In general, psychiatric stigma (which takes many forms) amounts to providers treating their mental patients and clientele either like immature, undisciplined, irresponsible, misbehaving children -- but at the same time trying to hold them responsible as adults. Or, they view their patients sort of like convicts out of jail and on probation (and always a potential menace to society). In other words, you're always prone to doing something bad, in their minds, because of a diagnosed (and presumably treatable) mood and/or anxiety disorder diagnosis -- and especially if there's a history of any conflicts with family, friends, school, or at work. In light of all of this malfeasance, it's mostly been certain upstanding members of the mental health community that have boldly come forward and identified the sorts of personal prejudices and other bullshit that their colleagues routinely engage in and project onto their patients. In the near future, I'll be writing a list of the frequent, common, one-size-fits-all remedies and solutions that patients are so often told to do by providers "if you want to get better." These are often unnecessary, even damaging solutions where a patient is told to gratuitously rearrange some major element of their life so providers can get them to troop along with everybody else in society.
BELOW is an excerpt of a speech given by a clinical psychologist of good faith who knows some of her collogues all too well (FAIR USE laws apply. The passage below is edited for brevity.)
This is an EXCERPT FROM:Now reflect upon the providers you've seen, whether for only a few sessions or over the span of several years. All I can say is that MOST providers I've encountered in the last 25 years going back to when I was in high school leaned far more towards the personal (i.e., subjective and self-absorbed) than the caregiving (i.e., objective and patient-focused) motives -- similar to what's outlined above. This should be a primer of whether or not you retain the services of your mental health provider, or fire them and find someone else.
How to Know When Psychotherapy is Really Working
By Martha Heineman Pieper, Ph.D.
This was a brief portion of a long lecture given by Dr. Pieper over a dozen years ago. In my humble opinion, it applies to BOTH prescribers and therapists, though usually more to therapists. I have boldfaced some words and statements for the sake of clarity and emphasis.
For the entire lecture, see https://www.marthaheinemanpieperphd.com/wp-content/uploads/2017/04/How-to-know-if-psychotherapy-is-really-working_final.pdf
...The therapist offers advice. If the advice is coming from the therapist’s caregiving motives, it will feel truly helpful and respectful. An example is a client who knew...that her motives for conflict often led her to behave in ways that irritated [her boss]. She knew it was his birthday and had gone out and bought him a tie and then thought to ask the therapist if she thought she should give it to him. The therapist, who by that time had a good sense for the boss’s personality, said that she thought he would think the client had crossed a boundary and that he wouldn’t like it. The client was happy and relieved to have brought the problem to the [therapist] and to have been spared the pain of causing herself another negative experience at work.
When a therapist’s personal motives are in control, the client may experience the therapist’s advice as artificial and imposed, or as covering territory the client feels entirely competent to handle on her own (emphasis mine). An example is the client who liked to entertain and who mentioned in one session that she was having a dinner party that night. The therapist asked what she was serving and proceeded to give the client advice on how to cook the dishes, even though the client felt no need for this input. The client felt both depreciated and also as though her process had been hijacked by the therapist’s remarks.
Another moment when it is possible to assess whether the therapist is responding with personal or caregiving motives is when the client is feeling negatively about her life, her work, her relationships, or the therapist. If the therapist is able to respond with caregiving motives, she will remain available to hear the client’s dysphoria, even when she is the target of it, and to help the client mourn the loss it represents.
The client can be certain that the therapist is being regulated by her personal rather than by her caregiving motives if the therapist reacts to the client’s negativity by expressing disappointment or irritation when the client’s pain surfaces in an intense manner. An example is the therapist who responded to the client’s renewed feelings of despair about her ability to lose weight by saying, “I don’t understand why you feel that way when you were able to lose three pounds last week.” The client felt the rebuke keenly, and, as a result, felt she had to watch what she said in her therapy to avoid angering her therapist. In general, it is a bad sign when clients who did not enter treatment with these concerns feel they have to monitor their words for fear of disappointing their therapist and being criticized.
