Therapist as boss

Not looking for people to agree with the premise. I expected that few would, and few have. I frequently read posts on this forum that defend all manner of crazy, dictatorial acts or commandments by therapists, on the basis that the therapist is in charge. Example--someone reports the boundaries set down by their therapists, and a bunch of people advise "you better follow them rules, or you might get terminated/fired".

I was trying to get inside this mindset, to see what makes therapists qualified to be the boss in this way… especially when it comes to terminating the relationship, which is an area where therapists seem to believe in their absolute supremacy.

As for comparison to other relationships, I think therapy is unique in its bizarre power dynamic and asymmetry, and the tendency for client to lapse into childlike regression. Totally different ballgame.

None of this surprises me. A therapist who disavows the psychological power they hold over some clients especially and all clients generally is either manipulative or dangerously ignorant. Agree that many therapists seem to get satisfaction from driving the client according to the therapist's own notions of progress. That, then, is therapy for the therapist. It's part of the basic makeup of therapy in many cases it seems--it's ostensibly client-centered but is in truth equally therapist-centered.

My experience and general sense is that therapists rarely request permission or consent for anything. I've certainly never had a therapist declare their intention to be in charge and ask for my consent. They just assumed that role, to varying degrees. I'd say it's an unspoken contract, the client is expected to become subordinate. Only the details and extent of that vary.

I would have been too intimidated in most cases to assert my own authority or to resist therapist control (though no longer). I gather that many clients feel the same. I've experienced what happens when you challenge that authority. The one therapist went semi nuts on me. Another got hostile in the second session. One other got weird in an email and then told me we weren't a good fit.

Agree, should not judge those who want a therapist who is the boss. My original point was to understand the idea that therapists should be considered, by default, the authority figure in any given therapy relationship and that their judgement should be primary and even absolute, because this idea manifests often here and everywhere. Again, going back to the question of terminating the relationship… many clients appear to live in fear of being summarily discharged by a therapist against their will. And this is totally accepted in wider therapy culture. It's written into all ethics codes. But when I look at this more closely, it is an absurdity.

My recent experience with therapists (three) has been of client empowerment in every aspect of the process. I would never consider the therapist to be the authority figure by default. They themselves have made it clear to me that I am in charge of what happens in therapy, but even if they hadn't that is something I would assume for myself anyway. I do know that not all clients are at a point in their own journey where they are able to feel the same though. Certainly when I first went to therapy I was at the mercy of the therapist... and I was fortunate enough to have therapists that helped rather than harmed.

I wonder if the therapist who assumes a position of authority and those who encourage the client to be in charge of therapy, is based on the type of modality that is practiced?


Idk, just throwing that out there.

Of course, not. No one who has attempted to cross my personal boundary ever asked for my permission to do so, just like no one who has mistreated me asked for my permission to behave that way, just like no one in many cases asks others for permission to do this or that if they don't see anything wrong with their behavior. People learn what not to do when the other person makes it clear that the behavior will not be tolerated.

It was only in the beginning of my first therapy when the T was able to play the "boss" game temporarily. At some point I decided that I didn't need that crap and when I realized that he was unwilling to change I ended therapy. It wasn't easy at all. It took a lot of struggle and inner strength. But I did it because I am not someone who can operate on blind faith and accept authorities of those who provide services.

With other two therapists the "boss" component was never present. I also had brief encounters with other therapists in between and as soon as they attempted to "boss" me my foot was out the door instantly. In most cases it happened on the first meeting.

I am sure this is the case with some therapists while it is not with others. I have no idea what percentage of professionals and clients enter into that kind of contract. I honestly don't know. In my experience, there is a diversity of contracts out there and I am not sure that a "boss-subordinate" type of contract makes the majority of cases. Again, there is no data on that and I honestly don't know so I can't assert one way or the other.

My own strong opinion of any therapist who needs to be a boss is that they have serious mental pathology and should not be practicing.

