Very Bad Therapy

Thank you for listening!

Carrie and Ben create their own model of therapy. Goal setting! Psychoeducation! Exploitation and worrisome sales tactics! What does it say about psychotherapy when our progressively cynical efforts to develop a modality end up mirroring some of the norms in our field? This episode is evidence-based and supported by neuroscience.   Thank you for listening. To support the show and receive access to...

All therapy books have an oddly similar message: *This* form of therapy is the one that truly matters, and *this* science/philosophy/whatever is the key to understanding how human psychology actually works. These narratives can't all be true, so are they all simply bullshit instead? We read through Scott Alexander's legendary blog post, Book Review: All Therapy Books, and discuss whether therapy g...

Life can be hard at times. Do you want to feel more visible and important in your relationships? Are you curious about why every Psychology Today profile looks the same? We get silly with the incredible Therapist Generator and learn all about treating sunroof addition with truckload therapy and registered turtleneck therapy. The therapist profiles are fake, but our desire to meet you where you are...

Social proof has become a crucial element of consumer decision making in the Internet era. So why don't the vast majority of therapists ask their clients to give testimonials or leave reviews? We ponder the frustrating tension between psychotherapy ethics codes and literature on marketing in the 21st century, and we do our best to advise therapists about what to do in response to a bad online revi...

What is religious trauma, and why do some therapists refuse to work with clients who use that language? In today's episode, Jeremy speaks about his experiences with therapists who felt the need to defend their faith in session, and we are joined by Josh Foster, LCPC to discuss the complicated intersection between evangelical Christianity and ethical psychotherapy.   Thank you for listening. To sup...

Trauma-informed therapy is…what, exactly? And is trauma actually stored in the body, or is that just a clever narrative that a few enterprising gurus have used to sell books and trainings? We dig deep into the research on trauma to answer these questions and more, and Carrie introduces her breakthrough trauma-focused treatment: dog therapy.   Thank you for listening. To support the show and receiv...

Let's get controversial! Is it a good idea for a therapist to project their own political views onto a client? For today's guest Ruth, the answer is a resounding "no." We hear her story of a therapist who took her political advocacy too far, and Dr. Ben Caldwell rejoins us to explore the ethics of discussing politics in therapy. Plus, how can therapists know if they are trauma-informed enough for...

No, EMDR is not a cultish pyramid scheme. With that out of the way, why is EMDR training so expensive when its theoretical foundations are supported by dubious (at best) research? In this clickbaity-titled episode, Angela Nauss, EMDRIA-certified LMFT, joins us to describe the experience of paying thousands of dollars to "watch the dumpster fire from inside the dumpster." Please direct all angry em...

How do we know which psychotherapy research is trustworthy? Dr. Alex Williams and Dr. John Sakaluk help us search for evidence in all the logical places: the replication crisis, RCTs, qualitative studies, dolphin therapy, Canadian football, researchers fighting Connor McGregor, and of course, EMDR. This episode is brought to you by MR. BEAR (Meta-analysis, Registered, Big sample size, Experiment,...

What makes for effective group therapy? Cohesion, expectation setting, and as today's guest Thomas can attest to, not having the therapist give the middle finger to a group member. We try to make sense of Thomas' experience by looking into research on group therapy, and we also try to make sense of our own experience of failing to find a single group therapy expert.   Thank you for listening. To s...

What exactly is treatment planning and why do some therapists dread having to do it on a regular basis? This episode is Carrie's love letter to treatment plans – why they are used, how they can improve therapy outcomes, and why Ben is wrong in his stubborn resistance to writing out a detailed plan for every client.   Thank you for listening. To support the show and receive access to regular bonus...

What's so important about a diagnosis? For neurodivergent clients, it can mean affirmation, community support, and access to much-needed services…if the diagnosis is correct. In today's episode, we talk to Harley about her challenges in seeking diagnoses of autism and ADHD, and Halina Brooke rejoins us to discuss some of the best practices (and controversies) in supporting autistic clients.   Than...

Nothing lasts forever, including therapeutic relationships. Therapy can end in lots of different ways, but what constitutes a good goodbye? We dig into the research on termination and the related ethics codes and come away with a surprising conclusion: firing a client is almost always ethically acceptable.   Thank you for listening. To support the show and receive access to regular bonus episodes,...

"No bad parts" is a common mantra in therapy – the various parts of ourselves are always working to serve some beneficial purpose. But what happens when a therapist communicates to a client that significant parts of who they are aren't welcome in the therapy room? Today's guest Adam describes having to compartmentalize aspects of his identity with his therapist, and Dr. Sheila Addison joins us to...

What happens in the first session of therapy? More importantly, why do one-third of clients not come back for the second session? We look for answers in the research on client expectations and consider some creative perspectives on increasing first session effectiveness, including a radical idea that clients dropping out of therapy might actually be a positive outcome.   Thank you for listening. T...

Is good therapy as simple as whatever activity makes a client feel better? What if that activity is a singular focus on sports betting strategy? In today's episode, we talk with Christine to learn from her experience of "gambling therapy" and answer the question of whether or not it's a good thing to be friends with your therapist (spoiler: no, no it is not).   Thank you for listening. To support...

Carrie hasn't worked as a therapist in over a year. Will she ever get licensed, and how is her decision connected to the apparent reality that many therapists are actively trying to not see clients? We explore the interesting trend of therapists looking for side hustles, and Carrie forces Ben to confront his extreme aversion to participating in the real world (aka sales and marketing).   Thank you...

You've already heard that the therapeutic alliance is important to client outcomes, but does anyone actually know why? We dig into the research to figure out if ruptures can be a good thing (yes!), what clients and therapists should know about the therapeutic alliance, and why this topic has been fervently researched over the last half-century.   Thank you for listening. To support the show and re...

Many clients want a spiritual component to their therapy, but what happens when a therapist acts more like a theologian than a mental health professional? Today's guest Kelsey describes her experience of having spirituality weaponized against her in sessions, and Dr. Jim Jobin joins us to discuss how religion can be ethically and effectively incorporated into the therapeutic environment.   Thank y...

It seems odd that most therapists – us included – aren't 100% certain about what constitutes an intervention. Are interventions scripted in-session activities? What about the theoretical orientations themselves? There isn't one single answer, but interventions aren't that difficult to understand if you zoom out far enough…and get a little bit of help from ChatGPT.   Thank you for listening. To sup...

Stereotypes aren't always a bad thing. That may not be true in therapy, especially when a client is made to feel like they are representing an entire group of people. That's what we explore with today's guest Jess, and we're also joined by Deanna Fierman, LPC, to talk about what therapists should do after their biases about identity lead to clinical errors. Plus, Ben finds a therapist and Carrie g...

There are over 600 types of psychotherapy. What are they, where did they come from, and what makes them important? We dive deep (too deep, probably) into a $900 textbook in an attempt to make sense of the spectacularly confusing topic of theoretical orientations. This is an integrative episode – we integrate a lot of information with even more information.   Thank you for listening. To support the...

In the United States, mental health professionals must pass a clinical exam to become licensed in their field. These exams appear to do nothing to make psychotherapy more effective or safe. They are, however, very efficient at furthering structural racism. Dr. Ben Caldwell joins us to make a very compelling, research-based argument for why these clinical exams should be abolished immediately.   Th...

It's not unusual for clients to develop feelings for their therapist. It's also not unusual for therapists to develop feelings for their clients. So why is it such a bad idea for a therapist to share (or act) on those feelings? Today's guest Kate shares a story that illustrates exactly why, and Dr. Ben Caldwell rejoins us to talk about what should happen when clients and therapists develop feeling...