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View Poll Results: Who holds the power in the client-therapist relationship?
The therapist 34 34.34%
The therapist
34 34.34%
The client 19 19.19%
The client
19 19.19%
Neither/considerations of power do not apply 11 11.11%
Neither/considerations of power do not apply
11 11.11%
They hold more or less equal power 12 12.12%
They hold more or less equal power
12 12.12%
Power shifts back and forth over the course of the relationship 15 15.15%
Power shifts back and forth over the course of the relationship
15 15.15%
None of the above (please explain) 8 8.08%
None of the above (please explain)
8 8.08%
Voters: 99. You may not vote on this poll

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  #76  
Old Jan 01, 2016, 11:16 PM
UglyDucky UglyDucky is offline
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Quote:
Originally Posted by atisketatasket View Post
The topic has come up in another thread, and deserves its own thread.

Who do you think holds the power in the therapist-client relationship?

I am talking here about the traditional therapist-client relationship: not inpatient, but people who have regular sessions, etc.

I am not talking about:

-inpatient mental health services
-psychiatrist relationships, given the power of an MD to prescribe medications and hospitalize
-situations in which a therapist might be testifying in court in relation to the client's affairs, e.g., a custody case

So in a "normal" therapist-client relationship, who holds the power?
How is the word power being used, here? Power as who is the person in charge of the therapy process? Who has the most influence in the relationship? Who, in the relationship, dictates the issues addressed? Perhaps I'm able to view this poll question only in terms of my own therapy and, if so, I don't think 'power' is part of our process. I sought out my T, my insurance pays my T (and I pay the insurance premiums and copays), and my T offers his/her professional assistance and competence to help me understand the issues that brought me to therapy and make suggestions to change or correct problems that would make a difference in my life.

I'll be interested to read what others think about this poll...I'm sometimes a bit short-sighted.
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  #77  
Old Jan 02, 2016, 03:00 AM
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ChipperMonkey ChipperMonkey is offline
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Each views the other as having power in many cases.

Clients are seeking out something from the therapist and believe that the therapist has the power to give them what they want. Love. Acceptance. Whatever. This is why so many emotionally unwell people go down dark paths in therapy. They think the therapist knows best.

Therapists know that the client has the power to stop paying them so the therapist oftentimes bows down to the client and won't even say "boo".
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  #78  
Old Jan 02, 2016, 04:42 AM
Anonymous37817
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In a relationship:

Whoever needs the most has the least amount of power.
Whoever needs the least has the greatest degree of power.

...In therapy and possibly other relationships.
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  #79  
Old Jan 02, 2016, 06:33 AM
missbella missbella is offline
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I agree and also believe:

Whoever takes the most risk in criticizing the other....
Whoever is identified as having the problems....
Whoever is expected to accept criticism....
Whoever has the expected obligation of "growth"....
Whoever is "labeled" with illness and disorder....
Whoever is identified as outside of the norm....
Whoever is identified as dependent, needing a strong other for decisions or function....
Whoever is instructed, given rules, restrictions and boundaries....
Whoever is most seeking the other's caring, approval and praise....
....has the least power

Whoever is identified with authority and "expertise".....
Whoever is the most detached, taking the role of the "observer"....
Whoever has the most permission to judge, evaluate and disapprove....
Whoever controls the narrative and interpretation....
Whoever diagnoses and labels the other....
Whoever can condescend, goad, bully or belittle with the least consequence....
Whoever sets the stage and the rules....
Whoever is the least flexible and available....
Whoever withholds his own self-doubts, deficiencies and weaknesses....
Whoever can (unapologetically) chose not to speak or respond....
Whoever puts forth a protocol without explanation, rational or disclosure....
Whoever can break rules and promises, or change them, with the least consequence...
....has the most power

And, frankly when we consider therapy a contract between two equal human beings, these roles can be unearned and arbitrary....

Quote:
Originally Posted by ex vivo View Post
In a relationship:

Whoever needs the most has the least amount of power.
Whoever needs the least has the greatest degree of power.

