What Therapists Get Wrong (and How We Can Do Better)

[00:00:00] Hello, friends. I have this podcast episode from my other podcast Inside Social Work, and I thought this might be a really good one for this complex life. It’s a bit of a peek behind the scenes into what happens for therapists. I interviewed Ben and Carrie from the Very Bad Therapy Podcast, and if you haven’t listened to it.

Check it out. It’s fantastic. It is great for all people, therapist, non therapist, it doesn’t matter

I had the pleasure of re-interviewing Carrie, and so I thought I’d replay the first episode. I thought I would share this episode on this complex life, and then next week you’ll have part two or the follow-up episode that gives you a little bit of information around.

Where therapy can go wrong. What we can get wrong is therapists how difficult and messy and complicated it can be. And when I think about it being messy and complicated, I’m like, yeah, that fits in with the brief of this complex life. So I hope you enjoy this episode from my other podcast Inside Social Work.

Marie: , [00:01:00] Today I have Ben and Carrie from the Very Bad Therapy Podcast. Welcome. Hi so much. Thank you for having us.

We did have the classic joke, Ben, before you logged on about the the time difference. So we’re currently, I’m in the future and it’s looking good today. 

Ben: Wonderful. Any lottery numbers. It’s a tiny joke, but I, we won’t 

Marie: know. I think that comes out in the evening. 

Carrie: Good answer. 

Marie: Do you wanna share with the listeners, so some of them may have heard of you and heard of your podcast, but do you wanna share a little bit about what you do and what your podcast is about?

Carrie: Sure. Yeah. I’ll go ahead and start ’cause mine’s quicker, probably. My name is Carrie Wida. I am a graduate of a master’s in marriage and family therapy programme in California. I’m not practicing right now, and I, so I technically don’t have a license of any kind at this point. I I came to this field after a long career in the entertainment industry actually.

So this has been kind of a, a mid-career pivot for me, but I started doing the podcast with Ben a couple of years ago, and I’ve just, I love it and I [00:02:00] find a lot of the work in this field. The, the work itself is very meaningful, but also I’ve really enjoyed. Kind of getting to know people who are advocating for making the field itself better, kind of from the inside out.

So that’s been really fun. And this is Ben. 

Ben: Thanks Harry. My name is Ben Feinman. I in addition to co-hosting very bad therapy with Carrie, I am also the clinic director of a low fee online. Counselling centre here in California called Sentio Counselling Centre. And what really excites me about Santio is in training our counsellors, we prioritise something called deliberate practice, which is an emerging approach to training therapists differently, hopefully to promote doing very good therapy.

I’m also an associate marriage and family therapist in the state of California. And just a bit of background about the podcast that Kara and I co-host Very Bad Therapy. We started this. In 2019, both of us were in our respective graduate programmes in different programmes, but in the same area in Los Angeles.

And we just had a chance encounter and we started talking and realised that neither one of us [00:03:00] really knew what we were doing as therapists, but really wanted to learn how to get better. And it seemed like everything that was available was like masters of therapy. Doing these incredible demonstrations with people who are volunteering or acting.

And there wasn’t a lot of insight into what happens when therapy doesn’t go well because of course, therapy doesn’t go well. Often that’s just a part of the work. So there wasn’t a lot of the client voice out there, but there was none of the client voice in terms of what happens when therapy doesn’t go well.

And so we thought it’d be very edifying for us to hear stories from clients about that exact scenario. But I think also important for our field to allow those conversations to happen, but also as a form of advocacy so that clients who have had difficult therapy experiences maybe wouldn’t feel so alone.

Because as we started talking with people, it became very clear that the most common response to a bad therapy experience is to kind of internalise it and think, I must have done something wrong if therapy didn’t work, or if I felt harmed by therapy. And the reality is that well-intentioned therapists, I think we all do bad therapy sometimes.

So [00:04:00] that’s, that’s behind what we’re doing and it’s been really interesting to hear these perspectives from clients. 

Marie: Yeah, and I think I came across your podcast, were you on Kurt and Katie’s Modern Therapist Survival Guide? 

Ben: Mm-hmm. Yeah, actually, so that’s how Carrie and I met because we had each just reached out to Kurt to say hello and just ran into each other.

He, he sort of bookended us in his meetings. Kurt actually became my supervisor, so I feel incredibly lucky to have learned from Kurt. But yeah, we’re, we’re close with Kurt and Katie and I think the world of them and the modern therapist survival guide. 

Marie: Yeah. So it’s, I think it’s a very similar school of thought of just kind of what’s happening right now.

What are we doing? Why are we doing it, and how do we reach people where they’re at, I guess. Mm-hmm. 

Ben: Yeah. How do we do it better? 

Marie: Yeah. I wanted to, so I thought it’d be really great to have a discussion around how your practice has changed through hearing some of these stories, so it’s not therapy and some of the people you’ve never met before.

What are you, what have you taken away? What have you both. Learned or implemented in your [00:05:00] practice? 

Carrie: Well, I will admit that when we first started the, the podcast, I, an ulterior motive that I very much had was to figure out how to, all the, all the different ways that therapy could go bad. So I would never do any of them.

And I, again, like what Ben said about how a lot of our training, I’m not sure how it is there, but in, in the US and certainly in California, a lot of. Almost the only access we have to understanding what therapy looks like unless we’re in it ourselves as clients is to watch these videos that are like, you know, produced, right?

The educational videos, and they’re often like really old. They’re very much like they’re staged, they’re usually staged. And when they’re not entirely staged with actors they are done at a conference where the quote unquote client is. The therapist knows exactly what is being expected of them from the therapist’s perspective, know how to play along with it.

