Do you feel you are in the driving seat in therapy? Or do you feel your therapist has control? Does it matter to you? Have power/control/autonomy issues ever been a problem for you in therapy?

[WrkNPrgress]

This is an interesting question. I think for a while I felt like my T was an 'authority' but then I realized this was my own projection. I am 40 years old and not a student or a patient. I am a client. I direct what we talk about, 99% of the time. She listens to my cues and offers insight and subtle direction which i can take or leave. I've come to a sense of self-agency in this realization.

She has since made it clear that we are doing work "together" i.e., though it's all about my progress, it's a team effort.

I feel that therapy is directed by me at my pace. I often place T in a position of power. But she doesn't accept it or abuse it
I think when we regress to an early state, it often feels 'as if' we are powerless, but that's part of the therapy too.

I've always felt in control of my own therapy. My therapists have always taken my cues, my needs, my requests and respected that. There have been times I felt like therapy was happening "to" me, but that was because I was feeling completely out of control in all aspects of my life; it wasn't unique to therapy. It was a perception, not a reality.

[ThisWayOut]

While I may sometimes hand T the reins, I think I direct most of it (by what I seek from therapy, what I choose to focus on, the choice to return or not return). I don't really see it as a power differencial though. I think the only time I ever feel powerless is, as Mouse said, when I regress or when I am so decompensated that a T ends up making safety decisions (though even with respect to safety, it's mostly a joint thing. I may tell T things to make her concerned, but any decision to act on keeping me safe is a mutual one... this has only every been with T's. PDoc's are a whole other animal).

While I look to a T for expertise, it is really a teamwork kinda thing.

I feel that there is a power issue in my therapy. I've raised this, but she has never said anything. I started a thread on here about this a few months ago and didn't get much response, I was left feeling that maybe others don't think about power issues and that the fact that I have studied sociology makes me more conscious of it

No, we discuss it. I can't speak for your T. All I know is that T doesn't wear the crown of 'king T'. Some do, I don't doubt it.

[stopdog]

The therapist sets the fees, the time and the place. I decide whether I agree that the time works, the place is not unreasonable and if I am willing to pay that person those fees - as I do with other professionals I hire. The therapist has no power over me personally. I do not believe the therapist knows anything particularly about me. They may know about therapy which is what I initially sought them for. The first one has refused to explain therapy to me but she does stay back and she does comply with my request that she not talk - so I use her to tell things to that I do not usually tell others. The second one I use to explain about therapy itself. So no - I do not see them in positions of authority over me nor as having more power than I do. I get to walk away with no explanation or further contact.

I felt in my therapy there were underlying control issues which I wasn't conscious of, but which left me feeling frustrated and powerless. Taking a break was partly a statement of ownership of therapy on a subconscious level. It remains to be seen whether the issues can be discussed and resolved.

Brown Owl - Did you manage to resolve the power issues, or are they part of the reason you are considering termination?

[grimtopaz]

The power dynamic in psychotherapy is a tricky issue.

From the outside, it would seem like a patient/client has ALL the power. That is, WE pay and decide if we want to stop seeing them and when.

On the other hand, therapists (specially as time goes on) hold tremendous amount of "emotional" power. That is, inherent in the therapeutic-relationship they have tremendous power to hurt us. They know more about us than almost anyone, and this is completely one-sided. They know our vulnerabilities and how to make us "tick". They have had 100's of patients (most, anyways), but we've only had 1 or a few therapists. If they were to terminate with us, for them it would only be another slot they can easily fill, for us, it might be years of grief.

The issue of power came up recently in my therapy: My T. works full time at a prestigious medical/academic institution and takes about 10-15 patients in private practice (works 12-14 hour days). She doesn't take insurance and charges over $200 a session. She "cherry picks" (is very selective) about who she works with, is completely booked, has a wait list, and does not need any specific client for financial security. Essentially, individual clients are expendable.

She'll only work with a narrow population: no personality disorders or personality disorder traits, no substance use problems, only depression and anxiety, can pay $230 a week, no suicidality, must benefit from CBT, must be a "good fit", must constantly be making progress. I feel like she's a commodity and I have to "earn" staying in her caseload (even though I pay $230 a week!). I hate that I am the customer but she has all the power.

