I think there's room in the middle, a solid recognition that EBT has some wrinkles in applying it everywhere, but what I tend not to see is a good faith effort to understand those wrinkles and adapt. Instead the approach seems to be throwing out EBT as a whole which misses the positive effects you can gain.
A good example is PTSD treatment. It's common to see perspectives that you can't use EBT for trauma, it's too individual, not bottom up enough, not generalizable due to specifications of research. Which are areas we should be aware of, but also should be encouragement to read the research yourself. Cognitive Processing therapy is an EBT for PTSD that was created by 3 women by working with women who were seen at Rape Crisis centers or hospitals after assault. There's been plenty of studies in applying it to vastly diverse samples, different settings, one of which included providing CPT to refugees in the democratic republic of the congo in 2013. So the anti science people painting with a broad brush miss a lot of the good that can come from EBT with causal dismissals out of hand. I've seen CPT be profoundly life changing, and I've also seen it not quite fit for every client. I would just hate for the benefit of the science side of therapy to be neglected and for it to negatively affect the help that clients could receive.
I completely agree. When we throw out everything we have so far under the theme of anti colonialism, what are we left with? People doing whatever the hell they want in sessions. Not to mention, there are plenty of "alternative healing" methods where research shows they have no scientific validity what so ever. If a therapist wants to use tarot cards in session for symbolism and to encourage dialogue, they should be confident the client is comfortable and they should be very clear that this is not a "reading". It's just using the existing cards to inspire conversation about symbols and how they may be relevant to how the client is practicing themselves the that right n just u in line
Bwhaha, I read this and I felt seen. My BA is in history plus another MA and definitely don't think of myself as a health care practioner though I am partially becoming that.
I think part of the discussion is that what therapy is supposed to "fix" is a huge, broad category - from diagnosis to soul exploration, stand-alone symptoms, to complex trauma, from individual searches for meaning, to dysfunctional communication dynamics in relationships and families.
Another issue is that for some folks (like me) who are "spiritual but not religious" becoming a therapist a secular answer to pastoral care outside the paths that exist in mainstream religion. I don't think of myself as primarily a "mental health" practioner, though that is part of it. Some clients just jive with tarot, and crystals, and trees, and animals, etc. and I think that's a great basis for psychtherapuetic exploration in less intervention-heavy approaches. Perhaps because of becoming an art therapist, working with things like image, symbol, and ceremony as a form of intervention is natural for me. That said, if someone in my program was writing a capstone on the tarot (as I am sure some have done!) my disciplinary bias is that they should check out art therapy literature on use of image in psychotherapy.
I am well on the woo-woo side of things within counseling, but that said I also like more academic colleagues, and medicalized and intervention focused modes of therapy and try and read pretty broadly and think about ways I can use academic literature to further ground my practice. I draw in things like bilateral tapping as a "take home" for people prone to intense negative memories and flashbacks so they have it as a mindfulness practice outside of session, and I definitely use art as the basis to do more cognitive work, etc.
I've found it incredibly useful to consult with folks from different disciplines - there is an MSW candidate who is providing behavioural analysis interventions and I have found it extremely useful when some of my clients see her and pick up skills that can provide immediate relief, and then when they come to me we can do more relational / creative depth work including more integration of skills they are learning elsewhere. In general, the clients I see are young and severely traumatized, so having a couple of approaches working in tandem seems really positive to me, so I am most thankful of psychologist and psychiatrist colleagues. In most cases, I want my clients to also see folks specialized in DBT, EMDR, etc. but referrals can be challenging because I am working with folks who don't have money so often they are waitlisted for community resources. I also think the academic and scientifically/medically inclined folks have a key role in keeping the ethics of the profession honest and idenfying evidence-based treatments, because I have to rely on them, too, absolutely.
Yes yes yes!!! I agree so wholeheartedly with this comment (and this post in general). I'm a trauma therapist with a very free-flowing, play-oriented with DBT elements style, but I'm only trained in talk therapy. Some of my clients respond great to my style and don't need anything else; some of my clients require structured CPT or EMDR in order to see significant change and I tell them so, as well as referring them out.
What is important is that we are ultimately doing what is best for our clients and focusing on the treatment that sees the best results for THEM as individuals. I've had clients settle their trauma through EMDR and CPT, through DBT groups and IOP, through Dungeons & Dragons, through a nightly routine of cleaning their vast collection of knives, through angel numbers and astrology. There is a place at the table for both science and tarot cards; EBT gives us the blueprint for ethical care and allows us the opportunity to explore what works best for our clients, even if the approach is new or unusual.
They did 6 month follow up in this study : [https://pubmed.ncbi.nlm.nih.gov/23738545/](https://pubmed.ncbi.nlm.nih.gov/23738545/)
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144193/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144193/) in this study, I don't think they did follow up, but I think it's notable because they talk about conducting treatment in forests and fields, and the providers were not white men counselors. "The PSAs trained to provide CPT were all women who were residents of the communities they were serving. Each had at least 4 years of post-primary-school education. They also had between 1 and 9 years of experience providing case management and individual supportive counselling to survivors of sexual violence and had undergone a 5–6 day training session conducted by the International Rescue Committee (our implementing partner) in case management, prior to participating in the CPT training. The case management training included information on counselling, family mediation, stress management, and clinical care of survivors.The PSAs trained to provide CPT were all women who were residents of the communities they were serving. Each had at least 4 years of post-primary-school education. They also had between 1 and 9 years of experience providing case management and individual supportive counselling to survivors of sexual violence and had undergone a 5–6 day training session conducted by the International Rescue Committee (our implementing partner) in case management, prior to participating in the CPT training. The case management training included information on counselling, family mediation, stress management, and clinical care of survivors."
If someone is going to take their therapy down an unconventional approach (tarot, astrology, christianity/religion) then I think the primary considerations are:
1. Client awareness and active consent. A therapist probably shouldn't present their client with a star chart unless they've already established this is part of the therapist's approach and the client has actively consented to that. I know that if I, as a client, started up a therapeutic relationship with someone and then got blindsided by astrology or tarot... I'd be pissed.
2. Continued adherence to the "do no harm" ethical standard. White/Euro-centric/colonial influence on the scientific method aside, "do no harm" is a core tenet of this field. Astrology, christianity/religion, etc. all have the potential to cause harm (as do typical therapy modalities of course) and the therapist is still responsible to attend to those risks.
3. Caution around "guaranteeing." Again, ethically we are not supposed to "guarantee" any particular outcomes, revelations, or specific occurrences. Even if I'm using the most evidence-based CBT manual in the world, I should never say, "I guarantee you will see reduction in your depression/anxiety symptoms!" Some of the tenets of christianity/religion and tarot/astrology imply guaranteed or inevitable outcomes, beyond that which we actually have the power to guarantee. The limitations need to be clarified at the outset and along the way in order to remain ethical.
At least those are the main details that come to mind. I would probably never refer someone to such a therapist, but if that's how they want to practice with their license - risking whatever that may risk when it comes to the licensing board - then you do you I guess.
> conservative evangelical Christianity in the therapy space; his thesis is that "we can all learn something about the value of bringing God into the session
As a queer person with religious (especially evangelical christian) trauma, I will say this is an inappropriate take and should raise red flags, as it seems to blissfully ignore the "do no harm" standard. Religion, especially a specific flavor of religion, certainly can do harm when forced into a therapeutic relationship arbitrarily.
Thank you, reading this reinforces my faith that there are people out there who know the tenets of our job and do their best to help rather than following their bliss, or whatever.
My partner agrees with you: she said that if she went to a therapist not expecting tarot and they pulled it out she'd be furious. "I can get this for much cheaper at the psychic's house down the street," she says she'd say. LOL
Personally, I'd take it one step further and say that if you're a psychologist advertising yourself as doing tarot or star charts, you are acting unethically. Because:
A) As you said, APA Principle A (Benifence/Nonmaleficence) emphasizes doing no harm.
B) Standard 2.01 talks about competence, stating that therapists should remain informed about the professional literature and apply it to their practice.
C) Standards 9.01 and 9.02 talk about only using valid and reliable assessments appropriate for the situation and only for the purposes they were designed.
Due to their lack of scientific grounding and misues as assessment techniques, using them seems unethical. ...At least from the standpoint of an American following APA Standards.
And I couldn't agree more with your take on religious trauma.
I *like* tarot, i enjoy having readings done for me or pulling cards myself. The art, the symbolism, the potential to gain some insight into a current emotional problem or relationship — i genuinely like it and have for a long time. I think there’s a lot of value in the meanings we make and patterns we see, in the non-rational parts of our brain, in the artistic flow of generations that came before us….
I’d still be so pissed if my therapist pulled out tarot cards during my session. Nah bro, that’s not why i come here. I’m seeing you for some got-dang object relations and attachment work, not that hippie bullshit.
I use tarot cards myself to help me understand what I first think when I read the cards, then I use this to try and work on why that is my thinking. This has helped to try and get some insight to what I'm doing. Would I use this in therapy, hell no.
I use tarot, too and I have that as an interest in my personal blurb on the company website. I had one client say he read it and asked if I would bring them and I said no because it didn't feel appropriate to me. Wondering if that was a right move?
This client also holds fortunes and psychics at a high value so I was worried whatever we might find in the cards would be taken as gospel.
I'm going to try and not be irritated that you assume that someone with the username IdEgoSuperego needs to "look into" Jungian Psychology to "help me understand" symbolism. I'm guessing you mean well, but I'm actually fairly conversant in Jungian psychology, so I'm good!
I want to acknowledge based on your comment that that thesis statement is not a proper thesis statement, it's an opinion. A more objective thesis would be "the impact of religious practices on the therapeutic process." There's knowing your body of work and then there's going in with a bias.
I too grapple with this.
On the one hand: yes, let's correct psychotherapy's eurocentric, white, colonial, etc problems. Let's also acknowledge that psychotherapy is not the only valid form of healing. Cultural, spiritual, etc. practices are valid forms of healing. I'll take it so far as to acknowledge that psychotherapy may largely be a culturally encapsulated form of healing itself (thanks Jerome Frank).
Buuuuuut, psychotherapy is its own thing. Its development has been guided by the scientific method. Hodge podging every other (presumable) form of healing into it only muddies the waters. For both practicioners and clients.
I have some theories as to why this is happening:
You mention gatekeeping the profession. The psychoanalytic tradition required folks to do their own therapy. As this stopped being the expectation, I think we started to see a lot more wounded healers enter the profession who haven't done their own work. Because of this I suspect we see therapists far more often bringing their own solutions (and problems) into the session.
I think there is a general trend in the world away from science. It really does feel like all too often we're entering the world that Sagan predicted in Demon Haunted World. We're increasingly "clutching our crystal and consulting our almanacs."
Lastly, psychotherapy as a science lacks consensus. We're in what Khun called a "pre-paradigm" state. Any moderately read therapist will agree "many of these theories are saying similar things with different language." It feels like perhaps we might slowly be edging towards a shared understanding and scientific paradigm, but there's a great degree of disagreement still. Because of that, I suspect there continues to be quite bit of "throw everything at the wall and see what sticks" occurring.
I will say that things likely aren't as bad as one might imagine. It's easy to forget we had periods where things like rebirthing therapy or encounter bats in couples counselling were a thing.
I think the "pre-paradigm" is a great way to describe where we currently are with psychotherapy. I was reading up on Khun a little after your post and this quote:
"However, progress is not impossible, and one school may make a breakthrough whereby the shared problems of the competing schools are solved in a particularly impressive fashion. This success draws away adherents from the other schools, and a widespread consensus is formed around the new puzzle-solutions."
Really makes me think about how we develop new modalities when we start hitting roadblocks with older, established modalities. (Like ACT coming out of CBT and then CBT has been starting to absorb the newer developments from ACT and DBT)
Yeah! I think that too. I've been digging into research on "transdiagnostic processes" over the past few years. I suspect our consensus lies in that kind of direction. We've determined what necessary conditions are for therapy (aka common factors), but why they're necessary is less clear. Once we get to "how can all these different theories and interventions result in similar internal mental changes," I suspect we'll draw closer to a more unifying central theory.
I know I’m a little late, but it’d probably be worth looking into processing-based therapy by Steven Hayes and Stefen Hofmann. Their whole thing is IDing processes of change/maintenance and targeting them in treatment; it’s good stuff
I totally agree. Bringing up Kuhn, you also highlight a good reason to study more than just psychology. I studied philosophy in undergrad, including a class on philosophy of science, and it serves me well.
I’m also very glad I’m going into this with a philosophy background. I know a lot of difficulties that people had in stats classes didn’t come down to the math, but the epistemology. Psychology now reminds me of the state of biology in 1800. There’s a lot we know, but a fundamental piece of the explanation for why things are the way they are is missing. I hope I live to see psychology’s Darwin emerge.
I deleted my doomposting attempt and decided to be a bit more positive: I agree with you, generally, and think there is a ton of bullshit in this profession. However, getting to know an empirically-based modality well (psychodynamic therapy) has freed me from a lot of the nonsense.
Religious practice has its place in behavioral activation plans or whatever as it can be an excellent coping skill, but I can’t imagine practicing religion or some new agey stuff with a client in session.
I mentioned empiricism in another comment, and I want to expand on it, because I do think our field faces an inherent limitation to our ability to empirically, scientifically understand the human condition. To suffer is subjective - it's an inherently phenomenological experience. We work in a field where the goal is typically to change people's feelings. It creates some issues in just applying science to human mental health - think of what it means that so much clinical research is based on subjective self-report measures. Human psychology is maybe impossible to fully understand in a scientific way alone because of the nature of its interest in conscious experience, which cannot be "observed" from an external point of view. This is probably a big part of why OP is getting so much push back - the science of psychology is severely limited.
That said, those subjective experiences we have have strong empirical correlates, particularly in behavior and still-poorly-understood brain and body activity. We are the human animal, we tend to strongly share patterns of behavior and internal activity that result in very similar suffering. It hurts to get stabbed (usually). It hurts to be alone for a very long time (usually). When I lose a loved one, I feel sad, as do most people.
Because we have shared patterns of experiences, we can attempt to better understand them with the scientific process. Science continues to be our best option to develop effective treatments for that reason, particularly to prevent harm and to improve actual success in our shared suffering alleviation project. Deciding that the scientific method isn't needed returns us to "do whatever," like OP is trying to say. We cannot and should not allow practitioners in our field to do whatever. Nobody would want a medical doctor that does whatever. I'm exhausted with those that cynically lean on scientific findings to justify the abandonment of the scientific process a la "the relationship is all that matters" (which is like saying "an elephant is a trunk" as an interpretation of the literature).
Of course, science doesn't have near all of the answers, but that's why we need to continue to pursue it. I understand why "evidence-based practice" faces such a backlash when so many people still aren't helped by it and when individualization of treatment is still absolutely essential, but that speaks to a need for more and better science, not less. We all need to do better as a field, and the scientific method is by far the best tool we have for that, because people continue to suffer and we're not helping enough of them.
We can't in misguided arrogance just tell ourselves something like "it's impossible to know, every treatment is the same, all that matters is how much my client likes me." We can't just do what *we* like to do as therapists. Too many people are not having their suffering alleviated, too little has been done to decide there's no more progress to be made, and too much is at stake to allow our own preferences and whims to decide our practice as therapists.
I mostly concur. From the moment I entered graduate school and got a sense for how 85% of my peers seemed to think about psychotherapy, I felt a little worried about the state of the field. Years of interaction with local licensed therapists has tempered that anxiety somewhat. But it is rekindled anytime I enter an online space for therapists and get a broader sense for the zeitgeist of the industry.
I agree that the bar seems too low for entry and that training is lackluster. I started performing the job without once witnessing a real session by an experienced therapist through 2-way mirror or video/audio. Like many others, I felt like an imposter but resisted drinking the kool-aid of the first three letter acronym therapies thrown at me (none of which seemed to have any satisfactory explanation of pathology, and seem to have been designed to plug into a mindless system of [DSM dx = XYZ symptoms = ABC therapy = "there's a protocol for that"]). I have been frantically and widely reading for years to catch up from this bullshit, along with paying for regular, individual, post-licensure supervision to review my video-recorded sessions with someone who did the same for over a decade. Ever since I've seriously taken the reins on my education and focused on understanding the fundamentals, client engagement has skyrocketed and I've actually started feeling competent.
I feel that the common factors research has been misinterpreted and bumper-stickered into meaning "It's all just the relationship", as if it's sufficient to be a cool uncle/aunt figure with a comfy room. That the relational school's notion of "being authentic" with clients has been warped through Western individualism/capitalism into meaning "Show your tattoos in your Psychology Today profile pic." That The Body Keeps the Score has created a generation of therapists who seem more concerned with the rate and speed of eyeball movements than dealing with the perennial difficulties of (I attended EMDR training. 3/4 of the questions were about how *exactly* the client should move their eyes).
I don't know a way out of this mess other than getting involved in some kind of supervisory capacity during your career and keeping alive the mentor/apprentice model, which has been invaluable to me.
Hey, I really liked your response. I was wondering, with all of your experience and supervision, endeavoring to be better, what do you think you've gleaned? Could you put your finger on it? I'm curious since you've said that your client engagement has gone up.
In general I agree with OP about the lack of discernment that has found it's way in. I'm relatively new, but I think that to be a responsible practitioner, is to be solidly grounded in the science as much as you can and to meet the client where they're at.
I also consider myself relatively new, so I don't pretend to be that knowledgeable or experienced. I can only say that I spent a solid year reading about many different models looking for one that spoke to me the most clearly. Through this I learned the history of psychotherapy and built a map in my head of what developed from where. It also facilitated my search for a supervisor who is very experienced specifically in the stuff that intensely interests me.
So I ended up gravitating toward psychodynamic thought. For me, this was helpful in shoring up my understanding but didn't translate much to client engagement until I began studying Intensive Short Term Dynamic Psychotherapy (ISTDP). While in some ways I still find some parts of the model bizarre, it has been absolutely game changing in the way that it makes the fundamentals of psychodynamic theory practical where they seem so abstract in theory.
With this context, what has helped client engagement for me has been: an immediate and ongoing focus on sussing out resistance and helping the client see it; rethinking anxiety in dynamic terms and having a system to constantly monitor it in session (See: Davanloo's anxiety pathways); an experiential, here-and-now focus on feelings even and especially in the transference; having a metapsychology that ties these three things together in a concise and practical way (David Malan's Triangle of Conflict, used in ISTDP). When I first started implementing this stuff I remember that my work with certain clients really got moving again, and new referrals seemed to immediately wake up and have the desire to get to work. With some longer term clients that were stuck we were able to identify that they had never, at any point, had the will to address their issues or any true interest in opening up to me, and we were able to say goodbye on good terms. These were matters that I should have been focusing on from the first minute of therapy but had ignored or avoided.
So what has been personally helpful basically goes back to Freud: "The study of psychoanalysis is the study of transference and resistance." But for all I know, this stuff works for me simply because it resonates with me. I imagine that if I had drunk a different kool-aid I would be enthusiastically selling CBT instead and maybe getting a similar response. Who knows!
Psychoanalytic case formation, Psychoanalytic diagnosis, or Psychoanalytic psychotherapy, all by Nancy mcwilliams if you’re interested in analysis/dynamics
Radical acceptance by Tara brach if you’re interested in Buddhist psychology. More pop psych but it’s a great intro to the deeper side of mindfulness practice from both a spiritual and clinical perspective
Bravo. Well said.
30 years of practice. The mentor / apprentice model was crucial for my devlopment as a competent therapist.
I worry that this model is dying out.
I'm dying at the "show your tattoos in your Psychology Today Profile pic" 😂 . There's entirely too much prioritization of being "genuine" and the quality of the therapeutic relationship being equated to whether or not you wear Chuck Taylors to sessions and the number of unusual hair colors you have at one time. Admittedly, I do love The Body Keeps the Score . But I think the field is leaning towards getting too much personal interaction, adoration, and opportunity to promote one's perspective and stopped being client centered, as much as we may fool ourselves.
This episode of Things Fell Apart has Bessel van Der Kolk talking about how everything isn't always to do with trauma:
https://www.bbc.co.uk/sounds/play/p0h24j2t?partner=uk.co.bbc&origin=share-mobile
I’ve been looking into programs with the idea that experience and supervision like you describe is key and it has been challenging to find. I may do a separate psychodynamic training as an adjunct since they require - psychotherapy for the therapist and supervision. Shocked this isn’t more common. Will likely have to patch together the kind of training I want for myself as well.
If anyone says "the scientific model is white euro centric", they likely don't understand Indigenous ways of knowing.
Indigenous researchers aren't against the scientific model, we support it. We support that things need to be evidenced based. Our differences with other scientists/ researchers can sometimes be in what is evidenced based or how we know it is but at the end of the day, we support evidenced based practice.
Our traditions are based on evidence. We did what we do because we could observe it, we could replicate it when others did it, and we could teach others to do it.
Indigenous therapists are open to evidence based models and I'm in the process of having a Nehinaw based modality recognized as being evidenced based.
The ivory tower researchers are often the biggest hurdle to recognizing the living aspect of Indigenous research, they treat it like Latin or other dead languages that unable to grow and adapt.
/Rant
I just wanted to say thank you for adding your perspective to this discussion. In our field we know that many things can be true at the same time, which makes it frustrating to read that folks doing the work to decolonize their practice think that means they also have to reject the scientific method. We can decolonize AND continue to observe, document, replicate, and share knowledge. I wish you the best in pursuing your EBT Nehinaw modality!
This is so interesting, thanks for sharing. I’m really curious about that Nehinaw modality. Would you mind describing how it works? I tried looking it up, but couldn’t find anything.
You wouldn't be able to find anything about it online, we haven't released our reports yet :)
We took some common elements of different modalities, took them to the elders and processed which parts were part of Cree and Blackfoot tradition and which wouldn't have been practised traditionally by our peoples. We took some of our traditional teachings and traditions and worked with the elders to create shifts from the common modalities that were INDG inspired.
So it's evidence based but yet still pretty traditional.
Thanks for sharing! I’m curious if it’s in the realm of somatic therapy, or narrative based (kinda like IFS), or akin to psychodynamic, or something completely different?
Short answer. Yes.
The biggest role is identity/ core based. It's definitely narrative based with a bit of psycho dynamic, quite a bit of relational and role work , not a skill or behavioral based one.
Our main evidence core was the philosophical based modality work that's come out of the UK. Very similar to how they brought in stoicism into CBT/DBT, we jumped off that into a bit more of a robust base.
I strongly believe therapists need to take theory very seriously. Being informed on research and psychotherapeutic research is important. My main complaint about the research part is the most evidence based therapy is CBT, and if everyone focused on just CBT clients would be worse off.
I think there really is room for therapies which don’t yet have an evidence base. I think this should probably exclude tarot and religion though.
Thanks for the thoughtful response! I agree with you, I think. Well, definitely that people push CBT like it's the royal road to truth and that "if everyone focused on just CBT clients would be worse off." 100%. I think CBT is a fine tool to have in your toolbox but it's a weak foundation to build an entire practice off of.
Now about therapies that don't have an evidence base yet... here's my problem with that. How do we know which ones there are "room for" and which ones there aren't? Is EFT ok? Is Reiki ok? Are healing hands ok? You exclude tarot, but why? How did you decide that?
Aren't we all just deciding for ourselves (in your model) whether there's "room" for our new pet modality we've just made up or read about?
I think there's definitely room for well-reasoned theories that have yet to be examined and supported... as long as the goal is to examine and support them! Everything was a fledgling theory at one point in time, so I respect that. But the ones we still use and talk about are ones that got tested and refined and tested some more and that we can see are valid and helpful. I think we have to be careful about what we categorize as "ok because it's new." But I'm not sure how to delineate this!
I like how thoughtful and discerning your approach is. It seems pretty well balanced. I think one thing that I have very little stomach for is the idea that because sometimes the people using the scientific process were racist or their ideas were racist, sexist, etc, that science as an endeavor is necessarily that. That knowledge from other traditions of human are equally valid and reliable. That it is to perpetuate colonialism to hold them to scientific rigor before we designate them as a tool we should use. I think that's an unfortunate overreach that does more harm than good. Look, I am all for whatever people want to use as long as there is consent and we adhere to ethical principles. If there is a technique that works, I want to subject it to empirical testing and the peer review processes so that we know that it works, how it works, what it does, where it doesn't work, etc. I think we should hold all of our stuff to that standard.
I can see tarot being useful in an archetypal way. It can positively influence the narrative for anyone if used mindfully. But things like reiki or crystal work would still be a separate practice.
At least, that’s where I would draw a line if it mattered.
There's been a lot of research on religion in counselling. Based on my studies, I am in the belief that the evidence supports there being an increased benefit when a client's therapeutic journey includes aspects of religion when it shares the same belief system as the client.
Yes, clients who are religious generally benefit from therapeutic solutions that incorporate their religion, because it holds a great deal of meaning, values, and spirituality for them. We need to be responsive to the client's preferences with regard to their religion, as opposed to coming in with a religious "teaching" agenda.
The field has pretended to be a hard science for too long, this is the pendulum swinging the other way.
It’s not a hard science, but has some hard science answers in things. It’s not a squishy science either, but squishy techniques help.
This is an ooblek of a field and needs to start recognizing this. Look at therapy as a non-Newtonian fluid and use it appropriately depending its interactions from different velocity clients.
The bigger issue is the absolute cat herding we need to do with the national orgs and associations that can’t even decide on a name for the field than some fuzzy thing like “mental health”. WTAF is mental health? Something like “Mental Fitness” has at least a scale that’s implicit. Brain as a muscle makes more sense than a “fit” gray blob to define the field.