I am just the opposite. I loved to assert my own sovereignity (I'd rather use this term as opposed to authority) even in situations when it was super tough to do so. I am not bragging and not saying that I am such a brave trooper. I am only a human and I do break down every now and then and I often pick my battles carefully. But I know my "red lines" that I will not let anybody cross. I've been willing to risk a lot in the fight for my independence. I've been willing to risk what most people never risk - a loss of relationships, a loss of employment, a loss of a "parent figure" whether it was a therapist or other person who served as a surrogate parent..and a loss of my actual parents. I've risked it all and have lost it all and have never regretted my choices nevertheless despite all the pain and trauma I had to pay as a price for my independence.

Probably. Again, I wouldn't know because I've never felt that way, so it's good to get a perspective of someone like you who was feeling that way.

Yep. I know exactly what you are talking about it. Those miserable little "experts" with God's complex get pretty insecure when someone tries to give them a piece of reality that they aren't God. They can't conceive of the idea that they are just as flawed and limited within the bounds of their humanity as their clients are and get pretty pissed when someone reminds them of the fact that they are just human and that a little humbleness can serve them well.

Well, I certainly don't believe that therapists by default or by any means should be considered authority figures and I believe that their judgment should be taken more as an "educated guess" (the expression Wilfred Bion once used) and it is certainly up to a client to consider a therapist's input or not. As to the blind faith, nobody's words should ever be taken as the Ultimate Truth in this life. No one should be blindly followed no matter how much respect and/or love we might have for that person IMO. Such following to me is a major violation of one's self, one's own nature and life's purpose.

Yes, sadly, it is true that many clients live in fear of being unexpectedly terminated and, sadly, many such terminations result in trauma. The sadness and injustice of that reality for me lies in the fact that therapy process is designed in such a way that creates an utterly unhealthy dependency on a therapist and then doesn't consider that dependency when clients gets disposed without any proper transition to a new practitioner or any further guidance on their further options.

It is also true that such situations are not seen as problematic in therapy culture because of the ignorance of the client's experience.

It is NOT, however, written in the ethics code. Quite the opposite. Abrupt terminations are considered unethical, but if the licensing boards ever get involved in those cases, they often let the therapist off the hook if he was cautions enough to document in his or her notes that the client was give proper referrals.

Many formal ethical rules get violated routinely by many therapists on a regular basis and that's another taboo subject within the profession.

Not necessarily. Often, therapists of psychoanalytic orientation may have this attitude because traditionally they were seeing themselves on par with medical doctors, but, in my experience, a therapist of any orientation can behave one way or another. It's the issue of personality mostly. People with big egos get training in all modalities.

I dunno, if a therapist tells me I am in charge, that means they have all the power. I think when therapists say this they are being disingenuous and manipulative, unless the client is not at all emotionally exposed.

For me just showing up and saying I need help and am willing to pay for it means I have forfeited a lot of psychological and emotional power. Add in the fact that the therapist makes the rules, controls the place and time, subtly controls the narrative, wields the power to diagnose and interpret, it's entirely lopsided. And what is most insane to me is when the therapist adds to all that by enforcing draconian boundaries and restrictions, or by imposing termination, or any other abuse of power where they decide they are running the show.

I don't disagree that all the things you list above can be viewed as a grab for power or authority over another individual, namely the client, by a therapist. But I have to say, I haven't now or in the past experienced the therapeutic relationship in the way your describe. I go in knowing that if I don't find the person helpful, I leave. In other words, I terminate or fire him/her. I don't carry any illusion that a therapist is going to be crushed, hurt or concerned when I fire him/her, but I definitely do understand that clients do sometimes (perhaps often) come away feeling terribly traumatized by a therapist terminating or firing them. But I've personally found that I can protect myself and not get entangled in a relationship that is stifling or harmful,maybe that happens because I'm older and didn't engage in a therapeutic relationship until I was in my mid-thirties. I do understand that how *I* experience a therapeutic is not how everyone else experiences it, but that doesn't mean my experience is any less real, true or common. In my cohort, I've had numerous friends and relatives who have sought out therapy and over time, we've talked about their experiences. None of them have been severely traumatized, some came away with a positive, productive experience and others came away with a take it or leave it mentality.

