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Old 09-14-2018, 08:14 AM   #1
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Default Therapy failure

I failed therapy or therapy failed me. Whose “fault” it is/was – to the extent that my faults were to blame, I was in therapy to try to identify and correct or accept my faults. To the extent that therapy was to blame – nobody much is looking much to identify the faults and correct them or accept them and inform potential clients.

There are some exceptions. The quote

Quote:
Interviewer [Male Voice]: In your recent book Prevention of Treatment Failure you talked about the fact that some patients do get worse in the course of psychotherapy. How common is the problem, what are the causes?

Michael Lambert: In adults who enter treatment, the rate is about 5–10 percent. In children and adolescents who seek treatment, the rate is about 15–25 percent. So it's relatively rare in adults but all too common in children. And the major causes are external events that set people back like a divorce or a death or loss of a job, so it's environmental. And then within the therapy itself, it's usually related to some kind of rejection that the person experiences while they are working with their therapist. It's usually not related to specific therapy techniques but to relationship factors where the patient feels misunderstood, uncared for, or neglected in some way.
From the article

Interview With Michael J. Lambert About "Prevention of Treatment Failure"

has a explanation for therapy failure that seems relevant in my case, I think.

I did feel rejected by my last T, and some others before her. And to the extent, as I have learned since the therapy ended, that I had unprocessed experiences of feeling rejected from early in my life, that made me vulnerable to feeling rejected, again, in therapy probably.

At the risk of sounding boastful, this seems to me like a potentially useful insight, from me to therapists – if any of them were interested. When my last T got haughty and shamed and rejected me – she later “knew” what she had “done”, I think, and was then caught up in her own shame and defensiveness about that so there was no way that my rejection experience could enter the room and be talked about.

If this were a recognized “thing” that can happen in therapy, then perhaps some strategies to help identify and deal with it, within an existing therapy relationship could be developed. So, OK, it was my last T’s issues and countertransference, which she “hadn’t done her own work” about, but perhaps she wasn’t entirely aware of it, either. Her fault, not mine, but I paid the price. Not “right”.

Nevertheless, moving on. . .
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Old 09-14-2018, 08:32 AM   #2
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Default Re: Therapy failure

I feel the same way....sorry, it hurts!
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Old 09-14-2018, 08:41 AM   #3
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Default Re: Therapy failure

Based on your descriptions of your experience, it seems to me that not only you felt rejected by your last T but she really rejected you by saying that she cannot handle your stuff.

I'm actually curious what exactly happened with this last T? What did you do that made her feel that she cannot handle you anymore? Have you written about it in more detailed way somewhere in this forum?

As far as devising methods for preventing such things, I guess you would not be surprised that I am sceptical. This is not something you can teach in classes and too many factors are very subjective. Everyone is in their journey to self-awareness precisely where they are and this applies to T's and clients both.

My guess is that for the majority of patients, not much self-awareness is necessary because these people just don't have the problems that would evoke major counter-transference issues. It would be stupid to ban such T-s because they serve the majority of patient population perfectly well.

Then there are cases that are very difficult and I suspect that you are on the more difficult end of that difficult spectrum. And so am I. And similar to you, I did not know that and so did not my T when we started. And how could either of us know?

My T has told me that I am her most difficult patient and I believe him. In that sense I am his training case, through my case he is learning stuff that he did not know before and it has not been easy for him. He recently admitted that ca two years ago there was a long period when it was extremely difficult for him to be with me because he felt I was constantly attacking him, belittling him, taunted him. He survived it but someone else might not have survived. I don't think it is a matter of training and I don't think you can teach anyone to survive and tolerate such things if the person is not in that level in his own self-development. At the same time, you can't describe and define such level of self-development and self-awareness. In short, I think the problem is too ill-defined to any kind of formalization. It's a messy stuff and if you're lucky (as I have been) then it can bring along a lot of good and when you're not so lucky (as you seem to have been) then there can be lots of obstacles in the way. But that's how life is in general and in that sense it's ok.
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Old 09-14-2018, 09:16 AM   #4
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Default Re: Therapy failure

I was aware that things that I felt toward the last T included some negative transference. I could still turn those bad feelings "off" for the general sake of "getting along", but I was in therapy, so I thought it was best not to.

I would not ban T's with such counter-transference issues, but I would like to raise awareness among them of the effect on clients when that happens. It can be very harmful. I do think some training in recognizing clients with the kinds of rejection issues I had could be helpful -- how, I'm not sure. I could come up with some ideas, but I'm just suggesting right now that it is an issue that deserves to be raised. I expect others might come up with ideas, too.

It's not OK in my book to say that you were lucky and I was not. It seems OK to you, I can understand that, but it does not seem OK to me. No, there are things in life that are not OK. Doesn't mean they are going to go away, right away at least, but they are not OK. And eventually, some of those things do get better or go away -- although others replace them. Nevertheless, the general history of humanity is that we do sometimes recognize problems and make improvements.

OK with non-OKness, I can go with that. But strive and argue for improvements -- that's a choice I'm happy to make.
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Old 09-14-2018, 09:26 AM   #5
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Quote:
Originally Posted by here today View Post

It's not OK in my book to say that you were lucky and I was not. It seems OK to you, I can understand that, but it does not seem OK to me. No, there are things in life that are not OK. Doesn't mean they are going to go away, right away at least, but they are not OK. And eventually, some of those things do get better or go away -- although others replace them. Nevertheless, the general history of humanity is that we do sometimes recognize problems and make improvements.
I don't know. I was extremely unlucky in terms of my parents and any adults that figured in my life in childhood. I could say that it wasn't ok and it's not ok but what does that accomplish. I am saying that it's not ok in terms of that I have strived to be and I am million times better parent to my own children. It does not compensate what I missed out though.

