Your T/doctor/psychiatrist isn´t nice to you because he/she NEEDS you!

It will always be an imbalanced need where I need them more than they need me. I will always feel like a little child as I´m in so much more need of my T or doctor than they will ever need me.

I think that these two sentences are very significant, SarahSweden. I know that when I'm in a therapy situation and when I feel "like a little child", those are the times that I am at my most dysfunctional and in need of the most help. If something triggers me into a "small" feeling, it's something from my past and is usually tied to shame. In therapy, those feelings ARE difficult to deal with, they are the feelings that often make me angry or wanting to flee. But those are the feelings that we usually need to work on IN therapy. For me, those feelings are the ones that prevent me from moving forward to emotionally carve out a comfortable intimate niche with others. If you could talk about those feelings of anger and resentment about the imbalance of a therapeutic relationship with a solid and well trained therapist, you might find where and why those feelings are triggered inside of you. Just a thought.

I'm sorry. I understand the sadness of not being a real person in a therapist's life. I'm a pretty good judge of fake niceness, though. And like jaybird said, there are plenty jerks out there taking our money who cannot even fake being kind (helloooo MDs!)—but if a therapist is being kind to me and it's not syrupy fake, I'll take what I can get. It's okay with me if it's part of the job, as long as they're really good at it. In the end, I just want to get better.

If the ones you've seen have been smarmy and patronizing, though, I'd feel awful too. But...there are those out there who are genuine, or at least care about people in general enough to make it worthwhile. I hope you find that.

I have thought of this as well. The way my T greets me at the beginning of sessions seems really fake at times. I always doubt how everyone feels about me. There are times I ask myself if she is just nice to me because she has to be. I do feel that she genuinely cares about me and she has said so. My mind often wanders. Therapy is weird. You are paying someone to sit and listen to you talk about your issues.

I do not want to see a therapist that "needs" me. Actually I don't want a relationship with anyone who "needs" me. (Been there, done that.) Far prefer the mutually supportive relationship in real life.

In therapy, I prefer to be the sole focus of the relationship and the only one whose needs are met. Selfish, but it's what I need.

i think it is really important to realize that therapeutic relationships are not equal. there is a clear power imbalance in the nature of the relationship, starting from day one. and that doesn't change

Is it not possible T is just a nice person? No seriously, what if T just knows that anger comes from a hurt place "hurt people hurt people" and because of what they know they are more willing to show compassion and empathy?? I don't feel there is any great deceit or mystery in this.

Just as an aside, from a few comments on here, I guess I should consider myself lucky that I've found an MD (my primary care doctor) who seems genuinely kind to me as well! (In addition to my T, marriage counselor, and p-doc).

My t says that she would never work with anyone she didnt like and care about.

Well for me a big part of therapy is learning I can be cared about by someone who DOESN'T need me in any way. I learned early on that I could avoid abuse through hard work--cleaning, cooking, etc . If I did a good enough job I might be okay that day. In my adult life that has left me too independent in a way that sometimes alienates even the people closest to me. I so firmly believe that I have to EARN love that I went to work with a compound fracture that had not been fixed yet. That's not healthy and I could have been hurt much worse. What ever my partner does around the house or for the business I have to do MORE because otherwise why would she keep me around??

The fact that my T doesn't need me used to be a huge issue for me until I started to understand how warped my thinking was ( not saying this is true for anyone else just for me)

Also the whole reason we pay T's is to release the social obligation to provide mutual support. Just like my clients feel OK waking me up in the middle of the night to ask a question about their horse without their having to be available to me in a similar way. The fee they pay me relieves the social niceties that would normally keep you from calling someone at 2 am. They don't get paid because they are more powerful or care less but to equalize the relationship dynamic. Also obviously people who chose to be T's LIKE dealing with people's issues and emotions just like I became a vet because I LIKE helping sick animals...

I've voiced this same concern with my t (many times) - my fear that she doesn't really like me and is just pretending to, and being nice, to make me feel good, raise my self-esteem, aid in my healing, etc. Each time, she has reassured me that she does not pretend. She says that she would not work with a client she didn't like - she would refer them on.

Recently, on one of my sessions, I described to my t what I thought the therapeutic relationship really was. I said that it felt like the therapy relationship is fake, that it is a fantasy that t's allow their clients to believe, so that it creates a feeling of safety that enables the client to open up and and share their problems. I said by thinking the t really cares about them, it gives them the courage to face their issues and feel like somebody is really right there with them (instead of in the past when the client had to face everything alone). I told the t it seemed almost like a trick because once the client makes some progress in healing, the relationship ends. To me, it seems like the t relationship is just "a method," "a means to an end."

