120: Ten Worst Errors Therapists Make

This is David and Fabrice’s top ten list for the worst errors therapists make.

1. Failure to Measure (symptoms, empathy and helpfulness). Research shows that therapists’ perceptions of how their patients feel, or feel about them, are not accurate.

TEAM therapists measure symptom severity at the start and end of every therapy session with brief accurate scales that assess depression, suicidal urges, anxiety, anger, relationship satisfaction, and happiness. This allows therapists to see, for the first time, exactly how effective or ineffective they are in every single therapy session. This can be threatening to the therapist’s ego, but has revolutionized clinical practice.

In addition, TEAM therapists assess the patient’s perception of therapist warmth, empathy, understanding, and helpfulness after every single session. The scales are extremely sensitive to therapist errors, and most therapists receive mostly failing grades from their patients initially when they use these scales, which can be a shock to the system! But dialoguing with the patient about the scores at the next therapy session can lead to breakthroughs in the clinical work and dramatic improvements in the quality of the therapeutic alliance.

2. Trying to help, “save,” “rescue” or “reassure” patients. Most therapists are addicted to this, but it simply triggers resistance. When therapists push in their efforts to help, most patients will push back. No one likes to be “sold” on anything. When patients are hurting, they want to be heard, not saved.

In TEAM we do Paradoxical Agenda Setting before trying to “help.” We emphasize, in a respectful way, all the really GOOD reasons NOT to change. We also highlight what the patient’s symptoms, such as shame, depression, panic, defectiveness, hopelessness and anger, show about him or her that’s positive and awesome, Then we raise the question: “Given all those positives, why in the world would you want to change?”

This strategy has led to breakthroughs in treatment, and I now see recovery from depression and anxiety at rates I would have impossible ten or fifteen years ago.

3. Reverse Hypnosis.

  1. Depressive hypnosis. The patient persuades the therapist that s/he really is worthless, inferior, and hopeless, and the therapist false into a trance and believes it! This dooms the therapy.
  2. Anxiety hypnosis. The patient persuades the therapist that s/he is to fragile to use exposure, or that the exposure is too dangerous, and the therapist buys right into it! This also dooms the therapy. Recovery from anxiety is more or less impossible without exposure.
  3. Relationship hypnosis. The patient persuades the therapist that s/he is the victim of some other person’s bad behavior, and that the other person is entirely to blame for the relationship conflict. Therapists almost always buy this message, and this also dooms the therapy.

4, Believing therapy must be slow and last a long time. This is taught in most graduate school programs, and tends to function as a self-fulfilling prophecy. I met a famous psychoanalyst who was proud that most of her patients had been in therapy for more than ten years, and a few were just now making baby steps, she said, toward change.

With TEAM, I usually see a complete elimination of symptoms at the first therapy session, although it has to be a double session (two hours). In addition, the recover usually occurs in a burst, all at once, in just a few seconds, or in several sudden orbital leaps during the session.

5. Believing that the purpose of therapy is to get in touch with your feelings (Emotional Reasoning). This message has been pushed for years, and was the basis of my training. The idea was that people bottle up their feelings, like anger, and then it comes out as depression. The message is still pushed today!

I’ve never seen much validity in this point of view. People can express their anger, their panic, and their feelings of worthlessness until the cows come home, but they’ll still be just as angry, panicky, and they’ll still feel worthless!

There is at least one notable exception to this rule. Most anxious patients are exceptionally “nice” and sweep their feelings under the table. Then the feelings come out indirectly, as OCD, panic attacks, GAD, or a phobia, or even as somatic complaints such as chronic pain, fatigue, or dizziness. Bringing the suppressed feelings to conscious awareness and expressing them is the basis of my Hidden Emotion Technique, and it often leads to a sudden and complete recovery from any form of anxiety.

6. Confusing your own feelings for how the patient feels. This is a psychoanalytic error. I read an article on the psychoanalytic view of empathy, which was defined as the analyst’s feelings when in the presence of the patient. This is a misguided and almost delusional notion. The analyst’s feelings are the complete creation of the analyst’s thoughts! And those thoughts will often be distorted and completely misleading.

