[notwithhaste]

Beyond involuntary hospitalization in the case of suicidal intent?

I think that ultimatums from a therapist ("take my advice or I won't work with you anymore") seem manipulative...and an instance of overstepping. What do you guys think? Is that something a T has the right to do?

[stopdog]

I am not sure I would call it a right. But I would think anyone can choose who to work with or not - client or therapist. I would quit a therapist who tried such a thing with me so the end result would be the same. I would not see the point in me continuing to deal with one of them who thought they had the right to tell me what I had to do.

[BlessedRhiannon]

I think the T has the right to say such things, just as I, as a client, have the right to leave the T if they say such things. So, I don't think it's about rights so much as a style of relating to clients. If a T feels the need to give ultimatums and insist that a client follow the T's specific requirements, then it is certainly their "right" to run their practice that way. For some people, that might even be helpful and they may need a T that sets such requirements. Personally, I would not want to be in a relationship where I am expected to do exactly what the T wants me to do. There are times where my T's advice is a better course of action than the one I'm currently following, and I will listen to her advice and suggestions and decide if that is a course of action I wish to follow. But, I reserve the right to decide that for myself and if I don't wish to follow T's advice, then I won't. If following everything a T tells their client to do is a requirement for continued treatment, then either the T or client might be better served ending the relationship if that is not acceptable to the client.

I think they have the right, but a competent therapist would not say or do something like that. I consider it a sign of severe incompetence.

[Seeking_Peace]

Ultimatums from a T may be manipulative or overstepping their bounds....but a T has every right to set their own rules/policies when it comes who they choose to work with. T is a service provider just like anyone else.

At the end of the day, they also have to feel comfortable with the client they're working with.

I also think if a therapist is going to make ultimatums it should be made VERY clear from the start of therapy so a potential client can know this might be a possibility. I would never choose to work with such a therapist.

I think ultimatums are overstepping, with the exception of dangerous situations. If my therapist gave me one, id get angry and term.

I've never had a therapist give me ultimatums; I've had them be quite firm with me, but not to the extent of an ultimatum.

Now, my pdoc is another story, but in his case, he was dealing with me on very much life or death terms surrounding severe suicidality and need for hospitalization. He needed to be hard-nosed with me because anything more subtle wouldn't have penetrated my depression and psychosis.

[stopdog]

I have found some people like to be told what to do. It mystifies me, but such people do exist. And some therapists (none I would hire) like to think they are creating a helpful atmosphere by ordering clients to do things (they have admitted such in their writings and lectures). It is a very paternalistic approach.

[JaneTennison1]

T can order but you don't have to do anything. My T would get no where ordering me to do something, it would annoy me so much. You have a right to choose not to see a T who thinks they can order you to do something.

[Crook32]

My T is strongly suggesting that I should go to php at the moment but she stressed that I still have free will and that she can't make me go.

Sent from my iPhone using Tapatalk

[unaluna]

Would this be a different thread? - why do we go to ts and then not listen to their advice? I had ts tell me for over 30 years to stay away from my family for a given period of time - say a year - so we could make some progress, but i always let my mother guilt me into doing what she wanted. Until recently. Until it was too late. So whose life is it anyway?

Advice is one thing (I'm not sure a therapist should even be giving advice.), but ultimatums are another. My ex-therapist told me the day before my session to bring my husband or not to come. This was something we had NEVER EVER discussed and he had never brought it up until this day. I don't think what he did was right or fair. I think it was stupid and idiotic.

[Ididitmyway]

If it has to do with the client's life choices, the therapist doesn't have the right to insist that the client makes a choice the therapist thinks they should make. The therapist does, however, have the right to express their opinion about the client's choices. This has to be part of therapeutic exploration, otherwise, it'd be no different from moral judgment.

I have to say though that in some cases, moral judgment of client's behavior is totally appropriate like in cases of child abuse, elder and dependent adult abuse and other behaviors that are clearly considered immoral by the large part of the society.

If the client tells me they use their elderly mother's social security money for their own purposes that have nothing to do with taking care of her, you bet I will have a strong opinion about that! And I will not hesitate to express that opinion apart from the fact that I will also report this to the adult protective service, as I am required to.

In fact, I believe that telling client that something they did was morally wrong when you firmly believe it was wrong, is much more caring than just sitting there and pretending to be "neutral", as if you are not a real human being with real moral values.

When it comes to therapy process it has to be collaborative. How therapy work is to be done is for both therapist and client to decide. This agreement doesn't have to be set in stone, it can be changed any time, but the whole process has to be collaborative. If, at any point, the agreement cannot be reached, therapy has to be terminated.

