My Biggest Fear About Therapy as a Therapist
I recently finished watching the Evil Influencer: Jodi Hildenbrant, a relatively new documentary on Netflix. It is intense (it comes with multiple trigger warnings). The story is about a Utah therapist who teams up with an online influencer and the story of the resulting child abuse and questionable therapeutic practices. I was left with so many questions. Mainly, how did this happen? How is it that a practicing therapist could deliver interventions that are so counter indicative of mental health care?
I do not, however, doubt that she believed in her interventions and thought she was doing the right thing.
The same with the story about the Sullivanians who were practicing in the latter half of the 20th century New York and have been referred to as a “psychotherapy cult.” Among many other things, they encouraged the separation of very young children from their parents, counter to our modern understanding of attachment theory. Therapists in this group were also encouraged to control much of their patients’ lives in ways that would be considered highly unethical today (and likely were back then as well).
I also think the founders of this group believed deeply in their methods and thought they were doing the right thing.
Yet both cases were so highly damaging.
How do we, as therapists, make sure that, while we likely believe in our methodology and interventions, we do not become coercive in the delivery of services? How can we prevent ourselves from harming others when we have good intentions? How can we make sure that we don’t just simply believe in our methods but that our methods are actually doing the right thing?
Because the belief that you are doing the right thing and whether it is the right thing, are, well, two different things. One is subjective, the other is objective. I can know my subjective experience, but I can only guess at the objective. And I know I don’t always get the objective right.
This is how I try to limit coercion in my therapy practice:
Your self-agency is central: I don’t know if you should break up or not, chose this job or that job, or move to this or that city. I only see you, usually, once a week. You are the expert on yourself. I bring in the questions and knowledge of studies and theories. The direction we go in therapy, is largely up to what your goals are (with a few exceptions, such as harm to self or others). Part of my job is highlighting your agency in this process.
Open-minded theory use: I present theories. And facts when they are available (such as statistics). Interpretation of the facts, however, is often theoretical. Theories, by definition, are things that can be disproven. I can tell you about attachment theory and I can provide statistics, but together we can decide how much of this to take in and apply. I’ll often say things like, “This is a theory and theories can be challenged. So let me know how this lands.” And I encourage expressions of disagreement with theories when it comes up. This is how we edit the process and find or develop more applicable theories.
Evidence-based practices: The mental health field has shifted in the past few decades to emphasize what’s known as evidence-based practices. This refers, in short, to using interventions that are backed up by the research. So that it’s not just the therapist’s opinion on what type of modality to use, but there is also a body of evidence supporting the treatment choice. While this can be very helpful, it’s also important to keep in mind that rarely do studies work with 100% of the populations sampled and certain types of research tend to be prioritized by others (i.e. ones that are cost effective and time limited). Just like with presenting theories, I also see integrating the research evidence as a collaborative process between the two of us and am always checking to see how this lands.
Supervision: I’m not all knowing. There are things that I miss. In accordance with the ethical guidelines of my profession, I seek regular supervision with a senior therapist.
Maintaining other sources of narcissist gratification: I think of narcissism as a scale we all are on. Life tends to get challenging for us and/or those around us when we fall too far on either side of the scale. Narcissistic gratification can feel good and being a therapist can be gratifying. But, it should not be the sole source of one’s gratification because we then fall at risk of using our practice for fulfilling our own needs which can come at the expense of our clients. Therefore, outside of work, I focus on fulfilling family relationships, pursuing non-therapy related interests, and making sure that I have other sources of joy in life. In the therapy profession, doing this goes beyond self-care and is very much a preventive measure against misusing one’s practice.
Therapy should not feel coercive. Therapy, from my perspective, is about empowerment, understanding, and acceptance. It is humble and non-assuming. It is an evolving practice that continues to be redefined as our theories, studies, and knowledge grow. It is a collaborative process with you (the client) at the center. It should be a safe and personalized space. This is what I strive to provide.
If you are thinking about therapy but feeling, understandably, cautious about the experience, I offer complimentary 20 minute consultations.
