boundaries in therapy

Therapy is better without true believers

Anonymous said:

I was wondering if you/ any of your followers have thoughts on mindfulness as a treatment for anxiety? It seems to be recommended by a lot of doctors where I live as something that always works and has no side effects.

realsocialskills said:

It sounds like you’re encountering a lot of true believers. 

“Always works and has no side effects” is not true of anything. That’s true believer talk; someone who is giving you medical advice ought to be giving you a more nuanced view of your options and the potential risks and benefits involved. If you can, it’s worth putting in effort to get a doctor who is willing to proactively take a frank and nuanced approach to treatment decisions. (Some doctors start acting that way if you ask them enough good questions. Some don’t. Finding good doctors who take your insurance can sometimes be hard.).

Mindfulness is one legitimate approach to managing anxiety that works very well for some people. It doesn’t work for everyone, and it’s not the only legitimate approach. I don’t have any way of knowing whether it’s something that you should try. (Both because I don’t know you and because I’m not an expert on helping people make that kind of decision.)

There are approaches other than mindfulness that some people find helpful. Eg: CBT, various types of medication, general psychodynamic therapy, art therapy, or working to accommodate sensory issues better so that you have less background stress. No approach is universally effective; no approach is universally safe. They all work to a significant extent for a significant percentage of people. They all also have risks and drawbacks.

Nothing is 100% effective, ever. No treatment or approach works consistently for everyone. People are complicated, and many things about the brain and body are still not well-understood. For many issues, there are wide ranges of legitimate and possibility-legitimate approaches. Trustworthy doctors and therapists are honest about this.

Further, everything that is powerful enough to have good effects is powerful enough to have side effects. Some people have this weird misconception that if something doesn’t involve medication or surgery, then there are somehow no risks. In reality, there is no risk-free approach to improving the way your mind and body are functioning. Anything that’s powerful enough to cause good changes runs the risk of causing bad changes. (The risk is not always high, and even high risks are often worth taking.) 

Does anyone want to weigh in with experiences with mindfulness? What are some things you wish you’d known, or that you think it would be helpful for the person who asked about this to know?

tl;dr Mental (and often physical) healthcare decisions are complicated. Some approaches work amazingly well for some people. No approach is effective for everyone. Every approach has risks and drawbacks. If you are seeking professional help, it’s worth looking for someone who is realistic and honest about likely outcomes, potential risks, and the range of treatment options.

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?

clatterbane:

Strong Glial Character: youneedacat: Social skills for autonomous people:…

soilrockslove:

youneedacat:

Social skills for autonomous people: stripesweatersandwaterbottles: realsocialskills: aura218: nichtigen:…

stripesweatersandwaterbottles:

realsocialskills:

aura218:

nichtigen:

aura218:

actuallyrlysrs:

Go click the link for the rest of the conversation.

TW: for psych abuse

Yeah, this shit happens.  I have been…

And I had been told that “social skills therapy"  was the only thing that would help me (including with ongoing bullying and abuse).  And most of that therapy ended up being about conforming to gender roles and not doing or saying anything that suggested I was anything but a straight girl.  Not even thinking those things.  Also a lot of putting up with things that were painful for sensory reasons.  And hiding my “weird" movements and interests.

And also getting asked questions, and when my answers were not the answers they liked, the therapist would act like I hadn’t answered at all, but ask me the question again.  Until I ether couldn’t talk anymore (which was common), or said what they wanted to hear.  Assuming I was lying when I didn’t match the “classic descriptions" they had in their books.  And deliberately trying to put me in altered states when I said “no" so that maybe they could get a second answer they liked better.

And telling them about horrible symptoms form psych medication and having my dosage *increased*.

And being told I was sexually messed up and probably abused (when I wasn’t) and being asked questions about private sexual thoughts when I was still a kid.

And having one adult therapist play power games with her eyes (more than just regular eye contact - this hurts worse than that) - once again with a 12 year old kid.

All this happened.  And I only have had one therapist-type who didn’t do harm (I actually admire him quite a bit for his respectfulness) but he didn’t really help all that much either.

