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Good therapist vs. Bad therapist

Giggly

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What makes someone a good therapist and what makes someone a bad therapist?

I imagine there's such a thing as them having different styles and some being good and some bad.

This came to mind because a friend of mine wants to be a therapist. She has a "tough love" approach to everything and is very blunt. It's like Dr. Phil but without any finesse (do they teach finesse in school?) She says that she's all about making people accountable and that she's not interested in providing long-term therapy for anyone. She said that short-term therapy is what she wants to do because in her words "people will drain you if you let them". I thought this was odd.

When I think of a therapist, I think of patient, enduring, understanding and helpful. Maybe that's what I think I need if I went to a therapist, but I can see how some people need tough love.
 

highlander

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I read somewhere once that the relationship with the therapist is of greater importance than their actual competence. Giggly, I think the characteristics you mention are probably those that you possess yourself and so that would work for you if you were to work with a therapist. Maybe a tough and blunt therapist would be good for a tough and blunt person. I really don't know though.
 

prplchknz

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depends on the issues/person, but I don't want a therapist that's like your friend that's stressful.
 

Giggly

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I read somewhere once that the relationship with the therapist is of greater importance than their actual competence. Giggly, I think the characteristics you mention are probably those that you possess yourself and so that would work for you if you were to work with a therapist. Maybe a tough and blunt therapist would be good for a tough and blunt person. I really don't know though.

That's what I think too but she thinks EVERYONE needs tough and blunt.

I have a pet theory that if a person grew up in and lives in an environment that's "tough" then they probably need the tender kind of therapy, but if a person grew up in and lives in a tender or mushy environment than they probably need the tough and blunt variety of therapy.
 

CzeCze

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Oh! Oh! Oh! Me! Me! Me!

I wanna answer!

First, I think your friend might do better with cognitive therapy or another modality that is about the nitty gritty and usually has a short term course.

Second, I think a good therapist is kind of what your friend is pin pointing - someone who actually believes in empowering and helping their patient. Your friend sounds like she might be a bit of bully though for some patients. You also need to be understanding of where the patient is coming from and be able to gauge how best to approach them. It's a balance.

I think a bad therapist is someone who makes the mistake of trying to be their patient's friend or gets caught up in being liked or admired. It's not something explicit (like sleeping with a patient) so it's not something you can get your license revoked over but I think it's egregious enough that you should.

I dated a woman (I won't say the type lest I offend those who share her type BUT YOU CAN HAZARD A GUESS!?! haha) who saw the same therapist for like 8 years. I think the therapist was one of those misguided bleeding hearts who really wanted to "help people". But her version of helping people was basically coddling them and being a mother figure and nodding sympathetically no matter what their patients told them and basically stroking the patient's ego. The girl I was dating never said what a great or effective therapist that woman was, just that she ENJOYED spending time with her pretty much and felt good that the therapist seemed to like her. DEAR GOD.

Seriously 8 years - no improvement, that girl actually nosedived while I was dating her and became suicidal (now THAT is a good time) and needed to see a psychiatrist on top of her crappy therapist and was put on suicide watch etc.

Bah, okay now I'm just in a bad mood.

But yeah, therapists do need a commitment to actually improving the lives of their patients and identifying and addressing the patient's main issues. They can do it in a nice soft way or maybe a more brusque confrontational way but they must do that in order to be effective and therefore a 'good' therapist. People who become therapists because they want to be "nice" to people disgust me now. Ugh. So much ego involved.

I've noticed from watching reality shows (whee) about OCD etc. that legit therapists (at least cognitive therapists) are true professionals in that they show absolutely no emotional reaction to the poking and prodding of their patients. Patients can manipulate you (I think my ex and her therapist were in some gnarly co-dependent relationship :sick:) They remained calm and focused on the patient and addressing the patient's issues and removed their own egos from the equation as much as possible. You can see some of the patients have an extinction burst but the calm, unyielding face of the therapist wins out.



