You bring up some interesting points. I think if a client believes they are not making progress, and cannot resolve the issue directly with their therapist, they should probably look elsewhere. That doesn't mean the first therapist is unethical necessarily. Certainly, prolonging ineffective therapy for the purposes of billing crosses that line. Therapists, on the whole, have not demonstrated a keen interest in the science of what we do. There are plenty of decent practitioners out there. People who listen empathically, people who are genuine and reliable and honest, etc. But precious few of my colleagues actually measure success in any kind of systematic way. There is a great deal of subjectivity in the human experience, as well as an almost incalculable number of confounding variables. Is it enough for the client to simply "feel better"? Are we, at that point, even practicing professional healthcare? I agree, conditionally, with your comments regarding CBT. I say conditionally because I'm not inclined to let insurance adjusters and actuarial tables determine bet practices: they have their own agenda, too. Spending as little money as possible. Have you ever had a client "run out" of session prematurely? Then what? See ya? Pay the full session fee themselves? It can be an important check-and-balance (not going overboard), but not what I would necessarily consider the "high end" of quality therapy. Also, psychotherapy has different goals for different clients. Treating a phobia vs. treating a personality disorder, for example. I agree with your comment about theoretical clarity, but not when it leads to dogmatic, one tool thinking. Lastly, there is, I think, a bit to be said for instinct. The problem is, many people think they have it, but they don't. No written test for that, unfortunately.
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