I had been wondering how people who are in therapy can trust their therapist. People who've rarely, if ever, had anyone prove to them they were worthy of trust. They are in therapy because they have issues trusting others, so how do they become comfortable, trusting, enough of the therapist to achieve their goals?
I asked Dr. Jean Mercer at CHILDMYTHS about this and she kindly agreed to share her thoughts here with me so that I could share them with you.
How can you, or why should you, trust a psychotherapist? I know many people wonder about this, and although I can’t completely answer the questions, I want to make a few comments. Before I do that, though, I need to say that I don’t speak as a therapist. I’m not trained or licensed as a therapist. I do have a doctorate in psychology, so I’ve studied a lot of material connected to psychotherapy; I’ve been in therapy myself; I was trained and worked dealing with telephone calls at a suicide prevention center; and I led therapy groups under the supervision of a licensed therapists. So, I speak as somebody with some experience of the field, but as it’s not a main part of my professional life, I don’t speak of therapy as a person would who is deeply identified with that kind of work.
I understand the real confusion between the therapist as a professional helping person and the therapist as a possible friend. When we tell therapists our deep feelings, we can’t help being reminded of the way we’ve done this, or wanted to do it, with friends, and it can feel very strange when the process doesn’t go the way it would with a friend.
When we tell a friend our secrets or feelings, he or she normally responds in some predictable ways. If we cry, the friend might cry too, or at least look sad. If we tell what someone else has done to us, the friend will usually speak up and say that we were in the right, our attacker in the wrong. And often a friend will respond to our problem by disclosing something similar, or at least equally secret and disturbing, in his or her own life. All those things are comforting and make us feel as if we have been heard and can trust this friend-- trust him or her to empathize, to take our side, and to share secrets with us.
Friends also sometimes do things that are predictable but not necessarily what we want. A friend may be embarrassed or annoyed by our emotion and try to change the subject. A friend may accuse us of making up part of the story, or state that until he or she hears both sides of a conflict, there will be no deciding who’s right. A friend may say “that’s nothing, listen to what happened to me!”. Those things are not comforting, and we may decide that while we can trust that person to do just what they feel like doing, we can’t trust them sometimes to give our needs first priority.
Talking to a therapist can feel very confusing because the therapist’s responses are pretty predictable, but they don’t follow either of those friend patterns. Well-trained therapists have learned that they need to empathize enough to know what you feel like, but that they should not become so “enmeshed” that your feelings seem like their own. If the therapist was that engaged, he or she could not think rationally or objectively about what’s going on with you and what approach should help you most. In the same way, if you’re talking about a conflict with another person, the therapist may want you to get better at understanding the other person’s perspective, so he or she is not going to tell you that you’re right and that’s all there is to it.
And the therapist is not going to try to win your trust by disclosing inappropriate matters from his or her own life. Therapists have been carefully trained to avoid telling personal secrets, and know very well that the whole point of therapy is to concentrate on what is happening with you, not to talk about their own lives, unless their stories can make a point that will really be helpful to you.
In all those ways, therapists are not supposed to act like friends, even friends who are being comforting. And of course they are not supposed to tell you off for what you say, or to insist on telling their own story to you, so they are also not to act like the kind of friend who does a poor job of listening.
There are also a number of things therapists are not supposed to do and can get into a lot of trouble for doing, even though there’s nothing to stop a friend from these actions. For example, if a therapist thinks you’re pretty attractive, he or she is not supposed to ask you out. If you live in the same neighborhood, the therapist is not supposed to ask you for a ride home if their car breaks down, or to take care of their cat while they travel. Above all, the therapist is supposed to keep everything you say, and the therapist’s opinions about you, perfectly confidential-- not to tell anyone or leave your file lying around where others can see it.
When you pay for therapy, part of what you’re paying for is a guarantee that your therapist will not take advantage of your emotional distress to behave in ways that exploit you. Another thing you’re paying for is that complete confidentiality which is so important. If the matters you disclose to the therapist were spread around, you could possibly lose your job, your spouse, or your children. When you disclose your concerns and history to your friend, you assume they won’t tell-- but people who have not been trained in confidentiality can let things slip quite unintentionally and cause catastrophes that they regret deeply but can’t repair.