Anyway, next week I'm starting a new job and will have to give up my session slot. I won't know what my schedule would be like, but all her slots are booked. She said she is willing to see me a day she doesn't usually do private practice, but only for a couple of months, and she made it clear that it is not a day when she regularly sees patients. I made me truly realize how important she is to me and how expandable I am (even though I give her $230 for 50 minutes). It's been so hard for me to open up, that if we have to terminate, I honestly don't think I can do therapy again.

In summary: technically we have the power in the sense that we are 'consumers' who pay for a service and can cancel services at any point in time, in reality, I think therapists have most of the power.

Originally Posted by lolagrace

There have been times I felt like therapy was happening "to" me, but that was because I was feeling completely out of control in all aspects of my life; it wasn't unique to therapy. It was a perception, not a reality.

This is an interesting observation, particularly about perception vs. reality. How can we determine where one ends and the other begins with such an abstract concept?

[stopdog]

I have never thought a therapist irreplaceable so that might add into it with me. I wouldn't go to one I thought looked upon it like they thought I had to prove my worthiness to give them my money.

Originally Posted by stopdog

I wouldn't go to one I thought looked upon it like they thought I had to prove my worthiness to give them my money.

You do have a way of cutting through the bull****, Stopdog.
I think that's what was happening with me, I was placing too high a value on the relationship and forgetting about the paying him to do his job bit. I think a bit of space and time has been important in putting those things into perspective.

Originally Posted by Echos Myron

This is an interesting observation, particularly about perception vs. reality. How can we determine where one ends and the other begins with such an abstract concept?

I can only speak to my case, but it was at time when I felt like my life was completely out of my control (which was not at all the reality; just my panic and anxiety and worry). When I'm stable, calm, healthy, I always feel some measure of control, if only a control over how I choose to react, respond, and handle what life throws at me. Therapy has always been in my control. I'm not forced to go there. I'm not forced to see this T and only this T. He gives me the autonomy to ask for what I need. He listens to my input and suggestions. It is a definite environment of give and take and dialogue. That is MY experience in MY therapy. Can't speak for anyone else's.

Originally Posted by lolagrace

I can only speak to my case, but it was at time when I felt like my life was completely out of my control (which was not at all the reality; just my panic and anxiety and worry). When I'm stable, calm, healthy, I always feel some measure of control, if only a control over how I choose to react, respond, and handle what life throws at me. Therapy has always been in my control. I'm not forced to go there. I'm not forced to see this T and only this T. He gives me the autonomy to ask for what I need. He listens to my input and suggestions. It is a definite environment of give and take and dialogue. That is MY experience in MY therapy. Can't speak for anyone else's.

It definitely can be the case for me too that what goes on in therapy (in terms of feelings) can reflect what's going on in wider life. Thanks for sharing your experience.

Originally Posted by Echos Myron

I felt in my therapy there were underlying control issues which I wasn't conscious of, but which left me feeling frustrated and powerless. Taking a break was partly a statement of ownership of therapy on a subconscious level. It remains to be seen whether the issues can be discussed and resolved.

Brown Owl - Did you manage to resolve the power issues, or are they part of the reason you are considering termination?

No not resolved, a work in progress.

I absolutely feel a balance of power in terms of the direction we take and the nature of my therapy, and I do not feel my therapist is an authority or godlike; however, I assume all the emotional risk, and that puts me at a disadvantage. The only way she can be hurt is to have to reschedule someone else. I can be hurt in a number of ways due to being vulnerable and not quite hitting all cylinders when I'm emotional. It has happened, but we worked it out pretty quickly.

So, all things considered, it doesn't feel entirely equal to me. But to be honest, that's more my doing than my therapist's. She doesn't position herself as the authority.

[UnderRugSwept]

Originally Posted by grimtopaz

The issue of power came up recently in my therapy: My T. works full time at a prestigious medical/academic institution and takes about 10-15 patients in private practice (works 12-14 hour days). She doesn't take insurance and charges over $200 a session. She "cherry picks" (is very selective) about who she works with, is completely booked, has a wait list, and does not need any specific client for financial security. Essentially, individual clients are expendable.

