The Elephant on the Couch: Side-Effects of Psychotherapy

Good article here:

http://anp.sagepub.com/content/43/9/787#sec-9

couple things about l’affaire Ghomeshi

Note: This post is about a couple of aspects of the Jian Ghomeshi scandal that broke about two and a half weeks ago.  If you don’t know about it, do some basic online research (there is no shortage of info) and then come back to the post.  It will make more sense then.

1) “Why not just trust?”

If you’ve read the rest of this blog, you’ll know that my therapist was REALLY stuck on this idea that I should trust the guy I was (barely) dating, despite all the red flags I saw and my own considerable misgivings about him.  This was also despite the therapist’s total lack of information about my relationship history or the guy, or anything really.  It was just a kneejerk assumption on her part that because I didn’t trust one man, I must have trust issues across the board and that the correct way to deal with them was just to press on with this one guy.  She had other options like, say, considering the possibility that I didn’t trust him for good reasons because, just maybe, he wasn’t actually a good guy.

As I’ve posted before, he did end up assaulting me.

When the Jian Ghomeshi story broke, especially the accounts of his vicious assaults against the women he dated, one of my first reactions was: HELLO YOU STUPID BITCH, HERE’S WHY YOU DON’T “JUST TRUST”.  What the hell kind of social worker doesn’t know about date rape, intimate partner violence and so on?  A really bad one!  A really stupid one!  What would she have told one of these women if they’d mentioned they had a date scheduled with a guy who was rumoured to be “weird about women”?  Maybe it’s just rumours, maybe it’s an all-singing all-dancing chorus of red flags.  They decided to “just trust”, like she advised me, and they got punched in the face, kicked in the stomach, forced into fellatio.  Jesus Christ!

And as we’ve been hearing from many other women in the last fortnight, this shit happens ALL. THE. TIME.  If we had the real numbers on it, I expect it would look like an epidemic.  As it is, nearly EVERY woman has a story to tell about being sexually harassed or assaulted.  Shit is fucked up and bullshit and women have truly excellent reasons not to “just trust” men.

2) Jian Ghomeshi has been seeing a psychologist weekly for years – why didn’t the psychologist notice something was amiss?

Before the scandal, Ghomeshi had talked openly about seeing a psychologist weekly for an anxiety disorder.  Fair enough. Except that the therapy industry (and this includes psychologists) absolutely claims to have and prides itself on having special insight into people’s psyches, issues, problems, and yadda.  Sure, you might start therapy wanting to talk about your divorce or whatever but the therapist knows that the real problem is really something else, something you may not even be aware of, but the therapist will dig it out regardless.  So shouldn’t a therapist be able to detect when a client harbours big-time violent attitudes towards a group of people AND acts violently against them?  Over a period of decades, apparently?  There must have been times when Ghomeshi’s psychology appointments took place within mere days, mere hours even, of his having assaulted a woman.  And yet the therapist didn’t pick up on it?  Did they never talk about Ghomeshi’s dating life?

Ghomeshi probably lied about his dating life anyway, but isn’t a therapist supposed to be able to see through such lies?  And since the physical safety of other human beings was at stake, maybe the therapist should have followed up somehow, done something?

My guess is there are at least two factors in play:

1) The therapist was a fucking moron and had no insight into anything.

2) The therapist certainly wasn’t going to jeopardize the income a steady client provides by probing in any way that makes the client uncomfortable.  Ghomeshi’s attitudes towards women were probably discussed in a very superficial way, if they came up at all.

—

In conclusion:  Therapy is as bullshit as ever.

Whoa.

This particular branch of the psychotherapy industry seems to be OK with torture.

http://www.theguardian.com/world/interactive/2014/jan/22/american-psychological-association-leso-letter

No wonder they don’t give a shit about the scam perpetrated on regular therapy consumers every day.

Jeremy becomes a life coach!

Peep Show is a great British comedy in general, but this episode had an extra-special bit. Watch all the way to the end, when Jeremy is awarded his life coaching certificate. Something about it was just so… familiar!

Peep Show, Series 8, Episode 2 (in three parts)

A bit of Q &A, and final remarks

Would you ever try therapy again?

Knowing what I now know about therapy, the answer is No. I think it is too risky and it’s always a bad idea to take chances with your mental health. Around the world people cope with all kinds of very serious problems and real trauma without any therapy at all. The vast majority of people who have ever lived somehow muddled through without therapy or therapeutic notions like “repression” or “the unconscious”. Surveying the works of philosophers, artists and writers over centuries, it is obvious that emotional suffering is simply a part of human existence. Clearly therapy is not necessary to live, or even to live well.

