Mandatory Therapeutic Disclosure Act for therapists

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Aspie1
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26 Aug 2022, 5:53 am

Most of us aspies have had horrible experiences with therapy. And there's a reason: NOTHING was honestly explained to us prior to starting it. We were told to go there and "just talk". Sure enough, we ran into landmines and air-to-surface missiles; and if we dodged one, we ran into the other. For instance, we were asked "How did that make you feel?", only to not be believed, because our answer didn't match their textbook training and/or personal beliefs. Or our therapist swindled us into trusting them, then sided with the people emotionally abusing us and blatantly mocked us.

What if it didn't have to be that way?

What if there was a Mandatory Therapeutic Disclosure Act (MTDA) regulating the therapy industry? What if therapists were legally required to disclose to the patient, in writing, two important things: (1) What they expect from the patient, and (2) Who they're ACTUALLY loyal to.

Oftentimes, the thetapist's true loyalty isn't the patient, but to the adults living with the patient and/or government agencies (this includes schools and jails). And equally often, the therapist never explains what they actually want to hear, like "emotion words" in a very specific tone of voice, or don't want to hear, like "whining" about parents' emotional abuse. So with this law, the patient can adjust their expectations and actions, and deliver what's required in order to be helped. Otherwise, they go into therapy, expecting to "just talk" and be helped, only to not be believed, mocked, angrily berated, and denied medications they legitimately need. All because they're not given the whole story.

False disclosures would be penalized by a permanent loss of therapy license with no possibility of appealing or getting it back.

The patient's age would be irrelevant. It could be a skittish 10-year-old boy brought in for difficulty coping with a cross-country move. It could be a hardened, successful 39-year-old man working a government job. It could be a geriatric 65-year-old man at death's door from liver problems. In all these cases, the therapist MUST disclose these things.

In the end, everyone benefits. The therapist gets the statements and behaviors they expect, and can't resist genuinely HELPING the patient in return. The patients gets actual HELP, rather than the blatantly fake "unconditional positive regard" :roll: and/or overt angry berating.

Discuss!



skibum
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26 Aug 2022, 3:21 pm

Interesting concept. Worth looking into.


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CockneyRebel
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26 Aug 2022, 3:28 pm

I think it would be a good idea to look into this.


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26 Aug 2022, 7:40 pm

Might the unpleasant feedback, in some cases, have been some horrid behavior modification attempt?

Negative reinforcement for behaviors they wanted to remove.


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Twilightprincess
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26 Aug 2022, 7:56 pm

I don’t think that most of us have had “horrible experiences with therapy.”


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skibum
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26 Aug 2022, 8:03 pm

Twilightprincess wrote:
I don’t think that most of us have had “horrible experiences with therapy.”
I have had some


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26 Aug 2022, 8:05 pm

skibum wrote:
Twilightprincess wrote:
I don’t think that most of us have had “horrible experiences with therapy.”
I have had some

I’m sure that some people have, but I don’t think that it’s the norm as Aspie1 is suggesting.


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DanielW
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26 Aug 2022, 8:23 pm

I don't see the point - both of those issues should be discussed and disclosed before anyone starts therapy. If the client doesn't bother, that's really more their own fault.



Aspie1
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26 Aug 2022, 10:50 pm

DanielW wrote:
I don't see the point - both of those issues should be discussed and disclosed before anyone starts therapy. If the client doesn't bother, that's really more their own fault.

Absolutely! In family therapy especially, there's a huge discrepancy in loyalty: the patient is the kid/teen, but the therapist serves the parents. So... if a patient being emotionally abused at home, the therapist pretends to be his friend. But when he talks about the abuse, she gaslights him that the abuse doesn't exist and/or mocks him for bringing it up in the first place.

That's NOT what family therapy should be like! The minor needs to be EXPLICITLY TOLD that the therapist is there for his parents and not him. Also, the therapist needs to disclose that she wants to hear about the patient's good grades in school and him doing chores at home, not about his parents' mistreatment of him. Whether he talks about actual good grades or makes up lies, that's on him; but as long as the therapist is pleased, the patient benefits. All so that he doesn't waste his time on her, or worse, turns to abusing alcohol to come with the adults ganging up on him.

Once that's been disclosed, the patient can strategically pick and choose what to share with her and what to keep to himself. Whether he shares abuse stories with a flying monkey or just feeds her fake success stories, he can now at least make an informed decision. I eventually learned that the hard way, but took me YEARS. I should have learned that right on the first session---not from easily deniable spoken words, but from a laminated printed pamphlet signed by a county judge.