That's also why being a life coach and a therapist are very different.
 

Mole

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Rapport is sign therapy will be successful.
 

ICUP

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I read somewhere once that the relationship with the therapist is of greater importance than their actual competence.

I think so. It just depends on what the person needs as to what makes a good therapist. Some people need kind and patient. Some people need tough love.
I tend to need a combination of the two. Support, understanding, and patience intermingled with setting goals, boundaries, and motivating and pushing me to new heights.
 

highlander

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That's what I think too but she thinks EVERYONE needs tough and blunt.

If I were to guess, I would think this approach would work particularly poorly with an INFP for example
 

Lily flower

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I'm sure that some people respond to some types of therapists and some respond to others.

That said, I think that to be a successful therapist, you really need to be able to empathize with other people and understand things from their point of view, and it sounds like she doesn't have the ability to do that.

It sounds like she would do better in a "fixing" profession like being a doctor. No one wants to go see their bossy aunt for therapy.
 

Xenon

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First, I think your friend might do better with cognitive therapy or another modality that is about the nitty gritty and usually has a short term course.

I was just about to mention Albert Ellis: the creator of one of the first types of cognitive therapies. He was known for being blunt and even pushy at times, and his therapy was much shorter term than was typical when he originated it. Here's a bit about him (from the book 'Learned Optimism' by Martin Seligman)

....Gaunt and anglular, always in motion, he sounded like a (very effective) vacuum-cleaner salesman. With patients, he pushed and pushed until he had persuaded them to give up their beliefs that sustained their depression. "What do you mean you can't live without love?" he would cry. "Utter nonsense. Love comes rarely in life, and if you waste your life mooning over its all too ordinary absence, you are bringing on your own depression.You are living under a tyranny of should's. Stop 'should-ing' on yourself!"

I do think that there are certain qualities all therapists should have. Even in an blunt approach like the above, the client should feel respected and listened to. You can respect someone as a person even while showing them that their beliefs or actions are absurd. And you'd need to continually listen to people and be open to new information about them, rather than quickly deciding what someone's deal is and what's best for them and stubbornly pushing that no matter what (last counsellor I saw did this...really pissed me off). Just to mention a few necessary abilities/traits, I'm sure there's more.

I dated a woman (I won't say the type lest I offend those who share her type BUT YOU CAN HAZARD A GUESS!?! haha) who saw the same therapist for like 8 years. I think the therapist was one of those misguided bleeding hearts who really wanted to "help people". But her version of helping people was basically coddling them and being a mother figure and nodding sympathetically no matter what their patients told them and basically stroking the patient's ego. The girl I was dating never said what a great or effective therapist that woman was, just that she ENJOYED spending time with her pretty much and felt good that the therapist seemed to like her. DEAR GOD.

Heh. Well, at the risk of being suspected to be the same type as your ex (and I'm "hazarding a guess" that it isn't the one I've listed), I'll confess to having been in that position myself. Not for eight years, but too long. It wasn't that I thought feeling good around my therapist was enough...but I liked being around him so much I kept rationalizing it to myself, telling myself it could start working at some point. It was like people can get in bad relationships: telling themselves 'we can make this work, we can make this work' because they're attached to the person and don't want it to be over, and it isn't until it has been over for a while that you look back on it and go 'What the hell was I thinking?'

To his credit, he did question me about what I wanted out of therapy, tell me things needed to change if I wasn't getting it, asked me if I wanted to see someone else. He didn't aim to just be my friend. But it wasn't happening for me, and I just wouldn't admit it to myself for a long time. I don't know if it was his style (he was very non-directive, and I often just felt lost and aimless), or my own ambivalence, or what. I've never actually had a successful experience, so I can't say. You hear so much, "It's the relationship that matters" and it's not bad advice, but it would be helpful to hear exactly what to look for in the relationship. It's not just rapport, or trust, or empathy or kindness. You can have all those things and still have ineffective therapy.
 

