Visitor in Session

Hi all,

I'm new here, but not new to depression/PTSD, and I have a question for y'all. At my last appt. with my therapist he asked me about a minute before the session started if it would be ok if a student joined us to observe. Being my therapist and all, it was difficult to say no on such short notice. Although the fellow was quite nice, and the session was pleasant if not particularly helpful, I became quite irritated later that day. I felt that my privacy was invaded, and that my therapist was seriously unprofessional for not giving me prior notice.

I sent him an irritated, but not super angry, email stating that I thought it wasn't cool to spring that on me. He replied asking me why I was looking for reasons to be angry. This wasn't totally out of the blue as letting go of anger is one of the reasons I see him, but I found it deeply disrespectful. When I told a couple of friends about this, they were appalled.

Question: Am I overreacting here? I'm ok with being pushed to examine my motives and thought processes, but I think this is 100% on him. He's missed two appts. in one year, and this might be the deal breaker. Any thoughts?

Thanks,
Weebles

He missed two appts? Did he give you notice? Was it an emergency? If either of those things happen, I don't understand the big deal. Life happens, even to Ts.

About having a student there...you agreed to it. I understand that if you had more warning, you maybe would have made a different decision? That's the issue, right? But maybe your T didn't know till that day?

I would have NEVER allowed a stranger to sit in. And my T would NEVER ask it of me either. I did have a Pdoc ask if another (new) Pdoc could sit in. I agreed to it, but when I wanted to talk about private things like my SI, I asked her to step out.

You are absolutely right to be angry and all your feelings are valid. This is 100% on him.
Even though this is not technically unethical to invite a student to a session when the T asked for your permission, it can't be done on such short notice so you wouldn't have time to assess how you feel about it and to make the best decision for yourself. Besides, this sort of things is usually done as a trade off for something because it's not something that the client particularly enjoys.

When I was in school we had training sessions when our instructor would let us watch her sessions with clients through two-way mirror, but clients were informed about it way in advance. It was part of the deal that they would get free counseling in exchange for letting students watch their sessions. They were informed about it before they signed up for counseling and the therapist discussed it with them in length to make sure they were comfortable with that. Then they'd sign the paper authorizing the therapist to use their sessions as educational material.

What your T did was mindless, disrespectful and insensitive at best, but, in my view, it was also unethical. Privacy is one of the most valuable attributes of therapy and a therapist can't be cavalier about it. If he absolutely must use your sessions as educational material he can't use the pressure of immediacy to get you to say yes. He should've given you more advanced notice so you could have a chance to think about it and to decide if that's okay with you.

Also, it's appalling that he refused to take responsibility and didn't apologize but instead turned it around and made it sound like it's your issue. It's not. Pretending that your anger has nothing to do with him is manipulative. I'd fire him to be honest.

I don't think you're over reacting at all! If I was put on the spot like that, I would be so thrown and would probably agree to it since I am not a very assertive person and then be furious afterwards at myself for not saying no and at T for putting me in that position! You should definitely have had notice and time to consider this. This is totally T's fault and you have every right to feel angry.

I really can't imagine any scenario where it's ok to ask a client if they are willing to bring someone else in to observe without a lot of time to think about it and discuss it. (Actually I can't even imagine any scenario where it's ok to ask a client to allow someone else to observe in the first place - you should not be paying to educate someone else.)

His unwillingness to allow any room for your feelings in the aftermath is also strange. Is he a poor therapist generally? I'm finding it hard to imagine how a good therapist would act this way.

I don't think you are overreacting, I believe you got triggered and that your therapist, of all people, should know that springing stuff on someone with PTSD at the last minute is about as bad as sneaking up behind them and scaring them would be, which is ...

TOTALLY. NOT. COOL. AT. ALL. ... !!!

I don't think cancelling on you twice in one year is that excessive ... But, things do tend to add up and then suddenly there's that one last thing, and it all falls apart.

Hopefully this didn't cause a rupture that y'all can't work through, but if it does, there are plenty of other qualified therapists out there that can help you get back on track with your recovery process.

Sincerely,
Pfrog!

Yeah, I agree it's weird.

I did a psych evaluation at my university and they told me it would be free if I let one of the PhD students observe and interact with me. Otherwise, it would've been $1000 ($250 per hour for 4 hours).

I think it was okay in that case, and I didn't mind because the girl was actually very good. They also told me this a month in advance, and they told me I could cancel my appointment if I didn't feel comfortable.

But anyway, Weebles' therapist should have at least offered a free session. I agree that no one should pay to educate someone else. It's wrong.

IDK. I would report her.

