Question:
Hello e and mick, ~~~~waves~~~~ Hope you don’t mind my jumping in. (clippage) After my prior therapies, I know that Ts can hurt me a lot. And so few of them seem to have even a clue about just how much and how.
I think unless one has experienced the hurt, one cannot know how it can possibly feel, ie. if one has ~only~ been a T never a client. Also, since feelings are so personal to the individual, I would think that the closest a T could get is by mere speculation. Yeah. Isn’t that weird? They think they can fix you but not hurt you. I really don’t understand their thinking about that. Any clues? 
I think some T’s may not take the time to really ponder their ability to cause harm. I don’t think all T’s fail to recognize the potential nor the actuality of causing harm. It’s bewildering to me to see the mistakes Ts sometimes make and how ignorant they are of the potential effects.
I can definitely understand the bewilderment you speak of! Personal firsthand experience. And how strongly they deny the actual effects. Esp to themselves, I think. What do you think is up with that, mick? Has it happened to you?
I know you’re asking mick here… It has happened to me. And again, I don’t think all T’s deny and abdicate responsibility to harm done. I do think however, that there does seem to be evidence to support that a growing number of personal accounts here that I’ve heard, speaks to therapeutic relationships really gone amiss and have been harmful. What I’m wondering about is if there is a lag between recognition of the role ab*se plays, dissociation, etc ~to~ that of how to effectively work with such a population from both a personal and professional place. We’re all human and we all make mistakes, yes – but the client _is_ paying here, and the T _is_ supposed to be doing a job.
True. Are you thinking reimbursement of fees paid? And getting help when they’re in over their head. I think it’s really difficult bc Ts seem to believe that they can single-handedly help most clients. I think that’s bunk. But since it’s the prevailing norm/belief, there’s a huge amount of institutional support for that denial. :-P~~~
I think there needs to be institutional guidelines requiring supervision vs it being at a T’s discretion. I disagree with the sweeping globalization that all T’s believe they can single-handedly help. What is important and critical imo is the role of outside feedback being continuous and if it’s not, it is best to look for a T who wholeheartedly embraces ongoing supervision-consultation during the course of providing treatment. Since there’s this institutional belief that experienced Ts can handle all but the really tough cases by themselves, I think it would be hard to get help.
Curious, what is the source of the institutional belief you are speaking of? It’s not only costly from a financial pov but from a professional and emotional one. 
~~
I do think there is connection between financial, professional, emotional and an ongoing adequate support system, ie. consultation. Plus, who are they gonna get help from?
I think this is where consortiums come in. Maybe one is needed? If there aren’t many ppl who understand a given problem at least as well and preferably better than they do, who are they gonna talk to?
Research and compiling of data, formulating more effective means, training & education. I think I understand some of the Ts’ problem but, imo, it would be much better if Ts were more honest with themselves and clients about this.
Some are, some aren’t has been my experience. [...] I’m still not sure if I know what transference is. Where you react to someone in the present like you did to someone significant in your past. My viewing ppl through my "brother lens" would be transference. It can be positive (e.g., good feeling about someone who reminds you of your mom) or negative (e.g., bad feelings). And ‘counter-transference’ is basically when your T is doing that style of thing to you? Yeah. Both the terms have varying definitions in various schools of psychotherapy (some broader, some narrower) but I think that’s the gist of it.
I’d add to the definition, the twist that what is generally transferred are the ~unexpressed~ and ~unacknowledged~ feelings towards the past person(s). Not always but sometimes. The meds stuff? I guess so. It was partially a result of a lie by my T. He told me that he’d be honest with me and he either wasn’t honest with me or with the meds guy he consulted with. (I found that out recently. Seems like even more CYA stuff to me. ~) He’d also said he wouldn’t pull the heavy-handed, paranoid stuff he pulled. He freaked, I guess, even though I kept reassuring him that things would be ok. :-P~~ I understand why he freaked. It’s just that his reaction was contrary to all the typical T bs he said about working together and trusting my feelings and respecting me and blah, blah, blah. What a load of crap! They all say it but then when things get tough, they want to call the shots. :-P~~~
Sorry you still have to deal w/physical stuff due to meds and it sounds like it’s been compounded by lack of recognition/acknowledgement. : o( That’s what some say is the fundamental emotional element to trauma, a sense of betrayal, even if by ‘the universe’ rather than by a person. Natural enough that a current sense of betrayal would bring old stuff to the surface.