...In therapy and possibly other relationships.
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  #80  
Old Jan 02, 2016, 08:32 AM
Anonymous37890
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Quote:
Originally Posted by missbella View Post
I agree and also believe:

Whoever takes the most risk in criticizing the other....
Whoever is identified as having the problems....
Whoever is expected to accept criticism....
Whoever has the expected obligation of "growth"....
Whoever is "labeled" with illness and disorder....
Whoever is identified as outside of the norm....
Whoever is identified as dependent, needing a strong other for decisions or function....
Whoever is instructed, given rules, restrictions and boundaries....
Whoever is most seeking the other's caring, approval and praise....
....has the least power

Whoever is identified with authority and "expertise".....
Whoever is the most detached, taking the role of the "observer"....
Whoever has the most permission to judge, evaluate and disapprove....
Whoever controls the narrative and interpretation....
Whoever diagnoses and labels the other....
Whoever can condescend, goad, bully or belittle with the least consequence....
Whoever sets the stage and the rules....
Whoever is the least flexible and available....
Whoever withholds his own self-doubts, deficiencies and weaknesses....
Whoever can (unapologetically) chose not to speak or respond....
Whoever puts forth a protocol without explanation, rational or disclosure....
Whoever can break rules and promises, or change them, with the least consequence...
....has the most power

And, frankly when we consider therapy a contract between two equal human beings, these roles can be unearned and arbitrary....
I agree totally. I think most power a client believes they have is simply an illusion.
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  #81  
Old Jan 02, 2016, 08:50 AM
Anonymous37785
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Quote:
Originally Posted by puzzle_bug1987 View Post
I agree totally. I think most power a client believes they have is simply an illusion.
I really never thought of psychotherapy has an issue of power, but maybe the ultimate test is making it out of the illusion, a bad daydream. I'm glad I made it out.
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  #82  
Old Jan 02, 2016, 09:30 AM
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atisketatasket atisketatasket is offline
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Quote:
Originally Posted by puzzle_bug1987 View Post
I agree totally. I think most power a client believes they have is simply an illusion.
Perhaps, but if so, it may be an illusion that can be very useful to a client. And may prevent problems from developing in therapy. Clients who think they have power will behave differently from clients who don't.
  #83  
Old Jan 02, 2016, 09:42 AM
musinglizzy musinglizzy is offline
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I voted the T.... but one place where the client has all the power is whether to stay or go. My T has the power to "giveth, and taketh away,) and has used that, with very damaging results for me. But I have the power whether to stay or not.
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  #84  
Old Jan 02, 2016, 09:45 AM
Anonymous37890
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Quote:
Originally Posted by atisketatasket View Post
Perhaps, but if so, it may be an illusion that can be very useful to a client. And may prevent problems from developing in therapy. Clients who think they have power will behave differently from clients who don't.
True, but it can be a devastating blow when the client realizes they really don't have the power they thought they did.
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  #85  
Old Jan 02, 2016, 09:46 AM
missbella missbella is offline
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Quote:
Originally Posted by atisketatasket View Post
Perhaps, but if so, it may be an illusion that can be very useful to a client. And may prevent problems from developing in therapy. Clients who think they have power will behave differently from clients who don't.
The illusion of the therapist as powerful healer was the opposite of what I needed.
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  #86  
Old Jan 02, 2016, 09:52 AM
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atisketatasket atisketatasket is offline
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Quote:
Originally Posted by puzzle_bug1987 View Post
True, but it can be a devastating blow when the client realizes they really don't have the power they thought they did.
There is always the power to walk out the door (again, with the exceptions in my op). That's more than enough for me. I haven't had to exercise it with a therapist yet, but I have with doctors. No devastation involved - sometimes a bit of regret that I put up with whatever it was that made me walk for as long as I did, but that's it.

I am not sure what you mean by "the power they thought they did."
  #87  
Old Jan 02, 2016, 09:55 AM
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atisketatasket atisketatasket is offline
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Quote:
Originally Posted by missbella View Post
The illusion of the therapist as powerful healer was the opposite of what I needed.
You're shifting topics. That is not the illusion to which I referred. Nor was I saying that all illusions are good ones.