Finally, when you pay for therapy, you’re paying for the fact that your therapist has a better understanding of how people usually feel and behave than your friends usually will. You go to the dentist rather than your friend, because the dentist has studied what teeth are like and how they should be treated. Similarly, good therapists have studied both common and unusual ways people feel and act, and how to tell the difference between sadness over a problem and serious depression, or between poor social skills and schizophrenia. In addition, where your friend might say “this is awful, but I don’t know how to begin helping you”, the therapist has studied ways to talk to you and to encourage you to talk, and can consult with medical colleagues if medication may help you. Therapists also have been trained to understand how uncomfortable it may be for you to do the work of therapy and how much you may want to quit at times.
Naturally, I don’t mean to say that all therapists do good jobs, or that every therapist works equally well with every patient, or that no therapist ever makes mistakes or even surprising ethical errors. But I do mean to say therapists play different roles in our lives than friends do, and their training allows them to do jobs for us which our friends can’t do-- jobs they deserve to be paid for, and which they could not afford to do without being paid.
When people say they don’t trust their therapists, it’s possible that they should go to different therapists. But it’s also possible that they should ask themselves, “trust the therapist … to do what?” To keep our secrets in confidence? To know how our problems can best be helped? To persuade us to keep working when we feel like giving up? If any of those points are of concern, certainly a client should make sure before going on with that therapist, and in fact should talk to the therapist about the concerns. But if the question is, “can I trust the therapist to do what a friend does?”, the answer should be “no”. Therapists should not do what friends do, and if they did, this would be clear evidence that we should not trust them.
Jean Mercer
11/21/10
I asked Dr. Jean Mercer at CHILDMYTHS about this and she kindly agreed to share her thoughts here with me so that I could share them with you.
How can you, or why should you, trust a psychotherapist? I know many people wonder about this, and although I can’t completely answer the questions, I want to make a few comments. Before I do that, though, I need to say that I don’t speak as a therapist. I’m not trained or licensed as a therapist. I do have a doctorate in psychology, so I’ve studied a lot of material connected to psychotherapy; I’ve been in therapy myself; I was trained and worked dealing with telephone calls at a suicide prevention center; and I led therapy groups under the supervision of a licensed therapists. So, I speak as somebody with some experience of the field, but as it’s not a main part of my professional life, I don’t speak of therapy as a person would who is deeply identified with that kind of work.
I understand the real confusion between the therapist as a professional helping person and the therapist as a possible friend. When we tell therapists our deep feelings, we can’t help being reminded of the way we’ve done this, or wanted to do it, with friends, and it can feel very strange when the process doesn’t go the way it would with a friend.
When we tell a friend our secrets or feelings, he or she normally responds in some predictable ways. If we cry, the friend might cry too, or at least look sad. If we tell what someone else has done to us, the friend will usually speak up and say that we were in the right, our attacker in the wrong. And often a friend will respond to our problem by disclosing something similar, or at least equally secret and disturbing, in his or her own life. All those things are comforting and make us feel as if we have been heard and can trust this friend-- trust him or her to empathize, to take our side, and to share secrets with us.
Friends also sometimes do things that are predictable but not necessarily what we want. A friend may be embarrassed or annoyed by our emotion and try to change the subject. A friend may accuse us of making up part of the story, or state that until he or she hears both sides of a conflict, there will be no deciding who’s right. A friend may say “that’s nothing, listen to what happened to me!”. Those things are not comforting, and we may decide that while we can trust that person to do just what they feel like doing, we can’t trust them sometimes to give our needs first priority.
Talking to a therapist can feel very confusing because the therapist’s responses are pretty predictable, but they don’t follow either of those friend patterns. Well-trained therapists have learned that they need to empathize enough to know what you feel like, but that they should not become so “enmeshed” that your feelings seem like their own. If the therapist was that engaged, he or she could not think rationally or objectively about what’s going on with you and what approach should help you most. In the same way, if you’re talking about a conflict with another person, the therapist may want you to get better at understanding the other person’s perspective, so he or she is not going to tell you that you’re right and that’s all there is to it.
