[Sarmas]

I guess this is an issue that some of us have experienced. I've come across a few times in therapy where my T has certain recommendations. I've disagreed with certain recommendations, but what happens when these recommendations becomes expectations by the T. What if we disagree with those recommendations and the client does not follow through or disagrees? Is that when the fear of termination and abandonment settles in? Should we adhere to Ts recommendation in order to keep our therapeutic relationship at peace? How much real, power, control, or opinion do we actually have in an environment where we the client is as at times looked at as the one with the lesser knowledge. Again this is not the case in every therpeutic relation or with every therapist. How many of you have encountered such an issue and how did you address it?

[atisketatasket]

I continue to do what I think is best for me.

A few weeks ago therapists and psychiatrist were convinced I need an emergency session with psychiatrist because I said I wanted a break from therapy. Psychiatrist and I spent some time arguing about whether this was necessary, ending in an ultimatum from her - be in her office at x time or lose her as a psychiatrist. I walked.

So, yeah, it probably is one source of fears of abandonment. And clearly psychiatrist thought I shouldn't have any control over my own care. But the power to walk is always there. You don't have to fill the role other people think you should.

[LonesomeTonight]

One thing that jumps to mind was when my former p-doc recommended that I do a day/ outpatient program while I was having a bad depressive episode. I freaked out, especially because she said we were going to set up a conference call with my T and marriage counselor (they were all in same practice) to discuss it, so I figured it would be like they'd already decided on it together. I felt sort of betrayed. And afraid that if I didn't go along with the recommendation, then they (or at least p-doc) might terminate me. Though part of why I didn't want to do the program is that I wouldn't be able to see my individual T or marriage counselor for like 8 weeks (or however long the program was), since I would just be seeing T's, groups, etc. in the program. Immediately after that appointment, I called my T, sobbing, basically asking if I had any other options. She called back pretty quickly, and it turns out that the 3 of them had *not* consulted on it, that it was just p-doc thinking it (and she didn't know me nearly as well), and T didn't even agree with the recommendation. I made a deal with her that I'd come up with a sort of improvement program on my own (which I didn't stick to that well, but oh well). It helped that she listened to me.

There was a more recent time when T suggested regular hospitalization, and I was like NO! She was like, "Would it really be so bad?" and I said yes! (I have a general hospital phobia.) I got really upset with her. And feared termination if I said no. Next session, she admitted that she thought she'd gotten too close to me and thought maybe she wasn't helping, so she was trying to take a step back.

Not sure if those are the types of things you mean. In both cases, I got upset and refused to do what they said. Feared termination, but it ended up being OK.

There were quite a few things my therapist suggested and recommended that I didn't like or didn't agree with,so I didn't do them.

I told him why I didn't like them or agree with them and he was okay with it.He may not have been happy with my choices,but I was the one paying him,not the other way around.

[mostlylurking]

My personal feeling is that most good T's would not continue to make recommendations that the client disagreed with unless it was a matter of immediate safety. I see therapy as facilitating change from within the client, as opposed to enforcing change from the outside, which could backfire in all sorts of ways. Social work literature is full of stuff about empowering clients, not placing demands on clients. You are the expert on you, and they're not the boss.

My own bias here is that I adore my T and he is very non-directive. I would respond very badly to one who was highly directive or placed expectations / homework on me. I am rather anti-authoritarian by nature, though, and others might welcome more direct guidance than I do.

[stopdog]

If I disagree, I simply don't follow them. I am an adult. I get to decide what makes sense to me and what does not or what will work for me or not. It is no skin off the therapist if I do or do not take a recommendation. They get paid either way and it is not their life.

[Sarmas]

Originally Posted by LonesomeTonight

One thing that jumps to mind was when my former p-doc recommended that I do a day/ outpatient program while I was having a bad depressive episode. I freaked out, especially because she said we were going to set up a conference call with my T and marriage counselor (they were all in same practice) to discuss it, so I figured it would be like they'd already decided on it together. I felt sort of betrayed. And afraid that if I didn't go along with the recommendation, then they (or at least p-doc) might terminate me. Though part of why I didn't want to do the program is that I wouldn't be able to see my individual T or marriage counselor for like 8 weeks (or however long the program was), since I would just be seeing T's, groups, etc. in the program. Immediately after that appointment, I called my T, sobbing, basically asking if I had any other options. She called back pretty quickly, and it turns out that the 3 of them had *not* consulted on it, that it was just p-doc thinking it (and she didn't know me nearly as well), and T didn't even agree with the recommendation. I made a deal with her that I'd come up with a sort of improvement program on my own (which I didn't stick to that well, but oh well). It helped that she listened to me.

There was a more recent time when T suggested regular hospitalization, and I was like NO! She was like, "Would it really be so bad?" and I said yes! (I have a general hospital phobia.) I got really upset with her. And feared termination if I said no. Next session, she admitted that she thought she'd gotten too close to me and thought maybe she wasn't helping, so she was trying to take a step back.

Not sure if those are the types of things you mean. In both cases, I got upset and refused to do what they said. Feared termination, but it ended up being OK.