And so it’s not just a few bad apples.  Some of this stuff they actually *teach* in psychology school.  Like that the Diagnostic Categories are realer than people’s real experience.  And that mentally ill people lie a lot.  And that developmentally disable people are just stupid about their own lives.  And “Lack of Insight".

And reading other people’s writing about this kind of stuff (and about all the good things in life that wait if you can just get through to the other side)  was so helpful and healing.

 #Psychaitry #psychiatric abuse #therapy#institutions #not treating people well #treating people well #disability #mental illness#developmental disabilities

I haven’t been able to add much to this discussion, because I do find it so triggering. (Though my own experiences with disregarding boundaries as SOP mostly look mild compared to some of the things people have been talking about.)

In general, if you are convinced that you know better than the person that you’re talking to what their own thoughts, feelings, and motivations must really be–and keep insisting that they’re just too sick or don’t have the insight to understand what their REAL thoughts, feelings and motivations are–you need to go away and stop hurting people who are already having a rough enough time. Especially if you think someone has been abused, you do not trample all over every fragile boundary they’ve got while claiming you’re just trying to help.

Also, you do not encourage somebody who already has fucking OCD (that you’ve interpreted as other unflattering things) to analyze and reanalyze and try to edit and replace every thought and feeling they have, if you do not want your clients to turn suicidal pretty damned quickly. Which is a sign of how badly they need more of the same therapy, yeah. :/

But, yes, I have run into some very similar things–and, indeed, if it were just a “few bad apples”, how do we keep getting a majority of the mental health professionals we see behaving in some of these same low-respect ways that keep getting discussed? I have seen one or two over the years who did not act like this, but they were definitely in the minority.

aura218:

nichtigen:

aura218:

actuallyrlysrs:

aura218:

realsocialskills:

aura218:

realsocialskills:

stripesweatersandwaterbottles:

youneedacat:

Social skills for autonomous people: boundary violations in therapy

realsocialskills:

all-women-kick-ass asked realsocialskills:

do you know what particular boundary violations in therapy AREN’T considered unethical? because i am also studying to be a therapist and would very much like to avoid said boundary violations with future clients.


Boundary…


Something horrible one of my therapists did to me:

He told me that because I was I’m the system, I was not a real adult and never would be. And that therefore I would never be allowed to make major life choices without consulting him.

He then told me exactly how he’d manage it. He would make my choices for me. Then he would communicate to my parents such that they would make all my decisions for me.

Another thing he did was hold my sleep disorder against me. He said real adults can control their circadian rhythms and he would not let me make choices until I could sleep all night.

He and another therapist also communicated with my parents, without my permission, signed out otherwise, about me, after I reached adulthood. That’s not only wrong, it’s illegal.

My psychiatrist had a lengthy conversation with my mother that was basically about how if I didn’t take a medication for narcolepsy (after it was clear I didn’t have narcolepsy), my life would go to hell in a handbasket and I’d lose all my friends because I didn’t care enough to take care of myself.

Same shrink decided that the only valuable course my life could take, was to overcome my autism, and go on to become another Temple Grandin. He wanted me to become a psychiatrist just like him, work with autistic children, and contribute to autism research. Anything less than this and my life would be a waste.

This was combined with another huge boundary violation:  He basically every time I went along with his plans for me, he wrote that I was making progress and becoming higher functioning. If I went against his plans for me, he’d say I was regressing, becoming lower functioning, or ruining my life.

Going against his plans for me was one of the best things I ever did. It was my first step towards being able to run my own life and my life has gotten better and better since.

Mind you, he was probably my best shrink. But not realizing the power he had, he abused it without even trying.

Another shrink told me that I would never be able to think for myself. That it would probably kill me to do so.

Same one told me that he was going to get inside my brain. Create a version of himself that lived inside me. Kill off the me that lived in there. And replace me with a version of me he built himself. And then climb in there with me so I couldn’t disobey him anymore.

I don’t know what the hell he did to me but there’s still remnants nearly two decades later.

And that’s just off the top of my head. All of these things are in the category of things you should never ever do to someone.

The easiest to do accidentally are protecting your goals for your patient onto them. And then seeing moving towards those goals as progress, moving away as regression. Watch out for that.

