When Therapy Fails

Given the ostensible theme of this blog, one feels compelled to keep readers apprised of the latest from the therapy world. So, one brings forth today a New York Times article about how and why therapy fails.

The answer, not to beat around the proverbial bush, is that therapists want to create something like a therapeutic alliance with their patients, but insist on treating their patients like children. It’s all about feeling feelings, emoting about emotions, and failing to address the salient issues that define one’s ability or inability to function in the world.

You will notice that not one of these so-called experts shows the least concern for how a patient functions in the world, conducts relationships, manages his or her life. It’s all one giant whine-athon. 

The most striking revelation, dating to a half dozen years ago, but not yet having made much of an impression on the therapy community, is that more than 70% of patients lie about their experience with therapy. They lie because treatment does not serve any purpose, and because they imagine that their thin-skinned, oh-s0-sensitive therapists cannot deal with the truth.

Patients play along with the charade, but they all know that therapy does not really help them. As it happens, and as people flock to therapy, the truth is, the kind of treatment highlighted in the Times piece, involving a deep exploration or one’s deepest feelings, does not do much of anything to help patients conduct their lives. 

Of course, therapists have no idea whatever of how to do the work that is needed, so therefore, patients feel honor and duty bound to lie. It’s an astonishing number:

In one 2016 study, they found that 72.6 percent of psychotherapy patients had lied about their therapy experience. Common lies included pretending to agree with the therapist’s suggestions, pretending to find treatment helpful and masking their opinion of the therapist.

The authors of the Times piece find there is not enough whining about needs and feelings. Considering that therapists refuse to recognize that patients are functioning adults who have lives and who might just need some guidance in how to deal with the dilemmas that arise in everyday life, one is not surprised:

In therapy, these white lies can rupture treatment because it means the patient’s needs aren’t being met. This is why it’s crucial for patients to discuss any negative or unsettling feelings that ensue during therapy.

Perhaps the therapist came across as judgmental, started the session late or didn’t provide a structured treatment plan. Whatever the therapist’s mistake, patients can be direct by stating why they are upset.

At what point do you begin to recognize that you are mouthing a bunch of therapeutically correct but useless cliches.

Apparently, the therapist writers think that everything is about hurt feelings. And they want their patients to express why their feelings are hurt. 

Just for a thought experiment, how does it happen that these licensed credentialed therapists do not know that their patients are unhappy with treatment? Aren’t they supposed to be attuned to non-verbal communication? Why do they place the burden on patients, pretending that if patients do not whine about their hurt feelings, they can go on thinking that they are doing a great job.

So, its a carnival of feelings. The patient’s feelings about not hurting the therapist’s feelings. And yet, most polite patients, who are paying for the privilege, are too well mannered to tell their therapists the truth about the so-called treatment:

Before sharing their misgivings, patients may feel the need to say something positive, as a way to protect the therapist’s feelings. But while therapists are trained to look out for their client’s well-being, patients don’t need to do the same.

Like I said, it’s all about hurt feelings. And it’s all about blaming the patient for not whining about all of those hurt feelings. Apparently, it has not crossed the mini-minds of these licensed credentialed professionals that they ought to look at facts, not feelings, and that they ought to help their patients learn how better to conduct their lives.

If a patient feels hurt by the therapist’s words, it’s O.K. to say, “I’m hurt by what you said, and I’d like to discuss it with you.” If the therapist is sharing too much personal information, patients can set a boundary by saying, “I prefer not to hear your personal stories because I’m here to work on myself.”

Now, that last is certainly rich. Everyone knows, because it has been a staple of therapy from the onset, that the communication between patient and therapist is decidedly and defiantly one-sided. The patient tells all about himself while the therapist tells nothing. Speaking of not sharing…. In truth, you cannot have an effective communication where everything is considered to be a function of the patient’s mental state. You cannot have an effective communication without there being something of a reciprocal exchange. It need not involve sharing personal stories, but it should certainly not all be made a function of the patient’s problems.

How do patients deal with therapists whose ability to conduct a professional relationship is seriously compromised? They quit treatment without explaining why. Now, you might know, from your extensive knowledge of such matters, that in many cases if a patient declares that he wants to stop treatment, his therapist will read that as a sign of mental illness and will try to convince him to continue. That this interpretation is self-interested does not seem to have  crossed anyone’s mind.

… unrealistic expectations about treatment, compatibility issues with the therapist and fear of facing painful experiences can cause patients to stop therapy prematurely.

Indeed, studies suggest that 20 percent of patients getting mental health care will end therapy too soon — often without telling their therapists why.

Perhaps because their therapists will not accept that patients can make adult decisions, without having to justify them.

As I said, to the therapist authors it’s all about hurt feelings. And about whining about hurt feelings:

From talking too much or not enough to mislabeling feelings and offering unsolicited advice, therapists may unintentionally upset their patients in various ways. When this happens, broaching the topic by saying, “I’d like to discuss how I feel about coming to therapy,” or “Your recommendations aren’t helpful — here’s why,” are two ways to begin the conversation.

It’s all in the emotional reaction. It’s not in what we would call a professional relationship. Can you imagine conducting your relationship with your lawyer or account in terms of hurt feelings. As in-- you hurt my feelings when you miscalculated my tax bill.

Again, this essay is chockablock with cliches about feelings, about sharing feelings and about tracing them to childhood traumas. 

Might it not be the case that the patient wants to deal with everyday life or even make a plan for the future, and not get lost in the past. And that the therapist, every time a patient brings up a present problem, ignores it to do a deep dive on toilet training.

To do this, they acknowledge the patient’s disappointment, anger and frustration. Curious to learn how therapy went off course, these therapists also invite their patients to share more. Because a person’s emotional reaction may offer clues about the nature of their suffering, client-centered therapists might also probe whether the patient’s negative feelings have roots in childhood experiences or traumas. To ease future treatment anxiety, these therapists often say, “If I do or say anything that makes you uncomfortable, I want you to let me know.”

Dare I say, that this all feels like girltalk. Or better, like a caricature of same. I will qualify that statement, because I do not believe that too many women sit around over brunch feeling each other’s pain. But, of course, most therapists today are mothers, and they have fallen into a caricature of femininity, where it’s all about emotional pain, vulnerability, grief, depression and intimacy. 

Unlike fixing a broken bone, healing a patient’s emotional pain isn’t always straightforward, which means patients may feel ambivalent about treatment (even after giving feedback) or become anxious when sharing vulnerable details about childhood abuse, grief, severe depression or intimacy issues.

While numerous psychological interventions can teach patients how to alter their behaviors and face their fears, according to the researcher and psychologist Dr. Allan Schore, ultimately, it’s the emotional communication between patient and therapist that’s curative.

Not a word, not a single word, not a moment’s recognition that these patients are anything but a bundle of inchoate emotions. Not a word, not a single word about the fact that these patients have lives, that they have jobs and careers, that they have conflicting obligations to different groups of people and that they do not want to get lost in their minds or to spend good money drooling over girltalk.