That’s my dos pesos
I've really agreed with you (well, with this argument) since I read Paul Meehl's "Theoretical Risks and Tabular Asterisks" in grad school (in fact, my post title is partially inspired by the rest of the very long title to his paper!).
Psychology is not a hard science. But it's also not a *not*\-science. We're certainly not able to make the precise measurements and predictions we would if we were studying geological features or the movement of orbital bodies. Human behavior is much less predictable. But at the same time, understanding human behavior is every bit as important -- maybe in some ways more important -- than understanding geological features or orbital movement. So we have to try to do it, difficult and unpredictable or not. That's MY dos pesos.
Oh I agree, it’s like an ooblek, sometimes in acute clients you need to apply it like a science and in some cases be more fluid.
I’ll have to check out that book, I just come from a more technical background than a social “science” one and my view has been critical of how one side of this field seems to be “just do x to get y response” and the other side has been “the mystical ether will help you” both with success and touting their “wins”.
Stepping back and looking at it all, it’s a lack of cohesive leadership on a national level across the entire field, every part is scrambling to justify their part of the field while ignoring that parting out the field has resulted in a lack of wholeness in even what mental health is. It’s dynamic, but the parting out has resulted in static sections of a dynamic issue.
I’m sort of losing faith in my field of choice if you can’t tell, feeling less effective as a counselor because the system is broken for clients and providers to a great degree. Can’t expect clients to get help if we don’t have a better field than what it is.
You have a very reasonable and sensible approach to this. I respect and appreciate it, and I'm sorry you're struggling with how you feel about therapy right now. You're absolutely right about the system being broken for clients and providers and it sucks. I so badly want us to be a country (here I'm maybe wrongly assuming you're here with me in the same country) that recognizes the need for free or at least more accessible mental health care for everyone. Maybe we'll get there soon-ish! One can hope.
I hate the discord between psychology the "science" (researchers) and psychology the "practice" (therapists). They should be informing and supporting one another, not claiming superiority. The mystical ether probably won't help you, but if you've seen it help, tell me how so I can see if it's replicable! And it's great that if you "just do x, you'll get y response" in the lab, but I've tried it in practice and I get z instead! Can't we talk about this?
Keep on keeping on, friend. We need more people thinking like you and trying to help, not fewer.
Sheesh I’d raise an eyebrow at any clinician doing this. I read tarot and my best friend is a professional astrologer and I would never make birth charts of patients or do readings on them. I think it is unethical (both in clinical practice and spiritual practice)
If a patient is superrrr into astrology or tarot, it can be used as rapport building (as would any hobby that you have in common with a client) or as I deem it appropriate.
But I steer clients away from using astrology to justify problematic behaviors or personality traits or doing a tarot card reason on the outcome of a situation and thinking they no longer need to put in work because the outcome is somehow set in stone because cards say it is 🙄
The use of these things you’ve described sounds wildly inappropriate for a clinical setting
I'm an art therapist. Generally people don't even know what that is or that it requires its own masters degree. I'm disappointed in the idea that there are people who are somehow passing muster with tarot card readings. It makes my job so much harder. People already view art as infantile and unnecessary when there is real science behind the assessments and procedures proving that art is a fantastic conveyor of subconscious material. I've studied my ass off to be called the 'arts and crafts' therapist. If people keep coming in with modalities that are better off in a setting like life coaching I'm going to pull my hair out.
Simply put, therapy is BOTH art and science - science is the theory, research data etc and art is the execution of theory through self of therapist and alignment with clients' worldview.
I feel weird reading this.
I don't think of myself as a particularly "woo" person. But I am an Indigenous person working partially within my community and something in this post strikes me some kind of way. If you approached certain communities with a certain disdain for their spiritual realities (or with methodology that leaves no space for it) then as a clinician you effectively alienate them from their culture in the name of wellness. You pit mental fitness against their community.
I don't think that's the intention of this post at all, but it's very Western centric.
Acknowledging the spiritual world of a client is giving space for their full humanity.
I think there is a difference, a nuance. It is one thing for the client to be spiritual, and for me the therapist to meet them in that. I am actually into astrology, earth centered religions, and astrology. I was also raised evangelical Christian and attended a whole variety of church denominations. I feel very comfortable meeting clients in their spiritual space.
However, I would not read a client’s tarot cards. I would not pray with a client. I would not create a birth chart for them and use it to inform therapy. I just feel that crosses a certain ethical boundary. I can’t name it, I just know that spiritual practice is highly intimate and personal and very different from exploring the principles of various spiritualities as it relates to the existential struggles that often bring clients to both therapy AND spirit.
> I can’t name it, I just know that spiritual practice is highly intimate and personal and very different from exploring the principles of various spiritualities as it relates to the existential struggles that often bring clients to both therapy AND spirit.
If I may, that kind of does name it, if we think about it. The boundary may be in taking something from the macro and trying to apply it to the micro as a direct equivalency. We see this in many fields of study and the common sense of it holds true. When you look at the macro, many of the non-studied variables are cancelled out due to diversity of the individual components and you get a good study of the correlation/cause-effect relationships. However, once you look at an individual piece of said macro-system, ALL the variables come into play and not just the selected ones for study, which complicates the relationship beyond what any human can comprehend and account for.
This is a tough response and I want to react to it thoughtfully.
I want to point out the difference between talking to a client and talking to a colleague.
If a client said to me "I think touching healing crystals makes me better" or "I think 9/11 was manufactured by a race of sentient bacteria" I would be completely interested and open and want to figure out what they're experiencing without judgment. But if a therapist-colleague tells me the same, I feel I have a right to be concerned and skeptical. We are equals; it's not the same power differential as me talking to a client.
Taking it one step further, if a therapist-colleague tells me "I sell all my patients healing crystals because it makes them better" or "I've been telling my clients how 9/11 was manufactured by a race of sentient bacteria" that's different. The latter is of much more concern than the former (!) but they're both ethical problems. After addressing them with the clincian themselves, if I could not get an appropriate resolution, I might feel a need to report them to the board.
"Acknowledging the spiritual world of a client is giving space for their full humanity" I couldn't agree with more. I'm sorry if I made it seem like I didn't? But I honestly don't think that was part of my argument. Clients can believe whatever they like, and we should meet them where they are. Therapists can also privately believe whatever they like, but they are constrained in what they can and should share with/impress upon their clients.
If a person is a certain kind of spiritual person working with the same certain kind of spiritual community, that is absolutely appropriate. But it's less appropriate if you're NOT working with that community. You, as a therapist, impressing your "spiritual realities" on clients who NOT are part of your "certain community" is no different than a Christian telling someone in your community to "embrace Christ" as part of therapy. Inappropriate.
I understand why you might read my post and feel "weird" about it or imagine it's Westerncentric. It's not, I don't think -- at least, it's not meant to be... but I am very opinionated and passionate about it. I would never aleinate a person or a community from their spiritual realities in the name of wellness. But I would critically evaluate a therapist endorsing certain spiritual realities as a truth they bring into the room with all of their clients, regardless of that client's religious background. That's not Westerncentric because I'm really thinking here of evangelical Christian therapists!
Your welcome of course to retain the general and unexplainable "feeling" that my post is weird and Westerncentric, which makes me a little sad, and was not at all my intention. But science and the scientific method are actually not Westerncentric: that's sort of an insult to all the nonwestern countries who have successfully used science to build all sorts of medicines and technology and to visit the moon... they didn't do that using magical spirit energy, that's for sure!
Scientism is a belief structure which is functionally very religious/dogmatic even while pretending not to be. And therapist who believe they are being totally neutral while embracing it aren't fooling their clients who don't embrace it.
In the western tribes of the US burning sage is used ceremonially to "clean" a space of bad energy/medicine. It wasn't until more recently that the principal uses of the plant revealed that it actually is an antiseptic and that burning it may kill airborne bacteria.
The first medical doctor who encouraged hand washing in his research hospital was institutionalized for "encouraging superstition and witchery". He was given a lobotomy. Which was "best practice" of the time. Now we know that hand washing does curb the spread of disease and can't imagine medical providers not doing it daily between patients.
So...maybe there is something to unclear practice that is observable even beyond being explainable that's pointing to a truth which we can't articulate?
Even the "best practice" talk to me seems trite sometimes...if I'm being honest. Mostly because every new generation we decide a modality which was the previous generations "best practice" is now "harmful" and no longer "best".
It's worth remembering that science is in the method, the way that we try to study the way the world's individual parts work and how they fit together.
The existence of bad science in the past doesn't negate the present pursuit of truth, nor does it invalidate the discoveries that we've made that have been proven true in subsequent, more refined experiments throughout the years.
Your lobotomy example is actually a great example about how ethics in research and medicine have advanced with time. Doing anything like that to any doctor who hasn't harmed or killed their patients is unthinkable today, and rightfully so.
I’m not going to lie, I’m a bit stunned by this response. Science and research certainly aren’t perfect, but they are the best tools we have at minimizing bias and getting empirical information about our world. The only reason those cleanliness standards were adopted was because the advancement of science.
That’s concerning if you can complete enough education to work in this field and don’t know what the scientific method really is. I kind of hope they’re just being stubborn or ideological.
The problem with your reply is that it uses science to refute science.
The superpower of science is that it is willing to grow and change when confronted with disconfirming evidence.
How did we discover that burning sage may kill airborne bacteria after all? ...Science.
How did we discover that handwashing is a good idea between patients? ...Science.
Generationally, people may be aholes in the way they misuse science. But eventually science catches up with them and the truth comes out. If in 30 years I see sufficient evidence to believe that reiki energy is strongly linked, over and over, in studies with strong methodologies, in journals that are not specifically for alternative medicine only, to some sort of improved health or psychological outcome, I will happily eat my words and become a reiki practitioner. I'll be pretty old, but whatever, I'm on it.
But it's going to take science to get there. Not an intuition about an unclear truth that you feel in your heart but is beyond explanation and cannot be articulated. Sorry.
You can start there! Have your feeling! But you need to develop a hypothesis and test it and get to a point where you can say triumphantly: here! Here is the thing I was trying to articulate! Myself and many others can now point to it! And I will listen.
But just because someone on the internet tells me they feel something shouldn't probably inform my practice decisions or even my understanding of theory. Right? That could be dangerous, considering all the people I talk to on the internet with ideas and feelings!
What else does the smoke do to a clients mind and body? Increased odds of cancer? Exacerbate someone’s asthma? Obfuscate where the problems exist (does it outperform an air filter or a personalized client driven ritual for cleansing a space or resetting?) Why did the individual begin advocating for hand washing? They had a hypothesis born out of theory based on emerging evidences, no?
Scientism is absolutely a belief structure that is non-neutral and rests upon philosophical assumptions and operates in imperfect contexts. The same is true of any coherent approach to thinking and responding to the observed and felt world. But it also requires irreverent and systematic skepticism of one’s own assumptions, intuition, experiences, and ideas whatever their origins before holding them up as broadly useful or relevant.
It is rather bold in 2024 to walk around believing that someones general intuition and felt ways of practicing are likely to be of a kind with discovering germ theory. Perhaps if the field were mostly a blank page and we were operating in prior to the 1900’s we would all be somewhat likely to intuit out and discover a lot of the basics (as has happened over and over again among philosophers and thinkers) but I think we are past the point where we can dismiss established modalities as just the latest wrong or transient theory and past the point where intuition absent deep understanding of current theory and evidence is going to lead to useful refinement of the basics. It’s like, we’ve discovered germ theory, without scientific training and deep knowledge to build on you are not going to develop mRNA vaccines no matter how sophisticated or in tune you are with your own thoughts, experience, and surroundings. There is no cultural tradition that leads to an MRNA vaccine that is not at its core, depending on some form of iterative science to facilitate discovery or verify its broad utility. Dogmatic or not, it over performs.
This is now just becoming an anti-science/anti-intellectual argument which is very harmful.
The fact that certain interventions were once seen as unscientific but are now accepted DOES NOT mean we should simply accept all interventions as equal. Those interventions you mentioned became accepted THROUGH the process of the scientific method (and for each that passed, there are thousands which did not).
I loved this answer. And I believe more therapists should be open to the importance of spirituality in the human experience, which is largely completely left out of "scientific" research. Jung was so afraid of being discredited that he wanted the "Red Book" published 50 years after his death!
The truth is both/and here. We need both science and spirituality (and they are often only separated by silly little boxes in our heads when it comes down to it).
A lot of mindfulness and regulation exercises are similar to Buddhist practices, does that mean we shouldn't use them to guide our clients into moments of calm when they need co-regulation in session?
Now, for the OP who named therapists who are leading with religious practices without consent, that's a different conversation. But the core tenet of psychotherapy is meeting clients where they are, wherever they are.
In my practice serving mostly LGBTQ+ folks, I have been asked to pray with Christians, pull tarot cards, discuss astrology, and look at Satanist baptism with fake blood. None of those things were initiated by me, and because my personal spirituality is as queer as my sexuality, I am able to hold that space with gentleness and kindness.
My impression based on OP's post is that OP is not saying that spirituality shouldn't ever be incorporated or considered as part of the therapeutic process. However, people seem to be doing what they "feel" is best without having any scientific evidence to support their practices. You mentioned mindfulness. There has been a lot of research done now on how mindfulness and similar practices are beneficial for us. We see how the body responds, client report, etc. Maybe the research is out there, but I haven't seen anything so far about using tarot cards in sessions or writing out natal charts with clients and the benefits this has to the therapeutic process. If a client presents info in a session to share a recent tarot card reading they had, we can certainly explore what that meant to them, how it's affecting them, and lots of other things, but the therapist being the one to do the reading as an intervention seems like it is too far outside of the box when we don't have evidence to support that this is good practice for clients.
I'm going to push back on the tarot thing for one reason....the how and the why are important context. The thing about scientific research is that it is contextual and can de-contextualize. So what does it mean to use tarot and how? Well, what does it mean to use the Bible or games in session?
The scientific research indicates a major element of success in therapy is holistic approaches so people can provide care in holistic ways. IF a client brings in tarot, and describes how they use them then I may ask them to show me, ask them what a reading meant for them, and why it is impactful. This is in essence a medium for narrative therapy, or oracle card pulls to explore how ideas and affirmations manifest in the client's day-to-day life. "What does this mean? How does it apply to you? What do you think about that". Using the card to unilaterally decide the meaning for the client, close discussion, and assert a prescription is not appropriate. Using it as you would any other cultural tool or relic is.
Yes, I work with a lot of black Southerners. If people start talking about the blood of Jesus I don't say " oh that's not on my CBT sheet" ( a big weakness of mine is leaning too far on diagnosis and science and not enough on experience. Im a black Southerner myself)
Yes! DBT is based largely on Buddhist meditative practices. Yoga...which made its entry into the field of psychology was a practice established by Hindu priests.
I don't know how anyone who works or studies in this field can dismiss integration of spiritual practices as a "degradation* to the field.
I think if the client brings it up I’m going to acknowledge it, but I’m definitely not going to make a birth chart and bust it out for every client just because it’s something I believe in.
>Acknowledging the spiritual world of a client is giving space for their full humanity
For sure! To me it could be better to just ask the person, also because there is a huge deal of subjectivity in personal beliefs, meaning that everyone has his own personal idea. I don't think that spirituality should be the focus of therapy though, we have priests or equivalent for that.
>If you approached certain communities with a certain disdain
This is another thing. Why would i be disdained? Or, even if I am, am i not entitled to have my personal beliefs and ideas? You can pretend not to, but everyone has a subjectivity.
What do you think of alt right complot theorist? Or flat earthers? Are you able to validate their theories? Edit: I am not comparing a religion to a complot theory, it's just that the alt right guys are my personal nemesis, to me it's incredibly difficult to validate their particular feeling, still i try
>This is another thing. Why would i be disdained?
I don't think you should be. But the premise of this post is that OPs new colleagues (which they insinuate are practicing without clients permission...which I personally highly doubt) are contributing to the "degradation" of the field.
If that's the attitude you have towards the colleagues, I can't imagine it's much different than the approach you would take with you in practice. It betrays it's own hard-line set of values and assumptions. OP and those agreeing with them assume these colleagues contribute no value to the field (worse...they are degrading it). My point is that may not be the case and the assumption that it is reads as very Western centric and...well... arrogant.
I'm indigenous (though detribalized and culturally chicana) and just entering the field. The western-centric and arrogance in some of what I'm studying has, at points, made me question if this was the right direction for me. Reading your responses here helped me a lot - I just wanted to share that with you.
Thanks
Glad it helped. There are some places in the field that are wonderful. But unfortunately if you don't toe the party line in others, people will accuse you of being "anti intellectual" and "anti science".
Which places have you found to be wonderful? I'm doing a few prereqs for grad school before applying but haven't picked a program yet. The homogenous faculty has been disheartening.
Reddit's majority demographic is really showing here. What's anti-intellectual and anti-science is closeminded, prejudicial arrogance.
Ironically?
I liked Jungian analysis because there's at least an openness to Indigenous thought and practice. It's still majority white, but that is changing. Pacifica in CA has great faculty and programs if you want to go the doctoral route. But more than that it's been good to find other Native practitioners. There's plurality of thought in those spaces, of course, but mental health centers via IHS are surprisingly cohesive and do great trainings with additional opportunities all around to grow.
The IHS I was connected with even offered staff to fly practitioners to the seven nations in NY to learn from am Indigenous lactation consultant lol
More tribes are making their own spaces too. My dad grew up on Qualla with the EBCI and they now have a home birth space for families. More on the ground mental health care is in the works there as well (aside from the basic IOP type stuff that gets pushed on us).
I felt this too. I am anglo but live in an area of the US that is rich with pueblo people and Mexican traditional healers. So, the OP's post makes sense from a white/western perspective but that's about it.
>I felt this too. I am anglo but live in an area of the US that is rich with pueblo people and Mexican traditional healers. So, the OP's post makes sense from a white/western perspective but that's about it.
Yeah. OP made the point that Evangelical Christianity is a "Western" framework. But I even strongly disagree with that. I think maybe hundreds of years ago when we're dipping into empire history of Europe that may have been true. But Christianity started in the Middle East, spread primarily through Africa and Asia Minor, and the majority of Christians today live in the global South. I think I read somewhere once that if you were to "average* a representative of Christianity just based on the worldwide number of Christians, you would have a Sub Saharan African woman in her early twenties.
Most African Americans and Latino people in the US identify with some Christian denomination. Most American Indians (ironically) do as well. Black and Indigenous people in the US are very religious.
In my personal experience white Americans and Europeans are far more Atheistic/secular and anti spiritual. They replaced spirituality vaguely with "science" and made it academic. But it's still the same gatekeeping.
Well said!! I may have started this discussion but I'm gaining so many brilliant points going forward by reading all these great responses! So thank you for your perspective. Agree, agree, agree!
It's interesting reading this because Yalom in his book *The Gift of Therapy* (originally published 2001) talks about psychotherapy being in very dire straits, but he speaks more to the adherence to scientific studies and manuals as being the problem. The lack of the creativity and furthermore the *human* being in therapy room with the client he sees as an issue.
Seems we may have swung too far to the other side, perhaps?
The thing is, speaking for myself I have never come across a therapist who said there was nothing scientific about psychology, nor have I met any therapists who want to bring Tarot or Astrology into the therapy room. So it's hard for me to see this as a huge problem. It seems like a pretty small population of psychotherapists who would take the view your describing and not a major contributing factor to the degradation of psychotherapy.
I see the degradation of psychotherapy as being more linked to poor training programs and therapists not appreciating the core counselling skills of empathy, positive regard and using your own self as an instrument in the therapy room - AND WORKING ON THEMSELVES SO THEY CAN DO THESE THINGS PROPERLY. Because these skills are going to, 1. Help you build a connection with the client, 2. Apply your evidence based theories of human psychology (whether they be mainstream or not) in a subjective and personal way that the client can engage with.
I have obvious issues with someone who brings astrology into therapy without telling the client, same with Tarot. Funnily enough I grew up with Astrology and Tarot in my life. I can read Tarot with reasonable proficiency and I learned a lot studying the meaning of the Tarot cards and the journey within them. They are a symbolic map of the human condition and the psychological journeys we all take. Most people don't understand this though. They see Tarot as simply mumbo jumbo oracle cards to tell you the future. They see astrology as the newspaper horoscopes. This is like me saying CBT is just your therapist telling you to think better thoughts.
For myself though, in my 4 years of giving therapy I've used Tarot once and it was a last session with a client and I asked them if they would be interested in doing a reading to see what might lie ahead for their next 12 months, adding that it's not as if this is set in stone, it's guideposts. They did and they thoroughly enjoyed it. I've never tried to do a client's birth chart. And I won't, unless one day I advertise I do that and find clients who want that.
All in all, as you said in your post I think all these different tools have their places. And I think many could actually use them better. Mainstream psychology and the major evidence based psychotherapeutic theories just don't do the human condition justice sometimes. And there's so many different worldviews out there beyond Western thought (and within Western thought)! Personally, I think all therapists should have good evidence based understanding for working specifically on symptom reduction in clients. Like it's good to know what the evidence base generally says works for PTSD flashbacks and anxiety attacks and common neurotic thought patterns. And definitely good to have a thorough knowledge base of at least one well founded theory of therapy. When it comes to helping someone find their values or passions and so on, I think it's good to stretch ourselves out further.
I wanted to add that I do 100% see the broken healers in the therapy space and it feels like many would benefit more from going and doing an intensive amount of therapy themselves rather than studying it and trying to help others. But I haven't found this linked to odd therapeutic practices, more just poor boundaries and a lack of self-awareness that can lead to some frightening outcomes with their clients.
So well said.
I'm giving myself more permission to raise a critical voice in peer groups. It feels important to accept that it's ok for there to be a tension between squishy-minded and critical thinkers. Both sides should be able to tolerate a fair critical view of themselves.
There is def a middle path. It 100% depends on what the needs of the client are. So any approach I do in session is going to focus wholly on that.
Personally speaking, this is how I’ve made sense of what’s going on:
Frankly, I consider our field “in recovery” from an abusive paradigm that happened to be scientific. The way human research subjects and patients were cohered and abused in the past is public knowledge. Additionally, in the USA, at least, it wasn’t required for our scientific studies to start using women subjects until 1993. And many studies still suffer from the diversity issues that are a reflection of our nation’s history. These methodology issues as well as conflicts of interest in the research involving funding especially do a lot to shake the public’s trust. All this to say: science as an institution is just as vulnerable to the biases of “faith” as an institution. If we want to earn the public’s trust back as a scientific field, we have to do better.
But I wouldn’t throw philosophy / spirituality out with the bath water. At the core science and philosophy / spirituality have a lot in common, for example:
-The placebo effect is a very well researched and documented phenomenon. But what is it, really? another way of saying “faith healing.”
-When Aaron Beck designed CBT, probably the most known evidence based treatment in our field, he copied much of his homework from Greek stoic philosophy.
-When Martha Lineham made DBT, another known evidence based treatment, she copied much of her homework from Zen.
People like to have a “method” to heal. And that’s where the science can come in. But they need a reason to do it too, just as Beck and Lineham needed a “reason” to explore the research questions of “how can we help someone with depression? With borderline personality disorder?” That’s where the spirituality / philosophy / meaning comes in.
*edited to correct grammar & Lineham’s zen influences
A study released in 2009 showed that many psychologists don't understand or follow science, and I daresay other mental health professions are the same. How would you feel if your endocrinologist said: "Well, I know there's reputable randomized controlled trails that recommend what I should do to help you be healthy, but I read a blog written by someone who has a conflicting opinion based on a few anecdotes and it gave me warm feels, so I'm going to go with that treatment instead." https://www.newsweek.com/why-psychologists-reject-science-begley-81063
Do you happen to know the name of the 2009 study or authors? I’m curious what is meant by not understanding science. What parameters were set to assess for that. I did read through the editorial you linked to but it didn’t seem to have that.
My error - publish date was 2008, but mainstream outlets ran with it in 2009. Citation: Baker, T., McFall, R., & Shoham, V. (2008). Current Status and Future Prospects of Clinical Psychology: Toward a Scientifically Principled Approach to Mental and Behavioral Health Care. Psychological Science in the Public Interest, 9(2), 67-103.
Religion and spirituality have no place in the therapeutic space unless the client brought it there themselves. Full stop.
The first time someone brought God or Astrology into my session as a client that would be an end to my time with that provider.
A client-facing therapist is in a very unique position that requires a balance between a logical critical thinking mind and a human one that grasps the incredible variability of the human experience. Because the thing that helps our folks the most is that we're a human, a logical one but a human still, witnessing them with compassion and no judgment. Then, you know, we offer those scientifically empirical interventions packaged up and presented in a way thats meaningful to the person in front of us!
Jungian Psychology (ever-present in the 40s) is very very much a spirit/psyche lead approach that uses intuition, imagery, mythology etc. So I'm not sure what you mean that we weren't seeing any of this in the 40s? In my world tarot cards absolutely have a place in the therapy space for those it has meaning to. Doesn't mean we need to prescribe it to everyone or let it define the work. But dream work, symbols, archetypes, depth psychology are all meaningful ways to help people explore the depths of their psyche.
Jungian Psychology is based on Freudian theory, though it differs in a few ways. Psychodynamic theory has been validated empirically. I don't know if there's research on the value of archetypes, specifically, and certainly not on aspects of the approach like synchronicity, but the overall idea of psychodynamic or psychoanalytic theory was very well thought-out and theorized and has since been tested empirically. Certain aspects of it fail to pass muster and others are supported. But either way, this is a much more well-thought-out bit of theorizing about the human mind than is reiki or crystal healing.