Also, I recovered from the therapy con, plus getting used for sex and assaulted by whatshisname, all on my own. It wasn’t easy, in fact it was one of the most difficult experiences I’ve had in the last decade, but I did it. So what can a therapist do for me that I can’t do for myself? Nothing.

A few bad apples?

At some point, someone will raise this question. They think that surely I must be wrong, that most therapists are ethical and competent.

The truth is, no one knows how many bad apples there are. No one even knows how many formal complaints have been filed with regulators. Even if that number were available, it would not represent all cases of therapist misconduct, just as rape statistics don’t account for all rapes.

Thousands of therapy sessions happen every day behind closed doors. The sessions are usually not recorded. Regulators consider the therapist’s notes the more reliable record of what transpired, not the client’s own notes or recollections. Rarely will a therapist make a record of their own misconduct or mistakes.

There simply isn’t enough evidence.

Someone will rebut with “Well then, tiac, since you yourself admit that there isn’t enough evidence, isn’t it unfair of you to bash therapy like this?”

Therapists are out there taking money from vulnerable people to conduct useless and/or dangerous therapies, and doing much worse in some cases. I’m blogging for free to warn people of the risks of bad therapy. Ethics-wise, I think what I’m doing is OK.

Aren’t you just bitter, tiac?

For a while, I was, kind of. Angry and feeling a like a chump are better ways to describe what I experienced.

Nowadays, I don’t think or feel much about it. In fact it has taken some discipline to finish off this blog as I have moved on to other things. That’s part of the story too – that even if you have been fucked over by a therapist, eventually you will get past it. It will just become a memory of a bad time when you trusted the wrong person. It won’t feel great to dwell on it, but from time to time you will, and you’ll only see more clearly each time how nuts it all was, and how far you have come. And probably, you’ll see that you didn’t really need therapy at all, since in the end YOU figured out a solution to your problem.

Why does therapy persist? Why do we still believe in it?

Because emotional pain is so very, very painful that the possibility of a solution is often the only thing that gives us hope. We believe in therapy because the alternative is so frightening: there may not be an end to our pain, except death. Fucking hell, with these options, OF COURSE we believe in therapy.

I saw a documentary about our society’s heavy use of anti-depressants which contained the following comment: We live in an uninhabitable society, that’s why you feel bad.

Elsewhere, I’ve come across the notion that if we set out to create a society that was least able to meet people’s emotional needs, we’d come up with… pretty much what we have.

I think both comments are right. Our society does a rotten job of creating and maintaining emotional and psychological health, in fact it actually damaging to health. Why else would women cut open their perfectly healthy breasts and put plastic sacs in them, to “feel better about themselves”? And that’s just one example.

Therapy is, in my view, a symptom of this sick society. It’s no coincidence that really took off just as our individualistic, consumption-oriented, media-saturated, community-destroying, indoor and sedentary lifestyles really set in. We used to work outside, in nature, alongside our relatives and neighbours, we now transfer from box to box, from screen to screen, and we often do so alone. It’s not healthy, we know something is wrong, so we pay strangers to listen to us talk about our troubles.

We wouldn’t need therapy if we took better care of each other.

My sign-off

I’ve now said my piece about therapy, and do not plan to post much in the future – just whenever an idea strikes. I’ll still check on the blog and respond to comments though. And I’ll definitely link to other personal blogs about therapy, so if you’re out there, let me know. I hope others have found the blog useful, validating, interesting, etc.

Thanks for reading & take care 🙂

How did this happen?

How did the therapy wind up in such a different place from where it started, so far from my original intentions? I have thought about that a lot and decided there are many reasons, both small and large.

The large reasons:

1) The bait-and-switch.

As I’ve previously discussed, the therapist never mentioned that she would use any particular approach or method or technique with me, but she did it anyway. Not only that, I don’t think she was doing Cognitive Behaviour Therapy (as she claimed) or even Gestalt Therapy (as I claimed). I think she was actually doing using something much more sinister – the Confusion Technique.

You can google the term and find out all kinds of things about it. It has been very influential in many types of psychotherapy. It is also used by interrogators, salespeople, cult recruiters and con artists. It is, to say the least, controversial. However, psychotherapy proponents of the technique claim that it helps people to access their un/subconscious beliefs and then to re-pattern them. Or some horseshit – I don’t care about the theory. It is a technique that can only be used without the client’s informed consent (think about it – if you tell someone upfront that you will attempt to confuse them, they’ll be alert to your manoevers and it won’t work) and is therefore unethical.

Anyway, my experience during the sessions was that the therapist would interrupt me, jump around from topic to topic, respond to my comments with random irrelevant questions, “challenge” my common-sense ideas (like thinking it is stupid to have affairs with married men) for no good reason, and so on.

