Psychotherapy Effectiveness for Depression Inflated by Publication Bias

Justin Karter
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While publication bias has been known to overestimate the efficacy of antidepressant treatments, a new study suggests that research on the use of psychotherapy in depression suffers from a similar bias.

“Our findings indicate that psychological treatment is efficacious and specific, but, as is the case for antidepressants, less than the published literature conveys,” the researchers, led by Ellen Driessen, wrote.

In an effort to account for previously unpublished results, the study, which appears in the journal PLOS One, examined all of the grants funded by the National Institutes of Health (NIH) on psychotherapy for depression between 1972 and 2008.

The researchers identified studies that were funded by the NIH but never published, they then requested the unpublished data from the original investigators.  Out of 55 grants from the NIH that met this criterion, only 42 (or 76.4%) had published their results. The investigators who led 11 of the remaining 13 studies turned over their unpublished data for the meta-analysis.

When the researchers combined the data from the 42 published studies with the 11 unpublished studies, the effect size for psychotherapy in depression was reduced by 25%. However, the psychological treatments remained significantly more efficacious than the control conditions even after the unpublished data was added.

The largest difference in effect size between published and unpublished trials appeared in studies where therapy was being compared to a pill placebo.  Adding in unpublished study data comparing therapy to a pill placebo caused a 45% drop in effect size.

Interestingly, the unpublished data did not change the comparison of therapy to antidepressants.  Even with the new data, no significant difference appeared between the two, though antidepressants combined with therapy had a larger effect than antidepressants alone.

When asked why their studies had remained unpublished, the investigators explained that “they did not think the findings were interesting enough to warrant publication, that they got distracted by other obligations or that they had practical problems.”

“The efficacy of psychological interventions for depression has been overestimated in the published literature, just as it has been for pharmacotherapy,” Driessen and her colleagues conclude.

“Clinicians, guidelines developers, and decision makers should be aware that the published literature overestimates the effects of the predominant treatments for depression.”

 

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For More Coverage of this Study:

The New York Times: “Effectiveness of Talk Therapy Is Overstated, a Study Says”

Medical Daily: “Psychotherapy Does Work For Depression Patients, But Its Effectiveness May Be Overstated In Studies”

NPR: “Studies May Overstate The Benefits of Talk Therapy For Depression”

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Driessen E, Hollon SD, Bockting CLH, Cuijpers P, Turner EH (2015) Does Publication Bias Inflate the Apparent Efficacy of Psychological Treatment for Major Depressive Disorder? A Systematic Review and Meta-Analysis of US National Institutes of Health-Funded Trials. PLoS ONE 10(9): e0137864. doi:10.1371/journal.pone.0137864 (Full Text)

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Justin Karter
MIA Research News Editor: Justin Karter is a writer, researcher and community organizer with graduate degrees in both journalism and community psychology. He is a doctoral candidate in Counseling Psychology at UMass Boston, an active member of the Society for Humanistic Psychology, and is currently working on several scholarly projects at the intersection of psychology, social theory, and political philosophy.

85 COMMENTS

  1. “Our findings indicate that psychological treatment is efficacious and specific…”

    I love how this truism is pronounced as if it is something insightful or revealing.

    One can also say,

    “Our findings indicate that good relationships help people feel better. (really?!!)

    “Our findings indicate that sunlight helps plant grow.”

    “Our findings indicate that water is wet.”

    “Our findings indicate that we have to make these solemn pronouncements to make it appear as if we are doing worthwhile research.”

    —————-

    More importantly, what was the average duration and frequency of psychotherapy in these cases? What type of psychotherapy? What skill of therapist? How depressed a client? Etc. When you think of all the factors that could be confounding these studies, it’s hard to take them seriously.

    Also, I’m going to copy and paste this because it applies here:

    “Depression” is not a valid, reliable illness. The reliability ratings for major depression in the DSM 5 field trials were close to 0 (0.2-0.3). That means that whether or not one gets labeled with depression or some other “illness” is usually arbitrary.

    Feelings of depression of varying degrees can be caused by a multitude of different internal and external causes, and the combination of causes in each case is unique to the individual’s situation. Therefore these studies of “major depression” should be viewed with extreme skepticism.

    This type of research, in my opinion,, is of limited use and the focus should be shifted to qualitative, narrative research of individuals, not this quantitative reductionistic label-based stuff.

    • “’Our findings indicate that psychological treatment is efficacious and specific…”’
      I love how this truism is pronounced as if it is something insightful or revealing.'”

      So, no issues with any research that is consistent with your own view or your truth. Such studies and their conclusions merely state the obvious. As in duh.

      But, of course, the operative sentence reads in its entirety: “Our findings indicate that psychological treatment is efficacious and specific, but, as in the case for antidepressants, less than the published literature conveys.” The last part you do not like, so that part of the study (its methodology, assumptions, etc.) is not valid.

      The conclusion reached by this study strikes me as credible and consistent with the facts on the ground: psychological intervention is helpful, but not to the extent claimed; it is a good thing, but for many, far too many, it will not be enough. Given a choice, most people would rather talk to a therapist than take a pill. The fact that so many do end up on medication cannot be attributed to Big Pharma and mainstream practitioners ALONE. The overwhelming majority of therapists (including those that decry medication use) rely on meds. Clearly, therapy (i.e., talk therapy) has its limits, and overselling it as a panacea does not further the cause of reforming the mental health system, imho.

      I know that people have been helped by therapy alone and there have been amazing therapists who were able to connect with troubled souls. Unfortunately, that is more the exception than the norm. Most therapists (including Freudian psychoanalysts) do rely on meds. In making this point I am not extolling meds, merely observing that therapy is not all that is it often claimed to be and claims of therapists and their successes should also be taken with a grain of salt.

      In fairness to therapy and its practitioners, it is a very tall order to help someone who is in crisis or deeply troubled when all that a therapist has at his/her disposal is a limited amount of time with the person. The best type of therapy or psychosocial intervention is an integrated society where “it takes a village” is a way of life. Interventions like Open DIalogue and Healing Homes are so promising precisely because they seek to surround a person in crisis with caring and supportive people. Through no fault of the therapist, the therapist cannot give a person the social capital and connection to other people that are indispensable to healing (when I say “indispensable,” I mean indispensable as in necessary; even these vital connections may not suffice). A big part of the answer may lie in building, from the ground up, healing, supportive and welcoming communities that place a premium on human connections.

      • Ok, I’ll be a little more serious. The data above was on therapy averaging 3-4 months or less. Rarely enough time to make big changes in life problems that usually take years to develop. I get tired of these headlines which distort what is really being discussed… this headline should be something like, “Very Short Term Therapy Isn’t Quite As Effective for Troubled People as Thought.”

        Here is some data on longer term therapy:

        http://www.bgrosjean.com/files/Psychodynamic_20psychotherapy.JAMA.2008_1_.pdf

        http://www.researchgate.net/publication/269312632_The_effectiveness_of_short-_and_long-term_psychotherapy_on_personality_functioning_during_a_5-year_follow-up

        https://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf

        http://psychrights.org/research/Digest/Effective/BGSchizophreniaMeta-Analysis.htm

        These are mostly papers looking at therapies lasting 2-5 years, sometimes with follow-ups afterward.

        From reading The Heart and Soul of Change by Barry Duncan, which summarizes a lot of this research, I understand that about 80% of the time, people are better off with psychotherapy than without. A minority of the time, therapy does not help or causes damage.

        If this is close to being true, then I think we have reason to be more optimistic about psychotherapy and reconsider opinions below like the one from Julie Greene saying, “I don’t think therapy alone will be of use to most people.” That idea is really coming out of nowhere, it’s bullshit and the evidence refutes it.

        • It’s not bullshit. Just cuz I choose not to use impersonal, lifeless statistics, but things I witness myself, which are actual stories of real people (including myself) doesn’t mean I’m full of nonsense. Please don’t discredit what I witness time and time again, with my own eyes and ears.

          • A few anecdotes are not reliable evidence nor are they generalizable to most people.

            As cited above, dozens of studies from many different time periods and locations show that more often than not, psychotherapy is helpful.

            Therefore, it is pretty nonsensical to say that psychotherapy alone will not be of use to most people.

        • The following (your own words) is very a propos to the claims that you are making for the efficacy of therapy:

          “Depression” is not a valid, reliable illness. The reliability ratings for major depression in the DSM 5 field trials were close to 0 (0.2-0.3). That means that whether or not one gets labeled with depression or some other “illness” is usually arbitrary.”

          “Feelings of depression of varying degrees can be caused by a multitude of different internal and external causes, and the combination of causes in each case is unique to the individual’s situation. Therefore these studies of “major depression” should be viewed with extreme skepticism.”

          I agree with your statement. But the inherent unreliability of psychiatric labeling and the multitude of causes that bring about psychiatric conditions is also relevant to any assessment of claims of successful psychotherapeutic interventions. How do we know that those alleged to have been “successfully treated” even warranted the “diagnosis” for which they got treated? How do we validate the severity of their conditions in order to judge the usefulness of therapy?

          If depression is not a real illness, or schizophrenia is not a real illness, etc., what exactly are the people who get better with psychotherapy healed from, nothing? Let’s be consistent. I am all on-board with the idea that there is no such thing as a psychiatric diagnosis, only descriptive labels of symptoms. But in that case, let’s not elevate such labels to something real and meaningful when it comes to claims that psychotherapy is effective.

          The sources that you cite put forth claims, not evidence of the patient’s condition, its severity, causation, etc. Ditto for claims of effective intervention without reliance on drugs.

          I would love psychotherapy to be THE answer for all psychiatric distress, severe as well as mild, so that drugs never rear their ugly heads. Unfortunately, the evidence (evidence, as opposed to claims or wishful thinking) and the life experience of too many people does not bear this out. Why do you suppose Lieberman came down so hard on analysts? (In posing this question, I am not suggesting that Lieberman is an authority for anything; I am talking tactics here.) Well, I believe he skewered the analyst types because he knew that they would not and could not defend themselves. And they didn’t. (If there was an effective response from the analytical community, affirming their ability and successful track record in healing people without drugs, I missed it.) They could not and did not mount an effective response to Lieberman’s attacks because most of them do rely on drugs.