*nodding* I guess you’re right. I also understand why it’s so strong with my new T. First, I’m generalizing my previous bad experiences with Ts to him. Second, he does have ties to my old T. Third, he’s never said anything negative about the way my old T handled the IME/meds fiasco so I assume that he’s pretty much siding completely with my old T.
Can I give another perspective to consider here? I hope so…. It is not uncommon to not give a personal nor professional opinion on a previous T (or anyone else for that matter that the client may discuss) bc it is felt that by doing so, T’s may think they are helping and may also, assist the client to split (object split) the T (person) into all good or all bad, leaving little room for the client to have all of their feelings concerning a previous T. I think validating what the client is going through is ok, validating (siding) with a client is totally different. I think it may be what a client may want and which may ultimately be counterproductive in the long run. Otherwise, I think he’d try to say something supportive of my pov (yet far short of saying my T did anything wrong – Ts gotta stick together; I think it’s part of their club or something .
hehehehe… A conspiracy eh? Well, some may in fact operate that way. And this one may have. Who knows but him right? Also, I was on his waiting list for 2 years. He knew that I really wanted to leave my old T that whole time and that therapy wasn’t going well. I get the sense that his "normal" waiting list isn’t 2 years, although it is long. Therefore, I assume that either he didn’t want to work with me bc of me or he thought that my old T was doing a pretty good job and the therapy was working (my old T’s view, even though he would admit, if pushed, that the therapy didn’t seem to be helping me at all), even though I’d told my new T that the therapy (with my old T) wasn’t working. IAE, I feel like he ditched me with my old T for a very long time and that he sided with my old T. (Maybe he’s trying to be neutral. Right. Like that’s possible since he was involved.)
Ever shared this w/him and asked him about his motives? Sierra of TN
Response:
Hello e and mick, ~~~~waves~~~~
Hi, Sierra. :) Hope you don’t mind my jumping in. (clippage)
I always like ppl jumping in. The more the merrier. After my prior therapies, I know that Ts can hurt me a lot. And so few of them seem to have even a clue about just how much and how. I think unless one has experienced the hurt, one cannot know how it can possibly feel, ie. if one has ~only~ been a T never a client. Also, since feelings are so personal to the individual, I would think that the closest a T could get is by mere speculation.
I think it’s much more the latter than the former, at least for the Ts I’m talking about. However, I’m puzzled about the relevance of having an experiential knowledge of something and knowing and acknowledging that it occurs. I don’t understand why there would generally be a connection between experiencing something (as the one it’s happening to) and acknowledging/dealing with its occurrence. I doubt that they’ve been through the same things. They may have been through similar things. I’m sure they’ve dealt with their own pain, whatever it’s source. Even if they’d been through exactly the same thing, I don’t think they’d know how I experienced it. So I don’t see that whether they’ve experienced the same thing matters. I guess I’m lost on that point. Yeah. Isn’t that weird? They think they can fix you but not hurt you. I really don’t understand their thinking about that. Any clues? I think some T’s may not take the time to really ponder their ability to cause harm. I don’t think all T’s fail to recognize the potential nor the actuality of causing harm.
Most of them I’ve known acknowledge that they can cause moderate or serious harm. It’s just that they never seem to. <g Kinda like F*SF and child abuse. "Of course, it occurs. I’ve just never seen it in a specific case [for Ts: where I was the T]." The Ts I’ve worked with/interviewed/have known in other contexts also seem to readily acknowledge minor harm. (Esp when it involved client pathology so that they could blame the harm on the client. "Blaming the client" is really clear with BPD. (No personal experience, just stuff I’ve read here and elsewhere.) With other stuff it’s more "There was no clear answer, it was a judgment call. You’re looking at this from hindsight.") How many Ts would be able to honestly answer the Q: "How many clients have you moderately or seriously harmed, how did you harm them, and what did you do about it?" It’s bewildering to me to see the mistakes Ts sometimes make and how ignorant they are of the potential effects. I can definitely understand the bewilderment you speak of! Personal firsthand experience.
And how strongly they deny the actual effects. Esp to themselves, I think. What do you think is up with that, mick? Has it happened to you? I know you’re asking mick here… It has happened to me. And again, I don’t think all T’s deny and abdicate responsibility to harm done. I do think however, that there does seem to be evidence to support that a growing number of personal accounts here that I’ve heard, speaks to therapeutic relationships really gone amiss and have been harmful. What I’m wondering about is if there is a lag between recognition of the role ab*se plays, dissociation, etc ~to~ that of how to effectively work with such a population from both a personal and professional place.