And I’d watched a lot of those just on [00:06:00] my own, like out of sheer terror of like, how was I going to do this? How was I going to see clients for the first time? I’d watched so many through the library at. At my college and didn’t fe knew that I did not feel like I was getting any better at therapy by doing it.

I, I didn’t understand therapy any better. So when Ben came to me with this idea for the podcast, I truly, and you know, and maybe this was my driving motivation, was I am finally going to hear from clients what it looks like when therapists do terrible, horrible things, just so I can avoid doing that. And the surprising thing is that after hearing so many stories, the biggest takeaway I, I think I can say for Ben and I we’ve talked about this before.

The biggest takeaway is that. You can’t make a list of the ways to do bad therapy. It’s, there is no such thing. Bad therapy is just infinite. It’s also entirely dependent on the individual client’s experience. What one person experiences as [00:07:00] traumatic, terrible, bad therapy. Another client might think is wonderful therapy.

It might speak about it later as a life-changing positive experience. So for me, that was one of the biggest impacts. On my work, knowing that when I walk into the room I can’t avoid doing bad therapy. So I think a lot of new clinicians are trying to do that, which can lead to imposter syndrome and all these other things, and I feel very much like I can’t avoid it.

So if I can’t avoid it, how am I going to focus on making sure I know when I do it and I fix it when I do it? Thank you. 

Ben: Yeah, I would add I, that’s essentially what I would say Marie to your question, and I would add, I think another part that I’ve learned from hearing stories from the guests on our show is to have a greater sense of compassion for myself to be okay.

Accepting that I’ve messed up to be okay talking about it in class with my supervisor. With peers, et cetera. Because the stories we hear, I mean, they, they, there’s a wild range of the [00:08:00] types of stories we hear on one end are the stories that are completely obviously terrible, illegal, unethical therapy, like grooming a client, right?

Like there’s no scenario in which that’s not bad therapy. There’s also the, you know, the therapist was late to every session and never mentioned it or apologised, which is not illegal, but clearly bad therapy as well. But there’s this other category of stories that we hear. Where Carrie and I will talk after we record and be like, oh shit, I did that yesterday, or I’ve done that in a client’s head.

It was really helpful, and this is to carrie’s point that you can’t know what will be received as bad therapy. And oftentimes it’s surprising and in that moment to have compassion for yourself that it’s okay to make mistakes and that the response isn’t to deny it, to get defensive if a client brings it to you, to stuff it way down because you don’t wanna feel like an imposter.

It’s, it’s to recognise every single one of us will do things. That don’t land with a client. Hopefully none of us will groom our clients, but nobody’s going to finish their first year, their first month, their first week as a therapist without doing something [00:09:00] that didn’t work out. And I, I think there’s this mentality in our field sometimes that if therapy doesn’t go well, it means you’re a bad therapist, which means you’re a bad person, which means.dot.

And there’s like this cascading series of emotions because we all have so much shame around therapy not going well ’cause we’re taught here’s how you do it. Do it well, don’t, don’t fuck up. And it’s unrealistic. Like it’s just, we’re, we’re all going to fuck up. And that has to be okay so that we don’t get defensive when a client says, Hey, that thing you said really hurt me.

And I think it’s been a huge lesson for me to be open to those and say, tell me more. Be without that. Client’s never gonna feel better if they can’t feel open talking to you about your relationship. 

Marie: Absolutely. I had so many, there’s so many things I’ve jotted down in what you were saying that I really wanna pull apart.

One of them, and I probably didn’t realise this when I first started working in a more therapeutic way, so through my coun my social work degree, I, I transitioned into counselling and then qualified for our accreditation process here. I used to think counselling had [00:10:00] no side effects. So we’d look at sort of.

We’d prescribe medication and we’d talk about the possible side effects or people were prescribed. I didn’t prescribe, but you just, we just assumed counselling was low risk, no side effects. But that is, I was so wrong. How that can dam like, well, tell me about your experiences. What, have you noticed that the, the impacts have been on your guests or what have you started to notice that that kind of, what are the side effects of therapy?

Carrie: Well, it’s so funny that you asked that. No, go ahead. You, you go ahead. We do. By the way, this is the majority of our conversations as we both start talking at the same time, and then one of us is like, no, no, no, you just go, go, go. I know what you’re gonna say. Go 

Ben: fine. I think it’s complicated in my mind because on one hand it’s important that our field as a whole communicates to prospective clients.

We can help you and. There’s something concerning if you say we can help you, but also we might harm you, it’s gonna lower the placebo effect, it’s gonna lower the expectancy effect. And some clients just won’t show up because they’ll be afraid of the side effects. And that’s a very real concern. On the other hand, I don’t think a lot of clients [00:11:00] walk into therapy thinking, you know what?

There might be side effects. I might feel worse. This might actually harm me. And so in the scenarios, when that does happen, which are of course rare, but they happen, this is what we’ve, we’ve learned on our show, is that clients will internalise it and think. Something’s wrong with me. I must be broken. If therapy can’t help, I must have done something wrong.

And all of these other things that locate the cause of therapy not working inside themselves. And so a huge message that Carrie and I have taken away is it’s important for therapists at some point to talk about this with their clients. If it feels like therapy isn’t helping. If it feels like therapy is.

Harmful to say, you know, this can happen. Let’s talk about it. Is it something that I can do differently? Is it something we can do differently? Would you be better off if I referred you to another provider? Dot dot? And it’s, I think it’s exceptionally tricky to balance making a client believe you can help them.

’cause that’s so important with making them not feel responsible if therapy doesn’t go well. 

Carrie: I think that’s such a great point too. And talking about, you know antidepressants or something, [00:12:00] medications, right? There is they, they have a reputation for yes, they also have side effects and people are very well aware of the side effects.

