Very Bad Therapy Ben Fineman and Caroline Wiita

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.
 
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Show Notes:
Ending Therapy: The Therapeutic Relationship During the Termination Phase 6 Strategies for Ethical Termination of Psychotherapy Practice recommendations for reducing premature termination in therapy. A meta-analysis of psychotherapy dropout. Client initiated termination of therapy at NHS primary care counselling services Comparing therapist and client perspectives on reasons for psychotherapy termination. Client and therapist views of contextual factors related to termination from psychotherapy: A comparison between unilateral and mutual terminators The Oxford Handbook of Psychotherapy Ethics The History and Ethics of the Therapeutic Relationship Termination and Abandonment: A Proactive Approach to Ethical Practice How to Fire a Client How to End Therapy the Right Way 7 Tips for ‘Breaking Up’ with Your Therapist

“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 discuss how to provide affirming services to all parts of a client.
 
Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today’s episode is sponsored by Mental Health Match.
 
Introduction: 0:00 – 4:53
Part One: 4:53 – 41:18
Part Two: 41:18 – 1:23:05
 
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Show Notes:
Donate to Trans Lifeline Dr. Sheila Addison: Website / Twitter

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. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today’s episode is sponsored by Mental Health Match.
 
Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story
 
Show Notes:
What’s the Smallest Amount of Therapy That’s Still Effective? The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work The First Kiss: Undoing the Intake Model and Igniting First Sessions in Psychotherapy Clinician interventions and participant characteristics that foster adaptive patient experiences for psychotherapy and psychotherapeutic changes. Clients’ pretreatment counseling expectations as predictors of the working alliance. A comparison of client preferences for intervention empirical support versus common therapy variables A prediction of initial appointment attendance and initial outcome expectations Premature discontinuation in adult psychotherapy: A meta-analysis. How to make the most of one session Is Dropout After a First Psychotherapy Visit Always a Bad Outcome? Single-session therapy: Maximizing the effect of the first (and often only) therapeutic encounter. Capturing the moment: Single session therapy and walk-in services. The Radical Therapist #100 – Single Session Narrative Therapy w/ Michael Morar

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 the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today’s episode is sponsored by Mental Health Match.
 
Introduction: 0:00 – 5:39
Part One: 5:39 – 46:05
Part Two: 46:05 – 1:23:37
 
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Show Notes:
Gamblers Anonymous Buzzfeed: Share Your Therapy Icks, Including The Worst Thing A Therapist Has Ever Said To You Apply to Train at Sentio Counseling Center! 6 Stages of Grooming Adults and Teens: Spotting the Red Flags

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 for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today’s episode is sponsored by Sentio Counseling Center – high-quality, low-fee online therapy in California with immediate availability for new clients.
 
Introduction: 0:00 – 4:16
Part One: 4:16 – 1:09:53
 
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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 receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community. Today’s episode is sponsored by Mental Health Match.
 
Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story
 
Show Notes:
Taylor Tomlinson: Look At You The generalizability of the psychoanalytic concept of the working alliance. Therapeutic alliance (Wikipedia) Studying psychotherapy using the one-with-many design: The therapeutic alliance as an exemplar. What is the Therapeutic Alliance and Why is it Important? The Alliance in Adult Psychotherapy: A Meta-Analytic Synthesis Current concepts of transference. Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research Therapeutic alliance rupture as therapy event for empirical investigation The development and decay of the working alliance during time-limited counseling. Patterns of working alliance development: A typology of client’s working alliance ratings. Clients’ and Therapists’ Views of the Therapeutic Alliance: Similarities, Differences and Relationship to Therapy Outcome The Therapeutic Alliance: The Fundamental Element of Psychotherapy Therapeutic Alliance Ruptures Alliance rupture repair: A meta-analysis.