By Steven Frankel, M.D.
The decision to work with a therapist is never straightforward, but there are times in life when we just need that extra emotional support. While we may have loved ones who will help us through rough times, it is often a good idea to seek the less biased support of a professional when dealing with life’s difficult emotional challenges.
Many people who go into therapy have good experiences. The patient feels understood and well supported by the therapist, who uses his skills to facilitate the patient’s discovery and healing process. But what if your therapy leaves you feeling frustrated? What if you believe your therapist isn’t “getting you”? What if you aren’t receiving the outcome you expected?
If your therapy isn’t going well, where does the responsibility lie? Is it with you? Or could it be the type of therapy you have selected or even the therapist? What is the best way to talk to your therapist about these issues?
It’s not uncommon in any therapist-patient relationship for the patient to expect that the doctor will be all-wise and all-knowing. Sometimes the patient assumes the therapist will take care of everything and that he or she, the patient, must simply follow doctor’s orders. It may seem easier to let the professional call the shots and make the decisions about treatment. As the patient you might feel reluctant to ask questions or voice concerns.
The problem with this perspective is that therapists are human beings, and therefore fallible. Therapy, by nature, is a subjective process, and the therapist can only give his own opinion, an opinion, which has been shaped by the therapist’s training and professional orientation, as well as his life experiences.
So, as the “consumer” in the therapy relationship, it’s ultimately your responsibility to look after your best interest and to be an active participant in your own therapy. If something isn’t working well for you, then it’s up to you to discuss it with your therapist.
In an ideal therapy situation, the process works because it is truly collaborative with patient and therapist working together in partnership. The patient participates with the therapist in determining the direction of the therapy and in making decisions about the course of treatment. The therapist is open to the patient’s ideas and concerns.
However, not all therapy alliances are ideal. Therapists are subject to their own biases. For example, the therapist may not be able to recognize when he is having a problematic reaction to the patient. To regain the kind of objectivity that will support the patient, the therapist may require direct feedback from the patient, or perhaps even the opinion of a third party: a therapist-consultant who is trusted by both. It may be worth noting that doing this is analogous to seeking a second opinion in medicine.
When you feel your therapy is off-course, the first step is to candidly discuss your concerns with your therapist. As difficult as this might feel, remember that your therapist is not a mind reader, and he or she won’t be able to fix the situation if you aren’t sharing your concerns. In fact, a good therapist should welcome this kind of input. Provided the therapist is open, you should be able to renegotiate the ground rules of your therapy, and the therapist should be willing to be flexible about modifying his or her approach.
Of course, direct feedback goes both ways and the patient must also be receptive to getting difficult commentary from the therapist. The patient may be reluctant to accept the therapist’s diagnostic assessments or recommendations for treatment. For instance, this kind of impasse may arise when the therapist recommends medication in addition to psychotherapy but the patient is resistant to the idea of taking medicine.
Whether it’s the therapist or the patient who is not being open to feedback, what can and should the patient do? Walking away won’t necessarily solve the problem, because it either leaves the patient to start over with a new therapist or with no therapeutic support whatsoever. In either case, it will take the patient that much longer to reach her objectives. A better approach would be for the patient to first discuss the options with the therapist.
If the therapist stands by his or her recommendations and the patient still does not agree, there is another solution short of the patient leaving therapy. The therapy pair could decide to invite another therapist to temporarily join in their work as a consultant. It may even be useful to choose a consultant who can administer psychological or neuropsychological tests. The consultant would work collaboratively with both the therapist and the patient to develop a more reliable view of the best course for the patient’s therapy, allowing them to move beyond the communication stalemate to a direction that they can endorse. The consultant would then remove himself and the therapy pair would go back to “business as usual”.
If you are in therapy, you and your therapist have already invested a significant amount of time and energy into your work, and you both have the same goal in mind: helping you achieve your own objectives for emotional growth and healing. If and when a difference of opinion over the treatment does occur, rather than walking away from your therapist, it is usually well worth the effort try to find a collaborative way to again go forward.
Steven Frankel M.D., a Distinguished Fellow of the American Psychiatric Association, is a graduate of Yale University Medical School. He is certified by the American Board of Psychiatry and Neurology in both general and child psychiatry as well as by the American Psychoanalytic Association. He is an Associate Clinical Professor at the University of California Medical School. He is the founder and director of The Center for Collaborative Psychology and Psychiatry in Kentfield, CA. His ideas are developed in his many professional papers and three books, Intricate Engagements, Hidden Faults, and his latest work: Making Psychotherapy Work: Collaborating Effectively with Your Patient. To learn more about Dr. Frankel and collaborative psychology in http://www.collaborativepsychology.com/