to such treatment? Is this an issue?

What precisely are we defining when we say "therapy abuse," and how would that differ from other issues that aren't really falling within the "abuse" category? How can we present these arguments in a logical, rational manner (because the arguments should be logical and understandable to most people)?

From my perspective , I was referencing the Nuremberg trials as containing things like " I knew it was wrong , I was only following orders " etc. As far as I'm concerned that is where I'm coming from in terms of any situation where those justifications are expressed , the Nuremberg trials are an example. I was not being either humorously sarcastic or serious.

@Out There

Thank you for explaining. I don't know much about the Nuremberg trials other than a quick Wiki search I did after I read your post. Forgive me. The only thing I knew about the trials was when I heard it on a scene in a movie called A Few Good Men. --When it comes to politics, I suck. I was imagining this huge trial with a bunch of nations or something, but I need to really read up on what Nuremberg was.

Your quote makes sense. Sorry I missed the reference. It's my ignorance that gets me all the time.

I'd like to suggest that we focus back on the topic and the question raised in the OP:

Whether it is called abuse or something else, if people have had bad experiences in therapy that affected their lives adversely, what are some of those things that people think need to be changed, and why?

Has to be one of their most absurd marketing slogans. What could be more unsafe than a secretive relationship with an ambiguous, voyeuristic stranger with unknown mental/emotional health.

I think this is kind of the rub for some of us.

I don't know about others, but I would say that a significant amount of the harm I suffered from treatment was rooted in therapists ascribing things to my symptoms. And I think there's a very real issue there. Are we allowing the perception of certain behaviors as "symptoms" to obscure client feedback? Is there enough of a check against confirmation bias? Are we correctly diagnosing clients in the first place, and do we have a plan for clients who don't fit our diagnostic criteria very well?

That would be my suggestion of what needs to change in the first place. Listen more and don't just attribute things to the client's pathology. Listen to things that might seem irrational - and consider how much of our idea of what's rational, what makes sense, may be affected by how we think of mental illness in the first place. But really listen in a way that doesn't ascribe anything that "doesn't make sense" to pathology without considering other possibilities.

@OnlyOnePerson

Thank you so much for your feedback! It's exactly what I meant when I presented those questions, not to undermine or minimize the pains that go on in therapy, or the outright abuses that occur in treatment.

When confirmation bias occurs, especially when our symptoms are called in to blame for the therapist's misconduct, it irks me! It harms! It's just not therapeutic or helpful for treatment.

What about the emotion regulation of the therapist?

What about the therapist's own unresolved issues?

What about the ways in which certain symptoms need different levels of interpersonal relating than what is being offered from the therapist?

In medicine, they have that phrase, "good bedside manner." In therapy, that concept falls by the wayside when it comes to the power differential between therapist (in power, control) and client (in a submissive role). The clients' symptoms of having certain attachment feelings toward the therapist might be there IN ADDITION TO the ORIGINATING PROBLEMS WITH THE THERAPIST, who said or did something that they knew would inflict some sort of harm that the client was not ready for or expecting.

Expectations need to be not only addressed at the start of therapy, but also reiterated throughout. If the therapeutic relationship changes in any way, that lack of consistency is an issue - in particular the sense of safety that comes with consistency should be met, and if transitions occur, they occur at a pace that is comfortable for the client, not at an abrupt pace that seems punitive, victim-blaming, etc.

Although our symptoms can easily correlate with our perceptions, we as clients should NOT be infantilized to the point of discounting our strengths to see clearly what is going wrong (or our intelligence, despite our symptoms), and we as clients should NOT be gaslit to the point that we are made out to be crazy/irrational and the therapist is made out to be the only non-crazy/rational person in the room who could do no wrong. In this regard, the client's strengths are never taken into account, only the pathology, and that is wrong. The client's strengths are a huge part of recovery and therapy, and any client who is able to honestly address what they feel is going wrong in the therapeutic dyad is STRONG enough to say something, and such strengths should be acknowledged by the therapist.

Strengths include one's bravery to say something about what they feel is going wrong, even if they are scared to do so.

Strengths include one's intelligence to understand that therapy abuse could occur, and what the client is doing is preventing any further trauma from happening in the therapeutic dyad.

Strengths include one's intelligence to discern that the treatment is not working and/or the way the treatment is disseminated in the therapeutic relationship is not working and/or the treatment is okay but the therapist is just too stoic, too judgmental, too gaslighting, too insensitive, too inconsistent, too elusive, too invasive, or too verbally abusive (almost to the point of coercion, insofar that it's their way or the highway, at the expense of victim-blaming and/or diagnosis-shaming).

Strengths include one's ability to introspect.

Strengths include one's ability to come to therapy in the first place.

Strengths include one's ability to live one more day without self-injury, suicidal attempts, doing something that is harmful to them such as drinking or doing drugs when addicted to those substances, etc.