She'll only work with a narrow population: no personality disorders or personality disorder traits, no substance use problems, only depression and anxiety, can pay $230 a week, no suicidality, must benefit from CBT, must be a "good fit", must constantly be making progress. I feel like she's a commodity and I have to "earn" staying in her caseload (even though I pay $230 a week!). I hate that I am the customer but she has all the power.

In your case, I would say your T has made it quite clear that she definitely has all the power, period. So how does she determine that you fit all of her criteria in order to become a client? Is there a test, perhaps or a trial period? What happens if she discovers a personality disorder trait or you become suicidal as therapy progresses? How is "progress" defined/monitored? I am not trying to put you on the spot...I am just somewhat confused and really curious.

[Partless]

Originally Posted by Echos Myron

Do you feel you are in the driving seat in therapy? Or do you feel your therapist has control? Does it matter to you? Have power/control/autonomy issues ever been a problem for you in therapy?

It's like this: You are the student driver. The therapist is the one who knows how to drive. Who is in control? I don't know, perhaps depends on the part of the journey. Sometimes you might be suicidal and feel out of control and the therapist takes the wheel. Other times you're doing well and the therapist just smiles and just leans back and is happy about all the progress you've made.

In therapy, the ultimate power belongs to therapist. In real life, it's you. In therapy you hand over some of your power to the therapist so you can be guided. It makes you vulnerable but if you were not forced to give up your power and if you did it yourself, you still have the power. You could walk out, for instance. But for therapy to work, you have to give up some of your power (not all) in therapy. You have to do it willingly. That's how therapy works. That's my view anyways.

[archipelago]

It depends. First what do you mean by power? and then by balance? If I look at the basic structure of therapy, then most people recognize asymmetry, where the therapist does have more power. But this is not necessarily because the therapist is an "expert" which is power we give them. They may think that of themselves, but if we do not recognize them as such, they no longer have that "power."

It is rather an issue of who is more vulnerable and more greatly impacted by the therapy. In that sense the therapist has more power or is in a position where they are less likely to be affected than the client.

But that is just a snapshot view of the structure of it. Some therapies actively address this imbalance and try to be more collaborative or otherwise balance the power difference.

If you take "balance" to mean what the relationship is like, then the structure of it may not have a lot to do with how it actually works at the experiential level. Some therapists are directive while others are not on purpose. And most do a blend because situations tend to require different modes.

My therapy works hard on mutual recognition so it is one of those that actively tries to be collaborative. It is called a "two person psychology," meaning that what happens is a co-creation. And the therapist also has to be willing to change alongside the client. While this is probably something that sounds unusual, it is in fact how most contemporary psychoanalytic therapies work now and have been since the 80s, if not earlier.

[Petra5ed]

I don't think about us having a power imbalance, I like to think we have a natural kind of dialogue, a mutual unfolding. Ultimately I think I could have a lions share of the power to direct what we talk about, if only I talked that much. As it stands I think I prefer to let him set the tone. I prefer him to have the power, so maybe that's why it seems like a non-issue for me. I want him to control the sessions and direct me with questions, but he wants to give it back and put me in control.

Originally Posted by archipelago

It depends. First what do you mean by power? and then by balance? If I look at the basic structure of therapy, then most people recognize asymmetry, where the therapist does have more power. But this is not necessarily because the therapist is an "expert" which is power we give them. They may think that of themselves, but if we do not recognize them as such, they no longer have that "power."

It is rather an issue of who is more vulnerable and more greatly impacted by the therapy. In that sense the therapist has more power or is in a position where they are less likely to be affected than the client.

But that is just a snapshot view of the structure of it. Some therapies actively address this imbalance and try to be more collaborative or otherwise balance the power difference.

If you take "balance" to mean what the relationship is like, then the structure of it may not have a lot to do with how it actually works at the experiential level. Some therapists are directive while others are not on purpose. And most do a blend because situations tend to require different modes.

