I definitely appreciate this article, the field of therapy could use some critical feedback. I would probably say that in every instance of therapy mentioned, it is ~bad~ therapy. Good therapy avoids the things you mentioned. Good therapists will discourage people who don’t need therapy from doing therapy, they will end therapy when it isn’t helpful anymore, they encourage people to solve their own problems so that they won’t need therapy anymore, they tell people hard, confrontational things, etc. This piece seems less like a critique on therapy and more a critique on therapy ~culture~ and the bad therapy that has created it.
Thanks for reading, Dane! While I was writing I was aware of a tendency towards hyperbole, which I think you've rightly picked out. That being said, I can't fully agree with you. For one, I think it is difficult, even for good therapists, to tell people to quit therapy. I'm sure there are some, but I think there are few. They are, after all, being paid. And given how intimate the relationship between therapist and client can become, I would imagine some therapists would feel cruel to voluntarily sever their client. It's ideal in theory, but dicey in practice.
Secondly, even if the therapist is acting with integrity in all things, I still think the same issues apply. Even good therapy is inherently decontextualized, and aside from short seasons of counseling for specific issues — like marriage counseling — I don't think therapy can really accomplish what it purports to do. And that's not even the fault of the therapist, its simply the fact that a therapist can't really know if a client is being honest. They have to rely on a clients ability to describe and translate themselves, and they have no idea how that client engages with the outer world. They can guess, but guessing takes time — which again, feeds back into our problem.
I'll think about what you said. I had a therapist I liked quite a bit in college. I don't think he was, in the end, tremendously helpful. But maybe I'll come around to a more measured perspective. Thanks again, for your thoughts!
Thanks for replying! I am excited to see more posts from you and look forward to reading more of your thoughts. Peter mentioned that you are an excellent short story writer, so I hope to see some of those come across my feed as well.
Here are a few things in response to your reply.
With respect to ending the therapy relationship:
You note that ending therapy is something that is above and beyond what would be expected of a therapist, however that is simply not true. It is a basic tenant of ethical practice of therapy that you do not encourage client dependency on yourself as a therapist and that you learn when to terminate therapy with a client because it is no longer helpful or is encouraging dependency. I’ll cite some examples. This is what the American Counseling Association (ACA)—which is what most every therapist is expected to abide by—says in A.11.C:
“Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to beneft, or is being harmed by continued counseling.”
An ethics textbook we used in school—“Issues and Ethics in Helping Professions”—says the following about discouraging dependency in clients:
“Most professional codes have guidelines that call for termination whenever further therapy will not bring significant gains, but some therapists have difficulty doing this. They run the risk of unethical practice because of either financial or emotional needs…Obviously, termination cannot be mandated by ethics codes alone; it rests on the honesty of the therapist and the willingness to include the client in a collaborative discussion about the client's readiness for ending therapy. Termination of a professional relationship can be a complex process, and problems often occur during termination. A successful termination calls for a blending of clinical, practical, and ethical factors that become the foundation for the termination process (Davis & Younggren, 2009). Rather than viewing termination as a discrete event that marks the end of therapy, it is best viewed as a process for ending therapy over a period of time…Open-ended treatments over a long period of time without clear and identifiable goals are especially difficult to end. In our view, the ultimate sign of an effective therapist is his or her ability to help clients reach a stage of self-determination wherein they no longer need a therapist. Essentially, it is our goal to work ourselves out of a job by empowering our clients and helping them achieve their goals in therapy.” (55-56)
And these are not just things that are said in textbooks or ethics codes, but are frequently talked about in class and with supervisors and other professionals. In terms of it being difficult to end such an intimate relationship, you are certainly right—as the textbook notes as well above—that this is a difficult and complex process, but that does not mean that it does not or will not happen. Rather, it is the responsibility of the therapist to be skilled in doing it well for the sake of themselves and their clients. Regardless, it is unethical for a clinician to continue therapy indefinitely when there is no clear gain for the client.
Of course, you could say that most therapist don’t do this well, and I wouldn’t necessary disagree with you, but that’s more of a systemic problem with therapy culture, not with therapy. It would be like saying we shouldn’t eat food because fast-food is unhealthy. Well, yes, that form of food is unhealthy, but it is also by definition just bad food, it isn’t a case against eating food at all.
