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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, check out the Very Bad Therapy Patreon community.   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   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   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   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   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   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   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story

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.

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 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 – 7:22 Part One: 7:22 – 37:54 Part Two: 37:54 – 1:23:15   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Effective Altruism Charity Resources: GiveWell / Giving What We Can / The Life You Can Save Pod Therapy ChatGPT

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 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 couples and individual clients.   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: ChatGPT Effective Psychotherapists: Clinical Skills That Improve Client Outcomes Types of interventions (NIH) Types of Interventions in Counseling The Complete Set of Client Handouts and Worksheets from ACT books Essential Techniques for the Beginning Psychodynamic Psychotherapist Commonly-Used Intervention Words for Mental Health Progress Notes Therapy Interventions Cheat Sheet What is the Change Triangle? Affect Phobia Therapy

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 gets a mammogram.   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 – 18:09 Part One: 18:09 – 54:04 Part Two: 54:04 – 1:38:02 Part Three: 1:38:02 – 1:40:39   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Support DC Texas Migrant Solidarity All the Colors Counseling and Consulting

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 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.   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: APA Handbook of Clinical Psychology Bruce Wampold on What Actually Makes Us Good Therapists The evidence for evidence-based therapy is not as clear as we thought Evaluating the Evidential Value of Empirically Supported Psychological Treatments (ESTs): A Meta-Scientific Review Obtaining Consensus in Psychotherapy: What Holds Us Back? Becoming an Effective Psychotherapist: Adopting a Theory of Psychotherapy That’s Right for You and Your Client Types of Therapy

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.   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.   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Clinical Licensing Exams in Mental Health Care (White Paper) Report: Clinical exams in mental health licensing are structural racism 2022 ASWB Exam Pass Rate Analysis org – ASWB: End Discriminatory Social Work Licensing Exams California BBS discussion of the ASWB report Racial Bias and ASWB Exams: A Failure of Data Equity Ben Caldwell: Email / Ben Caldwell Labs / Psychotherapy Notes

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 feelings for one another.   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 The Organized Therapist – Social Media for Therapists and Sentio Counseling Center – high-quality, low-fee online therapy in California with immediate availability for new clients.   Introduction: 0:00 – 8:40 Part One: 8:40 – 44:35 Part Two: 44:35 – 1:30:32   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Donate to NAMI: National Alliance on Mental Illness Ben Caldwell on Authory The Patient on Hulu Mentour Pilot (YouTube) Does sorry work? The impact of apology laws on medical malpractice “Sorry” Is Never Enough: How State Apology Laws Fail to Reduce Medical Malpractice Liability Risk

Justin Norris rejoins us to conclude our conversation about the perplexing maze that is the application process for grad school. We use the California State University (CSU) system as a case study to illustrate why program requirements aren’t always what they seem, and Carrie discusses which therapy programs do a great job of defining and providing quality to their students. Plus, Subaru gets lots of free advertising.   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 – 10:35 Part One: 10:35 – 1:10:11 Part Two: 1:10:11 – 1:13:21   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: The Patient on Hulu Sentio Counseling Center: Affordable Online Therapy for Californians MFT California Creating Impact: The four pillars of private psychology practice

Have you ever wondered why the process of applying to grad school is so unclear at times? In part one of two, we are joined by Justin Norris, an expert in systems of higher education, to talk about the surprisingly interesting topics of accreditation, for-profit vs. non-profit designations, and public vs. private universities. If you wanted to become a therapist but ended up in a sales funnel, this episode is for you.   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 – 19:21 Part One: 19:21 – 1:27:53 Part Two: 1:27:53 – 1:31:45   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: The Patient on Hulu Sentio Counseling Center: Affordable Online Therapy for Californians Sentio University MFT California Living with Harm OCD The Secret History of Thoughts (Invisibilia)

What happens when a therapist doesn’t want to work with a client? What should happen? Tom shares his experience with a therapist who chose avoidance over honesty, and we discuss ten types of hard conversations that frequently give therapists anxiety. Plus, is Steve Carrell a good enough TV therapist to avoid getting murdered?   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 The Organized Therapist – Social Media for Therapists.   Introduction: 0:00 – 11:00 Part One: 11:00 – 37:54 Part Two: 37:54 – 1:37:40   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: The Patient on Hulu Sentio Counseling Center: Affordable Online Therapy for Californians Why Therapy Is Broken Social Workers’ Ethical Responsibilities to Clients