I do think that there’s a big lag. Even the leading professionals in the trauma field seem basically clueless about many clients. I’ve been on a few lists and none of the professionals there seem to know squat about ppl who don’t fit the prototypical case of DID, PTSD, etc. Even worse, they seem to have a very hard time acknowledging that. They seem to think that if they keep applying these models, eventually they’ll work. (Maybe they never learned the definition of insanity. If they don’t work, it’s bc the T isn’t sensitive, professional, or basically, as good as they are. <puke Most of these ppl seem to be very good Ts and good ppl. I think the field just hasn’t had time to figure a lot of this stuff out. I also think that it’s psychologically difficult to even look at some of these issues honestly. I think that it’s too hard for many Ts to acknowledge that they aren’t helping ppl and are hurting some of them. That they have really only looked at a fairly small percentage of ppl who’ve been traumatized/abused (e.g., ppl with PTSD and DID). That focusing on a few dxes to the exclusion of other problems/sxes/presentations may only work to help most ppl with those dxes, not others. Until they acknowledge that, I don’t see how they can begin to work effectively with many traumatized ppl. We’re all human and we all make mistakes, yes – but the client _is_ paying here, and the T _is_ supposed to be doing a job. True. Are you thinking reimbursement of fees paid?
That was Mick but I’m more concerned with prevention. The professional organizations/licensing boards should do a lot more to require all Ts to get good ongoing supervision as well as good expert consultation as needed, imo. And getting help when they’re in over their head. I think it’s really difficult bc Ts seem to believe that they can single-handedly help most clients. I think that’s bunk. But since it’s the prevailing norm/belief, there’s a huge amount of institutional support for that denial. :-P~~~ I think there needs to be institutional guidelines requiring supervision vs it being at a T’s discretion.
Me, too. And those should be well enforced. I disagree with the sweeping globalization that all T’s believe they can single-handedly help.
Me, too. I never said that. (FWIW, our writing styles are very different. When I say that something is a prevailing norm, to me, that indicates that it’s the majority position and that, therefore, there are other, minority, positions on the issue in Q. I think that was the problem on the "mothers" post where I was making an analogy and said that "X was like Y" and you read it to mean that I was saying "X is Y". Well, no. If X were Y there would be no need for an analogy, imo. I generally use analogies when I lacks the precise words to fully describe something and think that painting a picture of something that X is similar to will better describe it than a more precise description, given my verbal inabilities, the ambiguity of words, the lack of precise words in that particular language, etc. I’m not saying that either way is right or better, merely pointing out a source of confusion, imo.) What is important and critical imo is the role of outside feedback being continuous and if it’s not, it is best to look for a T who wholeheartedly embraces ongoing supervision-consultation during the course of providing treatment.
I think I talked about this in my reply to Nancy. Ongoing supervision is generally good. Obviously, it’s only as good as the group one is in. It’s sometimes inadequate, ime. Since there’s this institutional belief that experienced Ts can handle all but the really tough cases by themselves, I think it would be hard to get help. Curious, what is the source of the institutional belief you are speaking of?
Since the norm doesn’t seem to be that one needs regular, ongoing supervision/consultation with various sources (I don’t think one group would generally cut it bc it’s usually not varied enough, imo.), there seems to be an implicit belief that Ts can handle most cases by themselves. Otherwise, wouldn’t it be unethical for Ts (in general) to practice without it? It’s not only costly from a financial pov but from a professional and emotional one. ~~ I do think there is connection between financial, professional, emotional and an ongoing adequate support system, ie. consultation.
How do you see the connection? Plus, who are they gonna get help from? I think this is where consortiums come in. Maybe one is needed?
Could you elaborate? There are a variety of sources for consultation/supervision. However, I’m wary of consultation that doesn’t involve the client. If the T is missing something, how’s the consultant gonna know that? I don’t see how relying solely on the T for a description of what’s going on is generally all that helpful. It’s definitively better than nothing. But it would seem to lead to serious distortions, particularly in those cases where the T needs help the most (e.g., bc s/he’s seriously missing important parts of the picture). If there aren’t many ppl who understand a given problem at least as well and preferably better than they do, who are they gonna talk to? Research and compiling of data, formulating more effective means, training & education.
