20 Secrets Your Therapist Won't or Can't Tell You

All professions have secrets the client is usually unaware

Source: Creative Commons 3 - CC BY-SA 3.0 Alpha Stock Images Nick Youngson

Every profession has a backstory and gossipy intrigue. The practice of clinical psychology is no different. These "secrets" are my take on some significant issues, and you may well disagree if you are a therapist.

Secret 1

The matter and tone of the therapeutic suggestion can make or break compliance. Your internist says: "I don't think this pill will work, let's try it." This affects compliance through suggestibility. If you are on a tight budget, and if the doctor hems and haws, you will not even fill the $200 prescription. I say at the end of the first session, "Be optimistic. I can help."

Secret 2

A "battery of tests" links cause and effect with diagnosis and treatment in physical medicine. However, In psychological treatment, the scientific relationship between cause and effect and diagnosis and treatment is dubious. If you saw ten therapists for the same presenting complaint, you would receive nine different therapies, but if you saw ten internists for the same presenting complaint, you might receive 1-2 treatments. There are many "schools of thought" in graduate psychology.

Secret 3

Therapists like to do their own thing behind closed doors. The interpersonal factor is the key. After doing therapy for 50 years, my conclusion is 70 percent of the variance of effective or ineffective outcomes is therapeutic rapport, also known as the therapeutic alliance. I might be a perfect fit for Client "A" and a lousy fit for Client "B."

Secret 4

The Internet allows rating therapists. This practice is an invalid and unreliable level of unresolved transference having little to do with what happened in therapy, the level of care, or the outcome.

Secret 5

Mental measurements, "testing," have a limited practical utility. A mental measurement is the use of quantitative scales and methods in measuring psychological processes. In research, these scales are often the dependent variables correlating the answers to personality types.

Mental measurement is the field of psychodiagnostics. Only a few mental measurements exist in clinical practice. These objective and subjective (projective) measurements measure emotions, IQ, and personality. I use these standardized test results to validate my educated clinical hunches.

Secret 6

Life, love, and corporate success are a function of three factors: IQ, EQ, and character. IQ gets you the job, but EQ (emotional intelligence) and a good character get you promotions and enduring relationships.

Secret 7

There is a heated debate within professional psychology on defining intelligence. A pragmatist would conclude intelligence is what an intelligence test measures. The WAIS-IV is the most widely used standardized test measuring verbal comprehension, perceptual reasoning, working memory, and processing speed.

Secret 8

Burnout is a problem for therapists. To not burn out, an effective psychotherapist must maintain therapeutic distance and obey the ethical standards of psychology. Therapeutic distance, a clinical term, presents practical problems. In a small town, it is impossible not to run into a client. Or a psychologist can't network as much as a CPA, lawyer, physician, or dentist. If your relationship is transactional, it is a dual relationship and unethical.

Secret 9

A therapist has to remain aware of the real world and remain alert to current issues, like the impact of COVID-19 on mental health and controversial social issues, to understand the reality of people's lives.

Secret 10

Often the IEP (Individualized Educational Plan) results of school psychology are unwittingly misinterpreted by the parents and abused or ignored by the administration to justify long-term academic track placements.

Secret 11

There is an inverse relationship between the length of a diagnostic psychological report and its cost. I read a 20-page report about Client "X" from an academic psychologist. It was fascinating. I could not use the results in therapy. The suggestions were too abstract. It contained academic jargon, ambiguity, too many "probabilities," and half-baked unreasonable conclusions.

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Secret 12

Many problems in living are caused by living inside dysfunctional social systems. Remove the dysfunctional system, and the client cured. This ecological determinism is the "system's approach" in family therapy.

Secret 13

Insurance companies fight tooth and nail to circumvent payment parity with physical illnesses. And the diagnostic classifications (CPT codes) keep changing to ensure significant delays in payment to the therapist or create such paperwork hassles the therapist gives up—precisely what the insurer wants.

Secret 14

Motivational coaching is not therapy. It is practical advice and guidance, which is fine, but "being in therapy" has different rules to maximize its usefulness.

Secret 15

The American Psychological Association has to shorten the Ethical Rules of Psychologists to the one-sentence Hippocratic Oath. When I started, the psychological ethics were eight pages; now, it is over 40 pages.

Secret 16

If a high school senior asked me, "Should I major in psychology" then apply to graduate school in clinical psychology?" I would say, "No, instead pursue a Psy. D., a Doctor of Psychology. If you want to be a researcher, get a Ph.D.

Secret 17

Counselors sell time. Physicians sell procedures. If you want to get rich and sail the Caribbean, you need a trust fund or win the lottery. Seeing clients takes a psychological toll requiring self-care.

Secret 18

Men, especially alpha males, dislike the idea of therapy but seem to profit from it once trust is established, and power hierarchies are established.

Secret 19

Law and mental health often do not mix. For example, "insanity" is a legal term and not a psychological diagnosis. It is impossible to prove you are sane.

I rarely treat court-ordered clients. The judge so much wants to believe something magical will happen as to character when therapy is not really about changing character, forcing a person to change in favor of the norms of the state.

Secret 20

To be a qualified expert witness challenges ethical norms. If accepted as an expert witness, too many variables affect your professional opinions. Your interpretations tend to be in favor of the lawyer paying your bill. However, you usually know more than the lawyer unless it is a serious crime creating a battle of the experts confusing the judge and the jury.

The knowledge of these secrets evolves

These secrets are rarely taught but necessary to survive. Many professors have never practiced outside academia. That lack of direct experience makes no sense if you are preparing the student to make a living, in addition to transferring knowledge. A licensed mental health worker should have a formal course in these kinds of professional issues.