Thanks for the reply! I'm glad you found it helpful and appreciate your questions - they are good ones.
I feel like I should start with a few disclaimers:
- I apologize in advance if I write a book here. I feel really passionately about ethical issues in counseling.
- I am writing my own opinions, from my own personal and professional experience. You should take everything I say (and for that matter everything everyone
says with a grain of salt). I believe in self-disclosure so that you know where I am coming from. I think self disclosure on the part of a counselor is good practice where it helps a client feel less alone, and de-mystifies the counselor as a person and counseling as a process. So - I also have been part of destructive groups (yes, plural, didn't learn well enough the first time) before and I genuinely understand the confusion and self doubt those experiences can leave one with. I've also been in counseling myself, on a few occasions, and have seen a variety of counseling styles, including the good, the bad, and the ugly. I will share some of my experiences with what differentiated the good and the bad later.
- Please don’t take anything I write too personally (like as criticism) – I am writing to you, but I’m also writing to everyone else who is in similar situations and will read this thread, as well as to myself and my own past experiences.
I think part of the schtick is that a lot of one's issues come out in the relationship with the therapist, so they focus a lot on that instead of ignore it. Are you saying this in itself is no longer considered good practice?
Issues *can* come out in the relationship with the therapist, BUT (and this is really important) your therapist should be using the opportunity to help you learn
- to trust your judgment and validate your experience
- to learn what information your feelings are giving you
- to communicate assertively
- to resolve conflict effectively (and some conflict cannot be resolved, so a valid option is leaving the relationship)
Issues are never a one-way street. If a therapist, a guru, a spouse, a friend, a boss, etc tells you that your issues with them are entirely due to your personal issues or personality defects, that is B.S. Yes, a therapist should address issues, but they should consider both the content of what you say (i.e. are there genuine problems with the relationship that the counselor needs to change to improve) as well as the process (how are you addressing conflict, are you trusting your experience, are you being proactive, are you able to communicate, seek compromise, find resolution, or leave an unsatisfactory relationship.)
I get VERY nervous when I hear about therapists turning problems back on a client.Theme: Therapy has risks, Informed Consent is very important
A therapist is in a position of power. Therapists know this. For this reason, and to prevent abuses of this power, professional organizations (APA, ACA, AAMFT, etc) as well as state law puts forth ethical codes that therapists are required to conform to, in order to protect clients. One of the most important of these ethical requirements is seeking informed consent
. I want to stress this because, all therapy has risks. And some therapeutic modalities have more risks than others.
If you had a medical problem, say diabetes... you would meet with a doctor and get a diagnosis. You might even meet with a few to confirm the diagnosis. You'd have tests run so that you could confirm for yourself that the diagnosis was accurate.
(Note: in psychology its worse because the tests aren't so good, and diagnoses are controversial and getting a diagnosis is risky in an of itself, but lets move on...)
You'd then be told of treatment options. You'd probably do some research on the internet to see what everyone else is doing. Your doctor would be ethically obligated (although unfortunately, many do not) to explain to you the risks and benefits of the various medications and protocols s/he recommends. You need to be informed of the risks and benefits of treatment options in order to give informed consent.
There is also something called the “standard of care” which is when one particular treatment is known to be the best, most effective, safest, etc. form of treatment. Not all problems have a standard of care, but MANY do. A therapist is ethically required to inform you of the standard of care treatment, and if he or she is not providing that standard of care treatment, s/he is supposed to explain why and seek informed consent. You are supposed to sign something which states that you understand the risks and benefits and want to proceed with the proposed treatment. What’s more, it is good practice to have periodic re-evaluations of your progress and seek additional informed consent to proceed.
You might choose not to pursue the standard of care treatment. That is your right as a client. However your doctor would be obligated to "warn you" against abandoning the standard of care practice. You'd even have to sign a waiver. You'd be informed that your alternative treatment is experimental, unvalidated, and has risks.