With respect to the therapist being paid:
This is also a good point, but I will say that it also just goes back to ethics. Yes, money is certainly something to be mindful of in affecting your judgment as a therapist, but it is also an ethical mandate of therapists to be aware of this and counter it. A therapist that is influenced by money is, by definition, not a very good therapist. In fact, many therapists use a sliding scale for clients who aren’t able to afford their fee, even doing pro-bono work. Additionally, many therapists have a long waitlist of people seeking therapy. There generally isn’t a problem of losing clients and then becoming destitute such that you would avoid losing a client at all costs by saying something they don’t want to hear. And going beyond therapy, if money is used as a reason for dismissing the ability of a therapist to do their job, then that would invalidate every paid helping profession, including non-profit workers, humanitarian aid workers, pastors, rabbi’s, missionaries, etc.
With respect to decontextualized:
This is certainly a good point as well, but I don’t believe it invalidates therapy. I could write quite a lot about this if you’d like, because it’s a good question, but I think the starting point would just be your comment about “what therapy purports to do.” I wonder what you believe the goal of therapy is? Therapy’s goal is the client’s goal. Therapy isn’t about fixing people, it’s about helping people to become the people they want to be. Therapy isn’t about making people whole or healthy, it’s about empowering people to have the efficacy to do what they need to do to become whole or healthy, however they define that. So if therapy is seen as a “solution,” then yes it will not live up to that. If therapy is seen as a pathway to a solution, then yes it can do that.
Happy to keep discussing! As I said before, I agree with you about the problem of bad therapy, but I also believe that good therapy—rightly defined—actually can be quite a good thing in society.
Apologies for the late reply, Dane. I appreciate you providing some insight as a licensed counselor, but I still think you side step the paradigmatic issue with therapy, irrespective of whether or not the therapist is rigorous in their practice.
But let me go through your thoughts in order.
I understand that therapists are trained to terminate a counseling relationship when appropriate, but I can't imagine how that would actually happen in practice. I've had two therapists (one a licensed psychologist) from separate clinics who used different approaches, but both expected me to lead the session. While they would touch upon themes from previous sessions, ultimately each session began with what was on my mind — how I was, what I wanted to talk about. As you yourself stated, "Therapy’s goal is the client’s goal." If that's the case, how could a therapist ever determine when to "terminate" a relationship? There's an endless supply of issues to address—we're infinitely fallen after all—and so long as the client keeps showing up with things to talk about, when would termination be necessary? You might say this is an application issue, and not an issue with therapy itself, but I'd disagree. Irrespective of the right theoretical frameworks, if those theoretical frameworks are hardly applicable, or are in contradiction with other frameworks (like being client-lead), then the foundation is wrong to begin with.
I agree with you that being paid does not invalidate the profession, and that this issue has more to do with the integrity of the individual therapist and less to do with the practice as a whole.
I'm glad for your honesty here: "Therapy isn’t about making people whole or healthy, it’s about empowering people to have the efficacy to do what they need to do to become whole or healthy, however they define that." I think that's right — that's certainly how my recent therapist put it. But don't you see how absolutely hollow and impotent that is? This is precisely why I quit ultimately; I realized the therapeutic practice was so bound to a insufficient definition of "harm" that ultimately I became the arbiter of what was good for me. So long as I wasn't wishing measurable harm upon myself or others, I was in the clear. I mean, I actually think that a therapist would be more concerned if I was self-deprecating or expressed low self-esteem than if I was consuming legal pornography 3x a week (I'm not, but as an example).
But putting that aside, even if we assumed that the aims of therapy, to empower people to have the efficacy to accomplish whatever they define as good, was noble, I still think the approach is ineffectual. I don't see how "talking about things" really inspires efficacy. Putting aside those who are so lacking in self-awareness that minor revelations become life-changing, the majority of us don't benefit from rumination. Having the right *ideas* about something, or how to do something, doesn't really translate to orthopractice. I mean, we know this about theo bros. Lots of people know the truth, have been made aware of their own sin, and yet lack the will-power to accomplish genuine change in their life.
And even if talking about things was effective (because in some cases, I think it can be), we still have the problem of therapy being decontexualized. Even with your revised definition of therapys goal, how can a therapist empower their clients to effect change when they can't really know their clients? People are absurdly self-deceptive, and often, bad at translating themselves to others. The whole practice is so disembodied, so detached from reality, that I can't really believe that therapy could get very far with a person.
