![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
For my own benefit, I am looking for stories of two types of therapy moments:
1. Things a therapist did right.
2. Things a therapist did wrong.
In both cases, I'm looking for things that weren't obvious.
For "wrong things," I'm not thinking of clearly, extremely terrible things that I would never do in a million years, like having sex with a client, telling a client their abuse was their own fault, telling a client not to be gay, etc. I'm looking for mistakes that were more subtle than that - things a well-meaning but inexperienced therapist might do. For example, it was not beneficial to me (as a client) to let me sit there and recount lengthy abuse stories, and then have the therapist immediately start delving deeper into the abuse. But that's not an obvious mistake on the level of "It was all your fault it happened."
For right things, also, I'm looking for moments that went beyond the obvious "She was very empathetic," "He told me it wasn't my fault," or "She helped me see the connections between my childhood and my adult relationships." I am particularly interested in any times in which a therapist managed to do a good job with identity issues (gender, culture, etc), whether or not the therapist had the same identity as the client.
I realize that everyone is different, and what's right for one person may be wrong for another. I'm not looking for a rule book, but rather for inspiration and food for thought.
Anonymous comments are enabled but screened. If you comment anonymously, please let me know whether or not you'd like me to unscreen.
1. Things a therapist did right.
2. Things a therapist did wrong.
In both cases, I'm looking for things that weren't obvious.
For "wrong things," I'm not thinking of clearly, extremely terrible things that I would never do in a million years, like having sex with a client, telling a client their abuse was their own fault, telling a client not to be gay, etc. I'm looking for mistakes that were more subtle than that - things a well-meaning but inexperienced therapist might do. For example, it was not beneficial to me (as a client) to let me sit there and recount lengthy abuse stories, and then have the therapist immediately start delving deeper into the abuse. But that's not an obvious mistake on the level of "It was all your fault it happened."
For right things, also, I'm looking for moments that went beyond the obvious "She was very empathetic," "He told me it wasn't my fault," or "She helped me see the connections between my childhood and my adult relationships." I am particularly interested in any times in which a therapist managed to do a good job with identity issues (gender, culture, etc), whether or not the therapist had the same identity as the client.
I realize that everyone is different, and what's right for one person may be wrong for another. I'm not looking for a rule book, but rather for inspiration and food for thought.
Anonymous comments are enabled but screened. If you comment anonymously, please let me know whether or not you'd like me to unscreen.
Tags:
From:
no subject
From:
no subject
A critical issue I wish people were taught in school is "when somebody has been wronged by a therapist, do not require a final visit." I have been asked multiple times to make one last visit, and I basically didn't need the confrontation all over again. (In two of the cases I am thinking about, the therapist knew s/he had done the wrong thing.) I think the involuntary final visit can again be more about the therapist's need for closure than about the patient.
From:
no subject
thus i had no idea how you sat around calmly talking about things.
she was really good at simply not reacting to things in an overly dramatic way and modeling for me the way a person really good talk about ANYTHING instead of being hooked into shame, judgment, denial, etc. By her calm behavior and how she took me seriously without ever being proscriptive, I learned how to think about things instead of assuming I was going to get judged and immediately stiffening up to resist that. It was a pattern of long standing in my family and she helped me break it. For example, I went in once talking about how I slept with my ex, and it was incredible when she didn't judge me for doing that, even though it clearly was a step back for me, but she didn't go into all that. She didn't tell me I shouldn't have. She let ME decide if that were true. That was a revelation for me. I was so astonished that she didn't have an opinion about whether I should or should not do that. of course she probably DID have an opinion, but the point was to help ME start making decisions instead of pingponging between people's judgments.
Another therapist an acquaintance briefly saw had no boundaries of her own. She bartered computer repair for therapy, socialized with patients, etc. That turned out to be bad.
From:
Also
P.P.S. In my dream office space, the patient waiting rooms and the exit are *different spaces* so that a patient can walk out without meeting anybody's eyes in the intake area.
From:
no subject
In a way it was validating of my perceptions, but I felt like I had been wasting the $30 I spent per session, and decided I'd rather pay more in the future and get actual presence for my money. (On the other hand, I have received fabulous work from bodywork interns. It's the luck of the draw, really.)
