Six Ways to be The Persecutory Therapist *cue the thunder and lightning*

The last few months coincidentally saw me grapple with some interesting clientele, but also I'd received a few opportunities to lecture about transference and counter-transference.  So, I thought I'd pull out an "old, but gold" paper published in 1977 by Russell A. Meares, and Robert F. Hobson, with which they point out several instances where therapists may become harmful to clients themselves.  These are situations where psychotherapy not only is merely ineffective, but may do serious harm to clients/patients.

Come on, it would be foolish to imagine that psychotherapy is always beneficial or helpful, even when we think some individuals really need the help.  We know that therapists can and may cause, or intensify a client's sense of being attacked or persecuted.  And the disturbing thing is that sometimes, just sometimes, therapists may also be cognisant of these responses as a result of their own personal issues and internal process.  We are never immune to the effects of our own histories and emotional triggers. Psychotherapists need to learn from their clients and it is regrettable that, despite a plethora of descriptions of the psychotherapeutic process from therapists, there are relatively few from patients.  Meares and Hobson's paper draws attention to some types of therapeutic intervention which are likely to do damage:

(1) Intrusion

Intrusion into the client's personal space can occur by crude interrogation, by premature intuitive understanding, and by forcing the confession of secrets experienced as a "core of self".

(2) Derogation

Derogation is a term used to cover various ways in which a therapist can denigrate his or her client, seriously damaging their self-esteem.

(3) Invalidation of Experience

This occurs when the therapist does not respect everything that his or her clients says, and responds by "explaining away" or categorising, rather than elaborating and amplifying affects, images, and memories. 

(4) The Opaque Therapist

The therapist in an attempt to maintain an impersonal neutrality, denies his or her involvement in a two-person situation with its rhythm of intimacy and distance. 

(5) The Untenable Situation

The untenable situation renders the client helpless, confused, and unable to explore and learn.  It is promoted by: 

1. a lack of clarity about the structure of therapy (which I argue should be made clear from the initial appt!)  See Book Review: An Introduction to the Therapeutic Frame for more on this topic.
2. imposing impossible requirements
3. giving conflicting messages
4. making conflicting demands

An example of such an instance is when an "orderly therapist" restricts his or her interventions to communications in linear logic whilst asking his or her client to respond in terms of associative fantasy thinking (or non-directive explorative ways).

(6) The persecutory spiral

This is an escalating destructive interaction in which both therapist and client are, or feel, persecuted. Potent factors are "all knowing", authoritarian, rigid, and sectarian attitudes and beliefs regarding psychotherapeutic theory and technique.

Further Reading:

Meares, R. A. and Hobson, R. F. (1977), The persecutory therapist. British Journal of Medical Psychology, 50: 349–359. doi:10.1111/j.2044-8341.1977.tb02433.x

Other sources to consider...

Bad Therapy: Master Therapists Share Their Worst Failures

Jeffrey A. Kottler & Jon Carlson

Description

Bad Therapy offers a rare glimpse into the hearts and mind's of the profession's most famous authors, thinkers, and leaders when things aren't going so well. Jeffrey Kottler and Jon Carlson, who include their own therapy mishaps, interview twenty of the world's most famous practitioners who discuss their mistakes, misjudgements, and miscalculations on working with clients. Told through narratives, the failures are related with candor to expose the human side of leading therapists. Each therapist shares with regrets, what they learned from the experience, what others can learn from their mistakes, and the benefits of speaking openly about bad therapy.

Erotic Transference and Countertransference: Clinical practice in psychotherapy

David Mann

Description

Erotic Transference and Countertransference brings together, for the first time, contemporary views on how psychotherapists and analysts work with and think about the erotic in therapeutic practice. Representing a broad spectrum of psychoanalytic perspectives, including object relations, Kleinian, Jungian and Lacanian thought, the contributors highlight similarities and differences in their approaches to the erotic in transference and countertransference, ranging from love and sexual desire to perverse and psychotic manifestations. Erotic Transference and Countertransference offers ways of understanding the erotic which should prove both useful and thought-provoking.