The powerful healer illusion is also not an illusion I have ever bought into - not with therapists, not with doctors. I agree that too many people do so - but again, that illusion can be made less powerful with a clearer idea of who holds what power and rights in relationships like this one.
  #88  
Old Jan 02, 2016, 10:06 AM
Anonymous50005
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Quote:
Originally Posted by missbella View Post
I agree and also believe:

Whoever takes the most risk in criticizing the other....
Whoever is identified as having the problems....
Whoever is expected to accept criticism....
Whoever has the expected obligation of "growth"....
Whoever is "labeled" with illness and disorder....
Whoever is identified as outside of the norm....
Whoever is identified as dependent, needing a strong other for decisions or function....
Whoever is instructed, given rules, restrictions and boundaries....
Whoever is most seeking the other's caring, approval and praise....
....has the least power

Whoever is identified with authority and "expertise".....
Whoever is the most detached, taking the role of the "observer"....
Whoever has the most permission to judge, evaluate and disapprove....
Whoever controls the narrative and interpretation....
Whoever diagnoses and labels the other....
Whoever can condescend, goad, bully or belittle with the least consequence....
Whoever sets the stage and the rules....
Whoever is the least flexible and available....
Whoever withholds his own self-doubts, deficiencies and weaknesses....
Whoever can (unapologetically) chose not to speak or respond....
Whoever puts forth a protocol without explanation, rational or disclosure....
Whoever can break rules and promises, or change them, with the least consequence...
....has the most power

And, frankly when we consider therapy a contract between two equal human beings, these roles can be unearned and arbitrary....
But most of the above does not describe the therapy situations I've ever been in, certainly not in any set, hard-fast way. I found many of these on the list didn't apply ever at all. Others occasionally described me (from both lists) and occasionally described my therapist (from both lists). Could be why the whole "power" issue just was a non-issue in my (and several others who have posted) therapy. It just wasn't a central issue.
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  #89  
Old Jan 02, 2016, 10:07 AM
Anonymous37890
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Quote:
Originally Posted by atisketatasket View Post
There is always the power to walk out the door (again, with the exceptions in my op). That's more than enough for me. I haven't had to exercise it with a therapist yet, but I have with doctors. No devastation involved - sometimes a bit of regret that I put up with whatever it was that made me walk for as long as I did, but that's it.

I am not sure what you mean by "the power they thought they did."
What i mean is the power the client thought they had. I was just going by the way you phrased it.
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  #90  
Old Jan 02, 2016, 10:10 AM
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atisketatasket atisketatasket is offline
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Quote:
Originally Posted by puzzle_bug1987 View Post
What i mean is the power the client thought they had. I was just going by the way you phrased it.
My idea of client power has always been the right to hire and fire and the right to evaluate the therapist's performance. The second could be ignored by the therapist if the client offers some feedback - it never was by either of mine - but hardly the first. And ignoring the second without a good reason would be grounds for the first to me.

So if a client goes in with those two ideas of power at minimum, I'm not sure how they could be devastated.
  #91  
Old Jan 02, 2016, 10:45 AM
Anonymous37890
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I was pretty devastated and i know others who have been. Sometimes I think if i had known all the things I was supposed to know about therapists and therapy and how it works (which i don't think it does) I wouldn't have gone to therapy. I would not have thought I needed it.
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  #92  
Old Jan 02, 2016, 01:24 PM
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atisketatasket atisketatasket is offline
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Quote:
Originally Posted by puzzle_bug1987 View Post
I was pretty devastated and i know others who have been. Sometimes I think if i had known all the things I was supposed to know about therapists and therapy and how it works (which i don't think it does) I wouldn't have gone to therapy. I would not have thought I needed it.
I'm not saying no one can be devastated by therapy; that's obviously untrue. From what I recall of your story, it's pretty horrible.

I also think hardly anyone goes into therapy knowing what they're "supposed" to know. I sure didn't. Which is one reason to discuss therapy - including the horror stories and urging skepticism - on a public forum like this.

But if I understand what you are saying, you did not feel you had the power to leave. May I ask why not? How was what seems a very basic power removed? Did the therapist convince you explicitly or implicitly that you couldn't leave without becoming worse, etc.?

Last edited by atisketatasket; Jan 02, 2016 at 04:57 PM.
  #93  
Old Jan 02, 2016, 01:44 PM
Anonymous37817
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Quote:
never thought of psychotherapy has an issue of power
I think it does because power dynamics are core to many issues. But I think of power dynamics correlating with death or survival.