I don’t understand. I’m asking with whom a T should consult. Presumably, the T has the same access to research studies, etc. as ppl with whom s/he’d consult. So do most clients, for that matter. snip – Hide quoted text — Show quoted text – I guess you’re right. I also understand why it’s so strong with my new T. First, I’m generalizing my previous bad experiences with Ts to him. Second, he does have ties to my old T. Third, he’s never said anything negative about the way my old T handled the IME/meds fiasco so I assume that he’s pretty much siding completely with my old T. Can I give another perspective to consider here? I hope so…. It is not uncommon to not give a personal nor professional opinion on a previous T (or anyone else for that matter that the client may discuss) bc it is felt that by doing so, T’s may think they are helping and may also, assist the client to split (object split) the T (person) into all good or all bad, leaving little room for the client to have all of their feelings concerning a
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Response:
Hello e and mick, ~~~~waves~~~~ Hi, Sierra. :)
And Hi Sierra from me too 
– Hide quoted text — Show quoted text – Hope you don’t mind my jumping in. (clippage) I always like ppl jumping in. The more the merrier. After my prior therapies, I know that Ts can hurt me a lot. And so few of them seem to have even a clue about just how much and how. I think unless one has experienced the hurt, one cannot know how it can possibly feel, ie. if one has ~only~ been a T never a client. Also, since feelings are so personal to the individual, I would think that the closest a T could get is by mere speculation. I think it’s much more the latter than the former, at least for the Ts I’m talking about. However, I’m puzzled about the relevance of having an experiential knowledge of something and knowing and acknowledging that it occurs. I don’t understand why there would generally be a connection between experiencing something (as the one it’s happening to) and acknowledging/dealing with its occurrence.
I think if they haven’t felt it they don’t recognise the vulnerability or the effect unless it’s _really_ obvious. If someone has just had their toes trodden on so badly that their foot is still in a cast then there’s more chance they’ll notice someone else’s foot about to be trodden on and greater sympathy if they see it happen. People just don’t watch out for things unless they have some sensitivity about those things, they walk around with a world-map thingie that tells them not to be concerned about feet so they don’t notice feet; when they’ve experience severe foot pain their world-map thingie now has an association saying that feet can be _really_ important to people and are worth noticing. I doubt that they’ve been through the same things. They may have been through similar things. I’m sure they’ve dealt with their own pain, whatever it’s source. Even if they’d been through exactly the same thing, I don’t think they’d know how I experienced it. So I don’t see that whether they’ve experienced the same thing matters. I guess I’m lost on that point.
I think this can be very different for different people. Hmm, and on different subjects. It usually helps me when I’m trying to understand something if another person has had similar experiences just because talking through similarities and differences gives me ideas and terms to understand myself better. On some things though it helps that my T is female and I know definitely _hasn’t_ experienced some things which are relevant to me because we don’t have the same biology. That means I know some feelings or whatever are kind of distinctly about s*xual difference. Yeah. Isn’t that weird? They think they can fix you but not hurt you. I really don’t understand their thinking about that. Any clues? I think some T’s may not take the time to really ponder their ability to cause harm. I don’t think all T’s fail to recognize the potential nor the actuality of causing harm. Most of them I’ve known acknowledge that they can cause moderate or serious harm. It’s just that they never seem to. <g Kinda like F*SF and child abuse. "Of course, it occurs. I’ve just never seen it in a specific case [for Ts: where I was the T]."
Selective memory? The Ts I’ve worked with/interviewed/have known in other contexts also seem to readily acknowledge minor harm. (Esp when it involved client pathology so that they could blame the harm on the client. "Blaming the client" is really clear with BPD. (No personal experience, just stuff I’ve read here and elsewhere.) With other stuff it’s more "There was no clear answer, it was a judgment call. You’re looking at this from hindsight.") How many Ts would be able to honestly answer the Q: "How many clients have you moderately or seriously harmed, how did you harm them, and what did you do about it?"
Hmm, I don’t know how my T would answer that. I know my renal specialist still feels that he ‘k*lled’ a girl when he was first practising. He thinks he made the decision he ’should have made’ according to the knowledge and technical understanding of the time but he knows that if he had made a different decision she wouldn’t have died (or at least not then). He doesn’t seem to feel particularly guilty about it now but he knows it was his call and it turned out wrong. And he’s never forgotten it through thirty-five more years of practise. His reaction impressed me because I don’t think he should feel guilty, just accept the responsibility and recognise how serious his decisions are and that’s how he seems to look at it. – Hide quoted text — Show quoted text – It’s bewildering to me to see the mistakes Ts sometimes make and how ignorant they are of the potential effects. I can definitely understand the bewilderment you speak of! Personal firsthand experience. And how strongly they deny the actual effects. Esp to themselves, I think. What do you think is up with that, mick? Has it happened to you? I know you’re asking mick here… It has happened to me. And again, I don’t think all T’s deny and abdicate responsibility to harm done. I do think however, that there does seem to be evidence to support that a growing number of personal accounts here that I’ve heard, speaks to therapeutic relationships really gone amiss and have been harmful. What I’m wondering about is if there is a lag between recognition of the role ab*se plays, dissociation, etc ~to~ that of how to effectively work with such a population from both a personal and professional place. I do think that there’s a big lag. Even the leading professionals in the trauma field seem basically clueless about many clients.
