Now that I'm an ECP, I am appalled at the psychotherapists from whom I've received treatment.

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Groupthink

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I've been licensed for some months now, and I've been thinking back on my several experiences in treatment with psychologists. I am struggling with dissonance between a field that claims to prioritize evidence-based practice versus my anecdotal experience of the reality of what these licensed practitioners are doing.

My question for each of you, to the extent you are willing to share, is 1. whether my n of 4 experience in treatment is reflective of the overall quality of practicing clinical psychologists, and 2. your opinion on whether "evidence-based practice" is actually practiced to the extent that the overall narrative of the field would have you believe.

Some humorous highlights:

1. My most recent treating clinician recommended a visualizing exercise. What I thought was going to be imaginal exposure turned into her asking that I "make contact with my inner Spirit Master". She then proceeded to talk to the Spirit Master as if it was a 3rd person in the room and said something about it being allowed to rest and it doesn't need to continue generating negative energies.

2. A previous psychologist told me that my glasses are a mask and that if I am to overcome anxiety I need to stop wearing them and get contacts. I tried to be understanding about this as a metaphor for defensive behavior and that I need to be more "genuine" (whatever that means -- I'm not a fan of abstract terms that cannot be operationalized). Yet she was serious about me not wearing glasses anymore and brought this up every session. I wanted to be defensive and ask in response if she was a licensed Optometrist, but I thought better of it.

3. Another therapist went into explicit detail about his sexual preferences with his wife, noting that he is especially fond of **certain features** when she is dressed in a French Maid outfit. I was fairly young at the time, so I think he was trying to normalize being comfortable with sexuality, but he gave way too much uninvited detail.

Of course, in all these circumstances I raised my concerns with these clinicians. The first one indicated that her technique "didn't work" so we went back to talk therapy but it just wasn't helping any. The second asked me if I am always so resistant to authority when I said speaking about my glasses is not helping, which I challenged back by saying I was being open and genuine about my concerns, doing what she had been (symbolically) asking me to do the whole time, and instead of listening to my concerns it felt as if she dismissed me as being resistant. The third was surprised that I was so uncomfortable with his descriptions, and actually had engaged in a rupture-repair process with me.

Look, I am all about Psychodynamic work. Understanding how affect drives defenses, identifying ways those defenses formed within a family system context, and learning how those defenses have been behaviorally reinforced is key to how I formulate and intervene. None of what these therapists did fit within any cognitive, behavioral, dynamic, or systemic perspective, at least from my understanding. I was never provided psychoeducation, I never had a homework assignment, never taught how to analyze my thoughts. Maybe they all assumed I already knew how to do this because I was in grad school at the time. I don't know.

Is this lack of EBPs normal? Is this just the state of the field right now?

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Most psychologists that I have worked with and interacted with are not of this ilk. I try to avoid kooks like this as quickly as possible. It is unfortunate how many of them slip through the cracks and unfortunate that a lot of kooks are drawn to our field and often the rest of us are too nice or conflict avoidant to call them out on it. As you can tell by my prior comment, I tend to be the latter.
 
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There are definitely some hacks out there. There are good and bad pockets of clinicians too, particularly when clinicians stay local.

Flip through the Psychology Today directory in places like San Francisco and L.A. and prepare to be dumbfounded by the breadth and depth of bogus treatments out there. It really should be illegal, but the horses left the barn decades ago.
 
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The first one is easy to understand. Some custo-- errr, patients--would be elated to dump their problems on some magical being and not have to actually do anything.

The glasses thing is befuddling. Were there cards for an optometrist with the same last name as the therapist in the room?
 
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I'm curious about the age of these therapists. The problem with loose guidelines is a lot nuttiness gets in and that has been true for a long time. Were you paying for this or using insurance reimbursement? That can matter as well.
 
At times I've been pretty dismayed by what patients tell me about their experiences with other therapists, including psychologists who graduated from mainstream, reputable training programs. I can forgive being a so-so or mediocre therapist but I draw a hard line at "energy healing," "tapping," and all that BS.
 
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At times I've been pretty dismayed by what patients tell me about their experiences with other therapists, including psychologists who graduated from mainstream, reputable training programs. I can forgive being a so-so or mediocre therapist but I draw a hard line at "energy healing," "tapping," and all that BS.

And people wonder why we insist that solid training in the production and evaluation of research is absolutely necessary to be a competent clinician...
 
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The bar to entry for LADCs is pretty low, at least in my current and past jurisdictions. Just more evidence of the watering down of licensure across a variety of disciplines.
The therapeutic techniques she used consisted of placing one group member in the middle of a circle and having the other group members scream insults and them for 45 minutes

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The therapeutic techniques she used consisted of placing one group member in the middle of a circle and having the other group members scream insults and them for 45 minutes

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That kind of thing will happen when you don't really need any training in therapy to do the job.
 