Therapist’s perceptions of how their patients feel are less than 10% accurate if you put it to an empirical test! If you ask patients, “How are you feeling right now,” and you ask therapists the exact same question, “How is your patient feeling right now,” the therapist’s answer will usually be way off base.

The only way to find out is to use assessment instruments at the start and end of each session, like I described in the first answer above, on failure to measure.

7. Believing therapists should never express their feelings. I was trained never to reveal how I was feeling. But when you think about, that’s nutty! How can we validly encourage our patients to be more genuine and open with their feelings if we are hiding our own at the same time? Of course, there is an art form in how to share your feelings during therapy. It is a high skill, requiring training, and one that can lead to more human and effective treatment.

8. Believing that you are an expert and know the causes of things, and why patients think, feel, or behave as they do. The causes of all psychiatric disorders are unknown. End of discussion. And yet, almost all therapists promote some fraudulent theory about causality. For example, what is the cause of depression?

There are lots of theories, but none has been confirmed, and almost all have been disproven. For example, there is no evidence whatsoever that depression results from a “chemical imbalance in the brain,” or from “anger turned inward,” and so forth. Those are just theories that someone made up.

I simply tell my patients that we don’t yet know the causes, but have really terrific treatment tools now for rapid recovery. That’s more than enough for the people I treat!

9. Confusing the process of therapy with a good outcome. For example, as a therapist, you could be doing really great job of listening, and give yourself high marks as a therapist because you believe in the importance of empathy, even though your patient is not improving.

Therapists have all kinds of things they’ve been trained to do, like hypnosis, or EMDR, or cognitive therapy, exposure therapy, or meditation, or an exploration of childhood traumas, or whatever it is you do and believe in. But if you’re not seeing rapid and dramatic recovery in your depressed and anxious patients, as documented with session by session testing, you’re not really “helping.”

10. Believing that insight will lead to change. This has only happened once in my career! It was a woman who discovered that she thought she always had to be submissive servant in intimate relationships. Not surprisingly, she always felt burned out and broke up with her partners after a while. She said that the discovery of this pattern when we did the Interpersonal Downward Arrow Technique during our first and only session transformed her life.

But usually, much more will be required. That’s why I have developed 50 methods to help patients change the way they think, feel, and behave. Correction—I have recently developed 51 additional powerful techniques, so now we have 101 ways to untwist your thinking so you can enjoy greater happiness, intimacy, and productivity!

Now, here’s the 60 thousand dollar question. Can therapists learn to stop making these errors? In most cases, the answer is NO! It’s not so much a problem with intelligence or aptitude, although those are important factors, but it has to do with motivation. Many therapists simply do not want to change, and are committed to what they’re already doing, in much the same way that people are committed to their religious beliefs, which they are unwilling to challenge.

That’s why it is so much easier to train young therapists, whose minds are still open, as well as lay people who do not have so much prior “training” they have to overcome.

Well, that’s my cynical side coming out, and I apologize! Still, I think I’m right for the most part.

Hey, if you liked my rant, I have at least five more common therapeutic errors on my list, so let Fabrice and me know if you’d like to hear about therapist errors in a future podcast. In addition, if you’d like to add to our list of therapist errors, let us know what your “favorite” (or most annoying) therapist error is!

Thanks!

david

Subscribe

Dr. Fabrice Nye currently practices in Redwood City, California and also works with individuals throughout the world via teletherapy (although not across U.S. state lines). You can reach him at fabrice@life.net. You can reach Dr. Burns at david@feelinggood.com. If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

12 thoughts on “120: Ten Worst Errors Therapists Make

  1. Hi Fabrice and David, thanks so much for a great episode. I quickly determined it was a good episode to introduce my sister to the show. She has a degree in psychology and was interested to learn the differences of TEAM compared to most models of therapy.