It's 2022, so... My reason for choice of pronouns is that 3/4th of aspies are male, and most family therapists are female.



Aspie1
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01 Sep 2022, 7:47 pm

DanielW wrote:
I don't see the point - both of those issues should be discussed and disclosed before anyone starts therapy. If the client doesn't bother, that's really more their own fault.
The problem with conventional therapy is that it puts minors at a disadvantage: they're the patient, but the people being helped are their parents. And yet, the minor is never told that! :evil: That's why we need the MTDA! Minors need to know they're not the ones the therapist is there to help, despite their butts sitting in the therapist's chair. The MTDA will explain to the minor why the therapist always mocks him/her instead of teaching him/her assertiveness techniques, and why the therapist berates him/her for no good reason. Then, the minor can adjust his/her narrative accordingly, to please the therapist as needed. Because a pleased therapist is a helpful therapist. While an angry therapist will use a perfect turn of a phrase to make you wish you were dead.

Similarly, the therapist can warn the patient directly and honestly, rather than with "subtle hints" :roll:. For instance, if a patient talks about being emotionally abused by his parents, she can tell him: "Listen, you piece of trash! I don't want hear you complain! According to your parents, you're a horrible kid, and I'm here to change that!" As opposed to the silly, patronizing cooing: "aww".

With adult patients, the MTDA is usually not necessary. With the exceptions of patients under legal guardianship, adult patients are almost always the customer themselves. Not to mention, even aspie adults are more skilled at reading people than minors are, so they can usually figure out what the therapist wants to hear, and deliver those exact expected answers or statements.



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02 Sep 2022, 5:18 am

Your suggestion is funny. :D I'm sure they're looking for certain things, but a truly experienced therapist would be impartial and know things can be complicated. People expect doctors to fix things, but mental health issues are difficult to fix. You gotta know what's wrong first, that task alone can be impossible sometimes, especially when healthcare funding is limited. They rush to fit your into an expected category so they can prescribe "cures". Most people who complained about anything usually end up taking a handful of medications everyday, one or two to fight their depressions or whatever issue, a couple more to fight the unpleasant side effects, another one to treat the long term effect like obesity or liver damage...etc. A few years down the road you're fat, tired, got high blood pressure and diabetes, and have no job and no friend. And you can't wean off any of those medications because of unpleasant withdrawal symptoms. :cry: Looking back you'd wish you have never complained about any of your issues.

Sorry for the rant. I guess you can tell I haven't had very good experience with therapists either. None of them figured out what was wrong with me. I had to study psychology myself to figure out. At least I refused to take antidepressants. I wish there's really an easy way to fix these things without ruining someone's life forever.

*I'm not saying you shouldn't seek therapy when you really need help. Just try other treatments first, medication as a last resort. In Canada they offer pills first, even without a diagnosis or even referral to see a psychiatrist. I do not like that.


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Aspie1
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03 Sep 2022, 7:03 am

y-pod wrote:
Sorry for the rant. I guess you can tell I haven't had very good experience with therapists either. None of them figured out what was wrong with me. I had to study psychology myself to figure out. At least I refused to take antidepressants. I wish there's really an easy way to fix these things without ruining someone's life forever.
I think the reason for so many bad therapy experiences among aspies is that we're not given "the story" at the beginning. We're told to "just talk", only to find out that there are so many hidden tricks and expectations, it can make your head spin! For instance, "there are no right or wrong answers" really means ""there are no right or wrong answers, unless it's an answer I wasn't looking for, and I'll make you regret giving it". NT patients can figure out those expectations like they figure out making friends. They shouldn't have to, but they have the skillset for it; thus, they can have good therapy experiences, since they intuitively know how to please the therapist.

It's even worse with children (rather than teens), who don't understand job titles and/or don't have the foresight to google their therapist's name. Oftentimes, they're told they'll be taken to "talk to a lady" (most family therapists are women), as opposed to being told who she is and what she does in her job. Now, she's very nice on the surface, and has toys in her office. But that "niceness" falls into the Uncanny Valley---"nice", yet disconcerting. It raises questions children may be afraid to ask:
"Why is someone who resembles a doctor or a teacher acting like she's my friend?"
"Why is she asking me weird questions, like how many legs a horse has?"
"Why is she talking to me like I'm 5, when I'm 11?"
"Why is she refusing to tell me if I said the right thing?"