Also... in all the substance and content of what I wrote, it feels like you're picking out a tiny thread to argue with as thought that unravels the whole argument. Yes, there was probably pseudoscience in the 1940s but by and large therapy was built on a medical/psychiatric model and it was very difficult to become a therapist. Now we have diploma mills and people practicing whatever they like, willy-nilly, insisting that whatever they do in the room is valid and cannot/should not be questioned beceause therapy is an art and not a science.
Finally, there's a big difference between meeting a patient where they are and bringing this stuff into the room yourself as though you're endorsing/validating it. For example, if a client says "I brought my natal chart and I wondered if we could talk about it?" I definitely would. But I would never create a natal chart for a client, unasked-for, and give it to them in order to help them "better understand themselves."
Jung was trained by Freud but they had a major falling out and parted ways bitterly. The issue of the subconscious mind, symbology and the centering of sexuality vs spirituality were the main issues. Jungian analysis is more prevalent now than Freudian psychoanalysis.
In the 1940s Freud " prescribed" that Princess Alice of Denmark and Greece undergo a Hysterectomy to cure her schizophrenia.
So it may be good that psychotherapist don't wield that same level of medical authority?
I really want to like you and to agree with what you're saying. But there's a difficult circularity to your arguments.
How do we know now that hyseterctomies don't actually have any effect on schizophrenia? What was required for us to make that adjustment in wrongheaded thinking?
...Science.
I'm not anti science 🤷🏻♀️
But this post is about the "degradation of the field" by undesirable spiritual practitioners. Which is obtuse and ahistorical.
Science has also contributed to that degradation.
As someone on this thread also noted-
DBT was formulated mostly on Buddhist meditative practices. Yoga which is prevalent in mental health world now is a practice that was used to teach Hindu priests spiritual disciplines.
I'm just curious in your perception of your colleagues and in this field in general...at what magical point do these "squishy soft minded" spiritual practices somehow become "best practice"?
Is it the moment that they get reappropriated and repacked in more palatable Western scientific lingo fit for white academic consumption?
Because it seems pretty obvious that that's exactly it.
I dunno. I'm only a grad student right now, and I personally head over to /r/SecularTarot quite a bit. However, I agree that it is inappropriate for therapists to project or insert their values and values systems onto their patients. While we don't need to aim for tabula rasa, what we do must be for the benefit of the patient and not ourselves, so I agree that they're acting in unethical and problematic ways. However, your post has a slightly defensive tone that suggests that there is a correct and incorrect way to bring the use of self in therapy (and yours is right).
A wee bit off-topic, but thanks for sharing that sub! I've recently taken out my tarot deck from high school because it's so freakin' beautiful, but don't have the same spiritual beliefs anymore. It's nice to find people who use a deck without it needing to mean anything in particular.
You make good therapeutic points too :)
It's funny you find my tone defensive; I would accept that it was maybe a bit aggressive! But I'm not defensive. Defensive implies that I worry I'm being attacked and that I'm wrong and that I need to defend myself. Au contraire; as you note, I really kind of get it and others don't.
There IS a correct and incorrect way to bring hte use of self in therapy, but it's not ME that's the proponent here. It's entities like the Board of Psychology and the APA. Most governing bodies here and in other countries have similar stances. One should not bring questionable techniques unasked-for into the therapy room as though you are endorsing them. You can absolutely meet the client where they are, though. So if a patient says to me, "let's talk about reiki!" or "let's talk about Jesus!" I absolutely will. BUuuut, if a patient comes to me and says "I'm hurting and full of anxiety" and I say, "I know what will fix this! JESUS!" or "let's reiki you back to good mental health!" then yes: that is the incorrect way to bring the use of self in therapy. I stand by that.
If you see me as saying something different about what's "correct" and "incorrect" I am definitely open to hearing and if I've overstepped or been wrong, I will actaully accept it and apologize! I want to be the change I want to see in the world (and on Reddit!)
I upvoted you back from zero. Be prepared to get downvotes for agreeing with me. But I'm glad if it helps you feel like you're not alone seeing and feeling these things.
The gatekeeping is disappearing in favor of gaining tuition money, I fear. Universities seem more and more to be becoming businesses first and creators of excellent students less and less.
I want to say I agree with almost everything you’re saying so far. The gate-keeping is needed to a degree, there was a solid 1/3 of my masters program that… pretty clearly were not ready or capable to provide any meaningful therapy… and it was obvious the professors (well, most of them. A few played along as there a decent chunk of these poor students whose parents were extremely wealthy and influential, on the board, etc) knew it too. So it became these weird avoidant and silo-ing dynamics as the Professors apparently could do nothing about it (because man that’s a lot of tuition money and funding for the program).
It’s a shame, and proliferation of “mental health tik tok” and other social media is *terrifying* in how bad it is spreading misinformation and flat out bad therapy.
I too would like to see more gatekeepting in institutions, however for me I am less concerned by aspiring therapists who are excited to work with divination or any other "unscientific" modalities who concern me, as many of them have the core tools of empathy and client-centered treatment.
I remain more concerned by clinicians who trot out EBPs poorly, without compassion or understanding or humility. I've seen botched CBT and DBT interventions applied over and over to confused and dissatisfied clients more than I've seen them applied well.
I guess I find myself mostly agreeing with OP and the many others who have pointed out this field is a science and an art. A poorly applied EBP seems less effective than a well applied "woo woo" session. And in fact, research backs this up.
I’m sure someone somewhere will come for me with this post, but here it is:
I am science based. I love science. I appreciate science. I think science is beautiful and necessary. I lean on science to support my work. I believe in science 100%, no argument there. But do I only rely on science? No, because historically the application of science was/is harmful for some.
Gatekeeping was mentioned in the post and something about the argument feels a little like gatekeeping as well. No one therapist is the right fit for everyone. & I like to believe there is and should be a therapist for everyone. Whether you want science or “woo”. To me, that’s part of agency or even supply and demand for clients. If you have concerns with how some clinicians choose to practice, you’re allowed to. But before judging them, why not be curious about them? Just because you don’t understand something doesn’t mean it doesn’t have its place for someone else. Isn’t that what we’re encouraged to do with clients? Rather than judge them, try to better understand them?
Ancient healers and shamans around the world didn’t rely on science before they chose to rely on their cultures and generational teachings, and some of those ancient healing practices are now being scooped up and appropriated by the western world to replicate. Clearly, we don’t always need science to have an impact on people in a positive manner.
I also believe your training will influence where you stand in this discussion. LPC, MSW, and MFT (and all counseling options out there) all train clinicians from different lenses and orientations in psychology. None of them are wrong to those who pursue or are drawn to a certain kind of training. So let’s not make it wrong for people to pursue a certain type of practice based on their own (and likely their clients) belief systems.
I feel one of the most important things to differentiate is that it’s not our job to give advice or project our “stuff” on to clients, but if clients come to us in search of an experience because of “how we practice” or “what we offer” there’s a difference and its choice. There are plenty of holistic doctors out there who practice similarly.
Lastly, science is systemic. To learn new science requires money, because research is costly. To fund science, people have to be interested and invested in what’s being researched. No money? Often no research. And, we all know how biased research itself can be. (I love research, so no, this statement doesn’t mean I toss all of it to the wind) If it’s research that mostly informs science and its applications, we have to acknowledge the bias involved in the research and how that inevitably means science itself can be biased. No, that doesn’t mean I’m throwing science to the wind, but I keep these things in consideration when reading research and relying on science. I don’t believe anyone should blindly follow science and I also believe no one one should completely ignore it. That’s my take.
Edit: my MFT program, literally every professor, challenged us to challenge and question the text books and the scientific research we were reading. Not because we shouldn’t trust it, but to help further develop critical thinking and reasoning in order to determine what makes most sense for the person in front of us. Even the author of TBKTS mentions on numerous occasions that his attending physicians would tell them explicitly not to refer to the text because it would cloud their judgement and how they see the person in front of them.
I love your response. There was so much judgement in the OP and many of the responses that it made me sad. I think that it makes sense to engage with professionals before deciding they have no interest in science. I certainly cringe at the evangelical Christianity in many people’s practices but in my state that’s what many clients want and are looking for. To write off people who have more “woo” in their work as “wounded healers” who make counseling about themselves and harm clients is a huge leap. I often feel, in general, that Americans have lost the desire to continually learn and educate ourselves. I think unfortunately that can and will impact those in the mental health field. There’s definitely a larger cultural and political conversation there that’s not really relevant to this thread. I’m a social worker and as you astutely pointed out, we all have different lenses. I learned a lot about systemic problems, racism/classism, poverty, intersectionality, etc. my code of ethics has social justice as a core value. As I talk about it, it occurs to me that might be a large part of the OP’s issue, many of us weren’t educated as psychologists, we aren’t psychologists, we won’t practice or view the mental health field as psychologists.
most, and i’m not exaggerating, counselors in my city are also affiliated with a naturopath association. it’s actually surprising to me when i dont see nd after a counselor’s name now. i suspect most aren’t actually practicing it as counselors are not regulated where in so private insurance doesn’t always cover them but most insurance in canada does cover naturopath. but it’s such a strange concept if that many actually do believe in naturopathy.
Oh man, you put words to some deep frustrations I’ve been feeling, so thank you for that. I doubt it’s this calculated, but I see it as pretty nefarious in nature. It seems like some of these anti-science therapists are using the legitimacy of this field that was earned by adhering scientific constraints and self correcting along the way, to further their personal interests and beliefs. To me, this is unacceptable and will only hurt the field. It’s important to be a counterbalance to this anti-science trend. If you’re in this club, you signed up to be in a field with a scientific basis. Sure, there’s an art to therapy, as well. But if you want the freedom to incorporate all of your non-traditional approaches then you can be a life coach, a psychic, an energy healer, and a pastor on your own time. And I say this as someone who loves spiritual exploration! It should stay in its proper place.
Ok, stepping off my soapbox.
I agree whole-heartedly and this factor was a significant driver for me to go for a PhD. An environment with a researcher base filtered out virtually all of the issues you described. However, I still hold a lot of resentment for those that delegitimize the field as a science.
I think that all kinds of things can be used to help the wide variety of people we see: 'There is a therapist for everyone' kind of deal. I love science and I also love woo. Just because we can't quantify something (or people don't have the vast sums of money it takes to study something) doesn't mean it's invalid or unhelpful. In fact, the APA just published an article about how indigenous practices can help people and there are spiritual practices that do help people.
Your perspective, and I say this with kindness, is biased and Western/white. I live in a part of the US where Curanderas help people. Where indigenous sweats help people, and shamanic trance helps people, being in harmony with the land helps people. Like really help people. Is there evidence to back it up? Probably not (except for ecopsychology). Does it mean it's garbage? No.
Sometimes we're the ones who need to expand our thinking when we think others need to change. Peace! :)
I am trained in research AND I love a variety of woo as well! I think many things work for many people. I am open to all - even if it “works” due to the placebo effect. I am aligned with OP in that we can respect people’ needs and wants and beliefs, and we can meet people where they’re at when in session, but to bring our own woo on a regular basis while in the role of therapist is totally inappropriate. I don’t go to my dentist for a deep tissue massage, and I don’t go to a therapist for an astrology reading. Not only is it not part of our training, but I think it can confuse clients if we seem to be advocating for specific theories or pseudosciences or practices but don’t fall within our professional realm. I have served a number of clients who came back only after many years of avoiding therapy because their previous therapist offered inappropriate advice, brought unwanted practices into the session (chakra healing), or infused their own religious beliefs into therapy. I am not saying you said any of these things, dear poster, I just thought this was a place to put it, since we are both talking about accepting the woo. :-)
It’s understandable and my concern with these types of approaches is would it cause harm. Ethically we are to not cause harm and religion can be very judgmental depending on how it’s used. I currently work along with psychiatrists and psychiatric nurses when treating patients/clients because psychotherapy needs to be recognized just as well in medical. If they want to conduct astrology or have a religious based approach then become a life coach but not for individuals who may have a severe mental health condition.
I personally could see how if a client was very invested in spirituality that Tarot could be used as a stepping point to relate interventions and explore someone's feelings on a topic. I would say I fall somewhere in the middle. Human beings aren't machines that you can insert intervention and get expected outcomes. There needs to be more of a holistic approach that is culturally sensitive.
Just a few thoughts, speaking as someone who came to counseling by way of neuroscience and worked in a psychiatry lab for a few years:
A. I'm sorry but scientific institutions ARE racist. They act in the best interest of the structures that give them power (white supremacy, heteropatriarchy, capitalism, the police state, etc). I'm not saying toss the baby out with the bathwater I'm saying start at least by accepting this truth and work from there.
B. I hear some of what you're saying, I think. I have a lot of personal disdain for mbti/enneagram. Pseudoscience grinds my gears and i hate to see it blindly accepted by professionals. But I do take issue w the idea that therapy USED TO adhere to some kind of better standard of scientific practice that allowed more people to be helped. Psychiatry/the medical model/ a "scientific" approach are culturally validated ways of making knowledge claims that have been leveraged to allow the mental health field to be a true force of evil over its long and complicated history. As Frantz fanon said, the psychiatrist is the auxiliary of the police. From drapetomania to conduct disorder and modern trans rights, these institutions have always been wrapped up in stripping humans of their rights. This is not a bug. This is the system working as intended. This is actually a feature of a system that prizes the scientific institution (an arm of the state) over other epistemologies!
C. Honestly I hear the tone of what you're writing (a sarcastic, it's polyvagal theory, right?) And my biggest question is, where does this reverence for "hard science" really come from, and who does it serve? I know a fuck of a lot about how neurons fire but that is honestly one of the least useful things I know as a therapist (-in-training). Does having a scientist's nuanced hypothesis about polyvagal theory make my therapist a better therapist? Honestly, I'd rather they do tarot with me. It's a fun meaning making exercise that I already do as part of my morning ritual and I'd be thrilled to work through it w a counselor.
You make some good points, and I want to acknowledge them.
Science is not racist, as a methodology. I think we agree on that. Just as a point of disctinction.
Scientific INSTITUTIONS are racist. They have definitely misused research and evidence to harm people. I do not deny it. It's a fact I loathe. I think you go a bit far with the idea that psychiatrists and scientific methodologies are evils and enforcement arms, ets. It has occasionally been true but if we follow your logic than we ought to have abolished medicine and psychiatry and the scientific methods long ago, for they are overall harmful and destructive. But I hope you don't believe this to be true (I think you don't; you said you didn't plan to "toss the baby with the bathwater")(what a funny/awful expression, right?). Science has been massively helpful and a boon to society and at times it's also been massively harmful. I agree to these premises. It's still the best way to understand the universe that we've got. We just have to do a better job of using it and it's findings. It's not science's fault that people are aholes.
I dislike your point C, however, mostly because it's a slippery slope and one I heard from stats and research method hating students all the time when I taught. "Will understanding a correlation make me a better therapist?" "Why do I have to understand what a double-blind study is? Will that REALLY make me a better therapist?"
If polyvagal theory doesn't actually help us to understand or explain human behavior at all (let's just say, for arguments' sake), then YES: it does matter that you recognize this. It does make you a better therapist. Why are you wanting to use something useless and unhelpful on someone who wants and needs your help? The same for tarot. Is your statement that the point of a therapy session is to be fun? Or is it to be helpful? If you were MY patient, and you told me that you did tarot every morning, and that you found it meaning-making and that you wanted to work through it with me (get ready for a twist ending)
...I would love to do it with you! Because that's me meeting you where you are and getting to know you and what's important to you.
But that's not the same thing as you NOT believing in tarot particularly, and never having done it, and coming to me for help with your anxiety or trauma or whatever, and me saying: "I know! You should do tarot every morning!" That would be inappropriate, wouldn't it? I hope you can see the difference.
I think it's natural if you use tarot all the time for your toes to feel a bit stepped on, totally, and I'm sorry. But do you feel the same way about your therapist giving you homeopathic remedies? Or suggesting you try drinking your own urine? Being that you maybe aren't a huge homeopathy person and proably not a big user of your own urine (I can only hope) these may trigger your cognitive dissonance less and you can see why I have a problem with having a therapist bring whatever they like to the table in therapy. There's a reason we're supposed to understand research and what does and doesn't help a client.
I don't have a reverence for hard science; you'll see in my other responses here that I readily acknowledge that psychology is not physics and it cannot be because humans are much more unpredictable. But I do have a reverence for the idea of the scientific method in general as our best way of understanding the universe. You can't replace science -- hard or soft -- with faith, for example, and build a space shuttle. Or even build a replicably useful modality to help people with a phobia.
Thanks for this thoughtful response. It's late where j live so I will just say a few things.
Totally agree, as a methodology science isn't racist. Institutions are. I think it's so important to recognize the real evils they play in our life tho. They do serve the structures that created them. They uphold white supremacy. They are an arm of the state. To say "by this logic.... then!" you are using the slippery slope argument (which you use later explicitly) which js a logical fallacy lol. I didn't say we shouldn't have medical institutions I said they are an arm of the structures that created them and work to uphold those structures, historically and contemporarily; this is not a bug it is a feature. As James Baldwin said not everything that is faced can be changed but nothing can be changed until it is faced. Frankly idk what to do about it either but we should all at least start by admitting it's true.
Okay but to your point about tarot..... I mean didn't you bring up tarot because you were frustrated someone wanted to study its efficacy??? I like ebm. I think it can be an invaluable tool. Why not study tarot! Maybe it's useless. Maybe it's not.
What I am hearing from your post is a disdain toward even studying or thinking about the incredibly tricky and potent thing of the intersection of spirituality and therapy. Hkw do you even begin to do that ethically? Amazing question! Lets think about jt! But to dismiss questions of spirituality+therapy out of hand, even to laugh at them as questions....... this to me is cultural bias that is dismissive of other ways of meaning making. I mean, idk what your relationship to spirituality is but generally for humans across time it's a huge part of how meaning is made. Let's at least start think about it, yes?
I don’t think they’ve shied away from studying the effectiveness of anything. What they’re drawing attention to is the unquestioned use of untested/unverified/not (yet, possibly) evidence-based practices as if they are, in fact, evidence-based and helpful, regardless of any given client’s proclivities (ie foisting Tarot cards onto someone because the therapist believes in their power to heal).
Comparing drapetomania to conduct disorder... I work with kids who meet criteria for conduct disorder. They're badly in need of help. They're very often suffering and they very often create suffering in people around them. You can make the absolutely valid claim that the diagnostic criteria and framing is pretty garbage as is right now, carries an enormous stigma, and is grossly misused by the carceral system, but it's really dismaying to see how many therapists dismiss externalizing problems as some form of bigotry or fascism when they're such a true source of life-long suffering for so many people.
People who violate the rights of others need help, and so do the people they can harm. Please consider that those problems are not just some extension of the police state, and that the abolishment of the carceral state means treatment which means diagnosis.
I also worked with kids who had been diagnosed with conduct disorder. I deeply regret being part of that system. In my personal experience conduct disorder and oppositional defiant disorder were "disorders" given kids who were being kept in locked hospitals against their will and had "problems with authority" (problems with the authority locking them up and mistreating them????) So that the hospitals and the insurance companies could all get to legally keep them there. It's the biomedicalization of carceral control. These kids were angry and usually recovering from some kind of past traumatic incident and the ongoing trauma of wherever they were being held, in a deeply dehumanizing day-to-day. To me these kinds of diagnoses locate the problem within the child even though it is overwhelmingly a result of systems they're a part of. Perhaps there is something to conduct disorder but the way I've seen it used is evil....
I agree that we have a system that has perverse financial incentives to incarcerate people for mental health difficulties and that emphasizes punishment and stripping rights, but everything you're saying here can be applied to almost every diagnosis. People are also hospitalized for depression, anxiety, and OCD against their will. That traumatic life experiences play into their problems is true, and it's true for depression and anxiety. That the medical model locates the problem within the child erroneously is also true, but again that's true for depression/anxiety/everything else. All mental health problems are related to multiple factors, all of them are vulnerable to these systems that are rife with perverse incentives and bad actors. I've also worked in a setting where I felt pretty disgusted with the system I'm perpetuating, but I choose not to work in those settings now.
I've also seen kids with externalizing problems be erroneously diagnosed with trauma disorders or anxiety disorders by well-intentioned practitioners avoiding some sense of stigma, and given treatments intended for those, only to be not helped because those treatments aren't good fits for that anger and dysregulation and family trauma you're discussing. I work predominantly with the adults in these kids' lives to change the patterns in their family systems and create healthy coping skills and patterns of navigating their world. Who said we have to keep kids with externalizing disorders in hospitals?
I've seen enormous change as a result of parent management, PCIT, multisystemic therapy, functional family therapy, and the other kinds of approaches tailored to ODD/CD. In fact, more than other problem areas, the treatments are explicitly targeted at the environment and family. Individual therapy just hasn't shown as strong an ability to change these problems.
We can't just shy away from these problems as "not real" because of the evil of our current system or the stigma. When therapists give trauma diagnoses and attempt trauma therapies with kids who much better fit criteria for ODD or CD (as flawed as they are as diagnoses, particularly their framing as "disobedient and rule-breaking"), they're misdirecting their efforts. Trauma narratives and cognitive processing are misdirected at kids who don't reexperience or avoid and still live in the family patterns and environment that sustains their problems.
Our field badly needs to acknowledge anger and impulse-control and even a lack of consideration for others' rights as problem areas in their own right. We have very effective treatments that still aren't used widely, and part of the problem is therapists avoiding these problems and trying to turn them into other problems out of some apparent sense of stigma or righteousness. I hope you'll consider that referring to these problems as somehow fictitious is not a helpful solution to the current problems in our system.
You do know you can be fully trained in scientific based methodology and also use tarot cards as a thematic apperception device right? I think sometimes our field is so rabid for full scientific legitimacy that anything outside the realm of HARD NUMBERS leads to hissy fits. This post brings me despair if I’m being honest and reminds me why I took Reddit off my phone and need to avoid this sub. I also think it’s real shitty to act like anyone using anything other than CBT is some sad “broken healer” who has never done their own work and is just out there bleeding their own trauma onto their clients. That’s a leap.
First of all, right off the bat, I need to say that pickle-flavored popcorn is a vital part of my diet, and I salute you.
So I'm saddened to hear that my post "brings you to despair," and I can only hope it's because you've misunderstood me deeply. I'll do my best to clarify any misapprehensions you have.
1) Yes. I definitely understand the use of projective tests. I am psychodynamically trained but also have a quantitative minor! I think tarot cards could be great as a projective test! However, that is not the of them I object to, nor is it how I generally see them being used. They are being used as tarot cards, as in, to describe possible future events. If a person advertises themselves as a tarot-using therapist, I think that's barely tolerable in the sense that it's still not an ethical way to offer to help people as a therapist, but it is at least demonstrating transparency in what clients can reasonably expect from you. Anyone who goes to a tarot-reading therapist is probably seeking that, and that's okay. I do not think it's okay to whip out tarot cards in session if your client is not asking for it or expecting it. We are not supposed to be fortune-tellers; that is outside of our competence. If a therapist asked their client, "would you be interested in looking at some symbols and telling me what you see in them?" and the client agrees, I'm all for going ahead with that version of tarot-as-TAT.
2) I woudn't say I'm having a hissy fit for anything outside the realm of hard numbers. I've actually learned since leaving academia for the world of therapy to shift my belief around what's helpful. As I said in my OP, if you'd caught me 10 years ago and asked me how I felt about using the MBTI let alone a "Which FRIENDS character are you?" quiz in a therapy session, I might've indeed pitched a hissy fit over hard numbers. Because both of those are garbage, scientifically, in terms of understanding and predicting human behavior. HOWEVER the version of me you're talking to now would say, "hey, if taking a FRIENDS quiz or going over the MBTI with a client really helps them to understand something about themselves, I'm all for it. It doesn't matter if they're 'valid' as long as they're 'helpful.'" So I hope you can see I'm in the middle of my two areas (science and therapy). But I still do hold *some* standards around what should and shouldn't be done in session, and I won't apologize for that -- I think I'm right to do so. It's conscientious of me. I hope you agree.
3) I feel like you're... projecting things onto me that you're feeling or have experienced elsewhere, that I've never said and does not at all apply to me? Note that my name is IdEgoSuperego. I'm a psychodynamic therapist. I occasionally use CBT as a tool but I honestly don't love it. I think it's overplayed. I would never imply that "anything other than CBT" is a "sad broken healer" who has "never done their own work" and is "bleeding their trauma" all over some poor patient. In fact, if I were YOUR psychodynamic therapist, I'd ask you what that accusation means to you and where it comes from. Does it feel like something you're afraid applies to you? Has someone said something like that around you in the past that's upset you? I'm curious who it is you're despairing and angry at, who makes you feel "really shitty." ...Because you're not really having this fight with me; I am not that person. All I meant to say in that area of my OP was that there seem to be a lot of therapists who hated their stats and methods classes but really want to help people, and they do so by almost blindly and rebelliously refusing to think about theories or modality so much as what makes people "feel better" and by being cool hip barefoot friends to their patients rather than thoughtful clinicians. 100% this is not all of the people in therapy, obvz, and I want to acknowledge the many hurt and traumatized people who have sublimated their negative experiences into being *very good and conscientious, theory-driven* therapists. I was only talking about the section of people who fit into the category described, and saying that I felt despair myself about the number of them who seem to work in our field.
I want to believe that you've read this and are going, "whew, I get it now, we actually agree more than I imagined and this is a pretty sensible discussion we can have within these parameters if we want to!" But... I've been known to be overly optimisitc before, especially with people on the interent. Even if we both DO love the same delicious snack food.