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I'm pretty sure that I'd have a strong urge to punch a therapist who told me to wear contacts instead of glasses, as I have a lifelong complex about my glasses and can't wear contacts anymore because I developed an intolerance (thank you, grad school!) despite having spent thousands of dollars trying to get back into contacts.

Disclaimer: I would not punch a therapist. I'd probably just cry.
 
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I'm pretty sure that I'd have a strong urge to punch a therapist who told me to wear contacts instead of glasses, as I have a lifelong complex about my glasses and can't wear contacts anymore because I developed an intolerance (thank you, grad school!) despite having spent thousands of dollars trying to get back into contacts.

Disclaimer: I would not punch a therapist. I'd probably just cry.

I think I'd just ask where they did their training so that I could screen out any other therapists from said programs in the future right off the bat.
 
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My own anecdotal observations are that the lower the training standards, then the higher the likelihood of fringe and quacky practices. Main reason that I have been hired to an administrative role in the past and again in a couple of months (I swear that time has come to a standstill!!!) is to oversee freshly minted therapists and psychologists to ensure evidence-based practices. It is nice to be able to have the authority to actually do this as opposed to working alongside these folks and being unable to do anything.
 
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Is this lack of EBPs normal? Is this just the state of the field right now?

Your mistake was assuming things like don't happen because some programs focus on EBPs. Said programs focus on EBPs BECAUSE things like this are all too common in the real world.

These threads are always a nice reminder to me that my fears I am not a good therapist because I don't always do a great job of empirically monitoring progress with validated measures or grow a bit more eclectic in my approach than I ideally would when I'm struggling to make progress with someone are probably unfounded.

I'm pretty sure that I'd have a strong urge to punch a therapist who told me to wear contacts instead of glasses, as I have a lifelong complex about my glasses and can't wear contacts anymore because I developed an intolerance (thank you, grad school!) despite having spent thousands of dollars trying to get back into contacts.

Disclaimer: I would not punch a therapist. I'd probably just cry.

Have you considered having a group of people stand in a circle around you and scream childish insults about your glasses at you? I hear that helps.
 
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I think I'd just ask where they did their training so that I could screen out any other therapists from said programs in the future right off the bat.
That seems like over-generalization, IMO--you can get ****ty providers from good programs, especially if they've been out of training for a long time.
 
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That seems like over-generalization, IMO--you can get ****ty providers from good programs, especially if they've been out of training for a long time.

Yeah, this was a lesson hard learned for me early on in my practice when I was trying to build a list of good referrals for patients. Also true of medicine. Reminds me of that old joke about what you call someone who graduated at the bottom of their medical school class...
 
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Your mistake was assuming things like don't happen because some programs focus on EBPs. Said programs focus on EBPs BECAUSE things like this are all too common in the real world.

These threads are always a nice reminder to me that my fears I am not a good therapist because I don't always do a great job of empirically monitoring progress with validated measures or grow a bit more eclectic in my approach than I ideally would when I'm struggling to make progress with someone are probably unfounded.



Have you considered having a group of people stand in a circle around you and scream childish insults about your glasses at you? I hear that helps.
I'm going to repackage this intervention as the Gestalt 2.0 and make a killing

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That seems like over-generalization, IMO--you can get ****ty providers from good programs, especially if they've been out of training for a long time.

Well, I was being slightly facetious. But, I imagine there are plenty of programs that are responsible for a large number of ****ty clinicians due to teaching questionable practices and not ensuring that its students know how to properly evaluate treatment literature. I stand by my comment largely.
 
I hope that what you experienced was a fluke array of bad therapists. I've had a few psychologists/psychologist trainees off and on in the past and none were extreme the way you describe; they were much more professional and generally CBT/humanistic-oriented.
I honestly haven't directly seen or heard of psychologists who practiced in the way that you mention.

More often than odd interventions and techniques, I hear about boundary/ethical issues from psychologists, which isn't directly part of their practice/interventions. I've never had a terrible experience with a therapist/psychologist in the way that you describe with my small sample, but I also don't have a lot of contact with non-psychologist therapists locally (master's level practitioners), which could be a different ballgame. My assumption is that psychologists are generally more careful about how they practice, but this is an assumption that may not be grounded in fact if I knew more professionals in the field...
 
I'm curious about the age of these therapists. The problem with loose guidelines is a lot nuttiness gets in and that has been true for a long time. Were you paying for this or using insurance reimbursement? That can matter as well.

The first and third therapists were private practice and had been practicing at least 30 years, so I would guesstimate that they were at least in their 60s. The glasses therapist was younger (maybe late 30s?) and was at a UCC. She was well-respected in our local area and had a number of books published. I was paying OOP.