The conversations were all over the place and we got into subjects I NEVER intended to discuss and didn’t even really care about. E.g. the reaction of some casual acquaintances I met while living overseas to the news that I was returning to my home country. I didn’t bring that up on my own and never would have; it only came up in response to her random questions.

I considered the most glaring instances of this behaviour to be red flags, but much of the time I was just… confused. So the technique works – watch out for it!

I want to be clear: The technique worked to confuse me, it did not help me. Literally all it did was confuse me and make me doubt my own good judgement. I consider this a net loss.

However, I have no doubt that it helped the therapist quite a bit. She managed to create the dynamic in which I would set aside my own judgement and replace it with her suggestions, especially re: the relationship. I think that laid the groundwork for her pitch for long-term therapy later on.

2) Therapist’s disregard for best practices such as assessment, goal-setting and treatment planning.

If these had been determined at the start of therapy, it would have been much easier for me to recognize and object to the therapist’s digressions. Notice how neatly a lack of goals or planning fits together with the Confusion Technique. A wily therapist can keep that going for years!

3) My own naivete, lack of research and trust in institutions.

I believed that because I had found this therapist through presumably trustworthy agencies, starting with my family doctor, and that because the therapist was registered with a regulating body, I could trust this therapist. Bait-and-switching, lying by omission, disregarding best practices – I did not anticipate that a supposedly appropriately credentialed therapist would do any of these things. Ask a random person about it and they would probably agree. Those are BAD things that only irresponsible quacks would do. Right?

The irony is that I was already aware that there were therapy quacks. I knew it was a bad idea to just surf the internet for a random therapist. That’s why I went through the channels I did, and it turned out to be a completely pointless exercise.

I also did not research therapy in general before I started. Had I done so, I might have at least stumbled onto the information about unvalidated therapies and treatment planning, etc, and insisted on them in my own therapy. On the other hand, a lot of rubbish is considered good therapy by practicing therapists and they are very willing to let themselves off the hook for any mistakes. (E.g. http://www.goodtherapy.org/what-is-good-therapy.html )

Also, many articles about choosing a therapist are really more about what the therapy is like once it is underway. A sample question like “Can your counselor accept feedback and admit mistakes?” can only be answered if you’ve attempted to give your therapist feedback, which would only happen after several sessions, at the earliest. By that time you have already invested time and money in your therapy, so what then? Back to the drawing board? What clients need is a way to determine early on if their therapist is any good, but I haven’t yet come across any good strategies for doing so. This is one of the reasons why I recommend staying away from therapy; it can drain you financially, temporally and emotionally with ZERO benefit.

At any rate, I would advise anyone who feels they MUST have therapy, to research it EXTREMELY carefully before and during the therapy. And to run a mile from any therapist who discourages you from doing so.

The small reasons:

1) The timing of appointments – They were spaced out enough (every two weeks) to make it harder to detect the patterns.

2) Apparent normalcy in the beginning – The therapist didn’t start using nutjob techniques right away , only after about five sessions, so I was caught off guard when it started. However, there were tiny red flags here and there that I saw in retrospect.

3) The notion that clients don’t reveal their “real” issues until therapy is underway – I’m fairly certain that the therapist saw my introducing the topic of the crap new relationship as a kind of “deepening” of therapy. As in: NOW we’re really getting to the heart of the matter. But it wasn’t like that at all. I mentioned the crap relationship in the six session because that’s when it began. I hadn’t even met the guy when I first started therapy, so I couldn’t have brought it up earlier.

I may add to this list as I clarify my thinking around all the reasons for the debacle. Heh – I just thought about the reasons the therapist would come up with: my unrealistic expectations (though we never discussed what they were), my leaving therapy “early” (thought I never committed to any particular length of time), my being too afraid/unwilling/defended to do the hard work of therapy and see it through (she’d be right about the unwilling part). Hell, you make up a Bullshit Bingo Card of all the ways therapists find to blame clients for therapy failures.

The therapist’s notes

Note that there is no mention of informed consent, no assessment, no treatment plan or goals, no monitoring of progress.

More commentary in following posts.

therapist’s notes

Therapist’s notes – my commentary – general

What you won’t find is any evidence of
-the therapist doing a comprehensive assessment or getting my history (even basic stuff like have I ever been diagnosed with a mental illness, have I been in therapy before)
-my giving informed consent to any particular therapy approach or technique
-setting therapy goals, creating a plan and a timeline
-monitoring or assessing progress

There is no evidence because these things didn’t happen. They should happen; they are all considered best practices. They are also required by the therapist’s regulating agency, but as we know from the complaint, the Agency doesn’t actually care about them (but I’m supposed to keep all that secret, remember).