          To say, as you do, that, by and large, “people are better off with psychotherapy than without” is not the point. I don’t know anyone who disagrees with that (not even Lieberman or any run-of-the-mill psychiatrist). The point is: is talk therapy alone, as a rule, sufficient to heal severe mental distress (e.g., extreme states and such)? As much as I would like for this to be so, I do not see the evidence or the basis for your optimism.) As to your point that one has to give therapy enough time to see its benefits, how about the decades that most patients spent at the Chestnut Lodge without getting better?

          To repeat myself, I am not against therapy; far from it. I am against overselling it.

          • It is a conundrum: how do you measure the effectiveness of interventions on a population scale when human psychological states are so variable and individual?

            There is no easy answer. I am aware when we discuss this that it can appear hypocritical to say that diagnoses are invalid, but then to say that studies based on these diagnoses support psychotherapy as an intervention. I don’t know of any way around that problem. When you think about these studies, they can at best be viewed as indicating a trend or likelihood, rather than proving anything certain about what helps so-and-so diagnosis.

            Veering off a bit, I think from personal experience and from reading many qualitative cases that psychotic states are real and that there is a spectrum of psychosis ranging from more “borderline” states to more disorganized and chaotic “schizophrenic” states. Not that these labels should be used, but they are loosely describing overwhelming mental states based on splitting, denial, and a predominance of all-negative feelings without sufficient love and support. People’s experience is real; the sharp boundaries of one person being “schizophrenic” and another being “bipolar” are false.

            Nevertheless, I think that the 37 studies of variously psychotic people in the type of metaanalysis I cited, and the many clinical reports of successful intensive psychotherapy of psychotic states, e.g. in books by Volkan, Steinman, Boyer, Karon, Jackson, etc. provide some indication that psychotherapy can often be very helpful, and yes, even transformative.

            Let me address Lieberman and Chestnut Lodge. I think Lieberman is an alien from Mars sent here to spread false propaganda about diagnoses and biological etiology, so I don’t read a lot of what he says. But why would he come down hard on analysts?
            – Their viewpoint threatens his and the drug companies.
            – He doesn’t understand their relational frame of treatment.
            – He is poorly informed about studies supporting the efficacy of long-term psychodynamic treatment.

            I don’t know whether or not they defended themselves; they probably viewed him as a fool and didn’t care to respond. I know there are several metaanalyses evidencing psychoanalytic therapy as an intervention for suffering people. Here’s one randomized study based on a false label I read today:
            http://tavistockandportman.uk/about-us/news/psychoanalytic-psychotherapy-can-help-depressed-patients-where-other-treatments-fail

            Hehe.

            As for the Chestnut Lodge study, it was biased in a number of ways. Many of the patients followed were heavily medicated due to a lawsuit brought by a parent against the owners of the hospital. It included many patients who only spent a month or a few months in treatment, hardly long enough to heal psychosis. It included many older clients who had already been medicated for years at other hospitals, causing earlier damage, and not given effective psychotherapy at that time.

            I spoke to one of the analysts who worked at Chestnut Lodge and they said that primary author McGlashan was biased and that, working with Dexter Bullard the hospital owner, whose psychotic son had suicided during a traditional analysis, McGlashan was eager for the results to discredit analysis.

            So I don’t put much stock in the Chestnut Lodge study at all. It’s just one study. It doesn’t stand up well against dozens of others indicating that psychotherapy can be and often is very helpful.

            As for, can psychotherapy alone heal severe distress? Absolutely. But it has to be sufficiently frequent and intense. Sometimes, if the person cannot even function on an outpatient basis, there has to be a supportive environment/home in conjunction, so you point about that can be correct; in sufficiently severe distress psychotherapy alone may be unable to provide enough support.

            It often takes 3-5 years of psychotherapy, 2-3 times a week or more, with a therapist who understands psychotic states well, to make a lot of progress. It’s sad that this is unaffordable for most people, despite the fact that society would save on disability/chronicity if it were provided. You can read some info about this sort of treatment in these 50+ individual cases:

            Ira Steinman – Treating the Untreatable
            Murray Jackson – Weathering the Storms
            Vamik Volkan – The Infantile Psychotic Self
            David Garfield – Unbearable Affect
            Gaetano Benedetti – Psychotherapy of Schizophrenia
            Bert Karon – Psychotherapy of Schizophrenia, Treatment of Choice

            I think you will feel more hopeful if you read these. I would say it’s not that intensive skilled therapy cannot frequently heal psychotic distress, but rather that it is insufficiently available/affordable, that is the big problem.

          • Rather than lazily say this, why don’t you cite your own evidence B? Saying, “oh your studies might be wrong” is not an argument. Sure any one of them might be wrong. But there are also many of them and they indicate a strong trend toward people being helped by therapy. Maybe you think that all of these studies are trying to deceive people. I wonder if you actually read them…

            If you think therapy is harmful more often than not, and that it frequently ruins people, you can cite some surveys or studies that support that idea beyond your own limited experience. If you can’t do that, you argument has to be dismissed as a non generalizable opinion of 1 person. What I am tired of is people making arguments based on an n of 1 and then generalizing as if it applied to everyone. It really is ridiculous and potentially harmful to do that.

      • I just got finished with one (I had one single session with him) who said since I couldn’t afford his fees (any more than the one session by phone) I should go get pills for my insomnia, which was what he was supposedly treating. That actually made up my mind for me, that I don’t want to go back. It goes to show he has very little faith in his methods. And GetItRight you are correct, most do fall back on pills. It’s kinda logical since they too endorse the disease model.

        • It is a big problem that psychotherapy is so expensive. It takes several months at the least to form a good relationship/alliance with a therapist, and many people who are very distressed and/or cannot work cannot afford that.

          However, there are a number of therapists who will offer sliding scale low cost psychotherapy to people in need. A lot of people don’t know about this or are embarrassed to ask. I’ve tried to encourage people I talk to seeking help to not rule out that option. In big cities, psychoanalytic clinics usually have candidate analysts (trainee therapists) who will do free or very low cost therapy for people in need. That can be a big help to someone without any money.

  2. Well, you figure it’s a bell curve, a total crapshoot when it comes to “therapy.” Some go and then feel better, but we know depression improves anyway. Then there are those who go who are “maintained.” That is, their mood is sustained at a low level because it’s not allowed to run its natural course. I would say most who go into “mental health care” get stuck there for life, and only get worse.
    Moral: Get out while you can.

  3. I totally agree with what Get I right said. I don’t think therapy alone will be of much use to most people. I know many people who need to get away from bad situations, and therapy only tells them to “cope better” that the patients are poor copers, that is, diseased and needy. This will only perpetuate the problem, especially since so often the oppressive situation is the therapy or the therapist, on top of the crapped situation that the patient started out with. That is how people get trapped into dependency.

  4. I wonder if you are factoring psych meds into the picture, BPDTrans. Because I agree that if a person takes psych meds, then they’re better off with therapy topping off the brainwashing than pills and only a psychiatrist to do the brainwashing in like 15 minutes once a month. I actually don’t see anyone getting better with therapy. Those that claim to be getting better are still hooked on therapy, dependent and more needy than when they started out, still stuck, still claiming their therapist saves their life and they can’t live without it. Somehow, that doesn’t look like wellness to me, but admission that they have a lifelong, disabling condition, since the only hope they think they have is that dude in the office collecting the money. I don’t think I’d ever agree to any therapy unless it was very very short term (like two sessions), wasn’t with a mandatory reporter, and didn’t involve diagnosis at all. I think I’d be much more happy doing a class, or music lessons, or fitness training, but that’s actual skilled help. No more dudes in offices for me.

  5. BPD, I choose to keep as many people away from diagnosis as possible. Nowadays, lots of insurances cover “therapy” without any copay anyway. If it’s covered, you are automatically diagnosed. Hello, discrimination, hatred, loss of job, loss of family, the cops profiling you, you can’t get back to college, your reputation ruined. All that happened to me even before I took one pill. I know people who committed suicide because of therapy alone. I’ve seen the most vicious, power-hungry, manipulative people call themselves therapists. I would never recommend therapy to anyone, and that’s my choice. I also won’t stop a person, because that’s force, and they are entitled to choose to see some dude in an office and get dependent if that’s what they really want. I have seen so many people lose their lives and all their dreams shattered because some therapist convinced them they had a diagnosis, a permanent character disorder, or brain disease. Most are dead now. Diagnosis is the biggest psych crime there is. I don’t think statistics tell us one thing about the human condition, about feelings, nor about real human suffering, grief, nor love. Numbers don’t tell you how a person feels when they end up forced into a hospital, and then, all their classmates and even families turn their backs, the great job is gone, or any of the psych horrors so many people go through. We cannot reduce such things to numbers and I think the new look at Study 329 tells us just that. Any study can be twisted around to suit someone’s wallet. A study won’t even tell you how many dead bodies there are, since there’s so much coverup. I love it when therapists get out of the torture business.

    • Yes, again of these bad situations you describe are possible, and they sometimes do happen in therapies. The question is, do they happen for most people going into therapy or do they happen at a frequency that means that people should be dissuaded from seeking therapy?

      And I think the answer is quite cleary No…. that more often than not, people seeking therapy on the balance benefit in terms of functioning and feeling better. That doesn’t invalidate your experience based on your own encounters with therapists or those people you know; but it does mean that your experiences are likely not representative of most people’s gains or losses in therapy.

      I agree that diagnosis can be very harmful – I am one of the most heavily antidiagnosis people out there. On the other hand I know that some people don’t feel as bothered by it and some don’t experience harm from using it to get reimbursement. But I too wish diagnosis would be abolished.

      Regarding the notion that being in therapy is equivalent to a harmful dependence, I disagree. First of all, dependence is not necessarily good or bad. It is. Young children are dependent on their parents and it is necessary and good for them. Some adults who are childlike emotionally need to regress and be dependent emotionally on a therapist for a period. That can be a good thing – it can allow regression and regrowth, if it is managed right and contained within the sessions. Overdependence or prolonged dependence can be a bad thing, yes. But many people can experience a healthy degree of attachment and dependence on the therapist’s functions without it being destructive. That’s one of the big things that helps in psychotherapy, the fact that the therapist is in some way a (good) parent substitute.