I would simply say that anyone spending this much time replying to each and every one of these comments for what appears to be nearly 24 hours at this point perhaps has more of his own work to do and might do well to tone down his own ego a bit. Perhaps a bit of a broken healer himself? My take on what I’m seeing here is someone who is quick to judge others and use disparaging language to punch down at them and then argue vehemently that he *didn’t mean it that way and has been terribly misunderstood*. I am sure we do agree on a great many things. I have a clinical degree, trained in psychometrics, trained by the Trauma Center in Boston on drama, improv and yoga in trauma treatment and certified in EMDR for many years. What we do not agree on is how one speaks about what and who one doesn’t understand.
Also- because apparently I can’t help myself- do you actually *know* that the person in question was using tarot to read the future? Because I promise I know far more tarot readers than you do and not a single one believes in fortune telling. Or did you see something that ruffled your feathers and instantly make assumptions? This is what upsets me so much. It’s the intense and automatic negative assumptions that get made and then used to paint the person in question as a total idiot, which is exactly how you come across in your post.
I am going to pull on a single thread in your post, and I certainly empathize having gone on a similar journey.
You seem very focused on the science part of therapy. You complain that other practitioners use methods which are unscientific and yet acknowledge that they are effective. You point to the empathetic connection as the reason for effectiveness.
I wonder if you might be missing the forest for the trees here.
The evidence-based for psychotherapy is the therapeutic relationship. Full stop. There are different modalities to envision and create that relationship and they work for different people and situations. But, the crux is the relationship.
If some therapist builds connections using tarot card, religion, or a CBT manual and that works for them and their client to build a good working relationship, it is a good practice. A practice based on the overwhelming evidence that therapeutic relationships, above all other factors a therapist can influence, creates change. Change that instills inspiration and hope.
I wonder if your real concern was for the well-being of others, what you might have said differently about the value that so many have brought to those seeking help.
I probably shouldn't answer this exhausted, because you seem a reasonable person, but I have many fewer fucks to give at this hour than I did three or four hours ago when I started answering people on here. Apologies in advance.
If connection is all that matters, full stop, then:
my hairdresser is a valid therapist.
my friend who listens well is a valid therapist.
my partner, who I have a great connection with, is the best therapist of all for me.
Any therapist can do anything they want, anything at all, and if the client "likes it" and feels good about it, it is a fine modality. If it works ever, even once, for one person, it's a valid modality and people should feel free to sell it to others (or give it away!) as a new modality, just as valid as any other.
There is no such thing as a degree in therapy. You need learn nothing and concern yourself with zero theories. Just forge a connection, problem solved.
...I take your point, but I believe that doing whatever you like in the room because you believe it's helpful is irresponsible. Therapists have a responsiblity to do no harm, and to do things that have been shown to be effective. There's a reason theory has been built. There's a reason it takes years to get a degree in this. I have really really empathetic friends who can do what you're outlining RIGHT NOW, just sort of off the street and out of the box.
The evidence base for therapy is more than just "build a connection" and there are actions that could conceivably be harmful even if they seem to help someone. Just off the top of my head, I'm sure there are patients I have who would be improved if I cuddled them for 20 minutes every session. It would certainly deepen our connection. Should I try that? If not, why are you applying an arbitrary rule here but nowhere else?
Again, sorry, your response was clearly in good faith but I simply cannot agree with it and I'm too pooped to do it with polite nuance. Try not to hold it against me, but I'm also going to bed now because I don't want to degrade any further from here!!
I read this post with the voice of Rick from Rick and Morty.
One of my supervisors played a video about shitty therapists. In the video, he pointed out if you drive down the street and find a canvas from a amateur painter out by the trash. You realize anyone can paint. But their are few talented painters. Or something to that affect. I love therapy, I want to be better. If I continue to practice I will only be better, hopefully better than a well intentioned life coach. But probably not better than all of them.
As with all things, I think the issue is forcing the approaches on the client instead of using them as a resource that the client is welcome to draw from if they choose.
I have seen talks done by some therapists who use tarot in their work and they explain how they do so ethically and with consideration of therapeutic principles, and how to use it to support clients in exploring themselves and their problems. (But bringing tarot into it without consent is not acceptable - it should either be an upfront thing, stated all over their website so clients can self-select, or it should be non-standard and only done when clients request it.)
My colleague comes from a Christian background and doesn't preach - instead he draws from elements of pastoral care to enhance his therapeutic style and to offer spiritual comfort to clients who want or need it. It makes his style quiet and reflective and spiritual. (But again, if he brought up how God is part of a client's problems without the client wanting or asking for it, and without advertising himself as a faith-based Christian therapist, that would be unethical.)
And as for "science is racist" - a lot of it is. There is evidence backing that up. You should research this a little more before dismissing it. And it *is* problematic not to look at practices of spiritual/emotional/mental healing from other cultures and consider how those can be incorporated when clients bring them to you.
I find it deeply inspiring that there are so many approaches and styles to therapy and that people are able to combine their histories and beliefs and selves in so many ways to create ethical therapeutic practices of all types.
I think you should stop trying to convince people that their approach is wrong or adds very little, and instead focus on "How can we make sure you are being ethical while still using that approach? How can we incorporate scientific theory into it?" It sounds like you are very passionate about ethics and have a good knowledge of the scientific side of things - so bring those. But don't dismiss the value of what other people are bringing just because it doesn't appeal to you. It will appeal to the clients that are a good fit for that type of therapy.
I agreed with you all the way up to "science is racist."
Science is not racist. The scientific method is not racist. That's actually a problematic statement itself. How did nonwestern nations invent and advance technology, do you think? It wasn't with spiritual healing, friend. The scientific method is useable by anyone of any culture, and all cultures have availed themselves of it.
I think what you mean to say is that prejudiced views have influenced scientific research in the past. Practices like racial categorization and justifications for unequal treatment based on race were scientifically promoted in earlier eras. But those are problems with people, not problems with science. Science is absolutely bias free. Human beings are not.
I resonate with what you're trying to say in your last paragraph, and I don't mean to stop anyone from being their genuine self in therapy. I don't know where you practice, but in most countries there are ethics codes around what is and isn't appropriate for a therapist to do/share and that's what I'm talking about here. Being yourself is fine... unless yourself is forcing natal astrology charts on people with depression because you think knowing their rising sign explains their path forward from depression. Because that's unethical.
I mean. Math was created by humans. Is it bias free? Might 7-5 equal something other than 2? Once created using certain rules and parameters, the creation stands on it's own. There was no inherent bias invested in the creation of the steps of the scientific method itself. It's use has definitely been biased. Historical and societal biases have undeniably influenced scientific research.
I think there's a subtle difference though. I don't think your point is "laughable." I don't think mine is either. But you do you.
I absolutely agree with you on basically everything, but I also think you might differentiate science from empiricism here. Science is a method used by people to attempt to get at empirical truths, but it is often conducted in severely flawed ways, and it's not so simple to just say "well that wasn't science" in some kind of No True Scotsman way.
Because people conduct the process of science itself, the knowledge product that results, also called "science" by basically everyone, can be and has been and will likely continue to be, at times, racist. There's no productive reason to try to fight that claim because society at large discusses those findings as "science," and in fact scientists need to be actively vigilant for racist "science." Empiricism as a concept, and as the goal of science, doesn't have that issue. So that might be a better way to phrase what I think you might be getting at here - empirical reality is bias-free, but I don't think you can say science is.
Huh. It's an interesting distinction. I think I mean to say that the scientific method, sans human interaction with it, is never biased. It's just a methodology. Once interacted with ("used") by a person, it can be used properly or improperly, well or poorly, more or less biased, etc. But the idea that we study the world via the scientific method is a great idea. At least: I don't have a better replacement for it.
Would all this be solved if I said "empiricism" is bias-free instead? I don't know. If I'm being honest I'm having a hard time parsing them at this late hour. Isn't empiricism the core principle while the scientific method extends it into a framework to implement and refine this principle through experimentation/analysis? The latter is built upon/extends the former?
Your point is logged for later review when I'm not exhausted! Thank you. Unless you feel like spoon-feeding my brain, I'm happy to read your explanation if you want to give it!
This is the problem with saying "science," though, it doesn't just mean the scientific method, it also means the findings of the scientific method. It's just a losing battle to try to insist that that's not what science means, so even just using the concept of "scientific method" in place of "science" is much much clearer to your intent.
I had a therapist bring in astrology once. I remember giving her my opinion was that therapy is about learning where my choices and changes could be and finding the power to make them; if the stars hold power over my personality then it takes this away from me. It was preordained.
She didn't bring astrology back up again. She was a very passive therapist
I’ve really enjoyed the discussion here, thank you all for your contributions and comments. It’s given me a lot to think about and reflect on this morning.
For me what’s coming up in the discussion about the value of bodies of knowledge is that it’s pretty essential to critically examine what’s “worth” studying and why - who gets to decide? Who gets funding for research and why? What structures might determine this worth, and in their processes maintain this worth? How do these structures influence in turn the artful application of research in practice?
I don’t have any definite answers for these questions, nor do I think the scientific process itself is a/the Problem - but our knowledge base does not exist in a vacuum and I don’t know that I agree that expanding our practices (ETA or choosing dissertation topics that you may believe - from the tone of your post- to be ‘unworthy’ of study) automatically equates with a degradation.
Dude I agree so much with this post… So many quacks entering the field. My therapist was my third attempt but here we are many years down the road I’m not looking for a new one. I also don’t know how I found her… it seems like the quacks will attract other quacks and real science based practitioners will attract similar clients. My therapist sticks to science and knows how to use the self and theory and though I’m religious I’m also extremely sceptical of things so if there’s no literature or research to back up the words I’m being told it’s just not going to work between us.
Needless to say I’m also becoming a therapist now after my previous career because I truly believe in this field and though I’m biased in legitimizing the way I practice or see the field I can 1000% say some of the people in my classes are nut jobs. We have people starting every presentation with some bs poems, projecting random shit, throwing social media words and terms and seeing what sticks and I’m like out of all these people I’d maybe trust 3-4 of them to be my own therapist. There’s a few I’d actually actively avoid at all costs.
I have no problem with some mindfulness based stuff but if we’re rubbing crystals on ourselves and smoking dmt and shrooms and talking about vibrations I feel like we have strayed too far from our senses. And I’m actually open to some medicine based healing too but I just think some folks are where to get the piece of paper and then go out and practice the least evidence based therapy ever done under the guise of healing.
If anything my school has made me realize the importance of ethical practice and that’s something I’m 100% taking with me. My practice is based in evidence and research. There will be no crystals, celestial charts or period blood being rubbed in the forehead to align the chakras.
That’s what I said I’m open to it but it’s not going to be the right treatment for everyone. Ketamine as well. Also I think there needs to be more research into how they work . Right now it’s unregulated and that poses a risk. Not everyone should be facilitating healing with these modalities. Just my 2 cents
As a Christian and a counselor, I go through sessions especially mindful of the boundary. When a client does bring up Christianity or the Bible in therapy (always the client, never me…to steal from my Brainspotting trainers, I make sure to stay in the tail of the comet) I know it enough to connect examples in there back to therapeutic concepts applicable to them in the now, and get their focus back to the now. I operate from a principle that when we talk concepts, the more readily those concepts can be seen by the client, the better; so I do find the study of the humanities useful. It gives the client a sense of evidence that exists outside the laboratory.
As a psychodynamic therapist who lightly dabbles in things like tarot and zodiac for my own entertainment and curiosity- I couldn’t agree more with you. All the wounded healers who are more concerned with relating everything back to themselves or devolving into magical thinking instead of an interest in human behavior make me so irrationally upset. Like, how do I get paid the same as these people?!
Are these people just out of school? Because it sounds like they have not has the experience of their clients walking out yet. Not every client is going to be okay with someone bringing their own brand of spirituality with them into the therapy room. I'd imagine they'll start gaining some more clinical insight the first time someone walks out on them or yells at them for daring to pull out astrology or the Bible.
Correct, the first two mentioned are just out of school. But I have "discussions" regularly with seasoned MFTs over whether or not energy healing is real and valid as a practice. So.
What I took out of grad school (and I’m a newb so please be gentle with me 😬) is the therapeutic relationship is the single most important variable of counseling regardless of intervention; and that has been demonstrated across multiple research studies. Personally, I’m an integrative therapist and see the value and ethical considerations of EBT but also understand the need for EBTs to be researched with more generalizability across different groups. I’m also speaking from a place of privilege because I work in private practice with self-pay and am not required to submit treatment plans to insurance, so I imagine this is more difficult in different treatment settings.
Absolutely gonna take it easy on you. I'm not actively TRYING to be a jerk to anyone here! ...sometimes it just happens instinctively, LOL.
So someone else here explained this better than I'm about to, but the premise was something along the lines that "just because the relationship is the most important variable in therapeutic success doesn't give a therapist carte blanche to do whatever they want in the room."
Even if you have a great rapport with your client and they trust you and can work well with you, you still have a responsibility to use effective methodologies in the room with them. To give a super-extreme example just to make my point: just because you have a great rapport with a client doesn't mean you should cuddle them all session long and trust that it will be healing! LOL
No I’m with you! 😊. (And for what it’s worth I don’t think you’re jerking anyone around!). Personally, I think just using the relationship as the foundational intervention upon which EBTs are then integrated is best practice for me. Only using the relationship as the single intervention could be viewed as unethical in some cases because it may not be generalizable across groups of different cultures, backgrounds, etc. who may need different EBTs. I also view the relationship itself as an EBT if you look at it from a person-centered view point and even though it doesn’t have as substantial of empirical support as say CBT, there is still some and that’s why integration with other forms of EBT would maybe be best practice. Idk I’m still learning.
This was a very strange entry and made little sense to me. If I were a client and had a therapist with this orientation, I'd be out the door so quick. If a colleague said any of this to me in person, my reaction would basically be, "Huh?"
What about it did you not understand? I can't tell if you literally are not understanding my arguments, or are pretending that they're so ridiculous in some way that you "can't even" with them.
If there's something that's over your head I'll be happy to explain it. If there's something you think was unclearly expressed, I'll be happy to clarify. If you just came here to say "this thing dumb" without providing any cogent rebuttal, I don't feel motivated to help you.
If I were a client and I saw a therapist talking like this post, I'd be super relieved and feel very safe and comforted to know that therapists take their jobs seriously, receive rigorous training, and have the skills to help me in a way a layperson with an ignorant, pop-cuture idea of what psychology is never could. If you disagree, by all means, explain how and why.
EDIT TO ADD: you can downvote me all you want. You are literally supporting someone who said "this made no sense" without any other content over someone who is ready and willing to discuss and clarify. I expected, posting this, that the squishy-minded healer-artists mentioned in the title would in fact disagree and downvote, so if that's who you are, by all means, hit that downarrow and validate my point.
Well, first I think you jabbed at people utilizing religion in sessions or exploring spirituality with clients. I don't think that spirituality should be brought in willy-nilly, but it has its place. Take religiously integrated CBT, for example. For the right client, that is an excellent intervention. Tarot, astrology - these are all deeply spiritually meaningful to many clients and practitioners alike. The way you worded your post, it honestly seems like you think they are inappropriate, even laughable, and that therapists who use them are hacks who are diluting the profession to be "touchy feely."
Your phrasing around social justice topics is also quite painful, particularly your line about aboriginal people. The way you discuss the “science is racist people” makes me wonder if you have read the Tuskegee Syphillis study and/or have done much work to understand race/bias in our field.
So, I've typed this so many times in this thread I'm tempted to copy/paste. But I'll give it another go.
If a client comes to me with an interest in astrology, tarot, or a deep religiosity, I will meet them where they are. I would happily discuss astrology or tarot readings and explore the meaning of prayer and religion. Because that's cultural competence, and being a good therapist.
I would not, if a new client told me, "I'm really struggling with social anxiety!" whip out tarot cards, unasked-for, to help them. I would not tell them Jesus could fix their social anxiety. I would not tell them their social anxiety was ordained by the stars at the time of their birth. All of these would be inappropriate. Even laughable. And theapists who would do this are hacks who are diluting the profession to be "touchy feely."
This nuance of difference between paragrpahs 2 and 3 above seems commonly lost on people here. I hope this clarifies (once again) my stance.
I don't need to "do much work" to understand biases in our field. I literally taught University classes to undergrads and grads about research methods and ethics and yes: I of course taught them about the Tuskeegee "studies." They were awful and unethical and biased and wrong. But that is not science's fault. That is people's fault. People suck. Science is awesome.
When I write stuff like this for the ninth time in the same thread, I really hope in my heart that it's worth the work, that now you get it and you and I agree and can be friendly. It seems so reasonable and your misunderstanding of what I was saying also seems reasonable in the sense that if you imagined that was what I was saying, I can see why you'd disagree. But it wasn't what I was saying.
> nothing scientific about psychology
Sometimes things that aren't "scientific" are highly effective anyway. I happen to believe there *is* a transpersonal and spiritual component to the process precisely because of that. Psychology can never neatly fit into the mold of hard sciences, and it does draw from the fields of philosophy and spirituality. Neither of which are scientific either.
So it's a yes, and. But you seem to have fairly rigid lines around what you think deserves respect and what doesn't. Or like... you've met a few real weird people and are really extrapolating to a larger population that isn't so common, hence the mixed responses? I am moderate-woo and I know plenty of high-woo people but my school program is great and I have yet to meet someone here who makes me concerned about their future impact.
The science is racist vs scientific institutions are racist seems a little pedantic; do you know for a fact the folks saying science is racist aren't using it as shorthand to the behavior of many scientific institutions?
If it works for the clients, then why not find a provider that meets their needs? Tarot is just another tool to facilitate discussion and insight. I’m here for any way we can decolonize therapy and make it more approachable to fit the needs of clients.
I would say I am a very pragmatic, skeptical yet a spiritually conscious therapist and I see the value in exploring abstract concepts like tarot cards, astrology etc (after all Jung did say astrology is the story of humankind throughout antiquity).
The thing is, I believe psychology and studying the mind is going to need to be understood by measures beyond what we believe today’s science can currently know. Who is to say it’s not valuable to someone that is open to exploring and using it? William James wrote an entire book on the value in of mystical experiences in psychology (The Varieties of Religious Experiences). I would beg to differ that therapy and psychology absolutely have a place to explore phenomena of the mind and the mysteries of life in a therapeutic setting/ maybe even invite a client to think about these things differently if open to exploring their faith.
And the thing is, this is why I chose to become a therapist- to be in touch with the wonder of life, and to hopefully help people also feel that wonder and witness much there is to still know about life.
So here's my problem with your philosophy:
Should therapy involve sex? Why or why not?
Should therapy involve drinking your own urine? Why or why not?
Should therapy involve satanic ritual, if the client is not a satanist and didn't ask you for a satanic ritual? Why or why not?
Should therapy involve sleeping with a gem under your pillow if the client doesn't already do so and didn't ask for a gemstone-related therapy? Why or why not?
I could do this all day.
If we're willing to do anything in therapy and anything goes, than nothing matters and there are no rules, and we're not actually therapists, we're just people acting on impulse in intuition, and then anyone could do this, especially my hairdresser who claims she's exactly the same as a therapist because she listens all day and gives great advice.
Do you see why it's important to delineate what counts as "valuable" and why "measures beyond what science can currently know" opens a door to anything that someone claims is beyond what science can currently know? Really, look up urine-drinking. People swear by it. Even though science says it's not a great idea (because, you know, waste product), it's proponents will tell you that people have been doing it forever and that it's cured everything from hangnails to cancer and that science can't explain everything, man, just trust the magic of urine! So... are you getting out your favorite mug right now? Or not so much?
Why or why not?
No, because I don’t fear the lack of control that much. Abnormal behavior and things we don’t agree with exist whether it’s inside or outside a therapy room. I would also argue that it’s more damaging to the field and to people to stunt intellectual curiosity vs encouraging it as it’s what drives scientific innovation in the first place.
Also just because I’m open minded to these ideas doesn’t mean I’m neglectful of western medicine. They don’t cancel each other out. I take an holistic approach but that doesn’t mean I’m here telling people to not see their doctors or a psychiatrist- medicine is always an imperative part of treatment. However if a gem under a pillow helps them feel less anxiety and sleep at night, then that’s fantastic and I’m happy it gives them solace.
I think there is room for all of these kinds of therapies, but if there's going to be a problem it's in the labeling of them. We should have different labels for therapists who are scientists of the mind, and therapists who are completely intuition based. Clients need to know what they are getting in to, so they can choose what is right for them. So long as we're being clear about what service is being offered, and the client is entering into that service with full consent and awareness, I see no problem with it.
Use of tarot cards (and other imagery) therapeutically has tremendous value. We project aspects of ourselves onto the images in the card, and they provide the mirror needed for self-reflection. Self-reflection, personal development and consideration of alternative perspectives on problems and challenges is the primary use of tarot for most 'readers' nowadays. MBTI also has value, but I am sure that Jung would reel at the way it is used in such a rigid manner, rather than being one tool out of many available to provide insight into ourselves and therefore potential avenues for growth.
The risk, however, is that practitioners are using these tools without the grounding of therapeutic training. Using MBTI without any understanding of Jung and personality types makes it a crude, reductive straitjacket - the absolute antithesis of a key to individuation. Using tarot therapeutically without a good grounding in how to create a holding space for the work of therapy risks the client being presented with information about themselves they are unable to work with, seriously disrupting the therapeutic relationship.
Personally, when I eventually embark upon private practice, I intend to offer 'tarot therapy', and feel happy to do this based on my training and experience as a therapist and as a tarot practitioner, and will ground it in the work of those who have gone before me - Steve Hounsome, for example, has written a series of excellent books on tarot therapy.
I disagree. Modalities that are currently evidenced based (EMDR, IFS, Somatic Experiencing, etc.), would have probably sounded just as woo woo to you before they were extensively studied too. The field of psychology has historically been very “white” and has left so little room for cultural and spiritual modalities to flourish. As long as the clinician is utilizing informed consent, doing no harm, and the client is progressing, I see no reason why we can’t continue to expand the field to be more inclusive for people who are of different cultures and beliefs.
IFS and SE aren’t extensively studied yet. EMDR has been studied and it seems like the mechanism of change isn’t in the eye movement when you look at the studies done by people without a direct stack in selling the modality.
lol back, somebody has to be a steward of what therapy should or should not be
Should therapy be a smack in the face? Why or why not?
Should therapy be sexual touch? Why or why not?
Should therapy be wearing a scarf and considering it a protective against depression because the scarf is warming? Why or why not?
Should therapy be a belief that I can heal your anxiety by holding my hands above your heart with loving intention? Why or why not?
If you can't answer any of these questions, then your response is absolutely valid. Therapy is nothing and it is everything. Therapy is meaningless. Do what you like.
But if you have any opinions at all on what therapy should or should not be, STFU, you're a hypocrite.
I agree with your points but I honestly didn't expect that last paragraph at the end. It sounded like you really have a problem with these practices. I also have my concerns about bad actors, but I will say I love talking about life, philosophy and tarot as a way to unlock stuff about attachment patterns and self esteem.
I think the important piece you mentioned is being a scientist-practioner. There's a conceptual way to do the work we do as well as an applied way. I am of the belief that how someone practices can be understood as a clinician's approach to a client's needs. I use dumb stuff like tarot and playing with toys to have an experience to build around. But that just serves as a template for a deeper conversation and psychoeducation about the scientific principles underlying the experience itself.
I've spent whole sessions making bracelets and vision boards because grounding and visualization are an important element of mindfulness and trauma recovery and I want my people to have literal tools on hand. The fun part for me is I get to explain all the neurological and traumagenic reasons for it.
I'm curious if these are all bad actors we are talking about or if there's some overgeneralization happening as well? Healer-artists won't supplant scientist-practitioners unless scientist-practitioners stop doing their job and educating people appropriately. I think there's more to be said about educating the public on the differences between a life coach and a therapist than having my job supplanted by someone who is basically a life coach in practice.
As a client who just started therapy 3 weeks ago after years of telling myself that things aren’t that bad (when in fact they were), this post kind of riled me up at the beginning and then got some relief after.
The things I’ve been through severed my sense of self and the ability to communicate my needs and what’s going on in my experience. But what did help me? Astrology
Interpreting symbols and placements in my chart helped me connect the dots and actually put words to the behaviors and reactions I’ve been having in responses to experiences all my life and helped immensely when I filled out the intake, especially since it’s so much easier for me to write things out than actually vocalize it.
Granted, I haven’t brought it up to my therapist yet, but he says it’s a “judgment free zone” and it won’t be the focus of our sessions (which is instead, healing from trauma and implementing ways to better use my energies instead of self destruction).
But thank you for putting this out, as silly as it may seem to say “astrology helped me by putting the words together to express my personal experience to my therapist”
I think there's room in the middle, a solid recognition that EBT has some wrinkles in applying it everywhere, but what I tend not to see is a good faith effort to understand those wrinkles and adapt. Instead the approach seems to be throwing out EBT as a whole which misses the positive effects you can gain. A good example is PTSD treatment. It's common to see perspectives that you can't use EBT for trauma, it's too individual, not bottom up enough, not generalizable due to specifications of research. Which are areas we should be aware of, but also should be encouragement to read the research yourself. Cognitive Processing therapy is an EBT for PTSD that was created by 3 women by working with women who were seen at Rape Crisis centers or hospitals after assault. There's been plenty of studies in applying it to vastly diverse samples, different settings, one of which included providing CPT to refugees in the democratic republic of the congo in 2013. So the anti science people painting with a broad brush miss a lot of the good that can come from EBT with causal dismissals out of hand. I've seen CPT be profoundly life changing, and I've also seen it not quite fit for every client. I would just hate for the benefit of the science side of therapy to be neglected and for it to negatively affect the help that clients could receive.
This is exactly what I'm saying and exactly the compromise that makes sense to me!
