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This is David and Fabrice\'s top ten list for the worst errors therapists make.

1. Failure to Measure (symptoms, empathy and helpfulness). Research shows that therapists\\u2019 perceptions of how their patients feel, or feel about them, are not accurate.

TEAM therapists measure symptom severity at the start and end of every therapy session with brief accurate scales that assess depression, suicidal urges, anxiety, anger, relationship satisfaction, and happiness. This allows therapists to see, for the first time, exactly how effective or ineffective they are in every single therapy session. This can be threatening to the therapist\\u2019s ego, but has revolutionized clinical practice.

In addition, TEAM therapists assess the patient\\u2019s perception of therapist warmth, empathy, understanding, and helpfulness after every single session. The scales are extremely sensitive to therapist errors, and most therapists receive mostly failing grades from their patients initially when they use these scales, which can be a shock to the system! But dialoguing with the patient about the scores at the next therapy session can lead to breakthroughs in the clinical work and dramatic improvements in the quality of the therapeutic alliance.

2. Trying to help, \\u201csave,\\u201d \\u201crescue\\u201d or \\u201creassure\\u201d patients. Most therapists are addicted to this, but it simply triggers resistance. When therapists push in their efforts to help, most patients will push back. No one likes to be \\u201csold\\u201d on anything. When patients are hurting, they want to be heard, not saved.

In TEAM we do Paradoxical Agenda Setting before trying to \\u201chelp.\\u201d We emphasize, in a respectful way, all the really GOOD reasons NOT to change. We also highlight what the patient\\u2019s symptoms, such as shame, depression, panic, defectiveness, hopelessness and anger, show about him or her that\\u2019s positive and awesome, Then we raise the question: \\u201cGiven all those positives, why in the world would you want to change?\\u201d

This strategy has led to breakthroughs in treatment, and I now see recovery from depression and anxiety at rates I would have impossible ten or fifteen years ago.

3. Reverse Hypnosis.

1. Depressive hypnosis. The patient persuades the therapist that s/he really is worthless, inferior, and hopeless, and the therapist false into a trance and believes it! This dooms the therapy.
2. Anxiety hypnosis. The patient persuades the therapist that s/he is to fragile to use exposure, or that the exposure is too dangerous, and the therapist buys right into it! This also dooms the therapy. Recovery from anxiety is more or less impossible without exposure.
3. Relationship hypnosis. The patient persuades the therapist that s/he is the victim of some other person\\u2019s bad behavior, and that the other person is entirely to blame for the relationship conflict. Therapists almost always buy this message, and this also dooms the therapy.

4, Believing therapy must be slow and last a long time. This is taught in most graduate school programs, and tends to function as a self-fulfilling prophecy. I met a famous psychoanalyst who was proud that most of her patients had been in therapy for more than ten years, and a few were just now making baby steps, she said, toward change.

With TEAM, I usually see a complete elimination of symptoms at the first therapy session, although it has to be a double session (two hours). In addition, the recover usually occurs in a burst, all at once, in just a few seconds, or in several sudden orbital leaps during the session.

5. Believing that the purpose of therapy is to get in touch with your feelings (Emotional Reasoning). This message has been pushed for years, and was the basis of my training. The idea was that people bottle up their feelings, like anger, and then it comes out as depression. The message is still pushed today!

I\\u2019ve never seen much validity in this point of view. People can express their anger, their panic, and their feelings of worthlessness until the cows come home, but they\\u2019ll still be just as angry, panicky, and they\\u2019ll still feel worthless!

There is at least one notable exception to this rule. Most anxious patients are exceptionally \\u201cnice\\u201d and sweep their feelings under the table. Then the feelings come out indirectly, as OCD, panic attacks, GAD, or a phobia, or even as somatic complaints such as chronic pain, fatigue, or dizziness. Bringing the suppressed feelings to conscious awareness and expressing them is the basis of my Hidden Emotion Technique, and it often leads to a sudden and complete recovery from any form of anxiety.

