“How can I provide a relationship which this person may use for his own personal growth?”
― Carl R. Rogers, psychologist
|Lincoln Stoller, PhD, 2021. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International license (CC BY-NC-ND 4.0)
What Therapists Do
This question is simple to ask but complicated to answer. It would be simpler to ask, “When to leave your doctor,” but a counselor or therapist is not so easily appraised.
If your doctor is wrong, find another doctor, but a therapist cannot be expected to be right. In fact, one should expect a therapist to be more a source for ideas than answers. Should you leave a therapist because you don’t like their ideas? What does that mean?
I recently lost a couple who were my clients and I thought a lot about it. Then I read the article “Deciding when it’s time to end therapy” (Segarra et al., 2023), from National Public Radio, and thought about it more.
This NPR article explained that the therapeutic relationship was one of trust, understanding, and support. It advised a client to leave their therapist if any aspect of this triad failed. The idea seemed to be that progress depended on everyone working by the same means toward the same goals.
I found this disturbing. While trust is important, it’s more a statement of character than judgement. Your therapist should be trustworthy, but that does not mean that you should agree with them.
Understanding and support are also problematic. A doctor should understand a blood test, but how do you know if someone understands you? A person can be agreeable and compassionate without understanding you at all.
It’s pretty easy to make another person feel understood, and most therapists are well-trained in evoking this feeling. In my experience, this is largely a charade to establish a compliant attitude in the client. There is no measure of real understanding, only a measure of having an understanding presentation.
The idea that your therapist should be supportive is too vague. Should they support your attitude, strategy, or goals? If you’ve gone to therapy then, most likely, your attitude, strategy, or goals are more a source of your problems than a solution for them.
It might be safe to assert that a therapist should support you as a person, but in almost every case, people only feel personally supported when their attitudes, strategies, and goals are endorsed. That is, people take criticism personally. Should your therapist be uncritical?
The article sounded reasonable if you didn’t think about it. Who wouldn’t want to feel therapy encouraged them in every way? But with even the slightest second thought, the article was wrong.
The bar for quality writing in psychology is abysmally low. Most of what you read is trash, so one shouldn’t expect much. This article seemed unusually bad, so I checked the credentials of the authors. It turned out that none of them had any experience as therapists. They are a talk show host, a fashion model, and a current events columnist.
At one point, the article said, “therapy should feel like a coffee date with a friend.” That set off my fire alarm: if there is anything that a therapeutic relationship isn’t, it’s a relationship with a friend. A therapist helps you understand why your life is crashing and your judgement is fucked up.
If you want a friend, buy a dog. Dogs are great, but therapists are paid to say the things that no friend will ever say. The things that break the mold.
To set the record straight, a therapist should help your situation, and that’s the only thing you can ask of them. Most likely, your situation won’t be seen the same way from any two perspectives, so it might be better to say that your therapist can demonstrate that they’re introducing new feelings and thoughts that are pertinent to your goals.
The only reason for a therapist to be friendly is to make it easier for you to see yourself clearly. We typically freeze when threatened, so being threatening usually won’t open another person’s mind. However, there are exceptions, and my former clients were one of those.
“I believe that the therapist’s function should be to help people become free to be aware of and to experience their possibilities.”
— Rollo May, psychologist
Counseling a couple is speaking to five people, the real people behind each of the two, the two people they pretend to be, and the fictitious, collaborative pair usually presented as their goal. The first goal in couples counseling is to find and speak to the real people, but these two are usually well hidden in their respective bunkers of fantasy, isolation, and need.
Speaking to couples together is usually an exercise in meeting those who people pretend to be and their fantasy vision of their collaboration. This is important because these are the stories they’ve been telling themselves all their lives. They’re attached to these stories, and they phrase their problems in terms of them. However, they are more the source of their problems than resources for solutions.
I have found I can make more progress by speaking to each partner separately and asking them, in some way, “What is it about this problematic relationship that attracts you?” This sounds like I’m asking them what they want to achieve, but I’m really asking them what they want to avoid.
Consider three approaches to couples therapy: the high, middle, and low roads. The high road is to foster growth and health, and this differs for every person. The middle road is to nurse the relationship on a little further with palliatives and poultices that buy more time. The low road is to foster a sense of progress so that you can generate more sessions and make more money.
Couples like the low road, it makes them feel progress is being made. The middle road offers coping strategies aimed at achieving the fictitious, collaborative pair. The high road fosters real change, and this is what each person needs for their own growth, but it’s not part of their relationship script.