On the positive side, I had a single session from a therapist that was amazingly helpful. She helped me connect with something in me that already felt peaceful, rather than focusing on all the chaotic parts. Sadly she wasn't available for more sessions!
It's powerful to help clients connect with what they're already doing right. (I hope they tell you that in school?)
From:
no subject
Bad: My high school counsellor was really nice and reassuring. She told me "You're just too smart and mature. Things will get easier when the other students catch up to your level." *facepalm* I'm sure she meant well, but actually my social skills really needed some work (understatement) and hunkering down behind a hard shell of "it's not me, it's them, I'm smarter/better/more special and they're stupid and don't appreciate me" was really not the answer. Particularly not since I was struggling with the schoolwork (granted, for executive function reasons, not IQ, but that's the point, isn't it? IQ is not the only factor in intelligence.) I don't think she could have prevented me from doing that anyway, not at that stage, but she didn't need to reinforce it.
Good: actually, I have one from today's session. I won't give you the full tl;dr, but the gist was that he disagreed with me last session about a treatment issue, and today I came back with more arguments, and he listened, and decided that I was right. He changed his mind. Because he listened to me and thought about what I said and didn't have to be right every time. This is not the first time that's happened with this therapist, but he was the first therapist it happened with. And knowing that he will change his mind in response to reason makes me a hundred times more likely to listen to him when he tells me I'm wrong.
From:
no subject
Yes, that's the basis for narrative therapy. If you click the psychology: narrative tag, you'll see some posts on it. I really like it.
From:
no subject
The same therapist I'm thinking of refused to refer me to someone else in the clinic when I asked her to.
I had some seriously bad experiences with CBT, too, but I think that was me rather than the therapist. When I'm anxious, I very deliberately stop thinking beyond the minimum necessary for getting through the situation. Thinking makes the anxiety worse, so I don't do it. CBT, as presented to me, required that I analyze my thoughts while in the middle of anxious situations. That meant that I had to let myself have thoughts which led to not being able to function. It ran entirely counter to every coping mechanism I have, starting to dismantle them right when I needed them most. I couldn't do it, and I got a lot of negative feedback over my inability.
I suppose the negative feedback was a therapist problem. There wasn't any sense of trying to adapt to make the therapy fit my situation better or even a maybe this isn't for you response. I got a particular kind of CBT pushed on me because it *must* work for everyone.
From:
no subject
It kind of hurts to think about how my life would have been different if that appointment had turned out differently. I could have been diagnosed with ADD before college, instead of years later when I was floundering in my first full-time job; I could have encountered therapy before various shitty things happened to me, some of which might have turned out differently if I'd had more self-confidence... anyway, I don't actually blame the psychologist for all of that. But I wish she had paid more attention to me at our appointment.
What happened was that having told my mother and succeeded in getting help (i.e. the appointment being set up), I felt relieved, and the problems I was experiencing went away. This was only temporary, but I didn't know that, and I think I sounded so cheerful and confident at the same time I was trying to tell the psychologist what was wrong that she concluded that I was fine. She sent me to see a nutritionist (!) about the binge-eating and that was it. When the depression dropped back onto me after the semester began, it didn't even occur to me to go back to student health.
From:
no subject
This is very different from objective observations of positive traits like "You're intelligent" or "You consider other people's feelings", or challenging beliefs about unlikeability in a different way. Basically I was dealing with feeling rejected by everyone, and she would respond with "Well, I like you".
When I politely explained that this wasn't appropriate or helpful and it was making me uncomfortable, she took it very personally, as though I in turn had said I didn't like her (which I didn't and never would). I was sure then that stopping therapy was the right move.
Even good therapists can make little missteps. I had one who helped me quite a bit, but once I was saying something about my parents, and she commented, "Wow, that reminds me so much of my own mother". Nothing further than that, and it wasn't a big deal, but still not helpful or appropriate IMO.
It's harder to think of specific good moments that stand out. The best therapists I've had were very skilled at maintaining a pleasant rapport while staying firmly within boundaries. I like therapists that I can laugh and joke with, but trust that as friendly as our interaction may look, the therapist understands 100% that it isn't a friendship. It doesn't have to be super-serious to be professional, if that makes sense.
