“If I were to suggest that between the Earth and Mars there is a china teapot revolving about the sun in an elliptical orbit, nobody would be able to disprove my assertion provided I were careful to add that the teapot is too small to be revealed even by our most powerful telescopes.
If, however, the existence of such a teapot were affirmed, … and instilled into the minds of children at school, hesitation to believe in its existence would become a mark of eccentricity and entitle the doubter to the attentions of the psychiatrist in an enlightened age or of the Inquisitor in an earlier time.” — Bertrand Russell (1952)
Is your therapist a modern take on the Spanish Inquisition?
Therapists are fallible. Even if they’re Dr. Prof. Ph.D.
Actually, especially if they’re doctor-professor-phd-academicGod.
Several of my clients have noted that, despite all their expectations, they found therapy with younger or less experienced therapists more useful and fulfilling than with the older super-qualified psychologists and psychiatrists. In fact, this has been mentioned often enough for it to be a consistent theme.
And they had their own ideas why. Compared to therapists who had been entrenched in their field for two decades, clients reported that the newer ones tended to be:
- more daring, to try new things
- more accepting of client as him/her-self (and less “do it my way/I know what’s best”)
- more socially progressive (e.g. less likely to follow DSM-III diagnostic standards of seeing homosexuality as a mental disorder!)
- more creative
- less dogmatic (e.g. sticklers to retro CBT (cognitive-behavioural therapy) )
- a broader “Weltanschauung” (less of a boxed-in perspective, e.g. a stereotypical educated white-male way of seeing things)
- listen more (again, less directive “listen to me, the authority”)
My client’s impressions mirror also scientific studies into this topic. In short, there are several factors we might think were relevant, but actually have absolutely no effect on how effective a therapist is.
Many features of a therapist have no impact on how effective she or he is, including:
- level of education
- what sort of education (counsellor, versus psychologist, versus medical psychiatrist, etc etc)
- years of experience
- age of therapist
- what school of thought (CBT fanboy, Freudian psychoanalysis, etc etc; at least, as regards therapy effectiveness as a whole)
And this is nothing new. We have most of a century of evidence that showing again and again, that what makes the best therapists is not what society measures. Ironically, in psychology we’re taught quite clearly that what we measure needs to reflect what it is we actually seek. This is called empirical validity. This is basic knowledge to data scientists and even software engineers. But despite this, psychological therapy as a whole tends consistently fails in precisely this. So much so, that the error has become institutionalised.
The problem is deeply entrenched in bureaucratic dogma in more countries than you’d care to consider. In Australia, there’s been decades of lobbying and the formation of an alternative regulation body, in protest of the baseless elitist hierarchical ordering of psychologists, which contravenes the evidence. As such, I would not expect meaningful reform any time soon; perhaps I won’t ever see it there in my lifetime.
For the client, therapy can be a dramatic and heartfelt outpouring of deepest emotions and hidden secrets. The therapist runs the risk of the job becoming “just a job”. And this mismatch is perhaps the most common obstacle in the therapist-client relationship.
So then for my readers who are currently, or will soon seek help of mental health therapist, what you should know:
If you’re not getting much out of therapy, it’s worth first checking that it’s not due to some ongoing internal voice of failure you’ve been wrestling with. Because if it is, then you won’t find any more success by changing therapists.
If it’s not due to some internal challenge, therapy might still have ground to a halt due an issue in the client-therapist relationship. It’s worth mentioning this directly in your therapy session; ideally you and your therapist work through this together and come out both stronger because of it.
But you might instead be entirely unhappy with the course of therapy, and it’s obvious there’s an irreconcilable difference between you and your therapist. Any therapist worth their salt should already see this him/herself, but as mentioned, some are just crap. Then, it’s time for you to take initiative.
- you, as a client, have rights. You have a right to question your therapist’s assumptions, to disagree, to correct them, and to make your own suggestions, and to tell them you think “xyz is a terrible idea and why would you even think that?!”
- if you’re not happy with your therapy progress, (and it’s not that internal self-sabotage,) then you’re allowed to end it, and try with another therapist
- if you therapist is unprofessional, difficult to schedule with, erratic in availability, and doesn’t pay attention to you pouring out your heart, drop him/her—they’re probably not worth the 180$/hour
- if your therapist is a racist, neo-conservative, self-righteous arse (or whatever sort of douchey), then tell him so, mic-drop, go find a better one
- if you’ve actually been rattled, or even traumatised by previous therapy, please know that not all therapists are crap. Leave a bad review. If it’s a violation of professional standards, report them. If you do indeed still need help, remind yourself your rights, and then go find a better one.
Have you ever had a bad experience with a therapist?
Has therapy at times felt like the Spanish Inquisition?
Let me know in the comments, or write to me directly. I read all personal messages sent to me.
Key Readings (Primary Sources)
- Eysenck, H. J. (1957). The effects of psychotherapy: An evaluation. Journal of Consulting Psychology, 16, 319-324.
- Wampold, B. E. (2001). The Great Psychotherapy Debate: Models, Methods, and Findings. Routledge
- Orlinsky, D. E.; Grawe, K.; Parks, B. K. (1994), “Process and outcome in psychotherapy: Noch einmal”, in Bergin, A. E.; Garfield, S. L. (eds.), Handbook of psychotherapy and behavior change, John Wiley & Sons, pp. 270–376.