That's exactly what I meant. It was great that you verbalized your thoughts and that you were heard. It was even better the the outcomes were great. I've had both issues as well where she wanted me to go to an inpatient facility and it wasn't hard for me to say no. I did have the fear of her saying that she can't help me if I don't help myself and follow her recommendations but she never played that card at that time. However I have come across a T questioning continuance of sessions if I continue to to follow recommendations. I think it's important to argue the point and state your opinion as you did in order for you to receive the treatment that you're looking for.

Originally Posted by mostlylurking

My personal feeling is that most good T's would not continue to make recommendations that the client disagreed with unless it was a matter of immediate safety. I see therapy as facilitating change from within the client, as opposed to enforcing change from the outside, which could backfire in all sorts of ways. Social work literature is full of stuff about empowering clients, not placing demands on clients. You are the expert on you, and they're not the boss.

My own bias here is that I adore my T and he is very non-directive. I would respond very badly to one who was highly directive or placed expectations / homework on me. I am rather anti-authoritarian by nature, though, and others might welcome more direct guidance than I do.

I very much feel this way too. My T would never expect me to follow any recommendation of his and I wouldn't feel bad for rejecting his suggestion as he's always made it clear that I am the expert on me, and everything he says is tentative.

[Sarmas]

Originally Posted by atisketatasket

I continue to do what I think is best for me.

A few weeks ago therapists and psychiatrist were convinced I need an emergency session with psychiatrist because I said I wanted a break from therapy. Psychiatrist and I spent some time arguing about whether this was necessary, ending in an ultimatum from her - be in her office at x time or lose her as a psychiatrist. I walked.

So, yeah, it probably is one source of fears of abandonment. And clearly psychiatrist thought I shouldn't have any control over my own care. But the power to walk is always there. You don't have to fill the role other people think you should.

That's a harsh ultimatum. It's sad when it's an all or nothing deal without a happy medium or being heard. I've seen where sometimes a T will state that there are no expectations but yet his or her actions and behavior state otherwise. Very difficult to continue a therpeutic relationship and continue to place trust in an area where it's an all or nothing deal.

[Sarmas]

Originally Posted by CrispApple

There were quite a few things my therapist suggested and recommended that I didn't like or didn't agree with,so I didn't do them.

I told him why I didn't like them or agree with them and he was okay with it.He may not have been happy with my choices,but I was the one paying him,not the other way around.

The one issue that I've also come across is the T losing interest or hope in the client because they're not following their recommendations. This causes sessions to become more about the personal gain for the therapist. However certain therapists will not see it as such. I guess they get frustrated and we become that "difficult" client.

[Sarmas]

Originally Posted by mostlylurking

My personal feeling is that most good T's would not continue to make recommendations that the client disagreed with unless it was a matter of immediate safety. I see therapy as facilitating change from within the client, as opposed to enforcing change from the outside, which could backfire in all sorts of ways. Social work literature is full of stuff about empowering clients, not placing demands on clients. You are the expert on you, and they're not the boss.

My own bias here is that I adore my T and he is very non-directive. I would respond very badly to one who was highly directive or placed expectations / homework on me. I am rather anti-authoritarian by nature, though, and others might welcome more direct guidance than I do.

Thanks for this and you're right. It sometimes depends what the circumstances are. in certain cases there might be a need for the therapist to emphasize a recommendation while hearing out the client. However in most cases the therapist should not place ultimatums if the client doesn't adhere.

[Sarmas]

I recently came across a T where not following recommendations or making adjustments mean that the person is a bulldog. I absolutely disagreed with her. Ts can be wrong as well and they don't always have the full Picture. Like someone said here on this forum that you're the expert of you. Stating your opinion and standing for what you believe in does not make you anyone a bulldog. If the client doesn't look after themself then who will and especially in the case where the therapists work is questionable.

[leejosepho]

Originally Posted by CrispApple

There were quite a few things my therapist suggested and recommended that I didn't like or didn't agree with,so I didn't do them.

I told him why I didn't like them or agree with them and he was okay with it.

Other than possibly in a military setting where someone might be told he or she must comply as if being "government property" or whatever, I would say no health professional of any kind ever has the authority to actually force compliance...and I would question the action of anyone thereafter refusing to continue trying to be helpful. I would possibly be blind today if I had not refused the edict of a bully cardiologist who tried to manipulate me (by lying to me) rather than my first having cataract surgery. It might be foolish for me to presume to diagnose my own case and prescribe my own treatment, but I am ultimately still the one who makes the final yes-or-no treatment decisions.

Originally Posted by Sarmas

The one issue that I've also come across is the T losing interest or hope in the client because they're not following their recommendations. This causes sessions to become more about the personal gain for the therapist. However certain therapists will not see it as such. I guess they get frustrated and we become that "difficult" client.

I didn't experience that with my therapist,I think it actually made him respect me a little more that I wasn't just a sheep.

We worked together on what I felt would be best,he didn't just tell me what to do.

[nottrustin]

I don't always agree with her recommendations. In some cases I have told her why and she she agreed with my reasoning. Other times she disagrees with me but has always said she will support me and work on the issue regardless of what I choose. Sometimes after multiple sessions I will finally see her reasoning and take her advice.