From:
no subject
On the good side, the therapist I had afterwards--actually a study skills specialist, but with therapy as a side bonus--explained to me that there's no value in saying that you "should" do something if every time you say "I should do this" you don't do it. The idea that "do or do not there is no try" was actually applicable to my daily life has helped me more than like, any other concept, ever.
From:
no subject
And she said: "Can you accept that you are a person who can't accept this?"
I stared at her. And then I laughed. And then I said: "Yes."
I think about that moment a lot.
From:
no subject
From:
no subject
I like to have a sense that the space in which I'm doing therapy (group or individual) is very safe and somehow set apart from the rest of the world. The more emotionally fragile I'm feeling, the more I'm sensitive to this and the less able I am to coherently and calmly ask for any change to be made!
The best example I have is from my first sessions of group therapy (DBT). I knew from the beginning that everyone participating was carefully interviewed first to make sure they would be a good fit for the therapy. New people could only join the group at the beginning of each eight-week session, and on the first day we discussed the rules and were able to suggest our own (mine, very well received, was "no unsolicited advice"). Each meeting had the same structure, and we always began with a five-minute meditation. One of the most important rules was to try to discuss our emotions and urges without lengthy narrative -- explaining the details of our own situations could be done in the required individual therapy, but in the group we were to focus on applying the DBT methods.
When I went to these meetings I could trust that the people and structure would be consistent and that the meditation would quiet everyone down and help us feel respectful of our time together. I soon realized that a couple of the group members were in situations that were triggering to me -- but when the "avoid narrative" rule was working, I could still feel safe because the rule protected me from hearing about it.
Things that occasionally disrupted the safe space for me: (1) the "avoid narrative" rule failing to protect me from some triggers, which was probably inevitable at that time; (2) a group member smelling so strongly of cigarettes that I got a headache (there was a rule against strong scents but it's harder to apply that to smokers, I think); (3) a stranger coming into the therapy room to fix a computer.
I have also (depending on how much emotional distress I was in) been discomfited by my individual therapist greeting me with small talk as we walked from the waiting room to her office: "How have you been?" I know the appropriate small-talk answer to that is "Fine, and you?" but when I'm talking to my therapist and the only reason I'm seeing her is that I'm not at all fine, small talk doesn't really fit... I think this was always made worse by the question being asked before we got to her office. If we'd been in there already with the door shut, I could have answered literally and honestly, and that would have felt so much better. But we weren't there yet and I didn't feel safe enough to be honest in the middle of the hallway.
From:
no subject
Oh God yes, the mmhmms. I remember one person (not a therapist, but clearly trained to do it, along with the fucking empathic paraphase and I statements) who mmhmmed so vehemently that I started wondering whether someone under her desk was performing oral sex on her.
From:
no subject
My therapist is much more verbal, which is also great. She's willing to tell me what she's thinking and why she's thinking it as we talk. "Maybe it's this..." or "go with me here and tell me if this sounds right...." It's much more of a dialogue than any of my past therapy sessions have been, and some sessions she might actually talk more than me, because she's really interested in making sure that she's understanding what I'm saying. The constant checking and rephrasing give me confidence that she isn't misinterpreting me (which has happened before). And she's willing to admit when she doesn't know if something will work or not, and tell me roughly what should be happening if it is working. "Let me do some research." Second best set of therapy words ever.
From:
no subject
From:
Re: Also
the patient waiting rooms and the exit are *different spaces* so that a patient can walk out without meeting anybody's eyes in the intake area.
BRILL
From:
no subject
Maybe this is too complicated a clusterfuck to be helpful, but I guess the takeaway might be something like "if you terminate treatment with a patient, be sure to give them a reason." Even a shitty made-up reason would have been better than nothing. I already had major trust issues to begin with, and having my first therapeutic experience basically confirm them was not good.
From:
no subject
I seriously think everyone -- therapists, staff members, whoever -- working in a clinic or hospital setting should be told NOT TO ASK PSYCH PATIENTS HOW THEY ARE in a non-serious manner. Maybe I'm too easily bruised a flower but it was already really triggering to constantly run into that question at the bus stop, at work, at the lunch counter, on the way home &c &c and have to lie and fake some kind of happy BS and a smile while severely depressed. To have to keep doing that in the place where I was trying to get help was really excruciating.