And the therapist is not going to try to win your trust by disclosing inappropriate matters from his or her own life. Therapists have been carefully trained to avoid telling personal secrets, and know very well that the whole point of therapy is to concentrate on what is happening with you, not to talk about their own lives, unless their stories can make a point that will really be helpful to you.
In all those ways, therapists are not supposed to act like friends, even friends who are being comforting. And of course they are not supposed to tell you off for what you say, or to insist on telling their own story to you, so they are also not to act like the kind of friend who does a poor job of listening.
There are also a number of things therapists are not supposed to do and can get into a lot of trouble for doing, even though there’s nothing to stop a friend from these actions. For example, if a therapist thinks you’re pretty attractive, he or she is not supposed to ask you out. If you live in the same neighborhood, the therapist is not supposed to ask you for a ride home if their car breaks down, or to take care of their cat while they travel. Above all, the therapist is supposed to keep everything you say, and the therapist’s opinions about you, perfectly confidential-- not to tell anyone or leave your file lying around where others can see it.
When you pay for therapy, part of what you’re paying for is a guarantee that your therapist will not take advantage of your emotional distress to behave in ways that exploit you. Another thing you’re paying for is that complete confidentiality which is so important. If the matters you disclose to the therapist were spread around, you could possibly lose your job, your spouse, or your children. When you disclose your concerns and history to your friend, you assume they won’t tell-- but people who have not been trained in confidentiality can let things slip quite unintentionally and cause catastrophes that they regret deeply but can’t repair.
Finally, when you pay for therapy, you’re paying for the fact that your therapist has a better understanding of how people usually feel and behave than your friends usually will. You go to the dentist rather than your friend, because the dentist has studied what teeth are like and how they should be treated. Similarly, good therapists have studied both common and unusual ways people feel and act, and how to tell the difference between sadness over a problem and serious depression, or between poor social skills and schizophrenia. In addition, where your friend might say “this is awful, but I don’t know how to begin helping you”, the therapist has studied ways to talk to you and to encourage you to talk, and can consult with medical colleagues if medication may help you. Therapists also have been trained to understand how uncomfortable it may be for you to do the work of therapy and how much you may want to quit at times.
Naturally, I don’t mean to say that all therapists do good jobs, or that every therapist works equally well with every patient, or that no therapist ever makes mistakes or even surprising ethical errors. But I do mean to say therapists play different roles in our lives than friends do, and their training allows them to do jobs for us which our friends can’t do-- jobs they deserve to be paid for, and which they could not afford to do without being paid.
When people say they don’t trust their therapists, it’s possible that they should go to different therapists. But it’s also possible that they should ask themselves, “trust the therapist … to do what?” To keep our secrets in confidence? To know how our problems can best be helped? To persuade us to keep working when we feel like giving up? If any of those points are of concern, certainly a client should make sure before going on with that therapist, and in fact should talk to the therapist about the concerns. But if the question is, “can I trust the therapist to do what a friend does?”, the answer should be “no”. Therapists should not do what friends do, and if they did, this would be clear evidence that we should not trust them.
Jean Mercer
11/21/10
Great advice. I've watched and listened to friends struggle occasionally with their therapists and have also been in therapy myself. For me it was relatively short-term and very helpful for reasons mentioned: the therapist is like a mirror, holding up yourself to yourself so you can go, "Duh!"--not a personal friend who validates everything you say, empathizes totally, etc. Also, I've heard a few people complain when therapists are too passive. Most people do not want to sit and babble endlessly until something bubbles up from their insides. They seem to want the tools to manage specific situations and live more successfully.
ReplyDeleteI like her response, but I think it's a little unrealistic. Unrealistic is not the word I'm looking for at all, but I can't think of anything else at the moment. Therapy is not at all like going to the dentist, but for some reason that seems to be a popular analogy. The dentist deals with something pretty cut and dry. Your teeth are not that complex. If you have a toothache, you can have that tooth extracted and the ache will go away. You can't do that with your heart.