The therapeutic techniques she used consisted of placing one group member in the middle of a circle and having the other group members scream insults and them for 45 minutes

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There was a cult in California that did used this technique to brainwash people. From the reports of ex-cult members, it was effective.

I hope that what you experienced was a fluke array of bad therapists. I've had a few psychologists/psychologist trainees off and on in the past and none were extreme the way you describe; they were much more professional and generally CBT/humanistic-oriented.
I honestly haven't directly seen or heard of psychologists who practiced in the way that you mention.

More often than odd interventions and techniques, I hear about boundary/ethical issues from psychologists, which isn't directly part of their practice/interventions. I've never had a terrible experience with a therapist/psychologist in the way that you describe with my small sample, but I also don't have a lot of contact with non-psychologist therapists locally (master's level practitioners), which could be a different ballgame. My assumption is that psychologists are generally more careful about how they practice, but this is an assumption that may not be grounded in fact if I knew more professionals in the field...

The common factor with each was that I had received their names as referrals from supervisors and program directors who I trust. When I shared my concerns with these colleagues, they were quite surprised. I find that the "Humanistic" label is broadly applied and often used as an excuse to include questionable or unstructured interventions. Again, I've never had a therapist who has actively utilized CBT techniques with me in session.

I agree that I hear myths about "just wait til you hear what THIS local practitioner did!" and that it is usually regarding boundary issues like driving your client to the airport. This seems more common and always surprises me, but then again Guthiel & Brodsky make very strong arguments for how even the most conscientious of psychologists are at risk for slippery slope boundary crossings leading to violations.
 
The common factor with each was that I had received their names as referrals from supervisors and program directors who I trust. When I shared my concerns with these colleagues, they were quite surprised. I find that the "Humanistic" label is broadly applied and often used as an excuse to include questionable or unstructured interventions. Again, I've never had a therapist who has actively utilized CBT techniques with me in session.

Every now and then I get a question from family/friends who are seeking a therapist, often in an area in which I don't know that providers personally. I always strongly urge them to ask about the theoretical orientation of the provider before ever stepping foot in the office. If it's for anxiety related issues, the provider better be saying CBT.
 
She said she’d free them from addiction. She turned them into her personal servants

This is really scary. She did drop out of her doctorate program but she was a licensed drug and alcohol counselor

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I just listened to the podcast about this from Reveal. She apparently dropped out of a doctoral program in her younger after developing a crack habit and became a counselor following her own recovery. She lost that license when she slept with one of her program participants where she worked. Now she runs a similar program as an "exempt" non-therapeutic recovery program so the state didn't try to shut her down till now.

This brings up two big issues for me. The first is why psychology never made more of push into substance abuse domains as there are few places where we actively involved in this (SARP being the main one I can think of) and it could have been a good stable business. The second issue is that this program caters to those without money (hence the work portion of the program) and really takes advantage of the lack of treatment options for mandated drug offenders. Better access to healthcare and mental health treatment is the issue here rather than hacks. It brings out the unethical types due to the model of care in this country.
 
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The first and third therapists were private practice and had been practicing at least 30 years, so I would guesstimate that they were at least in their 60s. The glasses therapist was younger (maybe late 30s?) and was at a UCC. She was well-respected in our local area and had a number of books published. I was paying OOP.

The two older therapists make sense in the context that EBPs were not pushed back then and training was even more variable than it is today. I took a seminar with a nationally recognized expert in the field in his 60s who did stuff that would not fly today (nothing to that level, but cursing and being blunt/borderline hurtful to evoke change). He may have once slapped a patient. He also used to have us write down therapy questions, crumble up the paper, call the question stupid, and throw the paper at us. Charming fellow. It was a different time then.

The younger therapist is just odd. Perhaps a few too many re-runs of She's All That? Do you resemble Rachel Leigh Cook?
 
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The two older therapists make sense in the context that EBPs were not pushed back then and training was even more variable than it is today. I took a seminar with a nationally recognized expert in the field in his 60s who did stuff that would not fly today (nothing to that level, but cursing and being blunt/borderline hurtful to evoke change). He may have once slapped a patient. He also used to have us write down therapy questions, crumble up the paper, call the question stupid, and throw the paper at us. Charming fellow. It was a different time then.

The younger therapist is just odd. Perhaps a few too many re-runs of She's All That? Do you resemble Rachel Leigh Cook?
Hahaha I am LOVING the she's all that reference!!!!!!!

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I just listened to the podcast about this from Reveal. She apparently dropped out of a doctoral program in her younger after developing a crack habit and became a counselor following her own recovery. She lost that license when she slept with one of her program participants where she worked. Now she runs a similar program as an "exempt" non-therapeutic recovery program so the state didn't try to shut her down till now.