And when you get prescribed an antidepressant for example, you are educated about the possible side effects. And it’s definitely, to Ben’s point about like taking it personally when it’s a medication, you are warned ahead of time this might happen and it’s not. Because your body’s bad. Right. But in therapy, we, we don’t have that warning.

Right? And so I think for me, in hearing the stories of, of our guests on our show, what has struck me as like so incredibly sad and it, it makes me so frustrated, is how many of them really did internalise the bad experience and. For a long time weren’t, didn’t even, didn’t even think to classify it as bad therapy, thought about it as a therapy failure.

They aren’t cut out for therapy. They don’t know how to do therapy. They’re not good at therapy, whatever. Because in our culture we have this, we have this [00:13:00] cultural script where the mental health professional knows everything and they’re an expert and they know inside your mind and they know what you’re resisting and they know, you know, all this.

Stuff that we know now is not true. It’s not, it, it’s, and it’s, and it can be very harmful and very oppressive. And for too many of the clients who end up on our show, for sure, too many of them don’t even, don’t know that until they hear our show or come on our show. And that’s, that’s been like the kind of saddest, most frustrating thing.

Hmm. 

Marie: That’s, I can, I so agree. ’cause all the friends I’ve spoken to who’ve had bad therapy, they internalise it. And so have I in the past I’m like, oh, I’m too much. Maybe it’s ’cause I know what I’m doing that I judge them. Maybe I just have high expectations and I’ve internalised all of that as well. And sometimes when the therapy doesn’t necessarily go bad, but you don’t go anymore, I think one of the side effects I’ve personally experienced is.

I don’t wanna seek help again for a very long time. So [00:14:00] it actually prevents reaching out. ’cause I’m like, I don’t want that to happen again. Or what if I stuff it up again or this, you know, it’s a really common thought 

Carrie: process I think. Absolutely. Or it can be just such a huge obstacle to have to tell it all again to somebody new have to go through that whole process can be just overwhelming.

Ben: Yeah. Carrie, I, I really like how in, in a lot of our interviews I. If one of our guests says, and then I went and saw another therapist, you will ask like, what gave you like the strength after a bad experience to go see another therapist? And I think it’s so interesting hearing people talk about where that motivation comes from.

’cause Marie, like you’re saying, it can be so demoralising. Especially if you internalise it, because why would you go back for something that, you know, quote unquote, you can’t do properly? Or, or whatever that internal track people tell themselves. Sounds like 

Marie: that’s true. How do you balance this with, with your clients around?

You don’t want, it’s not their fault if it doesn’t work, but then how do [00:15:00] we encourage some accountability for. Being honest, maybe doing your homework. You know, sometimes I, I think as Carrie was saying, what people think that we can, we know their triggers and we, we know what to pull out and sometimes we don’t.

So how, how do you balance that? You also have to work at it. It’s like rocking up to a gym with a personal trainer and just kind of chatting. You’ve gotta do the weights, you have to strengthen that versus, you know, also acknowledging it’s not your fault if it doesn’t go well. How do you balance those two kind of positions?

Carrie: You know, it’s so interesting. I had a client who came in once and said, I wish there was a manual on how to go to therapy, like how to be a good therapy client. And I thought, oh my God, yes. I wish, I wish that existed. I would give it to you. And then I would also read it immediately. And for Ben and I, we are going to do this at some point.

I don’t know, we’re, we are going to write that Ben, like, probably wrote a solid third of it already. But it’s been backburner, but but yeah, I like that. I feel like I wish we had that because [00:16:00] that would be just such an easier way to, to catch a client, to get, make sure the client and the therapist are on the same page.

So, you know, in, in my own work, I, the therapeutic approach that kind of. Appeals to me. The MO that resonates the deepest with me is a more collaborative approach. And that, you know, we, coming from a I mean that in the postmodern kind of sense. I, what the person who run my, who ran my programme, my master’s programme was Diane Gayheart, who is a collaborative language systems therapist worked with Henry Gallian and Harlene Anderson, Henry Gallian.

Harry Lucian, I can’t remember. Anyway, it doesn’t matter. But that approach in spec specifically very much has this wonderful balance of the client is the expert in their own life, but the therapist’s job is to present in the interaction with the client. They call it a difference that makes a difference.

And so it’s not that you’re coming into this interaction with. Expertise that the client desperately needs. [00:17:00] It’s that you are coming into this interaction with a different perspective, and that is the critical piece. It’s not what your perspective is. It’s not impor, it’s not the, the thing that is of paramount importance is not that you’re coming into the interaction with the perspective of a master’s degree or a PhD.

It’s that you are coming into the interaction with a different perspective and. What I think is the onus is on me as a clinician to present it in that way, to say, look, you came to me. I know you came to me because you know, people have presented me to you as a mental health professional of some. Strip and I Yes, am in the process of learning about this.

It’s a, it’s a, there’s a lot to learn and I’ll never know it all. I want to bring what I’ve learned into the room, but I also don’t want you to feel like everything I’m saying is golden. I need you to meet me halfway. Tell me what is working for you, what isn’t working for you. I need you to be as honest as you can, and I wanna invite feedback as much as possible, because that’s the only way [00:18:00] this is going to work.

Ben: Oh, I don’t have much to add. I really love the analogy of going to the gym and just like chatting with a trainer, because it’s your responsibility to make what is offered to you into a successful experience. That can’t be done without your participation and motivation. But if you go to the trainer and they give you like three times more, then you can lift and say, oh no, it’s fine.

And then they don’t spot you or. You know, it’s been like 20 years since I lifted weight. So however that works, that that is the fault of the trainer. But you still have to show up. You still have to go through the, the motions and actually want, like put in the effort. And I think that’s a perfect analogy.