THAT'S why we need the Mandatory Therapeutic Disclosure Act, even with patients as young as 5. The patient NEEDS to know what he's/she's is supposed to say and not supposed to say in sessions. Withholding the expectations from the patient turns therapy from marginally helpful to outright trickery, because it leaves the patient scrambling to figure them out on their own, or worse, get penalized for not delivering something that was never specified. And that's wrong beyond wrong!



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28 Sep 2022, 7:04 pm

The biggest problem with therapy is that it relies far too heavily on hints, which a patient is supposed to intuitively pick up on. For instance, if a minor talks about his parents emotionally abusing him, and the therapist coos "awww", it's a hint for the minor to stop "whining" and that the therapist has no intention advocate for him or stop the abuse. But it's the minor's job to pick up on that hint. That's where therapy fails most aspies, especially kids and teens. They go into it expecting help, and they get mockery instead.

The MTDA is meant to change all that. If a patient talks about his parents emotionally abusing him, and the therapist tells him to his face that he's on his own, at least he's not burdened with picking up on the therapist's hint. He can figure out more quickly elsewhere on how to deal with the abuse, or at least numb the pain from it with substances, rather than wait for the therapist's help that will never come.



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29 Sep 2022, 3:44 pm

Aspie1 wrote:
The biggest problem with therapy is that it relies far too heavily on hints, which a patient is supposed to intuitively pick up on. For instance, if a minor talks about his parents emotionally abusing him, and the therapist coos "awww", it's a hint for the minor to stop "whining" and that the therapist has no intention advocate for him or stop the abuse. ...

No, therapists are not trying to drop "hints" by cooing at people.

Your particular therapist may have been incompetent, but therapists as a profession are not there to drop hints at people.

It is more likely that when she said "aww," she was expressing *sympathy* because of something you'd just said.



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29 Sep 2022, 4:24 pm

Interesting to consider. I am looking back on my own experience with therapy and realizing that there have been really long runs with therapy where the therapist either did not believe I was autistic (I went to therapy with a number of different people before it came up and was quick to have ADHD brushed off at a glance too, because people think they know what that looks like within 2 minutes of talking to someone), or if they *did* believe me, then the experience wasn't necessarily better and often worse.

One experience I have is that my parents trained me early on the "correct" responses to questioning by professionals, because they were trying to have me pass as NT to my evaluators when I was a child. (My parents very succinctly telling me that if I said x y z, I would sound like "a crazy person.") I started spitting out these "correct" responses without really feeling much about it.

I also had a rather regimented way of working with therapists that often had a list of specific prioritized things I wanted to work on and tended to be very goal-oriented, so open ended discussions of feelings often just did not come up.

Almost any time I try to talk at length (about anything at all) to someone who isn't ND themselves, and relatively high verbal/abstract intelligence at that, I end up feeling gaslit about my own feelings and experiences, and or what I've said, and a struggle of my being in touch with my feelings at all is because of this gaslighting about what they mean.

I learned that there were two ways of talking - to other ND people vs to "official" people/coworkers/etc.

And I haven't yet been able to overcome this issue with therapists. I don't feel like I've "gotten real" with any therapist yet.


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Aspie1
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29 Sep 2022, 7:08 pm

orbweaver wrote:
One experience I have is that my parents trained me early on the "correct" responses to questioning by professionals, because they were trying to have me pass as NT to my evaluators when I was a child. (My parents very succinctly telling me that if I said x y z, I would sound like "a crazy person.") I started spitting out these "correct" responses without really feeling much about it.
...
Almost any time I try to talk at length (about anything at all) to someone who isn't ND themselves, and relatively high verbal/abstract intelligence at that, I end up feeling gaslit about my own feelings and experiences, and or what I've said, and a struggle of my being in touch with my feelings at all is because of this gaslighting about what they mean.

That's interesting. Your parents essentially acted as your MDTA. I, too, started spitting out "correct" responses without really believing anything I was saying, much to my therapist's gushing delight. Only I learned them through years-long trial-and-error, rather than through being coached by my parents.

My therapy was essentially gaslighting. Any time I said something my therapist didn't want to hear, she either mocked me or pretended not to know what I was talking about. Trying to explain/clarify myself was like hitting my head against a brick wall: she continued to either "not understand me" or try to make me look bad. In other words, she wanted to gaslight the "wrong" ideas out of me; either that, or condition me Pavlov-style into not believing them.

And that's why we need the MDTA. The patient needs to be told exactly what the therapist wants to hear, so he/she never gets gaslighted or deliberately undermined in the first place. The patient's statements can be true, or they can be made-up, but the expectations must be laid out from the get-go by the same person creating them: the therapist.