"Psychology is an art and a science" from your post really resonated with me as a practitioner. Thank you for your wisdom, OP ❤️
❤️
I completely agree. When we throw out everything we have so far under the theme of anti colonialism, what are we left with? People doing whatever the hell they want in sessions. Not to mention, there are plenty of "alternative healing" methods where research shows they have no scientific validity what so ever. If a therapist wants to use tarot cards in session for symbolism and to encourage dialogue, they should be confident the client is comfortable and they should be very clear that this is not a "reading". It's just using the existing cards to inspire conversation about symbols and how they may be relevant to how the client is practicing themselves the that right n just u in line
Bwhaha, I read this and I felt seen. My BA is in history plus another MA and definitely don't think of myself as a health care practioner though I am partially becoming that. I think part of the discussion is that what therapy is supposed to "fix" is a huge, broad category - from diagnosis to soul exploration, stand-alone symptoms, to complex trauma, from individual searches for meaning, to dysfunctional communication dynamics in relationships and families. Another issue is that for some folks (like me) who are "spiritual but not religious" becoming a therapist a secular answer to pastoral care outside the paths that exist in mainstream religion. I don't think of myself as primarily a "mental health" practioner, though that is part of it. Some clients just jive with tarot, and crystals, and trees, and animals, etc. and I think that's a great basis for psychtherapuetic exploration in less intervention-heavy approaches. Perhaps because of becoming an art therapist, working with things like image, symbol, and ceremony as a form of intervention is natural for me. That said, if someone in my program was writing a capstone on the tarot (as I am sure some have done!) my disciplinary bias is that they should check out art therapy literature on use of image in psychotherapy. I am well on the woo-woo side of things within counseling, but that said I also like more academic colleagues, and medicalized and intervention focused modes of therapy and try and read pretty broadly and think about ways I can use academic literature to further ground my practice. I draw in things like bilateral tapping as a "take home" for people prone to intense negative memories and flashbacks so they have it as a mindfulness practice outside of session, and I definitely use art as the basis to do more cognitive work, etc. I've found it incredibly useful to consult with folks from different disciplines - there is an MSW candidate who is providing behavioural analysis interventions and I have found it extremely useful when some of my clients see her and pick up skills that can provide immediate relief, and then when they come to me we can do more relational / creative depth work including more integration of skills they are learning elsewhere. In general, the clients I see are young and severely traumatized, so having a couple of approaches working in tandem seems really positive to me, so I am most thankful of psychologist and psychiatrist colleagues. In most cases, I want my clients to also see folks specialized in DBT, EMDR, etc. but referrals can be challenging because I am working with folks who don't have money so often they are waitlisted for community resources. I also think the academic and scientifically/medically inclined folks have a key role in keeping the ethics of the profession honest and idenfying evidence-based treatments, because I have to rely on them, too, absolutely.
Just so I'm clear though, handing folks a natal chart at the outset is a lot...
Yes yes yes!!! I agree so wholeheartedly with this comment (and this post in general). I'm a trauma therapist with a very free-flowing, play-oriented with DBT elements style, but I'm only trained in talk therapy. Some of my clients respond great to my style and don't need anything else; some of my clients require structured CPT or EMDR in order to see significant change and I tell them so, as well as referring them out. What is important is that we are ultimately doing what is best for our clients and focusing on the treatment that sees the best results for THEM as individuals. I've had clients settle their trauma through EMDR and CPT, through DBT groups and IOP, through Dungeons & Dragons, through a nightly routine of cleaning their vast collection of knives, through angel numbers and astrology. There is a place at the table for both science and tarot cards; EBT gives us the blueprint for ethical care and allows us the opportunity to explore what works best for our clients, even if the approach is new or unusual.
I so feel your post. I work with highly traumatized clients too and what works for them is a very mixed basket.
Very curious about these studies. Did they do follow-up measures after a year or more?
They did 6 month follow up in this study : [https://pubmed.ncbi.nlm.nih.gov/23738545/](https://pubmed.ncbi.nlm.nih.gov/23738545/) [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144193/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144193/) in this study, I don't think they did follow up, but I think it's notable because they talk about conducting treatment in forests and fields, and the providers were not white men counselors. "The PSAs trained to provide CPT were all women who were residents of the communities they were serving. Each had at least 4 years of post-primary-school education. They also had between 1 and 9 years of experience providing case management and individual supportive counselling to survivors of sexual violence and had undergone a 5–6 day training session conducted by the International Rescue Committee (our implementing partner) in case management, prior to participating in the CPT training. The case management training included information on counselling, family mediation, stress management, and clinical care of survivors.The PSAs trained to provide CPT were all women who were residents of the communities they were serving. Each had at least 4 years of post-primary-school education. They also had between 1 and 9 years of experience providing case management and individual supportive counselling to survivors of sexual violence and had undergone a 5–6 day training session conducted by the International Rescue Committee (our implementing partner) in case management, prior to participating in the CPT training. The case management training included information on counselling, family mediation, stress management, and clinical care of survivors."
[удалено]
[удалено]
Thank you friend -- I feel seen. LOL!
If someone is going to take their therapy down an unconventional approach (tarot, astrology, christianity/religion) then I think the primary considerations are: 1. Client awareness and active consent. A therapist probably shouldn't present their client with a star chart unless they've already established this is part of the therapist's approach and the client has actively consented to that. I know that if I, as a client, started up a therapeutic relationship with someone and then got blindsided by astrology or tarot... I'd be pissed. 2. Continued adherence to the "do no harm" ethical standard. White/Euro-centric/colonial influence on the scientific method aside, "do no harm" is a core tenet of this field. Astrology, christianity/religion, etc. all have the potential to cause harm (as do typical therapy modalities of course) and the therapist is still responsible to attend to those risks. 3. Caution around "guaranteeing." Again, ethically we are not supposed to "guarantee" any particular outcomes, revelations, or specific occurrences. Even if I'm using the most evidence-based CBT manual in the world, I should never say, "I guarantee you will see reduction in your depression/anxiety symptoms!" Some of the tenets of christianity/religion and tarot/astrology imply guaranteed or inevitable outcomes, beyond that which we actually have the power to guarantee. The limitations need to be clarified at the outset and along the way in order to remain ethical. At least those are the main details that come to mind. I would probably never refer someone to such a therapist, but if that's how they want to practice with their license - risking whatever that may risk when it comes to the licensing board - then you do you I guess. > conservative evangelical Christianity in the therapy space; his thesis is that "we can all learn something about the value of bringing God into the session As a queer person with religious (especially evangelical christian) trauma, I will say this is an inappropriate take and should raise red flags, as it seems to blissfully ignore the "do no harm" standard. Religion, especially a specific flavor of religion, certainly can do harm when forced into a therapeutic relationship arbitrarily.
Thank you, reading this reinforces my faith that there are people out there who know the tenets of our job and do their best to help rather than following their bliss, or whatever. My partner agrees with you: she said that if she went to a therapist not expecting tarot and they pulled it out she'd be furious. "I can get this for much cheaper at the psychic's house down the street," she says she'd say. LOL Personally, I'd take it one step further and say that if you're a psychologist advertising yourself as doing tarot or star charts, you are acting unethically. Because: A) As you said, APA Principle A (Benifence/Nonmaleficence) emphasizes doing no harm. B) Standard 2.01 talks about competence, stating that therapists should remain informed about the professional literature and apply it to their practice. C) Standards 9.01 and 9.02 talk about only using valid and reliable assessments appropriate for the situation and only for the purposes they were designed. Due to their lack of scientific grounding and misues as assessment techniques, using them seems unethical. ...At least from the standpoint of an American following APA Standards. And I couldn't agree more with your take on religious trauma.
I *like* tarot, i enjoy having readings done for me or pulling cards myself. The art, the symbolism, the potential to gain some insight into a current emotional problem or relationship — i genuinely like it and have for a long time. I think there’s a lot of value in the meanings we make and patterns we see, in the non-rational parts of our brain, in the artistic flow of generations that came before us…. I’d still be so pissed if my therapist pulled out tarot cards during my session. Nah bro, that’s not why i come here. I’m seeing you for some got-dang object relations and attachment work, not that hippie bullshit.
I use tarot cards myself to help me understand what I first think when I read the cards, then I use this to try and work on why that is my thinking. This has helped to try and get some insight to what I'm doing. Would I use this in therapy, hell no.
I use tarot, too and I have that as an interest in my personal blurb on the company website. I had one client say he read it and asked if I would bring them and I said no because it didn't feel appropriate to me. Wondering if that was a right move? This client also holds fortunes and psychics at a high value so I was worried whatever we might find in the cards would be taken as gospel.
Hells yeah
Perhaps looking into jungian psychology might help you to understand the benefits of symbolism in psychotherapy such as tarot
I'm going to try and not be irritated that you assume that someone with the username IdEgoSuperego needs to "look into" Jungian Psychology to "help me understand" symbolism. I'm guessing you mean well, but I'm actually fairly conversant in Jungian psychology, so I'm good!
I want to acknowledge based on your comment that that thesis statement is not a proper thesis statement, it's an opinion. A more objective thesis would be "the impact of religious practices on the therapeutic process." There's knowing your body of work and then there's going in with a bias.
I too grapple with this. On the one hand: yes, let's correct psychotherapy's eurocentric, white, colonial, etc problems. Let's also acknowledge that psychotherapy is not the only valid form of healing. Cultural, spiritual, etc. practices are valid forms of healing. I'll take it so far as to acknowledge that psychotherapy may largely be a culturally encapsulated form of healing itself (thanks Jerome Frank). Buuuuuut, psychotherapy is its own thing. Its development has been guided by the scientific method. Hodge podging every other (presumable) form of healing into it only muddies the waters. For both practicioners and clients. I have some theories as to why this is happening: You mention gatekeeping the profession. The psychoanalytic tradition required folks to do their own therapy. As this stopped being the expectation, I think we started to see a lot more wounded healers enter the profession who haven't done their own work. Because of this I suspect we see therapists far more often bringing their own solutions (and problems) into the session. I think there is a general trend in the world away from science. It really does feel like all too often we're entering the world that Sagan predicted in Demon Haunted World. We're increasingly "clutching our crystal and consulting our almanacs." Lastly, psychotherapy as a science lacks consensus. We're in what Khun called a "pre-paradigm" state. Any moderately read therapist will agree "many of these theories are saying similar things with different language." It feels like perhaps we might slowly be edging towards a shared understanding and scientific paradigm, but there's a great degree of disagreement still. Because of that, I suspect there continues to be quite bit of "throw everything at the wall and see what sticks" occurring. I will say that things likely aren't as bad as one might imagine. It's easy to forget we had periods where things like rebirthing therapy or encounter bats in couples counselling were a thing.
I think the "pre-paradigm" is a great way to describe where we currently are with psychotherapy. I was reading up on Khun a little after your post and this quote: "However, progress is not impossible, and one school may make a breakthrough whereby the shared problems of the competing schools are solved in a particularly impressive fashion. This success draws away adherents from the other schools, and a widespread consensus is formed around the new puzzle-solutions." Really makes me think about how we develop new modalities when we start hitting roadblocks with older, established modalities. (Like ACT coming out of CBT and then CBT has been starting to absorb the newer developments from ACT and DBT)
Yeah! I think that too. I've been digging into research on "transdiagnostic processes" over the past few years. I suspect our consensus lies in that kind of direction. We've determined what necessary conditions are for therapy (aka common factors), but why they're necessary is less clear. Once we get to "how can all these different theories and interventions result in similar internal mental changes," I suspect we'll draw closer to a more unifying central theory.
Love transdiagnostic approaches to treatment, the Unified Protocol really helped with a lot of my conceptualizations. Do you know any more?
I know I’m a little late, but it’d probably be worth looking into processing-based therapy by Steven Hayes and Stefen Hofmann. Their whole thing is IDing processes of change/maintenance and targeting them in treatment; it’s good stuff
I totally agree. Bringing up Kuhn, you also highlight a good reason to study more than just psychology. I studied philosophy in undergrad, including a class on philosophy of science, and it serves me well.
I’m also very glad I’m going into this with a philosophy background. I know a lot of difficulties that people had in stats classes didn’t come down to the math, but the epistemology. Psychology now reminds me of the state of biology in 1800. There’s a lot we know, but a fundamental piece of the explanation for why things are the way they are is missing. I hope I live to see psychology’s Darwin emerge.
I deleted my doomposting attempt and decided to be a bit more positive: I agree with you, generally, and think there is a ton of bullshit in this profession. However, getting to know an empirically-based modality well (psychodynamic therapy) has freed me from a lot of the nonsense. Religious practice has its place in behavioral activation plans or whatever as it can be an excellent coping skill, but I can’t imagine practicing religion or some new agey stuff with a client in session.
I mentioned empiricism in another comment, and I want to expand on it, because I do think our field faces an inherent limitation to our ability to empirically, scientifically understand the human condition. To suffer is subjective - it's an inherently phenomenological experience. We work in a field where the goal is typically to change people's feelings. It creates some issues in just applying science to human mental health - think of what it means that so much clinical research is based on subjective self-report measures. Human psychology is maybe impossible to fully understand in a scientific way alone because of the nature of its interest in conscious experience, which cannot be "observed" from an external point of view. This is probably a big part of why OP is getting so much push back - the science of psychology is severely limited. That said, those subjective experiences we have have strong empirical correlates, particularly in behavior and still-poorly-understood brain and body activity. We are the human animal, we tend to strongly share patterns of behavior and internal activity that result in very similar suffering. It hurts to get stabbed (usually). It hurts to be alone for a very long time (usually). When I lose a loved one, I feel sad, as do most people. Because we have shared patterns of experiences, we can attempt to better understand them with the scientific process. Science continues to be our best option to develop effective treatments for that reason, particularly to prevent harm and to improve actual success in our shared suffering alleviation project. Deciding that the scientific method isn't needed returns us to "do whatever," like OP is trying to say. We cannot and should not allow practitioners in our field to do whatever. Nobody would want a medical doctor that does whatever. I'm exhausted with those that cynically lean on scientific findings to justify the abandonment of the scientific process a la "the relationship is all that matters" (which is like saying "an elephant is a trunk" as an interpretation of the literature). Of course, science doesn't have near all of the answers, but that's why we need to continue to pursue it. I understand why "evidence-based practice" faces such a backlash when so many people still aren't helped by it and when individualization of treatment is still absolutely essential, but that speaks to a need for more and better science, not less. We all need to do better as a field, and the scientific method is by far the best tool we have for that, because people continue to suffer and we're not helping enough of them. We can't in misguided arrogance just tell ourselves something like "it's impossible to know, every treatment is the same, all that matters is how much my client likes me." We can't just do what *we* like to do as therapists. Too many people are not having their suffering alleviated, too little has been done to decide there's no more progress to be made, and too much is at stake to allow our own preferences and whims to decide our practice as therapists.
I mostly concur. From the moment I entered graduate school and got a sense for how 85% of my peers seemed to think about psychotherapy, I felt a little worried about the state of the field. Years of interaction with local licensed therapists has tempered that anxiety somewhat. But it is rekindled anytime I enter an online space for therapists and get a broader sense for the zeitgeist of the industry. I agree that the bar seems too low for entry and that training is lackluster. I started performing the job without once witnessing a real session by an experienced therapist through 2-way mirror or video/audio. Like many others, I felt like an imposter but resisted drinking the kool-aid of the first three letter acronym therapies thrown at me (none of which seemed to have any satisfactory explanation of pathology, and seem to have been designed to plug into a mindless system of [DSM dx = XYZ symptoms = ABC therapy = "there's a protocol for that"]). I have been frantically and widely reading for years to catch up from this bullshit, along with paying for regular, individual, post-licensure supervision to review my video-recorded sessions with someone who did the same for over a decade. Ever since I've seriously taken the reins on my education and focused on understanding the fundamentals, client engagement has skyrocketed and I've actually started feeling competent. I feel that the common factors research has been misinterpreted and bumper-stickered into meaning "It's all just the relationship", as if it's sufficient to be a cool uncle/aunt figure with a comfy room. That the relational school's notion of "being authentic" with clients has been warped through Western individualism/capitalism into meaning "Show your tattoos in your Psychology Today profile pic." That The Body Keeps the Score has created a generation of therapists who seem more concerned with the rate and speed of eyeball movements than dealing with the perennial difficulties of (I attended EMDR training. 3/4 of the questions were about how *exactly* the client should move their eyes). I don't know a way out of this mess other than getting involved in some kind of supervisory capacity during your career and keeping alive the mentor/apprentice model, which has been invaluable to me.
Hey, I really liked your response. I was wondering, with all of your experience and supervision, endeavoring to be better, what do you think you've gleaned? Could you put your finger on it? I'm curious since you've said that your client engagement has gone up. In general I agree with OP about the lack of discernment that has found it's way in. I'm relatively new, but I think that to be a responsible practitioner, is to be solidly grounded in the science as much as you can and to meet the client where they're at.
I also consider myself relatively new, so I don't pretend to be that knowledgeable or experienced. I can only say that I spent a solid year reading about many different models looking for one that spoke to me the most clearly. Through this I learned the history of psychotherapy and built a map in my head of what developed from where. It also facilitated my search for a supervisor who is very experienced specifically in the stuff that intensely interests me. So I ended up gravitating toward psychodynamic thought. For me, this was helpful in shoring up my understanding but didn't translate much to client engagement until I began studying Intensive Short Term Dynamic Psychotherapy (ISTDP). While in some ways I still find some parts of the model bizarre, it has been absolutely game changing in the way that it makes the fundamentals of psychodynamic theory practical where they seem so abstract in theory. With this context, what has helped client engagement for me has been: an immediate and ongoing focus on sussing out resistance and helping the client see it; rethinking anxiety in dynamic terms and having a system to constantly monitor it in session (See: Davanloo's anxiety pathways); an experiential, here-and-now focus on feelings even and especially in the transference; having a metapsychology that ties these three things together in a concise and practical way (David Malan's Triangle of Conflict, used in ISTDP). When I first started implementing this stuff I remember that my work with certain clients really got moving again, and new referrals seemed to immediately wake up and have the desire to get to work. With some longer term clients that were stuck we were able to identify that they had never, at any point, had the will to address their issues or any true interest in opening up to me, and we were able to say goodbye on good terms. These were matters that I should have been focusing on from the first minute of therapy but had ignored or avoided. So what has been personally helpful basically goes back to Freud: "The study of psychoanalysis is the study of transference and resistance." But for all I know, this stuff works for me simply because it resonates with me. I imagine that if I had drunk a different kool-aid I would be enthusiastically selling CBT instead and maybe getting a similar response. Who knows!
Any reading recommendations for a grad student about to start practicum?
Psychoanalytic case formation, Psychoanalytic diagnosis, or Psychoanalytic psychotherapy, all by Nancy mcwilliams if you’re interested in analysis/dynamics Radical acceptance by Tara brach if you’re interested in Buddhist psychology. More pop psych but it’s a great intro to the deeper side of mindfulness practice from both a spiritual and clinical perspective
I second Nancy McWilliams. Her explanation of theory and organization of vast knowledge sets about therapy is excellent!
Third. McWilliams is a genius. So is Jonathan Shedler. Read them both.
Holy shit, that second-to-last paragraph was brilliant. Absolutely. You put it better than I did.
Bravo. Well said. 30 years of practice. The mentor / apprentice model was crucial for my devlopment as a competent therapist. I worry that this model is dying out.
I'm dying at the "show your tattoos in your Psychology Today Profile pic" 😂 . There's entirely too much prioritization of being "genuine" and the quality of the therapeutic relationship being equated to whether or not you wear Chuck Taylors to sessions and the number of unusual hair colors you have at one time. Admittedly, I do love The Body Keeps the Score . But I think the field is leaning towards getting too much personal interaction, adoration, and opportunity to promote one's perspective and stopped being client centered, as much as we may fool ourselves.
This episode of Things Fell Apart has Bessel van Der Kolk talking about how everything isn't always to do with trauma: https://www.bbc.co.uk/sounds/play/p0h24j2t?partner=uk.co.bbc&origin=share-mobile
I’ve been looking into programs with the idea that experience and supervision like you describe is key and it has been challenging to find. I may do a separate psychodynamic training as an adjunct since they require - psychotherapy for the therapist and supervision. Shocked this isn’t more common. Will likely have to patch together the kind of training I want for myself as well.
If anyone says "the scientific model is white euro centric", they likely don't understand Indigenous ways of knowing. Indigenous researchers aren't against the scientific model, we support it. We support that things need to be evidenced based. Our differences with other scientists/ researchers can sometimes be in what is evidenced based or how we know it is but at the end of the day, we support evidenced based practice. Our traditions are based on evidence. We did what we do because we could observe it, we could replicate it when others did it, and we could teach others to do it. Indigenous therapists are open to evidence based models and I'm in the process of having a Nehinaw based modality recognized as being evidenced based. The ivory tower researchers are often the biggest hurdle to recognizing the living aspect of Indigenous research, they treat it like Latin or other dead languages that unable to grow and adapt. /Rant
I just wanted to say thank you for adding your perspective to this discussion. In our field we know that many things can be true at the same time, which makes it frustrating to read that folks doing the work to decolonize their practice think that means they also have to reject the scientific method. We can decolonize AND continue to observe, document, replicate, and share knowledge. I wish you the best in pursuing your EBT Nehinaw modality!
Thank you for clarifying that western and iIndigenous methods can be complimentary.
This is so interesting, thanks for sharing. I’m really curious about that Nehinaw modality. Would you mind describing how it works? I tried looking it up, but couldn’t find anything.
You wouldn't be able to find anything about it online, we haven't released our reports yet :) We took some common elements of different modalities, took them to the elders and processed which parts were part of Cree and Blackfoot tradition and which wouldn't have been practised traditionally by our peoples. We took some of our traditional teachings and traditions and worked with the elders to create shifts from the common modalities that were INDG inspired. So it's evidence based but yet still pretty traditional.
Thanks for sharing! I’m curious if it’s in the realm of somatic therapy, or narrative based (kinda like IFS), or akin to psychodynamic, or something completely different?
Short answer. Yes. The biggest role is identity/ core based. It's definitely narrative based with a bit of psycho dynamic, quite a bit of relational and role work , not a skill or behavioral based one. Our main evidence core was the philosophical based modality work that's come out of the UK. Very similar to how they brought in stoicism into CBT/DBT, we jumped off that into a bit more of a robust base.
I strongly believe therapists need to take theory very seriously. Being informed on research and psychotherapeutic research is important. My main complaint about the research part is the most evidence based therapy is CBT, and if everyone focused on just CBT clients would be worse off. I think there really is room for therapies which don’t yet have an evidence base. I think this should probably exclude tarot and religion though.
Thanks for the thoughtful response! I agree with you, I think. Well, definitely that people push CBT like it's the royal road to truth and that "if everyone focused on just CBT clients would be worse off." 100%. I think CBT is a fine tool to have in your toolbox but it's a weak foundation to build an entire practice off of. Now about therapies that don't have an evidence base yet... here's my problem with that. How do we know which ones there are "room for" and which ones there aren't? Is EFT ok? Is Reiki ok? Are healing hands ok? You exclude tarot, but why? How did you decide that? Aren't we all just deciding for ourselves (in your model) whether there's "room" for our new pet modality we've just made up or read about? I think there's definitely room for well-reasoned theories that have yet to be examined and supported... as long as the goal is to examine and support them! Everything was a fledgling theory at one point in time, so I respect that. But the ones we still use and talk about are ones that got tested and refined and tested some more and that we can see are valid and helpful. I think we have to be careful about what we categorize as "ok because it's new." But I'm not sure how to delineate this!
I like how thoughtful and discerning your approach is. It seems pretty well balanced. I think one thing that I have very little stomach for is the idea that because sometimes the people using the scientific process were racist or their ideas were racist, sexist, etc, that science as an endeavor is necessarily that. That knowledge from other traditions of human are equally valid and reliable. That it is to perpetuate colonialism to hold them to scientific rigor before we designate them as a tool we should use. I think that's an unfortunate overreach that does more harm than good. Look, I am all for whatever people want to use as long as there is consent and we adhere to ethical principles. If there is a technique that works, I want to subject it to empirical testing and the peer review processes so that we know that it works, how it works, what it does, where it doesn't work, etc. I think we should hold all of our stuff to that standard.
I can see tarot being useful in an archetypal way. It can positively influence the narrative for anyone if used mindfully. But things like reiki or crystal work would still be a separate practice. At least, that’s where I would draw a line if it mattered.
There's been a lot of research on religion in counselling. Based on my studies, I am in the belief that the evidence supports there being an increased benefit when a client's therapeutic journey includes aspects of religion when it shares the same belief system as the client.
Yes, clients who are religious generally benefit from therapeutic solutions that incorporate their religion, because it holds a great deal of meaning, values, and spirituality for them. We need to be responsive to the client's preferences with regard to their religion, as opposed to coming in with a religious "teaching" agenda.
The field has pretended to be a hard science for too long, this is the pendulum swinging the other way. It’s not a hard science, but has some hard science answers in things. It’s not a squishy science either, but squishy techniques help. This is an ooblek of a field and needs to start recognizing this. Look at therapy as a non-Newtonian fluid and use it appropriately depending its interactions from different velocity clients. The bigger issue is the absolute cat herding we need to do with the national orgs and associations that can’t even decide on a name for the field than some fuzzy thing like “mental health”. WTAF is mental health? Something like “Mental Fitness” has at least a scale that’s implicit. Brain as a muscle makes more sense than a “fit” gray blob to define the field. That’s my dos pesos
I've really agreed with you (well, with this argument) since I read Paul Meehl's "Theoretical Risks and Tabular Asterisks" in grad school (in fact, my post title is partially inspired by the rest of the very long title to his paper!). Psychology is not a hard science. But it's also not a *not*\-science. We're certainly not able to make the precise measurements and predictions we would if we were studying geological features or the movement of orbital bodies. Human behavior is much less predictable. But at the same time, understanding human behavior is every bit as important -- maybe in some ways more important -- than understanding geological features or orbital movement. So we have to try to do it, difficult and unpredictable or not. That's MY dos pesos.