  6. Therapists posing as substitute parent is almost always abuse. It’s abuse when they use scare tactics, accusations, rope the police into their threats, use harmful discriminatory language when speaking to or of their patients, or treat them with low expectations. I think the one of the initial harms is the lie, “Ask for help.” That’s the beginning of the dependency. I had over 20 therapists and I’d say almost all of them abused. Before therapy, I was an independent, career-bound, very successful music student. People were telling me that going to therapy was going to be a huge mistake for me. My college advisor told me he feared if I left school to go to therapy, I’d never return. He was right.

    • I think you are misunderstanding my points. Healthy dependence on another person – i.e. being vulnerable and asking for emotional help from someone who can empathically support and will not retraumatize you – is one of the key healing factors in good psychotherapy.

      It sounds like unfortunately a lot of therapists you had were not good therapists, or for some reason the fit between you and them wasn’t great. But, that doesn’t mean that most therapists are not helpful to their clients.

      I agree that “asking for help” may be the beginning of dependency, but the false implication here is that dependency is all-bad, I think. Asking for help can be a courageous thing, although it can seem dangerous when one has been repeatedly disappointed or betrayed in the past. But in reality asking for help can be the beginning of a good dependency. I.e. letting down barriers, being willing to be vulnerable, trusting another person.

      • Psychotherapy is to normal human relationship as prostitution is to sex with a loved one or a friend. You pay for someone to pretend they care for you.
        It’s relationship build on dishonesty and false pretenses from the get go, no matter who the therapist is.

          • Totally agree. Without two therapists when I was suffering horrific adverse side effects from psych meds, I would have been dead.

            One in particular motivated me to get out in the work world when I was stoned on 4 psych meds. It ended up being one of my most successful work experiences.

        • Hi B,
          I was prepared to try everything – bar (more) medication.

          I didn’t need the friendship – I needed information, and psychotherapy was helpful.

          My main problem was withdrawal syndrome – and this involved dealing with problems I’d never experienced before.

          But what was best was the independent support groups where people help other people in the same way as there been helped themselves.

          There is an opportunity for abuse within psychotherapy as well; but I didn’t come across this (thankfully).

          • Hi Fiachra,

            As one of the commenters who tends to be somewhat skeptical of therapy’s ability to heal extreme states without drugs, I totally accept and honor your experience. I am happy about your good outcome and wish this could be replicated more widely. I do wonder if your good experience with therapy is due to the fact that therapeutic standards and practices are higher or more evolved in the UK. — based on the insights reached and positions taken by UK psychologists (away from the biological model and drugging, more human support) that could well be. I also believe that good therapy outcomes depend on the relationship and the quality of the therapist, more than the modality or theory. Some therapists have that magic or spark to connect with troubled souls, and that is wonderful, but many do not.

          • Hi There GetItRight,

            I suppose you could describe my ‘catastrophy’ as an extreme state but depending on the therapist – it might be understandable.

            The last medical doctor I saw in a psycho medical setting told me they could identify quite well themselves: with the idea of my initial ‘high anxiety’ reaction – and how I was able to see things differently once I got some distance from the ‘event’.

          • Hi GetItRight,

            As I read further down I can hear of some very unappetising psychotherapists. I can see the exploitation and the power and slavery games (even maybe more insidious than psychiatry).

            I didn’t come across any of this in the UK – just chilled out people that really wanted to help.

        • Honestly, Margie, maybe you’re taking it too personally. If a person is bitten very badly by a dog, I would say it’s quite understandable, for a long time afterward, to be afraid of all dogs. Even if it’s not logical. The fear is instinctive, and protects the person from harm. That’s why people (and animals) develop fear of anyone in uniform, or anyone wearing a white coat. If a woman is raped, she might fear men, for a very long time afterward. After a person is abused, how can we expect that person to just get over that fear? It took me incredible effort to stop fearing cops, since I’d been hauled off by them, threatened, and wrongly accused by them so many times. I am no longer afraid, simply because the policio here are not like that. I choose to stay away from anything resembling a shrink because I don’t want a diagnosis. Diagnosis was more harmful to me than the pills. It was a lie, all wrong, all complete misunderstanding and mishearing for three decades. That’s a lot of life they stole from me. I am doing everything I can to rebuild and start over, and I’m nearly 60. I don’t think one person can blame me at this point for feeling the way I do.

        • Margie,

          I think B’s position is somewhat extreme but I agree with other folks who say you are taking this way too personally. Why not say to B that you are sorry her experience was so horrific but that not all therapists are like that and it is unfortunately, she didn’t have someone who could help her. Gets your point across and is alot more civil.

        • “That was a terrible and harmful comment. Shame on you.”

          Margie:

          I also believe that you overreacted and took things too personally. While I myself might have phrased things differently, I read and understood the offending comment (“Psychotherapy is to normal human relationship as prostitution is to sex with a loved one or a friend. You pay…”) differently.

          I did not and do not see this statement as equating therapists with prostitutes. It is analogizing one situation where a wounded/broken/lonely and suffering person needs to pay someone to pay attention, listen to him/her, spend some time with him/her. I can see why someone who is already feeling low would feel even more demoralized, demeaned, diminished or wounded by this. I am not saying one should, but I can and see why one can. The relevance of the prostitution analogy is not to call anyone names or to equate therapists with prostitutes, but to appreciate that someone who is already down feels acutely the indignity of having to pay someone for a bit of attention.

  7. B you said in a former comment, to “There’s no place like Home” that you almost killed yourself because of someone like me (I am a social worker) You have a grudge here and need to control your hostility towards all therapists; your message is lost in your harmful and angry words.

    • Margie, Listen to what you are saying. If B almost killed him/herself, that’s serious. I knew someone who did in fact kill herself because of her therapists. There was more than one, and I knew them myself. I see therapists as like any other, they are on a bell curve, with most being mediocre, some very bad, and a few exceptionally good. Same with musicians, car repair people, and college instructors. Of all the 20 + that I had, one I’d say was exceptionally good. In order to be good, she had to eventually go against her supervisor’s instructions. He handed her a patient (me) and told her the patient was “severe BPD.” After a while, this therapist realized her supervisor was wrong. Finally, she told me flat out, “You have an eating disorder.” I said to myself silently, “It’s about time someone figured that out. Why didn’t they just ask?” Then, she said, rather tearfully, since we’d been together for a long time, that she felt ill-equipped to handle my problem. She literally felt like she had failed me. I told her she hadn’t, that she’d listened better than the others. I told her that to me, listening and caring meant more than expertise, especially if that expertise is book-learning only. The real expertise is to have the problem yourself, so you know how it feels. Sadly, the next people she handed me to were the book-learning types. “Specialists.” They were totally clueless.

        • Margie, please don’t diagnose online. I thought the therapy profession didn’t do that. If the relationship is supposedly based on actual interactions and an actual relationship, then how can you state anything at all about B’s supposed disorder? I keep wondering if the only folks that understand just how harmful therapy abuse is are those that have been abused by therapists. Which, if true, further illustrates my point.

          From what I recall of therapy, I could talk to some of them about eating disorders till I was blue in the face and they still had no idea of what I was experiencing. I was laughed at for three decades and told, “That’s impossible,” more times than I can count. I was told by many, “That’s nothing, your complaint is trivial,” when by all means, it wasn’t. That’s how I almost died. Because they were totally clueless. Because very few ever believed me, nor had any idea of just how serious it was. I would have loved to have had one that had been through what I had been through, and also one who didn’t have too much distance on it, since the raw part of the memory fades fast and turns into anecdote and pat answers. I heard, “Follow your meal plan,” or “One day at a time,” or “Accept your body,” only because I don’t think they had any answers at all. A nutritionist would have been a better choice for me.

          Mental suffering is not the same as cancer because you can’t measure it. It’s not a tangible tumor, nor a disease.

        • Margie,

          I thought mental health professionals weren’t supposed to diagnose people online. Actually, you doing that is what is creating the animosity.

          It seems like you need to take a step back and think about what you are saying to various commentators.

        • One does not have to have cancer to help people who have cancer…B has a rage against all therapists; this is simply unrealistic bordering on a disorder that is effecting others…

          Wow. If your intention is to expose your total lack of comprehension of the bankruptcy of the medical “model,” or to demonstrate how “professionals” whose egos have been wounded take out their aggression on their clients, or invalidate their clients’ rage by “diagnosing” it, well done. As for the divisive animosity I suggest you research the psychoanalytic concept of projection.

    • Margie

      How can you sit there and make a statement like this? I don’t believe that you can look into B and see what she’s feeling and thinking. You are making some assumptions here without much to back it up. I have the feeling that you can be a little thin skinned at times when therapists are the topic of conversation. Let us face the facts, there are a lot of abusive therapists out there who do just as much harm as any psychiatrist who refuses to listen to the person they’re supposedly treating. Therapists are not the expert on my life in any way, shape, or form. No one is the expert on my life, only I can fill that position.

      If the shoe doesn’t fit you don’t have to sit there and try to jam your foot into it. Let it go and be done with it.

      • Folks, this is just another shining example of a mental health professional taking an analogy literally. I am amazed that in my past, mental health professionals claimed I was unable to think conceptually, unable to process, unable to think abstractly. Years later, I found that if I used abstract language in “sessions,” I was taken literally. I found this insulting. Did they not study literature to know what metaphor is? Apparently not. That’s what art is. Representation of life, as the artist sees it. All great political speeches contained metaphors and comparisons that enabled the listening public to more fully understand what the speaker was saying. Interesting, too, that the diabetes/mental illness/lithium/insulin comparison doesn’t even hold water (hold water also being a metaphor). And they know it, too. While psychiatry criticizes our inept thinking, it seems that on a whole, the profession doesn’t even hear us when we make such abstractions. I myself invented the prostitute analogy out of my own head, the day I realized I had no one to talk to and if I ever wanted a human relationship, I’d have to resort to paying some person in an office, ready and waiting for some sucker like me.

