Do you think a T has the right to insist on something for a client?

Not a fan of orders and do not want a therapist who gives them, whether they come in the form of ultimatums or just statements like, "Xenon, it's time to do x." I'm generally okay with suggestions, thoughts, or opinions given in a respectful, non-coercive, adult-to-adult way.

I'll echo the exceptions of being a danger to oneself or others, usual boundaries in therapy, blah-blah-blah.

I see most ultimatums as a way for T's to wash their hands of any responsibility when they want to get out of treating someone they don't want to see anymore.

Early on I had a T that wanted nothing to do with suicidal thoughts. He wanted me to get another T to handle everyday suicidality even if they were just thoughts. Of course I couldn't afford to see two T's and he knew that. He set ridiculous rules that no T I know of has ever done since.

That way, he could point to me and say that I "chose" not to see him.

Thanks for all the responses. I really appreciate the perspective. And I'm so sorry to hear about the experiences some of you talked about with incompetent, hurtful therapists.

Maybe I should have spelled things out a bit more when I originally posted. I just wanted to be clear that I'm not talking about a boundary issue. I posted the question because my T really wants me on meds, and I have some reservations about them. And she indicated that, if my depression reaches a certain severity (I think "serious suicidal ideation" were her exact words), she would have to insist that I see a psychiatrist and would not work with me unless I complied. And, to me, that just feels really manipulative and disrespectful. She's invited me to depend on her, fostered an attachment, described her "commitment" to our work, her "unconditional" feelings for me...and now she's talking about ultimatums, where I either obey her or she's out? I'm floored, honestly, so I wanted to know if this was a Thing that therapists do. I'm not looking to spark a debate about meds, though, and I'm not outright opposed to their use or anything. I know many people find them helpful. I just have some reservations, and I feel like my T should be able to address those reservations, rather than hand down proclamations to me.

That would bother me also, unless T said such a thing up front on day 1. Deep into a relationship is a bit late to set a rule like that. Some people like myself have tried just about everything with little success meds-wise, others have valid reasons to reject meds. It such a personal decision.

I wouldn't have a problem with a T giving an ultimatum with reasonable options. Such as, you are suicidal…you can meet with a pdoc to explore meds, go inpatient, or go cool down for a few days and touch base/promise safety.

I wish i had taken prozac when it first became available. There are so many generics now meaning the price is lower and covered better by insurances, and they have stood the test of time, that if you can afford it financially, and the meds work for you, it does make it easier to come out of depression and into the light. But its still like a relay between life changes and med changes. Imo.

So was this a one time conversation? Or is this a suggestion she's been talking to you about for awhile? Are her concerns about the severity of you depression founded? Is therapy really effective for you if you depression is at such a severe level that you are falling into suicidal ideation?

My depression at times has been so severe that therapy was honestly pretty useless and ineffective. I was completely spinning my wheels and digging deeper and deeper into that pit of depression. No amount of skill or support on the part of a therapist could have fixed that. I truly needed meds in order to lift that level of depression enough that I could function, to actually participate in my therapy, to make any forward progress.

It sounds like your therapist is seeing your level of impairment becoming so severe that you are stuck and perhaps starting to head backwards.

My T has never given me an "ultimatum" He has kept me safe and gotten me to go IP when I really needed it, but I " thought" I was.... not great ,but getting by. He was correct in pushing, he told me after IP had I still not seen that I needed it he would have just plopped me in his truck and driven me to the ER . lol I trust my T fully, so I think that factors in of course.

When I first started seeing in I was a bawling mess the entire first 3 visit. On the 4th visit we discussed what I needed treatment wise, he explained his approach, boundaries etc. He is in a huge multi site group. He's 67 he hasn't the energy to deal with nonsense. He made it clear if I was just looking to be coddled he isn't the right T and will refer the person to another T easily. Hes not being a jerk, He is just focused. He has gone above and beyond in helping me.

I am goal orientated so him and I clicked. We just work well, he pushes me when I "need" it and he backs off when needed.

I figure if your in T and either you don't like how your T works or think or you feel pushed and don't like it, Then you need a new T.

But legally if your a total mess and suicidal , I know here In TN , any Doctor Psych or not and T's will/can/should call 911 to keep you safe.. You may hate them and never want to see them again, but they are bound my law to do so.

Well, it's not quite a one time conversation. This is the third time she's suggested that I consider antidepressants. The first two times, she assured me that she wasn't going to force me to do anything, but now she's changed her stance...because I wrote her an email telling her that I was experiencing suicidal thoughts. And I think she feels quite frustrated with me for not wanting to be on medication. She indicated that she feels I am "setting her up to fail me" and "forcing her to work with one arm tied behind her back, but still expecting her to step up to the plate."