Yep. It seems like there’s a lack of understanding that someone dissy or ab*sed or suffering PTSD effects will probably not react to the world as ‘normal’ people do. Sure, it’s hard to formally characterise differences and expecting exact specific things is not what I’d want or advise, but it’s weird cos if they reacted to the world ‘normally’ then they wouldn’t be seeing a T. I’ve been on a few lists and none of the professionals there seem to know squat about ppl who don’t fit the prototypical case of DID, PTSD, etc. Even worse, they seem to have a very hard time acknowledging that. They seem to think that if they keep applying these models, eventually they’ll work. (Maybe they never learned the definition of insanity.
LOL If they don’t work, it’s bc the T isn’t sensitive, professional, or basically, as good as they are. <puke Most of these ppl seem to be very good Ts and good ppl. I think the field just hasn’t had time to figure a lot of this stuff out. I also think that it’s psychologically difficult to even look at some of these issues honestly. I think that it’s too hard for many Ts to acknowledge that they aren’t helping ppl and are hurting some of them. That they have really only looked at a fairly small percentage of ppl who’ve been traumatized/abused (e.g., ppl with PTSD and DID). That focusing on a few dxes to the exclusion of other problems/sxes/presentations may only work to help most ppl with those dxes, not others. Until they acknowledge that, I don’t see how they can begin to work effectively with many traumatized ppl.
Opportunity cost, limited resources, people want an easy time and all that – same as with more physical medicine the majority of docs treat the most common, and commonly understood, problems. We’re all human and we all make mistakes, yes – but the client _is_ paying here, and the T _is_ supposed to be doing a job. True. Are you thinking reimbursement of fees paid? That was Mick but I’m more concerned with prevention.
Yeah, that’s more what I was thinking of. If I pay someone to do something my default expectation is that they will do it properly – it’s up to me to make sure, but the whole point of paying is that it’s supposed to be a swap, money for job being done. If I only wanted someone to give it a shot with no expectation that they’ll do it properly I could ask anyone. If I pay an electrician to change a socket he has some moral/ ethical duty to be able to change a socket and to do so. If I asked a friend to do it for nothing then I expect he’d do his best but it’s different. If I just grabbed someone in a cafe I couldn’t really expect anything at all. The professional organizations/licensing boards should do a lot more to require all Ts to get good ongoing supervision as well as good expert consultation as needed, imo. And getting help when they’re in over their head. I think it’s really difficult bc Ts seem to believe that they can single-handedly help most clients. I think that’s bunk. But since it’s the prevailing norm/belief, there’s a huge amount of institutional support for that denial. :-P~~~ I think there needs to be institutional guidelines requiring supervision vs it being at a T’s discretion. Me, too. And those should be well enforced.
Yeah, I’m pretty keen on supervision too. People keep learning all the way through life and that means a less-experienced T will be guided away from mistakes by a more experienced T. I disagree with the sweeping globalization that all T’s believe they can single-handedly help. Me, too. I never said that.
I think Sierra was referring to ‘Ts seem to believe that they can single- handedly help most clients’, taking Ts to mean all Ts. (FWIW, our writing styles are very – Hide quoted text — Show quoted text – different. When I say that something is a prevailing norm, to me, that indicates that it’s the majority position and that,
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Response:
snip re: getting hurt by Ts – Hide quoted text — Show quoted text – I think unless one has experienced the hurt, one cannot know how it can possibly feel, ie. if one has ~only~ been a T never a client. Also, since feelings are so personal to the individual, I would think that the closest a T could get is by mere speculation. I think it’s much more the latter than the former, at least for the Ts I’m talking about. However, I’m puzzled about the relevance of having an experiential knowledge of something and knowing and acknowledging that it occurs. I don’t understand why there would generally be a connection between experiencing something (as the one it’s happening to) and acknowledging/dealing with its occurrence. I think if they haven’t felt it they don’t recognise the vulnerability or the effect unless it’s _really_ obvious. If someone has just had their toes trodden on so badly that their foot is still in a cast then there’s more chance they’ll notice someone else’s foot about to be trodden on and greater sympathy if they see it happen. People just don’t watch out for things unless they have some sensitivity about those things, they walk around with a world-map thingie that tells them not to be concerned about feet so they don’t notice feet; when they’ve experience severe foot pain their world-map thingie now has an association saying that feet can be _really_ important to people and are worth noticing.