I’d also recommend the video, the ethics of touch, by Dave Hingsburger. It’s not just about touch, it’s about boundaries in general.

I have had my sleep issue be ignored, glossed over, and have even had a therapist get angry with me because I was so desperate for sleep I wasn’t getting and they thought it didn’t matter. Literally “so?“ was said many times. Everyone thinks that my complete inability to sleep without meds/enough meds is my fault snd if I can’t sleep even with meds then it is clearly my fault bc i must be doing something wrong. This attitude coming from s therapist whom I enjoyed and trusted up until the last year I was in school, was damaging.

A lot of people I know who have sleep disorders have been emphatically told that it’s just because they’re practicing poor sleep hygiene and if they’d just try harder their problems would go away.

These stories above are bizarre, like, 60s shit. This is so far beyond ethics and legality it’s unbelievable. That should NEVER have happened and is NOT the norm or typical of ANY kind of therapy.

The Judge Rotenberg Center openly uses electric shock and food deprivation as behavior modification techniques.

Given that, which part of what youneedacat described is something you think no longer happens?

Those methods are contrary to AMA and APA guidelines and not how the typical psychiatrist acts. I don’t want to scare anyone off therapy by telling them that any of this is likely to happe nto them, because it won’t. This is NOT how psychiatrists are trained in modern universities.

Someone was unlucky to get stuck with a psychopath. Anyone can encounter a criminal, in any situation. If your psychiatrist is displaying warning signs, you don’t have to stick with them because you think the next one will be just as bad.

you really can’t say that it won’t happen because it absolutely does happen. therapy is not exempt from criticism just because it helps people.

Of course it shouldn’t be exempt from crit, I just think we should be presenting a balanced opinion to people considering going to therapy, who really need help. I’ve been in therapy for 15 years and it’s done me worlds of good. And I once had a really hideious therapist who should be disbarred or disbanded or whatever. Incarcerated for preference. 

But I don’t open the conversation with “I’ve been in therapy for 15 years and once, for a few months, I had a therapist who was awful.” Because there’s so much stigma against getting help, that most people don’t get help when they should, and stay sick, stay depressed, hurt the people in their lives, and don’t become the people they CAN be, because pop culture tells us that psychiatry is fake and wrong. 

So. Is there anyone following this thread who’d like to say that therapy helped them? That their therapist was professional, competant, helped them work out their issues and taught them helpful and adaptive skills? Because of my, like, 10 therapists across multiple offices and universities, that was the majority of my experience. 

obviously therapy helps people all the time, but this thread is specifically about boundaries and therapists breaking those boundaries and how the breaking of certain boundaries with certain patients isn’t seen as unethical for whatever reason. if you’ll notice, a lot of this thread is centered around the treatment of autistic patients, which are at a much higher risk for medical abuse.

so I don’t think this thread is adding to the stigma of getting help, I think this thread is an open and honest conversation about the abuses that are rampant in the medical field, specifically dealing with mental health, and more specifically dealing with patients that are viewed as disabled. and I think you’re derailing that conversation by saying that not all therapists/therapy is bad. we all know that. that’s not what’s being discussed here.

and sure, if you want to start a conversation about people’s positive experiences with therapy, I totally encourage that. but don’t use that to shut down this conversation, which is an important and necessary conversation for all of the people who have experienced abuse at the hands of their therapist.

Okay. I see what you’re saying. I didn’t mean to derail an important topic. I’ll stop now.

Thank you.

And I’d like to add explicitly:

I’ve seen therapy be dramatically helpful for many of my friends. Medication too. I think it’s great when those things work for people, and it’s horrible that there’s such a stigma attached to them. So many people are needlessly pressured into struggling alone.

I think it’s also horrible that the problems with therapy culture make therapy and medication unsafe for so many people who would otherwise benefit from them. I wish it was safer. I wish these things were realistic options for more people.

I also wish that people who have serious problems and address them in ways other than therapy/medication got more respect. Therapy and medication can be important tools, but they are not the only tools.

The stigma of seeking help is large, and can mess people up badly.