6. Confusing your own feelings for how the patient feels. This is a psychoanalytic error. I read an article on the psychoanalytic view of empathy, which was defined as the analyst\\u2019s feelings when in the presence of the patient. This is a misguided and almost delusional notion. The analyst\\u2019s feelings are the complete creation of the analyst\\u2019s thoughts! And those thoughts will often be distorted and completely misleading.

Therapist\\u2019s perceptions of how their patients feel are less than 10% accurate if you put it to an empirical test! If you ask patients, \\u201cHow are you feeling right now,\\u201d and you ask therapists the exact same question, \\u201cHow is your patient feeling right now,\\u201d the therapist\\u2019s answer will usually be way off base.

The only way to find out is to use assessment instruments at the start and end of each session, like I described in the first answer above, on failure to measure.

7. Believing therapists should never express their feelings. I was trained never to reveal how I was feeling. But when you think about, that\\u2019s nutty! How can we validly encourage our patients to be more genuine and open with their feelings if we are hiding our own at the same time? Of course, there is an art form in how to share your feelings during therapy. It is a high skill, requiring training, and one that can lead to more human and effective treatment.

8. Believing that you are an expert and know the causes of things, and why patients think, feel, or behave as they do. The causes of all psychiatric disorders are unknown. End of discussion. And yet, almost all therapists promote some fraudulent theory about causality. For example, what is the cause of depression?

There are lots of theories, but none has been confirmed, and almost all have been disproven. For example, there is no evidence whatsoever that depression results from a \\u201cchemical imbalance in the brain,\\u201d or from \\u201canger turned inward,\\u201d and so forth. Those are just theories that someone made up.

I simply tell my patients that we don\\u2019t yet know the causes, but have really terrific treatment tools now for rapid recovery. That\\u2019s more than enough for the people I treat!

9. Confusing the process of therapy with a good outcome. For example, as a therapist, you could be doing really great job of listening, and give yourself high marks as a therapist because you believe in the importance of empathy, even though your patient is not improving.

Therapists have all kinds of things they\\u2019ve been trained to do, like hypnosis, or EMDR, or cognitive therapy, exposure therapy, or meditation, or an exploration of childhood traumas, or whatever it is you do and believe in. But if you\\u2019re not seeing rapid and dramatic recovery in your depressed and anxious patients, as documented with session by session testing, you\\u2019re not really \\u201chelping.\\u201d

10. Believing that insight will lead to change. This has only happened once in my career! It was a woman who discovered that she thought she always had to be submissive servant in intimate relationships. Not surprisingly, she always felt burned out and broke up with her partners after a while. She said that the discovery of this pattern when we did the Interpersonal Downward Arrow Technique during our first and only session transformed her life.

But usually, much more will be required. That\\u2019s why I have developed 50 methods to help patients change the way they think, feel, and behave. Correction\\u2014I have recently developed 51 additional powerful techniques, so now we have 101 ways to untwist your thinking so you can enjoy greater happiness, intimacy, and productivity!

Now, here\'s the 60 thousand dollar question. Can therapists learn to stop making these errors? In most cases, the answer is NO! It\'s not so much a problem with intelligence or aptitude, although those are important factors, but it has to do with motivation. Many therapists simply do not want to change, and are committed to what they\'re already doing, in much the same way that people are committed to their religious beliefs, which they are unwilling to challenge.

That\'s why it is so much easier to train young therapists, whose minds are still open, as well as lay people who do not have so much prior "training" they have to overcome.

Well, that\'s my cynical side coming out, and I apologize! Still, I think I\'m right for the most part.

Hey, if you liked my rant, I have at least five more common therapeutic errors on my list, so let Fabrice and me know if you\'d like to hear about therapist errors in a future podcast. In addition, if you\'d like to add to our list of therapist errors, let us know what your "favorite" (or most annoying) therapist error is!

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