I guess that makes sense. However, it doesn’t seem to be enough. Just being a therapy client doesn’t seem to give Ts particular sensitivity to being hurt by that T. I think part of the problem is that something that might help you might hurt me and vice-versa. And if it’s been quite a while since a given T has been hurt (as a client), I doubt that sie’d be more sensitive than other Ts about it. Or more sensitive about hurting clients in different ways, or reading clients who expressed their hurt differently, etc. I guess it seems right that having been through something similar would be one factor in whether a T would recognize hurting a client but my guess is that it generally would be less important than other factors (e.g., having recently worked through something similar with other clients, having recently read about similar problems, etc.) I’d guess that all kinds of experience, whether as a client, a T, a friend, etc. would be important. I guess it would vary from T to T. I doubt that they’ve been through the same things. They may have been through similar things. I’m sure they’ve dealt with their own pain, whatever it’s source. Even if they’d been through exactly the same thing, I don’t think they’d know how I experienced it. So I don’t see that whether they’ve experienced the same thing matters. I guess I’m lost on that point. I think this can be very different for different people. Hmm, and on different subjects.
I agree with both. It usually helps me when I’m trying to understand something if another person has had similar experiences just because talking through similarities and differences gives me ideas and terms to understand myself better.
Yes, it helps me, too. Ppl having similar reactions to different experiences also helps. I guess as long as there are some similarities, it’s easier for me to sort things out. On some things though it helps that my T is female and I know definitely _hasn’t_ experienced some things which are relevant to me because we don’t have the same biology. That means I know some feelings or whatever are kind of distinctly about s*xual difference.
Hmmm. I don’t think it necessarily makes sense to generalize from such small samples of men and women. <g However, having someone with a different reaction to similar experiences can be very helpful in helping me sort out my reaction or in giving me indirect suggestions for other ways to look at or deal with things. I guess similar reactions to similar experiences help in different ways, esp bc no one’s experiences or reactions are exactly the same. Yeah. Isn’t that weird? They think they can fix you but not hurt you. I really don’t understand their thinking about that. Any clues? I think some T’s may not take the time to really ponder their ability to cause harm. I don’t think all T’s fail to recognize the potential nor the actuality of causing harm. Most of them I’ve known acknowledge that they can cause moderate or serious harm. It’s just that they never seem to. <g Kinda like F*SF and child abuse. "Of course, it occurs. I’ve just never seen it in a specific case [for Ts: where I was the T]." Selective memory?
Partly but I also think it’s very selective perception, e.g., bias; power differentials; roles; wanting to avoid seeing/taking responsibility for something painful, esp when one has caused the pain. The Ts I’ve worked with/interviewed/have known in other contexts also seem to readily acknowledge minor harm. (Esp when it involved client pathology so that they could blame the harm on the client. "Blaming the client" is really clear with BPD. (No personal experience, just stuff I’ve read here and elsewhere.) With other stuff it’s more "There was no clear answer, it was a judgment call. You’re looking at this from hindsight.") How many Ts would be able to honestly answer the Q: "How many clients have you moderately or seriously harmed, how did you harm them, and what did you do about it?" Hmm, I don’t know how my T would answer that. I know my renal specialist still feels that he ‘k*lled’ a girl when he was first practising.
That would be hard to deal with. He thinks he made the decision he ’should have made’ according to the knowledge and technical understanding of the time but he knows that if he had made a different decision she wouldn’t have died (or at least not then). He doesn’t seem to feel particularly guilty about it now but he knows it was his call and it turned out wrong. And he’s never forgotten it through thirty-five more years of practise. His reaction impressed me because I don’t think he should feel guilty, just accept the responsibility and recognise how serious his decisions are and that’s how he seems to look at it.
I agree if he’s correct about the "right" decision being unknowable (with a fairly thorough search of the then-available knowledge). – Hide quoted text — Show quoted text – It’s bewildering to me to see the mistakes Ts sometimes make and how ignorant they are of the potential effects. I can definitely understand the bewilderment you speak of! Personal firsthand experience. And how strongly they deny the actual effects. Esp to themselves, I think. What do you think is up with that, mick? Has it happened to you? I know you’re asking mick here… It has happened to me. And again, I don’t think all T’s deny and abdicate responsibility to harm done. I do think however, that there does seem to be evidence to support that a growing number of personal accounts here that I’ve heard, speaks to therapeutic relationships really gone amiss and have been harmful. What I’m wondering about is if there is a lag between recognition of the role ab*se plays, dissociation, etc ~to~ that of how to effectively work with such a population from both a personal and professional place. I do think that there’s a big lag. Even the leading professionals in the trauma field seem basically clueless about many clients. Yep. It seems like there’s a lack of understanding that someone dissy or ab*sed or suffering PTSD effects will probably not react to the world as ‘normal’ people do.