The high road takes each person on their own journey because this is where each person needs to go. A healthy relationship can only be established in a collaborative context and, sad to say, most relationships I see are not built on collaboration and most people are not willing to work to create it.
“I do not like to work with patients who are in love. Perhaps it is because of envy – I, too, crave enchantment. Perhaps it is because love and psychotherapy are fundamentally incompatible. The good therapist fights darkness and seeks illumination, while romantic love is sustained by mystery and crumbles upon inspection.”
— Irvin D. Yalom, psychologist
My Problem Couple
Bob and Alice have been married for a decade, and now Alice wants a divorce and Bob doesn’t. They have a few kids. Alice’s childhood was bad, and her mother was worse. Bob didn’t complain about much, and both said they loved each other.
When I asked each to explain themselves in the presence of the other, the other was disturbed and inattentive. Whenever I asked the two of them a question, Bob always answered, and whenever a decision needed to be made, Bob made it.
Alice’s reason was that she felt she was suffocating, she had to leave, but other than that she didn’t know why. Bob said she shouldn’t leave because everyone depended on her, especially him. Bob suggested that if she wanted a divorce, then she could have everything, and he would leave and never speak to her or the kids ever again.
I then saw each of them separately. Bob repeated his hard line: divorce was emotionally and financially out of the question and, if forced to split, he was going to cease to exist for the family.
Alice was emotional and at her wits end. She said that Bob’s demands alienated her and the kids. She didn’t know what to ask for, and she didn’t know how to make progress. Bob took any overture as a concession, and every olive branch as a surrender.
I told them that I was not working for either of their benefits, I was working for the benefit of their children. Their children were the canaries in the coal mine, and any solution that did not support them was not a good one. It surprised me that neither Bob nor Alice saw the welfare of their children as their primary obligation. Bob said he did, but it seemed the kids didn’t believe it, nor did I.
In our private consultations, I told Alice she needed to establish her boundaries. Her lack of boundary made it harder for Bob to recognize her needs. Granted, Bob was in no mood to really support Alice, but without any line in the sand, he was just going to keep dragging her toward the conclusion he wanted.
I told Bob that in spite of his pretense of generosity and support for Alice, he was neither generous nor supportive. His adamance of the financial necessity of staying together was probably untrue and was driving Alice to extremes. He was actually imprisoning her, and threatening a kind of suicide if she left him. I have another client whose husband actually did commit suicide when she threatened to leave him. This shattered the family and deeply damaged all the survivors.
I knew that contradicting Bob and blowing his cover of piety and support was not what he wanted. He didn’t respond to what basically amounted to an accusation that he was abusing his wife. He took the lead in making no future appointments. He then told me he had found another therapist. Alice, following true to form, accepted his decision and did not respond to my emails.
I’ve had a few weeks to think about this, and I have not changed my opinions. I also have not changed my feeling that I was there to serve the children, and not support either the fantasy of Bob’s dominance or Alice’s submission. In a real sense, that was their problem: both were servicing their weaknesses, and neither were developing their strengths.
If there was any truth to Bob’s claim that they could not afford to split up—I’m sure that splitting up would not have fit into their budget—then my taking any more of their money was unethical on my part.
Bob no longer trusted me to further his goals, he didn’t value what I was working to accomplish, and he saw me as failing to support him. Alice probably did trust, understand, and appreciate my support, but her problem centered on being unable to recognize and exit an abusive relationship.
Bob and Alice will now look for a therapist who will follow another path, probably the middle road. They’ll spend more money substantiating their growing alienation. When coping strategies fail—if they still have any money and Alice has not asserted herself—they may find a therapist who offers the low road: think and act positively, return to earlier fantasies, or some other misconceived, cognitive therapy.
As a therapist, you can’t be sure what other people want or need. The public story is always a whitewash. The thresholds for change are hidden. Compromise, coercion, or capitulation are not solutions, but sometimes things need to get worse before they get better.
Should Bob and Alice have left my practice? That is their decision. Ultimately, I trust my clients to make the right choices given their state and situation. It may not be the right choice in the long term, but as long as there are changes, there are opportunities.
Should I have acted differently? I don’t think so.
“What saddens me is seeing patients who have been going to therapy for years and years with no change, but they keep going to the same therapist. To me, that’s not right.”
— David D. Burns, psychiatrist
Segarra, M., Young, I., & Schneider, C. M. (2023 May 2). Deciding when it’s time to end therapy, National Public Radio. Retrieved from: https://www.npr.org/2023/04/20/1171010523/how-to-break-up-with-your-therapist
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