Only once did she stand firm and made a threat. I had been dealing with a toxic family member. She suggested I break off all contact but I kept making excuses. Then a piece of information came out and she told me I needed to break off contact because I needed to protect my child from the person...she then reminded me she is a mandatory reporter.

[ScarletPimpernel]

Ex-T made the suggestion of going to a crisis house SO many times. I only listened to her once.

Current T has suggested that I walk around my block to get more comfortable with my neighborhood. I agree, but am too scared. She suggested it like 3 months ago, and I still haven't done it. She also suggested that I make an appointment with disabled student services at the college, but I'm too scared to do that.

My T doesn't punish me for things I don't do. Sometimes I'm scared she will, but she always reassures me she won't.

[Argonautomobile]

Originally Posted by Sarmas

I guess this is an issue that some of us have experienced. I've come across a few times in therapy where my T has certain recommendations. I've disagreed with certain recommendations, but what happens when these recommendations becomes expectations by the T. What if we disagree with those recommendations and the client does not follow through or disagrees? Is that when the fear of termination and abandonment settles in? Should we adhere to Ts recommendation in order to keep our therapeutic relationship at peace? How much real, power, control, or opinion do we actually have in an environment where we the client is as at times looked at as the one with the lesser knowledge. Again this is not the case in every therpeutic relation or with every therapist. How many of you have encountered such an issue and how did you address it?

I tell him to go **** himself.

Haha, no. That's not really true. I usually tell other people to go **** themselves

It's different with my T. For whatever reason, I find myself much--like MUCH--more willing to take my T's recommendation than anybody else's. Except maybe my boss'. Probably because they both know how to coat everything in sugar.

And I totally know when my T is bathing recommendations in sugar. Coating them in chocolate. Couching them between compliments. I mean, I'm not an idiot. And I can see myself responding to them almost without meaning to. Preening under compliments, made amenable by validation, totally primed to accept whatever he says. It's like an out-of-body experience.

And probably incredibly manipulative on my T's part.

But, hey, that's just how it goes for me. It goes differently for other people. I always try whatever my T recommends. Which is a hell of a lot more than I usually do for other people.

I guess what keeps it from being deeply unhealthy is that I've always felt free--after trying X--to tell my T I think it's BS, and he's always been amenable to hearing that.

Probably because I coat it in sugar.

Monkey see; monkey do. I guess.

Good question!

[kecanoe]

I guess it depends on the recommendations. And how messed up I feel at the time. Pdoc recommended inpatient trauma treatment a few years back and I went even though I wasn't sure it was a good idea. He wouldn't have terminated me over it, though. I just decided that he might have a better perspective on things than I did. I have often chosen to try something that t suggested even though I wasn't sure it would be helpful. Sometimes t has been right. I think I am pretty open to giving things a try. I trust that they have experience and expertise. And there are parts of me that like to please.

But there have been a few times where I have refused to do what t wanted. Once was when I was at that IP program, They wanted me to stop talking to T1 while I was there. I refused. The t there was not happy about it, but she didn't make any ultimatums. She just told me that I was making a mistake. T3 told me the other day that we were going to be addressing vulnerability next and she says that I told her "bullcrap". That is not a word that I use-but as it turns out, I had switched to a 14 year old alter (same one as stood up to IP t). Apparently she comes in quite handy when I am being told to do something I do not want to do.

I don't think I would see a t who threatened to drop me if I didn't obey. I am the client. The one who is paying for the service.

[stopdog]

Actually, at this point, if I agreed with what the therapist said when I let her talk, she would probably fall over.

[atisketatasket]

Originally Posted by stopdog

Actually, at this point, if I agreed with what the therapist said when I let her talk, she would probably fall over.

Maybe you should try it some time...in the name of research, of course.

[ruh roh]

I've seen two therapists who tried to lay down the law and seemed to think they knew best. I don't know how any therapist can be so sure they know what's best for someone.

[runlola72]

I tell him or don't follow through. There hasn't been too much I have disagreed with so far. He did say "premature hatching" again and I scolded him for that. As far as actual recommendations, he has been encouraging me to find a church, but the reason I haven't is more sheer laziness than anything else. He also said DBT would be good for me but ditto on the lazy.

[leejosepho]

I had forgotten about this until just now, but many years ago I once told a certain psychiatrist I truly wanted to hear what he was saying but that I could not do so because his tone was like that of someone who had bullied and abused me for many years. He changed his tone immediately for the remainder of that session and then again the next day -- I was IP at the time -- but then after that went right back to sounding so condescending and intimidating that I just could not hear him.

[BudFox]

It's an interesting concept -- paying someone and then having to answer to them to avoid being punished.

[Argonautomobile]

Originally Posted by BudFox

It's an interesting concept -- paying someone and then having to answer to them to avoid being punished.

Isn't that what teachers and personal trainers do? I'm not saying it isn't ****ed up or infantilizing, but it's still a thing, right? Don't we pay people to keep us accountable all the time?