Strengths include one's ability to actually express emotion to another person as a form of communication, including anger (without threats), sadness with tears (without threats of self-harm), disgust (without ad hominem attacks), and any other authentic expression of emotion that doesn't attack others but rather expresses in emotional form the pain one is experiencing from a certain event, including the therapeutic relationship. For instance, if a client is raising their voice and expressing anger when they tell the therapist that sleeping in the middle of the session or eating during the session or constantly answering phone calls during the session is unprofessional and not helpful, then the therapist could take that time to not only apologize, but also to acknowledge the strength it took for their client to stand up for themselves, to address a person of power, and to rationally see that something was wrong. The therapist could also admit their wrongdoing and unprofessionalism, without making excuses about things they could have controlled before the session. For instance, it's an excuse to say that the therapist's other client was dealing with a crisis and that the current client (being negated and disrespected now) should be more understanding and empathetic for the therapist and the other client, and that the current client just has attachment issues or lacks empathy for the therapist or the therapist's other client; that's gaslighting, that's deflecting the originating problem at hand, and that's therapy abuse! If a therapist has issues with time management, that's the therapist's unprofessionalism, not the client's sensitivities or symptoms to what they are witnessing, no matter how overly emotional the client presents. In such cases, find a different therapist, because it is likely that the therapist has a pattern that will not be rectified immediately, and because the therapist is disrespecting the client and the client's time/money/insurance.

There are so many examples of these issues.

Like one person put it in a different post here on PC (paraphrasing from memory): "if the treatment doesn't work for a cancer patient, they say that the treatment failed, not that the cancer patient failed the treatment" or that the cancer patient was just treatment-resistant. The same should apply for therapy. If the treatment failed, the client didn't fail, but rather the administration of the treatment failed, the therapeutic dyad failed, etc. There are ways of expressing what goes on in treatment without disability-shaming or victim-blaming.

@OnlyOnePerson

In addition to what I responded immediately prior, was that our responses to therapy abuse have to be looked at through both existential and rational eyes. Existential - how we felt and interpreted the abuse, and rational - whether or not my expectations of therapy are not feasible or agreeable with the therapist's expectations for my treatment, and whether we never discussed boundaries or expectations together, or reiterated them. Sometimes what we think is therapy abuse is actually just a misunderstanding, but the dyadic relationship can easily get out of hand when both parties start reacting to that and harming each other with their words; the originating issues were never rationally discussed or worked out.

In terms of symptoms and rationality, sometimes clients who are in a very depressive place and prone to self-injury and/or suicidal ideation and attempts will feel that their needs aren't being met from a therapist who seemed kind last week but didn't seem kind and attentive this week, or whose attachment with the therapist was not a result of treatment but rather a result of the kindness that the therapist shows the client through words, but such kindnesses are perceived as inconsistent; that inconsistency perception might not be anything more than the irrational beliefs of the client, based on the client's symptoms, even though it is existentially painful for the client and the inconsistencies perceived are normative for human relating (a person cannot just be one emotion all of the time, otherwise they'd be walking on eggshells and inauthentic). If the client then threatens to harm themselves because the therapist wasn't being kind enough or the therapist decides that what they have to offer is not beneficial for the client (which is an ethical and rational response from the therapist), and the therapist does abruptly terminate treatment and has the client committed, with the often hidden request to offer the client referrals while in-patient, then that is NOT therapy abuse, but rather something that unfortunately occurs when therapists and clients are not a good match and symptoms of the client affect the treatment being offered by a therapist who wasn't a good match. The therapist might later learn what he or she could have done to prevent it from escalating to that point, but sometimes ruptures are nothing more than ruptures in treatment, not therapy abuse, even if it genuinely feels that way from the client.

That said, I do think that more training and better approaches for certain mental health disorders should be in place so that prevention of even perceived harms (even if not actual or lawful harms) are being done. It's not supposed to be about symptom-shaming or diagnosis-shaming, but rather about what is not working for a particular group of people with certain mental disorders that are not screened properly at the outset before such ruptures take place, and what can be done in terms of proper screening (for both the therapist's competency as well as for the client's disorders) without unnecessarily harming or triggering the client, even if it does not fall within what normative definitions of abuse are.

There are also others, including both professionals and clients, who believe that therapy isn't right for everyone. Nevertheless, those people still need help in some way, and for therapy to not be right for everyone is problematic when certain populations are not being treated for whatever reasons. It's those populations who need a different kind of treatment, which may or may not exist.

BTW, I have DID and so I see things from so many different lenses. If you're confused as to my different viewpoints that I posted in this thread, I'm so sorry I confused you.

I also didn't mean to sound insensitive to other people's experiences of feeling hurt with the attachment or verbal abuse or anything else that I may have had different views on. It's probably that I don't understand fully since I don't struggle with certain symptoms - or at least not as much as I used to.