I guess what I'm trying to say that the change always happens in the level of particular people. You can't demand someone to change the whole system. The only thing you can do is to try to do something yourself (and I realise that this is what you are trying to do in some sense in this forum by raising these issues). But somehow I get the sense (maybe wrongly) that you would like to someone else to do something about it and I don't have much belief in that.

People do things that they find important. This topic is important to you, it's probably not that important to the majority of therapists because they never meet a patient like you. They can go through a course or whatever and it all remains a distant theory to them because they don't have the first hand experience of what it really means. And thus they are not interested. Why should they?

You are interested because it has affected you. I am interested because it has affected me but because it has affected me differently (I experience huge gratitude towards my T because when I contemplate what he has done for me then it looks unbelievable) and thus my interest is different. I would like to pay it forward if I can. I don't know yet if I can but if I can then I would like to do that.
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Old 09-14-2018, 09:29 AM   #6
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Default Re: Therapy failure

HT, I also can't help and really wonder what you actually did to that therapist. Because you keep posting about this story and the rejection, but I don't recall ever reading what exactly was rejected by her. Negative feelings,transference, okay, but what did really happen in your therapy?
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Old 09-14-2018, 10:17 AM   #7
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Here Today,

It's really crappy that those of us who can evoke strong countertransference feelings in our therapists also tend to be the ones told how therapy is the only way we can heal. If we're not outright told that we're "untreatable", "manipulative", "difficult"...

I might be projecting my own stuff as I've a personality disorder and have heard of similar reactions from therapists with some friends of mine with DDNOS/DID and/or with personality disorders... The T couldn't handle certain parts/modes, especially angry part(s), the T couldn't manage their countertransference issues (all written about in clinician books for treating the spectrum of complex trauma from personality disorders to polyfragmented DID)...and if I remember your posts right what happened was similar...

I believe you.
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Old 09-14-2018, 10:21 AM   #8
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Default Re: Therapy failure

HT Thank you for the article. I read it with interest.

It is almost like in order to function, T's must believe patients are improving, and have cognitive distortions of their own ( just called "silver linings"here) . Seen that way, it is like if a patient is struggling to the point of breaking through that distortion, the therapist is threatened in the core part of where they find motivation if they are not resourceful and trained to deal with what the client brings into the room.

I too am on the difficult end, but my T has spent a career dealing with horrific stories and seeing people recover ( PTSD). I think he brings that tolerance for emotional stress to me ( CPTSD) so he can handle downturns, even steep ones( red feedback) without losing sight of an overall future story arc in which he succeeds and I get better . In this case, the experience of succeeding gives the T some tolerance of apparent failure without throwing in the towel.

I dont think you would be in that 5-10 percent if you had my T, or a T like that able to tolerate a long red challenge to silver lining thinking for an extensive time and stay emotionally present and creative. I also think if I went to the T you describe you went to see, I would be the 5-10 percent, instead of now gaining ground. I do not think you failed therapy or that all of Therapy failed you, but I think your specific therapy failed you big time.

It is not you.

All of this is to say I don't think it is something about you, HT, but about the specific T(s).
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Old 09-14-2018, 11:43 AM   #9
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Quote:
Originally Posted by Xynesthesia View Post
HT, I also can't help and really wonder what you actually did to that therapist. Because you keep posting about this story and the rejection, but I don't recall ever reading what exactly was ejected by her. Negative feelings,transference, okay, but what did really happen in your therapy?
Thanks. I'll try to write down a concise history that still includes the relevant stuff, at least as best as I can tell.

It will need cooperation, and some switching back and forth, between my "activated" self and my rational self so it may take a day or two, but a very good idea. Thanks for your interest.

The main thing -- the rejecting element -- came when she said she lacked the emotional resources to continue. Rationally, that makes sense. But to the activated self it was/is a rejection. (WARNING, ACTIVATED SELF NOW SPEAKING.) My stuff is/was too much. A lifetime of trying to get to it, and it was too much! How on earth was I supposed to find a "good fit"? I'd tried and tried -- and this was a person recommended by an international-level author and trainer in trauma and dissociation who lives in my city!! Where in the world --ANYWHERE -- is there someone whom I'm not "too much" for? Who can accept me? Who can help me find socialization skills to help me, if that's the problem? DBT is not for me -- I had overcontrol issues and the notion of "wanting" a relationship (by my emotional self) was absent, so the interpersonal effectiveness module wouldn't work. Therapists (in the past) couldn't hear that, they just blamed me! Of course!

So, it's not just the last T, it's ALL T's and THE WHOLE WORLD. NOWHERE IN THE WORLD ARE THERE ANY OTHER FEMALES WHO CAN ACCEPT ME. I CAN GET ANGRY AND "AGGRESSIVE" AND THAT'S NOT OK. ANYWHERE. THAT'S WHAT I LEARNED AS A CHILD AND STILL HOLDS TRUE.

Seeing any reenactment here, anybody? But how would/could this (ideally) end? How could I, rationally, have known how to select a better T? It is really too much for the profession to expect that of those who have parts cut off. It hurts us. Our lives are wasted. Maybe they don't care -- maybe the whole society doesn't care -- but I, now, care.

That's something. Actually, maybe a lot. Thanks for allowing me a chance to be heard.

Last edited by here today; 09-14-2018 at 12:03 PM..
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Old 09-14-2018, 12:05 PM   #10
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Hm. . .I didn't realize I had posted something and then edited it. Usually, I don't lose time.
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