The stigma of having a mental illness or other serious problem and *not* going to therapy or using medication, or otherwise being noncompliant, is an order of magnitude worse.

People need to know that the risks are real. People who’ve been mistreated in therapy need to know that they are not alone.

nichtigen:

misohead:

realsocialskills:

oliveseraphim:

realsocialskills:

Not precisely a boundary violation, but boundary related — it’s always helped me when therapists are willing to outline exactly what their legal responsibilities are. For example: when they are required to contact medical personnel. This makes it easier to discuss certain topics without worrying about medical interference.
That makes a lot of sense.
I don’t know how much what they say matches what they do, though. Do you know?

well, i’ve seen psychologists on and off since I was a kid and was even studying to be one so i can say with absolute certainty there is a very strict code of ethics psychs are expected to abide by. I can also say with absolute certainty that this high standard in practice virtually never happens in reality and I haven’t met a single person who *hasn’t* had a psychologist breach confidentiality with such severity that if it was reported they could lose their license to practice. 

I don’t know where the real lines are. But I do know they’re not where everyone says they are.

I’ve never had a therapist break confidentiality, but I know several people who have, and their therapists are still practicing. The existence of widely cited rules does not, in itself, cause those rules to be followed. Rules aren’t magic.

And then there’s the thing where, it’s not breaking confidentiality exactly, but they make helping you contingent on you agreeing to let them discuss things with someone else. (eg: a disability support professional, your medical doctor, a parent, etc).

This is exactly why I am too scared to continue going to a therapist:

The existence of widely cited rules does not, in itself, cause those rules to be followed. Rules aren’t magic.

while I’ve never experienced this, I know just how common it is. from reading the above comments, my suggestion to anyone concerned about the confidentiality of their therapy would be to discuss the exact boundaries your therapist has. and if you want something binding (and have the means,) consider drawing up a contract which details exactly how your therapist should treat your information. some things to consider:

- what information your therapist is and is not allowed to share with others
- with whom your therapist may share this information
   - consulting professionals? your parents? your other doctors?
- under what circumstances can they share your information, if any?
- is your therapist required to retain your anonymity if/when sharing your info with consulting professionals?
- is your therapist allowed to discuss you, your treatment, or your mental state in any publication? (books, scholarly journals, scientific journals, etc.)
- if they are allowed to use your information in publication, must they retain your anonymity through omission or changes in identifying information?

also, do some research on the laws and code of ethics for therapists/psychologists/psychiatrists to see if there are any other concerns you might have.

It seems like the kind of thing that could really easily make someone feel safer without actually changing anything or making it any clearer in which cases someone would violate confidentiality.

But I can imagine that it might work sometimes, too. I personally haven’t seen it, but that doesn’t mean it’s never worked.

Have any of y'all used this effectively, or know of it being used effectively?

the-magical-crawdad:

matchbook-stories:

realsocialskills:

stripesweatersandwaterbottles:

youneedacat:

Social skills for autonomous people: boundary violations in therapy

realsocialskills:

all-women-kick-ass asked realsocialskills:

do you know what particular boundary violations in therapy AREN’T considered unethical? because i am also studying to be a therapist and would very much like to avoid said boundary violations with future clients.


Boundary…


Something horrible one of my therapists did to me:

He told me that because I was I’m the system, I was not a real adult and never would be. And that therefore I would never be allowed to make major life choices without consulting him.

He then told me exactly how he’d manage it. He would make my choices for me. Then he would communicate to my parents such that they would make all my decisions for me.

Another thing he did was hold my sleep disorder against me. He said real adults can control their circadian rhythms and he would not let me make choices until I could sleep all night.

He and another therapist also communicated with my parents, without my permission, signed out otherwise, about me, after I reached adulthood. That’s not only wrong, it’s illegal.

My psychiatrist had a lengthy conversation with my mother that was basically about how if I didn’t take a medication for narcolepsy (after it was clear I didn’t have narcolepsy), my life would go to hell in a handbasket and I’d lose all my friends because I didn’t care enough to take care of myself.

