thoughts on good therapy

anonymous said:

Since you talk about abusive therapy so much (for which, thank you so much) - do you or anyone know anything about distinguishing between good and abusive therapy for OCD? Given that the main idea of the condition is irrationality and the method of the therapy is triggering on purpose, it both seems that it would be really easy for it to get abusive, and that I don’t know how to tell if that happened.

realsocialskills said:

I don’t know that much that’s specific to OCD, and I hope that some people who do will weigh in.

This is what I do know about therapy in general:

Therapists are fallible. Sometimes, you will be right and your therapist will be wrong. (Even if your primary issue is OCD-related irrationality). If a therapist expects you to accept their perspective uncritically, that’s a problem.  

Good therapy involves thinking for yourself, with the assistance of a therapist who respects you and has a lot of experience and tools to help you figure things out.

If a therapist is a good match for you, they will be right more often than they are wrong. They will be right sometimes when you initially thought that they were wrong. But you still have to think for yourself and decide what you think of their advice. You can’t just turn off your mind and replace your thinking with theirs. If a therapist seems to expect that, it’s a major red flag.

The specific ways in which a good therapist helps a client develop their perspective differ depending on methodology. For instance, CBT places considerably less emphasis on the effects of past relationships than psychodynamic therapy does. There are a lot of differences in methods, and that’s ok.

What every legitimate method has in common when it’s done well is that it’s respectful and consensual. A good therapist will respect you and your ability to think for yourself, even though you need help figuring things out. A good therapist will not try to coerce you into adopting their perspective. A good therapist will recognize that they are fallible, and that sometimes you will see things that they don’t. 

If you develop trust with a therapist over time, there will likely be times when you agree to try what they are suggesting despite your reservations. That’s part of how therapy works for most people. When you do this, it means that you’re deciding that they might be right, and that it’s worth trying your suggestion to find out. (Part of what trust means is that you trust them to respond appropriately and help you find another strategy if what they suggested does not work or has side effects you find unacceptable.)

And this is true even if you have OCD or another condition that interferes with your ability to be rational. Being irrational doesn’t mean that you should turn off your mind. It means that you need to get better at thinking effectively. And you can only get better at thinking if you practice. A good therapist will understand that.

Followers with OCD: Are there things that you would advise someone who wants to find a good therapist to look for? Are there red flags you would advise them to watch out for? How do you tell the difference between abuse and legitimate uses of invalidation?