I think that’s true for many doctors and Ts. It can make it hard to get good medical care and therapy. :( Sure, it’s hard to formally characterise differences and expecting exact specific things is not what I’d want or advise, but it’s weird cos if they reacted to the world ‘normally’ then they wouldn’t be seeing a T.
LOL. Good point. snip I also think that it’s psychologically difficult to even look at some of these issues honestly. I think that it’s too hard for many Ts to acknowledge that they aren’t helping ppl and are hurting some of them.
Which would apply to all dxes, imo. That they have really only looked at a fairly small percentage of ppl who’ve been traumatized/abused (e.g., ppl with PTSD and DID). That focusing on a few dxes to the exclusion of other problems/sxes/presentations may only work to help most ppl with those dxes, not others. Until they acknowledge that, I don’t see how they can begin to work effectively with many traumatized ppl. Opportunity cost, limited resources, people want an easy time and all that – same as with more physical medicine the majority of docs treat the most common, and commonly understood, problems.
I’d guess that a fairly high percentage of T time is devoted to treating ppl who’ve experienced trauma. IIRC, neither PTSD nor DID are the most common reactions to trauma. (I think PTSD is fairly common but not as common as, e.g., general anxiety or depression. DID is far from the most common reaction to trauma or abuse.) However, they seem to be the most studied and written about. Even among DDs, I think DID is relatively uncommon yet there’s far more literature on it than on the other DDs. E.g., I don’t think there have been many studies about whether Ts should treat depression caused by abuse differently than depression from other causes. I don’t understand that. – Hide quoted text — Show quoted text – We’re all human and we all make mistakes, yes – but the client _is_ paying
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Response:
I think consultation involving the client, whether it means the client going alone or with the T to another T for a second opinion, is valid. Therapy needs to be client-centered and flexible. And I think T’s do need to anser the question of when and how they’ve harmed clients. I am very willing to admit to mistakes with my clients, and I think for many of my clients, hearing me talk about my mistakes and what I did to resolve the mistake has been helpful. If I make a mistake with a client, I think it is important to aplogize, explain why I did what I did and why it was wrong, and ask them to give me feedback on how to make it up to them if they are able- if not, I need to think of this on my own. My current T is very willing to admit to mistakes, and she admits she has made decisions in my treatment that have been harmful to me, we’ve talked about them every time I’ve needed to bring them up (in one instance, this meant many times over 2 years), and she is not defensive about it. This ahs helped me a lot in gaining trust. I think any decent T should be willing to do this. -Nancy
Response:
I think consultation involving the client, whether it means the client going alone or with the T to another T for a second opinion, is valid.
Thanks for the feedback. My old T finally brought my new T in as a consultant. He met with us together and then with my T alone. Therapy needs to be client-centered and flexible. And I think T’s do need to answer the question of when and how they’ve harmed clients. I am very willing to admit to mistakes with my clients, and I think for many of my clients, hearing me talk about my mistakes and what I did to resolve the mistake has been helpful. If I make a mistake with a client, I think it is important to aplogize, explain why I did what I did and why it was wrong, and ask them to give me feedback on how to make it up to them if they are able- if not, I need to think of this on my own.