Marie: Yeah. And I think that’s I think it’s, as you were talking, I was thinking, I find this much harder to implement with private pay clients because they wanna come in and get. Results straight away. And when it’s a service that’s low cost or subsidised, it feels like there’s more flexibility to say We have a several day intake, a several session intake process.

We’re gonna talk about how we [00:19:00] work together. You know, and actually talking about those things. Do you find a difference between those different kind of models and people’s expectations? Like some will come to therapy in the first session and won’t you to? Fix it and then they’ll leave and say, therapy didn’t work.

Like it’s a fun session. 

Ben: I don’t know if I’ve noticed a difference. And part of that could just be that I, I only have a, a few years of experience and that’s largely been part-time. So I, I can’t rely on, you know, a large number of clients over decades. It seems pretty random. I, I think, ’cause I’ve seen clients at a, a low fee clinic, I’ve seen clients in private practice.

And something that I, I sort of take away from your question is the importance of understanding what is that expectation and then talking about it because of you can get a client to share that they expect this to work. In one or two sessions, you have the chance to then say, this won’t work in one or two sessions, most likely.

And then go from there. And if that’s unrealistic for them and they want something else. That’s not your responsibility of course, ’cause you can’t, you know, snap your fingers and [00:20:00] work miracles. But it allows there to be an honest conversation. And I think that’s oftentimes where bad therapy happens is when something just wasn’t talked about in advance.

The kind of bad therapy that we all do is when we miss having an important conversation that keeps us from understanding what clients’ expectations are and just to be able to, I think this is something you talk about a lot, Carrie, is a question you always ask your clients. When you saw clients and when you will see clients in the future, like in the first session, is what are your expectations for therapy?

What do you think is going to happen here? Because if it’s something completely unrealistic or something that you don’t provide it, that’s an important conversation to have before five sessions go by and they say, this is terrible. This isn’t what I wanted at all. And that could have been avoided, maybe with a referral, maybe with some expectation setting, but it doesn’t have to proceed to becoming bad therapy.

Whether that happens more often in private practice or not, I’m not sure. I think maybe in America people just sort of have their own ideas and bring it in and it’s just completely all over the map. I dunno. Carrie, I’d be curious what you think. 

Carrie: Well, you know, I think that that’s like, that [00:21:00] is one of, in my opinion, the most important places to do psychoeducation is in that moment where you’re trying to suss out the client’s expectations for therapy, preferences for therapy.

And, you know, do they have, I, I feel strongly, I don’t blame clients who think that going to the therapist is like going to the dentist. They’ve been primed and taught to believe that that is how things work, that there’s some. Machinery of mental health research that has figured out and hacked the brain.

And obviously therapists must be the ones who got that information and know what it is. And so of course they think, oh, well if I just go in and, and pay the the nice person the money, then they’ll be able to get me my money’s worth in terms of this mental health knowledge that they have. And I don’t, and.

If they know that, if that’s, if that is what they feel coming in, I wanna empathise with that. And I’m, I’m a very transparent kind of kind of straight talking, plain talking therapist. I, I don’t I [00:22:00] think that like hiding behind clinical language can be super detrimental and definitely contribute to, to bad therapy in a lot of instances.

And so I’ll be very honest with them and say. You know, I see where you’re getting that kind of, I, I, I see why you would come in here with that kind of an understanding of what therapy is. If you think it’s gonna, if, if you think you need two, three sessions tops. Let me be honest about what I think we could actually change towards whatever goal you’ve specified in two to three sessions.

But I tell you, if it was that easy, you would’ve done it already. You wouldn’t be here in this office 

Ben: and, and you’d be charging a lot more money 

Carrie: and I’d be charging so much money. I’d be doing weekend retreats for thousands of dollars.

Marie: That’s it’s a really great tip, the asking, what are your expectations? ’cause often we ask, what are your goals, but not around expectations around. You know, how long is it gonna be, the frequency? Like all of that stuff. That’s where I notice those bad therapy moments happen more, more frequently is it almost looks like an administrative [00:23:00] error where someone’s like, oh, I didn’t, I, I, I don’t need to come this week.

It’s like, I are good. It’s like, that’s when you need to come, you know, we need the con. Or they’re like how about now’s I don’t have the money now. How about two months time? Like, well then you’re not in therapy. Because that’s not, you know, so it’s, it’s really trying to understand their expectations and see if it works for the model of your practice, I guess.

Carrie: Yeah, there absolutely has to. Oh, no, go ahead. 

Ben: Oh, no, see, see, last time you let me go first. So this time it’s only fair that you go first. 

Carrie: Oh God. I was just gonna say, that’s why there has to be a, a, a consensus. There has to be consensus on both sides. It has to be talked out, you know, just like there is.

Gold consensus. We all know that’s critical to starting treatment, but consensus around what does, how does therapy work? What is the therapist’s role? What is the client’s role? How are we going to proceed in the work that is just as important, I think. Okay. That’s all I had to say. Go Ben. 

Ben: The conversation reminded me of one of my.

Bad therapy moments as a therapist, where it was at the clinic that I trained at, and it was a large clinic, over a [00:24:00] hundred trainees. And so we’d all rotate doing intakes and there was a long wait list, like six to eight months, and I did an intake with a man who just like touched my heart. He’d never been to therapy.

He was going through really tough times and it broke my heart that he’d have to wait like six to eight months to get therapy at our clinic. And so I just, you know, I kind of like pulled some strings and was able to see him next week, skip the line. We weren’t supposed to do it, but if like you really wanted to, you kind of could if you said the right things.