Same shrink decided that the only valuable course my life could take, was to overcome my autism, and go on to become another Temple Grandin. He wanted me to become a psychiatrist just like him, work with autistic children, and contribute to autism research. Anything less than this and my life would be a waste.

This was combined with another huge boundary violation:  He basically every time I went along with his plans for me, he wrote that I was making progress and becoming higher functioning. If I went against his plans for me, he’d say I was regressing, becoming lower functioning, or ruining my life.

Going against his plans for me was one of the best things I ever did. It was my first step towards being able to run my own life and my life has gotten better and better since.

Mind you, he was probably my best shrink. But not realizing the power he had, he abused it without even trying.

Another shrink told me that I would never be able to think for myself. That it would probably kill me to do so.

Same one told me that he was going to get inside my brain. Create a version of himself that lived inside me. Kill off the me that lived in there. And replace me with a version of me he built himself. And then climb in there with me so I couldn’t disobey him anymore.

I don’t know what the hell he did to me but there’s still remnants nearly two decades later.

And that’s just off the top of my head. All of these things are in the category of things you should never ever do to someone.

The easiest to do accidentally are protecting your goals for your patient onto them. And then seeing moving towards those goals as progress, moving away as regression. Watch out for that.

I’d also recommend the video, the ethics of touch, by Dave Hingsburger. It’s not just about touch, it’s about boundaries in general.

I have had my sleep issue be ignored, glossed over, and have even had a therapist get angry with me because I was so desperate for sleep I wasn’t getting and they thought it didn’t matter. Literally “so?“ was said many times. Everyone thinks that my complete inability to sleep without meds/enough meds is my fault snd if I can’t sleep even with meds then it is clearly my fault bc i must be doing something wrong. This attitude coming from s therapist whom I enjoyed and trusted up until the last year I was in school, was damaging.

A lot of people I know who have sleep disorders have been emphatically told that it’s just because they’re practicing poor sleep hygiene and if they’d just try harder their problems would go away.

when i met her my roommate told me by way of explaining something that i did not catch, “because (she) practice(s) sleep hygiene." 

she is a shrink. is sleep hygiene a shrink thing? is it trendy? It looks like a buzzword. I’ve read about all that stuff before back when I had insomnia issues, and I don’t remember it ever being called ~*~sleep hygiene~*~.

I feel like it’s kind of weird to call it hygiene when it’s about habits, not cleanliness. like…keeping irregular hours or eating before bed doesn’t make you dirty.

idk it seems like a stupid name for a thing.

I didn’t stay with my psychiatrist very long, but it was long enough for me to realize I didn’t want her in my life. I am biologically intersex and mentally agender (if that’s a thing, it’s how I feel) and it took me a long, long time to become comfortable with that, to understand my difference and realize that just because it made me different it did not make me a lesser person. My psych outright ignored my request not to grill me over it, after I had provided her my emotional journey through it (psychs need to know where you’re at, right??? I felt it was an important part of what makes me me, the strength I gave myself when I stopped hating myself for that), and devoted all of her time to weaseling more and more sensitive, near-triggering memories of that time from me. Demanded I take a look at support groups and hormone specialists to fix my ‘problem’.

I told her precisely where she could shove her bigoted, self-centered demands and left. So I guess when someone tells you that they’re happy with who they are, or some aspect of themselves, don’t immediately launch into an attack as if that site has a huge red bulls-eye targret on it.

God that lady pissed me off and left me in panic attacks after seeing her every week for four months.

This.

And, more generally - if a therapist doesn’t care what *you* want to work on, and seems to prioritize triggering you over helping you figure out how to deal with the problem you’re seeking help with, something is seriously wrong.

cosmicfingertips:

realsocialskills:

apheline:

Social skills for autonomous people: boundary violations in therapy

realsocialskills:

do you know what particular boundary violations in therapy AREN’T considered unethical? because i am also studying to be a therapist and would very much like to avoid said boundary violations with future clients.
Boundary…

Assuming that just because someone is able to verbalise certain things (for example, answering questions which they have scripted) that they can verbalise what they are feeling, wanting, or needing currently. I have had therapists and others assume that it is a kind of refusal to discuss something when in fact I just didn’t have the ability to communicate it verbally.

