OK, so each of us has an idea of what therapy is all about and what therapists are like, based on our own experience, the experience of someone we know, or perhaps through their depiction in movies. In movies, therapists all sleep with their patients, and are very, very wounded people. Of course, there are many reasons folks choose to become therapists.
Well, therapists tend to be wounded heroes: they tend to have been parentified children and were often seen as family mediators, and are even sometimes codependent caretakers. They are also more likely to have been emotionally or physically or sexually abused. Not all, but many.
Did you know that most therapists are not qualified to be offering services? There are several graduate degree programs that offer little to no training or education in providing counseling and therapy! One is the typical MSW program, and I mean even to include the clinical social work degree. At one flagship graduate program in Social Work, the Master's program requires only this in therapy training: one semester of a seminar in group therapy, and one semester of a seminar in family therapy. No counseling theory, few techniques, no diagnostics, no theory or training in how to perform individual therapy, etc. (in fact, social workers are not allowed by law to use psychological diagnostic tools.) I fully believe that folks in a Counseling Psychology program would benefit from Social Work courses. I think it crucial that social workers take Psychology courses. How many bother to do this in either direction? Few.
I do know some social workers who HAVE gone on to more education and to learn about how to effectively do individual therapy, and I have known a very few psychology people who studied social services and policy issues. I will toot my horn and say I took several social work classes. This was very helpful. I gotta say, those folks are very very prickly about their domain: I was told loudly and clearly, by more than one faculty member, that I was not welcome in their graduate program. Why so touchy?
I don't mean to disparage social workers in particular, I really don't. I could say similar things about a wide variety of therapists' training. I have seen some really ill-prepared psych folks, too. It just seems that social workers get a "pass" on learning academically and often experientially about theory and skills needed to do therapy and counseling.
Did you know that what therapists say they do in the therapy hour, including the style and theoretical framework they use, is far different from what they actually do. Therapists are often very poor at self-monitoring, but are excellent at rationalizing. They may only be comforting a patient instead of applying a particular technique within a particular framework, and may have only taken a one-day workshop anyhow. I think what really irks me is the "one size fits all" mentality, wherein a therapist thinks that all problems can be treated with the same technique(s). When all you have is a hammer, all the clients' problems look like nails, and they are not.
In 1984, my then wife and I went to a "therapist." Her office was in her basement. There sat a red pit group surrounded (and I mean on all walls) by mirrors: floor to ceiling. It felt a bit like some bizarre fun house, or maybe Stuart Smalley's place on steroids. At one point in the second session she had my wife turn to a mirror and repeat self-affirmations, while I looked on in surprise and disgust. I thought to myself, "Damn, I can do this!" And at $100 an hour, who wouldn't want to give it a whirl?
Did you know that virtually all therapists commit insurance fraud on a regular basis? Insurance companies will typically only pay for the treatment of certain diagnoses, such as depression. They won't typically pay for marriage or sex therapy. So what therapists do is diagnose pretty much everything as depression, adjustment disorders, or occasionally, an anxiety disorder. This way, the client can be seen and the therapist can be paid. We must remember, however, that diagnoses follow clients around like flypaper and can cause problems later in their employment and insurability. In addition, how you treat each disorder can vary significantly. Now, many therapists are quick to rightly point out that depression is often a comorbid condition for most other disorders, because once you've struggled with something and it doesn't remit, you tend to get depressed. But that is not what the therapist ought to be working on; the base problem should be addressed at some point, or the client simply will not get better in the long run. And maybe that's not what the therapist is working on; maybe they are working on the "right" issue. I can make a claim, even a righteous one, that the object is to treat the person, so a little twist and wiggle with the insurance forms ought to be no big deal. Right?
Did you know that therapists are typically lousy diagnosticians? They have usually only taken one course in Abnormal Psychology (an introduction to the major categories of disorders), and then learn OJT after that. This is a very tricky, artful and a less science-driven skill that takes a very long time to get good at. You really need expert supervision and tons of back-checked experience to do this well. Part of this dilemma is wrought from spending very little time in a diagnostic process with clients, one that should take hours to complete (insurance companies require an instantaneous diagnosis.) It took me about ten years of very diligent effort to get really good at diagnosing, and I'm not particularly slow-witted.
Lastly, it appears that many therapists really don't treat much of anything, preferring to simply be a mirror for their clients, a kind of Rogerian reflector and a close "friend," hoping that this will make things better. I have heard and seen many therapists do this. I trained many who were not adequately schooled. They start off well, appear to understand the issues, and then quickly descend into friendly, "active," inert listening. I don't really blame them for this: it's their training that's sorely lacking. Few master's level training programs ever really show its students what real psychotherapy is like and how it could/should be conducted. They talk a lot about peripheral issues, like ethics, and theories of counseling, which is of course necessary, but never teach things such as: how to handle and process with a client emotion, how to ask great questions, how to know when it's time to refer, and so on. I'm very serious about these claims.
All this makes me think of the joke that goes: therapists are "the rapists." Or psychotherapists are "psycho therapists."
I know this is provocative and without precision, but I fully believe that around half of all psychotherapists are incompetent. I would estimate that only about ten percent are really excellent. The rest are OK. And the public has absolutely no way of assessing this!
I believe I have a handle on my assertions: I am a psychotherapist specializing in sex therapy, and I am also a Professor of Psychology who teaches this stuff. I have trained many beginning therapists and have heard their confessions in their own therapy sessions. I've also listened to many faculty members in even APA sites talk about these things.
As always, the most dangerous professional is the one who does not know what he does not know about, and therefore is more likely to think he does. I don't know how to do lots of things therapeutically, but I know what those things are. That's what referrals are for!
On behalf of our profession, I apologize.