And he had no, no idea what therapy was. He just knew that this was where you go when it’s kind of a last resort. And after about four sessions he looked at me and he said. Ben, this feels completely aimless. I don’t know what we’re doing here. And I, I tried to recover. I asked him what he wanted, like what specifically did he think would be more helpful, tried it the next session, and that was the last time I ever saw him.

He didn’t come back. He didn’t call it a cancel, he just realised it wasn’t for him, and at no point did I sit him down and ask, what do you expect to happen here? Or did I sit down and be thorough and make sure I communicated what was going to [00:25:00] happen and make sure he understood it? And that it was okay with him.

I just sort of launched into, great, let’s do therapy. I can’t wait to help you. Like this is gonna be so meaningful, blah. And it, it just, it failed because I didn’t ask that question and he had no prior experience in therapy and in retrospect, there was a, a small chance that it was gonna be helpful because we weren’t looking at it from the same perspective.

Marie: Hmm. Yeah, that’s a really tough one. And, and the gender roles we notice here, I think our most recent stats say, I think it’s close to 50% of of males don’t come back for their second session. Wow. Really? Yeah. We’ve got some really high stats there around poor engagement. Wow. Wow. 

Carrie: I’ve never heard that statistic.

Oh, that’s fascinating. 

Ben: Mm-hmm. Yeah. That makes, so it’s very unlikely 

Marie: to seek help. And then when they do, they don’t come back for the second session. 

Ben: Yeah, because 

Marie: I think it’s that same thing. This is pointless. Yeah. I was told to go to therapy, but everyone else thinks I’ve got the problem. 

Carrie: You know, and this is something that really bothered me about my counsellor education, so many times, either like in my programme or from [00:26:00] supervisors, I got the message speci, like specifically like.

Explicitly, oh, don’t get into all of that. Like clinical stuff, like what therapy is, how it works with your clients. They don’t care. That’s a, that’s not why they’re there. They’re gonna get bored. They’re not gonna get it. And I really, I, I, I listened. I believed it. I didn’t do it. And I, I’m mad that I didn’t because I do feel like, honestly.

When you’re a client of therapy, I, I firmly believe you’re a consumer of a service and you have a right to know what exactly you are buying, what you’re, what you’re signing up for, especially if you’re like going into a room with a stranger. And the service is you bearing your soul to that person.

And I think clinicians should. You can’t come, if you can’t describe what you do in a way that isn’t reading a CBT textbook or something to the client, then I think you need to like spend some time to come up with an [00:27:00] explanation of how you do, like, how what you do and how you do it in client terms, so that in that first session you can say, this is how I approach the work.

This is what I do. And I also think it’s important to say. This is not the only way to do therapy. So I wanna hear about what you thought was gonna happen, what you were hoping I was gonna say, and if there’s too big of a gulf between those two things, then maybe this is a bad fit. And maybe then a therapist could actually support clients around finding a better fit rather than just having this like ghosting thing happen.

Ben: Hmm. 

Marie: I, I want to rewind back to right at the start when you were saying some of the things you’ve learned and Ben, you sort of mentioned how to or not to get defensive and not to feel like an imposter. How do you both manage that? So when someone does share, this isn’t working for me, or you notice you’ve done bad therapy, how do you prevent in that moment?

That defensiveness or that that pain, and then [00:28:00] maybe the shame spiral and feeling like an imposter. 

Ben: Carrie, I know you need to take the imposter part of the question because I know this is something that you’re so passionate about. Can I take the defensiveness part of it? 

Carrie: Do it, do it. 

Ben: I think what helps me not well, I do feel defensive.

I think it’s a natural human instinct to feel defensive when somebody says. Anything that’s critical of you, and I think it’s important to recognise this is not a personal failure or something shameful. This is being human. That when somebody that most likely you care about makes a comment that suggests that you did something that they are bothered by, that is always gonna bring up some feeling.

And defensiveness is a, a common one of those. I think a really helpful way for me, and something that I would share with other therapists in terms of how to respond to those feelings of defensiveness is to recognise, A, that it’s normal that we all feel it, but B, that the statistics on how effective therapy is suggests that oftentimes it doesn’t work.

Sometimes it causes harm. I think depending on where you look, it’s about 50 [00:29:00] to 60% of the time. Therapy works really well. Maybe five to 10% of the time clients actually feel worse after therapy. And then the, the other 20 to 30%, I think my math is wrong there, but you got the point close. Yeah, there’s, there’s no change.

So if a client says, I don’t know if this is helping, or a client says, you know what you said. It feels like you don’t get me, or some clients are much more upfront and direct and will just say, go fuck yourself. None of that feels good, but none of that is avoidable in the long run. And so you notice those feelings of defensiveness and you think, all right, this is a basic human response.

I shouldn’t act on this. I shouldn’t do anything about it. I should recognise this is just part of being a therapist. Now. How can I shift, shift my focus back to the person in front of me and what do they need from me in this moment? And then I can kind of take care of my own stuff. After the session in supervision with my therapist, whatever works for you.

Carrie, what are your thoughts on imposter syndrome? Well, I just wanna say for the record, I also experienced defensiveness. I think you’re absolutely right by saying like everybody experiences it and it’s not like you can ever [00:30:00] turn that off. And I think maybe listening to all of these stories, the Hana R Show did have, I think, a great effect too.

Carrie: Shine a big light on the fact that it happens all the time. It happens a lot. And so if something goes wrong in your therapy room, even though you may have never heard a colleague explain a time when they felt like they just did terrible therapy, it’s actually happening all the time. It feels to you like it’s only happened to you, and that is where shame comes from, right?