(I also personally think "How are you doing today?" is a useless question to start a session with because it's much too global. "What's happened since our last session" or "Have you been thinking about what we talked about last time, or do you have something new you want to bring up" would be better.)
From: (Anonymous)
no subject
. . .. uh. Unless its sheer LENGTH makes you think otherwise. Jaysus, self. -.-
First, things that various psych professionals have done wrong, because I've had more experience with them; some of them are super-personal, and I fully admit I am a hard patient/client/whatever to deal with. However:
- inform me that I cannot be $thing, because they have never seen me do $thing. I am unbelievably adept at behaving as if nothing is wrong and I am a totally normal and functional human being. The less comfortable I am, the more I will force myself to do this. I do not show, for example, autistic traits in front of people I don't feel safe around; I will flat and outright lie to people I don't feel comfortable around about how I am feeling and what's happened lately; and I will repress PTSD reactions to the point where four hours later I will quietly go be painfully and violently sick, because it comes out in my body. I am capable of doing all of this, but it's not healthy, it has a very limited timeplay before I have a screaming meltdown even I can't repress (although I will probably run away and hide/claim a physical illness/channel it through a physical illness before I show it to anyone). I feel exposed breaking down and crying in the living-room of my own house when there's nobody around: I will probably go hide in the shower with a locked bathroom door instead (again: the house is EMPTY, the door is already locked, etc, but I still need a smaller, more controlled environment).
This means that unless I have become super-comfortable in your presence, I will not SHOW YOU, willingly, any symptoms of my various Issues. I will happily tell you all about them at great length, but I will not display them. If I do get pushed to breaking down before I'm comfortable, you have just classed yourself as the enemy, and I will be even LESS comfortable around you than I was before I started crying in your office.
As a result of this, I went all the way to a suicide attempt without anyone noticing I was depressed, and then went another five years coping with depression, undiagnosed autism and burgeoning PTSD before anyone said anything about it. The tentative steps I made in that period to get these things identified were shut down by professionals informing me that since I was performing at high levels at uni, holding a job, had friend, etc, etc, etc, I was a totally functioning adult who had no problems and should stop self-sabotaging by thinking I did.
If it were not for the dedicated efforts and help of my totally untrained but rather more psychologically useful friends, I would be dead right now. And it sounds rather stupid insisting "but she couldn't've been depressed, she was so functional!" after someone's cut their own throat.
- push talk/cognitive therapy at me before medicating me. This is a very individual one, I know, but at the time it was being pushed at me "instead of" medication, talking/thinking things thru/etc ACTIVELY MADE THINGS WORSE. I would go away after having done the exercises/talk session/whatever feeling more self-loathing and suicidal than I had beforehand. I couldn't do it, it didn't work, and it became something else to fail at. What made the difference at that point was finding a med that worked so that I was physically capable of, you know, reading more than a paragraph through my brianfog, and being able to write coherently, and being able to even think about emotions without dissolving into a pile of wet tissue.
-ignore/challenge boundaries I had explicitly set. This is another personal quirk one, but it arises from the fact that I spent years of my life having my boundaries - especially emotional, but also physical ones, thank you interrupted attempted sexual assault and following helplessness - ignored, or told I was a selfish cow for having them, or that I was wrong about where they were/where they needed to be. The proper response to me saying "and if X happens, I will do X" is, in this case, at the most, "I hope you will someday feel comfortable enough to talk about X". It is not, in fact, "well this won't work if you're not willing to deal with X, because the entire point of this is dealing with X and if you won't deal with X you are just going to fail at this." This relates back to my first point about "I will not display these things to people I do not trust". My boundaries exist because beyond them I am harmed. I will enforce them. If how I enforce them is "fire you as my therapist", so be it. (If for some reason I was unable to, I . . . well, it would depend on how angry I was, but I have it on good authority I could be a nightmare patient if I set my mind to it.)
- probably THE most personal of the lot, but: present me with a blank, unreadable aspect. Firstly, I get super anxious if I cannot read people's reactions to me. Being unable to read people's intents or decipher their thoughts about me has invariably led to the most horrible and traumatic experiences of my life. I understand that for some people, this is actually a technique that works? this idea of not having a personal reaction of any kind to anything the patient says, and presenting this smooth mirror front of emotionless listening? I could even see how it might work, theoretically. For me IT'S A BIG SCREAMING TRIGGER.
