10 Comments to
Effective therapy requires collaboration between therapist and patient

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  1. i am using a therapist now with great success. But that is not reflective of my history with therapists. I find young inexperienced social workers and family counselers are not merely judgemental but secretive about it. No amount of collaboration could have fixed the problems i had with such care-givers. They needed an attitude adjustment from their peers. I was their victim for trusting them.

  2. On spot! And 314159pi – your thoughts mirror mine. I spent 6 years with an empty suit of an MSW who was very young, inexperienced and – I now realize – judgmental to the point of adversarial, manipulative, secretive and incompetent.

    It took more than a year outside of that setting for me to recognize the great harm he had done. I’m with a therapist now who is non-judgmental, encouraging, open and a collaborative ally. I wish I had had this article back then when I needed it most.

    Now if we could just get doctors and therapists to expunge the word ‘non-compliant’ ESPECIALLY as it extends to people who ask questions, the therapeutic climate would feel safer. Less intimidating, anyway.

  3. hi regular reader.
    i don’t mind judgemental or opinionated social workers until it gets in the way of their relationship with the client. i think they are secretive and thats bad. i often wonder whether judgemental quality isn’t some form of defense mechanism when their ministrations are ineffective.
    eg, how many times must a sometime psychotic hear nonsensical accusations that he’s a former drug addict and bought his condition on himself. or alternatively a family counseller takes sides in a family dispute leading to more destructive behavior?

  4. I am not sure what specifics are being referred to regarding “judgemental qualities”. However, I do know that patients need to be called out on the choices and subsequent behaviors that contribute to their pain. This is true whether mental health therapy or even other therapies such as physical therapy.

    Many patients are of the mindset that the therapist should cure them while they sit there passively (victim posture). The collaborative theme is right on.

  5. one example of a therapist being judgemental is concealed anger and frustration by lack of progress. young social workers don’t ‘call people out’ for their behavior. they don’t want any responsibility for their patients behavior. instead they grind their teeth and sabotage the therapy process.
    at least thats my experience more than once. i assumed someone was my advocate and could give me some direction when i was confused and in danger. boy was i wrong.

  6. This is very very true – all of it. This is what must be achieved if the alliance is to be created but we also mustn’t forget that many clients entering therapy are suffering from self-esteem issues and may not at that time have the courage/strength/ability to assert themselves in this way therefore part of the therapist’s work must also be to encourage this kind of discussion and this kind of relationship.

    Great post and article – thanks!


  7. I am so very grateful that finally a therapist has been willing to help me. I think my whole family was in on the intervention. I have so many questions about myself that would be so easy to answer by my therapist. I understand myself pretty well, but don’t know if from what I hear on tv if I need to fear for my life. Or is that part of my therapy???? There is so much doubletalk, I can’t know if all is better now that my town knows I’m OK, or if there is really something out there I need to fear. The whole world knows about me. I know nothing but what I have put together in my head. HELP!!!!

  8. True, but don’t overdue it. Unless your therapist is a real *****, give it a little time to see if you and T can learn to understand each other. Do speak up if something makes you uncomfortable, then figure out WHY you’re uncomfortable. Do you not like suggestions or help? Then you’ll never be happy. On the other hand, if you don’t like the style/method, talk about it and change if needed.

    “T-hopping” doesn’t solve anything (especially if “hopping” tends to be your pattern. And it does put up flags if you have a list of ex’s.

  9. I am a therapist & am reading this to gain more info about what people want. So, I hope this sheads some hope that therapists are willing to do what it takes to truly help out. Unless in private practice, therapists make less than teachers, honestly! So, in order to go into the profession, you truly want to help people. I agree that many get off track or burnout but consider the more recent graduates have the lastest info. The #1 thing I can say is find a therapist that believes in discussing thoughts because you dont have a feeling or behavior w/o having a thought first(discussing feelings & behaviors can only get you so far). Make sure he/she gives you homework because even 1 hour a week is not going to change your life unless you have direction to work on something until you see them again. Even I get frustrated w/ the bad apples in the profession but your input is critical to your success. YOU are YOUR own expert! Communicate & use your therapy time wisely. Sometimes personalities clash so move on if needed but if thats your pattern, consider your own barriers to treatment. Find a way to try new ideas & receive constructive criticism. Even if you dont like something that is pointed out to you (& you label it judgemental) you are thinking differently about something & that will lead to change. Hopefully you are being taught how to solve problems so you will not need therapy in the future (unless you have certain mental diagnosis) If you are only talking about 1 problem & dont link it to real problem solving, you will need therapy again when the next big issues comes up in your life. I wish you all the best!

  10. I have been in therapy (off and on) since I was 18. Many therapists are completely clueless. Fortunately, there are also several that are quite excellent and one or two that probably saved my life.

    If someone just doesn’t “get it” it’s time to move on.

  11. “You can’t teach what you don’t know, you can’t lead where you won’t go.” Any therapist is only as good as the internal work that they themselves have accomplished. And it works the other way too. I find that the more I make an internal transformation, the more I gain from the course of therapy.

    In my opinion, the notion of “non-compliance” is b*llsh*t. Any therapist who expresses this arrogance needs an attitude adjustment (and a different client). It’s an expression on the part of the therapist that only they know what is best for you. On the contrary, only you know what is best for you. You are the only person who can save you.

  12. I had already logged off my computer, and decided not to respond. I didn’t feel like getting into the ‘politically correct’ thing, and explaining that of course, not all Social Workers are horrible, and that there are exceptions, and then there are some who have something like a ‘marriage and family license’ on top of their social work degree, and that this helps, etc.

    But, this is the deal with Social Workers, I think, I completely agree with the two above commentors who say that Social Workers suck for many reasons.

    Yes, there are exceptions, but as a rule, I hate them too, and I do think they have generally many more nasty than good qualities. They can make your life hell, and they are arrogant, deceptive, too sweet when they really cannot stand you, and/or you them, and both sides know it.

    I generally have more respect for the profession of a prostitute than for Social Workers. (Oh yes, and there are exceptions, like I say)



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