After I said those things, I could tell my t was clearly disturbed by what I'd expressed. She wasn't mad or anything, but I could tell it bothered her. She told me that what I'd said made her feel "completely objectified." When I asked her what she meant by that, she said, "It makes me feel like I am an object. Like I am not human and don't have any genuine feelings about people." She went on to tell me that although our relationship is very different, and it is designed to have an ending someday, it is definitely a real relationship based on real feelings of caring.

I think what happens is that so many of us have been rejected, used, and treated badly, we have an almost impossible time believing that our t could truly care about us as individuals. But many of them do. Also, many of us tend to see things in a black and white way, rather than a balanced way. For example, if we said, "I don't mean anything at all to her" or "The only reason she is nice to me is . . .."

I do admit, though, that there are bad t's out there, just like there are people in every profession who aren't good at what they do, or aren't particularly nice people. But I think in the t business, there are many more of them who actually care about their patients than we give them credit for. I know that's true of me. I am always on the lookout for "proof" that my t doesn't care about me. I don't want to fault find, but there is a part of me that is literally terrified to wrongly trust somebody again and get burned. I've been burned too many times already.

On the subject of whether my t "needs" me or not, I don't want or need her to need me. But I do definitely want her to like me as a person and not just pretend to like me because that is her job.

I totally agree with this. You want your life to have meaning, you want your day's work to have meaning. If only in some small way. We cant all be rebuilding haiti and new orleans every day.

It is the therapist’s responsibility to establish the boundaries of the therapy situation. This includes providing a comfortable safe environment and establishing a warm, caring therapeutic culture. It is also the therapist’s role to define what exactly psychotherapy is, because what constitutes psychotherapy is different for different therapists. It is also important for the therapist to define clearly the administrative rules that apply to the therapeutic situation. This amounts to a contract between the therapist and the patient. The therapist provides professional services to the patient for a fee, the patient agrees to be responsible for keeping appointments, being compliant with medications, if prescribed, and paying their bills.

A major part of the professional role of the therapist is to facilitate the awareness, growth and psychological development of the patient.
The uniqueness and strength of the patient-therapist relationship forms a vehicle for therapeutic inquiry and growth. The therapist is responsible for building rapport with the patient through empathic listening, caring and warmth. It is understood that the rapport between therapist and patient is one of the most consistent predictors of successful treatment. As trust builds between the therapist and the patient so does self-knowledge and understanding for the patient.

Therapy is a relationship between the patient and the therapist in which both are expected to change through their interaction in the process of therapy. This is an asymmetrical process in that the patient is expected to change more than the therapist.

One of the goals of therapy is to explore the factors that may interfere with the relationship between the patient and the therapist. By delving into these factors and identifying them, effective strategies can be developed to overcome them. Typically the barriers to a better relationship in therapy are a microcosm of the barriers to better relationships with people outside of therapy. And this is why they get the big bucks$$$

My hair stylist is also friendly, and always happy to see me...yet I'm sure she would much rather not have to wash my dirty hair.

But I think it can be hard to know in some cases, due to the one-way disclosure and the T playing a role. And the relationship does not begin or progress organically, so it is easy to lose perspective, especially if old wounds are exposed.

I actually felt that the mystery and secrecy with my primary ex T was very distressing at times.

For me there is a nagging feeling that the whole process lacks authenticity and could implode at any time, but that also there is the possibility that it could become authentic.

Well said. That was exactly my experience last year. I felt lured into the trap of infantilizing dependency by exT and the process. And then there was no way out that did not involve pulverizing rejection and abandonment.

It was not unlike getting someone hooked on heroin and then telling them you don't know what to do next, so you will just take the heroin away.

I agree it's sad, and it's ironic. Those of us with attachment issues are likely to have this pain, we attach to our therapists because they act as though they really love and care for us... but because it's limited to the professional hour, it creates an extremely frustrating dynamic of craving something you cant have, and feeling loved by someone you know doesn't love you. Sometimes I wonder if it has not harmed me given the number of tears shed over the years because I see that our connection is both "fake," paid for, and lopsided. Meanwhile at my core is an insecure child longing for love and approval and it's like a tease almost, here is this love and approval, but it's just an act, or is it?

But how many Ts are actually seeking or getting support, perhaps unconsciously, from their clients? I know mine was.