Not only that, the culture/class/whatever you want to call it I grew up in? That's how women express disgust and anger for someone to whom, for some reason, they cannot say "you disgust and enrage me". You get very calm, polite, reserved and unreadable. It means "for professional/life reasons I must cooperate with you, and together we will agree not to make a big deal about this, but secretly I would be happier if I never had to look at you again."
Thus, when presented with it, I get a double trigger: firstly, I have no idea what someone is really thinking, and secondly, WHAT THEY'RE THINKING IS ALMOST CERTAINLY AWFUL. (I realize that logically, these two things sort of contradict each other. Believe me when I say that the part of my brain that's panicking doesn't care about logic other than its own special defensive brand.)
This was only reemphasized by the fact that the few times I threw her a serious curveball, I DID manage to see a very clear sense of " . . . . . . . " from the lady in question.
Then there are things various professionals have done right. MOST of these are my current psych, which is why she continues as my current psych, but others are spread around:
- be a human being. The professional boundaries are quite well-observed, but still, I have a sense that current!psych has a life outside her practice, and what kind of person she is in it, and how she relates to the world. This makes her a human being I can figure out how to communicate with. She was able to establish this with a tiny amount of small-talk on our first appointment which allowed me to relax and SHOW a number of the behaviours that actually demonstrate my issues, rather than having to present a pure public face. (This was also totally a test: I managed to relax enough, and then I was watching to see if she would pick things up/how she would interpret them. I am UNBELIEVABLY socially paranoid, and not easy to work with because of this, and I acknowledge that).
- assume that I am being as honest as I possibly can, that I have no intention of deceiving you, and that I am here because I want to get better. I realize this is not the case for all clients, and that some of them are better at self-deception than I am, but I am not them. I am here because I am fucked up. I would like to become less fucked up. I am, if anything, brutally honest - as long as I don't feel that honesty is going to be used as a tool to harm me. If I'm hiding something, it's not from me: it's from you, because I think you're going to hurt me with it.
- assume that I am a freaking grownup, and that I have lived in my head for quite a long time, and know more about my head than you do, even if you have the shiny degree and I don't. I might not know the WORDS, I might not know the REASONS, but if I say "when X happens, Y results" or "Q means V", it's because I have experiential reasons to say it, not because I'm making it up. I realize that there's stuff I don't know, and that I need help with, or I wouldn't be here, but I am not an empty-headed disciple for you to fix.
- listen to what I say, not what you want to hear/what you think would make more sense.
- interact with me as a complicated human individual, rather than a textbook case. I have a weird and twisted up conjunction of ASD, MDD, PTSD and Giftedness combined with a specific and rather unusual family background and all the lovely priming shit that was my childhood interaction with my peers. I won't look like what you learned in the classroom, or what you read about in this month's magazine. (I'd imagine few of your patients would - I don't think I'm that unusual in being Bloody Weird and Unexpected, so I think this one applies pretty broadly.)
- have spontaneous reactions to things I say. This one might be super-just-me, I don't know, but I genuinely feel more comfortable with my psych when she has a clearly-unscripted reaction to something I say. (the last best example was the expression of " . . . .wtfBWAH" and laughter at the point where I solemnly explained that I cannot use logic to talk MYSELF out of self-hatred spirals no matter HOW ridiculous and extreme and outright laughable, because I am always certain that I am lying to myself to make myself feel better.) It reassures my screaming paranoia that she is not carefully lying to/manipulating me to some unseen end.
(the thought "well maybe she's just THAT GOOD" has, in fact, arisen. It is countered by two things: one, I am really quite good at seeing that in people these days, and two, if she is that good, I'm fucked anyway, so I might as well just ignore that thought, it's not useful.)
