Therapist Types: The Confrontationalist

These are the overbearing I-have-all-the-answers counselors.  They listen only long enough to figure out what you need to be told.  The bulk of the counseling is directive and educational.  The direction might come from a defined theoretical perspective or it is often simply a hodge-podge of common sense and non-sense.

This is still the industry standard in drug and alcohol counseling where 12-step provides the material for indoctrination.  Input from clients is allowed so long as it follows the prescribed 12-step path.  Any wayward or contradictory beliefs expressed by the client about their own life and motivations are met with staunch correction from the counselor.  Independent thought is labeled intellectualization, rationalization, denial, “escape into health,” and such.

There are also Confrontationalists in mental health counseling.  The temperament and relationship is similar to the 12-step based counselor, but the content may be different.  Confrontationalists may impose a medical model or use reality therapy or any number of different approaches, but it is always delivered in a confrontational and directive manner.

Confrontationalists are the tough-love counselors who may tell you that you’re the boss but the unspoken message is: “My way or the highway.”  If you deviate, you feel like you are being corrected.  Any insight you express about your own inner life is squashed and replaced by common adage dressed up as psychological theory.

The Confrontationalist Symptom List

• Loud or authoritative tone of voice
• Interrupts
• Talks-down-to
• Educates
• Directs
• Poor listening skills
• Imposes a model of therapy regardless of whether it fits the clients needs
• If the client is argumentative he or she is re-educated or may be booted from therapy.

Therapist Types: The One Diagnosis Wonder

Certain therapists become enamored with a particular diagnosis.  This one diagnosis becomes their professional obsession.  They become widely knowledgeable on the topic and proficient at diagnosing even latent and subtle manifestations of the chosen disorder.  Soon they are uncovering the disorder everywhere they look and in just about every client they see.  Besides providing the therapist with that Maslowian peak feeling that he or she has become a true expert in something, it also becomes quite lucrative and therefore a little difficult for the therapist to be truly objective.

Through the 1990’s and 2000’s the mental health industry relentless expanded its markets into new niches and populations that had never been tapped before, benefiting drug companies and therapists alike.  One of the ways this happened was through the promotion of “shadow” or “spectrum” syndromes.  These are mild versions of genuine psychiatric disorders.  Shadow syndromes have been identified for Attention Deficit Disorder (ADD), Autism, and Bipolar Disorder, among others.  The idea that some people manifest “sub-clinical” symptoms of these disorders is not new.  What is new is that some professionals now diagnose and treat people who present with these mild forms. 

This is one way in which the One Diagnosis Wonders get away with over-diagnosing their favorite disorder.  Another approach is the development of non-standard and unapproved diagnostic criteria that are broader than that given in the Diagnostic and Statistical Manual (DSM) of the APA.  One example of this is the currently popular “Complex PTSD” that allows counselors to semi-legitimately diagnose people with PTSD (Posttraumatic Stress Disorder) who do not meet the criteria for the official diagnosis as defined in the DSM.

Lastly, there are One Diagnosis Wonders who simply do not use careful or considered judgment in assessing and diagnosing.  These are therapists who diagnose from the hip and never give it a second thought.  Some may even disavow using the DSM criteria because they believe their expertise is so great, they can simply intuit that someone is afflicted with [insert favorite diagnosis].  This approach to diagnosing is particularly favored among the proponents of recovered memories and dissociative disorders (such as Multiple Personalities).

The problem with over-diagnosing is the simple fact that people are being labeled and treated, sometimes with medications, for a spurious or at least questionable diagnoses.  This can cause problems with side effects from psychiatric drugs (up to and including death), undue dependence on a therapist or the mental health system, and unnecessary labeling that can have an adverse effect on self-esteem, identity and personal development.

The One Diagnosis Wonder Symptom List

• Many or most clients are diagnosed with the very same thing
• The therapist seems to ignore, discount or minimize problems that don’t fit their favored diagnosis
• The therapist pressures clients to accept they have symptoms or past experiences (such as childhood sexual abuse) even when the client denies these things.
• Often these therapists will be good at talking and explaining their expert knowledge but don’t come off as very good listeners.

Therapist Types: The Rescuer

This type is also very common and has several sub-types.  The rescuer may be male or female but is more often female (as mental health workers are predominately female anyway).  The Rescuer often projects a maternal or maternalistic feel.  Typically if her client is compliant than she is maternal, but if her client is non-compliant she becomes maternalistic, meaning she knows what best for the client.

Like the Narcissist, the Rescuer also likes dependent relationships.  But, she is less intolerant of antagonistic clients.  She may see the difficult client as a challenge to prove herself as a carer.  It goes with the whole maternal thing, after all.

