- Joined
- Jan 24, 2012
- Messages
- 97
- Reaction score
- 59
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?
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?