This. I think the way therapists act is probably a major contributing reason that a lot of autistic kids cover their disabilities by pretending to be acting out on purpose.

this is one of the reasons I love the T.E.A.M. system my current therapist uses. after every session you rate your therapist on a lot of different things (“my therapist was caring and supportive. my therapist understood how i felt. they suggested useful things that i am going to try.”) on a scale of 0 to 4, and you also answer questions about how honestly you answered the other questions (“it was difficult for me to answer these questions honestly. it would be too difficult to tell my therapist if things weren’t working” that kind of thing.) I don’t think it’s a coincidence that the fact that my therapist uses this system AND just happens to be the therapist I’ve felt most comfortable with and felt most productive with, out of the six or seven or so I’ve seen over the past few years.

Wow, that sounds awesome.

voltron-da-eclair:

realsocialskills:

aura218:

realsocialskills:

stripesweatersandwaterbottles:

youneedacat:

Social skills for autonomous people: boundary violations in therapy

realsocialskills:

all-women-kick-ass asked realsocialskills:

do you know what particular boundary violations in therapy AREN’T considered unethical? because i am also studying to be a therapist and would very much like to avoid said boundary violations with future clients.


Boundary…


Something horrible one of my therapists did to me:

He told me that because I was I’m the system, I was not a real adult and never would be. And that therefore I would never be allowed to make major life choices without consulting him.

He then told me exactly how he’d manage it. He would make my choices for me. Then he would communicate to my parents such that they would make all my decisions for me.

Another thing he did was hold my sleep disorder against me. He said real adults can control their circadian rhythms and he would not let me make choices until I could sleep all night.

He and another therapist also communicated with my parents, without my permission, signed out otherwise, about me, after I reached adulthood. That’s not only wrong, it’s illegal.

My psychiatrist had a lengthy conversation with my mother that was basically about how if I didn’t take a medication for narcolepsy (after it was clear I didn’t have narcolepsy), my life would go to hell in a handbasket and I’d lose all my friends because I didn’t care enough to take care of myself.

Same shrink decided that the only valuable course my life could take, was to overcome my autism, and go on to become another Temple Grandin. He wanted me to become a psychiatrist just like him, work with autistic children, and contribute to autism research. Anything less than this and my life would be a waste.

This was combined with another huge boundary violation:  He basically every time I went along with his plans for me, he wrote that I was making progress and becoming higher functioning. If I went against his plans for me, he’d say I was regressing, becoming lower functioning, or ruining my life.

Going against his plans for me was one of the best things I ever did. It was my first step towards being able to run my own life and my life has gotten better and better since.

Mind you, he was probably my best shrink. But not realizing the power he had, he abused it without even trying.

Another shrink told me that I would never be able to think for myself. That it would probably kill me to do so.

Same one told me that he was going to get inside my brain. Create a version of himself that lived inside me. Kill off the me that lived in there. And replace me with a version of me he built himself. And then climb in there with me so I couldn’t disobey him anymore.

I don’t know what the hell he did to me but there’s still remnants nearly two decades later.

And that’s just off the top of my head. All of these things are in the category of things you should never ever do to someone.

The easiest to do accidentally are protecting your goals for your patient onto them. And then seeing moving towards those goals as progress, moving away as regression. Watch out for that.

I’d also recommend the video, the ethics of touch, by Dave Hingsburger. It’s not just about touch, it’s about boundaries in general.

I have had my sleep issue be ignored, glossed over, and have even had a therapist get angry with me because I was so desperate for sleep I wasn’t getting and they thought it didn’t matter. Literally “so?“ was said many times. Everyone thinks that my complete inability to sleep without meds/enough meds is my fault snd if I can’t sleep even with meds then it is clearly my fault bc i must be doing something wrong. This attitude coming from s therapist whom I enjoyed and trusted up until the last year I was in school, was damaging.

A lot of people I know who have sleep disorders have been emphatically told that it’s just because they’re practicing poor sleep hygiene and if they’d just try harder their problems would go away.