I guess what I'm suggesting is that we all approach therapy in a different way and we all experience it differently. No one person's experience is wrong or incorrect in their assessment of what happened. My needs in a therapeutic relationship is perhaps different than it is for those who go in feeling as if they are under the control or authority of the therapist. I get it that I'm someone who is pretty self-assured and confident in what I'm looking for in a therapeutic relationship, and I have no problem saying, "Uh, this isn't what I contracted for. I'll be taking my business elsewhere."

I do understand that others don't feel comfortable proceeding that way and things can get ugly fast. But personally, I think that insisting that people who feel or disagree with the premise that ALL therapists and therapeutic relationships are inherently set-up to hurt people is just as harmful as the people who advocate that people "get over" the pain they feel about a bad therapy experience or that they simply find a new therapist. I truly believe that therapy is not for everyone. In some cases, it's downright harmful and detrimental, but it is not the case for everyone. Simple fact, humans respond differently and experience things on a continuum.

I know you made a bunch of interesting comments but I wanted to zoom in on this part. For me it is not just the abrupt and extreme terminations, it is any imposed or unilateral one. And it's the very idea that a therapist can or should do this. Same goes for other aspects of managing the relationship.

This excerpt from an Americ Psychological Assoc ethics document says it all:
"Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service."

This makes clear the hierarchy that exists from day one. The professional is granted the power to decide for the client what is best. They can impose an ending, sometimes in bullying fashion, and that is considered normal. Plus, i think it's absurd that the therapist -- the one who has likely failed and/or harmed the client -- is given full responsibility for deciding when and how things will end, as if they are in any better position than the client to act rationally or prudently.

I think the basic issue for me is this -- therapists presume a position of authority and then set boundaries, decide on contact between sessions, make the rules in general, decide when it's over, and decide what the client needs going forward… ALWAYS more therapy of course. But when you deconstruct this authority, there is no basis for it. There would need to be some tangible expertise behind it. There isn't. Articles about what to look for in a therapist invariably list things that are very vague and elusive. There is no there there.

Any relationship can be unilaterally dissolved.
My wife could leave me.
My doctor could eject me from her practice.
My friends can choose to never speak to me again

There doesn't seem to be anything unusual.to.me about the termination aspect. If someone truly feels they can't work with someone else its not as if you can force them to.

Are you saying there should be some sort of arbitration?, in general its assumed in our society that consenting adults have the right to.leave any relationship, professional or otherwise, that is not working for them.

You're not getting it. Maybe you don't want to get it, dunno. Therapy is not like other relationships. None. That's why special provisions are needed to keep therapists from molesting their clients, or otherwise abusing or exploiting them. Think about it.

What I'm saying is that at the core of the alleged authority of therapists is a lot of smoke and mirrors and not much else. Therapists foster dangerous dependency and sometimes destabilize and disrupt lives, then walk away when they grow tired of it, or get creeped out, or whatever. And the professional codes condone it. Yea sure, the codes say, you can be the boss and tell the client to go away, even if it's to cover up your own failure or neurosis, and even if it traumatizes them. Because you are a "clinician" and you get to play God or make-believe doctor. And we, your professional organization, will back you up. Unless you have sex with the client, and then we'll have to disown you. But only then.

I think Bay has a valid point. My psychiatrist gave me an unmerited ultimatum this week that obviously sprang from her ego being unable to tolerate dissent: her way or the highway. I picked the highway. While this was not a person I liked much, and I'm furious and hurt at the way she treated me, and I also suspect I'll lose No. 2 and/or No. 3 out of this, there is no way in hell I would want to continue my relationship with any of them or even see or talk to them again in the name of assuaging any pain I'm experiencing. When you get gangrene, better to amputate the limb than let the infection take over.

ETA: and what use would it be to have the source of your pain also assuage your pain?

--

At times it is in the patients best interest to be terminated by the therapist--how does most damage occur in the therapy process on the part of the therapist? One of two ways: (1) therapist is incompetent or unethical to begin with and the techniques are causing harm, OR (2) Despite each party knowing that therapy is going nowhere or is toxic, the therapist doesn't step up and say "I don't think I am the best person to help you." Yes, termination is painful, but there is more long-term damage being done when ineffective or toxic therapy occurs for months/years on end.

--

Now, to answer the original question of who has the authority in therapy. It largely depends on the therapist style and the client. I've never had my therapist act like the boss of me, it wouldn't work because I am stubborn as a mule.