Dr. Sally Gibbons is an Oxford-educated philosopher, professor of bioethics and philosophy at UCLA, and licensed professional clinical counselor. We discuss her academic background, what inspired her transition to a career in mental health, and how philosophical thinking informs her humility and curiosity with clients. We also explore the intersections between philosophy and psychotherapy and how this relates to questions about what it means to be a human being and what we owe each other. Plus, Dr. Gibbons shares her own experience of very bad solution-focused brief therapy.   Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community.   Introduction: 0:00 – 13:08 Part One: 13:08 – 1:11:38 Part Two: 1:11:38 – 1:16:26   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Sally Gibbons’ Website The Patient on Hulu Sam Morril: Up on the Roof

Psychological testing can be complicated. It shouldn’t have to be hostile, even if the evaluation is not intended to be in a client’s best interest. In today’s episode, Jacob shares his experience of a truly ridiculous psych assessment, and we speak with Rachel Simon, LCSW MEd about how assessors can minimize the harmful impact of their own biases – and the biases built into the psych tests themselves.   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 The Organized Therapist – Social Media for Therapists.   Introduction: 0:00 – 6:49 Part One: 6:49 – 43:54 Part Two: 43:54 – 1:20:49   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Donate to Transgender Law Center Rachel Simon’s Website The Every Body Book Minnesota Multiphasic Personality Inventory (MMPI) The Gender Affirming Letter Access Project

The history of expertise in medicine and science led the field of psychotherapy to its beloved empirically supported treatments (ESTs). Psychiatrists were prescribing pills, and psychotherapists were offering best practices. But how did these best practices get their reputation, and what happens when clients and therapists alike believe uncertain truths about mental health treatment? We conclude our two-part historical journey with a look at some contemporary alternatives to the medical model and what this all means for the most important aspect of therapy: helping clients get better outcomes.   Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community.   Introduction: 0:00 – 3:39 Part One: 3:39 – 58:05   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story

Therapists are considered mental health experts. How did this come to be, and is it necessary for the future of the field? Join us as we trace the surprising history of the medical model in therapy from its origins in the Scientific Revolution to the evolution of treatment manuals. Part I takes us all the way to 1987, with cameos by the Catholic Church, Ben Franklin, Sigmund Freud, Hans Eysenck, and more. If you’ve ever wondered why psychotherapy seems to have such a confusing relationship with medicine and science, this episode is for you.   Thank you for listening. To support the show and receive access to regular bonus episodes, check out the Very Bad Therapy Patreon community.   Introduction: 0:00 – 4:02 Part One: 4:02 – 55:39   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story

Today’s guest Marie shares her thought-provoking story about a preoccupied telehealth therapist, and we drag Dr. Ben Caldwell into another one of our philosophical crises about what constitutes very bad therapy. Is it not following a treatment plan? Having young children show up in session? Ignoring ruptures? Regularly showing up late? And while we’re at it, what even is therapy? Who should get to be a therapist during the pandemic? Join us on the struggle bus as we try to parse out issues related to telehealth, laws, ethics, clinical practices, privilege, social systems…and bullshit.   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 The Organized Therapist – Social Media for Therapists and Empifany (Instagram / Facebook).   Introduction: 0:00 – 11:20 Part One: 11:20 – 54:41 Part Two: 54:41 – 1:57:06 Part Three: 1:57:06 – 2:02:04   Very Bad Therapy: Website / Facebook / Bookshelf / Tell Us Your Story   Show Notes: Donate to Cystic Fibrosis Foundation Ben Caldwell Labs Psychotherapy Notes SimplePractice Learning Calling Bullshit: The Art of Skepticism in a Data-Driven World Potential fabrication in research images threatens key theory of Alzheimer’s disease Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department: A proof-of-concept randomized controlled trial The Radical Therapist #100 – Single Session Narrative Therapy w/ Michale Morar