[CantExplain]

To what extent does the therapist have a right to decide what is best for the patient?

[wotchermuggle]

Originally Posted by CantExplain

To what extent does the therapist have a right to decide what is best for the patient?

If the patient's life is at stake, it's their right to make that call.

Ultimately, everything is up to us. If we keep employing the therapist, we're allowing them a say in what is best.

[ECHOES]

Don't know. My therapist always says that I know best.
But we work together to find what that is sometimes

[Ike McCaslin]

To no extent, they have no rights. IMO

[Fixated]

No right.

But the others are correct that if you continue to go back every week, your giving them some leeway to express and exercise their judgement in relation to you.

[healed84]

None.. Unless it has to do with suicide..

[BlessedRhiannon]

The only time they have the obligation to decide what is best is if the client is a risk to themselves or others.

Otherwise, you are paying for the therapist's professional opinion, so they get to offer it. They can say that they might know what is best, but it's up to the client to decide if that is true or not, and up to the client to decide whether or not to follow the advice.

My therapist has never told me that she knows best. I've asked her for her opinion about things, and asked her what she thought the best course of action might be, but she's never acted like she has a "right to decide what's best."

[pbutton]

I pay for the therapist's professional opinion. It's my option to take it or leave it. However, I do not have the right to try to CHANGE the T's professional opinion, just because I do not agree. I can ask for what I'd like, but cannot force anyone to give me something just because I want it to be that way.

[Syra]

Originally Posted by CantExplain

To what extent does the therapist have a right to decide what is best for the patient?

Almost absolutely none.

I might consider making an exception for seriously hurting oneself. I would probably make an exception for intending to seriously hurt another. In many states those would be law. I doubt I would draw the lines exactly the same place, but no one cares where I would draw the line except me and my therapist.

Other than that, the client decides what is best for the client. There are many schools that would support this. Person-centered/Client-Centered Therapy, and Internal FAmily Systems (not to be confused with Family Systems) are two. I suspect Jung also but not sure.

[Perna]

I don't think of it as what is best for the patient as much as they have their training and experience and professional opinion and they give it and we make decisions based on what they have to say. I treat it like I do my medical doctor, he's there to advise me but I have to make the decision do I want this treatment or to ask questions about another, etc. But we're the only experts possible for our own lives and have to take responsibility for our decisions, whether they work out or not.

One can lead a horse to water but not make him drink and doctors can hospitalize us to try and better help us but if we're unable or unwilling to work with what's there/what we've got, eventually we get fewer and fewer options.

[sunrise]

Originally Posted by CantExplain

To what extent does the therapist have a right to decide what is best for the patient?

The word "right" seems strange to me here. The T does have an obligation to hospitalize you (or at least have you assessed for that by your local crisis team) if you are at risk for harming yourself or others.

My T has told me, "only you know what you need to heal." And I have believed him. I do ask his advice a lot, though. I figure he has a lot of experience helping people and I want to know his ideas on what might help me in certain situations. (Like recently I asked him for ideas on how to deal with and get rid of the feeling of annoyance.)

CE, has your T ever told you she knows what is best for you? I think that language would put me off.

[healed84]

CE, I would like to know if this question is coming from a specific situation with you and your t?

[stopdog]

They do not know better than the client.
I know that laws are enacted so they can forcibly hospitalize clients, but I think it is wrong.

Regardless of whether the therapist knows best or not, as you know, I am of the opinion that it is absolutely the T's right to decide they are unwilling or unable to change the manner in which the T practices just because his or her method makes the client angry. If the T truly believes his or her way is in the best interest of the client, I do not believe the client gets to demand the therapist change. The client can stay and deal with the therapist's methods (and stop agonizing and raging against it) or the client can leave.

[healed84]

Originally Posted by My kids are cool

Regardless of whether the therapist knows best or not, as you know, I am of the opinion that it is absolutely the T's right to decide they are unwilling or unable to change the manner in which the T practices just because his or her method makes the client angry. If the T truly believes his or her way is in the best interest of the client, I do not believe the client gets to demand the therapist change. The client can stay and deal with the therapist's methods (and stop agonizing and raging against it) or the client can leave.

Or the T could just comply.. Right?

When I started of in T.. it was with a different T (saw him no more than 3 times before he for medical reasons). My chief complain was panic attacks.. So the first two appointments were about how to handle the panic, ways of dealing with the stress. I finally said, ummm.. these are good techiniques, but after years of dealing with all of this, I would love to get to the root of all of my issues. After thinking about it for awhile he said, ok. That is easy, I can shift the therapy we are doing. So, isn't that a way that the T thought he knew best, but client said I disagree and changed his course.

[stopdog]

I do think a client gets to tell a therapist what is not working and that is is a reasonable expectation for the therapist to try to work with the client to find a way that does work for that client. Perhaps that is from the place where I go to those who are more eclectic than strictly following just one type. Granted the therapist can be rigid, inflexible and unwilling to explored different ways to work with someone. I don't find that an admirable quality in a therapist (and I would not work with one who was like that). Then the client can choose to find one more flexible or suitable for them.

[Bill3]

I am of the opinion that it is absolutely the T's right to decide they are unwilling or unable to change the manner in which the T practices just because his or her method makes the client angry.