Because it’s not something that we talk about as often as we talk about our clinical successes. It’s. Not always what we wanna bring up in supervision. It’s certainly not what we brag about on Facebook. So, you know, the, the thing is recognising that this happens to everyone, and if it happens to everyone, that means you are not special.

When it happens to you, you’re not like specially bad at your job when it happens to you. You are just completely typical. And the what, what we know from the research is, I mean, it’s kind of. A little depressing depending on how you look at it, [00:31:00] right? But we don’t know the mechanism of action in therapy.

We don’t know what it is about psychotherapy that actually works. We have all these ways of doing therapy. They all work roughly the same. Lot of debate on that. It’s very confusing, but they all roughly work the same, which means that there’s a lot of ways to crack the nut. We don’t know what makes therapists better than other therapists.

We know that some therapists are better than others, but we don’t know why. So if there are all those unknowns in this field, you can’t possibly be expected to know it all and to do things right every time. And so if you are going into the room with that expectation for yourself. Something goes wrong and your client reveals you to be an imposter because you’ve done something wrong.

I think really honestly, it’s the clinician who’s at fault there because the clinician is the one who’s being willing to walk into the room with this extraordinary, unrealistic pressure. The reality is we [00:32:00] are all. You can only know what you know at this point in your career. No one is expecting you to have trained in therapy to be, you know, training for this life from the moment you are four years old and you have been, you know, destined for this purpose.

And now you are sitting in the therapist’s guru chair with all of the anointed with holy knowledge. That’s not, it’s not a thing. It’s not a thing. So you can only, you can only know what you know. You know, different things than the therapist in the room next door and it’s kind of look at the draw who you end up in the room with.

But if something goes wrong, it’s not, you could have done the exact same thing with the very next client and it could go absolutely right. So I. I really feel strongly that if clinicians are feeling imposter syndrome, if you are walking into a room feeling like, oh my God, I don’t know what I’m doing, number one, talk about it with more people.

You are gonna find out that you are not the only one. And number two, learn more. That’s like, and I don’t [00:33:00] mean get, get credentialed in in more things, get more letters after name. That’s not what I mean at all. Learn more about your field, about you, about who you are as a therapist so that when you go in the room, you do know exactly what it is you can offer, and you also know where your powers end.

That’s what I think is so powerful about being able to explain what you do and how you do it in client terms, because once you can do that, you feel empowered to answer the hardest question, which is, how can you help me? 

Ben: I wanna echo something you said, Carrie, which is like at that moment when you feel defensive or when you accept the reality that all therapists make mistakes and most of us don’t know what we’re doing and never will there, there’s a choice.

You can become complacent. And say, well, this is, you know, I’m never gonna know all the things and I’m gonna make mistakes, so why put in the work to try and become a better therapist? I’ll get paid just the same, I’ll, I’ll step up my marketing game and get clients that way. Not because I’m great, but because I have a really good SEO [00:34:00] presence or however that works.

That’s one path you can take. And I think a lot of people do take that path. Our, our field incentivises that path almost, which is. Conversation for another day. The other path is to say, oh wow, I’m noticing that I get defensive around these certain things. I’m noticing that these are the mistakes I tend to make.

I’m gonna go work to get better so I can help people better. And that’s what’s amazing about this humility and this openness to the fact that we all do bad therapy is over time you’ll realise where do you most often do bad therapy? And then you can go and work on it. And that’s a beautiful, amazing thing.

Marie: I really love that. ’cause it was, I think, something Carrie was saying earlier about the type of deliberate practice, and that’s something I try and do with my my team is focusing on particular skill, not a modality. So you go through, you know, is it rapport building? Is it in the first three sessions? Is it in, you know, hope, like we use the taxonomy of deliberate practice and we kind of pull out what are the bits that you want to improve?

And it doesn’t matter what your therapeutic basis is. That’s doesn’t matter if it’s [00:35:00] C-B-T-D-B-T-E-M-D-R, whether you’re trauma trained, attachment based, family therapy co. It, it’s where, where are you getting stuck and what do you want to improve? And actually just honing in on that skill for like a year and just focusing on that piece really intensively.

It’s only again. I’m gonna let you talk about this, but I just wanna say I am so blown away. That is so awesome. It is so rare to hear clinicians talk about like that as being something that’s they’ve rolled into their practice. That is by far one of the coolest things I’ve ever heard. 

It fell by the wayside a little bit with all the changes with lockdown, but it was, it’s something that, that’s something we try to implement.

Ben: I think it’s fantastic, and it’s something where when you realise that this is an option in our field to identify what skills you may need improvement on and to go practice them, you think, wait, of course. Like why wasn’t this? Of course you look at every other field and this is the the norm, pretty much like you think about an athlete.

An like an elite athlete, a professional athlete will know exactly what skill they need to work on. They’ll have a coach that [00:36:00] helps them get better at it and they’ll work on that precise skill before going out into a game. Same thing with musicians, same thing with, I don’t know, surgeons do deliberate practice.

It’s, it’s amazing that our field is just getting there, but it’s always wonderful to talk to people that recognise the value in it and that are putting it to practice. So fantastic. So happy that we’re having this conversation. 

Marie: I wanted to, before we kind of start wrapping up I really wanted to talk about how do you, if you do get defensive, and maybe this is when I’m a guest on your podcast.

I’ve had a therapist who got defensive, then shut down completely and just terminated the session midway through and I was just, oh, yeah. Dumbfound. But then in telling. Another therapist about that and complaining about all the other things that went wrong. I started to notice it was happening again and actually having to call it out.

But how do you, if you’re in that position as the therapist, what are your tips on repairing that? Potential rupture. So we’ve got the [00:37:00] in defensiveness might come up. You might start feeling like an imposter. How do you interrupt that while it’s happening? And if you can’t or don’t, with that kind of hustling and, and, and kind of begging the client and bombarding them with emails or texts, how do you repair it?