Do you 'use' people? This reads like you live a sad existence. Perhaps projecting parts of your own attitude in life in to others that can fill that role.

My therapists were far more needy than I was. They needed to be sagacious. They needed to be saviors. As therapy progressed, I got into role play carrying the weight of their needs and illusions rather than the opposite.

That may happen. But you are not OBLIGATED to reciprocate their support the way you are with social friends etc. If I constantly called my best friend for help but wasn't there when she needed me the relationship would not last. In T, I can call her for help but she NEVER calls me because the money takes the place of reciprocal social support. I think anyone who spends the years to get a doctorate in a discipline is fulfilled by it and the work they do. As a veterinarian helping owners and their horses gives me deep satisfaction and meets my need for purpose in life etc. I'm sure my T gets the same kind of needs met in her job. We ALL do. But specifically the money releases the obligation to be available to T to meet their emotional needs.

There has been pushback against the medical community because in prior times medical providers were too patronizing. Doctor knows best, patient's autonomy not respected. I don't see this happening so much anymore.

I have never viewed my patients as children (well, except for those that literally ARE children! )

I view my patient's as human beings first. I gain great value out of interacting with these people; farmers, truck drivers, homeschooling moms, sisters, nephews. I learn about lives that differ greatly from mine and others that strike a similar chord. These interactions form a tapestry of life and human experience that I cherish. I would never be able to view life from so many eyes were it not for these interactions.

I stand up for myself if a patient has a complaint. If it has merit I listen and see what I could do better. I don't make false noises of understanding, I instead try to put myself in their shoes and understand why they feel how they do. However, I'm firm with a patient if THEY are in the wrong. I'm not a therapist so I don't have to follow the unconditional positive regard, and if there is a very toxic patient I will decline to see them again.

Just some thoughts from a family medicine practitioner.

Thanks for sharing, very interesting.

The thing about referring clients if a T or a doctor doesn´t like you I think is more frequent within private practises than within public mental health care.

I see a doctor within psychiatry and public mental health care and here they can´t dismiss people as easy as they are contracted and financed in a different way.

I think it was both brave and good of you to tell your T about how you feel about your relationship. I don´t think though it´s objectifying the T to question the relationship. I see it in a very simple way - I need a T both for talk and for comfort, many clients don´t have this in their real life.

I absolutely believe most T:s care but not because you matter to them in a wider perspective. Even if some T:s of course are living by their own, they have an education (as a T), they have their own practise (if having their own business), they have a job. That´s a lot more than many clients have.

At the end of the day many clients and patients long for their T:s, they miss them and so on. What do the T:s or doctors do? Of course they don´t miss their clients or would want them to accompany them after work, to give them a hug or whatever.

That is - they aren´t nice to us clients because they need us.

What do you mean by "use" people? I don´t see seeking therapy or a doctor as using people, they have chosen to work with helping people.

What would the "using" consist of you mean?

I think that in every profession there are always certain clients that hit a soft spot. Just because your therapist keeps a professional attitude in a session does not necessarily mean that you have not impacted their life in some way. I know this is a different situation, but when my dad passed away the hospice Dr. sat on my mom's bed and cried with her. She said that there are always those people that you make a connection with and even though it is their job the emotions are real. Just remember that if you were in a session with a therapist that seemed too emotionally connected with you then it could be more difficult to say the things you need to say. I think possibly keeping those boundaries in place could sometimes be difficult for the professionals then we realize.

This really is a misunderstanding of the mindset of a T. We are nice because we are nice people. Most T's are also nice with non-clients, and I know this because I have so many T friends. Most of us (the good ones) like people in general and want to be helpful, and this is why we got into the field. No, the fact that we are nice to you doesn't make you special (although hopefully a T sees and likes what IS special about each client), but it's not something that's just done mechanically for a purpose.

I don´t have those experiences of meeting T:s and doctors, that they are nice and want to be helpful.

My psychiatrist is nice as long as I ask for what they can afford to give me in terms of therapy and evaluating me for a diagnosis. But when I ask for something they don´t afford at this clinic, it isn´t much about being nice anymore. More the opposite. I´m never aggressive or such, I just tell them what I need and I´m very aware of how therapy works.

At the end of the day, meeting with me and other patients, this psychiatrist or T or doctor just closes her door to her office and it´s nothing more to that. I keep suffering, longing for someone to listen as I wasn´t listened to and never was when trying to find help which I´ve done for a very long time now.