My therapy works hard on mutual recognition so it is one of those that actively tries to be collaborative. It is called a "two person psychology," meaning that what happens is a co-creation. And the therapist also has to be willing to change alongside the client. While this is probably something that sounds unusual, it is in fact how most contemporary psychoanalytic therapies work now and have been since the 80s, if not earlier.

The co-creation way of working sounds good.

I feel that in my therapy my T gives her understanding of the things we talk about and this dominates over my views. She thinks that it is transference that makes me think this, but to me this is what actually happens.

[BlessedRhiannon]

Originally Posted by Echos Myron

Do you feel you are in the driving seat in therapy? Or do you feel your therapist has control? Does it matter to you? Have power/control/autonomy issues ever been a problem for you in therapy?

My T tries to keep me in the "driver's seat" as much as possible. There are times I really just want her to guide the discussion, though. I don't think either of us has control or that it's a power play on either side. It's more like a conversation which I guide. If T feels like we need to explore something specific or she needs further details on something, she will ask questions and guide the conversation in that direction as much as needed. With previous therapists, yes, it was somewhat of a problem - I never felt like I had any control over the sessions and I desperately needed it. With my current T, I don't have as strong of a need to be in control and she manages the sessions in such a way that I never feel as if I'm fighting her for power or control.

Originally Posted by archipelago

It depends. First what do you mean by power? and then by balance? If I look at the basic structure of therapy, then most people recognize asymmetry, where the therapist does have more power. But this is not necessarily because the therapist is an "expert" which is power we give them. They may think that of themselves, but if we do not recognize them as such, they no longer have that "power."

It is rather an issue of who is more vulnerable and more greatly impacted by the therapy. In that sense the therapist has more power or is in a position where they are less likely to be affected than the client.

But that is just a snapshot view of the structure of it. Some therapies actively address this imbalance and try to be more collaborative or otherwise balance the power difference.

If you take "balance" to mean what the relationship is like, then the structure of it may not have a lot to do with how it actually works at the experiential level. Some therapists are directive while others are not on purpose. And most do a blend because situations tend to require different modes.

My therapy works hard on mutual recognition so it is one of those that actively tries to be collaborative. It is called a "two person psychology," meaning that what happens is a co-creation. And the therapist also has to be willing to change alongside the client. While this is probably something that sounds unusual, it is in fact how most contemporary psychoanalytic therapies work now and have been since the 80s, if not earlier.

I think by 'power' I mean who is driving the way therapy is headed and by how much. I think with my first therapist I ended up feeling like a little child skipping two paces behind her Dad (who she idolises) and following him into whatever shops he likes. Sometimes those shops were good for her, and sometimes neither of them knew why they were in there, but he always chose the shop. The therapist I am currently seeing is really very passive, and we rarely enter any shops, we're just sauntering about the high street, Starbucks takeout in hand, waiting for the other one to suggest a shop. When I suggest a shop we go in, and it always feels good, but we don't buy anything.
Sorry for the weird analogy, but that is how it feels.

[Ellahmae]

I think that's a PERFECT analogy. T and I talked about this yesterday actually.

About how she could push and ask and drive but the best therapy happens when the client drives and determines where to go with her along for the ride and she'll be there to assist as a co-pilot so to speak if I get to where I can no longer drive or we end up off the road she can help direct us back.

We go into shops, some I'm scared to go in but we walk in and 'window shop' for a little while and then walk back out (or crawl out sometimes ) and when I'm ready we'll stop/stay and do some shopping but she'll never force me or pressure me to buy anything that I'm not sure I want to buy or am ready to buy yet. (if that makes any sense)

I LOVE this analogy! I'm going to talk about it with T on Tuesday

Originally Posted by Echos Myron

I think by 'power' I mean who is driving the way therapy is headed and by how much. I think with my first therapist I ended up feeling like a little child skipping two paces behind her Dad (who she idolises) and following him into whatever shops he likes. Sometimes those shops were good for her, and sometimes neither of them knew why they were in there, but he always chose the shop. The therapist I am currently seeing is really very passive, and we rarely enter any shops, we're just sauntering about the high street, Starbucks takeout in hand, waiting for the other one to suggest a shop. When I suggest a shop we go in, and it always feels good, but we don't buy anything.
Sorry for the weird analogy, but that is how it feels.