All of the notes were written the day after the session. She never took any notes during sessions. She didn’t so much as hold a pen. Day-after notes strike me as pretty unreliable. Think back to your student days. Would you write notes for a lecture the day after and expect them to be useful and accurate later? Of course not. And there is a reason why many business meetings have an assigned minute-taker: greater accuracy.

Now, I don’t necessarily think day-after notes are so terrible, one one condition: The therapist must always be aware of their limitations. I.e. know what they don’t know and remember that the notes don’t tell anywhere near the whole story. However, I now feel that ALL therapy sessions should be recorded. It is the only way to ensure accuracy. (That is, if you see a therapist at all, which I don’t recommend and which you probably don’t need.)

Sure, you could ask: How is your memory any more reliable than hers? For one thing, I was journalling a lot at the time, and I still have emails I sent to a friend at the time in which I discussed some of these issues. And of course I know all the details of my own family, and I tend to pay quite a bit of attention to any relationship where I have sex with the person. So I am very confident that I know more than any therapist about the facts and events of my life.

I’ll comment in other posts on the various omissions and inaccuracies I see in the individual notes. In general I find her notes LIGHT YEARS away from what actually went on in the sessions. She didn’t note her defense of women who have affairs with married men, for one thing. (I hope she gets karmic retribution for that bit of bullshit. See how she feels about adultery when it’s her husband doing the cheating.) Also, I find it disturbing how little she actually wrote. The sessions were an hour long, we discussed complex issues, and yet she feels she’s captured all the relevant info in less than a hundred words? Yikes.

Therapist’s notes – my commentary – pages 1 and 2

First page – Her cover letter

That bit about how typically she discusses the notes with the client but won’t this time because of the complaint? That comes across as bitchy snark. I didn’t ask to discuss the notes with her, I didn’t ask what she typically does with other clients, I just asked for a copy of the notes.

It’s interesting that she chose to volunteer that bit of useless info/commentary but she failed to tell me what type of therapy she was doing with me.

Second page – Client History and Intake

Notice there is no history on this page.

In the “goals” section I wrote “less stress and obsessing”. That’s the first and last mention of goals in all of the notes. You can judge for yourself whether that goal was achieved.

Therapist’s notes – my commentary – pages 3 and 4

Third page – Session at July 23, 2008

Hoo boy. The first paragraph is wrong. Yes, I reported feeling anticipatory grief about my grandparents’ deaths (they’re very old, it’s just not that far off). No, it’s not about “family conflict that she believes will follow.” It was about family conflict that WILL follow (it’s not just a matter of my belief) regarding my grandparents’ estate, the division of assets and so on. I wasn’t anticipating that my family would just start fighting once my grandparents passed, I anticipated that they would fight over money. Big difference.

The qualifier “she believes” really strikes at the heart of this whole fiasco. Right from the start, the therapist was doubting me. And on what basis? It was the first session – she knew nothing about me or my family. Maybe my family has already begun to fight over inheritances, maybe my family has a long ugly history of doing so. Inheritance disputes are extremely common (ask any estate lawyer), maybe mine is one of those families. Why doubt my intepretation of the likely behaviour of people I know very well and she knows not at all?

Oh right – because she’s a Gestalt therapist and they make shit up.

In the next paragraph, she wrote “harassment”, as if there was some question about whether or not it was actual harassment. Again, it was the first session, the therapist knew nothing whatsoever about the harassment. Again, workplace harassment is extremely common. Why doubt my interpretation of an experience that I actually had and that she knows nothing about? The only thing I told her that my ex-boss accused me of having mental health problems, which is in itself harassment. It’s textbook harassment.

The part about “social workers have been problematic for her” isn’t quite accurate. I wouldn’t have used that language but I did tell her that I have had negative experiences with social workers, but not as a client. It was in a professional context. I worked for a government agency that funded many community-based organizations which happened to be led by social workers. These agencies habitually filed late, inaccurate and incomprehensible financial reports, and it was my job to address it. These social workers had appalling attitudes about being expected to account for their use of taxpayers’ money. They fought me every step of the way. THAT is the problem that I had with them.

Fourth page – Session at July 30, 2008

This one isn’t so bad. There aren’t really any significant inaccuracies here, it’s more about the omissions. Obviously in an hour a lot more ground was covered than is shown in these notes.

I don’t understand her liberal use of quotation marks because some of that language I would never use. E.g. I would never say that my parents did not “validate” my thoughts or feelings. I would say my parents never gave a shit about my thoughts or feelings because they were too caught up in their own dramas. So either quote what I actually said or lay off the quotation marks.