Carrie: How do you try? You want me to take this one first, huh? 

Ben: No, I mean, I, I have thoughts. You’re very quiet over there. I’m, I’m processing, I’m processing my thought, and I think that speaks to how difficult this is. Carrie, if you, if you want to please feel free, but. 

Carrie: I mean, I’ll, I’m happy to throw out there. I, this is, I wouldn’t say this is right.

I, because I, I don’t know this is the right way to do it, but my, my own personal process when I am in the middle of something going terribly wrong and tanking and somebody calling me out and knowing I’m in the middle of doing bad therapy and I have to stop it and also fix it somehow, so I grew up riding horses and there’s this mantra which is heels down, eyes up.

You always wanna keep your heels down so that you, because if your toes are pointed, they could slide through the stirrup [00:38:00] and your, and your leg could get stuck in the stirrup. But you keep your heels down and you always wanna be looking ahead to see where to get yourself outta trouble. And these things are.

Typical, but it’s especially important when something is going terribly wrong, like if your horse is losing their shit. So when your horse stumbles, when something goes wrong and you are in the middle of a, you are in the middle of a legitimate crisis, it’s drilled into you till you don’t have another response down, eyes up.

And I feel like in therapy, that’s what I do, which is I am. Very aware of that hot feeling that happens, that feeling of like, you know, zooming in on the pupil of my eye and oh my God, what have I done? And as soon as I have that feeling, I know I need to put my feet on the ground and start breathing slowly.

Remind myself I’m not a bad person. I, this is, IM important information that I’m hearing. I need to be able to hear it and not take it personally. That kind of like. Instant in the [00:39:00] moment sort of gripping back onto something real like that is my, the way I’m able to stop myself from defensively saying something I’m going to regret later.

So for me, that’s where it starts. I, the repair process. I think it’s, I, for me that’s so different from, for every client it looks very, very different. What I need to do to repair the relationship so much depends on what has ruptured and that particular client, what they need from me. But I find that process easier than the dealing with the defensiveness in the moment.

So that’s what, that’s, that’s me. Go pen. Tell us the right way to do it.

Ben: That’s a trap. Okay, so the right way to do it,

I think the right way to do it is to practice it when you’re not in the moment. I mean, like we all know in those moments our, our brains function differently. Our bodies function differently. We’re not as present. Our, you know, our prefrontal cortex or all that neuroscience stuff, like things go offline and it’s hard to just be present.

And so, I don’t know if you get better at dealing with rupture and repair if the only time you work on it is when there is a rupture and a repair. And [00:40:00] this goes back to the idea of deliberate practice. And Marie, this is like a, a total pitch for something that Carrie and I are working on. So if you don’t mind indulging me.

We’re, we’re about to, it’s actually like a separate podcast entirely from very bad therapy. It’s called Learn Psychotherapy, and it’s a deliberate practice podcast. It’s the first one that I’m aware of where it’s released in seasons. Each season features a specific theme of therapy, so like the common factors is season one, and then we’ll do specific modalities going forward.

And in each season there’s about five or six episodes where Carrie and I together carrie’s the client. I’m the the host, the. Instructor, as it were. I guide somebody through 15 increasingly difficult prompts to practice one specific skill of therapy. So in the first season, these skills are related to the common factors, and one of the episodes in the first season is specifically on rupture and repair.

And so Carrie and I had a lot of fun, tormenting our, our poor, wonderful friend Jen, as Carrie read 15, increasingly more provocative. Offensive and [00:41:00] challenging statements of client ruptures. And then we have specific criteria that define like what is a good response to a therapeutic rupture. So things like validate, take accountability, ask the client for their perspective and to learn more.

And it’s just a matter of practicing in a safe, comfortable environment. How do you respond in these situations? And so it doesn’t mean you have to listen to this podcast, it doesn’t mean you have to, you know, familiarise yourself with the taxonomy of deliberate practice activities. It could be that you and a peer of yours, another therapist or social worker sit down and say, okay, hit me.

Pretend that you’re a client and you’re really angry at me and something really bad just happened. Get me dysregulated by telling me that there’s a rupture. And you as the the person who wants to get better. It has to sit there and take it and come up with really good responses that feel authentic to you, but also feel like you’re matching what the client needs in that moment.

And it will be hard. It might feel really silly. You might laugh a lot, you might cry, but it, it’s [00:42:00] just like any other skill. If you only do it in the performance zone. You may not get better. It’s the practice zone where you actually build the skill that you can then take into session. So I think that’s the right way.

Just, just kidding. I like, just 

Carrie: kidding. I, I, for the record, I agree that is the right way, but 

Marie: it is it sad dis or maybe it’s sadistics not the right, but a part of me is like, I really wanna play that client who gets to dysregulate? People I know. Like a part of me is like, I’d love to use my powers for evil just for a role play.

Ben: At, at one point, Carrie just. Stopped and started apologising. ’cause she was really like really getting into the zone. I was like, 

Marie: I can’t see this seat. Oh my God. It’s such an interesting thing you bring up. ’cause I think we, everyone seems to think that they can compartmentalise and when they sit in that chat, this is not just for therapy.

I mean, people listening will be working across a variety of different human services fields where these skills are still present. It just might not be in a sit down 50 minute counseling session. And they think they just go in the room and all of their attachment stuff, all of their ways of appeasing people being the nice person, all of that just leaves.

But [00:43:00] it doesn’t, ’cause that will get triggered in the session. Like, and that’s probably something I learned a lot through my, family therapy course was. What you bring, what gets triggered in you, and that requires really intentional work, supervision, peer work, reflection, your own therapy. Like, I don’t think you can do this job well without that.

