Archive for the ‘therapist’s notes’ Category

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.


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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

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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.

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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.

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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.

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Fifth page – Session at August 13, 2008

It’s the second paragraph (starting with “Friendships”) that drives me up the wall. She has done a very poor job of summarizing a very complex situation.

Yes, there were four friends with whom I was very disappointed when I returned from living overseas, but each case was different. E.g. two of them had plenty of time for me, they just spent it all talking about their problems. Hence the “in their own drama” remark. I didn’t cut off all four friends. One drifted away, another is still in touch intermittently.

The two drama queens? Yeah, I cut them off. They were major users. I NEVER said I was “cold, mean” – I just don’t think of it that way, I see it as extricating myself from a toxic situation. I think the therapist thought I was cold and mean (again, she had too little info to make that call), but her opinion should not be in quotation marks as if I said it.

It’s true that the two cut-off friends would “have no clue” about how I felt, because they had their heads too far up their own asses to even contemplate another person’s perspective. But I think the therapist interpreted that to mean that I had failed to express my feelings, probably due to not have them validated by my parents as a child and yadda yadda.

Sixth page – Session at August 27, 2008

I’ve got mixed feelings about this one. On the one hand, the stuff she wrote is more or less accurate. On the other, she hardly wrote anything – 95 words to cover an hour of complex topics, like my parents’ custody fight when I was 13-15 years old.

The two-column part bothers me because it looks like she believed that my beliefs about my family are wrong, and that I needed “new possibilities” to believe. Except that my beliefs were not wrong. My family really is just that way – not listening and “bad”. (I doubt I said “bad”, but meh, close enough.) Do you see enough information in the previous notes for the therapist to have determined that my beliefs are actually wrong? And if my beliefs are correct, how it is therapeutic to change them?

Let’s work with another example. Say I have all my money invested with Bernie Madoff (whose Ponzi scheme was revealed later that year) and I’m starting to see red flags. I’m getting nervous, afraid of losing everything. I express this to my therapist, and she just assumes it’s all in my head and gets to work on changing my thoughts. But it’s not all in my head. I’m right. What would following the therapist’s advice lead to? Financial ruin.

I think believing that your dysfunctional family is in fact healthy could just as easily lead to ruin. Especially when there is an inheritance in the offing…

Then there is the part about “the client feeling [that parents’ custody fight] not because they wanted her”. My parents’ custody fight was NEVER about their care for their children. It was always about getting back at each other for past grievances. You know how I know? I lived with them for 18 years. They were not caring parents. Neither of them ever took much interest in their children UNTIL the other parent claimed to want them.

So I never would have told the therapist that I merely felt that my parents did not want me. They actually did not want me. (I know, it’s horrible, but I’m past it now. I was past it back in 2008 when I saw this therapist. I never brought it up. She was digging for dirt.)

Notice that we are now into the fourth session and the discussion has nothing to do with dealing with anticipatory grief. The topics are all over the place.

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Seventh page – Session at September 10, 2008

I remember this session quite well. I was feeling good that day, not preoccupied with anything. I thought that it was getting to be time to wrap up therapy, that maybe I’d go for a session or two more. I’d only ever planned to go for 6-8 sessions anyway.

But I was still there for an hour and we talked the entire time. Why so little in her notes? And her notes say so little. E.g. “women – men – relationships” what does that even mean? I guess we talked about “human nature, philosophy, personal experience” but what was actually said?

I did make a remark about how people seem to treat those closest to them the worst, when you’d think they would treat them the best. It’s one of the things that puzzles me. But whenever I talk about it, I also express amazement at how people who mistreat their intimates seem to expect no consequences, that the relationship can go on, undamaged. I don’t know why she chose to leave that part out because I think it is pretty important. Either way, I was speaking in generalities but I suspect the therapist thought it was the expression of some subconscious issue that I should delve into.

I know I never said I “want growth”. That’s just not language I use. And if I wanted personal growth, I wouldn’t see a therapist for it. I’d go on an Arctic rafting trip or something. I think she was projecting her own agenda.

