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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by pegasus on June 17, 2011, at 10:14:52
I had an interesting discussion with my T this week. We were talking about the power imbalance between the therapist and the client, and how it is an obstacle for me when trying to trust him. I've heard stories about Ts suddenly dumping their clients for various reasons, and with various rules around future contact - always decided upon by the T. And I've actually experienced a T moving away without much warning, due to a family crisis. Of course, I was devastated. You just never know when/how that type of thing might happen.
He tried to say that he doesn't see our relationship that way (i.e., with him having so much more power). So, I called b*llsh*t, and asked him who decides where we meet and how long sessions are? Who decides how much I pay? Who decides how many times per week I can come in? Who would be devastated if the other one suddenly quit? Who would decide whether/how we had any contact after that?
He got it, I think. So, then I said that I would feel like I had more control if, instead of him always telling me how *he* handles these things, we could discuss them and decide together how *we* will handle these things. Surprisingly he said he was open to it!
I didn't expect that! Wow, I think this might help things feel a lot more safe.
Is there a reason that we don't experience this more often in therapy? Working together to set policies on a per client basis seems like such an obvious way to foster a therapeutic relationship.
- P
Posted by Dinah on June 17, 2011, at 21:45:51
In reply to cooperative policy setting in therapy, posted by pegasus on June 17, 2011, at 10:14:52
I think that could be a good idea. Did he give any idea of which things would be open for cooperative decision making? What things would you like to fall into this category?
My therapist tried to point out all the power that the client has, but it seems to mainly boil down to whether or not we quit. On the other hand, he does make an effort to work things out with me.
Posted by Daisym on June 18, 2011, at 0:43:57
In reply to Re: cooperative policy setting in therapy » pegasus, posted by Dinah on June 17, 2011, at 21:45:51
I'll be interested to hear more about this too. I'm of the opinion that the basic structure of therapy is indeed controlled by the therapist - for obvious practical reasons. Just like in my business, I have to know how many billable hours we must have in order to cover our costs and we also have liabiity issues to think about. Not to mention best practice guidelines.
That said, it does make sense that things that can be negotiated, are. Number of sessions per week, contact between sessions, etc.
And I suppose we need to look at it from the Therapist's viewpoint if we really want to see our power. We decide whether to show up or not - we decided how honest to be and we decide whether to find the therapist useful or follow through, etc. We can be difficult during sessions or we can be pleasant or somewhere in between.
But there is no question that there is a power imbalance, just like in most services. Otherwise, you would just be talking to a friend, more or less.
Posted by Dinah on June 18, 2011, at 8:51:29
In reply to Re: cooperative policy setting in therapy, posted by Daisym on June 18, 2011, at 0:43:57
When you think about it, many relationships are unbalanced in power. Unless both parties care equally about the relationship, one will always have a significant power advantage. We're always going to care more about the "relationship". Or at least we probably *should*.
In therapy, with a few exceptions like termination, I think the power differential works in favor of the client as long as the therapist has integrity. I think the biggest part of the problem in my therapy came from a narrowing of the power differential and too flexible boundaries. I don't think he felt the proper pressure to be professional, and I sometimes felt like the parent in the room.
Posted by Dinah on June 18, 2011, at 8:53:56
In reply to Re: cooperative policy setting in therapy, posted by Dinah on June 18, 2011, at 8:51:29
But as Daisy said, many things can be decided in a cooperative way. When and where to work certainly. And, I think, termination ought to top that list. Clients could get a lot more done if they didn't have to obsess about the big T word.
Posted by emmanuel98 on June 19, 2011, at 21:15:18
In reply to Re: cooperative policy setting in therapy, posted by Dinah on June 18, 2011, at 8:53:56
My p-doc (also my primary T for five years) and I have talked a lot about the power he has. As he put it, I need him more that he needs me. I feel dependent on him and he does not feel dependent on me. But we have also talked about what our "contract" is -- as in how often we meet, etc. When I have worried about him abruptly cutting back or something, he reminds me that we have always made these decisions collaboratively, never unilaterally.
On the other hand, he is 72 years old and says things like, I can see you as long as you feel the need to see me, unless external factors interfere (he could get sick, decide to retire). I feel upset when he says that. He is not going to practice forever. If he gets sick, I won't get to help take care of him, but will be cut out of his life. I love him and he does not love me. He is central to my life and I am not central to his life. So, by definition, he holds power over me.
Posted by pegasus on June 20, 2011, at 8:23:14
In reply to Re: cooperative policy setting in therapy, posted by emmanuel98 on June 19, 2011, at 21:15:18
For me, the biggest issue in the power differential is about termination. My experience with Ts is that they get to make all of the decisions about what happens after that (and even when/how the termination happens - in at least one case). Including whether I get to communicate at all with them. Knowing that is making it very hard for me to allow myself to connect deeply with my current T. It just feels like too big of a risk.
I understand that it's best for him to choose his own office, and what hours he's available and his fees, etc. I have no issue with that.
I do like the idea of agreeing together about contact between sessions, though. Although that has not been much of an issue with my current T. Except that I don't like how he presents it as a done deal that he's totally figured out already. So, we might have a chat about that.
I'm meeting him tomorrow, so I'll let you know what we agree to cooperatively decide.
- p
Posted by pegasus on June 22, 2011, at 8:13:01
In reply to cooperative policy setting in therapy, posted by pegasus on June 17, 2011, at 10:14:52
Well, my T claims that he *always* works out what happens after termination on a case-by-case basis in a cooperative way. He told me a few stories about ex-clients who had different needs and handle it in different ways. They were reassuring stories.
