Bad Therapy: What You Didn't Learn in Grad School

Bad Therapy: What You Didn't Learn in Grad School

by Deb Kory
Psychologist and Psychotherapy.net content manager Deb Kory pulls no punches in critiquing what is missing from our training programs, and calls for more authenticity, humor and humility in the ways we teach and learn to practice therapy.

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The Problem with the "Great Masters"

Going through graduate school training, we were barraged with examples of “good therapy” from every well-known therapist of the last century. We learned unconditional regard from Carl Rogers, the empty chair technique from Fritz Perls, the nature of deep intrapsychic conflicts from Freud, the collective unconscious from Jung, group therapy from Yalom, EFT from Sue Johnson. We were treated to endless case studies of poor souls trudging through the morass of their unmanageable lives, whose problems were deftly transformed by analysis, exposures, emotion-focused “interventions” and, when all else failed, that ineffable “therapeutic alliance” the great Masters of therapy seemed to so effortlessly form with their clients.

Irreparable empathic failures, sexual transgressions, narcissistic hostage-taking, wounding reservedness that traps clients in unrequited longing, client suicides, damaging advice, damaging refusal to give advice—these topics weren’t on our syllabus.
We learned the art of “case formulation,” whereby a complicated human’s life was distilled into three or four paragraphs of neutered narrative, followed by a plan of action that conformed to the theory and world view of whoever was supervising us. Depending on the supervisor, we either shared our real anxieties about our work with clients, or we manufactured false narratives to avoid their opprobrium—but in either case, we endeavored to tie the loose ends of our work into pithy parables with tidy endings. We all make mistakes, our teachers said. Even the great Masters made mistakes! But fortunately for them, through concerted effort, self-analysis and the lucky fact that clients tend to make good use of us even when we suck, everything always seemed to work out in the end.

Notably absent from our lectures, case conferences and readings? Terrible, no good, very bad therapy. Irreparable empathic failures, sexual transgressions, narcissistic hostage-taking, wounding reservedness that traps clients in unrequited longing, client suicides, damaging advice, damaging refusal to give advice—these topics weren’t on our syllabus. If we were really lucky, we found a friend or two in our training cohort who we could dish the truth with, and if we were really, really lucky, we had a supportive supervisor somewhere along the way who encouraged our self-honesty with their own. Otherwise, it seemed that the collective ego of the therapy profession was a bit too fragile to handle its own dark side.

With no one showing us how to fumble and fail, we become very invested in our “look good,” at great cost to both us and our clients.
This is tragic, if you think about it. It has created a professional culture that values vulnerability on the part of clients while encouraging therapists to keep tight-lipped about our own. When we are stuck in the mire of our own crappy work, we’re taught that our clients must have “primitive defenses” and just can’t “take in” our “good breast.”* As we progress through training, the laid-back, open, casual style of interacting with clients we began with takes on a weighty “professionalism” that turns what is simple into something complex, and what is complex into something simple. Love, which one might argue is the basic foundation of good therapy, becomes “countertransference,” a narcissistic use of the client’s idealized “transference” with us. Meanwhile, a complex amalgam of "bio-psycho-social factors" (a favorite grad school term) are boiled down to “maladaptive patterns,” “unconscious drives” and “negative thought cycles.” With no one showing us how to fumble and fail, we become very invested in our “look good,” at great cost to both us (it’s a straight jacket that literally takes the form of our therapy “outfits”; I once had a supervisor advise me against wearing open-toed shoes—too suggestive) and our clients.

Thankfully, I was one of the lucky ones, with both colleagues and a few supervisors willing to be authentic and vulnerable, as well as a therapist who shares her weaknesses and vulnerabilities with me. The safety of these relationships allowed me to come to terms with the bad therapist in me. The one who wants all of her clients to love her, who has omnipotent savior fantasies, sometimes fuzzy boundaries and who, in my first year of training, felt compelled to continually ask a client, “How is it for you that I’m white and you’re black?”—a directive from my multicultural therapy class—to which she replied, “I don’t give a shit!” She was a poor, old, disabled widow living alone and I did house visits. I brought her baked chickens and occasional groceries, even though I was explicitly forbidden from doing so by the agency I was working for. I was supposed to be doing psychodynamic therapy with her, but how do you do psychodynamic therapy with someone who doesn’t have enough to eat and doesn’t give two sticks about her unconscious? Was baked chicken good therapy? Yes, I think it was. Would I do it again? Probably not. I had very little sense of my own boundaries back then (nor the financial ruin that lay ahead of me due to years and years of school loans that were never enough to live on) and today would be more self-protective. But do I regret it? Nope.