ThatsWhatHeSaid

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What makes someone a good therapist and what makes someone a bad therapist?

I imagine there's such a thing as them having different styles and some being good and some bad.

This came to mind because a friend of mine wants to be a therapist. She has a "tough love" approach to everything and is very blunt. It's like Dr. Phil but without any finesse (do they teach finesse in school?) She says that she's all about making people accountable and that she's not interested in providing long-term therapy for anyone. She said that short-term therapy is what she wants to do because in her words "people will drain you if you let them". I thought this was odd.

When I think of a therapist, I think of patient, enduring, understanding and helpful. Maybe that's what I think I need if I went to a therapist, but I can see how some people need tough love.

Hey Jiggly,

Statistically, they say that the best predictor of therapy is a therapist's empathy, nothing else. I haven't read those studies, but it's a popular statistic they teach you in psych grad school.

I think different styles work for different people depending on their background, how they think, and what they need. That applies for both therapists and patients.

Personally, I've had a bunch of experience counseling friends and I've decided that people benefit most not from getting answers or creating plans, but from creating a genuine connection to another person. I think most dysfunction comes from people not being settled, mentally and emotionally, and I think bonding helps them do this. Solving problems tends to have a decent intellectual impact, but it's short-lived and can cause a person to become more obsessed with their problem, more high strung, and lead to more dysfunction.

Here's one of my favorite videos. This is a bit like what your friend was talking about. It's akin to reality therapy and existential therapy (also what your friend is describing). Look at how the therapist doesn't pull any punches, but manages to be sincere and kind.

[YOUTUBE="_QMCtVRMzUo"]_QMCtVRMzUo[/YOUTUBE]
 

Giggly

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My friend plans to do biblical counseling. She going to do the tough love thing and also use biblical verses to help people.

I think the best therapists must have some sort of balance, where they aren't too tough or too soft. Maybe that's why Dr. Phil was so successful.


Yeah the guy in that video seems more empathetic, methodical and patient than my friend. My friend is more curt and short.
 

CzeCze

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I do think that there are certain qualities all therapists should have. Even in an blunt approach like the above, the client should feel respected and listened to. You can respect someone as a person even while showing them that their beliefs or actions are absurd. And you'd need to continually listen to people and be open to new information about them, rather than quickly deciding what someone's deal is and what's best for them and stubbornly pushing that no matter what (last counsellor I saw did this...really pissed me off). Just to mention a few necessary abilities/traits, I'm sure there's more.

Yes to the bolded. I forgot to add that before in my rant. :p The therapist has to gain the clients trust and not abuse it. I think some people who seek therapy are especially vulnerable and susceptible to idealizing their therapist or depending on the relationship or basically have self-esteem issues. So a good therapist knows the balancing act and is good with boundaries.

Heh. Well, at the risk of being suspected to be the same type as your ex (and I'm "hazarding a guess" that it isn't the one I've listed), I'll confess to having been in that position myself. Not for eight years, but too long. It wasn't that I thought feeling good around my therapist was enough...but I liked being around him so much I kept rationalizing it to myself, telling myself it could start working at some point. It was like people can get in bad relationships: telling themselves 'we can make this work, we can make this work' because they're attached to the person and don't want it to be over, and it isn't until it has been over for a while that you look back on it and go 'What the hell was I thinking?'

Interesting - I'm quite surprised to hear that it's the relationship that is supposedly the most important aspect of a successful therapy run. For myself, perhaps it's my tendency to keep an appropriate distance to other people, but I would naturally try NOT to bond or like my therapist too much. Because then it becomes more of a personal relationship than a professional one and it would take the focus away from ME! ME! ME! and my issues. And seriously, you're paying the person (usually A LOT of money per hour). My friends are very different (because they are Fe?) but they form personal relationships with their contractor, their personal trainers, etc. and will invite them over for a meal. Personally, that is really anti-intuitive and unnatural for me.
 

CzeCze

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My friend plans to do biblical counseling. She going to do the tough love thing and also use biblical verses to help people.