We talked a bit about the hard boundaries, too. Apparently, the only really hard boundary, in terms of what we can talk about, is that he's not willing to talk about the intimate aspects of his relationship with his wife. Fair enough.
He actually did 90% of the talking yesterday. Which was, I think, what I needed. And him too. I had previously not wanted him to tell me stories about how his relationships with other clients, but I think it will be helpful for me to have heard this stuff.
- P
Posted by Dinah on June 22, 2011, at 13:11:46
In reply to follow up, posted by pegasus on June 22, 2011, at 8:13:01
Posted by lucielu2 on June 22, 2011, at 16:36:01
In reply to cooperative policy setting in therapy, posted by pegasus on June 17, 2011, at 10:14:52
When I covered this ground with my T, he did not deny his power in the relationship. However, he helped me to see mine. He pointed out the vulnerability of being a T. Namely, after investing a tremendous amount of time, energy and one's self in a client, that client could just walk away and never look back. He/she could ignore everything that was worked through together with the T. He implied that such occurrences can be traumatic for a T. It's a two-way street. We need each other.
L.
Posted by Dinah on June 22, 2011, at 20:01:16
In reply to Re: cooperative policy setting in therapy, posted by lucielu2 on June 22, 2011, at 16:36:01
Good to see you.
Posted by lucielu2 on June 22, 2011, at 20:20:13
In reply to Hi!!! » lucielu2, posted by Dinah on June 22, 2011, at 20:01:16
Same here :-) Missed you. It's been a while.
Lucie
Posted by emmanuel98 on June 22, 2011, at 20:51:59
In reply to Re: cooperative policy setting in therapy, posted by lucielu2 on June 22, 2011, at 16:36:01
I don't think it's a two-way street really. Yes, they care about you and worry about you if you terminate abruptly. They have feelings. But they have to learn to contain their feelings or they would be too vulnerable. I have come close to suicide on three occasions and I know my p-doc cares and worries. He calls my husband and daughter, calls me, tells me to go to the ER. He cares. But if I suicided, he would move on. My husband and daughter, on the other hand, would be devastated. That thought and that thought alone has kept me alive.
Posted by lucielu2 on June 22, 2011, at 21:29:18
In reply to Re: cooperative policy setting in therapy, posted by emmanuel98 on June 22, 2011, at 20:51:59
That is true of most people in my life - if anything happened to me they would feel sad, grieve, but eventually they would have to move on. I put my T in this same category. But you're right, my family is at a different level. They are the most important thing in my life. But it doesn't take away from my other relationships where there are real bonds.
Posted by pegasus on June 23, 2011, at 8:27:25
In reply to Re: cooperative policy setting in therapy, posted by lucielu2 on June 22, 2011, at 16:36:01
It didn't feel like a 2-way street when my ex-T suddenly moved away, and then eventually stopped responding to my emails with no explanation. That felt like he was in control, and I had zero say in what happened.
Sure, I could have done the same thing to him. But he wouldn't have suffered one tenth as much as I did. He had/has a lot more power than me, any way you slice it.
- P
Posted by lucielu2 on June 23, 2011, at 16:51:19
In reply to Re: cooperative policy setting in therapy, posted by pegasus on June 23, 2011, at 8:27:25
Peg,
Point taken. What your T did was really horrible. He abused his power and betrayed your relationship. I'm so sorry you had to go through that.
Lucie
Posted by lucielu2 on June 23, 2011, at 17:51:05
In reply to Re: cooperative policy setting in therapy, posted by lucielu2 on June 23, 2011, at 16:51:19
On a positive note, it sounds like your new T is willing to explore this territory with you. That is a good development.
Posted by Daisym on June 24, 2011, at 13:38:11
In reply to Re: cooperative policy setting in therapy » lucielu2, posted by lucielu2 on June 23, 2011, at 17:51:05
Interesting discussion.
My therapist often reminds me that all relationships are at risk of ending abruptly - loving someone means risking being hurt by them. But that love is worth the risk - usually, at least. He often uses his best friend as an example - his friend died a few years ago. And he misses him and it hurts. But he says it was worth it.
We actually have very little control of most things in life. Which is very disconcerting to me to ponder.
The point is to know that while we might not have control, we do have choices. We must be willing to say what we need and negotiate with another to get it. And then to decide where our own lines in the sand are. In therapy, it would be wise to do this early - before the emotional investment is too high. We can get a sense of who this person is and how they are likely to make decisions. Which is why the conversations you are having around this seem so important.
Which sounds reasonable and sort of easy from a grown-up to grown-up place. But in therapy, there are periods of regression in which we feel even more powerless - like a young child. I think it is then up to the therapist to really hold all the pieces and stay aware that their decisions can have devastating effects. Which goes back to making sure that person we've chosen to invest our trust in is worth the risk. And, as some here know all too well, people change. Lives change. People move, die, get divorced, get old, etc. Life is not excluded as part of the therapy relationship. We just wish it could be.
Posted by lucielu2 on June 26, 2011, at 14:36:21
In reply to Re: cooperative policy setting in therapy, posted by Daisym on June 24, 2011, at 13:38:11
Good post. One of the concepts I've always struggled with is the idea that people will come and go in your life. That someone who is very important to me now may no longer be so at a later point in my life at some point, for one reason or another. I can accept the idea of people walking with us for some of the way on our journey. It makes it all the more important to find people you can trust and, as you said, negotiate together that part of your life that you share. I think I have paid my T's kid's college tuition grappling with these ideas - power, trust, and the lastingness of relationships.
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