THERAPY'S DIRTY LITTLE SECRET

An article appearing in the latest issue of NEWSWEEK reveals a secret that I, as a retired therapist, was well aware of: sometimes psychotherapy is more than just ineffective, sometimes it is downright harmful. I started grad school to get a MA in Counseling late in life after selling a business I owned.  During my first semester I became aware that some of my fellow students had issues, conditions or beliefs that would prevent them from becoming effective therapists.  One was being treated for a diagnosed borderline personality disorder; a female student and all of her sisters had been molested as children by her alcoholic father and had serious unresolved alcohol and anger issues, several had very strong religious views and wanted to use their counseling degree to bring patients to their particular religious denomination. 

The first rule of the health professions, whether you are a MD, or a therapist is “do no harm”.  A therapist cannot meet this requirement without being fully aware of their own emotional history and psychological issues so they can maintain a balance between emotional support and objectivity; to focus strictly on the needs of their patients.  They must not intermingle their own emotional issues with those of the patient. My experience of going to grad school to get my MA in Counseling, combined with the personal psychotherapy that I undertook at the same time, was the most liberating and positive experience of my life. It greatly enhanced the effectiveness of my professional work as a therapist.

As a child I grew up in a dysfunctional family headed by a violent and threatening father who I now recognize as being severely depressed and probably bipolar. He finally deserted our family when I was seventeen.  As the result I carried depression and feelings of insecurity and low-self esteem into my outwardly successful adult life.  The therapy and education allowed me to resolve these issues and prepared me to be of real help to my future patients.

There is little or no professional oversight or evaluation of the therapeutic approach that a given therapist may use.  Alternative therapies such as rebirthing, primal scream, stress debriefing, recovered memories, and others too numerous to detail here be doing actual harm to patients.  The problem is that these same approaches may actually help a specific patient. A good therapeutic relationship is an intensely personal one. The patient must be willing to utterly truthful about his or her life and experiences and capable of enduring the emotionally distress associated with progress and resolution. This emotional pain and distress is what therapists refer to as “doing your work”. It is the cost of achieving emotional health. Many patients that stop therapy before it is complete do so because they cannot get through this phase.  They cannot complete their work.

The therapist, like an auto mechanic or oncologist, must have a “toolbox” of approaches and techniques that he or she can choose from that fits the personality, experiences and needs of the patient.  Some therapists have a “one size fits all” mentality.  Like all professions, some therapists are excellent, some terrible and most are somewhere is the middle.  

If you are considering beginning therapy you need to become an informed consumer.  Ask your physician for a referral to a psychotherapist.  If relatives or friends have had therapy, ask them for suggestions.  During your first visit discuss the therapist’s education, experience and professional qualifications and associations.  Find out what therapeutic tools he or she has in their toolbox. Ask about cost, frequency of sessions, medications, estimated length of treatment. If you do not feel yourself becoming more comfortable and trusting with your therapist within three or four visits, discuss it with him or her and consider finding another therapist.  

 In general, most emotional issues should respond to therapy within one year, assuming the patient is doing their work and being fully disclosing. The best way to guarantee that your therapeutic process will fail is to not to be fully disclosing.  The best way to know that progress is being made is that you will become aware that you are disclosing thoughts, feelings and life experiences that you have always hidden away.