No Disagreement
by Dr. John Riolo
Bonnie, your excellent article accomplished one thing already. It got Garry and I to be in complete agreement at last on something, that your article should be required reading at schools of psychology, counseling, social work, etc. I would add however, that it should be required reading and posted on every (I mean every) Internet discussion group bulletin board and listserv frequented by psychotherapists of all disciplines. While it is important for new therapists to learn early about the importance of collaborating with clients, I think that seasoned therapist who have been around for a while and perhaps gotten too wedded to their theories and notions need a refresher course on who we work for and, even more, who therapy’s all about.
Unfortunately I am not sure that too many in our profession are ready to hear you just yet. I would not count on too many invitations to speak at professional schools and in fact I predict if someone were to post even the link to your article on some listservs it would be censored. Ironically some of the same therapists who proclaim to everyone that they have developed the art of truly listening to their patients would be the first to dismiss or censor your post. I hope I am proven wrong and that your article will be discussed by my colleagues in a variety of settings.
Let me give a couple of my own examples of therapists who claim they listen to their clients and that therapy is collaborative, and then act the opposite.
Have you ever asked your therapist how frequent therapy should be? What answer would they give? In the days when psychotherapy and psychoanalysis were more or less synonymous it was multiple times a week. Nowadays, it’s more like once a week. But is that carved in stone? Some people may need more and others less. No? Well, not to some therapists. I have heard therapists say, “Therapy is weekly. It requires many boundaries, including consistency. Weekly sessions are for the benefit of the patient.” They add that any suggestion of less therapy dilutes the therapy. But where is it written that therapy should be once a week or any set number? And who really benefits from this type of consistency (or rigidity)?
Then there’s the matter of the records that your therapists keeps on you. Have you ever seen or read them? They’re all about you, and what’s in there could profoundly impact you in many ways. See The Mental Health Record: What's In It & Can You See It? . Yet despite that fact that it’s your records, and laws and professional standards acknowledge that you have a right to access them, many therapists would do back flips to keep you from seeing your own records. Some would tell you that you can’t see your record because if you did it might cause you harm. But what on earth can a therapist say about you that would cause you harm? And if it could cause you harm, why would they write it? Rather than harming you, it’s far more likely that if you knew what your therapist wrote about you, it might cause the therapist embarrassment and might lead you seek a different therapist.
There is one point where I would differ with you. You seem to be making a distinction between what you call “neutral and abstinent stance" camp, and the "let's all be warm and fuzzy" club. I suspect that there is not that much of a difference between these two apparent extremes. I think you touch upon the common denominator with your astute observation that they can be “equally obstinate” One can just as easily say equally arrogant. Again let’s look at a couple of examples.
Have you ever been curious about your therapist and wanted to know something about him or her? Of course they have the right to decline to share much of their personal life if they choose, but it’s not like there is something wrong with you for simply being curious. They can simply say no without making a big deal about it or without analyzing your request to death. One prominent therapist proclaimed not long ago that, “if a patient questions me at length, or even at all, about where I got my credentials, how much experience I have etc. etc., these are usually indicators that they're highly anxious/ambivalent and may not come or continue in treatment.” Really! This patient was not asking about the therapist’s sex partners or bank account balance but was concerned about the therapist’s competence. Patients have a right to ask questions about that.
With some therapists, no matter what problem you may have that brings you into therapy, that’s not considered the “real problem”. Some will actually use those words and will dismiss other therapists as not doing real therapy unless they attempt to get at the underling problem, which is unconscious. Now do some people have underling problems that are beyond their awareness? Sure. But everyone? And even if there are some problems that are unconscious, the problems that they are aware of need attentions nonetheless. Some patients know exactly what their problem is, and it’s the height of arrogance for a therapist to suggest they know better. This group puts their theories and training above everything else, including their patients. In their own eyes, they’re the only experts in the therapy office.
So as Garry mentioned, it takes the acknowledgement that there are two experts working together, the therapist with his or her expertise (which should include more than good intentions, a firm theoretical perspective and a degree) and the consumer who brings their own expertise about themselves and their experiences.
But here is probably the most important point. Every now and then experts will have differing opinions. In a relationship between a therapist and a patient when there is a difference of opinion it is the consumer’s opinion that should carry more weight. The consumer should have veto power.