I think the best therapists must have some sort of balance, where they aren't too tough or too soft. Maybe that's why Dr. Phil was so successful.

I agree about balance and boundaries. Therapists shouldn't steam roll their patients or decide what's best for them and not listen to them anymore. Or bend too much to the patient and try to be liked.

Having said that - Dr. Phil, really? I thought he was a smug jerk. Was he even licensed as a therapist or counselor? I think he was popular because he made for good television and could find participants whose dysfunction was relatable (like overbearing mother in laws) to the audience or was just entertaining.
 

Magic Poriferan

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This looks kind of like the popular debate about being honest as opposed to being an asshole.

A therapist needs to be honest in order maintain trust with the patient and not screw with the patient's sense of reality. That still gives the therapist a lot of options because there are many tacts to being honest. The word pushy came up here and I know that wouldn't work on me at all. Pushiness makes me talk less. As long as a therapist gets a chance to comment at all, they have a chance to be honest with me about what they think, so pushiness isn't necessary anyhow.
 

Totenkindly

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What makes someone a good therapist and what makes someone a bad therapist?
I imagine there's such a thing as them having different styles and some being good and some bad.

Yes, I think maybe there can be some downright "good" therapists and some really 'terrible" therapists, but typically therapists are decent, and whether they are "good or bad" for someone is based on what that person needs and whether the therapist can provide it.


This came to mind because a friend of mine wants to be a therapist. She has a "tough love" approach to everything and is very blunt. It's like Dr. Phil but without any finesse (do they teach finesse in school?) She says that she's all about making people accountable and that she's not interested in providing long-term therapy for anyone. She said that short-term therapy is what she wants to do because in her words "people will drain you if you let them". I thought this was odd.

I think there's a market for that, just as much as there is a market for life coaches vs career counselors vs therapists vs mentors vs whatever other type of "people helping/teaching" that we can imagine. The angle is just a little different for each. Your friend sounds more like she just wants someone to come with a difficult problem that they're desperate to resolve, she wants to get the data, and she wants to spit out and answer and send them on their way. That's kind of like a troubleshooter or advisor or fixer approach. Some people want that, and sometimes it is appropriate.

However, other people have chronic/pervasive issues maybe even based on an entrenched distorted view of the world, and those kinds of issues do not resolve overnight. The therapist typically has to enter into the situation with the person and provide some sort of anchor/protective embrace so the person can be stretched and explore themselves and slowly change how they see things, resulting in getting back in sync and having a healthy view of reality. This kind of long-term haul, where she has to "be with" someone rather than just troubleshooting their problems and not getting involved in the emotional mess, sounds like something that frustrates and bores your friend. She wouldn't be effective in a situation like that, nor is she willing to make the committment to be there for someone long-term and put herself on hold in order to help them.

We're basically comparing a "people-centered" approach with a "problem-solving" approach.

Having said that - Dr. Phil, really? I thought he was a smug jerk. Was he even licensed as a therapist or counselor? I think he was popular because he made for good television and could find participants whose dysfunction was relatable (like overbearing mother in laws) to the audience or was just entertaining.

I read a few articles about him years back. I forget what he was into to start with, but I think he did try to do conventional therapy for a bit and hated it... because he' s a problem-solver, and he was sick of listening to people emo about their problems. So he found a niche for himself.
 

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I had a short session with a woman who seemed like she hated me personally (I've seen two therapists before for my phobias) and this time I just got tested, for a professional-related assessment test. I basically came in to the office and took the test and was given a couple of consultation sessions. There are a number of therapists in that firm, but I was unlucky to get this one.