Okay, where am I getting with all this. Reichian Character Analysis is not the standard of care treatment for any psychological problem. That doesn’t mean its 100% bad; I honestly don’t know because I don’t know anything about it. But I know it is not standard of care treatment because we don’t learn about it in school. I also strongly doubt that it is evidence based. Evidence based means that you can look up a research study that shows how effective the treatment approach is. This is something that goes into informed consent- you are supposed to be told 1) how effective the treatment is (how much improvement can you expect) and 2) how long treatment is expected to take. Not everyone is wild about evidence based treatments, because it can be hard to scientifically validate certain types of approaches, however, relying on evidence based approaches reduces the risk
of wasting your time, money, and risking your psychological health on something that is mostly speculation or cult following.
This is all about risk management.Theme: Some approaches are Riskier than Others
All therapy has risks, but some approaches are riskier than others. Riskier approaches are ones that emphasize intense emotional experience/expression (like Primal Scream – which has been discredited, Gestalt therapy – some find it useful, but definitely a psychologically riskier approach because regression is common and intense emotions are evoked which a client often does not yet have good coping mechanisms in place yet to deal with, and Psychodynamic or Psychoanalytic therapy which emphasize dependence on an “expert” therapist, regression, unconscious motives.
It's not my feelings that are minimized or criticized, in fact the emphasis is on validating my feelings and feeling them deeply, but the content attached to them is what seems to be minimized/criticized. Like, whatever I'm pissed at him about, that's not important. But the feeling of being pissed at him and allowing myself to feel that IS important so it doesn't get shoved down. I can see how this could be a useful tool that i don't want to dismiss, but it feels like a slippery slope (the dismissal of the content of my concern about him) to disempowerment. I'm not sure.
It *is* a slippery slope. Can you see why? Yes, feeling your feelings has its value, but if nothing ever changes, I’m not sure it matters.
Let me clarify with an example: If you are in an abusive relationship and shove your feelings down, then that’s unhealthy because you will never leave the abusive relationship. Feeling those feelings is important so that you are alert to there being a problem. Feelings are your internal warning signal that something is wrong. Yes, its good to feel them. But if all you do is feel angry, hopeless, lost, etc. and never use the feelings as information
that something is wrong and something needs to be changed, then you are little better off than when you started. Feelings are important but Action is important too. Maybe even more important.
Based on that alone I would recommend making a good plan to transfer your business elsewhere.
Thanks for being so frank. I have thought about this, but a lot of fear comes up. Actually very similar to my situation with the cult, I feel like he is holding me up somehow and if i leave him, I will crash again.
I really appreciate your honesty in saying that. I think it is very understandable that you feel that your therapist is holding you and up and that if you leave him you will crash again. You came to your therapist out of a vulnerable place, and (perhaps with the best intentions) your therapist hasn’t managed to help you get strong enough to hold yourself up. I’m not saying that you are necessarily in an abusive relationship, but this sentiment reminds me a lot of what women (or men) in abusive relationships say. They hate their situation, but don’t feel strong enough to leave. It feels dangerous to leave. There is validity in that. If you feel that you are not ready to leave this relationship, that is valid. When women are in those situations, it can take time to prepare a viable exit strategy. An exit strategy should include social support from safe friends and family, possibly a new therapist waiting in the wings, and a sense of psychological readiness. It may take some time to get there. Or it may take some really supportive friends who are prepared to help you through the transition.
He also talks about a period of temporary dependency that develops naturally with the therapist in the process of healing the past parent-child relationship...do you think this is also not good practice?
I think this is not
good practice for treating someone who has come out of a cult. You have already be broken down. You probably need to be built up and find your confidence again. There may be special cases where this is necessary like with kids with reactive attachment disorder or conduct disorder (and by necessary I mean that the benefits outweigh the risks) but in the case of someone who is coming out of an abusive relationship, a destructive organization, a dysfunctional family, etc. this is playing with fire
. I hope that your informed consent document included mention of these risks.
You are your own person and you can play with fire if you want to. If you feel that it is helping you and moving you towards healing, that is your right. Is it good practice? I'd say no. Is it ethical? In my opinion, it is ethical only if you were informed of the risks and were psychologically free enough to make an informed independent decision.
Surely you have heard of Wilhelm Reich? A student of Freud, definitely a controversial one though, who some (many?) thought was crazy. Core Energetics is some offshoot of his work. Maybe his teachings are a bit fringe and aren't included in the graduate education? Anyway my therapist has a masters in family therapy, but he has done additional (probably nontraditional to say the least) trainings/certifications.