Eighth page – Session at October 14, 2008

A month passed between appointments because I was ill and cancelled the one in-between. What I didn’t know then was that a common way that clients “run away” from therapy is to cancel an appointment claiming illness and then just never come back. The therapist called me back right away, and I remember that she was kind of pushy about getting me to come for the appointment anyway, and then when I held firm (because I was actually sick), she was pushy about getting the next appointment booked. I think she believed I was trying to bail on therapy, which meant a loss of income for her, and that’s why she was pushing. I also think she had an agenda to use the next session and any that followed to convince me that I needed LOTS more therapy, and there was an urgency about it because I was showing signs of slipping away.

Again, another case where she doubted me according to her own pre-conceptions. Sometimes people get sick and need to cancel appointments. Why not just believe me?

This is the point where therapy started to get really weird. Red flags were popping up all over the place.

First, some background. During the month away from therapy, I met a man whom I found interesting and attractive. We went out a few times, he wanted to have sex, but I declined because I did not feel ready. And….he dropped off the radar. So it was pretty clear that he was only in it for the sex. It was the same time as this therapist appointment that I was realizing the truth of what was going on. (I’d already gone through the “maybe he’s been away”, “maybe he didn’t get my email” phases.) I was pretty disappointed, and since I had a therapy appointment booked, I thought – fuck it, that’s what I’ll talk about today.

I will never forget that session because it was weird from the start. I gave the therapist the basic rundown of what had happened (virtually identical to what I wrote above), and ended it with “So he was only it for the sex”. And her next words were “Maybe he just wanted… to get closer.” I was stunned. I mean, come ON, I just told her a story that MILLIONS of women could tell. There are literally MILLIONS of men in the world who just want to score. Why is she doubting my account AT ALL?

Oh right – because she’d been doubting me from the beginning. I just hadn’t figured it out yet.

Her remark threw me for a loop. Could she be THAT naïve about men? Or what? I had never told her anything about my past relationships. Where was this coming from?

Anyway, she spent the rest of the session trying to convince me that the guy didn’t disappear because I didn’t have sex with him. She pushed me to accept ANY other explanation, including, as she put it, “maybe he didn’t want to continue for some other reason”. Just so long as it wasn’t my original interpretation.

This was pretty much the pattern for the rest of the sessions. I would come in saying the sky was blue and she keep at me until I admitted that maybe, if you looked at it from a certain angle or squinted the right way and just believed a little, yeah, maybe it could be green, maybe I should try believing that it’s green.

So, let’s look at her notes.

“Got dumped”, “silent treatment”, “cut him off”, “suffered all weekend”. Christ. That’s not how I described it at all.

Then the section on exploring issues of trust and openness. Where to start? I’d only gone out with the guy three times by this point, so perhaps being trusting and open wasn’t yet appropriate. He could be a date-raping asshole for all I (or the therapist) know. A guy is not required to be “attentive enough” with someone he is not actually in a relationship with, so what was she thinking?

My guess is, she TOTALLY jumped to the conclusion that this was an established relationship with a good, decent guy who cared about me and that the only real issue was….me.

Yet again, she had no information on which to base this assumption. It was pure guesswork, which is actually encouraged in Gestalt therapy.

Bear in mind that I still didn’t know that she was using this approach or even that she was making assumptions, let alone what those assumptions were. From my perspective, the conversations were all over the place and the only constant was the pressure to change my beliefs – without ever assessing whether my beliefs were in fact correct.

I found this and all the following sessions very disorienting. There is such a thing as the “confusion technique” which cults and interrogators use to gain mental control over their targets. I strongly believe that the therapist was doing a version of this on me. It’s consistent with Gestalt therapy, since it’s all about getting around a person’s “habital defenses” to reach the real truth that they are trying to hide. Gestalt theory doesn’t allow for the possibility that the person isn’t hiding anything.

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