Sooo soo goooddddd!!! Gave a me a lot to think about!!!!❤️❤️
Thanks, Naa! 💕
I definitely appreciate this article, the field of therapy could use some critical feedback. I would probably say that in every instance of therapy mentioned, it is ~bad~ therapy. Good therapy avoids the things you mentioned. Good therapists will discourage people who don’t need therapy from doing therapy, they will end therapy when it isn’t helpful anymore, they encourage people to solve their own problems so that they won’t need therapy anymore, they tell people hard, confrontational things, etc. This piece seems less like a critique on therapy and more a critique on therapy ~culture~ and the bad therapy that has created it.
Thanks for reading, Dane! While I was writing I was aware of a tendency towards hyperbole, which I think you've rightly picked out. That being said, I can't fully agree with you. For one, I think it is difficult, even for good therapists, to tell people to quit therapy. I'm sure there are some, but I think there are few. They are, after all, being paid. And given how intimate the relationship between therapist and client can become, I would imagine some therapists would feel cruel to voluntarily sever their client. It's ideal in theory, but dicey in practice.
Secondly, even if the therapist is acting with integrity in all things, I still think the same issues apply. Even good therapy is inherently decontextualized, and aside from short seasons of counseling for specific issues — like marriage counseling — I don't think therapy can really accomplish what it purports to do. And that's not even the fault of the therapist, its simply the fact that a therapist can't really know if a client is being honest. They have to rely on a clients ability to describe and translate themselves, and they have no idea how that client engages with the outer world. They can guess, but guessing takes time — which again, feeds back into our problem.
I'll think about what you said. I had a therapist I liked quite a bit in college. I don't think he was, in the end, tremendously helpful. But maybe I'll come around to a more measured perspective. Thanks again, for your thoughts!
Thanks for replying! I am excited to see more posts from you and look forward to reading more of your thoughts. Peter mentioned that you are an excellent short story writer, so I hope to see some of those come across my feed as well.
Here are a few things in response to your reply.
With respect to ending the therapy relationship:
You note that ending therapy is something that is above and beyond what would be expected of a therapist, however that is simply not true. It is a basic tenant of ethical practice of therapy that you do not encourage client dependency on yourself as a therapist and that you learn when to terminate therapy with a client because it is no longer helpful or is encouraging dependency. I’ll cite some examples. This is what the American Counseling Association (ACA)—which is what most every therapist is expected to abide by—says in A.11.C:
“Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to beneft, or is being harmed by continued counseling.”
An ethics textbook we used in school—“Issues and Ethics in Helping Professions”—says the following about discouraging dependency in clients:
“Most professional codes have guidelines that call for termination whenever further therapy will not bring significant gains, but some therapists have difficulty doing this. They run the risk of unethical practice because of either financial or emotional needs…Obviously, termination cannot be mandated by ethics codes alone; it rests on the honesty of the therapist and the willingness to include the client in a collaborative discussion about the client's readiness for ending therapy. Termination of a professional relationship can be a complex process, and problems often occur during termination. A successful termination calls for a blending of clinical, practical, and ethical factors that become the foundation for the termination process (Davis & Younggren, 2009). Rather than viewing termination as a discrete event that marks the end of therapy, it is best viewed as a process for ending therapy over a period of time…Open-ended treatments over a long period of time without clear and identifiable goals are especially difficult to end. In our view, the ultimate sign of an effective therapist is his or her ability to help clients reach a stage of self-determination wherein they no longer need a therapist. Essentially, it is our goal to work ourselves out of a job by empowering our clients and helping them achieve their goals in therapy.” (55-56)
And these are not just things that are said in textbooks or ethics codes, but are frequently talked about in class and with supervisors and other professionals. In terms of it being difficult to end such an intimate relationship, you are certainly right—as the textbook notes as well above—that this is a difficult and complex process, but that does not mean that it does not or will not happen. Rather, it is the responsibility of the therapist to be skilled in doing it well for the sake of themselves and their clients. Regardless, it is unethical for a clinician to continue therapy indefinitely when there is no clear gain for the client.
Of course, you could say that most therapist don’t do this well, and I wouldn’t necessary disagree with you, but that’s more of a systemic problem with therapy culture, not with therapy. It would be like saying we shouldn’t eat food because fast-food is unhealthy. Well, yes, that form of food is unhealthy, but it is also by definition just bad food, it isn’t a case against eating food at all.