These stories above are bizarre, like, 60s shit. This is so far beyond ethics and legality it’s unbelievable. That should NEVER have happened and is NOT the norm or typical of ANY kind of therapy.

The Judge Rotenberg Center openly uses electric shock and food deprivation as behavior modification techniques.

Given that, which part of what youneedacat described is something you think no longer happens?

One of my first jobs was at an “autism treatment center” as tutor in a preschool and then kindergarten/first grade classroom. As part our our “treatment,“ we used aversive consequences on children as young as 18 months, including but not limited to taste aversions (vinegar spray, cayenne pepper, etc), making kids stand up and sit down up to 100 times in a row, screaming at them, putting them in padded rooms for periods of time, physical restraints, spraying water in their face, etc. That was just the obvious abuse… which of course was signed off on by parents and a “human rights committee.” The psychological abuse was much more prevalent, nuanced, and frightening.

I’m not saying that therapy is bad or that no one should ever get therapy. Therapy is incredibly helpful for some people.

But there are also major problems with the way therapy culture sees boundaries, and the way therapists are taught to relate to seriously atypical people.

The problems are especially bad for people who have developmental disabilities, brain damage, or severe mental illness.

For instance, a white able bodied person is likely to be able to find someone who can help them treat their depression and still respect their boundaries and treat them like a person, especially if their depression responds well to medication.

Likewise, it’s usually possible for white women to find a therapist who will help them learn how to have boundaries women are often socialized not to have. 

It’s a lot harder for a developmentally disabled person to find a therapist who will help them learn how to have boundaries they were socialized not to have. And it’s very easy to end up with a therapist who will make matters worse.

It’s not just a matter of there being some bad people in therapy the same way there are in any other spaces. There are actual problems. And, while therapy can be very helpful, it can also be very dangerous.

That’s something that people in therapy or considering therapy need to know.

boundary violations in therapy

all-women-kick-ass asked realsocialskills:

 

do you know what particular boundary violations in therapy AREN’T considered unethical? because i am also studying to be a therapist and would very much like to avoid said boundary violations with future clients.

Boundary violations that aren’t considered unethical:

  • Teaching people not to trust their own judgment
  • Telling people their reservations about therapy are just a symptom of their disease
  • Equating wanting to stop therapy with wanting to give up on improving one’s life. Those things are different.
  • Insisting that people speak verbally or make eye contact as a precondition for working with them
  • Insisting that someone repeat details of sexual abuse over and over, even when they are coming to you for help with something largely unrelated
  • Threatening to have someone institutionalized if they stop taking medication
  • Ignoring someone’s concerns about medication side effects
  • Asking questions in a way that makes it impossible for someone to refuse to answer

Any others y'all know of?

More on good therapy

A good therapist will be honest about their qualifications, and respect your expertise.

For instance:

  • A good therapist will not claim to be an expert in gay issues just because they are a good person and don’t hate same sex couples
  • A good therapist will believe you about religious conflicts, and won’t attempt to dictate to you how to resolve them (eg: If you can’t eat certain things, or need to wear certain clothing around members of the opposite sex, or can’t do certain things on certain days).
  • A good therapist will be honest about which conditions they do and don’t have experience treating

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?

realsocialskills said:

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

Getting therapy doesn’t mean renouncing all boundaries

If you want to try therapy (OT/PT/psych/CBT/whatever):

  • Keep in mind that you’re under no obligation to do so
  • You should do it if it helps you, and not if it doesn’t
  • It’s ok to judge this for yourself
  • If the therapist doesn’t respect you, find a different one (if you still want to continue trying therapy; it’s ok to decide not to)
  • If the therapist seems to prefer for you to be in pain, that’s a problem
  • Whether it’s emotional or physical pain
  • Some therapy inevitably involves a certain amount of pain, but it’s a major red flag if a therapist seems to be pursuing it as an end in itself
  • You do not need your therapist’s permission to quit
  • If they keep convincing you in person to continue, but you always want to quit when you’re not with them, it’s ok to end the therapy over the phone or email
  • Or to just quit making appointments
  • Some therapists are really good at manipulating people into doing things that are bad for them, and you don’t have to cooperate with that