This brings up two big issues for me. The first is why psychology never made more of push into substance abuse domains as there are few places where we actively involved in this (SARP being the main one I can think of) and it could have been a good stable business. The second issue is that this program caters to those without money (hence the work portion of the program) and really takes advantage of the lack of treatment options for mandated drug offenders. Better access to healthcare and mental health treatment is the issue here rather than hacks. It brings out the unethical types due to the model of care in this country.
It really is predatory, which makes it all the more disgusting. I agree about the substance use point but then I go to conferences and speak with psychologists who "don't want to touch substance use or personality disorders". Things like that drive me crazy.

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... a nationally recognized expert in the field in his 60s who did stuff that would not fly today (nothing to that level, but cursing and being blunt/borderline hurtful to evoke change).

We’re not supposed to swear and be blunt?!
 
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We’re not supposed to swear and be blunt?!
I could be in trouble then. Seriously though, there are times when being forceful and direct and using appropriately colorful language is clearly indicated. I have told more than one substance user that if they keep doing what they are doing they are going to f'ing die. At times it has been identified as a key moment in treatment. It's kind of like comedy though, all in the delivery and the timing.
 
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We’re not supposed to swear and be blunt?!

Except for you, PSYDR, you're cool. Besides, I doubt that you're walking in from behind the one way glass to do so. His stories (and entire personality) used to crack me up. I mean, compared to Zimbardo, he was a pussycat. Can you imagine submitting that to an IRB today?
 
I'm a fan of Ellis, though I think Fritz Perls was more confrontational in the Gloria tapes from my recollection. Perls also got to smoke in session. The good old days?
Fritz was a downright jackass and blowing cigar smoke in her face. I hear they did a remake of the Gloria tapes with cbt, emotion focused, and I can't remember the third orientation

Edited: it was Beck, Greenberg, and McWilliams. I need to buy that.

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Wasn't there this supposed thing where they said that Gloria ended up choosing Perls, but then it turned out that was a myth spread by a Perls disciple?

Also on that topic: PHONY.
 
Wasn't there this supposed thing where they said that Gloria ended up choosing Perls, but then it turned out that was a myth spread by a Perls disciple?

Also on that topic: PHONY.

I do recall remembering something about Gloria feeling Perls was the most effective of the three for her. Not sure if it was a myth. Anyone want to do some digging for the betterment of general knowledge?
 
I found this article: 'Permanently Cheated' Part 2 | Contemporary Psychotherapy

After the filmed sessions had taken place Gloria was asked by Shostrom for an assessment of her experience of working with the three therapists. She was asked to make a hypothetical choice of which one of them she would like to work with in the future. Gloria’s surprising response was to choose Perls.

In 2004, Albert Ellis commented in correspondence with Rosenthal that, Gloria, in the film that we did, had been a patient of Everett Shostrom’s for four years before we actually made the film. Carl Rogers and I didn’t know about this until later. So, she was under his influence and he got her to say that Perls helped her, when he actually didn’t.

So, not a myth, but apparently she was influenced to pick Perls by her therapist? I mean, assuming that you trust this article.
 
Gloria's daughter wrote a book about it, I think, and Gloria picked Perls partially due to the conflict of interest.
Meanwhile, Gloria maintained contact with Rogers for the rest of her life, so he definitely left an impression on her.

If anyone can confirm the details, please do; I don't remember it as well at this point so this is just what I can recall off-hand.
 
Gloria's daughter wrote a book about it, I think, and Gloria picked Perls partially due to the conflict of interest.
Meanwhile, Gloria maintained contact with Rogers for the rest of her life, so he definitely left an impression on her.

If anyone can confirm the details, please do; I don't remember it as well at this point so this is just what I can recall off-hand.
Yes. She picked Perls right after the sessions ended but actually it turned out that she was somewhat coerced into picking him and she actually felt Rogers was the most helpful. Also, it's clear from watching the tapes that she had the best session with a Rogers. In fact, I believe she felt Perls was actually somewhat harmful.

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From the title of your post I thought you were going to slam psychodynamic therapy, but in fact the examples you listed are bonkers and would send any sensible person running.
 
Recently needed to find a therapist for a close family member. I’m am truly appalled at the bonkers s**t that is out there. What the heck is “energy work”? How can you offer CBT and reiki?

I place those people into one of two categories. 1) They know it's BS but still want to get gullible people in the door who are into that stuff, hence lacking integrity, or 2) too stupid to know when things are BS, and have zero ability to evaluate research and outcomes.
 
There are definitely some hacks out there. There are good and bad pockets of clinicians too, particularly when clinicians stay local.

Flip through the Psychology Today directory in places like San Francisco and L.A. and prepare to be dumbfounded by the breadth and depth of bogus treatments out there. It really should be illegal, but the horses left the barn decades ago.

I have found many hacks also. So I only refer to less than a handful of therapists.
 
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