ktgirl, this is a response to Dr. Muffin. Please do not take anything I say as a comment on your own T. Your own T responded very well to what you told her, and I think you are teaching her a lot by being so brave.

Study after study trying to prove the efficacy of one 'type of therapy' over another has yielded one simple result: The most important factor to successful therapy is the relationship the client has with the therapist. If the therapist does not feel capable of adapting to help the client, then I would advocate for that therapist taking a good hard look at why they refuse to change? Not put the onus onto the client.

I appreciate that you (Dr. Muffin) are trying to provide the therapists approach, but I respectfully call your approach into question.

*If* the therapist is feeling stuck in the therapy they need to examine any possible issues of counter-transference. It would be likely to find that the client is feeling stuck, and the therapist is acting as a mirror to for the client. Now, lets assume the client does not have healthy coping mechanisms when they feel stuck, they look to the therapist to provide healthy modeling. If the therapist starts to hint about termination, what sort of a message are they sending to their client? What lessons are they teaching them about how to respond when they feel stuck? What lesson are they sending to the client about trust? All of these questions, and more *should* be given due deliberation before a therapist even thinks about bringing it up with the client directly.

This attitude is, IMHO, harmful. It is harmful to the client, and it is harmful to the therapist. First of all, it reminds me way too much of what an abusive parent might say to a child who protests about X thing. "If you don't like living in this house by my rules, then leave."

Second it absolves the therapist of any real responsibility. It is the 'client's choice' afterall to be here, and if they don't think I'm working for them then they have the right to leave. It smacks of inflexibility and defensiveness.

The client absolutely should be empowered to make their own choices. When I have come into sessions and told my own T I felt stuck, his own response was 'What can I do to help you feel unstuck?' or 'Can you explain to me what stuck feels like?' I have always known that I can leave therapy at any time, because T repeatedly refocuses the session onto what I need, not what he needs. When he made a suggestion for a course of treatment, and I refused, he has never sat in judgement...he let me choose my own path.

It is sad to me to hear that therapists have these ideas about 'must treat X before Y'. On the one hand, the mark of an emotionally healthy person is the ability to adapt. On the other hand, this approach to therapy is decidedly rigid. Do you see the contradiction?

The client must commit to show up and do as much of the work as they are able, and the therapist has to be present and clear and focused on what the client needs. Maybe they need to really feel how frustrating being stuck feels? No part of threatening termination to a traumatized person is helpful.

I apologize for speaking so firmly about this, but I cannot stay silent. I have run into similar attitudes from mental health professionals before, and IMHO it is not an approach we should cultivate or condone.