The main identifying characteristic of the Rescuer is she does-for the client instead of teaching the client or challenging the client.  She takes on the problems of the client and does her upmost to fix them, or failing that, to protect her client from anything that might cause distress or pain.  She may go to extraordinary lengths to do so, such as giving the client access to her on a 24/7 basis.  In the business we call this poor boundaries and it results in . . . you guessed it . . . dependence on the therapist.

Protecting the client from distress or pain includes protecting the client from the natural consequences of his or her own choices and behaviors.  Rescuers will not confront their clients about their problematic behaviors or distorted thinking and they will resist any attempt by others to do so.  This comes from the belief that to do so will cause too much emotional distress to the client.  There may be a secondary rationalization that the client is being victimized by the judgments of others, and therefore is not responsible for his or her behavior.

The Rescuer feels good about doing-for.  It gives her the feeling she is helping and that’s why she became a therapist.  Her motivation is pure, and Rescuers are typically good people at heart, but, unfortunately, they are blind to the harm they do.  Because their motivation is “good,” they run on the belief that their intuitive values trump counseling ethics and best practice.  As a result they may resist or ignore supervision.  If she is allowed to practice like this unabated, she will often create a large clientele of child-like dependents who go to her for their every need.  That is when the Rescuer feels at home—at least, that is, until she gets burnt out and has to quit and abandon all her infantilized clients.

The Rescuer Symptom List:

• Manner: friendly, good eye contact, touchy, huggy, minimal personal space.
• Clothing:  lose-fitting casual clothing, often with beaded accessories and, of course, sandles.
• Speech: every phrase is framed in the positive with no negative, critical or politically incorrect words spoken.
• Resists challenging the client on beliefs or behaviors, sometimes to the point of reinforcing and even advocating for the client’s rationalizations and denial systems.
• Continually in motion in the service of clients.  Looks like frantic activity, multitasking, advocating, interrupting therapy sessions to give crisis counseling to another client with a hangnail (for instance).
• Does not set limits on availability to clients.  May give out home number or cell number.
• Does not set limits on what she will do for clients.  May provide many non-therapy services such as giving rides, taking shopping, helping with chores, paying bills, etc.
• Actively and assertively advocates in the community to prevent the effects and consequences of the client’s behaviors from having a negative impact without making any attempt to prompt a change in the problematic behavior.

The Wounded Healer

This is a sub-type of the Rescuer.  It is a commonly held maxim that psychologically wounded people are drawn to work in the mental health field.  This may be so, but not everyone displays their wounds on their sleeves—the Wounded Healer does.  She is more often female than male, but not exclusively so.

In the simplest form, she uses her personal history for therapeutic illustration.  In her worst form, she uses her personal material to create empathy from the client toward the therapist.  The Wounded Healer is a deeply empathetic carer toward clients who have a similar profile or history to herself, but she often has trouble understanding or empathizing with clients who do not.

Problems develop because (1) she cannot distinguish between her own issues and those of her clients, and (2) her divulging of her personal material puts an emotional burden on her clients.  She is motivated to connect with others who have suffered similarly to herself and, in some cases, may seek an empathic reaction.

The Wounded Healer Subtype Symptom List

• Talks openly of her past psychological trauma in a manner that seeks an empathetic reaction or acknowledgement of a special condition/status.
• Drawn to work with a special type of client that matches her own profile or history.
• Has difficulty understanding or working with clients who do not share her issues.
• Becomes emotionally enmeshed with clients and may misunderstand clients due to projecting her own issues on them.
• Clients become emotionally burdened or alienated by the therapist’s needs.

The Alan Alda

This is another sub-type of the Rescuer.  This is specific to men who came of age in the 1960’s and 1970’s.  Many men of this generation accepted the belief that men of previous generations were the source of all social ills through patriarchy, racism and violence.  To counter-act this, they were drawn to caring “feminized” professions where they could actively heal the wounds caused by patriarchy.

In character, they are beneficent and generally non-violent in word and deed.  The concept of non-violence may be so prominent that he is unable to make any comment that could be viewed as even remotely critical.  Because of this, this type is not able to effectively deal with entrenched denial or poor insight in a client.  They may even encourage denial in order to avoid the perception of conflict.  The exception to the rule of conflict avoidance is if he has a client who reports being a victim of injustice, especially sexist or racist injustice, then this type will become a fearless advocate and activist regardless of actual facts.

The Alan Alda Symptom List (symptoms in addition to the Rescuer symptoms)

• Ponytail
• Good listener
• Mostly non-assertive.  In instances where he is assertive, he will be passive-aggressive and condescending.
• Will inexplicably develop a spine and argue for the rights of his client if triggered by he perceives social injustice against his client.  This will be done with no attempt to actually verify the facts.