        As for lack of statistical evidence of the instances of therapy abuse, I know that if a person seeks therapy after abuse, the next therapist says, right on cue, “It was a bad match.” They also tell the patient to “Be present,” meaning to forget the past. They will insist that the anger needs medicating. It’s now the patient’s disorder, the patient’s crime that such atrocity took place. Then, when that doesn’t fail, out comes the paranoia card. If the patient has enough guts to contact the state human rights agency, that agency’s role is not to protect, but to stall any real lawsuit until the statute of limitations is over. If then, the patient has any energy left, he or she might have a tough time getting a real lawyer to take him/her seriously. If ever the case makes it to court and it is even heard, more often than not, the judge places a gag order on the accusers. In brief, if ever abused in therapy, you can expect silencing. I was forced-drugged because I refused to shut up about abuse. I was called crazy, delusional, or at least oversensitive. I was told “Human rights are trivial.” MGH told its patients to stay away from me and not read anything I write because I am “against recovery.” Yeah, almost like a representation of the Devil. I was repeatedly threatened and told I had to stop writing. I saw even worse times coming. If I had not left the USA to a safe place, I wouldn’t have told you all the Maria story, and all the other stories I tell, the funny, the sad, the infuriating, the scary, the joyful, the uplifting, all these stories that are who I am. I can only safely tell them, without reserve, without fear of retaliation because I have done this drastic relocation. If I were in USA, I can assure you, they’d have locked me up by now, or tormented and terrorized me, disregarding all laws, until I was dead. I am alive. I love saying “Nyah nyah.” I’ll keep retelling them, too, until I am heard, believed, acknowledged as human, and honored simply for that.

  8. I agree that 1:1 psychotherapy is extremely risky and potentially very dangerous. You just never know with whom you are dealing behind closed doors, and a lot of therapists are extremely sensitive and get triggered very easily. That’s when they can start throwing your issues back in your face or trying to control your emotions, being manipulative (which is how a lot of ‘therapy is designed to work, e.g. CBT), and giving you rubbish about all sorts of things. Indeed, it can be very abusive and disorienting. Exactly the opposite of what one would expect were services to be rendered with competence.

    It’s good to have intuition, but at the same time, people who seek psychotherapy are generally feeling disconnected and troubled so they are vulnerable. I respect that some people feel helped by this, but I also know a lot of people feel very harmed by psychotherapy. I agree with Julie, it’s a crap shoot, and it could have devastating results on one’s psyche that can be hard to understand if one has not been through this.

    Be careful and stay alert.

  9. Thanks so much, Alex, for validating my and B’s experience. I’d say by all means I am still affected to this day by the “treatment” I got from Maria. Before I started with Maria, I had a best friend and also had a boyfriend. She sabotaged those relationships and I lost both. As soon as she knew I had an eating disorder she tried to stop me from running, assuming that all people with ED overexercise. She also assumed all people with ED throw up. I don’t. She assumed all people with ED are sneaky liars and I’m not.

    Immediately, she began the forced weigh-ins at my primary care doctor’s office. I had a better relationship with my previous T, based on trust. With Maria, it was all about distrust. She forced me to play with stuffed animals in her office. It was so degrading! That’s therapy?

    After I was brutally abused in Massachusetts General Hospital, Maria claimed the “unit” I’d been on didn’t exist. This woman was a mandatory reporter and should have taken me seriously. After that, she made moves to try to get me into a state hospital.

    Maria threatened to put me in State at every appointment (twice a week), if I didn’t show up, she called the cops, and if I was ten minutes late due to subway outages, she was already on the phone with the cops. She told me if I didn’t show up to my forced weigh-in, she was calling the EMT’s. Not only that, but there were two ways to get to the forced weigh-in. One by foot, which Maria said I couldn’t do because it burned calories, and the other, I had to pay $13 each way for the cab ride. She accused me of vomiting when I never did that. That got to the point of ridiculous accusations. She spent a few sessions saying “bullshit” after everything I said. She had a seven-page contract written for me, and changed it at her whim or broke her end of the agreement. She bossed me around. When I got injured and the orthopedist told me I’d never walk or run again, she said, “Yay.” I have diabetes insipidus (from Lithium) and I tried to explain I need LOTS of water. She told me, “You are self-harming with water.” Or, “You are addicted to water.” Or, “You use water to manipulate others.” Or, “You drink water to give yourself edema to make it look like you weigh more.” These accusations reflected gross ignorance on her part. Then once when I was on the brink of death from dehydration and stuck in an ER for three days, she fired me because I refused ED “treatment” and said I would only go to a medical floor. A few days later, she phoned me, apparently changing her mind.

    Firing her some six months later wasn’t the end of it all. I couldn’t get anyone except other patients of hers to believe that a therapist could possibly be so abusive. During those next few months not one person would speak to me, not on the phone nor in person. Not one person returned my calls. I tried everything. All I wanted was to go out to coffee with someone. People just refused, rather rudely. I love solitude, but the forced social isolation that resulted from Maria’s abuse was pure hell.

    What could I do? Go hire another person, pay someone to talk to me? It was coming down to that, because I had not other opportunity to speak to anyone. I thought that was only going to last one month, but it dragged out and dragged out. No conversation from family, no workplace, no clubs (I was denied entrance to many), no friendly neighbors, nothing.

    You bet I am still affected, even though several years have passed. I’ve developed a fear of losing friends. I feel often on the defensive, like i have to “prove” everything I say, back it all up with “statistics” since my word was never good enough. Because of Maria’s abuse, I was denied future medical care. My psychiatrist believed Maria over me and that eventually led to more abuse while inpatient.

    This abuse isn’t limited to what happens in the office. It affects your whole life. It can affect you for years to come. I know why Donna killed herself. I know why Diane killed herself, too. Apparently, Adam Lanza was abused by a therapist. I can see why he did what he did. Because no one understood.

    I am doing everything I possibly can to get over the trauma. I can’t just go into a meditative trance or pray and then say it’s over with. All I want is for others to believe my story. That means others should not downplay it, stop claiming “it was a bad match,” stop claiming I’m “oversensitive,” stop claiming that what happened was a reflection of misperceptions due do “disorder.” Just accept what I am saying. The more acceptance I get, the easier it gets to heal from what she did.

    • I believe there are a lot of people who’d make similar claims and what you describe would more than likely ring true to them, as it does to me.

      I’ve certainly had similar experiences, and even witnessed this during my MFT training. In my clinical training group, we were taught that our clients would be manipulative and deceitful, that it was up to us to discern this and not ‘let them get away with it.’ That was really off-putting to me simply in my training, but I thought it was, perhaps, this supervisor’s perspective. I wasn’t aware at the time that this is the actually the generalized belief, as I later discovered it was, when I worked in social services. So the education begins with stigma, right off the bat, and then continues to self-perpetuate and snowball.

      In training, psychotherapists are also taught to have very rigid boundaries for themselves, while pushing the boundaries of clients. As a result, I found the various one’s I tried to work with over the years to be extremely disrespectful of my boundaries, and downright pushy and insistent, while at the same time, having boundaries that would make anyone feel totally powerless. What I picked up is that they were very emotionally needy, and expected clients to play that role of fulfilling their needs.

      This is a generalization, of course, but I’ve worked with tons of therapists and they were also my classmates and professional peers. What I say above was pretty much par for the course. It was becoming apparent to me that this was a terribly misguided field. But it was hard to know from just this one perspective, as a clinician. To really get this, I’d have to experience it as a client.

      And when I entered the system as a client, just after graduate school, I did experienced this first hand, on the other side of the fence.

      It was 100% totally impossible to engage any of the therapists I knew in a normal adult-to-adult conversation, for the purpose of achieving clarity on an issue. The stigma of being a client in the system is so overpowering, it is such a thick and dense filter that permeates that reality, really overtakes it in the worst possible way.

      Having one’s truth challenged repeatedly when trying to gain clarity is extremely taxing and draining and, indeed, can create post traumatic stress. It’s such tragic irony.

      • Alex, it’s interesting that throughout this discussion, no one has presented any surveys, data or studies showing that therapy frequently cause harm. I put a number which show that the positive influence of psychotherapy is often significant, and that people getting psychotherapy are better off on various distress measures about 70-80% of the time compared to people getting no therapy.

        Your experience with your therapy training was valid for you, but it’s again an n of 1 and non generalizable. Saying “therapy harmed me” or “I’ve met a bunch of bad therapists” or “I don’t like the profession” is really not a valid argument that therapy is a crapshoot or is more harmful than not. I don’t know this, but it’s possible that your own life situation or the lack of a good fit between you and the therapy profession somehow influences your perception of psychotherapy as a whole. That could be wrong, but my point is that 1 person’s experience is not reliable evidence about psychotherapy as a whole, nor justification for arguing in a broad way that getting benefit from psychotherapy is rare/occasional or that psychotherapy is more often than not harmful.

        • To me, this isn’t about evidence or proving anything. This is about our voices, our experiences, and our truth. Period. Personally, that’s where I find the value and spirit of life and humanity.

          Statistics dehumanize the experience, so they ring false to me. As does falsely projected analysis.

          I appreciate your comment, bpdtransformation, but trying to guess get inside my head like you just did ain’t gonna work, ever. Yet another reason I personally dislike psychotherapy.

  10. Margie,

    It is fairly common for MH professionals to become defensive over what they perceive as a personal attack, and immediately make accusations right before making the *diagnosis*, which only furthers the argument that the power and authority-card is a weapon. I have witnessed this power and authority used to retaliate (shame, degrade and punish) against kids, the elderly and vulnerable young adults in clinical settings where they *dared* speak their truths. So much for the therapeutic milieu?

    “B has a rage against all therapists;”

    I don’t see this as anything but an emotionally based accusation, that you state as though it is fact. What follows is your perfect illustration of the true purpose for the DSM.

    “this is simply unrealistic bordering on a disorder that is effecting others and creating an animosity that divides others and destroys the purpose of this site.”

    Not interested in what has happened to B ? But all set to point out what is wrong with B– because B pushed *your* buttons. Or rather, you have demonstrated the risk one takes *paying for professional advice*.

    • Again the “power” and “authority” issue. You seem to perseverate on the illusion that therapists have those characteristics. There is no point discussing this again because this perception reduces you to a powerless individual and thus we are not on the same playing field. Also turning the issue around so that the other person is “defensive” instead of looking at the problem of equating therapy with prostitution is a sticking point. The issue was the black or white view of therapists; all bad or all good that was the point of my statement. There are good and bad therapists, good and bad nurses, good and bad people, good and bad doctors……..