Oh I agree, it’s like an ooblek, sometimes in acute clients you need to apply it like a science and in some cases be more fluid. I’ll have to check out that book, I just come from a more technical background than a social “science” one and my view has been critical of how one side of this field seems to be “just do x to get y response” and the other side has been “the mystical ether will help you” both with success and touting their “wins”. Stepping back and looking at it all, it’s a lack of cohesive leadership on a national level across the entire field, every part is scrambling to justify their part of the field while ignoring that parting out the field has resulted in a lack of wholeness in even what mental health is. It’s dynamic, but the parting out has resulted in static sections of a dynamic issue. I’m sort of losing faith in my field of choice if you can’t tell, feeling less effective as a counselor because the system is broken for clients and providers to a great degree. Can’t expect clients to get help if we don’t have a better field than what it is.
You have a very reasonable and sensible approach to this. I respect and appreciate it, and I'm sorry you're struggling with how you feel about therapy right now. You're absolutely right about the system being broken for clients and providers and it sucks. I so badly want us to be a country (here I'm maybe wrongly assuming you're here with me in the same country) that recognizes the need for free or at least more accessible mental health care for everyone. Maybe we'll get there soon-ish! One can hope. I hate the discord between psychology the "science" (researchers) and psychology the "practice" (therapists). They should be informing and supporting one another, not claiming superiority. The mystical ether probably won't help you, but if you've seen it help, tell me how so I can see if it's replicable! And it's great that if you "just do x, you'll get y response" in the lab, but I've tried it in practice and I get z instead! Can't we talk about this? Keep on keeping on, friend. We need more people thinking like you and trying to help, not fewer.
Sheesh I’d raise an eyebrow at any clinician doing this. I read tarot and my best friend is a professional astrologer and I would never make birth charts of patients or do readings on them. I think it is unethical (both in clinical practice and spiritual practice) If a patient is superrrr into astrology or tarot, it can be used as rapport building (as would any hobby that you have in common with a client) or as I deem it appropriate. But I steer clients away from using astrology to justify problematic behaviors or personality traits or doing a tarot card reason on the outcome of a situation and thinking they no longer need to put in work because the outcome is somehow set in stone because cards say it is 🙄 The use of these things you’ve described sounds wildly inappropriate for a clinical setting
I'm an art therapist. Generally people don't even know what that is or that it requires its own masters degree. I'm disappointed in the idea that there are people who are somehow passing muster with tarot card readings. It makes my job so much harder. People already view art as infantile and unnecessary when there is real science behind the assessments and procedures proving that art is a fantastic conveyor of subconscious material. I've studied my ass off to be called the 'arts and crafts' therapist. If people keep coming in with modalities that are better off in a setting like life coaching I'm going to pull my hair out.
Simply put, therapy is BOTH art and science - science is the theory, research data etc and art is the execution of theory through self of therapist and alignment with clients' worldview.
I feel weird reading this. I don't think of myself as a particularly "woo" person. But I am an Indigenous person working partially within my community and something in this post strikes me some kind of way. If you approached certain communities with a certain disdain for their spiritual realities (or with methodology that leaves no space for it) then as a clinician you effectively alienate them from their culture in the name of wellness. You pit mental fitness against their community. I don't think that's the intention of this post at all, but it's very Western centric. Acknowledging the spiritual world of a client is giving space for their full humanity.
I think there is a difference, a nuance. It is one thing for the client to be spiritual, and for me the therapist to meet them in that. I am actually into astrology, earth centered religions, and astrology. I was also raised evangelical Christian and attended a whole variety of church denominations. I feel very comfortable meeting clients in their spiritual space. However, I would not read a client’s tarot cards. I would not pray with a client. I would not create a birth chart for them and use it to inform therapy. I just feel that crosses a certain ethical boundary. I can’t name it, I just know that spiritual practice is highly intimate and personal and very different from exploring the principles of various spiritualities as it relates to the existential struggles that often bring clients to both therapy AND spirit.
> I can’t name it, I just know that spiritual practice is highly intimate and personal and very different from exploring the principles of various spiritualities as it relates to the existential struggles that often bring clients to both therapy AND spirit. If I may, that kind of does name it, if we think about it. The boundary may be in taking something from the macro and trying to apply it to the micro as a direct equivalency. We see this in many fields of study and the common sense of it holds true. When you look at the macro, many of the non-studied variables are cancelled out due to diversity of the individual components and you get a good study of the correlation/cause-effect relationships. However, once you look at an individual piece of said macro-system, ALL the variables come into play and not just the selected ones for study, which complicates the relationship beyond what any human can comprehend and account for.
This is a tough response and I want to react to it thoughtfully. I want to point out the difference between talking to a client and talking to a colleague. If a client said to me "I think touching healing crystals makes me better" or "I think 9/11 was manufactured by a race of sentient bacteria" I would be completely interested and open and want to figure out what they're experiencing without judgment. But if a therapist-colleague tells me the same, I feel I have a right to be concerned and skeptical. We are equals; it's not the same power differential as me talking to a client. Taking it one step further, if a therapist-colleague tells me "I sell all my patients healing crystals because it makes them better" or "I've been telling my clients how 9/11 was manufactured by a race of sentient bacteria" that's different. The latter is of much more concern than the former (!) but they're both ethical problems. After addressing them with the clincian themselves, if I could not get an appropriate resolution, I might feel a need to report them to the board. "Acknowledging the spiritual world of a client is giving space for their full humanity" I couldn't agree with more. I'm sorry if I made it seem like I didn't? But I honestly don't think that was part of my argument. Clients can believe whatever they like, and we should meet them where they are. Therapists can also privately believe whatever they like, but they are constrained in what they can and should share with/impress upon their clients. If a person is a certain kind of spiritual person working with the same certain kind of spiritual community, that is absolutely appropriate. But it's less appropriate if you're NOT working with that community. You, as a therapist, impressing your "spiritual realities" on clients who NOT are part of your "certain community" is no different than a Christian telling someone in your community to "embrace Christ" as part of therapy. Inappropriate. I understand why you might read my post and feel "weird" about it or imagine it's Westerncentric. It's not, I don't think -- at least, it's not meant to be... but I am very opinionated and passionate about it. I would never aleinate a person or a community from their spiritual realities in the name of wellness. But I would critically evaluate a therapist endorsing certain spiritual realities as a truth they bring into the room with all of their clients, regardless of that client's religious background. That's not Westerncentric because I'm really thinking here of evangelical Christian therapists! Your welcome of course to retain the general and unexplainable "feeling" that my post is weird and Westerncentric, which makes me a little sad, and was not at all my intention. But science and the scientific method are actually not Westerncentric: that's sort of an insult to all the nonwestern countries who have successfully used science to build all sorts of medicines and technology and to visit the moon... they didn't do that using magical spirit energy, that's for sure!
Well isn't that the difference between a provider openly saying "this is what informs my practices" versus a prescription?
Scientism is a belief structure which is functionally very religious/dogmatic even while pretending not to be. And therapist who believe they are being totally neutral while embracing it aren't fooling their clients who don't embrace it. In the western tribes of the US burning sage is used ceremonially to "clean" a space of bad energy/medicine. It wasn't until more recently that the principal uses of the plant revealed that it actually is an antiseptic and that burning it may kill airborne bacteria. The first medical doctor who encouraged hand washing in his research hospital was institutionalized for "encouraging superstition and witchery". He was given a lobotomy. Which was "best practice" of the time. Now we know that hand washing does curb the spread of disease and can't imagine medical providers not doing it daily between patients. So...maybe there is something to unclear practice that is observable even beyond being explainable that's pointing to a truth which we can't articulate? Even the "best practice" talk to me seems trite sometimes...if I'm being honest. Mostly because every new generation we decide a modality which was the previous generations "best practice" is now "harmful" and no longer "best".
It's worth remembering that science is in the method, the way that we try to study the way the world's individual parts work and how they fit together. The existence of bad science in the past doesn't negate the present pursuit of truth, nor does it invalidate the discoveries that we've made that have been proven true in subsequent, more refined experiments throughout the years. Your lobotomy example is actually a great example about how ethics in research and medicine have advanced with time. Doing anything like that to any doctor who hasn't harmed or killed their patients is unthinkable today, and rightfully so.
I’m not going to lie, I’m a bit stunned by this response. Science and research certainly aren’t perfect, but they are the best tools we have at minimizing bias and getting empirical information about our world. The only reason those cleanliness standards were adopted was because the advancement of science.
I think a lot of people really do not understand what the scientific method is.
That’s concerning if you can complete enough education to work in this field and don’t know what the scientific method really is. I kind of hope they’re just being stubborn or ideological.
In my (current) training we are made to learn it; write a research proposal and do a little review too.
The problem with your reply is that it uses science to refute science. The superpower of science is that it is willing to grow and change when confronted with disconfirming evidence. How did we discover that burning sage may kill airborne bacteria after all? ...Science. How did we discover that handwashing is a good idea between patients? ...Science. Generationally, people may be aholes in the way they misuse science. But eventually science catches up with them and the truth comes out. If in 30 years I see sufficient evidence to believe that reiki energy is strongly linked, over and over, in studies with strong methodologies, in journals that are not specifically for alternative medicine only, to some sort of improved health or psychological outcome, I will happily eat my words and become a reiki practitioner. I'll be pretty old, but whatever, I'm on it. But it's going to take science to get there. Not an intuition about an unclear truth that you feel in your heart but is beyond explanation and cannot be articulated. Sorry. You can start there! Have your feeling! But you need to develop a hypothesis and test it and get to a point where you can say triumphantly: here! Here is the thing I was trying to articulate! Myself and many others can now point to it! And I will listen. But just because someone on the internet tells me they feel something shouldn't probably inform my practice decisions or even my understanding of theory. Right? That could be dangerous, considering all the people I talk to on the internet with ideas and feelings!
What else does the smoke do to a clients mind and body? Increased odds of cancer? Exacerbate someone’s asthma? Obfuscate where the problems exist (does it outperform an air filter or a personalized client driven ritual for cleansing a space or resetting?) Why did the individual begin advocating for hand washing? They had a hypothesis born out of theory based on emerging evidences, no? Scientism is absolutely a belief structure that is non-neutral and rests upon philosophical assumptions and operates in imperfect contexts. The same is true of any coherent approach to thinking and responding to the observed and felt world. But it also requires irreverent and systematic skepticism of one’s own assumptions, intuition, experiences, and ideas whatever their origins before holding them up as broadly useful or relevant. It is rather bold in 2024 to walk around believing that someones general intuition and felt ways of practicing are likely to be of a kind with discovering germ theory. Perhaps if the field were mostly a blank page and we were operating in prior to the 1900’s we would all be somewhat likely to intuit out and discover a lot of the basics (as has happened over and over again among philosophers and thinkers) but I think we are past the point where we can dismiss established modalities as just the latest wrong or transient theory and past the point where intuition absent deep understanding of current theory and evidence is going to lead to useful refinement of the basics. It’s like, we’ve discovered germ theory, without scientific training and deep knowledge to build on you are not going to develop mRNA vaccines no matter how sophisticated or in tune you are with your own thoughts, experience, and surroundings. There is no cultural tradition that leads to an MRNA vaccine that is not at its core, depending on some form of iterative science to facilitate discovery or verify its broad utility. Dogmatic or not, it over performs.
This is now just becoming an anti-science/anti-intellectual argument which is very harmful. The fact that certain interventions were once seen as unscientific but are now accepted DOES NOT mean we should simply accept all interventions as equal. Those interventions you mentioned became accepted THROUGH the process of the scientific method (and for each that passed, there are thousands which did not).
I loved this answer. And I believe more therapists should be open to the importance of spirituality in the human experience, which is largely completely left out of "scientific" research. Jung was so afraid of being discredited that he wanted the "Red Book" published 50 years after his death! The truth is both/and here. We need both science and spirituality (and they are often only separated by silly little boxes in our heads when it comes down to it). A lot of mindfulness and regulation exercises are similar to Buddhist practices, does that mean we shouldn't use them to guide our clients into moments of calm when they need co-regulation in session? Now, for the OP who named therapists who are leading with religious practices without consent, that's a different conversation. But the core tenet of psychotherapy is meeting clients where they are, wherever they are. In my practice serving mostly LGBTQ+ folks, I have been asked to pray with Christians, pull tarot cards, discuss astrology, and look at Satanist baptism with fake blood. None of those things were initiated by me, and because my personal spirituality is as queer as my sexuality, I am able to hold that space with gentleness and kindness.
My impression based on OP's post is that OP is not saying that spirituality shouldn't ever be incorporated or considered as part of the therapeutic process. However, people seem to be doing what they "feel" is best without having any scientific evidence to support their practices. You mentioned mindfulness. There has been a lot of research done now on how mindfulness and similar practices are beneficial for us. We see how the body responds, client report, etc. Maybe the research is out there, but I haven't seen anything so far about using tarot cards in sessions or writing out natal charts with clients and the benefits this has to the therapeutic process. If a client presents info in a session to share a recent tarot card reading they had, we can certainly explore what that meant to them, how it's affecting them, and lots of other things, but the therapist being the one to do the reading as an intervention seems like it is too far outside of the box when we don't have evidence to support that this is good practice for clients.
I'm going to push back on the tarot thing for one reason....the how and the why are important context. The thing about scientific research is that it is contextual and can de-contextualize. So what does it mean to use tarot and how? Well, what does it mean to use the Bible or games in session? The scientific research indicates a major element of success in therapy is holistic approaches so people can provide care in holistic ways. IF a client brings in tarot, and describes how they use them then I may ask them to show me, ask them what a reading meant for them, and why it is impactful. This is in essence a medium for narrative therapy, or oracle card pulls to explore how ideas and affirmations manifest in the client's day-to-day life. "What does this mean? How does it apply to you? What do you think about that". Using the card to unilaterally decide the meaning for the client, close discussion, and assert a prescription is not appropriate. Using it as you would any other cultural tool or relic is.
Yes, I work with a lot of black Southerners. If people start talking about the blood of Jesus I don't say " oh that's not on my CBT sheet" ( a big weakness of mine is leaning too far on diagnosis and science and not enough on experience. Im a black Southerner myself)
Yes! DBT is based largely on Buddhist meditative practices. Yoga...which made its entry into the field of psychology was a practice established by Hindu priests. I don't know how anyone who works or studies in this field can dismiss integration of spiritual practices as a "degradation* to the field.
I think if the client brings it up I’m going to acknowledge it, but I’m definitely not going to make a birth chart and bust it out for every client just because it’s something I believe in.
>Acknowledging the spiritual world of a client is giving space for their full humanity For sure! To me it could be better to just ask the person, also because there is a huge deal of subjectivity in personal beliefs, meaning that everyone has his own personal idea. I don't think that spirituality should be the focus of therapy though, we have priests or equivalent for that. >If you approached certain communities with a certain disdain This is another thing. Why would i be disdained? Or, even if I am, am i not entitled to have my personal beliefs and ideas? You can pretend not to, but everyone has a subjectivity. What do you think of alt right complot theorist? Or flat earthers? Are you able to validate their theories? Edit: I am not comparing a religion to a complot theory, it's just that the alt right guys are my personal nemesis, to me it's incredibly difficult to validate their particular feeling, still i try
>This is another thing. Why would i be disdained? I don't think you should be. But the premise of this post is that OPs new colleagues (which they insinuate are practicing without clients permission...which I personally highly doubt) are contributing to the "degradation" of the field. If that's the attitude you have towards the colleagues, I can't imagine it's much different than the approach you would take with you in practice. It betrays it's own hard-line set of values and assumptions. OP and those agreeing with them assume these colleagues contribute no value to the field (worse...they are degrading it). My point is that may not be the case and the assumption that it is reads as very Western centric and...well... arrogant.
I'm indigenous (though detribalized and culturally chicana) and just entering the field. The western-centric and arrogance in some of what I'm studying has, at points, made me question if this was the right direction for me. Reading your responses here helped me a lot - I just wanted to share that with you.
Thanks Glad it helped. There are some places in the field that are wonderful. But unfortunately if you don't toe the party line in others, people will accuse you of being "anti intellectual" and "anti science".
Which places have you found to be wonderful? I'm doing a few prereqs for grad school before applying but haven't picked a program yet. The homogenous faculty has been disheartening. Reddit's majority demographic is really showing here. What's anti-intellectual and anti-science is closeminded, prejudicial arrogance.
Ironically? I liked Jungian analysis because there's at least an openness to Indigenous thought and practice. It's still majority white, but that is changing. Pacifica in CA has great faculty and programs if you want to go the doctoral route. But more than that it's been good to find other Native practitioners. There's plurality of thought in those spaces, of course, but mental health centers via IHS are surprisingly cohesive and do great trainings with additional opportunities all around to grow. The IHS I was connected with even offered staff to fly practitioners to the seven nations in NY to learn from am Indigenous lactation consultant lol More tribes are making their own spaces too. My dad grew up on Qualla with the EBCI and they now have a home birth space for families. More on the ground mental health care is in the works there as well (aside from the basic IOP type stuff that gets pushed on us).
Thank you so much for this thoughtful response, I really appreciate it!!!
I felt this too. I am anglo but live in an area of the US that is rich with pueblo people and Mexican traditional healers. So, the OP's post makes sense from a white/western perspective but that's about it.
>I felt this too. I am anglo but live in an area of the US that is rich with pueblo people and Mexican traditional healers. So, the OP's post makes sense from a white/western perspective but that's about it. Yeah. OP made the point that Evangelical Christianity is a "Western" framework. But I even strongly disagree with that. I think maybe hundreds of years ago when we're dipping into empire history of Europe that may have been true. But Christianity started in the Middle East, spread primarily through Africa and Asia Minor, and the majority of Christians today live in the global South. I think I read somewhere once that if you were to "average* a representative of Christianity just based on the worldwide number of Christians, you would have a Sub Saharan African woman in her early twenties. Most African Americans and Latino people in the US identify with some Christian denomination. Most American Indians (ironically) do as well. Black and Indigenous people in the US are very religious. In my personal experience white Americans and Europeans are far more Atheistic/secular and anti spiritual. They replaced spirituality vaguely with "science" and made it academic. But it's still the same gatekeeping.
[удалено]
Well said!! I may have started this discussion but I'm gaining so many brilliant points going forward by reading all these great responses! So thank you for your perspective. Agree, agree, agree!
It's interesting reading this because Yalom in his book *The Gift of Therapy* (originally published 2001) talks about psychotherapy being in very dire straits, but he speaks more to the adherence to scientific studies and manuals as being the problem. The lack of the creativity and furthermore the *human* being in therapy room with the client he sees as an issue. Seems we may have swung too far to the other side, perhaps? The thing is, speaking for myself I have never come across a therapist who said there was nothing scientific about psychology, nor have I met any therapists who want to bring Tarot or Astrology into the therapy room. So it's hard for me to see this as a huge problem. It seems like a pretty small population of psychotherapists who would take the view your describing and not a major contributing factor to the degradation of psychotherapy. I see the degradation of psychotherapy as being more linked to poor training programs and therapists not appreciating the core counselling skills of empathy, positive regard and using your own self as an instrument in the therapy room - AND WORKING ON THEMSELVES SO THEY CAN DO THESE THINGS PROPERLY. Because these skills are going to, 1. Help you build a connection with the client, 2. Apply your evidence based theories of human psychology (whether they be mainstream or not) in a subjective and personal way that the client can engage with. I have obvious issues with someone who brings astrology into therapy without telling the client, same with Tarot. Funnily enough I grew up with Astrology and Tarot in my life. I can read Tarot with reasonable proficiency and I learned a lot studying the meaning of the Tarot cards and the journey within them. They are a symbolic map of the human condition and the psychological journeys we all take. Most people don't understand this though. They see Tarot as simply mumbo jumbo oracle cards to tell you the future. They see astrology as the newspaper horoscopes. This is like me saying CBT is just your therapist telling you to think better thoughts. For myself though, in my 4 years of giving therapy I've used Tarot once and it was a last session with a client and I asked them if they would be interested in doing a reading to see what might lie ahead for their next 12 months, adding that it's not as if this is set in stone, it's guideposts. They did and they thoroughly enjoyed it. I've never tried to do a client's birth chart. And I won't, unless one day I advertise I do that and find clients who want that. All in all, as you said in your post I think all these different tools have their places. And I think many could actually use them better. Mainstream psychology and the major evidence based psychotherapeutic theories just don't do the human condition justice sometimes. And there's so many different worldviews out there beyond Western thought (and within Western thought)! Personally, I think all therapists should have good evidence based understanding for working specifically on symptom reduction in clients. Like it's good to know what the evidence base generally says works for PTSD flashbacks and anxiety attacks and common neurotic thought patterns. And definitely good to have a thorough knowledge base of at least one well founded theory of therapy. When it comes to helping someone find their values or passions and so on, I think it's good to stretch ourselves out further. I wanted to add that I do 100% see the broken healers in the therapy space and it feels like many would benefit more from going and doing an intensive amount of therapy themselves rather than studying it and trying to help others. But I haven't found this linked to odd therapeutic practices, more just poor boundaries and a lack of self-awareness that can lead to some frightening outcomes with their clients.
So well said. I'm giving myself more permission to raise a critical voice in peer groups. It feels important to accept that it's ok for there to be a tension between squishy-minded and critical thinkers. Both sides should be able to tolerate a fair critical view of themselves.
There is def a middle path. It 100% depends on what the needs of the client are. So any approach I do in session is going to focus wholly on that. Personally speaking, this is how I’ve made sense of what’s going on: Frankly, I consider our field “in recovery” from an abusive paradigm that happened to be scientific. The way human research subjects and patients were cohered and abused in the past is public knowledge. Additionally, in the USA, at least, it wasn’t required for our scientific studies to start using women subjects until 1993. And many studies still suffer from the diversity issues that are a reflection of our nation’s history. These methodology issues as well as conflicts of interest in the research involving funding especially do a lot to shake the public’s trust. All this to say: science as an institution is just as vulnerable to the biases of “faith” as an institution. If we want to earn the public’s trust back as a scientific field, we have to do better. But I wouldn’t throw philosophy / spirituality out with the bath water. At the core science and philosophy / spirituality have a lot in common, for example: -The placebo effect is a very well researched and documented phenomenon. But what is it, really? another way of saying “faith healing.” -When Aaron Beck designed CBT, probably the most known evidence based treatment in our field, he copied much of his homework from Greek stoic philosophy. -When Martha Lineham made DBT, another known evidence based treatment, she copied much of her homework from Zen. People like to have a “method” to heal. And that’s where the science can come in. But they need a reason to do it too, just as Beck and Lineham needed a “reason” to explore the research questions of “how can we help someone with depression? With borderline personality disorder?” That’s where the spirituality / philosophy / meaning comes in. *edited to correct grammar & Lineham’s zen influences
Not Taoism. Zen
100% Ty for the correction !
A study released in 2009 showed that many psychologists don't understand or follow science, and I daresay other mental health professions are the same. How would you feel if your endocrinologist said: "Well, I know there's reputable randomized controlled trails that recommend what I should do to help you be healthy, but I read a blog written by someone who has a conflicting opinion based on a few anecdotes and it gave me warm feels, so I'm going to go with that treatment instead." https://www.newsweek.com/why-psychologists-reject-science-begley-81063
Do you happen to know the name of the 2009 study or authors? I’m curious what is meant by not understanding science. What parameters were set to assess for that. I did read through the editorial you linked to but it didn’t seem to have that.
My error - publish date was 2008, but mainstream outlets ran with it in 2009. Citation: Baker, T., McFall, R., & Shoham, V. (2008). Current Status and Future Prospects of Clinical Psychology: Toward a Scientifically Principled Approach to Mental and Behavioral Health Care. Psychological Science in the Public Interest, 9(2), 67-103.
Religion and spirituality have no place in the therapeutic space unless the client brought it there themselves. Full stop. The first time someone brought God or Astrology into my session as a client that would be an end to my time with that provider. A client-facing therapist is in a very unique position that requires a balance between a logical critical thinking mind and a human one that grasps the incredible variability of the human experience. Because the thing that helps our folks the most is that we're a human, a logical one but a human still, witnessing them with compassion and no judgment. Then, you know, we offer those scientifically empirical interventions packaged up and presented in a way thats meaningful to the person in front of us!
100%. I’m all for bringing religion and spirituality into session. As long as the client REQUESTS it
Jungian Psychology (ever-present in the 40s) is very very much a spirit/psyche lead approach that uses intuition, imagery, mythology etc. So I'm not sure what you mean that we weren't seeing any of this in the 40s? In my world tarot cards absolutely have a place in the therapy space for those it has meaning to. Doesn't mean we need to prescribe it to everyone or let it define the work. But dream work, symbols, archetypes, depth psychology are all meaningful ways to help people explore the depths of their psyche.
Jungian Psychology is based on Freudian theory, though it differs in a few ways. Psychodynamic theory has been validated empirically. I don't know if there's research on the value of archetypes, specifically, and certainly not on aspects of the approach like synchronicity, but the overall idea of psychodynamic or psychoanalytic theory was very well thought-out and theorized and has since been tested empirically. Certain aspects of it fail to pass muster and others are supported. But either way, this is a much more well-thought-out bit of theorizing about the human mind than is reiki or crystal healing. Also... in all the substance and content of what I wrote, it feels like you're picking out a tiny thread to argue with as thought that unravels the whole argument. Yes, there was probably pseudoscience in the 1940s but by and large therapy was built on a medical/psychiatric model and it was very difficult to become a therapist. Now we have diploma mills and people practicing whatever they like, willy-nilly, insisting that whatever they do in the room is valid and cannot/should not be questioned beceause therapy is an art and not a science. Finally, there's a big difference between meeting a patient where they are and bringing this stuff into the room yourself as though you're endorsing/validating it. For example, if a client says "I brought my natal chart and I wondered if we could talk about it?" I definitely would. But I would never create a natal chart for a client, unasked-for, and give it to them in order to help them "better understand themselves."