I had medical students present at my gyn exams and at my minor surgery and at my ultrasound exams. ( my gyn teaches at medical school). I always agreed to it. If I didn't want them there I didn't have to agree. I was never given prior notice. I never thought my appts should be free because I had a student there. I think the way I see it since you agrees to it you can't do nothing about it afterwards. You could say no. IMHO. I understands it sucks though and you have rights to be upset. I just don't see how you can complain if you agreed to it

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I have had students in on medical exams , surgeries, hospital visits, and childbirth without notice. I have always been given the option to say no, and did so whem I was in the hospital; the other times I agreed. You agreed, so there isn't much you can do about it after the fact. You can voice how you felt put on the spot, but beyond that it is what you agreed to. Just make it known that in the future you do not want any training done in your sessions.

I have been asked several times in medical situations to allow students in- sometimes I refuse, sometimes I allow them in. Therapy is not the same thing at all, however. Plenty of clients feel terribly vulnerable in therapy and find it difficult to refuse a therapist's requests. Weebles pointed out that it was difficult to say no to the therapist. Therapy is such an intimate relationship, and allowing a third party into the dynamic is bound to have effects, some of which may be unpredictable. It's the therapist's responsibility to maintain the safety of the relationship and he failed here.

I am kind of horrified by the idea that the OP shouldn't complain if they agreed to it. The OP is now upset by the situation - where else should one work through it if not with one's therapist? A therapist who believes that one should not complain if one is upset by a situation one agreed to under such circumstances really shouldn't be treating anyone with trauma in their background.

But the therapist isn't giving Weebles space to voice how he/she felt about being put on the spot. Instead of exploring the anger he sounds like he's getting defensive.

I suspect the therapist, who has been working with this client specifically on anger issues, may have a reason for handling the reaction the way he is. The OP did express her anger. The therapist is working with the OP about anger issues and is choosing to handle it according to what he knows about the OP and the entire situation.

Except the entire situation is really quite unorthodox. I've been reading this board since about 2009, and I don't recall anyone ever saying that their therapist had asked them with no notice (or with notice for that matter) to allow a student to observe a session. There are a lot of issues here with safety, boundaries, privacy, that come into play when a third person has been allowed to enter the room. I think it's bizarre that he gave no notice he was going to do this - that seems irresponsible and, given the power dynamics likely to be in play in the room, unethical.

I would not trust the judgment of a therapist who would put a client in this situation- particularly one with trauma in their background.

I don’t think you overreacted at all.

He should have given more notice and talked it out with you. He ought to ensure clients are comfortable & not foist people into a client’s private, safe, space.

I find this - not only springing an ‘observer’ on you at the last minute but also his reaction when you told him you were angry - rather unprofessional. I am really uneasy (red flag) with his comment re you trying to find reasons to be angry.

I also think he owes you a free session. Or at least it would, imo, be the decent thing to do.

OP -- you need to find another therapist.

This is a rather big deal -- the fact that he didn't see it as one beforehand AND doesn't seem to see your issue with it later, would make me lose all my trust in him.

I've also had plenty of students sit in when I was having rather intimate medical exams (hazard of having to first go to the university's health facilities for most medical stuff when in grad school) but I can't imagine how any of those situations even remotely parallel how I am / feel in my therapy.

If this happened, I'd just leave the T for good, no discussion or explanations. Period.

This therapist's response is rather typical, I think, with respect to blaming the client for the therapist's screw up. It can take time to figure out what one is feeling about being pressured by one of those guys. I would not let students in whether with an md or a therapist.
I say be as angry as you like and certainly decline next time.

Oh of course she can complain to her t and on here. I meant formal complaint
As someone suggested to report this t. That's what I was referring "complain".

I personally wouldn't want someone sitting on my session and maybe said no. Or maybe I'd say yes. I don't know

I don't know how things are different or not, I had a med student sitting on the consultation discussing my biopsy results and me with snot and tears all over my face. And I feel pretty vulnerable with my vagina on display and discussing various symptoms and during painful procedures squeezing my nurses hand. Pretty damn vulnerable

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The difference is that therapists are actually supposed to be aware of the potential for psychological harm, and actively work to alleviate it.

I am very sorry you had those experiences in medical offices. I relate to that.

I expect nothing in the way of even normal human understanding from the medical profession, frankly, having been brutalized by it on many occasions. I have regularly had my physical pain and other concerns downplayed or dismissed. I was in regular contact with the medical industry as a small child and it left me deeply traumatized. The way they treated children in the 1970s was truly uninformed about basic psychological needs. I simply don't expect normal humanity from doctors- I have met far too many who lack compassion, and have suffered greatly for it.

But a therapist has been trained to consider the psychological impact of all their actions. It's a really basic failing to not recognize how allowing a third person into the therapy space without any discussion could threaten the relationship's safety.

I agree that you were put on the spot. I tend to give in as I'm one to avoid confrontation.