Quote:
How was what seems a very basic power removed?
Though in response to another's reply, I think the context was in a client's power to quit, leave therapy. For me it's not a matter of a power 'being removed'. The attachment in the therapy setting can be so strong that it feels like parent-child. And for a child, this attachment is a matter of survival. So it was already there, brought to surface by the relationship.

Rationally, I think, this is just a therapy relationship. I can just leave! But the emotional part of me keeps me tied up in these dynamics. Leaving therapy before it's finished would be traumatic for me, similar to how it played out in childhood. ie the attachment is so painful that I sever it and cut my parents off emotionally and physical, going on my own before I'm ready-with traumatic consequences. I have thought of quitting numerous times, but it seems to be a lose-lose situation. I am trying ot work things out right now but am afraid I did all I can do at this point.

Some of us make ourselves more vulnerable than others. Because of our temperament, character, beliefs in therapy, defenses, or other reasons. The most vulnerable natural seem most likely to be hurt.

Quote:
vul·ner·a·ble

susceptible to physical or emotional attack or harm.
"we were in a vulnerable position"

synonyms: helpless, defenseless, powerless, impotent, weak, susceptible
"he was scared and vulnerable"

•(of a person) in need of special care, support, or protection because of age, disability, or risk of abuse or neglect.
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  #94  
Old Jan 02, 2016, 02:45 PM
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Partless Partless is offline
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The long list missbella refers to in her response reminds me more of the cult-ish type new age therapy gurus or alternatively the real orthodox psychoanalyst. And I hope nobody has had the experience of dealing with (what I hope) to be a very small group of therapists where the balance of power is completely lopsided.

Another thing just now that I was thinking about, not directly related to the above, is about whether power comes from the individual or the institution:

The guru type therapist gets most of her power from herself, being special and superhuman. She may not even have a license but could have a big following. The psychiatrist type of therapist gets most of his power from institution of psychiatry, which requires the person qualify as a psychiatrist and also be regulated by them. The power to prescribe drugs, to officially diagnose, to commit someone against their will, etc, comes mainly from psychiatry's power, not the person themselves.

Perhaps for some people this distinction makes no real difference, because power is power, but one thing I try to do, whenever I feel powerless, is to try to see the source of power. Where is it coming from and who has it?

These kinds of questions are useful if you feel powerless all the time. I know myself going into therapy often feel quite powerless in my life. And I have a tendency to project too much power into others. Sometimes the power they have is real and I was right. But sometimes it's not. And sometimes I have more power than I imagined.

But it, well, sucks, that people go into therapy to feel empowered and sometimes therapy situation itself just adds to their disempowerment. It's like going to a doctor and getting sicker!
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  #95  
Old Jan 02, 2016, 02:51 PM
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atisketatasket atisketatasket is offline
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Quote:
Originally Posted by Partless View Post
The long list missbella refers to in her response reminds me more of the cult-ish type new age therapy gurus or alternatively the real orthodox psychoanalyst. And I hope nobody has had the experience of dealing with (what I hope) to be a very small group of therapists where the balance of power is completely lopsided.

Another thing just now that I was thinking about, not directly related to the above, is about whether power comes from the individual or the institution:

The guru type therapist gets most of her power from herself, being special and superhuman. She may not even have a license but could have a big following. The psychiatrist type of therapist gets most of his power from institution of psychiatry, which requires the person qualify as a psychiatrist and also be regulated by them. The power to prescribe drugs, to officially diagnose, to commit someone against their will, etc, comes mainly from psychiatry's power, not the person themselves.

Perhaps for some people this distinction makes no real difference, because power is power, but one thing I try to do, whenever I feel powerless, is to try to see the source of power. Where is it coming from and who has it?
I see the distinction you're making, and I think it is a real one, but it seems to me most therapists would fall into neither category. Most therapists are not psychiatrists and therefore don't have institutional power. I'm not sure what you mean by new age therapists, but neither of mine set themselves up as a guru, and that seems to be the case with a good number of therapists described on the forum (not all, though). So where does that rather large middle of mental health professionals get the power they are perceived to have?
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  #96  
Old Jan 02, 2016, 04:09 PM
missbella missbella is offline
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I've seen power taken and surrendered in extremely subtle ways, in controlling the narrative, in who instructs, who can belittle without consequence etc. And if someone is vulnerable, needs relief from pain, needs answers, the client can be easier to manipulate, particularly if they ascribe expertise to the counselor. I've seen a hierarchy in many social relationships, not just therapy. In junior high it's the mean girl thing.