Awareness and, and bringing to your kind of, intentional kind of, you know, just bringing that to the forefront of your mind. 

Carrie: Yeah, I really agree with that. Absolutely. I feel like there, I feel like there’s a way in which. That understanding, that awareness kind of takes the pressure off a little bit because you can, in the moment when you do get triggered, you can have an awareness, oh, that’s coming from me, and things that I’ve gone through.

This is old stuff, old stories maybe. But this is not about me in this moment or my worth. My worth as a person, my worth as a therapist to this client. There’s an issue at hand that has to be dealt with, but it’s maybe doesn’t need to be, [00:44:00] it’s hitting a nerve right now that is like, has nothing to do with the current situation.

Maybe that’s a, a topic for another time. Sure. I mean, that is, 

I think 

Marie: a very rich topic. So in some, I mean any kind of. You’ve all kind of, you both sort of mentioned what you’ve learned and all the different things and how you’ve reflected, but was there one thing that really stood out to you as one of the, the biggest single takeaways from, you know, all those dozens of interviews that you’ve done with, with podcast guests around their experiences?

Carrie: Hmm. Mine would be, you cannot underestimate enough. Did I say that right? I think we often gravely underestimate how we are coming across to our clients and we assume that they have a lot more knowledge about us or our profession or the field than they actually do. And in reality. What are they? We need to think about it from their perspective.

What are they seeing? They’re seeing just the sliver of us in whatever therapeutic [00:45:00] setting it’s happening, whether it’s over Zoom or whether it’s, you know, in an office from a waiting room, whatever they’re seeing. Just that piece. But then they’re also seeing any other touches that happen from you. You are living your whole life as a clinician, but they might experience the one hour a week and then intermittent emails, right?

And so to us, you know that there’s so much more going on behind the scenes, but if we are going along our merry way and we decide, like say as a private practice clinician, you need to raise your fees. And part of, you know, the administrative tasks of doing this is you have to shoot out an email to all your clients to let them know you’re raising the fee.

It’s important to be mindful of what that looks and feels like to your client. And I, raising fees is a, is a hot button issue. So, but I mean this like more just from a, what is that? How do they experience that touch that, that moment of interaction with you. It’s not just an administrative task the way it is for you.

And I think that the more time we can spend [00:46:00] on the. Like thinking about ourselves from the other side of the couch. I think that’s gonna make us better clinicians. 

Ben: I think what I would add to that, and I think it compliment well, is, is the importance of humility. That as a therapist, you will do bad therapy, you will make mistakes.

There will be clients that you don’t help, you’ll get defensive. All of this is normal. By accepting that you can then respond to clients, take their feedback, solicit feedback, and actually value it and put it into practice because you’re not holding onto this false ideal of yourself as a perfect therapist or that you need to be a perfect therapist or anything that.

Kind of we, we get instilled into us as an unrealistic expectation of what happens with enough experience. And with that humility so much opens up that simultaneously all of these things that Carrie is describing do matter, but also you are not responsible for perfection in any of them. Just allow yourself to try and be a little bit better at all of them when the opportunity presents itself.

Awesome. 

Carrie: Super easy. It’s no problem. [00:47:00] All of this is really easy, 

Marie: you guys. Yeah, well I think, I mean, what I think I take away from that is that it’s, it’s a growth and we have blind spots, and by us showing up and that, having that humility, I think you’re also giving the client permission. To have that humility in other areas of their life.

So often we can role model how to navigate those ruptures, those repairs. That flooding that happens and we feel defensive because they might never have experienced that in their lives somewhere else. So I think even that can be a really great moment of, you know, and I used to work in a service for homelessness and we used to sort of say when people start complaining.

That means they’re starting to trust us. And so we kind of saw it as they started to feel a bit more empowered. And so when they’re bringing those things, it’s not like, where has this come from? All of a sudden it’s great. They’re feeling connected, we’re feeling like a safe person. They now are advocating for themselves and what do we do with that?

So I think therapy can sometimes be really great if you do get called out in session. That can be [00:48:00] really valuable work ’cause. It could be that the client’s doing it for the first time, or maybe they are showing you a part of their dysregulation that pops up somewhere else and you get to see it live.

So it’s 

Carrie: that’s so powerful. I love that. I love what you just described. Yeah, that was great. 

Marie: Awesome. Well, thank you both. And there’ll be we’ll put links to all the bits and pieces in the show notes. And when’s your new podcast coming out? 

Ben: So the, the introduction episode exists just to get it out into the world.

Ooh, exciting. But it’s, it’s like a seven minute monologue of me just talking. Don’t go check it out until everything else is released. The, the whole first season will be out in mid-April, and that’s not only wherever you get podcasts, but it’ll be on YouTube as well. So you can see the video of Carrie and I tormenting our poor, wonderful friend Jen.

But yeah, it’s, podcast will be called Learn Psychotherapy, and you can find the website for it sentia.org/podcast. 

Marie: Great. And thank you both for the vulnerability in doing the Very Bad Therapy podcast because that, that’s taken a lot of your own courage [00:49:00] and authenticity and just showing up and admitting you don’t know it all and fumbling through it and, and all of that stuff across all those episodes.

Thank you so much. It’s a lot easier to be an expert in. Not knowing things. You don’t have to, you never have to pretend. You can just say you don’t know what’s going on. It’s very liberating. I gotta be. It sure is. 

Thank you both so much. Thank you. Thank you for listening to today’s podcast. Be sure to check out the show notes for today’s episode’s resources, and don’t forget to click subscribe and review us wherever it is you get your podcast.