Therapist Types: The Miracle Worker

These are the woo-woo practitioners, the snake-oil salesmen, of the 21^st century.  This tradition goes back to the Paleolithic when certain unscrupulous shamans played tricks on their patients to make them think they were healed.  Sometimes the belief alone caused the patient to get better.  Other times, the patient died anyway, probably cursing the quack shaman.  These days, we call this the placebo effect.

Don’t be fooled by the Evidence Based Practice jingle.  That’s just another way of not saying anything at all.  It means about as much as “New and Improved” on a box of detergent.  There are plenty of Evidence Based Practices that are nothing more than placebos.  After all, there is plenty of scientific evidence that placebos can have a positive healing effect.  Thus, anything with a placebo effect can and does get labeled an Evidence Based Practice.

The Miracle Worker type peddles questionable and nonsensical therapies.  Does that mean Miracle Workers are shameless swindlers and mountebanks?  Maybe, but usually not.  Most Miracle Workers sincerely believe in the efficacy of their own therapy but lack the ability or intellectual will to critically analyze their own practices.  He or she (and there doesn’t seem to be a gender preference) present no objective scrutiny regarding their therapy.  Any attempt to apply critical analysis will be met with hocus pocus, meaningless jargon, and if that doesn’t work, the final fall-back of “There are more things in heaven and earth . . . than are dreamt of in your philosophy.”

Cultic non-therapies include, but are not limited to, Eye Movement Desensitization Reprocessing (EMDR),  Primal Therapy, Past Life Therapy, Thought Field Therapy (TFT), Emotional Freedom Technique (EFT) (and variants), brainwave synchronizers (various brands), Orthomolecular Therapy, etc.  These are just a few. There are many more and many therapies to be skeptical about.

The Miracle Worker Symptom List

• Sounds too good to be true.
• One easy solution for many or all problems.
• Feels like you’re being sold something.
• Counselor uses an excess of scientific-sounding words but without fully explaining their meaning.
• Explanations of the therapeutic method are confusing and contradictory, or may be overly simplistic.
• When asked to clarify, the counselor responds with more jargon and gobbledygook.
• Criticism of the method is responded to with irritability or hostility.
• The counselor only uses one method of therapy—few or no therapeutic choices are offered.
• Counselor only collaborates with colleagues who use the same method.

Therapist Types: The Narcissist

This type is not uncommon and may come in male or female, hippy or square varieties.

The classic Narcissist type was a male Freudian analyst.  They would sit behind their “patients” while making them divulge shaming thoughts and feelings they may have experienced as children.  They would then “educate” their patients about what was really going on in their head.  The analyst had the knowledge and insight.  The patient was ignorant and unconscious of their own mental emotional processes.  The “insights” generally boiled down to repressed sexual feelings for Mom or Dad.  And if you didn’t buy it, obviously you’re an unsophisticated dufus.

Nowadays, Nacissitic therapists come in all shapes and sizes and theoretical orientations.  They may be traumatologists or chi-id synergistic specialists or psychodynamically informed eclectic practitioners or anything in between.  The common thread is, the therapist is the source of knowledge and insight.  There is often a distinctly paternalistic quality to the person or the relationship.  The therapist has special inside knowledge about what makes the client tick (regardless of theoretical frame—special inside knowledge may derive from beliefs about childhood trauma or beliefs about chemical imbalance, or any of the other myriad theories and wacky beliefs floating around out there).  Alternatively, the therapist may offer a special relationship and understanding of the client that no one else could offer.  The client could never solve his or her own problems without the therapist.  And, finally, the therapist seems to derive emotional sustenance from dependent relationships and will nurture dependence, sometimes indefinitely, but will not tolerate a critical client or colleague.  Some therapists of this type will actually meet the DSM-IV criteria for Narcissistic Personality Disorder.

The Narcissist Symptoms List:

• Excessive number of capital letters listed after name
• Posture:  sits back in chair with legs crossed, looks down nose.
• Speech:  arrogant and polysyllabic with gratuitous use of opaque technical jargin.
• Actively or inactively endorses criticism of other therapists, may even take part.
• Deeply committed to his or her own opinions even in the face of contrary evidence.  This may be most apparent in the process of diagnosing and post diagnosis education.
• Fails to stop or dismiss flattery.
• Appears to thrive on the positive transference, adoration and emotional dependence of clients.
• Promotes the idea the he has a special relationship/rapport with client or that no one truly understands the client at the same level that he does (yes, that’s an old pimp trick).
• Low esteem or tolerance for colleagues.  May refuse to consult or collaborate.
• Becomes irritable or even hostile in the face of criticism.  May even terminate services to clients who fail to reinforce the therapist’s ego.
• Clients and colleagues are obsequious and sing the therapists’ praises.