Quote:
Originally Posted by atisketatasket View Post
I see the distinction you're making, and I think it is a real one, but it seems to me most therapists would fall into neither category. Most therapists are not psychiatrists and therefore don't have institutional power. I'm not sure what you mean by new age therapists, but neither of mine set themselves up as a guru, and that seems to be the case with a good number of therapists described on the forum (not all, though). So where does that rather large middle of mental health professionals get the power they are perceived to have?
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  #97  
Old Jan 02, 2016, 04:18 PM
Anonymous37890
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Originally Posted by atisketatasket View Post
I'm not saying no one can be devastated by therapy; that's obviously untrue. From what I recall of your story, it's pretty horrible.

I also think hardly anyone goes into therapy knowing what they're "supposed" to know. I sure didn't. Which is one reason to discuss therapy - including the horror stories and urging skepticism - on a public forum like this.

But if I understand what are you saying, you did not feel you had the power to leave. May I ask why not? How was what seems a very basic power removed? Did the therapist convince you explicitly or implicitly that you couldn't leave without becoming worse, etc.?
I never really thought about leaving. He ALWAYS said he would be there with me through the healing process. I trusted that and then he told me out of the blue not to come back unless i would bring my husband which was something (a boundary i had) he knew I would never do. He refused to see me anymore to even talk about it. He called me the day before my session. That was power he had to refuse to see me. It really damaged me.
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  #98  
Old Jan 02, 2016, 05:27 PM
BudFox BudFox is offline
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Quote:
Originally Posted by SkyscraperMeow View Post
Client and therapist share power in the relationship - right up to the point the client becomes emotionally invested, at which point the power is immediately transferred to the therapist.

The only power the client ever has is whether or not to remain a client. The therapist gets to choose time, place, fee, how much support they will offer, whether or not you can call them outside sessions, whether or not they will take off for two months on vacation, etc, etc, etc. More importantly, the therapist is never, ever as dependent on the client as the client is on the therapist if emotions come into the picture.
Was just reading through this thread, and glad to see someone made this distinction. You can almost divide all therapy relationships into two categories -- those where the client has become exposed emotionally (or invested as you say), and the rest. Two totally different animals. Even the decision to remain a client or not is, as some have noted, not within the client's power if they things have progressed to dependency or addictive clinging.
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  #99  
Old Jan 02, 2016, 05:30 PM
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PinkFlamingo99 PinkFlamingo99 is offline
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Quote:
Originally Posted by atisketatasket View Post
I see the distinction you're making, and I think it is a real one, but it seems to me most therapists would fall into neither category. Most therapists are not psychiatrists and therefore don't have institutional power. I'm not sure what you mean by new age therapists, but neither of mine set themselves up as a guru, and that seems to be the case with a good number of therapists described on the forum (not all, though). So where does that rather large middle of mental health professionals get the power they are perceived to have?
Working with people who are hurting, desperate to be cared for, and are looking for a connection. I felt therapy was hurting me for a long time but I was terrified of leaving because I loved her and she told me she loved me. When you're in pain and feel alone and depressed, feeling safe/loved like that is everything. In my case, I believe she did love me at one point(or thought she loved me, you don't hurt people you love and not care), but it gave her a *huge* power advantage because I would have done anything to keep her in my life. And she forgot her role was to help me and didn't even try to minimize any damage.

I think for people with different personalities/stories/hurts, it's hard to understand this dynamic or how strong the pull is to feel like someone loves you. It's why cults use "love bombing." For someone like me with abandonment issues, who was alone and struggling, the power came *from* that relationship. It was unhealthy and kind of codependent, but at the time, I basically would have done anything to have her in my life.

Yes, this sounds totally mentally unhealthy, but that's why I was in therapy in the first place. AND why I ended up so damaged by what happened.
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  #100  
Old Jan 02, 2016, 05:35 PM
Anonymous50005
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But one can be emotionally invested without being dependent and without it being about power. That's one of the great lessons and experiences in life -- to have relationships that are invested in healthy ways, realistic in expectations, not full of power plays, and understand that ups and downs and beginnings and endings do happen as the usual course of things. I've been fortunate enough to experience that both within and outside of therapy.
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