ReplyDeleteTherapists are people too with all the same complexities and contradictions that make up human beings. Training can change outward behaviors but it can't change thoughts and feelings.
I think I'm afraid of my therapist's thoughts and feelings about me and what I have to tell her. I'm afraid of judgment. I'm afraid of what she will think of me after learning things about me. I'm afraid she won't believe me. I'm afraid she doesn't like me or care about me. No--I'm not looking for a friend, but I need to feel cared about in order to open up. As much as people say that a therapist doesn't need to like or care about their client to treat them, I don't agree with that at all. I would not want to go to a therapist that didn't like me or care about me. No matter how good a therapist thinks they are at hiding their feelings, I think most clients would be able to sense when they are not liked or cared about. That's just a basic human need and exchanging money doesn't change that.
Thanks Campbell!
Dr. Mercer wrote, "When you pay for therapy, part of what you’re paying for is a guarantee that your therapist will not take advantage of your emotional distress to behave in ways that exploit you. "
ReplyDeleteAgreed. Sadly, in my case, I have had so many bad experiences with therapists that I have felt very exploited. When I speak my mind or correct a therapist about a fact or how I have felt hurt by something s/he said, they often take it personally and take it out on me. This is unprofessional. Or I have been told, "It's not adoption anxiety, just take assertiveness training." Or "I don't see why you care that your amom is threatened by your search for your nmom." Or "Your relationship with your newly found nbrother was like a one-night stand. Put it behind you and move on. It's not a big deal." Or calling me by my wrong name, over and over. Or saying in couples therapy to my husband, "Yes, I can see, vaginas are very scary. How frightening for you." Or "Try to get your nmom out of you." As if she were ever IN me! ARGH.
On the one hand, I think I've been exceedingly unlucky in the eight therapists I've seen in my life. They (at times) have validated my feelings, but more often, they've dismissed how I've felt or thrown their own issues on me. Why pay for that? I think I could probably find a good therapist, but it takes energy and courage to keep opening oneself up to people, and baring one's soul, only to be dismissed or lectured. And when I've politely said that I've been hurt by what they've said, three therapists have outright attacked me. Doesn't encourage me to trust and open up, now, does it?
I have come to the conclusion that therapy isn't for me right now. I do get more from my friends, who understand me and don't sugarcoat anything. They know the depths to which I have sunk, and they listen. They don't tell me what I want to hear. I am very fortunate in the friend department. And they're free. I am devastated that one dear friend who listened so well, BJ Lifton, has passed away. It is a great loss.
Talking about adoption with therapists has been one huge mindf*ck for me. When I pay a therapist to listen, that's what I want them to do: LISTEN. Not judge, not pat my head, not suggest that all I need is assertiveness training. My problems run WAY deeper than my inability to speak up and stand up for myself. I left my last therapist because I left each meeting feeling vaguely uncomfortable. He told me nothing I didn't already know, and sometimes condescended to me, "Don't push away your nfamily, now." How the hell can I push them away when they don't TALK to me? I told him about this numerous times, and he seemed to use a formula to treat me that didn't work at all. If he can't listen to me and change the space to what helps me, I am not about to continue paying him.
As I said elsewhere, I need a therapist who is way smarter than I am, with a literary bent, who is also very compassionate. Personally, if I had money, I'd see a psychiatrist who does psychotherapy, but I can't afford it.
Therapy is so personal. Jessica above writes that some people want someone to give them tools to manage situations. I, on the other hand, don't want to be "fixed." I just want a space to work out my demons that doesn't involve paying people to be annoyingly dense and/or dismissive.
Yes, this is a red button issue for me. Therapy has its place, but it is really dicey when a client feels a therapist isn't a good match and can do more harm than good. Therapists' encouragements to stick in there is often more about $$$ than the mental health of the client.