She was very judgmental as opposed to empathetic or methodologically understanding. Wow. I was quite baffled. She basically asked me how much I earned as a writer (!) and asked me my employer's salary system and implied I was lazy and unmotivated. I came in with a couple of classmates (in graduate school) and they came out fine. Their therapists helped them figure out what kind of work environment they would fit in best and what kind of work they should do upon graduation. My therapist was almost spiteful with me! She kept putting me down. I was really surprised. Wow!
 

feisty

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I had a short session with a woman who seemed like she hated me personally.... She was very judgmental as opposed to empathetic or methodologically understanding. Wow. I was quite baffled. My therapist was almost spiteful with me! She kept putting me down.

I have been on and off in therapy for [among other things] an eating disorder and family issues. When I was 17 I was assigned to my second therapist after a particularly trying time in my young life. Not only was she devoid of empathy towards my situations, she actually told me how to feel. I brought in a letter one day that I had written to a family member who had been a huge source of unrest in my family and a huge trigger for me in terms of my life being out of my control. It was strictly my thoughts on paper, and rather than unleashing them upon my family and causing more turmoil, I decided to read it to her out loud so she could understand how I felt about the injustice being done to my family. She proceeded to tell me that I was wrong for being upset and that my parents brought it upon themselves. I was so enraged and hurt that the one person I was trying to go to for understanding of my frustrations was sitting there telling me how to feel. That's like anti-therapy 101.

The therapist has to gain the clients trust and not abuse it. I think some people who seek therapy are especially vulnerable and susceptible to idealizing their therapist or depending on the relationship or basically have self-esteem issues. So a good therapist knows the balancing act and is good with boundaries.

EXACTLY. They need to recognize when their clients are fragile. In my younger years, therapy meant to talk about things and have someone agree with you. It didn't translate to me as a teenager that therapy was supposed to make you come to grips with reality. When the wrong therapist got ahold of me they really did some damage to me, because although they told me things I didn't want to but needed to hear, they also were completely unaware and insensitive to my age, mentality and my own sensitivities to certain things. It was like they had one way of dealing with clients no matter their background or demographic, and they specialize in opinions and cold hard facts and if you can't handle that then you just need to cry yourself a river, build a bridge and get the fuck over it.

Which leads me to.......
Yes, I think maybe there can be some downright "good" therapists and some really 'terrible" therapists, but typically therapists are decent, and whether they are "good or bad" for someone is based on what that person needs and whether the therapist can provide it.

The therapist I have now is awesome. Since she specializes in eating disorders, she can actually truly put herself in my place and say "I really do understand that mentality." However, she can even do one better, because she can say "I get it. Now here's what's wrong with that thinking and here's how to change it." The biggest difference I noticed was the changes aspect. I'd never had a therapist with actual proposed solutions to my decade long problems. She is very understanding, and lets me say my peace, but she will also literally "call bullshit" in a loving way, that makes me rethink whatever I'm talking about.... and 90% of the time I know it's bullshit too, so she's just good at not letting me trick myself into getting away with bullshit.
 

HisGirl

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Not only was she devoid of empathy towards my situations, she actually told me how to feel.

Exactly! The therapist I'm talking about also did the same thing. She kept telling me how SHE would have handled the situation, she told me about HER principles, she told me how SHE feels about it. Well, SHE had to be the most self-centered therapist I had ever encountered.

I was so enraged and hurt that the one person I was trying to go to for understanding of my frustrations was sitting there telling me how to feel. That's like anti-therapy 101.

And "enraged" and "frustrated" was exactly how I felt about her. And disappointed! I mean you come to this person who you expect to be a trained professional, you expect objectivity and impartiality and then she judges you.
 
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Totenkindly

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Exactly! The therapist I'm talking about also did the same thing. She kelp telling me how SHE would have handled the situation, she told me about HER principles, she told me how SHE feels about it. Well, SHE had to be the most self-centered therapist I had ever encountered.

And "enraged" and "frustrated" was exactly how I felt about her. And disappointed! I mean you come to this person who you expect to be a trained professional, you expect objectivity and impartiality and then she judges you.

Wow. Sounds like she should have been paying you, so that she could talk you about her life.

I typically stop sharing anything of value with family/acquaintances who behave that way consistently... let alone a therapist.
 
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