    I do have a question though… something I’ve been wanting to ask for a while…
    About a year ago I started working on the 5 Secrets. I was most affected by the Disarming technique. I found such truth, power, and humility in it and I continue to work at it knowing that I still often default to a defensive tone when I’m accused of something. However, I must say that there’s something you often mention that I haven’t found to be true in my case. When I listened to early episodes you used to highlight the paradox that happens when you find the truth in what people are accusing you of. Then I started working on this and for a while, over many months, I started to think maybe you were moving away from that idea because it seemed to be discussed less (or not at all) when Disarming came up in the show. But more recently you brought it up again (I believe in the interview with Stephanie James). So my question is, are you sure there’s ALWAYS this paradox where the person stops believing what they accused you of? While I will say there has been 1 or 2 times where the person responded by back-tracking a little, or maybe restating their accusation in a more gentle way, for the most part this hasn’t been true for me.
    I will say even without the paradox I still find SO much value in Disarming, so I am still very much committed to it. I love that it honors the other person so much and it completely kills the urge to start a fight.

    Thanks for your integrity and commitment to real help!

    • Thanks for the excellent question. Sadly, you are not giving a specific example. All the learning, and the only learning, comes from helping you with a specific example. So if you can provide one, then we can turn on the lights, so to speak. It is a hard concept to grasp, due to our humanness and compulsion to defend ourselves, and the idea can NEVER be truly grasped on the general, philosophical level. What, exactly, did the other person say to you that you had trouble finding the truth in? All the best, david

  2. I love the cranky Dr. Burn’s because he is right in that it’s ridiculous for people to believe that therapy should take years to help. Baloney! I’m all for a two-hour session thank you very much, one that focuses on a specific problem (procrastination, perfectionism, etc. and the tools needed to fix it. And Relapse Prevention to prevent the inevitable relapses. Lastly and most importantly (my opinion) is that the patient has to do the homework as prescribed. I love that David requires that and if the patient doesn’t want to do it then find another shrink.

    Hope you guys have a great Christmas and holiday season Keep up the terrific work!

    Phil

  3. I LOVED this! Thanks so much! More please!

    This is the first time I’ve heard about the downward arrow technique. I googled it and am now practicing with a friend.

  4. Wow! This is your best podcast yet – and my favorite so far: direct, clear and to the point.
    I’ve certainly seen some really disappointing therapists in my search for healing. I’m a child abuse survivor, so in my experience one error my therapist made was *Blaming The Victim* maybe you and Fabrice could please give us your take on that.

    And I’m also dying to learn about your exciting new technique to turn Procrastination into Productivity – so please share!

    Thanks a million for your hard work in spreading the hopeful word to all of us who are looking for real answers and healing. I wish you a happy (and mentally healthy) new year!

    • Thanks, Christine. I really appreciate your supportive comment since I was worried I was sounding too much like a grump! We had a podcast on how to overcome procrastination. You can search for it on this new podcast page: http://feelinggood.libsyn.com/ Let me know if that works for you! David

      • Dear Dr Burns,
        You never have to apologize for being a grump nor for being a little cynical. Be thankful for those qualities because it is your excellent critical thinking skills, healthy skepticism and willingness to ask the difficult questions that have allowed you to develop so many wonderful and powerful tools and techniques to help people find real healing and finally get rid of their pain and suffering. I think we just did some Positive Reframing there? LOL
        Anyway, please don’t change a thing you are doing – just keep doing it.
        All the best,
        Christian

      • Thanks, Christian, I appreciate your comments and agree with you, I think. I believe our field is in desperate need of critical thinking to challenge so much BS that tends to sometimes dominate the field of psychotherapy and psychopharmacology as well! Glad to hear there is a receptive audience to my “grumpiness!” Will try to continue with some grumpiness in 2019, thanks to your encouragement! david

  5. Thank you David for this most enlightning podcast.. Looking back on my therapy experience (several yrs.ago), I was most fortunate to find success and have continued working with the ‘tools’ I learned from an excellent therapist, After studying the 10 mistakes, I could only find one that I can pinpoint from that therapist.. lucky me. Keep the info. coming, it has benefited my greatly, and I look forward to each time I click and your site is there.

Leave a Reply