      • Margie, to some of us, therapy is, or was, prostitution. For some of us, the therapy served to end our outside relationships and then we had none. So where do you go to bounce something off of someone. It’s a sad day indeed when you realize there’s no one out there except the ones you pay. Mostly, it’s not even the person’s doing, but societal prejudice and ignorance. Another thing I see happening is when a person goes to therapy, others back away saying, “Don’t talk to me about it, talk to your therapist.’ I’ve even heard people say, “He’s in therapy now, so I’m off the hook and don’t have to talk to him anymore.” No, I don’t have statistical data on this and I don’t need it to prove that this was my experience. I don’t want to be discredited just because I don’t cite studies.

      • Margie,
        There is nothing but good reason to continue this discussion– if only because it raises the major issues that are in contention. How else can we, any of us here, reach new understandings when you continue to cite the reasons *these issues* cannot be discussed?

        Let’s be real. I have lived experience as a professional working in close quarters with SWs in acute care settings, locked wards. I have witnessed abuses of power from ALL of the power brokers on these units.Therapists, LCSWs are in the power broker category and thus there is the same potential for the abuses of this power. This is not an illusion. It is a potential inherent in the authority a therapist.

        You would outrank me in some major ways on these units, that directly impact patient treatment, even disposition/discharge. However, I am smart enough and dedicated enough to have learned a myriad ways of lessening the damaging impact from the abuse that passes for *treatement* and have learned to use my specific credential to thwart many of these abuses. YET, being real, Margie, you absolutely have authority I would never have, and you surely know this.

        I am not a powerless individual–this is your perception based on your perception that my awareness of the power hierarchy in my profession lessens my status and divides us in terms of —what? Credibility? I mean, here you are making all the pronouncements– I have illusions, B shows indications of a disorder–. What is it you are basing these pronouncements on? You are reacting defensively. This is your response to others having perceptions based on experiences with therapists.

        Equating therapy with prostitution is your issue? What does that actually mean? Well, if it is true that having a good, dependable, responsible, caring friend is better than hiring a therapist, then what we are talking about is what the recourse is for those who need a good, dependable, responsible, caring friend, but don’t have at least one. They have to hire a therapist — or will be directed to in the MH system, for sure. Therapy is a service, could rightly be called a human service business.

        What is prostitution? A business operated by people who will provide sexual services for someone who is unable to access sexual gratification via a personal/intimate relationship. Prostitution is just another human service business, albeit illegal, no less important to those who have the money to buy what they need or want.

        The inequality of these two human service businesses lies in two main distinctions 1) Prostitution is illegal. Therapy is legal. 2) Prostitution is predicated on the power of the human sex drive. Therapy is predicated on the power of the human need for connection to other human beings.

        The two could be said to be equal in terms of risk for harm to the person who can never be sure he/she will get what they are paying for.

        Comparing therapy to prostitution does not imply that ALL therapists are abusive or that ALL prostitutes are *bad* people. The point of comparison is mainly, imo, a matter of risks — and buyer beware warnings are applicable to both, also, imo.

        I disagree that there is a black or white view implied here– but there is a clear warning implied; one that is absolutely appropriate because, there are lived experience stories about the hazards a consumer *may* encounter — because there are abusive therapists who prey on vulnerable people and prostitutes who do the same.

        I consider myself a good nurse, but I have made mistakes. Would I be human if I hadn’t ever made mistakes? More than one of my young patients called me out on my shortcomings, and I have to say that I am deeply grateful that I heard them out. It wasn’t long before I found out that their perceptions of my *profession* were spot on.

        • As long as you continue to lump all social workers together and consider that in all settings we have “authority” (I was very low on the scale and psychiatric nurses earned 10,000 more than I and had more authority) then there is no discussion. My friends (psych RN’s) are wondering just how many settings you worked in and how your conclusions can be drawn from a small sample including individuals who share your opinion. You are not correct in your conclusions and the generalizations along with the “authority” issue is a barrier in this dialogue. I will say this even though you will probably take offence; you sound very dogmatic and authoritarian on the subjects that you discuss; there is no compromise, no looking at things from a different perspective. It’s almost like those individuals who have freed themselves from cult-like experiences but have taken on the authoritarian tone now that they are liberated, without being aware of it.

          • These are fair questions.
            My psychiatric nursing experience started in 1988- 3 years working in a residential treatment setting; then, completed a child psych nursing internship at Johns Hopkins, 2 years part time at pilot inpatient program “The Center for Addiction and Pregnancy”; a year working at the Locked eval and crisis unit in girls residential treatment setting ; a year working in inpatient 30 day substance abuse rehab — I did *staff relief* agency nursing on the adolescent and adult units at Crownsville State Hospital– all in Maryland.
            In the Boston area, where I moved in 1995– I have worked *full time* on 2 different adolescent psych units, (one was Bader 5, Boston Childrens hosp. ) Also worked per diem: Intensive adult inpatient; substance abuse/detox, young adult, adolescent and geri psych. – at 2 separate facilities.

            On child/adolescent locked units at the 2 academic medical centers where I have worked (total of 8 years), therapists were usually LCSW’s,with a few psychologists as administrators-. there were also SW and psychology – interns training in these fields. The therapist was second in command on a patient’s treatment team- above the RNs , right below the attending psychiatrist.

            Observations of the behavior of some these therapists were cited in complaints to the Dept. of Mental Health, licensing agency in Boston, by me and 5 of my nursing colleagues– reports were substantiated. Therapists penned behavioral mod/treatment plans that caused vicarious trauma in addition to the traumatizing of the actual patient. I am still recovering…Thank you for asking about my credentials/credibility.

            I share my observations and have developed conclusions over years of contemplating the enigma– helping profession v. degrading patients/families and even sadistic treatment of the most vulnerable people– kids, the elderly, homeless, deeply trouble people.

            I have participated in thousands of treatment team meetings– and listened to gossip & value judgments from therapists who, after all, could claim to have the *most* comprehensive info about a patient. (most of the most damning info obtained via phone calls. I did note that amongst the therapists I have known in each setting where i have worked, there were instances of what would definitely qualify as *good work* with *tangible benefit to a patient*– invariably it was also noted (conclusions shared by many of my fellow RNs) that these patients were generally well liked, or had VIP parents, or some attribute that served them well in the MH system.

            I have no more or less authority than anyone posting here about their *lived experience*– and almost as much outrage as those who suffered directly have expressed.

            Am I offended that you have assumed I am not qualified to voice an opinion on this topic? Am I offended that you assume my conclusions aren’t correct?
            am I offended that you see me as “almost like those individuals who have freed themselves from cult-like experiences but have taken on the authoritarian tone now that they are liberated—without being aware of it?

            The answer to all of the above is, No. I am not offended. How can I be offended by your assumptions?

            Throughout every comment you have posted since the push back on your *no place like home..* blog post, you are categorizing, finding the fault with or looking for the weakness in the commenter who *speaks his/her truth*.
            This is interesting, because it really mirrors what is being cited by those of us who are sharing our lived experience with therapists– Mind you, Margie, none of us know you personally– we can only address what you write here– and seems like you can only come up with something that discredits us– and diminishes the value of our stories.

            Oh– should address the salary issue. Yes, I earned more money than SWs in any setting where I worked. My RN license was a bottom line responsibility factor– especially when I was in the role of Charge Nurse. — responsibility for lives– medical monitoring, and early detection of serious medical issues. Specialized knowledge, tremendous responsibility that goes with my RN license. Out ranked does not always = bigger salary–

            Toward the end of my career, I often made as much money as a new nurse manager and a good deal more than the interns and residents– . My experience was compensated according to the policies of each facility I worked in.

            What was your role, Margie, when a patient stopped breathing?

          • Want my credentials, too? I was incarcerated over 50 times in both private facilities and community hospitals. I attended four or five day treatment programs. One I spent over three years in. My longest hospitalization was over two months. I dutifully attended my therapy sessions and was praised for compliance. I was rarely late. I had the pills memorized, the doses and what dates I started and stopped them. I dutifully kept symptom charts and was praised for how cleverly I used graph paper and colored pencils. For the first two decades I was never sectioned. I went willingly. While in those places you bet I saw abuses. I figured it was necessary treatment and that I had no rights. I came from an upper middle class family and both parents had master’s degrees. My dad had two master’s degrees. Because therapists lied to my family, I have no family left and am sitting here wondering what to do with no money no voice no credibility.

            I no longer buy into the argument that I was the unlucky exception. When they can take money from you, you get better care. As spoiled rich kid I had it good. I thought therapy and all those facilities were great. I had no idea why others were complaining. Some three decades later and broke, I had seen plenty enough. Facilities where I was kept included McLean, Massachusetts General, Brattleboro Retreat, a state hospital, Gould Farm, and more. I still managed to earn my bachelor of fine arts degree and MFA even though the social workers said I didn’t belong in academia. They begged me to quit. They even claimed they knew me better than I knew myself. Of all the professions out there, for sure a writer of memoir knows herself better than anyone else does. It is necessary for the work I do. I am not a statistician nor political scientist. In fact all I need is to be myself. That is my credential.

      • Keep repeating your mantra if you think it works for you; in the eyes of almost everyone else you embarrass yourself more and more with every post. Whatever psych/word games you think you’re playing, your defensive responses are clear for all to see.

        BTW, in case you are oblivious to this, at this point people on this thread are not talking about “therapists,” they’re talking about you.

  11. Well I disagree with the statement, “There are good and bad people.” To me, that is black and white thinking. People are flawed, but I have not met a truly bad person. There are people who are dishonest, there are those who have values I disagree with, there are those that are discriminatory. But intrinsically bad, no. Just misinformed. Or brainwashed or drunk. Or being abused. In fact, that question came up a while back about a “bad mother” who harmed her child. The media was all over her. But I believe she was being abused and didn’t in fact commit this crime, but took credit for the crime to protect the abuser.

    When I see bad therapy, I ask, who are the administrators running the clinic? I recall one therapist who took me on simply because she heard I show up. I found out she had no interest in helping me and had no knowledge of my challenges. I found out the agency was “fee for service” meaning she wasn’t on salary but was paid per patient that showed up. A salaried one is in similar boat because if there are too many no-shows the agency puts the pressure on to “get one’s numbers up.” It was like an assembly line. I had one change my dx saying she had to do that to get paid. It all sounded like a crooked racket to me.

  12. Dear BPD, You have to realize that those of us who have been harmed were also deprived of a voice. We cannot sue and if we win, we are forced into silence. Those of us who have been abused by therapists have also been discredited by them.