- dealt with my weirdness. I tend, for example, to speak of the way that all my stuff interacts into a lump that can't readily be disentangled as "dragon-brain", because of . . . reasons. *waves hand* There is a way in which my brain interacts with the world that is totally internally consistent and predictable and does not match up with human norms. I explained this to current!psych and she took it in stride and it is now a useful bit of shorthand. Similarly, when I explained that I think in a combination of texture-colour-temperature-sound that amounts to an internal language that is only with DIFFICULTY translated into English, and thus sometimes I would flounder around with words or resort to "it's not sadness, it's a scratcy-electric-crazy-chaotic-blue-and-silver ball of STEEL WOOL in my HEAD", she took this in stride and moved on. (In contrast, last!psych kept insisting that I secretly meant "sadness" or "anger" or something that could be expressed in useful words, and I very nearly screamed at her.)
- accept and respect my boundaries when I declare them. Doing that is passing a test. If you're not willing to do that, no questions asked, then you are not a safe person and I cannot trust you. If you do, then I can start thinking about moving the boundaries around and opening myself up to things on the edge of "need to talk about this/this is going to hurt." My body, my brain, my rules.
. . . that incredible pile of word-spew is all I can think about right now. I have no idea if any of it is useful, but if it is, woo. :)
From:
no subject
Maybe if it were reframed - not so much the therapist wants to see you but "this is an opportunity for you to tell me anything you might not have already and for me to maybe learn what to do better." But in every case deciding not to go anymore was traumatic enough, let alone sitting there for an hour discussing it. One therapist I really didn't click with called me three or four times for WEEKS afterwards trying to at least get me on the phone, and that just made me more convinced not to talk to him ever again.
From:
no subject
From:
no subject
Also CBT therapist would often illustrate her points with stories from her own life, which kind of annoyed me because she was a generation older, more well off, and in types of social situations I might not be in.
I also always feel weird when my therapists praise me? I feel some of it is positive reflection, but I find it way more useful to me when it's something I come up with by myself. ("You're a very ethical caring person" vs. "That sounds very ethical and caring to me, what do you think?")
A really big therapy miss, though, was when social worker therapist diagnosed me with adjustment disorder due to breakup instead of listening to me say I'd been depressed for about two years by then. Psych therapist also took me at my word re: I didn't know if I had a genetic history of depression or anxiety. But then, she believed me re: depression and also poked around stuff with my mom a lot more, until we ended up armchair diagnosing my mom (I count this as a plus).
Good: CBT therapist was very good at pushing me. Sometimes it was at things I didn't necessarily want to do (i.e. the internet stuff), but some things, like setting more definitive boundaries with my parents and modeling what that would look like, or making me come up with statements about class to get over my own class anxiety, were INCREDIBLY HELPFUL. For class, I think therapist is the same class as my parents? I'm currently not sure where I am in terms of class shifting. I know it's CBT stuff, but having a script for certain things was really useful.
CBT therapist was good at pushing but was also good at hearing me talk about my therapy experiences, because a lot of times I would be feeling a lot of resistance. And she always made it clear that I had the option of seeing someone else if I felt this wasn't working out. This was esp. nice compared to grad school therapist, who I tried to break up with because I said I wanted more CBT, and she said, "I do CBT too! You don't feel like exercising? Tough, go exercise!" Me: "Thanks, but no thanks."
Not necessarily good or bad? It was weird seeing personal philosophy differences between me and CBT therapist and psych therapist, both of whom I think were more used to counseling people with more resources? I have a lot due to parents, but because it's due to parents, it's complicated, and sometimes I felt like they understood but didn't quite get the whole thing with "I am unemployed and have no insurance." That could be me projecting thought.
From:
no subject
I dunno. Maybe other people liked it.
He was also reluctant to explicitly say "Our time is going to be up soon" or anything like that as we neared the end of the session. For the first several sessions, I ran things straight through the hour, so I was leaving just as his next patient arrived. Talking to other friends with therapists made me realize that the sessions were probably meant to be only fifty minutes long, so I asked him if that was the case. He said it was. I asked him why he hadn't told me I was running over, and he said he thought he had been sending cues that we needed to start wrapping things up. When...part of why I was there was because my reading of social cues is really, really bad.
It wasn't awful, because we got to talk about what those cues were and I got some new things to add to my lexicon of what other people's body language means, but it was awkward. In both cases, I think he thought he was being delicate; I felt like he was being deceptive. I really treasure bluntness. It would have made the space feel safer to me.