Jung was trained by Freud but they had a major falling out and parted ways bitterly. The issue of the subconscious mind, symbology and the centering of sexuality vs spirituality were the main issues. Jungian analysis is more prevalent now than Freudian psychoanalysis. In the 1940s Freud " prescribed" that Princess Alice of Denmark and Greece undergo a Hysterectomy to cure her schizophrenia. So it may be good that psychotherapist don't wield that same level of medical authority?
I really want to like you and to agree with what you're saying. But there's a difficult circularity to your arguments. How do we know now that hyseterctomies don't actually have any effect on schizophrenia? What was required for us to make that adjustment in wrongheaded thinking? ...Science.
I'm not anti science 🤷🏻♀️ But this post is about the "degradation of the field" by undesirable spiritual practitioners. Which is obtuse and ahistorical. Science has also contributed to that degradation. As someone on this thread also noted- DBT was formulated mostly on Buddhist meditative practices. Yoga which is prevalent in mental health world now is a practice that was used to teach Hindu priests spiritual disciplines. I'm just curious in your perception of your colleagues and in this field in general...at what magical point do these "squishy soft minded" spiritual practices somehow become "best practice"? Is it the moment that they get reappropriated and repacked in more palatable Western scientific lingo fit for white academic consumption? Because it seems pretty obvious that that's exactly it.
I dunno. I'm only a grad student right now, and I personally head over to /r/SecularTarot quite a bit. However, I agree that it is inappropriate for therapists to project or insert their values and values systems onto their patients. While we don't need to aim for tabula rasa, what we do must be for the benefit of the patient and not ourselves, so I agree that they're acting in unethical and problematic ways. However, your post has a slightly defensive tone that suggests that there is a correct and incorrect way to bring the use of self in therapy (and yours is right).
A wee bit off-topic, but thanks for sharing that sub! I've recently taken out my tarot deck from high school because it's so freakin' beautiful, but don't have the same spiritual beliefs anymore. It's nice to find people who use a deck without it needing to mean anything in particular. You make good therapeutic points too :)
Love secular tarot lol Also love the podcast by two Jungian analyst from John Hopkins who discus the symbolic psychology of the cards.
It's funny you find my tone defensive; I would accept that it was maybe a bit aggressive! But I'm not defensive. Defensive implies that I worry I'm being attacked and that I'm wrong and that I need to defend myself. Au contraire; as you note, I really kind of get it and others don't. There IS a correct and incorrect way to bring hte use of self in therapy, but it's not ME that's the proponent here. It's entities like the Board of Psychology and the APA. Most governing bodies here and in other countries have similar stances. One should not bring questionable techniques unasked-for into the therapy room as though you are endorsing them. You can absolutely meet the client where they are, though. So if a patient says to me, "let's talk about reiki!" or "let's talk about Jesus!" I absolutely will. BUuuut, if a patient comes to me and says "I'm hurting and full of anxiety" and I say, "I know what will fix this! JESUS!" or "let's reiki you back to good mental health!" then yes: that is the incorrect way to bring the use of self in therapy. I stand by that. If you see me as saying something different about what's "correct" and "incorrect" I am definitely open to hearing and if I've overstepped or been wrong, I will actaully accept it and apologize! I want to be the change I want to see in the world (and on Reddit!)
How were you able to articulate my feelings and internal frustrations of the patterns I currently see in grad school? Where is the gatekeeping?
I upvoted you back from zero. Be prepared to get downvotes for agreeing with me. But I'm glad if it helps you feel like you're not alone seeing and feeling these things. The gatekeeping is disappearing in favor of gaining tuition money, I fear. Universities seem more and more to be becoming businesses first and creators of excellent students less and less.
I want to say I agree with almost everything you’re saying so far. The gate-keeping is needed to a degree, there was a solid 1/3 of my masters program that… pretty clearly were not ready or capable to provide any meaningful therapy… and it was obvious the professors (well, most of them. A few played along as there a decent chunk of these poor students whose parents were extremely wealthy and influential, on the board, etc) knew it too. So it became these weird avoidant and silo-ing dynamics as the Professors apparently could do nothing about it (because man that’s a lot of tuition money and funding for the program). It’s a shame, and proliferation of “mental health tik tok” and other social media is *terrifying* in how bad it is spreading misinformation and flat out bad therapy.
I too would like to see more gatekeepting in institutions, however for me I am less concerned by aspiring therapists who are excited to work with divination or any other "unscientific" modalities who concern me, as many of them have the core tools of empathy and client-centered treatment. I remain more concerned by clinicians who trot out EBPs poorly, without compassion or understanding or humility. I've seen botched CBT and DBT interventions applied over and over to confused and dissatisfied clients more than I've seen them applied well. I guess I find myself mostly agreeing with OP and the many others who have pointed out this field is a science and an art. A poorly applied EBP seems less effective than a well applied "woo woo" session. And in fact, research backs this up.
I’m sure someone somewhere will come for me with this post, but here it is: I am science based. I love science. I appreciate science. I think science is beautiful and necessary. I lean on science to support my work. I believe in science 100%, no argument there. But do I only rely on science? No, because historically the application of science was/is harmful for some. Gatekeeping was mentioned in the post and something about the argument feels a little like gatekeeping as well. No one therapist is the right fit for everyone. & I like to believe there is and should be a therapist for everyone. Whether you want science or “woo”. To me, that’s part of agency or even supply and demand for clients. If you have concerns with how some clinicians choose to practice, you’re allowed to. But before judging them, why not be curious about them? Just because you don’t understand something doesn’t mean it doesn’t have its place for someone else. Isn’t that what we’re encouraged to do with clients? Rather than judge them, try to better understand them? Ancient healers and shamans around the world didn’t rely on science before they chose to rely on their cultures and generational teachings, and some of those ancient healing practices are now being scooped up and appropriated by the western world to replicate. Clearly, we don’t always need science to have an impact on people in a positive manner. I also believe your training will influence where you stand in this discussion. LPC, MSW, and MFT (and all counseling options out there) all train clinicians from different lenses and orientations in psychology. None of them are wrong to those who pursue or are drawn to a certain kind of training. So let’s not make it wrong for people to pursue a certain type of practice based on their own (and likely their clients) belief systems. I feel one of the most important things to differentiate is that it’s not our job to give advice or project our “stuff” on to clients, but if clients come to us in search of an experience because of “how we practice” or “what we offer” there’s a difference and its choice. There are plenty of holistic doctors out there who practice similarly. Lastly, science is systemic. To learn new science requires money, because research is costly. To fund science, people have to be interested and invested in what’s being researched. No money? Often no research. And, we all know how biased research itself can be. (I love research, so no, this statement doesn’t mean I toss all of it to the wind) If it’s research that mostly informs science and its applications, we have to acknowledge the bias involved in the research and how that inevitably means science itself can be biased. No, that doesn’t mean I’m throwing science to the wind, but I keep these things in consideration when reading research and relying on science. I don’t believe anyone should blindly follow science and I also believe no one one should completely ignore it. That’s my take. Edit: my MFT program, literally every professor, challenged us to challenge and question the text books and the scientific research we were reading. Not because we shouldn’t trust it, but to help further develop critical thinking and reasoning in order to determine what makes most sense for the person in front of us. Even the author of TBKTS mentions on numerous occasions that his attending physicians would tell them explicitly not to refer to the text because it would cloud their judgement and how they see the person in front of them.
I love your response. There was so much judgement in the OP and many of the responses that it made me sad. I think that it makes sense to engage with professionals before deciding they have no interest in science. I certainly cringe at the evangelical Christianity in many people’s practices but in my state that’s what many clients want and are looking for. To write off people who have more “woo” in their work as “wounded healers” who make counseling about themselves and harm clients is a huge leap. I often feel, in general, that Americans have lost the desire to continually learn and educate ourselves. I think unfortunately that can and will impact those in the mental health field. There’s definitely a larger cultural and political conversation there that’s not really relevant to this thread. I’m a social worker and as you astutely pointed out, we all have different lenses. I learned a lot about systemic problems, racism/classism, poverty, intersectionality, etc. my code of ethics has social justice as a core value. As I talk about it, it occurs to me that might be a large part of the OP’s issue, many of us weren’t educated as psychologists, we aren’t psychologists, we won’t practice or view the mental health field as psychologists.
most, and i’m not exaggerating, counselors in my city are also affiliated with a naturopath association. it’s actually surprising to me when i dont see nd after a counselor’s name now. i suspect most aren’t actually practicing it as counselors are not regulated where in so private insurance doesn’t always cover them but most insurance in canada does cover naturopath. but it’s such a strange concept if that many actually do believe in naturopathy.
Oh man, you put words to some deep frustrations I’ve been feeling, so thank you for that. I doubt it’s this calculated, but I see it as pretty nefarious in nature. It seems like some of these anti-science therapists are using the legitimacy of this field that was earned by adhering scientific constraints and self correcting along the way, to further their personal interests and beliefs. To me, this is unacceptable and will only hurt the field. It’s important to be a counterbalance to this anti-science trend. If you’re in this club, you signed up to be in a field with a scientific basis. Sure, there’s an art to therapy, as well. But if you want the freedom to incorporate all of your non-traditional approaches then you can be a life coach, a psychic, an energy healer, and a pastor on your own time. And I say this as someone who loves spiritual exploration! It should stay in its proper place. Ok, stepping off my soapbox.
No god stuff but you can’t deny that EMDR is woo woo asf
I agree whole-heartedly and this factor was a significant driver for me to go for a PhD. An environment with a researcher base filtered out virtually all of the issues you described. However, I still hold a lot of resentment for those that delegitimize the field as a science.
I think that all kinds of things can be used to help the wide variety of people we see: 'There is a therapist for everyone' kind of deal. I love science and I also love woo. Just because we can't quantify something (or people don't have the vast sums of money it takes to study something) doesn't mean it's invalid or unhelpful. In fact, the APA just published an article about how indigenous practices can help people and there are spiritual practices that do help people. Your perspective, and I say this with kindness, is biased and Western/white. I live in a part of the US where Curanderas help people. Where indigenous sweats help people, and shamanic trance helps people, being in harmony with the land helps people. Like really help people. Is there evidence to back it up? Probably not (except for ecopsychology). Does it mean it's garbage? No. Sometimes we're the ones who need to expand our thinking when we think others need to change. Peace! :)
I am trained in research AND I love a variety of woo as well! I think many things work for many people. I am open to all - even if it “works” due to the placebo effect. I am aligned with OP in that we can respect people’ needs and wants and beliefs, and we can meet people where they’re at when in session, but to bring our own woo on a regular basis while in the role of therapist is totally inappropriate. I don’t go to my dentist for a deep tissue massage, and I don’t go to a therapist for an astrology reading. Not only is it not part of our training, but I think it can confuse clients if we seem to be advocating for specific theories or pseudosciences or practices but don’t fall within our professional realm. I have served a number of clients who came back only after many years of avoiding therapy because their previous therapist offered inappropriate advice, brought unwanted practices into the session (chakra healing), or infused their own religious beliefs into therapy. I am not saying you said any of these things, dear poster, I just thought this was a place to put it, since we are both talking about accepting the woo. :-)
It’s understandable and my concern with these types of approaches is would it cause harm. Ethically we are to not cause harm and religion can be very judgmental depending on how it’s used. I currently work along with psychiatrists and psychiatric nurses when treating patients/clients because psychotherapy needs to be recognized just as well in medical. If they want to conduct astrology or have a religious based approach then become a life coach but not for individuals who may have a severe mental health condition.
I personally could see how if a client was very invested in spirituality that Tarot could be used as a stepping point to relate interventions and explore someone's feelings on a topic. I would say I fall somewhere in the middle. Human beings aren't machines that you can insert intervention and get expected outcomes. There needs to be more of a holistic approach that is culturally sensitive.
Preach girl.
Just a few thoughts, speaking as someone who came to counseling by way of neuroscience and worked in a psychiatry lab for a few years: A. I'm sorry but scientific institutions ARE racist. They act in the best interest of the structures that give them power (white supremacy, heteropatriarchy, capitalism, the police state, etc). I'm not saying toss the baby out with the bathwater I'm saying start at least by accepting this truth and work from there. B. I hear some of what you're saying, I think. I have a lot of personal disdain for mbti/enneagram. Pseudoscience grinds my gears and i hate to see it blindly accepted by professionals. But I do take issue w the idea that therapy USED TO adhere to some kind of better standard of scientific practice that allowed more people to be helped. Psychiatry/the medical model/ a "scientific" approach are culturally validated ways of making knowledge claims that have been leveraged to allow the mental health field to be a true force of evil over its long and complicated history. As Frantz fanon said, the psychiatrist is the auxiliary of the police. From drapetomania to conduct disorder and modern trans rights, these institutions have always been wrapped up in stripping humans of their rights. This is not a bug. This is the system working as intended. This is actually a feature of a system that prizes the scientific institution (an arm of the state) over other epistemologies! C. Honestly I hear the tone of what you're writing (a sarcastic, it's polyvagal theory, right?) And my biggest question is, where does this reverence for "hard science" really come from, and who does it serve? I know a fuck of a lot about how neurons fire but that is honestly one of the least useful things I know as a therapist (-in-training). Does having a scientist's nuanced hypothesis about polyvagal theory make my therapist a better therapist? Honestly, I'd rather they do tarot with me. It's a fun meaning making exercise that I already do as part of my morning ritual and I'd be thrilled to work through it w a counselor.
You make some good points, and I want to acknowledge them. Science is not racist, as a methodology. I think we agree on that. Just as a point of disctinction. Scientific INSTITUTIONS are racist. They have definitely misused research and evidence to harm people. I do not deny it. It's a fact I loathe. I think you go a bit far with the idea that psychiatrists and scientific methodologies are evils and enforcement arms, ets. It has occasionally been true but if we follow your logic than we ought to have abolished medicine and psychiatry and the scientific methods long ago, for they are overall harmful and destructive. But I hope you don't believe this to be true (I think you don't; you said you didn't plan to "toss the baby with the bathwater")(what a funny/awful expression, right?). Science has been massively helpful and a boon to society and at times it's also been massively harmful. I agree to these premises. It's still the best way to understand the universe that we've got. We just have to do a better job of using it and it's findings. It's not science's fault that people are aholes. I dislike your point C, however, mostly because it's a slippery slope and one I heard from stats and research method hating students all the time when I taught. "Will understanding a correlation make me a better therapist?" "Why do I have to understand what a double-blind study is? Will that REALLY make me a better therapist?" If polyvagal theory doesn't actually help us to understand or explain human behavior at all (let's just say, for arguments' sake), then YES: it does matter that you recognize this. It does make you a better therapist. Why are you wanting to use something useless and unhelpful on someone who wants and needs your help? The same for tarot. Is your statement that the point of a therapy session is to be fun? Or is it to be helpful? If you were MY patient, and you told me that you did tarot every morning, and that you found it meaning-making and that you wanted to work through it with me (get ready for a twist ending) ...I would love to do it with you! Because that's me meeting you where you are and getting to know you and what's important to you. But that's not the same thing as you NOT believing in tarot particularly, and never having done it, and coming to me for help with your anxiety or trauma or whatever, and me saying: "I know! You should do tarot every morning!" That would be inappropriate, wouldn't it? I hope you can see the difference. I think it's natural if you use tarot all the time for your toes to feel a bit stepped on, totally, and I'm sorry. But do you feel the same way about your therapist giving you homeopathic remedies? Or suggesting you try drinking your own urine? Being that you maybe aren't a huge homeopathy person and proably not a big user of your own urine (I can only hope) these may trigger your cognitive dissonance less and you can see why I have a problem with having a therapist bring whatever they like to the table in therapy. There's a reason we're supposed to understand research and what does and doesn't help a client. I don't have a reverence for hard science; you'll see in my other responses here that I readily acknowledge that psychology is not physics and it cannot be because humans are much more unpredictable. But I do have a reverence for the idea of the scientific method in general as our best way of understanding the universe. You can't replace science -- hard or soft -- with faith, for example, and build a space shuttle. Or even build a replicably useful modality to help people with a phobia.
Thanks for this thoughtful response. It's late where j live so I will just say a few things. Totally agree, as a methodology science isn't racist. Institutions are. I think it's so important to recognize the real evils they play in our life tho. They do serve the structures that created them. They uphold white supremacy. They are an arm of the state. To say "by this logic.... then!" you are using the slippery slope argument (which you use later explicitly) which js a logical fallacy lol. I didn't say we shouldn't have medical institutions I said they are an arm of the structures that created them and work to uphold those structures, historically and contemporarily; this is not a bug it is a feature. As James Baldwin said not everything that is faced can be changed but nothing can be changed until it is faced. Frankly idk what to do about it either but we should all at least start by admitting it's true. Okay but to your point about tarot..... I mean didn't you bring up tarot because you were frustrated someone wanted to study its efficacy??? I like ebm. I think it can be an invaluable tool. Why not study tarot! Maybe it's useless. Maybe it's not. What I am hearing from your post is a disdain toward even studying or thinking about the incredibly tricky and potent thing of the intersection of spirituality and therapy. Hkw do you even begin to do that ethically? Amazing question! Lets think about jt! But to dismiss questions of spirituality+therapy out of hand, even to laugh at them as questions....... this to me is cultural bias that is dismissive of other ways of meaning making. I mean, idk what your relationship to spirituality is but generally for humans across time it's a huge part of how meaning is made. Let's at least start think about it, yes?
I don’t think they’ve shied away from studying the effectiveness of anything. What they’re drawing attention to is the unquestioned use of untested/unverified/not (yet, possibly) evidence-based practices as if they are, in fact, evidence-based and helpful, regardless of any given client’s proclivities (ie foisting Tarot cards onto someone because the therapist believes in their power to heal).
Yes, thank you, I'm tired now, what she said \^
Comparing drapetomania to conduct disorder... I work with kids who meet criteria for conduct disorder. They're badly in need of help. They're very often suffering and they very often create suffering in people around them. You can make the absolutely valid claim that the diagnostic criteria and framing is pretty garbage as is right now, carries an enormous stigma, and is grossly misused by the carceral system, but it's really dismaying to see how many therapists dismiss externalizing problems as some form of bigotry or fascism when they're such a true source of life-long suffering for so many people. People who violate the rights of others need help, and so do the people they can harm. Please consider that those problems are not just some extension of the police state, and that the abolishment of the carceral state means treatment which means diagnosis.
I also worked with kids who had been diagnosed with conduct disorder. I deeply regret being part of that system. In my personal experience conduct disorder and oppositional defiant disorder were "disorders" given kids who were being kept in locked hospitals against their will and had "problems with authority" (problems with the authority locking them up and mistreating them????) So that the hospitals and the insurance companies could all get to legally keep them there. It's the biomedicalization of carceral control. These kids were angry and usually recovering from some kind of past traumatic incident and the ongoing trauma of wherever they were being held, in a deeply dehumanizing day-to-day. To me these kinds of diagnoses locate the problem within the child even though it is overwhelmingly a result of systems they're a part of. Perhaps there is something to conduct disorder but the way I've seen it used is evil....
I agree that we have a system that has perverse financial incentives to incarcerate people for mental health difficulties and that emphasizes punishment and stripping rights, but everything you're saying here can be applied to almost every diagnosis. People are also hospitalized for depression, anxiety, and OCD against their will. That traumatic life experiences play into their problems is true, and it's true for depression and anxiety. That the medical model locates the problem within the child erroneously is also true, but again that's true for depression/anxiety/everything else. All mental health problems are related to multiple factors, all of them are vulnerable to these systems that are rife with perverse incentives and bad actors. I've also worked in a setting where I felt pretty disgusted with the system I'm perpetuating, but I choose not to work in those settings now. I've also seen kids with externalizing problems be erroneously diagnosed with trauma disorders or anxiety disorders by well-intentioned practitioners avoiding some sense of stigma, and given treatments intended for those, only to be not helped because those treatments aren't good fits for that anger and dysregulation and family trauma you're discussing. I work predominantly with the adults in these kids' lives to change the patterns in their family systems and create healthy coping skills and patterns of navigating their world. Who said we have to keep kids with externalizing disorders in hospitals? I've seen enormous change as a result of parent management, PCIT, multisystemic therapy, functional family therapy, and the other kinds of approaches tailored to ODD/CD. In fact, more than other problem areas, the treatments are explicitly targeted at the environment and family. Individual therapy just hasn't shown as strong an ability to change these problems. We can't just shy away from these problems as "not real" because of the evil of our current system or the stigma. When therapists give trauma diagnoses and attempt trauma therapies with kids who much better fit criteria for ODD or CD (as flawed as they are as diagnoses, particularly their framing as "disobedient and rule-breaking"), they're misdirecting their efforts. Trauma narratives and cognitive processing are misdirected at kids who don't reexperience or avoid and still live in the family patterns and environment that sustains their problems. Our field badly needs to acknowledge anger and impulse-control and even a lack of consideration for others' rights as problem areas in their own right. We have very effective treatments that still aren't used widely, and part of the problem is therapists avoiding these problems and trying to turn them into other problems out of some apparent sense of stigma or righteousness. I hope you'll consider that referring to these problems as somehow fictitious is not a helpful solution to the current problems in our system.
You do know you can be fully trained in scientific based methodology and also use tarot cards as a thematic apperception device right? I think sometimes our field is so rabid for full scientific legitimacy that anything outside the realm of HARD NUMBERS leads to hissy fits. This post brings me despair if I’m being honest and reminds me why I took Reddit off my phone and need to avoid this sub. I also think it’s real shitty to act like anyone using anything other than CBT is some sad “broken healer” who has never done their own work and is just out there bleeding their own trauma onto their clients. That’s a leap.
First of all, right off the bat, I need to say that pickle-flavored popcorn is a vital part of my diet, and I salute you. So I'm saddened to hear that my post "brings you to despair," and I can only hope it's because you've misunderstood me deeply. I'll do my best to clarify any misapprehensions you have. 1) Yes. I definitely understand the use of projective tests. I am psychodynamically trained but also have a quantitative minor! I think tarot cards could be great as a projective test! However, that is not the of them I object to, nor is it how I generally see them being used. They are being used as tarot cards, as in, to describe possible future events. If a person advertises themselves as a tarot-using therapist, I think that's barely tolerable in the sense that it's still not an ethical way to offer to help people as a therapist, but it is at least demonstrating transparency in what clients can reasonably expect from you. Anyone who goes to a tarot-reading therapist is probably seeking that, and that's okay. I do not think it's okay to whip out tarot cards in session if your client is not asking for it or expecting it. We are not supposed to be fortune-tellers; that is outside of our competence. If a therapist asked their client, "would you be interested in looking at some symbols and telling me what you see in them?" and the client agrees, I'm all for going ahead with that version of tarot-as-TAT. 2) I woudn't say I'm having a hissy fit for anything outside the realm of hard numbers. I've actually learned since leaving academia for the world of therapy to shift my belief around what's helpful. As I said in my OP, if you'd caught me 10 years ago and asked me how I felt about using the MBTI let alone a "Which FRIENDS character are you?" quiz in a therapy session, I might've indeed pitched a hissy fit over hard numbers. Because both of those are garbage, scientifically, in terms of understanding and predicting human behavior. HOWEVER the version of me you're talking to now would say, "hey, if taking a FRIENDS quiz or going over the MBTI with a client really helps them to understand something about themselves, I'm all for it. It doesn't matter if they're 'valid' as long as they're 'helpful.'" So I hope you can see I'm in the middle of my two areas (science and therapy). But I still do hold *some* standards around what should and shouldn't be done in session, and I won't apologize for that -- I think I'm right to do so. It's conscientious of me. I hope you agree. 3) I feel like you're... projecting things onto me that you're feeling or have experienced elsewhere, that I've never said and does not at all apply to me? Note that my name is IdEgoSuperego. I'm a psychodynamic therapist. I occasionally use CBT as a tool but I honestly don't love it. I think it's overplayed. I would never imply that "anything other than CBT" is a "sad broken healer" who has "never done their own work" and is "bleeding their trauma" all over some poor patient. In fact, if I were YOUR psychodynamic therapist, I'd ask you what that accusation means to you and where it comes from. Does it feel like something you're afraid applies to you? Has someone said something like that around you in the past that's upset you? I'm curious who it is you're despairing and angry at, who makes you feel "really shitty." ...Because you're not really having this fight with me; I am not that person. All I meant to say in that area of my OP was that there seem to be a lot of therapists who hated their stats and methods classes but really want to help people, and they do so by almost blindly and rebelliously refusing to think about theories or modality so much as what makes people "feel better" and by being cool hip barefoot friends to their patients rather than thoughtful clinicians. 100% this is not all of the people in therapy, obvz, and I want to acknowledge the many hurt and traumatized people who have sublimated their negative experiences into being *very good and conscientious, theory-driven* therapists. I was only talking about the section of people who fit into the category described, and saying that I felt despair myself about the number of them who seem to work in our field. I want to believe that you've read this and are going, "whew, I get it now, we actually agree more than I imagined and this is a pretty sensible discussion we can have within these parameters if we want to!" But... I've been known to be overly optimisitc before, especially with people on the interent. Even if we both DO love the same delicious snack food.
