Difficult therapy vs harmful therapy?



Anonymous asked realsocialskills:

How do you tell therapy that’s difficult but which will help in the end from therapy that’s just harmful?

I’m not entirely sure (in part because I haven’t had many good experiences with therapy), but here are a few things that I think are good indications:

Attitudes towards pain and suffering

  • In good therapy, pain is never an end in itself.
  • Some things hurt, but the point isn’t to make them hurt
  • And the pain should not be the primary evidence that you are making progress
  • And when you talk about pain, your concerns are taken seriously
  • You’re not mocked or told that you’re being a wuss or lazy or any polite euphemisms for either

Respect for your autonomy:

  • In good therapy, you get to decide what you’re working on
  • And whether it’s working
  • And whether you want to change things
  • And whether you want to keep working with that therapist
  • And whether you’re interested in continuing with therapy at all.

Respect for where you are now:

  • Good therapy respects you as a person as you are now
  • It doesn’t say that you’ll become worthwhile only once you are cured
  • You have to build from where you are now and make improvements to it, not wait for an imaginary better mind or body
  • Most (mental or physical) conditions that are treatable are not curable
  • If a therapist thinks that your condition is curable, make sure they have a good reason
  • And even if it is curable, you and your mind and your body still have value even as they are now. It’s important that your therapist understand that.

Explaining what’s going on:

  • Good therapists are honest
  • They’ll tell you what they think, and what they’re doing
  • And what they think will help
  • Good therapists are willing to answer your questions
  • And don’t treat you like you’re stupid or faking when you ask
  • Or like it’s an imposition or a sign of disease
  • Good therapists don’t try to trick you into relying on their judgement instead of your own
  • They are there to help you, not to control you
  • This can be hard to find. It is unfortunately not the default in a lot of fields

My main experiences with good therapy have been from sports medicine stuff. What I noticed:

  • They warned me that things might hurt, why they might hurt, and what different kinds of pain from it could mean. (Like a stretch would hurt in a kind of typical stretch way if I’m tight, but if it’s not the way that stretching often hurts/pulls, I should stop.)
  • They would tell me ways to minimize the pain for things like stretches and such.
  • If I said something hurt too much to do it, they listened.
  • They answered my questions and they asked me a LOT of questions. (I told them I wasn’t always sure what was relevant so they should ask me lots of things, and they actually did it.)
  • They gave me ideas for things I could do at home once I stopped having therapy with them so that I could keep working on the issues even if I stopped all formal therapy. Putting it into my own hands, basically.