I'm okay with hearing counterarguments to anything I shared, and I probably had some counterarguments myself that I shared which maybe didn't quite get at understanding the full scope of the pain that was described.

I am sorry if I came across as being insensitive and misunderstanding. I just need help to understand when others describe therapy as a "system" or therapy as "attachment" and how that is harmful/abusive. Maybe I emphasize the definitions of abuse too much without truly hearing what is being said. Forgive me for not being able to understand (yet). I'll refrain from saying any more than I've already shared regarding my own experiences of therapy abuse.

I might add: I'm one of the people here who doesn't necessarily identify traumatic experiences in therapy as abusive. I would also say that attachment played little role for me - the heavier role was in the attempts to fix supposedly irrational or unhelpful thoughts without sufficient attention to whether they actually were such.

I've noticed my own memories and perceptions of abuse in childhood started going from being seen as irrational distortions to rational reactions to traumatic memories about when I started learning to talk about them in the language therapists use rather than the language of how I remember experiencing them. While there was some internal shift in perspective, a lot of it just amounted to learning how to provide what therapists were looking for. I noticed the same thing with executive function issues. Simply changing how I frame the struggle when talking to a therapist, and providing the evidence in the format they're expecting, can change the exact same internal thought from an anxiety-based distortion to a realistic recognition of a personal limitation.

The studies on ADHD in women are I think a good example of this. We're finding out in the last few years that our diagnosis was biased towards symptoms in boys, and doesn't perform as well both on adults and on girls/women. Furthermore the language that most laypeople would use to describe ADHD symptoms is often similar to how someone might describe a mood disorder (for example, "racing thoughts" might happen in both an anxiety disorder due to work, or in ADHD or similar due to focus issues). It's going to rely on the clinician to be able to tease out the difference. To complicate things, untreated ADHD in adults frequently does result in secondary depression or anxiety.

Unfortunately this often doesn't happen - rather the client gets diagnosed with one of depression, anxiety, or bipolar disorder. The treatment is likely even to try to fix the client's perception (attributed to their mood disorder) of their own differences and struggles. And it ends up not working because it's just not dealing with what's actually going on for that particular client. It's also not uncommon for clients with ADHD or other executive functioning issues to be seen as uncooperative or resistant in therapy, because the symptoms interfere with successfully completing assignments and similar.

I find the research on female ADHD interesting because it's clearly not simply a case of individual therapist bias or failure. Rather it's that we didn't write our symptoms very well to deal with a particular population, and there's been a widespread lack of awareness of things like ADHD as differential diagnoses to primary mood disorders. This combines with both client factors of not fully understanding their issues, societal factors that expect that an intelligent person should be able to manage "simple" organization, and therapy factors of considering discussions of inability as likely distortions in mood disorder clients. And the whole mess can end up being quite harmful to someone who finds that therapy reinforces the existing idea that they could do these things if they really tried, while the therapist is still entirely following standard and accepted practice norms.

I'm really trying to get at this problem when talking about listening and about rationality. "Irrational" beliefs can sometimes simply mean they're not being presented in the way that the therapist is looking for, or that they run contrary to our societal perceptions and expectations. But it's very easy for those to be simply dismissed as resulting from the client's disorder in such a way that prevents useful information from being considered.

Let’s assume (absurdly? but what’s the harm) that what people have written here in this forum could have some impact somewhere, someway. When I have been involved with things like this in organizations before, people frequently summarize the responses. Others here in this forum may DEFINITELY disagree and see other categories. But, to start off, here are some serious problems with therapy that have been listed here, as I see it. I’ve cut and pasted from people’s posts, without attributing the names. Hope that’s OK.

I have not summarized anything from the more detailed discussions, with one exception as noted.

Here are 2 main categories, as it seems to me.

1. Lack of respect for clients’ experience and individuality. Lack of respect for their dignity as individual persons – even when they may not be dignified in what they are doing or expressing.

Why does this need to be changed? From lillib: “trauma can be defined as anything that threatens not only a person's life, but also a person's livelihood, including beliefs about the self.”