Originally Posted by Ididitmyway

IIf, at any point, the agreement cannot be reached, therapy has to be terminated.

Or . . . you can agree to disagree (which in a way is an agreement I suppose). My T and I have done that on several fronts over the years.

[ThisWayOut]

I wouldn't work with a therapist that gave me ultimatums, even when it comes to life or death. If I have a decent working relationship with the T, I will take their opinion and thoughts under advisement. Even at my most "unsafe", my T was able to get me to go inpatient voluntarily (that was not always the case with a clinician or PDoc I didn't know).

While a T has every right to be selective about their clientel, I agree that ultimatums are not very professional. Therapy should eb a collaborative process, as Ididitmyway said. If no agreement can be reached, then it's time ot find a new working relationship.

[Ididitmyway]

Originally Posted by lolagrace

Or . . . you can agree to disagree (which in a way is an agreement I suppose). My T and I have done that on several fronts over the years.

By agreement I meant the agreement on how we both want to do the work. If you, as a client, want me to do one thing, and I don't want to do that thing, I don't see how we can continue to work. We can agree to disagree about it in the sense that we respect each other's opinions, but we cannot continue our work.

For example, some people want to bring their family member to their therapy sessions every once in a while and some therapists don't mind that. I do mind that and this is not how I do the work. If having an opportunity to invite other people to their therapy sessions is vitally important for the client, then this is an unworkable situation because I won't be able to accommodate it. In this case, I will refer them to a therapist who will be able to do for them what I can't and won't do.

[Jordy]

My T has actually given me an ultimatum in October '13. The deal was I could come to the skills group sessions, but she would not see me individually except for crisis mangement until I had send at least one job application out.
This was at a time when I desperately needed a new job, but was even unable to look at job offers without thinking I was so worthless that no one would hire me anyway, so why bother. T really worked with me on this for months before coming to this ultimatum and I truly believe at that point she was at her wits end.

Anyway I sent a terrible application in a few weeks later and have resumed therapy with her shortly afterwards. I'm not sure whether this was the best courseof action she could take, but I know that even though she likes working with me she also says I'm a tough case and she has asked her supervisor for advice on a few occasions.

[stopdog]

I did not start going to see a therapist because I wanted their advice. That was never part of it for me. I don't want their moral judgement or their caring opinion - I don't care about it and don't want to pay for the time it takes them to say it. And I am not so stupid as to tell them anything that is part of mandated reporting.

[BlessedRhiannon]

The only time I really want advice from my therapist is when I directly ask for it. My T is very good at not giving advice unless asked. However, there have been a few times when I just wasn't capable of making a good, rational decision, and at those times, my T will tell me what she thinks is the best course of action. I still have the right to not follow through with it. I have told my T several times "I need some ideas around how to deal with xyz" and she will offer advice at that point.

[scorpiosis37]

I think it depends on what kind of "ultimatum" you are talking about. I think, in some cases, there is a fine line between an ultimatum and a boundary. For instance, I think it would be fair for a T to request that the client show up sober to appointments, not overstep clearly laid out boundaries (i.e. don't text 10 times/day), or comply with a medication regimine given by a PDoc. A T may need those minimums met in order to conduct proper therapy. However, I do not think it would be appropriate for a T to give ultimatums with respect to the client's personal life (i.e. break up with a partner, stay away from family, quit job, etc). That is the client's business.

[ScarletPimpernel]

If your life is in danger, it is part of their responsibility to contact appropriate authorities (i.e. hospitals and police). They also can terminate if they don't feel equipped to handle such situations. But you also have the right to walk away.

My ex-T did this to me all the time. "Do this, or i wont see you anymore." ALLL the time. I attended support meetings that had nothing to do with anything i had as an issue, at her insistence. I went to doctors i didnt need to go to. And she always upped the ante. Nothing was ever good enough for her- once i did one thing, she insisted on me doing another and another and another.
Then she ended up dumping me anyway.

[Rive.]

That depends. In my opinion (Ts are bound to have their own take and/or boundaries on this) if one is a danger to themselves or to others, then it might be warranted. If a patient is recalcitrant, then this 'ultimatum' might be the one thing to shake them to take action. I don't see it as being manipulative in this instance.

However, in other (non life-threatening instances) I believe a T should not tell a patient how to lead their lives.

[AllHeart]

I'm not a fan of giving ultimatums, but sometimes it does need to be done. I do not understand ending therapy as being part of an ultimatum though...especially if a client's safety is involved. T sounds like s/he is perhaps immature, or lacking compassion.