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ASK DR. LEEDOM: What about therapy?

A reader wrote in with the following:

I have a question for you related to the sociopath and the therapeutic relationship, and how to regain trust in the therapeutic process when it appears to have failed you during the relationship.

I have been in therapy with a therapist I trust and have bonded with for more than two years, as well as in group therapy, most of which was also parallel to the duration of my marriage to a sociopath. For a short period of time, the sociopath was in therapy with me in order to try work out the issues in our marriage.

I am currently struggling to regain my trust in therapy, when I view it as having eroded the very instincts that were telling me to get out of the relationship and away from the sociopath by teaching me how to work on “my issues” in the relationship, to be more understanding, less demanding, less needy, etc.

I do not blame therapy for my getting into or even staying in the relationship (as obviously no one could have known he was a sociopath if even I didn’t), but I’m having trouble continuing to recognize its value when I feel like it was a primary force in suppressing the red flags that were popping up everywhere screaming for me to leave him, because it had me focusing on “my issues” and how my past was influencing me to assume negative traits in him that were perhaps more tied to “my parents” or “family of origin” or to his natural family of origin issues.

I have tried to bring these issues and concerns up in my therapy, and am told that there is no way that anyone could have known, and that my rage needs to be directed towards the sociopath only.

But my point isn’t really rage or anger at her or the group for not seeing the truth, but really just in how to learn to value the process again, when in at least one case, it was reinforcing the same mind games he was playing with me.

I hope I’m being clear here and that this makes sense. I do honestly value and understand the necessity of therapy and would like to regain this trust, but am increasingly confused by how to do so given the doubts this situation has raised.

I would love some guidance or thoughts on this, or just to know if anyone else has experienced it and how they’ve coped.

Dr. Leedom answers

Thank you for taking the time to share your story and this important question. I have some very strong opinions about therapy and so forewarn you ahead of time.

First, I believe that anything offered by professionals, that is supposed to treat an illness, should have proven efficacy. In this regard, I hold psychotherapy to the same standard as I would medication. Psychotherapy should have proven benefits or it should not be sold. Sometimes people would opt to take a medication that does not have proven benefit because they feel good doing so. In that case, a doctor can tell the patient, “Here try this, it is not proven and may have side effects, but you might feel better.” In the same vein, if a therapist uses techniques that are unproven, he/she should be required to say, “This therapy may make you feel good but there is no scientific evidence that it works.”

Psychotherapy with proven benefit?

The above comment out of the way, there are psychotherapies with proven benefits. Therapy that works has goals and is of brief duration. If you are in therapy, work with your therapist to develop very specific goals. Wanting to feel better is NOT a specific goal. Specific goals often surround the symptoms of disorders. For depression, goals would be to improve sleep patterns, increase activities like self care and house work, and to decrease the dysfunctional thoughts that go along with the depression. Another goal for therapy could be to begin and maintain a satisfying friendship.

In regard to an intimate relationship, the goals of the therapy should also be articulated. The goal should be to increase loving behavior and to decrease negative behavior. If there is ongoing physical abuse, couples therapy is not considered acceptable. If there is psychological abuse, it has to stop before therapy can begin.

In general, therapists should not give advice. Then they are not responsible if someone stays in a relationship with a sociopath. That being said, having a vision for a functional relationship and a goal to attain function within 4 or 5 sessions should weed out sociopaths. Similarly, substance abuse has to stop before “therapy” can begin.

There are two specific therapies with proven efficacy CBT and DBT. DBT is a type of CBT.

What is CBT?

Cognitive-Behavior Therapy is devoted to the relief of human suffering using methods that have been shown to work. The latest in scientific advances are used to design personalized treatments in a culturally sensitive manner. In CBT the therapist and client work together to determine the goals for therapy, the agenda for each session, home practice between sessions, the usefulness of each intervention, and how long to continue therapy. In CBT the client does the work! The therapist is a facilitator.

What is DBT?

Dialectical Behavior Therapy (DBT) is a comprehensive treatment specifically developed for individuals with impulsive and self-harm behaviors. These behaviors can include binge eating, destructive relationships, self-cutting, frequent suicidal thoughts, urges, or attempts, and other self-destructive tendencies. Many individuals with these behavior patterns also meet criteria for personality disorders.

DBT combines cognitive behavioral therapy (CBT) strategies with Eastern mindfulness (Zen) practices and involves both individual therapy and group skills training. Clinical research has consistently found DBT to be effective in reducing self-destructive behavior patterns and in optimizing ability to cope more effectively.

Some links:

Guidelines for choosing a CBT therapist.

Is DBT for you?

DBT Psychotherapy Network.

If you are in long term therapy and feel supported, and the therapy makes you feel good, don’t leave because of these recommendations. I have written this post for people who are questioning the therapy they are receiving. Most importantly, the joke about the light bulb is no joke. How does a psychotherapist change a light bulb? First it has to want to change.



46 Comments on "ASK DR. LEEDOM: What about therapy?"

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  1. W8ing4change says:

    Thank you MiLo.
    I too have considered this as a possible explanation.
    The other thing I should mention is my long concern about this little girl.
    First of all, she isn’t my bio child. I met her when she was 22 months old, and have been her father since. I knew when she was only two there was something wrong. The way she acted was unusual, and she had a very difficult time learning. She started talking at a young age, but struggles with alot of things especially recognizing symbols. Numbers, letters… She also has very low attention span. Many other things. In short, I faught with her mother for yearsto get her evaluated and to find out what we could do to help. Her mother always refused, and would be furious with me for even mentioning it. Eventually the school intervened and suggested she get some extra help. I though maybe she suffered with ADHD, but that alone didn’t write explain what I was seeing. Until recently, when I finally figured out her mom is likely a sociopath. Suddenly, it made sense. I’ve observed this little girl being downright mean to other children. She has tried to kill her little brother several times. The first when he was just a baby. She pushed him over a twelve foot flight of stairs. Shoving him hard enough that the first step he even touched was about eight feet down. She nearly killed one of her classmate in a similar incident. She is very sadistic. She never shows any remorse for her actions. She has no empathy whatsoever. I mean absolutely none. She started stealing when she was only four. She lies constantly, she always plays the victim, and always instigates. She CANNOT and WILL NOT take responsibility for anything she does. She is just like her mom but worse. It doesn’t help that her mom is validating her behavior. And even teaching her the behavior. It’s phoque ing SICK!!! So yes. This girl needs alot of love and attention. Now that I have joint custody of her, I’m also going to try to get her some therapy.
    It’s pretty scary what she may do to her brother and sister. Especially her brother. He’s the scapegoat. She at least says she loves her sister but has told me she hates her brother for “ruining her life”. I asked her what he did to ruin her life, and the best answer she could come up with was “being born”. I feel much pain for this little girl, and really hope I can help her.

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