That sounds really good. What kinds of mistakes have you handled this way? How did you make it up to your clients? I guess I’m stuck bc I don’t see how my T could ever make up for the mistakes I’m thinking of. The major mistake, imo, was his freaking out after a forensic psychologist intentionally pushed me over the edge and destabilized me. I wasn’t dealing with it very well and, imo, neither were the psychologist nor my T. They panicked, too. I think they thought that there was a substantial risk that I’d kill myself. IMO, they seriously overestimated that risk. My T gave me drugs that caused lots of long-term problems. The drugs were much riskier than my T realized. He was badly informed. Even after the problems lasted much longer than he thought was possible, he had a hard time acknowledging the situation. IMO, he never acknowledged that he should have looked for and discussed other strategies or learned about the risks and advised me of them before prescribing the drugs. He didn’t/doesn’t see it that way (although he agrees with me that the psychologist was freaking badly and that he was "very concerned about me.") He doesn’t think he did anything wrong when his actions are viewed prospectively. I do. (We both agree that his actions should be evaluated on a prospective basis, not based upon hindsight.) FWIW, most ppl I’ve talked to say that most psychiatrists don’t realize the risks involved so, from that pov, his actions were reasonable. Most non-Ts/non-MDs think that he should have known the risks and advised me of them bc he could have done a thorough search of the lit and found out about them. My reaction was "See? I told you that your concern would hurt me." and "I told you that you were overreacting and that it would cause problems. Why didn’t you trust me to evaluate my own condition and know better than you would what was going on for me?" I think that the 2 main problems that happened were that (1) it was hard for my T to acknowledge that he wasn’t the expert here, I was and (2) to acknowledge that his own reaction was causing him to distort his evaluation at least as much as my reaction was causing me to distort my evaluation. I think it’s hard for Ts to deal with their limitations when they think that a client is in danger, even if their reactions are leading them to overestimate that danger. I think that it’s hard, in part, bc Ts have professional ethical responsibilities and potential legal liability, both of which push them to overestimate the risk of client self-harm and overreact to that risk. I think that, viewed within those frameworks, my T’s actions were eminently reasonable. I think that outside those frameworks (i.e., real life from a client’s pov), they were stupid, arrogant, unethical (from an interpersonal, non-professional pov), and wrong. <g I think that from my T’s pov, I was underestimating the danger and thereby distorting how I viewed his actions. I was resenting him for doing his job. I was blaming him for problems that weren’t his fault. I can understand that but I disagree. So, given our different pov (which are both probably partially accurate and partially self-serving), we could never figure out how to work through the problem. I wanted him to acknowledge something that he didn’t think was accurate. He wanted me to acknowledge something that I didn’t think was accurate. I think that he acted negligently (not from a malpractice – what would the run of the mill psychiatrist do – pov but from a common-sense, what a client should reasonably expect from a T one). He disagrees. He thinks that I’m not giving him credit for taking reasonable actions to protect me. I disagree. Other than agreeing to disagree, which we did, I’m not sure what else either of us could do. I don’t want him to acknowledge something that he disagrees with. Even if he did, I don’t see how he can "make it up to me". He can’t fix the damage. The damage caused by therapy is similar except that I’m not sure that he reasonably could have known about that risk ahead of time. His model says that clients shouldn’t deteriorate except on a short-term basis. He didn’t push. He was an excellent T (viewed within the general psychodyanamic/trauma models). He didn’t make many mistakes within those models. The ones he made were little. I understood his probable reasons for them before he apologized. IMO, he apologized way too much for them. IMO, he focused on them as a way of avoiding the larger problems of the available models not working well and therapy causing deterioration for me. I sometimes let him do that. Other times, I tried to move the discussion to the bigger picture. He generally followed that lead but neither of us knew what to do about it. In the end, I’d just say something like "Don’t worry about it. It wasn’t a big deal." Bc, imo, the little mistake never was. As far as I can see, the only thing that he did "wrong" (wrt non-meds issues) was not acknowledging the deterioration and getting expert consultation much sooner than he did. I’m not sure that he "owes" me anything for that. I did push him (a little but even that was hard and I mentioned it several times) to get expert help much sooner than he did. However, I was pretty sure that he wasn’t getting it. I could have pushed to find out and left if he didn’t get it. So it seems to me that continuing to work with him was my choice, even though I think that he was wrong to not get more/better help. I don’t see that he’s more responsible for my deterioration than I am. It seems to me that he’s less responsible. Even if he does "owe" me something, I’m not sure how he can make that up to me. He can’t fix it with more therapy. If he could, there wouldn’t have been a problem. He wanted to "fix" my therapy so it would work for me. He didn’t know how. Neither did I. (Suggestions or feedback are appreciated.) My current T is very willing to admit to mistakes, and she admits she has made decisions in my treatment that have been harmful to me, we’ve talked about them every time I’ve needed to bring them up (in one instance, this meant many times over 2 years), and she is not defensive about it. This ahs helped me a lot in gaining trust. I think any decent T should be willing to do this.
What kinds of mistakes has your T admitted making? I do think many mistakes are fixable and that working through/fixing them can help the client, the T, and the therapy. I guess I’m trying to figure out what kinds of mistakes are fixable and how one fixes them. I appreciate your sharing your experiences. They help me sort this out. I’d guess that other clients want info like this so, too. Thanks, e — For info about this service, see http://www.twwells.com/anon/ or e-mail:
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