I've primarily done client-centered, so not one person permanently holds the authority in the therapeutic relationship. Each have the right to abruptly terminate (however therapist must give referrals), the patient has the right to dictate the speed or topic of conversation, and the therapist has the ability to guide and ask questions.

My therapist does not foster dependency--that would imply that I need her in order to make it through life. She does foster and encourage interdependence, not just with her but with the people I interact with on a daily basis.

Who said anything about assuaging pain? I'm talking about the basic pretense to authority that underlies much of therapy. It's a joke.

These therapy relationships that end suddenly with the therapist exiting as they please, they were never legit to begin with. And every therapy relationship contains this potential. There are almost zero barriers to therapist indiscretion, up to and including abandoning the client on a whim. And again, the basis for this is what? Delusion is what.

Or when therapists boss clients around with crazy boundaries and ultimatums, or even subtly pull the puppet strings. Because they took a few classes?

I wish I could swear at my boss like I swear at my therapist.

I completely disagree with the idea that a therapist gets to decide what is in the client's best interest. I have no problem with a therapist quitting because they don't want to work with a person any more but I would never let one get away with the idea they were doing it in my best interest. I also don't see those that want to describe me as a patient. I prefer consumer - but will go with client.
If they want to quit - fine - but they have to own it is on them - not me.

Sorry but I am calling BS on that. The client can make the decision to stop or go, unless they are a child or are incapacitated. Believing otherwise is to accept some notion of therapist omniscience. It's not healthy to have someone deciding what is best for someone else (unless again there is a child or seriously impaired adult involved). That is a toxic concept.

In my case i sought the following: I talk, she listens, when I'm done talking, it's over. Her resistance to that indicates (a) she has drunk the therapist-as-overlord kool aid, or (b) the idea made her uncomfortable in which case therapy was about her (it was) and whole thing is a fraud (it was).

Second all this in light of recent experience - not that I ever thought they knew what was best for me anyway. And I am now proven correct.

Psychologists and therapist are always supposed to keep the patients best interest in mind. I think you disregarded my statement after that. I never placed the blame on the client, I did state that it would be in the client/patient's best interest if the therapist terminated because of their own unethical practice, incompetence, or inability to help.

APA wording says to terminate when the therapist believes the current treatment is not in the patient/client's best interest. I didn't make up the words, they are the basis for referring out Also, I didn't pass the buck to it being the clients fault. I pointed out when the therapist would make a decision while minding the patient's/client's best interest.

If a therapist isn't skilled or knows nothing about eating disorders it would be unethical and against the client/patients interest to continuing to treat them when they are deteriorating. So, even if the client begged not be terminated, ethical standards dictate that you don't practice outside of your competency.

I know they think they can make decisions in a clients best interest - I am saying I don't believe it, find the idea extremely patronizing, and reject the stance entirely.

That they think such a thing, and in such terms, supports the idea they think they get to be the boss.

I think mostly what a therapist should do is just sit there and say very little. If that's what the client wants, why not. If the issue is when and how to terminate because of some incompatibility, leave it up to the client. They are paying after all. Maybe they want to spend 2 sessions or 20 sessions telling the therapist how stupid or incompetent they are before stopping, and maybe that would be quite therapeutic.

Question: So if a therapist wishes to terminate for good reason because they lack a competency in a certain area, they realize they are not helping a client, or there is incompatibility--are they permitted to do so even if the client does not agree? In this scenario, even though the client know things are getting worse, but continues to go--at what point would you say it's the therapist responsibility and ethical obligation to refer out? Does a therapist also deserve autonomy to decide that I'm not the best fit and I can't continue to justify services with the best interest of my client and myself in mind?

There is a level at which a therapist HAS to refer in the face of deterioration. Eating disorders are deadly, as is substance abuse, severe mental illness like psychosis, schizophrenia etc. Unless you make the argument that we should allow anorexics to starve themselves to death or depressive individuals to kill themselves. In which case though I'd disagree with you, your argument is logically consistent....

I do agree that people get to do harm to themselves if they choose. I know it is not a popular position, but I believe in autonomy more than being kept againt my will from harm.