Was baked chicken good therapy? Yes, I think it was.
In future "Bad Therapy" blogs, I will dive into some vulnerable, messy material in an attempt to correct for the “look good” problem we therapists have. Besides, bad therapy is incredibly good learning material, an object lesson on what not to do, and an opportunity to reflect on how and why we miss the mark. I will share some of my bad therapy experiences, on both sides of the couch (I will heavily encrypt those in which I’m the bad therapist), and want to hear yours. I am more interested in your experiences as a client than as a therapist, since it’s hard for therapists to really deliver the bad word on ourselves—and we are also bound by confidentiality—while as clients we can be more truthful about the badness of our therapy.

A Case Study

For example, when I first moved to the Bay Area in my early twenties, I innocently tore off a phone number of a therapist posted in a local grocery store. In that first session, he took off his shoes and sat with his legs wide open, his dick bulging against his pants unfettered, like a co-therapist. After recounting my travails (sweet, naïve thing that I was), he said, “Are you sure you want to be telling me all of this in your first session?” What therapist says that??! I left Dick Guy’s session feeling horribly exposed and vulnerable, knowing something wasn’t quite right. The following day I got the courage to leave a message for him saying that I didn’t think we were a good fit. He then proceeded to phone stalk me for the next week, alleging that we needed a few more sessions to really process this and I was giving up too early. Shouting “leave me the hell alone!” at his voicemail ended the sordid ordeal. Almost. The following year I went to a local hot spring where people go to relax and be naked in nature for retreats (this is the Bay Area, remember) and … well, you see where this is going. We pretended we didn’t know each other and I got the heck out of there. Sometimes a cigar would be a welcome relief.

What caused this guy to be overly familiar, strangely awkward around my self-revelations, and a stalker? Honestly, I think he was kind of a sicko, but it does bring to mind this thing we do with clients when they want to leave: “OK, how about we take three months to talk about termination?” “Let’s explore your resistance a bit further before making any changes to your therapy schedule.” Sure, sometimes that’s appropriate, but a lot of times clients feel trapped, and if there is any care-taking of family in their past, they’ll take care of us…for years!

What I know is these stories are not unusual. There is so much bad therapy going on that it deserves some attention. I’ve got lots of stories in my arsenal already, both from my life and those of my friends, and I want to invite you to send me yours. Now that I’ve introduced the idea behind this blog, we can dive right in.

One favor: Please don't reveal the identities of the therapists in question, as these are meant to be anonymous anecdotes that will serve as object lessons, help us therapists hone our craft and view ourselves with a bit more humor and humility. I don't want to be in the position of having to report illegal behavior; please do that directly with the Board of Psychology, or your version of the equivalent in your state.

If you (or a friend) would like to submit anonymously, you can set up a pseudonymous email account with gmail or another service provider, and submit your email from there. Again, this isn't about nailing anyone publicly (we all fail at times) and I will take every last precaution to make these stories as generalized and unidentifiable as possible. If you're fine telling me your story directly, you can email me your anecdote and your identity will be kept confidential. Send your stories to: deborah@psychotherapy.net and spread the word to others who may have bad therapy stories!


*True story.



© 2014, Psychotherapy.net LLC.
Bios
Deb Kory Deb Kory, PsyD, is the content manager at psychotherapy.net.  She received her doctorate in clinical psychology from the Wright Institute and has a part-time private practice in Berkeley, CA. She loves both of her jobs and feels lucky to be able to divide her time between therapy, writing and editing. Before deciding to become a psychotherapist, she worked as the managing editor of Tikkun Magazine and published her writings in Tikkun, The Huffington Post and Alternet. Currently, she is working on turning her dissertation, Psychologists: Healers or Instruments of War?, into a book. In it, she describes in great detail the historical context and events that led to psychologists creating the torture program at Guantanamo and other "black sites" during the War on Terror.