However, I actually DO allow others to participate in my sessions. My psychiatrist is a teaching doctor, my sessions held at the mental illness wing of the hospital. It just seems to me to be a go-for-the-course that students be involved. But! I actually get paid by the university when this happens.

What? Oh, heck no. No, no, no. I don't think what your therapist did was in any way appropriate, at all. I think you have every right to be upset.

I'm surprised at the number of people who are saying, "well you agreed to it". Not everybody is in the same place, mental-health-wise. It's not uncommon for people to look to their therapists as having more power than them, or wanting to please their therapists. Some people have trouble saying no, especially to perceived authority figures. Someone who doesn't process things quickly under stress (like me!) might have trouble figuring out what to say or do, especially with the student ALREADY THERE. Some people would feel too guilty to say no when asked at the beginning of the session because, clearly, the person is already there, on the premises, and you'd be wasting their time by saying no (i.e. they'd have to leave, or sit around the waiting room waiting for the next client).

For anything else out in the world, this might be fine. For medical exams, this might be fine. But therapy is where we go to deal with all the issues listed above. Therapy is where we go to see a model of a respectful relationship that takes our needs in to account. This therapist did neither of these things. He/She put the student's needs above the paying client. That's really unfair.

I agree with the poster who said it was unethical. I 100% believe it was unethical.

So, what can you do?

Do you feel like the relationship is strong enough to discuss with your therapist? It sounds like your therapist isn't getting why this is a big deal, but perhaps that's because email is not a good medium for emotional discussions? Do you think he/she would respond better in person?

If you don't, or if there's been too many other red flags, I'd quit. Seriously. I think I've gotten to the point where I don't want to spend money to try to work problems caused by an incompetent therapist. But, this really depends on how your prior relationship has been with him/her, and whether you think this was a one-time oversight on their part, or a bigger pattern of them not understanding and respecting you.

I'd also be *really* tempted to try the following:

1. Write to the head of psychology at the school training the student. It's not the student's fault, but it IS disruptive and disrespectful to your therapy. Perhaps they could emphasize to future participating therapists that they must get permission from the client at the session prior to the one where the student attends?

2. Ask for a refund or partial refund. You probably won't get it, but I think that if your session is used for teaching, you shouldn't be paying the full fee. Your session is not going to be as useful with someone else in the room, that's human nature, and your T should understand that. BOTH you and your T are more likely to be "acting" somewhat for the audience... from your perspective, it's going to be much harder to get into deep, important, painful material with a stranger watching. From your T's perspective, isn't it likely that they'd want to show how great a therapist they are, and perhaps act differently than normal?

3. I'd try other options first, but if I didn't get any relief, I'd consider leaving a negative (factual) review on yelp or something similar. I'd want to make sure that I wrote it in a very factual (non-emotional) way, and maybe have a clear-headed friend double check it first. You want to avoid emotions and unfounded accusations, to avoid slander. Facts are OK.

I'd explain, briefly and sticking to the facts, exactly what happened, that it made you uncomfortable, and that the therapist did not seem to understand why it made you uncomfortable.

I think this type of thing SHOULD be reportable to an ethics committee, but sadly, I don't think it actually IS.

And, I'm so sorry that your T did this. It seems like such a violation to me. Oh, and one thing I'd personally want to take away and work on is my ability to say "no" in such situations, to prevent this from happening again. Even if it's a nice/soft no ("I'm sorry, but I'm just not comfortable with that."). I find that sometimes thinking about things like this after the fact, and thinking through how I would have handled it, can help me react better if a similar situation ever arises. Sort of like programming your brain... especially for me, because I tend to react by just blanking out and being compliant when I'm surprised like this, which is not the best reaction.

Again, I'm so sorry. I hope you're able to find a more competent therapist to work with!

I don't think it's helpful to lecture the OP about how they agreed, so kwitcherbeefin'. Under duress or surprise we all have agreed to things we regret later. A therapist of all people should understand that.

What would really bother me is the therapist's response. Telling a client who has a legitimate complaint that they are just looking for reasons to get angry is unprofessional. I would leave this therapist just over that condescending I-know-what's-best-and-you-don't attitude.

Under what effective therapeutic approach would it be helpful to have a therapist dismiss a client's anger? Under that approach, the client's not allowed to get angry at all, at anything. That is not the way to deal with anger issues.

A number of people on this thread would also be angry at the therapist. That suggests the problem is not with the client's anger issues. It is with the therapist.

Therapy by public forum popular vote. Got it.

Thank you for ignoring the substance of my comment - which includes a valid point about how to treat anger issues.

I agree 100%.

Regarding medical, when I was in labor with my first child, I was asked to let students observe. Barely able to breathe, it didn't seem like a bad idea at the time and I felt guilty saying no. After the fact, having 'observers' seemed really violating of my privacy.

I would never want anyone to observe my session, but would feel badly saying no to my therapist. Particularly on the spot.