With respect to the therapist being paid:
This is also a good point, but I will say that it also just goes back to ethics. Yes, money is certainly something to be mindful of in affecting your judgment as a therapist, but it is also an ethical mandate of therapists to be aware of this and counter it. A therapist that is influenced by money is, by definition, not a very good therapist. In fact, many therapists use a sliding scale for clients who aren’t able to afford their fee, even doing pro-bono work. Additionally, many therapists have a long waitlist of people seeking therapy. There generally isn’t a problem of losing clients and then becoming destitute such that you would avoid losing a client at all costs by saying something they don’t want to hear. And going beyond therapy, if money is used as a reason for dismissing the ability of a therapist to do their job, then that would invalidate every paid helping profession, including non-profit workers, humanitarian aid workers, pastors, rabbi’s, missionaries, etc.
With respect to decontextualized:
This is certainly a good point as well, but I don’t believe it invalidates therapy. I could write quite a lot about this if you’d like, because it’s a good question, but I think the starting point would just be your comment about “what therapy purports to do.” I wonder what you believe the goal of therapy is? Therapy’s goal is the client’s goal. Therapy isn’t about fixing people, it’s about helping people to become the people they want to be. Therapy isn’t about making people whole or healthy, it’s about empowering people to have the efficacy to do what they need to do to become whole or healthy, however they define that. So if therapy is seen as a “solution,” then yes it will not live up to that. If therapy is seen as a pathway to a solution, then yes it can do that.
Happy to keep discussing! As I said before, I agree with you about the problem of bad therapy, but I also believe that good therapy—rightly defined—actually can be quite a good thing in society.
Apologies for the late reply, Dane. I appreciate you providing some insight as a licensed counselor, but I still think you side step the paradigmatic issue with therapy, irrespective of whether or not the therapist is rigorous in their practice.
But let me go through your thoughts in order.
I understand that therapists are trained to terminate a counseling relationship when appropriate, but I can't imagine how that would actually happen in practice. I've had two therapists (one a licensed psychologist) from separate clinics who used different approaches, but both expected me to lead the session. While they would touch upon themes from previous sessions, ultimately each session began with what was on my mind — how I was, what I wanted to talk about. As you yourself stated, "Therapy’s goal is the client’s goal." If that's the case, how could a therapist ever determine when to "terminate" a relationship? There's an endless supply of issues to address—we're infinitely fallen after all—and so long as the client keeps showing up with things to talk about, when would termination be necessary? You might say this is an application issue, and not an issue with therapy itself, but I'd disagree. Irrespective of the right theoretical frameworks, if those theoretical frameworks are hardly applicable, or are in contradiction with other frameworks (like being client-lead), then the foundation is wrong to begin with.
I agree with you that being paid does not invalidate the profession, and that this issue has more to do with the integrity of the individual therapist and less to do with the practice as a whole.
I'm glad for your honesty here: "Therapy isn’t about making people whole or healthy, it’s about empowering people to have the efficacy to do what they need to do to become whole or healthy, however they define that." I think that's right — that's certainly how my recent therapist put it. But don't you see how absolutely hollow and impotent that is? This is precisely why I quit ultimately; I realized the therapeutic practice was so bound to a insufficient definition of "harm" that ultimately I became the arbiter of what was good for me. So long as I wasn't wishing measurable harm upon myself or others, I was in the clear. I mean, I actually think that a therapist would be more concerned if I was self-deprecating or expressed low self-esteem than if I was consuming legal pornography 3x a week (I'm not, but as an example).
But putting that aside, even if we assumed that the aims of therapy, to empower people to have the efficacy to accomplish whatever they define as good, was noble, I still think the approach is ineffectual. I don't see how "talking about things" really inspires efficacy. Putting aside those who are so lacking in self-awareness that minor revelations become life-changing, the majority of us don't benefit from rumination. Having the right *ideas* about something, or how to do something, doesn't really translate to orthopractice. I mean, we know this about theo bros. Lots of people know the truth, have been made aware of their own sin, and yet lack the will-power to accomplish genuine change in their life.
And even if talking about things was effective (because in some cases, I think it can be), we still have the problem of therapy being decontexualized. Even with your revised definition of therapys goal, how can a therapist empower their clients to effect change when they can't really know their clients? People are absurdly self-deceptive, and often, bad at translating themselves to others. The whole practice is so disembodied, so detached from reality, that I can't really believe that therapy could get very far with a person.
I'm willing to be wrong.