    If a car repair person does a lousy job, and the customer speaks out and complains or tells his buddies, the car repair person can’t say, “Well, you know those Buick drivers can’t be trusted, they’re all deranged.” However, a therapist can quickly discredit a patient, “She’s bipolar.” Then what? That patient has been effectively silenced.

    So yes, the studies very well could be flawed. They didn’t poll dead people. Their definition of “recovery” might mean “compliance” or might mean “not in the hospital.” Actually, there were times I wanted to be in hospital just to get away from an outpatient therapist.

    Julie

    • Julie,
      Of course I realize that some people are abused and harmed by therapists and do not have adequate recourse afterwards. My point is that despite this fact, on the balance the data shows that your experience is the minority, and not by a small margin, but by a large one.

      If you read through the studies carefully, you’d see they are mostly reporting client self-reporting of feelings of well-being or depression/anxiety (measured by things like Beck depression scale, Hamilton anxiety scale, CGI scale, etc.). Not perfect instruments, but give them credit because they are asking the individuals. A few of these individual studies (in the metaanalyses) even rate patient opinion on the perceived quality (good or bad) of the relationship to the therapist over time. So no, it’s not just “compliance” or ” not in hospital”.

      Speculating about these ideas, having obviously not even read the links, is not a real argument.

      I stand by my point that you have presented no real argument beyond opinion. Your opinion is valid for you, but should not be generalized to therapists and their clients more broadly.

      • Those scales aren’t all that valid. I remember filling one out (I did this regularly and dutifully) which was read by computer so I had to fill in those circles real good. When it was read back to me the counselor said, “This says you have panic attacks. But that’s not true of you.” turned out that my answer to one question, “Do you have cold hands and cold feet,” had tripped off an alert. Hmm… It was winter and I am skinny. The therapist had to go back to her supervisor and explain that the test had come back wrong and not to worry. So much for that.

      • @bpdtransformation,

        Working on inpatient locked wards here in Boston, I was privy to all information precipitating all admissions. Out patient therapists in the Boston area pretty routinely send patients directly to emergency rooms from their offices. Therapists coordinate via ambulance transports to emergency rooms from group homes. Referrals from therapists for crisis team evaluation and/or 72 hour holds are not uncommon. What is also common, predictable in fact is the anger expressed by people who are taken to the ED against their will, not uncommon either for police to be involved, for the person to be restrained mechanically and physically before finally getting admitted to a locked ward. The usual precipitant is the person has disclosed feeling suicidal, or is self harming-i.e. “cutting”. Adolescents, young adults even older adults disclose feeling betrayed in these circumstances. Who wouldn’t?

        Routinely, the OP therapist is in direct contact with the SW who has been assigned to her/his patient. Routinely, the *patient* expresses trepidation over this relationship. Unfortunately, from my position with regard to these admissions, I can validate the *patient’s* worst fears. The dynamic of coercion , control and disregard for the *patient’s* voice is the norm. I can also tell you that the documentation of the patient’s response will probably note that he/she is exhibiting *paranoia*.

        In the community, advocating for people who want *out* of the MH system, I have had run- ins with therapists who behave an awful lot like the ones Julie has described. The worst incident for me to date, involved a therapist who called 911 and authorized *involuntary/Section 12 *in MA- via ambulance transport of a young adult to a *psych ED*. This therapist’s stated goal, due to my client deciding to stop meds cold turkey –again, after not gaining any support to be tapered off of Zyprexa and Depakote , was a long term stay at *The State Hospital* — in fact the therapist had threatened this prior to the episode I am referencing. Coercion to *stay on meds*. So, no surprise there, but what was surprising was after my client stayed in control for 2 days in the ED and 2 more on a locked ward, I was able to share pertinent info with my clients treatment team–.The result was immediate discharge, no meds and new diagnosis PTSD– the trauma associated with numerous inpatient admissions, restraints etc in the past– . I had success in getting the diagnosis converted from /bipolar disorder . My client was trauma reactive, not manic. It was risky to keep my client on a locked unit where the triggers were unavoidable. My client’s therapist threw a fit, and when she was fired by my client’s parent, did make a few attempts to sabotage my client’s recovery– mainly via unethical communication with my client’s new therapist. This is how I was able to read her extensive — full of crap notes, compiled over a few years.

        Another coercion tactic , new to me, involved threatening a client of mine with disqualification for disability IF my client stopped taking psych meds. This therapist refused to discuss the matter– and refused to read medical literature from a prominent neuropsychiatrist who adamantly stated that psychotropic drugs were contraindicated in people with chronic Lyme disease. My client, in fact , was also being treated for chronic Lyme. Not only did my client exhibit adverse effects of the psych meds (prescribed by the nurse practitioner working in partnership with this psychologist/ therapist) , my client desperately wanted to follow the advice of the Lyme specialist. Caught between a rock and a hard place– the Lyme doctor could not authorize even short term disability. My client was already in foreclosure– needed extended short term disability. The therapist won.

        Inpatient therapists, or SWs have the title , *therapist* but are not doing therapy with their patients. They are coordinating after care, and putting pressure on group homes and long term care facilities– even family members to expedite early discharge. I witnessed a SW arrange for transport home via taxi for a patient to prevent another inpatient day that would not be reimbursed by medicaid–

        I have heard so many stories from young 20 something women, diagnosed “Borderline”, about the ways in which their therapists *turned family against them*, kept them from returning to college mid-semester, and kept those prescriptions for Ativan coming—. A few former clients in this category were coerced by their therapists into residential treatment for BPD (Babcock house, Brookline, MA) where they learned several new techniques to self harm.

        Inpatient therapists/SWs in private, for-profit hospitals sporting the latest in Behavioral Health, have devised ways to circumvent the *tactics* employed by patients who want to remain in the hospital (rather than go to a shelter or sober house). Some patients do say “I am not feeling safe and may hurt or kill myself outside of the hospital”. SWs document on the suicide lethality scale/assessment tool. The numbers don’t add up to much more than *low* risk– . Higher numbers can mean a patient who wants to leave, is detained- and especially if on Section 12, will be informed that filing has been completed for court ordered involuntary commitment– no less than 6 months. A SW/therapist around here has a lot of power, which patients know and seldom test to the limit.

        I have met more clients unraveling due to a therapist who has set limits they cannot abide, than client’s cheerfully singing the praises of their therapist’s expertise.Most of my clients have fired their therapists, after the therapist refused to work with anyone who would be assisting them to withdraw from psych drugs. It takes months for some of them to get over fears of how their therapist may either punish them .
        or sabotage their recovery–.

        I broke down a cried during a meeting with a new client’s therapist when she told me she had decided she could not put herself through the suffering of watching this anorexic *patient*starving herself to death. This client did not meet criteria for inpatient *medical* admission, was not below 80% of her ideal body weight, had normal pulse, blood pressure, blood glucose, etc– BUT had confessed to “not following her meal plan”– This therapist was close to my age, and well known to me. Regardless of all of the valid reasons for supporting this person through a personal crisis (her beloved Aunt had just passed away) this therapist began to usurp her authority, saying she was recommending an inpatient admission– either to a psych unit or eating disorder inpatient treatment center, depending on bed availability. She claimed that she would feel responsible for what she was sure would be a poor outcome for the client she was, in fact, ditching. I could not believe she was pulling this, and asked why she did not trust my clinical judgment– . She referenced my ordeal at Children’s hospital, saying, “I really don’t know exactly what happened, but have heard that you were sabotaging the recovery of patient’s with anorexia.”– Yeah, I cried– or teared up… then quickly regained my composure seeing the smug satisfied look on her face as she said, “I’ll just arrange for a psych eval —”
        .”Great’, I replied.”I will take my client to the ED and remain at my client’s side. I will share the safety plan we have developed. My client will not meet criteria for psych eval or inpatient ED– the most you can accomplish is wasting my evening, though I think it might be valuable for L.. and our *therapeutic rapport* So, yeah, go ahead…”
        She changed her mind.

        Still, I believe in the inherent potential for all therapists to be as compassionate and skillful as the one I know who is in private practice. She works with *non traditional families* and is especially well known for her work with adoptive families. Here is what I like best about her. Rather than diagnosing kids, referring them for meds– or supporting meds as treatment for the behavior/emotional issues these kids were struggling with, she closed the clinic she could not afford to maintain. Routinely, claims for the therapy she and her staff provided were denied– due to no diagnosis, etc. Additionally, she lost referrals and consult requests from the child welfare system due to her position against drugging and labeling kids–. She scaled down–her practice, but is still very active doing trainings and presenting conferences. Whenever I am feeling depressed or triggered /I can stop by her office for some play therapy.

        . Maybe psychotherapy is a great thin, but I stand by my buyer beware warning–: Any MH treatment reported to be highly effective these days should absolutely be scrutinized– and regarded with healthy suspicion, at the very least.

        • Hi Katie,
          I am well aware of how untherapeutic an environment, tantamount to the worst prisons, that mental hospitals are. I was briefly incarcerated in one of these hospitals in my early 20s and so understand it from the patient perspective (you can see on my site I’ve written about this experience).

          Mental hospitals are not at all an environment where meaningful effective therapy can be conducted, due to many factors including overdrugging, diagnosing, lack of freedoms, etc. I have no doubt of the truth of your stories.

          There are a very few hospitals like Austen Riggs and Cooper Riis where meaningful therapy is possible, but these are 0.001% of mental hospitals and available only to those with money. Almost all mentally hospitals in the US are fatally infected by drugging, diagnosing, and coercion.

          I would say your view is a bit biased – not in the negative sense, but in the sense that everyone’s view is biased by their particular experience – by your having been a nurse in a (presumably poorly run in some ways) hospital and often seeing people in crisis and at their worst.

          Most of the studies I cited are studies of long term outpatient psychotherapy, often occurring in private settings and more often than not in European countries. In a hospital environment, especially in recent years where the average stay is 3-10 days with perhaps a few more weeks or months of outpatient “treatment” to follow, successful psychotherapy is simply impossible.

          A therapeutic relationships and trust simply cannot be developed in a few days, nor can it be done in an environment of coercion, severe power imbalances, drugging and diagnosing. When I was in a hospital I had the thought that doing soothing psychotherapy in that setting was like trying to have a relaxing picnic in hell.

          I think several of the commenters on this thread have unfortunately not had the money or resources to seek long-term outpatient psychotherapy in a safe, non-medical environment, with a well-trained therapist who operates completely outside the medical model and is truly committed to their client’s wellbeing. These therapists are out there but few of them are to be found in mental hospitals.