Regardless of what a client may want, it would be unethical for a therapist to use techniques that she/he is not trained in or otherwise able to do in a professional manner.

[doyoutrustme]

Therapy is a team effort. There is no clean cut treatment and your treatment must be custom made to fit your needs. Therefore your input is required.

[stopdog]

Originally Posted by Bill3

Regardless of what a client may want, it would be unethical for a therapist to use techniques that she/he is not trained in or otherwise able to do in a professional manner.

It would not be unethical for a therapist to be eclectic nor for the therapist to try different ways to work with a client. I don't think anyone was suggesting the therapist not act in a professional manner.

But we're not talking about a. situation where a client just wants to change the focus of therapy but instead is trying to insist the therapist react in as certain way and repeatedly getting angry when the T tries to explain why she is acting a certain way or why she believes the requested reaction is not in the client's best interest.

I completely agree that a client has a right to request a method of therapy hat he or she believes to be more helpful. I do not believe the T should have to implement that method if she believes it is not in the client's best interest. The client is free to stay or go when the T makes that determination. When the T has clearly indicated she will not change, I do not see the point in staying but continuing to rail at the T and continually be angry and complaining about it.

My first T just irritated to me to no end. I hated the blank slate thing he was doing. I ended up having a mini meltdown about it and he agreed to try a different method. Had he refused, I would have simply changed therapists. If the T refuses, he or she refuses. They are an autonomous person and attempting to browbeat the T into accommodating a client when the T believes it is not in the client's best interest is, in my opinion simply wrong.

[stopdog]

Originally Posted by My kids are cool

They are an autonomous person and attempting to browbeat the T into accommodating a client when the T believes it is not in the client's best interest is, in me opinion simply wrong.

This may well be the path some people need to take. It is not hurting the therapist any. Perhaps the therapist may find a way to make it a winning situation for both, it may lead the client to figuring out a way for both to win. The therapist may actually realize they have been wrong. The client may come to see the therapist was not all wrong. Some people may need to see the therapist can handle all their rage and disappointment and so forth and not die or hate them. Some people may need to see they can survive other disappointing them. It may well not get the client what the client wants, but I don't see why the client should not try.
I just think it is not black and white.
(and I am totally against the therapist making any decision as to what is in a client's best interest - so I realize a lot of my stance in this area is based on that main premise for me - it is a big thing for me and I get somewhat worked up by the whole thought of health care people doing this sort of thing in any capacity. I realize this is not the issue for most like it is for me)

[unaluna]

SD: Some people may need to see they can survive the other disappointing them. It may well not get the client what the client wants, but I don't see why the client should not try.

And hence a difference between Ts and lawyers; that the r/s should continue in spite of this, and that this would be a positive outcome. Well put, SD. And Mkac.

[learning1]

I'm continually confused, and curious, about why you want to keep seeing your t, CE. I might have asked before and I remember you saying there are things you like about her, but I don't remember you talking about what. Maybe she says supportive, nice things sometimes that you don't post about or I haven't seen? I know you've been seeing her for 10 years, and that has got to have caused some attachment and familiarity, but I don't know why you wanted to talk to her for that long. I don't read on here consistently, but it usually seems like your posts are about your t being pretty extremely cold when you just want basic reassurance that she gives half a damn about you. It seems pretty reasonable to me that clients need to feel their t at least cares or gives a sh**. I can understand if sometimes a t won't show a client they care if it comes across like the client is being too dependent or manipulative or something. But if the t continually shows they can't meet the client's basic, human need to know he or she is worth caring about at all in the relationships he or she is in, I think it's an unhealthy relationship.

I'm also confused why you say you like power. It seems like you're pretty self critical and humble on here. Maybe I don't understand or maybe you don't express your demanding side on here. I'm not saying that for the purpose of being nice, it just really doesn't make sense to me. It comes across to me more like you might enjoy the habit of criticizing yourself if anything.

[Bill3]

It would not be unethical for a therapist to be eclectic nor for the therapist to try different ways to work with a client.

There are hundreds of therapies. A therapist cannot be competent (or eclectic) in all of them. It is unethical to try to be or to so present oneself.

If a client wants (say) Jungian therapy, and the T is not trained in Jungian therapy, then it is the T's professional responsibility to refer the client to someone who is trained in it.

I agree that this requirement is thought to be in the best interests of the client, and I understand that you object to such requirements. For better or worse, though, therapists' rules of ethics do require a referral.

[stopdog]

Originally Posted by Bill3

There are hundreds of therapies. A therapist cannot be competent (or eclectic) in all of them. It is unethical to try to be or to so present oneself.

If a client wants (say) Jungian therapy, and the T is not trained in Jungian therapy, then it is the T's professional responsibility to refer the client to someone who is trained in it.

I agree that this requirement is thought to be in the best interests of the client, and I understand that you object to such requirements. For better or worse, though, therapists' rules of ethics do require a referral.

I agree if you want a jungian - go see one. But a good number of people who go, even after reading about different types, still have no idea what the differences are so I doubt most people are demanding a freudian be a jungian instead. Plus the ones I see are eclectic and label themselves as such- I don't want anyone of them who are strictly one thing or another. Too rigid for me. But I don't think we are arguing about the same thing really.
I completely do disagree about the best interests part.