A related instance in which the therapist responds with personal motives to the client’s negativity is the therapist who buys into the client’s feelings of self-deprecation, thereby endorsing and cementing them. Clients who are troubled by persistent bouts of self-rage, which occur in the therapy hour as elsewhere in their lives, hope deep down that the therapist will not view them as negatively as they see themselves. When the therapist seems convinced by the client’s self-critical opinions, the client is harmed considerably.
An example is the client who was very bright but had trouble believing in his academic abilities because he was tortured by an internal voice that constantly accused him of being “stupid.” He repeatedly told his therapist that he didn’t think he was going to make it through architecture school, to which he had just been accepted, because he was sure he wasn’t as capable as his fellow classmates would be. After the client reiterated this viewpoint in a number of sessions, the therapist replied, “Well, maybe it wouldn’t hurt to put in an application in a related field, like design.” The client agreed that this would be a good idea and that it was in keeping with his own desire to make the world beautiful, but deep down, he felt devastated.
Clients should not experience their therapist as accepting clients’ worst feelings about themselves as reality. Rather, when a therapist’s caregiving motives are in control, [s]he will retain a balanced view of the client’s capabilities no matter how negative the client’s self-evaluation.
Another indication of whether a therapist is being regulated by personal or caregiving motives is whether the therapist attempts to impose her own agenda on the client. As long as the client is not pursuing self-destructive motives (emphasis mine -ed.), the therapist should remain open to whatever life choices the client makes, and should focus on increasing the effectiveness of the client’s pursuit of these choices, whatever they are.
The client can regard it as a bad sign when her therapist has an agenda that is different from hers, for example in relation to: job change, divorce, dating, wanting children, choice of friends, political or social views, etc. An example is the client who was in a marriage that was making her utterly miserable and who concluded after much soul searching and many months of discussing the marriage in her treatment sessions that she wanted a divorce. When she conveyed this decision to her therapist, the therapist responded that she didn’t think the client had worked hard enough on saving her marriage to be able to reach that conclusion legitimately and that she should continue to work on this issue in her treatment.
Fortunately, the therapist had previously shared with the client that her own marriage had been rocky but that she had stuck it out. The client wisely decided to seek treatment elsewhere with a therapist who didn’t have an agenda in this area.
When a therapist’s caregiving motives are in control, she will not initiate displays of physical affection or make out of context statements about the client’s virtues – this restraint allows the client freedom to have and express any negative feelings she may have about the treatment or the therapist. Therapists who heap praise on clients or begin or end sessions with physical affection, such as hugs, are giving clients the message that therapists need clients to feel positively about them. While once in a while a client who has been through a very emotional positive or negative experience (has had a baby, has just heard that a parent died, etc.) may give the therapist a hug, these occurrences are rare and should always be initiated by the client. When therapists initiate hugs or make them a regular part of the therapy process, these physical displays of affection interfere with the therapeutic process by giving the client the message, “You should arrive (or leave) feeling good about me and our work together.” The client who knows that a hug will begin or end every session does not have the freedom to really explore and share negative feelings. So while, manifestly, hugs are a sign of closeness, in reality they can be coercive and distancing.
One sure way to distinguish a therapist’s personal motives from her caregiving motives is how she reacts to experiencing her own angry, irritated, bored or other negative feelings toward the client. There are schools of thought that recommend that the therapist share negative feelings with the client on the grounds that this sharing is justified by the client’s behavior, deepens the relationship, provides the client with reality testing in the relationship, and so on. blogger's note: or what the snowflake and/or self-absorbed conformance-promoting shrink deems upsetting and disrespectful TO THEM] However, this kind of therapist transparency always stems from personal rather than caregiving motives. In fact, any and all negative feelings about the client always originate in the therapist’s personal rather than caregiving motives and, therefore, should never be shared with the client. Rather, the therapist has some internal work to do to understand why her personal motives, which are causing the irritation, anger, dislike, disapproval, etc., are regulating her caregiving motives, when it should be the other way around.