          • I’ve had both private and public. I had private long term psychotherapy in my 20’s. I really loved my first therapist, saw her for several years when I first started looking at my issues. This was back in the 1980’s.

            In San Francisco, from about 1996-early 2000’s, I started out with private psychotherapy, had to shop around a bit, most were awful right off the bat, being incredibly patronizing and saying kind of dumb things that were irrelevant to what I was saying.

            But one of them was actually respectful and seemed intelligent, so I stuck with him for a while. We did some good work, but at the same time, he was trying to get me to ‘fit in,’ I see that now, in retrospect. I knew we had gotten kind of stuck, but I wasn’t sure why, then I got it.

            But more than that, by that time, I was on so many drugs that he was pretty helpless about why I was going downhill, despite having been totally responsible and perfectly compliant with all my therapies. No one had any idea of what was happening, that turned out to be really bad drug side effects. That’s when I chose to get off all medication, and I entered the system for support. I had graduated, and no more student loans, so the system was my only option at that point. That’s where I got a crash course in public psychotherapy, which still makes me shudder to think about.

            So my feeling about this is that 1) times have changed and people are way more uptight and anxious, especially in the professional community, and 2) I was really not impressed by the psychology community in San Francisco, starting with graduate school.

            I had had psychotherapy in Texas in the 1980’s and I have no complaint about that whatsoever. Although it certainly didn’t cure me of anything or resolve my issues, but it was nice to have an attentive and warm person listening to my troubles, and giving me intelligent and welcome feedback. She moved me along pretty well, and I’m grateful for that.

            So I don’t know if we’re talking about west coast culture or urban culture. But I do know that it was consistent in SF, regardless of public vs private. Before I moved to SF, I had no gripes about therapists or therapy, which is why I went to graduate school. That’s when the shit hit the fan, and I discovered a whole different side of things in the world of mental health.

          • So, okay, I hear this now. Money is power. Those with money get a voice. I know this to be true, since most books that sell well are written by people who have hired publicists or who have their rich buddies buy multiple copies of the book. Selling a book has little to do with the book’s merit. It’s all about knowing rich people who can bribe bookstores and who can get you reading slots in the big venues. It’s about having parents who sell you. It’s about having husbands who are filmmakers and decide to make your book into a movie. It’s about having an “in” with the big media. That means money. I guess therapy is effective if and only if you have tons of money. My own family was upper middle class, mind you. My parent paid $10,000 for my first day treatment program and over the years, likely a million. I was horrendously harmed by McLean. Isn’t that one of the greatest mental hospitals in the world? A friend of mine who might very well be reading this is currently working on collecting McLean abuse stories. Yes, it’s that common there, you just don’t hear about it often since the abused lose their voice. You only hear about how wonderful they are. And I know many who were locked up there over six months. I went to their day programs, where we were treated like toddlers. When i complained, they tried to send me to State. My friend Diane was psychiatrized at the Hartford Institute, for which her family paid a fortune. She stayed two years. That caused her to lose custody of her child. She’s dead now. Funny thing one day Diane said to me, “Don’t ever let yourself end up in the hands of social workers.” Now they are uncovering that David Foster Wallace had lengthy contact with the MH world and also addiction “treatment.” He already had earned his MFA, the same writing degree I earned, too, before he went in. He felt like he was being treated like a first-grader. For sure, I can relate. I, too, was insulted by the handouts, the groups, the kiddie games, and being pushed into working a dead-end, minimum wage job until someone finally figured out he was a scholar. He’s dead now, too.

  13. Therapy can easily be as harmful as psychiatry. The two often go hand in hand, anyway. I’ve survived some terrible counselors. Even now, as I recover from “treatment,” some counselors in my area are going after me. Bipolar. ODD. OCD. ADHD. NPD. Diagnosis as a weapon…its not just psychiatrists! Actually, come to think of it…here, in my little corner of the world, my recovery seems to be “triggering” terrible (mis)behavior on the part of some “professionals.” Troublemakers…aren’t…supposed…to…recover.

    I find that many MH people are elitist, too, or at least extremely class conscious. Why don’t working class and poor people get good therapy? Because they’re not good enough. Drug em up, send em away, basically. Now, if you’re upper middle class or above (or have people like that behind you), then…well, maybe some compassion is in order…

    I think part of the problem is all these mass-produced masters in counseling people who are paid too much (For what they do) and think too highly of themselves, while failing to deliver anything useful. Not that training is all that important, but…give some of these asinine creatures a masters, they think they can rule other peoples’ lives. It used to be said, “Those who can, do. Those who can’t, teach.” I think now this is true of counseling…”Those who can, do. Those who can’t, counsel.”

    Just my experience, that’s all. 🙂

      • I filed a medical board complaint against an ex-shrink because she got me hooked on Klonopin as a teenager (now 18/19 year old needs 3mgs/day Klonopin, plus Sonata). As part of the investigation, lots of people got subpoenas for my records, and now…retaliation. My recovery has only intensified things, honestly.

        If it wasn’t for my upper-middle/upper-class people behind me, I’d be…somewhere terrible, for sure.

    • Very movingly stated, yeah_I_survived, and you say what I discovered, too, exactly. Class snobbery and ignorance are exactly what I found in graduate school, internship, and when I worked in the system. It is an extremely elitist field with a one-sided perspective of humanity, which would make it not only useless to most people, but also harmful because it repeats these dynamics, creating only social pressure for clients. This is not at all a good thing.

  14. I can speak to the cult survivor analogy. I was in a cult once. I was in the Moonies. The System uses the exact same brainwashing techniques that the Moonies used. As an ex-cult member, for the first year, I was very confused and lost. I had many questions about religion. I “tried out” many religions to find one that was “just right.” I was disappointed. I almost went back to the Moonies. Why? I found love there, but to keep the cult’s love, I had to be a slave to it. I couldn’t have both.

    Later, the MH System provides a walled ghetto for people, real or figurative, where yes, there’s love. For a price. You give your life. All sorts of threats will follow you if you try to leave. “You’ll be unstable!” “You can’t live without us!” “You can’t manage your life.” “You’ll only come running back.” “You’ll fail without us.” “You can’t do that without our permission!” “You’re a danger to yourself and others.”

    Anyone running from them right now, keep running. Don’t look back.

  15. Even though I feel psychotherapy can be potentially dangerous, I also think it can potentially be a good tool for gaining clarity around confusing issues. If the therapist is present, authentic, neutral, and can own their issues as the client talks about their’s, then I think there is hope of achieving clarity, which to me, would be the goal in psychotherapy.

    But I also feel psychotherapy is limited in scope and can only do so much, and I feel it has over-inflated itself rather arrogantly and presumptuously. I think that’s a sign of the times. I think psychotherapy used to be practiced more humbly and with focus. Now, it seems like kind of a hodgepodge, with a lack of focus, at least that’s been my impression.

    I was in therapy for a long time until I finally stopped and did other healing work to get my head back on straight. I had developed all of these inner critical voices as a result of the last group of therapists I dealt with. It took a while to clear all that up, and I finally did, when I found my own sense of self and started living the truth of my own heart, with no one’s opinion in my head but my own. That was extremely freeing.

    It can work as long as it is neutral and respectful. Personally, I found that very hard to come by, and finally gave up. It was amazing how clear I got when I walked away from letting someone fiddle around with my mind, beliefs, and perception that way. And because of this, I chose another path to healing, and this time, it worked.

    I used to love psychology, even as a kid. I loved reading Freud, Jung, R.D Laing, etc., and people used to always tell me that I was ‘psychologically minded.’ I loved thinking about how we operate as human beings and as a society, I find it fascinating, always have.

    But I have to say, that ever since my experience in graduate school and then in the system, along with how my health so totally deteriorated for the time I had turned to the mental health world for support, and then how it totally turned around when I did other kinds of healing not recognized by the mainstream mental health industry, that’s when it dawned on me that this isn’t about psychology, but it is about how we run our energy, how we direct our thoughts, how we pay attention to how we feel above and beyond anything else. And how important it is to stay away from toxic communities.

    I’m no longer focused on the psychology of humanity because I realize now that this is mainly an illusion, our personal and subjective stories and interpretations. In psychology, we are at risk telling our stories, as our words tend to haunt us, personal stories are so often disrespected, as I’ve seen here. Why are we analyzing people, rather than loving their spirits? No way is this healing, in fact it is terribly invalidating to our hearts and spirit. That’s what I would consider to be ‘toxic,’ and it’s widespread in the psychology world.

    I mean no personal offense to anyone, we’re all human and we all have learning curves. But I do think this is a national emergency and no time to mince words. As far as the world of psychology goes, I just think there are too many filters that are not recognized when dealing with people, and it’s creating a big ol’ mess. I think it’s time to see reality through a different lens. That would be an awakening for the psychology world which I strongly feel needs to happen, and soon!

  16. I just thought of this, had forgotten about it and it’s relevant.

    The very last therapist I saw was in the private sector, and I went to her after having totally given up on the mental health system, after having felt literally brutalized by it for years, I walked in and told her specifically that I had post-traumatic stress from the system and wanted to heal it.

    I’d already transitioned in every respect away from psychology and even had had my own practice going for a while, which is geared toward natural, energy, and spiritual healing. But I really felt I needed closure with the mental health world, I’d been a part of it for so long and had all these unexpectedly wild and eye-opening experiences leading to really major transitions in my life and being. I’d already moved from San Francisco, to a progressive small rural town, where I live now, and I was hoping that I’d find someone grounded and open to listening with a respectful ear.

    I found a semi-retired psychotherapist who was a professor at a local college, and who was just a few blocks from me, I could easily walk. She advertised specializing in transitions and ‘practical’ therapy. I had just moved here, so it all seemed perfect, as I was setting up shop. This is all I wanted.

    I told her about my history, and about how I healed through alternatives and natural medicine and opened my own practice, made a film, etc. When I mentioned how now I wanted to address the post-traumatic stress–which I do not consider a disorder, but trauma which can be worked through with the right kind of dialogue, insights, and permission for shifting to occur–from what I went through in the mental health system, she said, “I’ll be the one that says what you have” (I’m serious!), and pulls out a pen and pad and starts asking me about my childhood!

