treating people well in therapy

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

Another thing about therapy

A good percentage of people who need therapy only get it after repeatedly failing at things everyone around them can do. (Especially developmentally disabled children). This is often humiliating.

This means that therapy can be triggering. Therapy involves focusing on difficulties that someone has learned to regard as humiliating flaws. It’s important to keep this in mind when you give therapy.

Don’t expect someone to trust you right away. You have to demonstrate that you are trustworthy. You have to show them that you can be relied on to treat them respectfully. You have to demonstrate that you won’t ever regard them as broken, or make respecting them contingent on them progressing toward a cure.

And it needs to be true. You can’t just affect safety and kindness. You have to actually be trustworthy in a deep way, and let that show through your action.

You don’t get to decide when you have established trust; you don’t get to decide when someone receiving therapy should feel safe. It’s up to the person getting the therapy. (Even if they are a child.)

And if you understand this, you’ll be much more able to help people.