It didn't occur to me that therapy might be ineffective if you are too depressed. That might be what she's thinking, and I appreciate your insight. I guess I'm not sure if therapy is effective for me? I'm not entirely sure what criteria to use to determine whether it's effective. But I guess she must not think it's working, or she wouldn't be worried that she's going to fail.

Anyway, thank you, you've given me a lot to think about.

As a therapist, your T has a ethical and legal duty to do everything in her power to keep you safe. Based on what you wrote, she is not insisting that you do anything right now. Your T told you that if you became severely depressed, she would insist you see a psychiatrist. Would you prefer that she commit you involuntarily at a hospital where you are locked up and possibly medicated against your will? Isn't it a good thing that your T is sharing her plan of action with you right now instead of surprising you with it IF/WHEN you become suicidal? This is no different than a OB insisting that a high-risk pregnant woman go on bed rest if she's in danger of losing her baby and refusing to work with a patient who doesn't follow that advice.

As for meds......your T is not a psychiatrist and not trained on the specifics of medications.....which is why Ts are not allowed to write prescriptions. I don't understand why you're not open to meeting with a psychiatrist and discussing your reservations with the psychiatrist. Instead of waiting until your depression becomes a crisis, I think it's better for you to have a meeting with a psychiatrist right now just to discuss your reservations. Its not like the psychiatrist can force you to go fill a prescription.

No matter how committed your T is to you and how "unconditional" her feelings are.....do not for a moment forget that this is a professional relationship. T has ethical and legal obligations towards you, and she must also take steps to protect herself/her license. Majority of the health care providers (Ts, MDs etc.) will not work with a patient who refuses to follow their advice.....especially when that refusal could potential lead to serious injury/death (ie. you becoming suicidal). This is not about you "obeying" her. You are not suicidal right now and can think reasonably. Your T is simply giving you control over this situation. Its time for you to decide whether or not this is the right T for you. If you feel that you can't follow her rules, you are 100% free to find another T who doesn't have this particular rule.

I would not continue to see a therapist who had rules I had to follow. The first one I see kept mentioning drugs despite me saying I would never take them. I finally told her to never mention them to me again. She agreed. The second one I see said it was good to not take the drugs but she mentioned them because she thought she should let me know they were something someone could do. I refused and she agreed and we went on. There are ones out there who don't try to foist drugs upon clients who don't want them.
I thouht this was interesting on the subject
https://www.psychologytoday.com/blog...t-superstition

Thanks for that sd. That's not the first time I've heard that.
I've walked away from therapists who insisted I needed to take medication to start or keep working with them. I've gone inpatient when needed, but it was after a conversation with my t at the time.
I think there's something to be said for the natural cycle of a depressive episode. The only time the cycle had even not followed through was when I was on ad's...

Good points were brought up in other posts also: a pdoc is more qualified to talk about med concerns than a t would be. And there is no requirement to either fill a script or return to the pdoc. I understand the hesitation however. I have had experiences of going to see a pdoc, mentioning suicidal ideation in an attempt to be honest, and getting hospitalized for it. Most pdocs did not do that however.

IMO and FWIW, mentioning drugs to solve dysfunctional therapy is the sign of lazy therapist.

I terminated my ex-T for this very reason. She gave me a homework that triggered horrible flashbacks, to the point I was fighting against myself to avoid unsafe behaviors.
At the following session, she was flabbergasted that PTSD could trigger such reactions while reading a book. Obviously, she was not as much experienced about PTSD as she said !
The worst point is that I warned her that such situation could happen with the homework she gave. She brushed off my concern as something that could not happen to her experience. Unfortunately, it did happen and then, she was dumbfounded
Then, she continued with giving the homework and insisted that I saw my hospital pdoc for antidepressants. At this point, I made up my mind : taking antidepressants for fixing bad therapy is not in my best interests.
Therefore, I preferred terminating ex-T rather than following dangerous advice. She genuinely had good intentions, but lacked the knowledge to deal with issues stemming from abuse (I told her so once during a session).
My GP told me that medication for solving a dysfunctional therapy is a no go right off the bat.

The problem is my extreme sensitivity at dysfunctional therapy, like someone who has an asthma attack for a femtogram of nut in a dish.
Taking antidepressants to put up with dysfunctional therapy is like casting a wooden leg IME.

Yes I understand this concern. But the poster stated her T said "IF" she has suicidal ideations she would need to get meds which leads me to believe that is not happening right now. That's why this is the perfect time for her to meet with a Pdoc to address her concerns about meds b/c she is not suicidal right now. She doesn't seem to be 100% against meds...she has concerns and is open to discussing them. If after meeting with a Pdoc if she decides she is 100% against meds....then she needs to look for another T b/c in the event of an emergency, this T will drop her if she refuses meds.

The bottom line is that she is not in a crisis right now and is in a good position to figure out this med situation. Being suicidal is not the time to decide whether she wants to go on meds OR deal with a T who is threatening to drop her.