    I took a really big deep breath to gather my thoughts and ground because my heart started pounding out of my chest at that point, and was kind of shaking from the rush of emotion I felt, and trying hard to keep my cool, which I managed to do only because I really felt suffocated and angry, and I wanted to get out of there asap.

    I got up and pulled out my wallet and fumbled it open, pulled out a $5.00 bill and put it on the table and said, “This is for your time,” and got the hell out of there. She was taken aback of course and was saying something to me as I walked toward and out the door, but I could have cared less what it was and just kept on walking, in a bit of a huff. By the time I got home and told my partner what had happened, I had steam coming out of my ears, I was so angry. Then I settled down and was absolutely 100% that I’d never again seek out a psychotherapist for any reason. That was that, after 30 years.

    That’s when my pts started to heal, once the smoke cleared. I just felt so free, as though I had communicated exactly what I needed to communicate, with that one gesture. And, as Julie says, I ran out of there and fast, and I’ve never looked back.

    • Alex,
      You might find this interesting– since it is a self discovered kind of therapy.

      I work with a lot of young adults who were traumatized by the MH system. Makes sense, since Jos. Biederman is right next door–.

      Trauma during childhood and adolescence being the crux of the matter– and my main area of interest,I am always discovering wider applications of what I first sought out as specialized knowledge. Your experience here– got me thinking–.

      I have extensively studied Lenore Terr’s work-she is child the psychiatrist who worked with the 26 children who were kidnapped from their school bus and buried alive (all survived) 1976- Chowchilla, California. She wrote about her long term experience working with these elementary school aged kids in “Too Scared To Cry”- Terr was the first child psychiatrist to fully explain how trauma affects kids.

      Lenore Terr made breakthroughs in understanding how kids react to traumatizing events, they “freeze” when they find themselves helpless, alone, scared–. In fact it is because they tend to look like deer caught in headlights, instead of being visibly upset, it is often missed entirely that they are *frozen in terror* (side bar: this is the look you will see on may kindergartners or first graders faces on the first day of school) —

      Lenore Terr’s work with the “Chowchilla” kids was amazing– she was their first and only *therapist*. She employed *play* therapy exclusively– documenting what She observed, and called *trauma play*, which was *symbolic* reenactment of the kidnapping events, etc. She noted that the typical excitement and building of tension, that can be seen when watching kids play, is not released in *trauma play*. Why? Because the child has not been able to figure out how to resolve the problem/conflict–so becomes more upset and frustrated, which is the opposite of the purpose of play to begin with–. She found that -until the child *on his own* figures out how to resolve the *terror* he is feeling in the act of play, he is essentially *stuck*–

      Important side bar: With regard to *traumatized* children it is USELESS to even attempt *talk therapy*– the concepts, schemas are *not there* yet– play – sensory motor activity is the mechanism that engages the child in *working out the problem*–

      Lenore Terr postulates that writers like Stephen King and Alfred Hitchcock had unresolved early childhood trauma– their horror & suspense stories , respectively, are *trauma play* reenactments, repetitive themes — evoking intense feelings. Stephen King was traumatized witnessing a train *monster machine* kill a person lying on the train tracks– Alfred Hitchcock was traumatized by a *scared straight* prank his father arranged ; had his young son thrown in jail for some minor offense– short term, of course, –the *horror/suspense feelings evoked in his films , may just be the adult at play, still working on resolving his early childhood trauma…

      This is way brief– just a taste really, but I needed some ground work to describe what I think may have been * the breakthrough* you experienced via your last therapy appointment–which was a first encounter with a *new* therapist.

      I think you resolved your “Psychic Trauma”-childhood experiences of sudden, unexpected , overwhelmingly intense emotional blows, or a series of emotional blows that made you feel utterly helpless–?
      First getting your feet on the ground –Studying psychology, pursuing a career as a therapist, then entering the system– testing over and over “Who’s right about me?” Experiencing these scenarios as trauma play , trying to resolve your own history of psychic trauma–

      Finally, you know enough about the field and yourself, you schedule an appointment– YOU begin to feel in control– and when the therapist starts to pull the rug out from under you–? You take full control, –heart pounding (I love this part– because you were not thrown into survival mode this time when triggered)–YOU resolve the tension, you act on your rational thoughts– then after you have left– you have the *shake it off* post traumatic experience *reset* experience.

      For many of my clients, trauma play starts with an involuntary 72 hour hold– replay, replayed again– inpatient– almost court committed– until “they” walk out of the ED– not sectioned– not medicated– heart pounding as they send me the text–“I did it–I’m free”

      No two are alike really– because there are so many different aspects of the system that wound the spirits of young people– what is the same is the *play*–that I witness in awe of the creative expressions I am privileged to observe–

      It is worth repeating, I think, that we all do have our own reset buttons–
      Cheers,
      Katie

      • Nice, Katie, I do agree wholeheartedly that we do have our resent buttons. In my work, we call that ‘coming back to center.’ It’s an all day everyday practice. It is human to go in and out of center, we all get triggered all day long, whether we are conscious of it or not. When we are conscious of it, then we can consciously practice coming back to center, which is the healthiest and most calming, grounding, and clarifying thing in the world. To me, that would be the reset.

        It’s such a catch-22 when one’s anger is triggered anywhere in the vicinity of the mental health world, as it often is by a clinicians words and deeds, because while most of us know it is healthy and natural to express anger when one is angry, a natural human emotion, there is always a blowback, mostly diagnosis.

        But there is also deep stigma, because immediately the clinician fears violence and gets totally rigid, controlling, and forceful at that point, leaving the one expressing anger feeling totally powerless and as if they were crazy.

        It has taken a lot of practice and focus to learn how to best express my anger when I feel angry, in an attempt to have good closure with the mh field, and I’ve shifted a great deal as a result, given that I had to work with my own perspective and issues in order to experiment with how I express myself to be heard and responded to in a respectful way.

        What I discovered is that, in the end, there is no effective way to do this, because it is a closed system with locked in strategies for dealing with dissension. I think it’s cruel.

        As a kid, I was not aware that I was being traumatized day after day, I thought it was normal to live in fear and feeling perpetually unsafe, as if the boom could be lowered at any moment, seemingly unprovoked, which of course often this is what would happen, and we all felt powerless to it. My mother was the only other adult in the household, and she chose to live in fear and anger, rather than to make another choice, so we were stuck with this as long as we lived at home.

        Otherwise, I was a perfectly normal-acting kid, high achieving and involved in all sorts of things, debate, theater, honor roll, etc. But inside was this horrendous anxiety that kept building and building, along with negative self-beliefs, which I hardly expressed, for fear of consequence for not being ‘happy’ all the time, and having any needs at all. My folks were extreme narcissists.

        After high school and going through all the initial diagnoses and starting with medication and weekly therapy, I worked for 17 years as a retail administrative and customer service manager and loved it, I did well and was very creative in my job, and well-respected in the company. I also get my BA in Film during that time.

        During this whole time, I lived with diagnoses and on meds, and all the while I had the belief that I had a chronic illness and would need medication for life. I adjusted to that and moved along with my health support in tow.

        It was during my years in graduate school, after retiring from retail, and intensive psychotherapy that the extent of the trauma from living in constant fear and dread–which continued with me internally, wherever I went, which was the reason I got diagnosed and medicated–was really profound, and explained a lot of what had seemed like ‘irrational feelings’ (I don’t like that phrase, but that is how it felt at the time) and negative self-image and self-talk. All of this had been suppressed by meds, and denial, for over 20 years.

        There began my dark night, and the transition period where I went from having a ‘mental illness’ to realizing that my troubles were really the result of childhood trauma, my energy sucked dry by needy parents. Although my dad was a well respected physician, they were ‘pillars of society.’ So it all went undetected.

        So for me, the challenge became all of the dissociation that occurred as a result of the medication, and simply not being connected to my feelings about it all. I kept analyzing my experiences rather than allowing myself to feel them, so while I may have gotten insights, nothing really changed because I could not be present in the moment with a narcissistic vampire (my preferred term for energy-suckers and those who demean and control). I’d walk away, and realize later that I got whacked or drained or demeaned or something like that.

        That was hard to deal with, because I was not present to stand up for myself in the moment, and the feelings of powerlessness from abuse would snowball.

        In this case, with this therapist, I had already figured out so much of these toxic mind games and had done a lot of work around this, but I figured face to face with a therapist would really make the closure authentic, rather than my going off and doing it on my own, forgiving, taking responsibility, etc.

        So by the time we go to this point, I was totally present and of course I’d long released all medication, and I had gotten myself back together from all that, grown in so many ways, and also I was not in fear of consequences, what could she do? I knew this, I had internalized my freedom.

        I believe my rush of energy did have a lot of fear in it, simply from the old tapes, but I don’t engage with that, I know it is an illusion.

        That’s the awareness that brings me great comfort and feelings of safety in life now. I’m the one in control because I’m in present time. It’s good to know I can stop a bullet flying at me now. That was the new trick I learned, and it is what keeps me feeling safe and confident to take risks needed to evolve and create.

        Thanks for sharing this Katie. Most interesting stuff, indeed!

  17. It’s a indescribably complex subject but, unless I’m just glossing over this in people’s commentary, the term “psychotherapy” is as vague and general as the term “government.” So many people want to argue against “big government,” for example. But the real issue is what kind of government, e.g. one which serves the needs of the people or one set up to benefit the corporations; how “big” it is is secondary. Likewise any form of “psychotherapy” is predicated on the underlying value systems of those who develop it or practice it, whether or not this is acknowledged. Without specifically defining the particular “psychotherapy” being discussed the term is largely meaningless, as are studies such as that being discussed here.

  18. I tend to view psychotherapy to be about as precise as interpretation of imagery and allusion in poetry. Both are largely opinions that may say more about the interpreter than the person being interpreted. In addition, truth is not an absolute. It is subjective as is trauma. It also doesn’t take long for people with any real experience with psychiatry to establish the “right” things to say d while children can be easily led or accidentally influenced in their responses.

  19. Precisely. I can not absolutely tell you the underlying meaning or motivation in Plath’s Lady Lazarus. I can tell you my opinion, but regardless of how hard I try, I read myself into the narrative. (Which might explain a lot about Freud). I also don’t think people who find our thought process so alien as to require the distinction implied in mental illness are well suited to analyze us.