Just like in any profession, there are good and bad therapists. But the reason I would say you can trust a therapist is the fact that they are not allowed, legally or ethically, to discuss you with anyone else without your permission. They (unlike others) are there solely for YOU, with no other baggage to be brought in.
ReplyDeleteOk, so of course I'm thinking about this...
ReplyDeleteMaybe Campbell B means the answer is a little simplistic, if unrealistic is the wrong word.
I can see that with the teeth analogy until I think about actually going to the dentist. As I said in the last post, I am a procrastinator, and especially am for things I do NOT WANT TO DO, and the dentist is one of those. So...when I head in there I expect to be judged, and am, for waiting so long to go to the dentist. This makes me avoid it even longer, making the judging get even worse.
When I had to get the water people out to fix my leak (yayyy me I did it!) they came earlier than expected so I didn't have the basement as clean as I would have liked. I was embarrassed and of course ended up mentioning it to which the guys said, "you think this is messy?! HAH! it's nothing compared to what I've seen other places".
Maybe it's like this for therapists (and dentists)? WE think we're the worst or the weirdest or the least tidiest or whatever but to professionals, it's like doctors seeing us naked. You see one set of boobs, you've seen 'em all.
Cognitive Behavioral Therapy right now is considered one of the best ways to help people find better ways to help manage their feelings and emotions. My last therapist was super awesome.
ReplyDeleteLike Mercer said, not every person in the helping profession that may provide help and counselling is a licensed therapist. I think knowing their education level and what realm in which they practice is helpful in learning the moral context in which they have to work--like being familiar with their particular profession's code of ethics.
Not every client/therapist is a perfect match. I have had several I really liked and several who I didn't feel were clicking with me.
It can be really hard to share something and not feel like the therapist is judging you. When I was in therapy, I tried to keep in mind that they have lots of clients and see lots of problems every day. I wasn't the only one. I believed that my therapist also saw and evaluated the problems, not me as a person, and was not holding them against me as a person. I know when I worked in health care, I felt the same way. Stuff that patients/clients were super embarrassed about were things I saw a lot and I didn't judge them for it. They were sick and needed my help! :-)
While on the one hand, I want everyone to be paid for their contributions to society, I have a really hard time with the way we have compartmentalized people "with problems" and we assume that someone "with problems" needs to go to therapy.
ReplyDeleteReally, I have known many people who no longer really believe they should be their for a friend in an emotional crisis because that's a therapists job. There is nothing the same as finding people who are there for you because they care and not because of money.
There are certainly a lot of people who are just plain lonely and the only time they have friendship is with a therapist. This doesn't necessarily make me think therapists are bad, it just makes me think that it's awful sad that people with emotional issues and the highest need of human intamacy often have the highest amount of stigma and social avoidance attached to them.
I dislike that therapists tend to assume they have the answers. One example, alcoholics anonymous has incredibly low success rates compared to other programs. But therapists tend to think if a person doesn't find AA helpful and stops going it's because the client is bad.
And you can't go with "Oh well people need to improve themselves to live happy lives and base their axis of control on themselves."
The entire practice of therapy came about because we decided the status quo was not good enough and that some people can't make in on their own. Right? So therefore we created a system for offering support that is there to help. While no one can get anywhere if they aren't willing to fight to get there; that doesn't mean that if your program didn't help them it's their fault or that they "just weren't trying enough".
If people only have problems because they "aren't trying enough" the entire helping profession would exist for no reason because people should just try harder.
Therapists can't take the place of friendships, family, or chosen family, and therapy is not love or religion, that's for sure. I think the decision to go depends on how you see your own functioning and quality of life. The only yardstick that counts is your own, really. While not being successful in therapy should not be seen as a personal failure, perhaps it could be seen as a situation not yet resolved? I don't know. Sometimes it's time to fire the therapist; sometimes it's time to fire the people in your life! (Or at least shrink them, no pun intended.)
ReplyDeleteCampbell, sorry for the double identity--it all depends on what blogger will let in that morning.
Simplistic! Yes! That's what I meant.
ReplyDeleteVery fascinating post and comments! I love reading all the thoughtful responses!