I cannot overemphasize that when a therapist’s caregiving motives are in control, she will view the client’s criticisms, complaints, backsliding, missed appointments, failure to progress, etc. as expressions of problems the client brought to treatment that the therapist is trying to help her with, and not as behaviors that are personally aversive to the therapist When these behaviors are viewed through the perspective of the therapist’s caregiving motives, they will stimulate the therapist to reflect on the most helpful response to the client, rather than to think about her personal reactions, which ideally she will be aware of, but which she will have no need to act on. (blogger's note: unless she is a solipsistic head case, when any and all interactions are about her in her mind. This sort of nonsense shows how blameless they see themselves as, and the lack of empathy these therapists have -- the very sort of thing many tell clients that they're lacking and need to develop).
When therapists share negative feelings about the client with the client, they are in essence attempting to control the client in order to sooth their own inner disquiet – they are trying to get the client to “shape up” and stop making them feel uncomfortable. In other words, when the therapist tells the client that she is feeling angry, bored, irritated, etc., the client hears the therapist saying, “I don’t like you when you do this.” In order to be liked by the therapist, the client will try to change her behavior.
In contrast, when the therapist’s responses remain regulated by caregiving motives, the client who is unhappy or critical will get the message that the therapist doesn’t change toward her when she is feeling negatively, but remains just as motivated to help her as when she is feeling happy and positive...
Another test of the therapist’s ability to put caregiving over personal motives occurs when the therapist makes the inevitable caregiving lapse (forgets a rescheduled appointment, makes an insensitive comment, etc.). The therapist whose caregiving motives are in command will respond to her own caregiving lapses with the willingness to take responsibility and listen to the client’s point of view, whereas the therapist whose personal motives are in the driver’s seat will handle her errors by blaming the client, denying the lapse, or by taking other evasive actions designed to keep herself from having to acknowledge her error...
You can do a search for the entire piece by Dr. Pieper on Google. The purpose of therapy is not to hire someone to dictate to you, either outwardly or subtly, how to live your life, what to think, or how to feel. Many folks will complain that their therapists "don't give me enough advice." True, individuals approach therapists at the times in their lives that their problems have become hugely overwhelming, and deep down they're aware of the inevitability that changes will need to be made. But while showing personal concern, the therapist is there to guide the client through their personal morass, hopefully raising questions about how realistically the client sees their situation (without deriding how the client has approached every situation in their life before, and directing the client to seeing where he or she does and does not have control within their lives). The biggest problems arise, I believe, when therapists insist that clients always kiss the asses of others, as if these others always have a higher social or moral positions (which doesn't entitle them to be abusive) and are always right in any disagreement with the client (the one glaring exception to this would usually be when battered women are urged to leave their abusers by mental health professionals). But being cheated out of wages or a legitimately earned promotion by unethical bosses and saying nothing about it just to keep the peace at a dead-end job, or being deprived of care (or have care delayed) by a doctor on the basis of insurance and going back to that doctor anyway, or having your living arrangement unlawfully threatened by a landlord and keeping your mouth shut so as "not to cause problems" hardly lends any advantages to someone at the receiving end. This is because these therapists (and often prescribers as well) believe that their avoid-all-conflict band-aid will help solve your problems, or at least avoid any new ones, especially if some sort of conflict with someone else was the source of your mental angst when first entering mental health treatment. Even when shrinks decidedly approach their clients as if the clients are randomly conflict-prone, recalcitrant children (and the client MUST BE at fault for any dispute they have), who just stir shit for the fun of it, it is still not hard to see how the client LOSES BADLY without a higher wage, without proper care for a physical health problem, or without a secure place to live. Too many modern shrinks see it as their foremost duty to paternalistically (or even coercively) keep people "in line with" what's "socially acceptable," which doesn't simply mean not breaking the law and committing any major crimes. It's about learning to follow orders, and adhere to many of modern American (and other Western) society's "morals." Psychologist Bruce Levine is the expert in this area.
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