As you say, maybe his teachings are a bit fringe. Pursuing a fringe psychological treatment is playing with fire, but that's what some people prefer and you are free to do this so long as you are capable of making a free and informed decision. If your therapist is a Licensed Marriage and Family Therapist he has certain ethical obligations to inform you of the evidence supporting his treatment modality, the risks, and benefits. If he is not Licensed, then he is probably not practicing legally.
So here is another question: is it considered bad practice to have the paradigm that the client doesn't know what he or she needs to get well? That's kind of what it feels like. I believe it may be true in one sense—after all I can't see my own deep defenses; but in another sense, it reminds me of the guru thing. Like he knows better for me what I need than I do.
Bingo. Yes. This is considered bad practice. This attitude is rampant in old-school Psychodynamic therapies, although today most therapists are given a firm basis in Client-Centered Counseling, and that should inform their way of treating clients.You
are the expert of your life. No one
knows more about or better understands yourself and your life than you. Anyone who tells you different has something to sell or a seriously inflated ego. A therapist should be a consultant. They know about skills, treatment approaches, their own experiences etc, and they can offer suggestions, listen, and support you, but they don’t know you
and they don’t know best for you. I will come back to this when I describe good therapy.mini-theme: Just what are defenses anyway and what, if anything, should we do about them?
Just for the record, not everyone believes in the notion that we have “deep defenses”
- this construct has NEVER been scientifically validated. Or for another perspective - what would it mean if psychological defenses were GOOD. They are your way of taking care of yourself. Why should a therapist be breaking down our defenses? Good therapy should teach you concrete life skills (communication, assertiveness, practice facing fears, self-affirmation) that are so psychologically empowering that defenses that got you into trouble in the past will simply become irrelevant because you’ll have such better tools. But you can’t remove defenses before you have something better in place. They are there for a reason, to keep you safe.
Your feelings are providing you with solid information about what’s going on. Your feelings are telling you: something feels off, this reminds me of the situation with the guru, and also, I feel too vulnerable to leave right now. That is great information to have. You can use that to move yourself forward.Theme: What does Good therapy look like anyway?
I’ve seen a lot of different styles of therapy and having been through the cult thing myself, I can from my personal experience that what differentiates healthy vs. destructive therapeutic relationships are the same things that differentiate healthy vs. destructive religious groups.
- Therapist knows best, client is “sick”
- Therapist uses various forms of pressure (or client dependency) to control client’s actions (including staying in therapy)
- Dependency is encouraged (“I’m the only/best therapist for you”, parent-child dynamic is encouraged)
- Questioning/Critiquing therapy/therapist is not allowed, or is turned back on the client as evidence of the client’s “dysfunction”
- Focuses on problems the therapist has identified (therapist is the expert who identifies problems to be solved)
- Is open-ended with no end in sight.
- Relies on fringe psychological theories that are not validated and/or not accepted by the broader psychological community
- Has no accountability (i.e. through supervision, licensing board, state dept. of health, good standing in professional organizations)
- Leaves you feeling insecure, dependent, psychologically bound or constrained, less like yourself
- Client is the expert on her own life, Therapist is a consultant/co-journey-er
- Client can terminate therapy at any time – client is “free” to make own decisions about what is best
- Independence is fostered (client is encouraged to make own decisions)
- Questioning/critiquing therapy is welcomed. Client and therapist examine critiques objectively to see if changes are needed. Client’s experience is validated.
- Focuses on the client’s goals. Progress towards goals is regularly evaluated (every 2 months for example)
- Is time-limited. Progress is re-evaluated after a set time and therapist and client decide together whether to keep working together (and on what goals) or to terminate.
- Relies on evidence based practices, or at least practices that are widely accepted by the psychological community and considered to be reasonably safe.
- Has built in accountability – you should be given the number of the state licensing board, and professional credentialing organizations where you can complain if you feel you have been harmed by your treatment. Obtaining therapy through a hospital outpatient clinic, University, or Agency can provide some built in accountability and quality control. Therapists in private practice are expected to take extra steps to ensure that they are providing quality care to their clients.
- Leaves you feeling psychologically free to pursue your passions, confident, compassionate towards yourself, accepted as you are
Figlady, sorry again for writing so much. I hope that you find some of this helpful. Please trust yourself and do what you need to do to keep yourself safe and healthy.