The power indifference.
The minimizing of traumatic experiences from the therapist who reiterates little t from bit T; they are both traumatic.
The lack of belief in continuous traumatic stress.
The lack of help for those with DID or thise who have partially integrated but still need treatment for DID.
The stigma on certain mental disorders from professionals.
The toxic countertransference.
The lack of attending to patient preferences.
The lack of cultural training.
The disregard for treating microaggression trauma.
The not allowing emotional expression.
The stopping a client who is crying and in the middle or beginning of a would-be breakthrough in disclosing a trauma memory.
The lack of empathy from the therapist.
The putting words in a patient's mouth.
The disbelief in dissociative disorders.
The lack of treatments for past therapy abuse and iatrogenic effects.
The premature termination.
The misdiagnoses.
The lack of mental health parity.
The stigma.
The lack of grief and loss processing.
The lack of assessing strengths in addition to symptoms.
The burnout felt by clients, not just therapists' compassion fatigue.
The effects of the therapists' compassion fatigue on the client.
The lack of explaining different treatment options and modalities.
The infantilizing of the client.
The lack of spending more time building trust and rapport.
The lack of screening therapists before licensing them.
The lack of cultural sensitivity training.
The lack of veteran-related training for civilian therapists.
The lack of understanding that chronic fatigue, fibromyalgia, multiple sclerosis, ageing transitions, pain management issues, and other physiological or neurological issues is not curable through therapy, and is not psychosomatic per se, but they do impact our emotiins, memories, and cognitions.
The lack of unconditional positive regard and candor, both at the same time.
The lack of therapy for false memory syndrome, if it truly is an issue.
The lack of therapy for therapists so that they do not take it out on their clients.
The names of certain diagnoses need to change to reduce stigma and more accurately reflect symptoms instead of dispositions; there should be a growth perspective that is stronger than a fixed one when defining symptoms and assigning labels
I think they need to be more admitting of the fact that they might not know us as well as they think they do since they see us such a small % of time and completely out of context of everyday life.
(Therapists) use obfuscating language
(Therapists) apply stigmatizing and debilitating labels
(Therapists) impose their will
(Therepists) appeal to fear
(Therapists) pretend to have the answers
(Therapists) put blame on victims

2. Lack of accountability and honesty, and a code of conduct that recognizes the different kinds of harms that therapists can cause even if they are not covered by traditional concepts of ethics.

Why does this need to be changed? Because of pre-existing psychological conditions, which therapists have identified and written about elsewhere in their literature, the client may not be able to recognize when the therapist is harming and/or exploiting them. Without honesty, a client may find it hard to impossible to make decisions about what is in their own best interest.


The lack of accountability.
The ethical dillemas.
The inability or unwillingness to share notes.
The lack of stating what the treatment goals, approaches, and risks are up front.
Justice for when something goes wrong rather than cover ups. They are not being honest.
The first session should have in depth explanation about what is therapy and how the whole process works. Things like transference should be addressed up front and termination.
I think they need to admit all they do is guess.
They seem oblivious to the fact that they hurt people. Hey , YOU HURT PEOPLE. I don't think the bad ones can be eradicated , even when the good ones do TRY to.
I totally agree with all therapist should be under supervision and also have there own therapy to get a sense of what we go through in therapy.
I think it should always be known what the boundaries are from the very first session like outside contact ect.
They get away with crap because some clients are for some reason willing to put up with it.
Dogmatism and close-mindedness, especially about obviously way too exaggerated claims about the power of the "treatment" and themselves, such as Ts can reparent clients and it is the relationship that heals, in general.
(Therapists) withhold information
(Therapists) resist transparency

Wow! I am blown away by the amazing insight and support shared on this thread!! I love you all so much. It means so much to me to see so many others who are passionate about this subject and are willing to share their hard-earned insight!

I want to add something (that may have already been shared).

- Complaint processes are an utter sham, as are licensing bodies: They should be completely abolished and rewritten.

- All psychiatric / therapy session notes should no longer be considered LEGAL record. (If anything, they should be no more or less credible than if patients wrote notes about the sessions).

Thanks,
HD7970ghz

With 57 posts above my own I realise I run the risk of being repetitive.

What needs to change? Possibly ourselves. We need to come to the table so to speak absolutely ready and willing to be full participants in therapy. We need to commit ourselves to doing our part. That means work. It means doing the homework we are given and following through with suggestions. It means accepting that the therapist has no magic wand and that he/she is not there to fix us. They are there to provide guidance and show us they way. They are there to provide skills which we ought to be at least attempting to utilize. If we don't make a commitment to do our part the therapy is going to be no more than a failure. I don't think we have a right to then blame the therapist because our lives are not changing and improving.

If one is in fact doing there part and it still isn't working then I will grant you that it is a change of therapist that may be due.

Therapy does not work for everyone. And no amount of client blaming or shaming is going to make it do so. Therapy is not a science. It is not always clear what is supposed to happen or what the client is supposed to do. Asking the therapist is not always beneficial. Therapists have claimed to me that they don't know. I do blame therapists for being unclear and mushy about what they get handed money to do. I do not believe a therapist is a guide - what are they guiding. Not everyone is there because they need "skills" whatever the hell that is. I do not believe being told one's mother was a narcissist by a therapist is a skill to practice of any sort. I have no idea how that sort of information was supposed to be useful even if it was true. Why would one believe a therapist's declarations over other people? They are a stranger who is not imbibed with super powers. They can be (and often are) just dead flat wrong. Not the client isn't ready - no the freaking therapist is just not correct.