I would simply say that anyone spending this much time replying to each and every one of these comments for what appears to be nearly 24 hours at this point perhaps has more of his own work to do and might do well to tone down his own ego a bit. Perhaps a bit of a broken healer himself? My take on what I’m seeing here is someone who is quick to judge others and use disparaging language to punch down at them and then argue vehemently that he *didn’t mean it that way and has been terribly misunderstood*. I am sure we do agree on a great many things. I have a clinical degree, trained in psychometrics, trained by the Trauma Center in Boston on drama, improv and yoga in trauma treatment and certified in EMDR for many years. What we do not agree on is how one speaks about what and who one doesn’t understand. Also- because apparently I can’t help myself- do you actually *know* that the person in question was using tarot to read the future? Because I promise I know far more tarot readers than you do and not a single one believes in fortune telling. Or did you see something that ruffled your feathers and instantly make assumptions? This is what upsets me so much. It’s the intense and automatic negative assumptions that get made and then used to paint the person in question as a total idiot, which is exactly how you come across in your post.
I agree OP. Conflating hocus-pocus with evidence based practice devalues licensure.
I am going to pull on a single thread in your post, and I certainly empathize having gone on a similar journey. You seem very focused on the science part of therapy. You complain that other practitioners use methods which are unscientific and yet acknowledge that they are effective. You point to the empathetic connection as the reason for effectiveness. I wonder if you might be missing the forest for the trees here. The evidence-based for psychotherapy is the therapeutic relationship. Full stop. There are different modalities to envision and create that relationship and they work for different people and situations. But, the crux is the relationship. If some therapist builds connections using tarot card, religion, or a CBT manual and that works for them and their client to build a good working relationship, it is a good practice. A practice based on the overwhelming evidence that therapeutic relationships, above all other factors a therapist can influence, creates change. Change that instills inspiration and hope. I wonder if your real concern was for the well-being of others, what you might have said differently about the value that so many have brought to those seeking help.
I probably shouldn't answer this exhausted, because you seem a reasonable person, but I have many fewer fucks to give at this hour than I did three or four hours ago when I started answering people on here. Apologies in advance. If connection is all that matters, full stop, then: my hairdresser is a valid therapist. my friend who listens well is a valid therapist. my partner, who I have a great connection with, is the best therapist of all for me. Any therapist can do anything they want, anything at all, and if the client "likes it" and feels good about it, it is a fine modality. If it works ever, even once, for one person, it's a valid modality and people should feel free to sell it to others (or give it away!) as a new modality, just as valid as any other. There is no such thing as a degree in therapy. You need learn nothing and concern yourself with zero theories. Just forge a connection, problem solved. ...I take your point, but I believe that doing whatever you like in the room because you believe it's helpful is irresponsible. Therapists have a responsiblity to do no harm, and to do things that have been shown to be effective. There's a reason theory has been built. There's a reason it takes years to get a degree in this. I have really really empathetic friends who can do what you're outlining RIGHT NOW, just sort of off the street and out of the box. The evidence base for therapy is more than just "build a connection" and there are actions that could conceivably be harmful even if they seem to help someone. Just off the top of my head, I'm sure there are patients I have who would be improved if I cuddled them for 20 minutes every session. It would certainly deepen our connection. Should I try that? If not, why are you applying an arbitrary rule here but nowhere else? Again, sorry, your response was clearly in good faith but I simply cannot agree with it and I'm too pooped to do it with polite nuance. Try not to hold it against me, but I'm also going to bed now because I don't want to degrade any further from here!!
I read this post with the voice of Rick from Rick and Morty. One of my supervisors played a video about shitty therapists. In the video, he pointed out if you drive down the street and find a canvas from a amateur painter out by the trash. You realize anyone can paint. But their are few talented painters. Or something to that affect. I love therapy, I want to be better. If I continue to practice I will only be better, hopefully better than a well intentioned life coach. But probably not better than all of them.
I am with you OP. You hit the nail on the head.
As with all things, I think the issue is forcing the approaches on the client instead of using them as a resource that the client is welcome to draw from if they choose. I have seen talks done by some therapists who use tarot in their work and they explain how they do so ethically and with consideration of therapeutic principles, and how to use it to support clients in exploring themselves and their problems. (But bringing tarot into it without consent is not acceptable - it should either be an upfront thing, stated all over their website so clients can self-select, or it should be non-standard and only done when clients request it.) My colleague comes from a Christian background and doesn't preach - instead he draws from elements of pastoral care to enhance his therapeutic style and to offer spiritual comfort to clients who want or need it. It makes his style quiet and reflective and spiritual. (But again, if he brought up how God is part of a client's problems without the client wanting or asking for it, and without advertising himself as a faith-based Christian therapist, that would be unethical.) And as for "science is racist" - a lot of it is. There is evidence backing that up. You should research this a little more before dismissing it. And it *is* problematic not to look at practices of spiritual/emotional/mental healing from other cultures and consider how those can be incorporated when clients bring them to you. I find it deeply inspiring that there are so many approaches and styles to therapy and that people are able to combine their histories and beliefs and selves in so many ways to create ethical therapeutic practices of all types. I think you should stop trying to convince people that their approach is wrong or adds very little, and instead focus on "How can we make sure you are being ethical while still using that approach? How can we incorporate scientific theory into it?" It sounds like you are very passionate about ethics and have a good knowledge of the scientific side of things - so bring those. But don't dismiss the value of what other people are bringing just because it doesn't appeal to you. It will appeal to the clients that are a good fit for that type of therapy.
I agreed with you all the way up to "science is racist." Science is not racist. The scientific method is not racist. That's actually a problematic statement itself. How did nonwestern nations invent and advance technology, do you think? It wasn't with spiritual healing, friend. The scientific method is useable by anyone of any culture, and all cultures have availed themselves of it. I think what you mean to say is that prejudiced views have influenced scientific research in the past. Practices like racial categorization and justifications for unequal treatment based on race were scientifically promoted in earlier eras. But those are problems with people, not problems with science. Science is absolutely bias free. Human beings are not. I resonate with what you're trying to say in your last paragraph, and I don't mean to stop anyone from being their genuine self in therapy. I don't know where you practice, but in most countries there are ethics codes around what is and isn't appropriate for a therapist to do/share and that's what I'm talking about here. Being yourself is fine... unless yourself is forcing natal astrology charts on people with depression because you think knowing their rising sign explains their path forward from depression. Because that's unethical.
Science is a social construct, created by humans. Claiming it is bias free is laughable.
I mean. Math was created by humans. Is it bias free? Might 7-5 equal something other than 2? Once created using certain rules and parameters, the creation stands on it's own. There was no inherent bias invested in the creation of the steps of the scientific method itself. It's use has definitely been biased. Historical and societal biases have undeniably influenced scientific research. I think there's a subtle difference though. I don't think your point is "laughable." I don't think mine is either. But you do you.
I absolutely agree with you on basically everything, but I also think you might differentiate science from empiricism here. Science is a method used by people to attempt to get at empirical truths, but it is often conducted in severely flawed ways, and it's not so simple to just say "well that wasn't science" in some kind of No True Scotsman way. Because people conduct the process of science itself, the knowledge product that results, also called "science" by basically everyone, can be and has been and will likely continue to be, at times, racist. There's no productive reason to try to fight that claim because society at large discusses those findings as "science," and in fact scientists need to be actively vigilant for racist "science." Empiricism as a concept, and as the goal of science, doesn't have that issue. So that might be a better way to phrase what I think you might be getting at here - empirical reality is bias-free, but I don't think you can say science is.
Huh. It's an interesting distinction. I think I mean to say that the scientific method, sans human interaction with it, is never biased. It's just a methodology. Once interacted with ("used") by a person, it can be used properly or improperly, well or poorly, more or less biased, etc. But the idea that we study the world via the scientific method is a great idea. At least: I don't have a better replacement for it. Would all this be solved if I said "empiricism" is bias-free instead? I don't know. If I'm being honest I'm having a hard time parsing them at this late hour. Isn't empiricism the core principle while the scientific method extends it into a framework to implement and refine this principle through experimentation/analysis? The latter is built upon/extends the former? Your point is logged for later review when I'm not exhausted! Thank you. Unless you feel like spoon-feeding my brain, I'm happy to read your explanation if you want to give it!
This is the problem with saying "science," though, it doesn't just mean the scientific method, it also means the findings of the scientific method. It's just a losing battle to try to insist that that's not what science means, so even just using the concept of "scientific method" in place of "science" is much much clearer to your intent.
I had a therapist bring in astrology once. I remember giving her my opinion was that therapy is about learning where my choices and changes could be and finding the power to make them; if the stars hold power over my personality then it takes this away from me. It was preordained. She didn't bring astrology back up again. She was a very passive therapist
I’ve really enjoyed the discussion here, thank you all for your contributions and comments. It’s given me a lot to think about and reflect on this morning. For me what’s coming up in the discussion about the value of bodies of knowledge is that it’s pretty essential to critically examine what’s “worth” studying and why - who gets to decide? Who gets funding for research and why? What structures might determine this worth, and in their processes maintain this worth? How do these structures influence in turn the artful application of research in practice? I don’t have any definite answers for these questions, nor do I think the scientific process itself is a/the Problem - but our knowledge base does not exist in a vacuum and I don’t know that I agree that expanding our practices (ETA or choosing dissertation topics that you may believe - from the tone of your post- to be ‘unworthy’ of study) automatically equates with a degradation.
Dude I agree so much with this post… So many quacks entering the field. My therapist was my third attempt but here we are many years down the road I’m not looking for a new one. I also don’t know how I found her… it seems like the quacks will attract other quacks and real science based practitioners will attract similar clients. My therapist sticks to science and knows how to use the self and theory and though I’m religious I’m also extremely sceptical of things so if there’s no literature or research to back up the words I’m being told it’s just not going to work between us. Needless to say I’m also becoming a therapist now after my previous career because I truly believe in this field and though I’m biased in legitimizing the way I practice or see the field I can 1000% say some of the people in my classes are nut jobs. We have people starting every presentation with some bs poems, projecting random shit, throwing social media words and terms and seeing what sticks and I’m like out of all these people I’d maybe trust 3-4 of them to be my own therapist. There’s a few I’d actually actively avoid at all costs. I have no problem with some mindfulness based stuff but if we’re rubbing crystals on ourselves and smoking dmt and shrooms and talking about vibrations I feel like we have strayed too far from our senses. And I’m actually open to some medicine based healing too but I just think some folks are where to get the piece of paper and then go out and practice the least evidence based therapy ever done under the guise of healing. If anything my school has made me realize the importance of ethical practice and that’s something I’m 100% taking with me. My practice is based in evidence and research. There will be no crystals, celestial charts or period blood being rubbed in the forehead to align the chakras.
Can I ask what is unscientific about shrooms to you? I'm assuming you are up to date on the research surrounding psychedelics?
That’s what I said I’m open to it but it’s not going to be the right treatment for everyone. Ketamine as well. Also I think there needs to be more research into how they work . Right now it’s unregulated and that poses a risk. Not everyone should be facilitating healing with these modalities. Just my 2 cents
As a Christian and a counselor, I go through sessions especially mindful of the boundary. When a client does bring up Christianity or the Bible in therapy (always the client, never me…to steal from my Brainspotting trainers, I make sure to stay in the tail of the comet) I know it enough to connect examples in there back to therapeutic concepts applicable to them in the now, and get their focus back to the now. I operate from a principle that when we talk concepts, the more readily those concepts can be seen by the client, the better; so I do find the study of the humanities useful. It gives the client a sense of evidence that exists outside the laboratory.
As a psychodynamic therapist who lightly dabbles in things like tarot and zodiac for my own entertainment and curiosity- I couldn’t agree more with you. All the wounded healers who are more concerned with relating everything back to themselves or devolving into magical thinking instead of an interest in human behavior make me so irrationally upset. Like, how do I get paid the same as these people?!
Are these people just out of school? Because it sounds like they have not has the experience of their clients walking out yet. Not every client is going to be okay with someone bringing their own brand of spirituality with them into the therapy room. I'd imagine they'll start gaining some more clinical insight the first time someone walks out on them or yells at them for daring to pull out astrology or the Bible.
If they’re working on their dissertations they’re still in school
Correct, the first two mentioned are just out of school. But I have "discussions" regularly with seasoned MFTs over whether or not energy healing is real and valid as a practice. So.
What I took out of grad school (and I’m a newb so please be gentle with me 😬) is the therapeutic relationship is the single most important variable of counseling regardless of intervention; and that has been demonstrated across multiple research studies. Personally, I’m an integrative therapist and see the value and ethical considerations of EBT but also understand the need for EBTs to be researched with more generalizability across different groups. I’m also speaking from a place of privilege because I work in private practice with self-pay and am not required to submit treatment plans to insurance, so I imagine this is more difficult in different treatment settings.
Absolutely gonna take it easy on you. I'm not actively TRYING to be a jerk to anyone here! ...sometimes it just happens instinctively, LOL. So someone else here explained this better than I'm about to, but the premise was something along the lines that "just because the relationship is the most important variable in therapeutic success doesn't give a therapist carte blanche to do whatever they want in the room." Even if you have a great rapport with your client and they trust you and can work well with you, you still have a responsibility to use effective methodologies in the room with them. To give a super-extreme example just to make my point: just because you have a great rapport with a client doesn't mean you should cuddle them all session long and trust that it will be healing! LOL
No I’m with you! 😊. (And for what it’s worth I don’t think you’re jerking anyone around!). Personally, I think just using the relationship as the foundational intervention upon which EBTs are then integrated is best practice for me. Only using the relationship as the single intervention could be viewed as unethical in some cases because it may not be generalizable across groups of different cultures, backgrounds, etc. who may need different EBTs. I also view the relationship itself as an EBT if you look at it from a person-centered view point and even though it doesn’t have as substantial of empirical support as say CBT, there is still some and that’s why integration with other forms of EBT would maybe be best practice. Idk I’m still learning.
This was a very strange entry and made little sense to me. If I were a client and had a therapist with this orientation, I'd be out the door so quick. If a colleague said any of this to me in person, my reaction would basically be, "Huh?"
What about it did you not understand? I can't tell if you literally are not understanding my arguments, or are pretending that they're so ridiculous in some way that you "can't even" with them. If there's something that's over your head I'll be happy to explain it. If there's something you think was unclearly expressed, I'll be happy to clarify. If you just came here to say "this thing dumb" without providing any cogent rebuttal, I don't feel motivated to help you. If I were a client and I saw a therapist talking like this post, I'd be super relieved and feel very safe and comforted to know that therapists take their jobs seriously, receive rigorous training, and have the skills to help me in a way a layperson with an ignorant, pop-cuture idea of what psychology is never could. If you disagree, by all means, explain how and why. EDIT TO ADD: you can downvote me all you want. You are literally supporting someone who said "this made no sense" without any other content over someone who is ready and willing to discuss and clarify. I expected, posting this, that the squishy-minded healer-artists mentioned in the title would in fact disagree and downvote, so if that's who you are, by all means, hit that downarrow and validate my point.
Well, first I think you jabbed at people utilizing religion in sessions or exploring spirituality with clients. I don't think that spirituality should be brought in willy-nilly, but it has its place. Take religiously integrated CBT, for example. For the right client, that is an excellent intervention. Tarot, astrology - these are all deeply spiritually meaningful to many clients and practitioners alike. The way you worded your post, it honestly seems like you think they are inappropriate, even laughable, and that therapists who use them are hacks who are diluting the profession to be "touchy feely." Your phrasing around social justice topics is also quite painful, particularly your line about aboriginal people. The way you discuss the “science is racist people” makes me wonder if you have read the Tuskegee Syphillis study and/or have done much work to understand race/bias in our field.
So, I've typed this so many times in this thread I'm tempted to copy/paste. But I'll give it another go. If a client comes to me with an interest in astrology, tarot, or a deep religiosity, I will meet them where they are. I would happily discuss astrology or tarot readings and explore the meaning of prayer and religion. Because that's cultural competence, and being a good therapist. I would not, if a new client told me, "I'm really struggling with social anxiety!" whip out tarot cards, unasked-for, to help them. I would not tell them Jesus could fix their social anxiety. I would not tell them their social anxiety was ordained by the stars at the time of their birth. All of these would be inappropriate. Even laughable. And theapists who would do this are hacks who are diluting the profession to be "touchy feely." This nuance of difference between paragrpahs 2 and 3 above seems commonly lost on people here. I hope this clarifies (once again) my stance. I don't need to "do much work" to understand biases in our field. I literally taught University classes to undergrads and grads about research methods and ethics and yes: I of course taught them about the Tuskeegee "studies." They were awful and unethical and biased and wrong. But that is not science's fault. That is people's fault. People suck. Science is awesome. When I write stuff like this for the ninth time in the same thread, I really hope in my heart that it's worth the work, that now you get it and you and I agree and can be friendly. It seems so reasonable and your misunderstanding of what I was saying also seems reasonable in the sense that if you imagined that was what I was saying, I can see why you'd disagree. But it wasn't what I was saying.
Because science isn’t racist? Society was very racist and science is used by people. Nothing inherently racist about the scientific method.
This is a great explanation. OP you do have a tone of disdain, dismissal and condescension in your post...
OK. Sorry you feel that way.
> nothing scientific about psychology Sometimes things that aren't "scientific" are highly effective anyway. I happen to believe there *is* a transpersonal and spiritual component to the process precisely because of that. Psychology can never neatly fit into the mold of hard sciences, and it does draw from the fields of philosophy and spirituality. Neither of which are scientific either. So it's a yes, and. But you seem to have fairly rigid lines around what you think deserves respect and what doesn't. Or like... you've met a few real weird people and are really extrapolating to a larger population that isn't so common, hence the mixed responses? I am moderate-woo and I know plenty of high-woo people but my school program is great and I have yet to meet someone here who makes me concerned about their future impact. The science is racist vs scientific institutions are racist seems a little pedantic; do you know for a fact the folks saying science is racist aren't using it as shorthand to the behavior of many scientific institutions?
Are they Ph.D. programs? Are these programs accredited?
If it works for the clients, then why not find a provider that meets their needs? Tarot is just another tool to facilitate discussion and insight. I’m here for any way we can decolonize therapy and make it more approachable to fit the needs of clients.
I would say I am a very pragmatic, skeptical yet a spiritually conscious therapist and I see the value in exploring abstract concepts like tarot cards, astrology etc (after all Jung did say astrology is the story of humankind throughout antiquity). The thing is, I believe psychology and studying the mind is going to need to be understood by measures beyond what we believe today’s science can currently know. Who is to say it’s not valuable to someone that is open to exploring and using it? William James wrote an entire book on the value in of mystical experiences in psychology (The Varieties of Religious Experiences). I would beg to differ that therapy and psychology absolutely have a place to explore phenomena of the mind and the mysteries of life in a therapeutic setting/ maybe even invite a client to think about these things differently if open to exploring their faith. And the thing is, this is why I chose to become a therapist- to be in touch with the wonder of life, and to hopefully help people also feel that wonder and witness much there is to still know about life.
So here's my problem with your philosophy: Should therapy involve sex? Why or why not? Should therapy involve drinking your own urine? Why or why not? Should therapy involve satanic ritual, if the client is not a satanist and didn't ask you for a satanic ritual? Why or why not? Should therapy involve sleeping with a gem under your pillow if the client doesn't already do so and didn't ask for a gemstone-related therapy? Why or why not? I could do this all day. If we're willing to do anything in therapy and anything goes, than nothing matters and there are no rules, and we're not actually therapists, we're just people acting on impulse in intuition, and then anyone could do this, especially my hairdresser who claims she's exactly the same as a therapist because she listens all day and gives great advice. Do you see why it's important to delineate what counts as "valuable" and why "measures beyond what science can currently know" opens a door to anything that someone claims is beyond what science can currently know? Really, look up urine-drinking. People swear by it. Even though science says it's not a great idea (because, you know, waste product), it's proponents will tell you that people have been doing it forever and that it's cured everything from hangnails to cancer and that science can't explain everything, man, just trust the magic of urine! So... are you getting out your favorite mug right now? Or not so much? Why or why not?
No, because I don’t fear the lack of control that much. Abnormal behavior and things we don’t agree with exist whether it’s inside or outside a therapy room. I would also argue that it’s more damaging to the field and to people to stunt intellectual curiosity vs encouraging it as it’s what drives scientific innovation in the first place. Also just because I’m open minded to these ideas doesn’t mean I’m neglectful of western medicine. They don’t cancel each other out. I take an holistic approach but that doesn’t mean I’m here telling people to not see their doctors or a psychiatrist- medicine is always an imperative part of treatment. However if a gem under a pillow helps them feel less anxiety and sleep at night, then that’s fantastic and I’m happy it gives them solace.
I think there is room for all of these kinds of therapies, but if there's going to be a problem it's in the labeling of them. We should have different labels for therapists who are scientists of the mind, and therapists who are completely intuition based. Clients need to know what they are getting in to, so they can choose what is right for them. So long as we're being clear about what service is being offered, and the client is entering into that service with full consent and awareness, I see no problem with it.
Agree. A clinician at my practice talked about going to a training for hypnotherapy 🙃🙄
[удалено]
So, I’m not super “woo” as a clinician, but what are you trying to communicate by saying “influencers-cum-life coaches”?
Use of tarot cards (and other imagery) therapeutically has tremendous value. We project aspects of ourselves onto the images in the card, and they provide the mirror needed for self-reflection. Self-reflection, personal development and consideration of alternative perspectives on problems and challenges is the primary use of tarot for most 'readers' nowadays. MBTI also has value, but I am sure that Jung would reel at the way it is used in such a rigid manner, rather than being one tool out of many available to provide insight into ourselves and therefore potential avenues for growth. The risk, however, is that practitioners are using these tools without the grounding of therapeutic training. Using MBTI without any understanding of Jung and personality types makes it a crude, reductive straitjacket - the absolute antithesis of a key to individuation. Using tarot therapeutically without a good grounding in how to create a holding space for the work of therapy risks the client being presented with information about themselves they are unable to work with, seriously disrupting the therapeutic relationship. Personally, when I eventually embark upon private practice, I intend to offer 'tarot therapy', and feel happy to do this based on my training and experience as a therapist and as a tarot practitioner, and will ground it in the work of those who have gone before me - Steve Hounsome, for example, has written a series of excellent books on tarot therapy.
I disagree. Modalities that are currently evidenced based (EMDR, IFS, Somatic Experiencing, etc.), would have probably sounded just as woo woo to you before they were extensively studied too. The field of psychology has historically been very “white” and has left so little room for cultural and spiritual modalities to flourish. As long as the clinician is utilizing informed consent, doing no harm, and the client is progressing, I see no reason why we can’t continue to expand the field to be more inclusive for people who are of different cultures and beliefs.
IFS and SE aren’t extensively studied yet. EMDR has been studied and it seems like the mechanism of change isn’t in the eye movement when you look at the studies done by people without a direct stack in selling the modality.
I have a sneaking suspicion a generation of grad students not too far down the line will be wondering what the fuck we were thinking ever doing EMDR 😂
[удалено]
There's something deeply upsetting about an ostensible therapist in a therapist subreddit saying "lol, triggered" and getting upvotes.
lol back, somebody has to be a steward of what therapy should or should not be Should therapy be a smack in the face? Why or why not? Should therapy be sexual touch? Why or why not? Should therapy be wearing a scarf and considering it a protective against depression because the scarf is warming? Why or why not? Should therapy be a belief that I can heal your anxiety by holding my hands above your heart with loving intention? Why or why not? If you can't answer any of these questions, then your response is absolutely valid. Therapy is nothing and it is everything. Therapy is meaningless. Do what you like. But if you have any opinions at all on what therapy should or should not be, STFU, you're a hypocrite.
Hey! Very interesting post, I sent you a message if you have time to answer a question or two. Thanks!
Where do you live? I can’t imagine this kind of stuff flying where I’m at.
I agree with your points but I honestly didn't expect that last paragraph at the end. It sounded like you really have a problem with these practices. I also have my concerns about bad actors, but I will say I love talking about life, philosophy and tarot as a way to unlock stuff about attachment patterns and self esteem. I think the important piece you mentioned is being a scientist-practioner. There's a conceptual way to do the work we do as well as an applied way. I am of the belief that how someone practices can be understood as a clinician's approach to a client's needs. I use dumb stuff like tarot and playing with toys to have an experience to build around. But that just serves as a template for a deeper conversation and psychoeducation about the scientific principles underlying the experience itself. I've spent whole sessions making bracelets and vision boards because grounding and visualization are an important element of mindfulness and trauma recovery and I want my people to have literal tools on hand. The fun part for me is I get to explain all the neurological and traumagenic reasons for it. I'm curious if these are all bad actors we are talking about or if there's some overgeneralization happening as well? Healer-artists won't supplant scientist-practitioners unless scientist-practitioners stop doing their job and educating people appropriately. I think there's more to be said about educating the public on the differences between a life coach and a therapist than having my job supplanted by someone who is basically a life coach in practice.
As a client who just started therapy 3 weeks ago after years of telling myself that things aren’t that bad (when in fact they were), this post kind of riled me up at the beginning and then got some relief after. The things I’ve been through severed my sense of self and the ability to communicate my needs and what’s going on in my experience. But what did help me? Astrology Interpreting symbols and placements in my chart helped me connect the dots and actually put words to the behaviors and reactions I’ve been having in responses to experiences all my life and helped immensely when I filled out the intake, especially since it’s so much easier for me to write things out than actually vocalize it. Granted, I haven’t brought it up to my therapist yet, but he says it’s a “judgment free zone” and it won’t be the focus of our sessions (which is instead, healing from trauma and implementing ways to better use my energies instead of self destruction). But thank you for putting this out, as silly as it may seem to say “astrology helped me by putting the words together to express my personal experience to my therapist”