In need of advice: should I apologize to my pdoc for hurting his feelings?

You definitely sound angry to me and trying to say things that you know will hurt him. I don't think it's unprofessional to point that out and wonder why that is. Of course as the patient you get to call the shots, but you don't get to pretend that what you say has no consequences. How is that helpful? But as I said you're ultimately in charge; you certainly don't have to apologize to him if you don't want to.

The more I think about this, the less sense it makes. Your pdoc was specifically asking how you felt about your treatment. You said you didn't think therapy was the reason you were feeling better and that you thought it was, in fact, the lack of therapy that might be behind the improvement. If that's how you really feel, I don't understand what you were supposed to say. Therapy can be powerful, both as a force for good and for harm. That's the whole point of informed consent, right? So did he want you to say, "Oh yes! I am sure therapy is working!" if you didn't think it was? Or if you had a sense that maybe therapy was making you worse? Seems like some nonsense to me...

Given your unusual situation, I wonder if your pdoc wants an unnecessary amount of credit for agreeing to take you on. If he is feeling resentful and needing your adoration to counterbalance that feeling, then he needs to put a stop to that dynamic pronto.

Seems many therapists have their self worth wrapped up in client adoration and worship. Burst that bubble for them and suddenly everything is about their hurt feelings. Are you supposed to repress your feelings about doing better with less therapy because it can't bear to hear it?

Worse still, clients are encouraged to disregard therapist needs and feelings, which of course is impossible unless you are a major sociopath, and so when the therapist suddenly wants their hurt acknowledged, it's jarring and "breaks the frame" and reveals the contrivance of it all. This kind of crap drove me crazy.

And now you have to focus on repairing some weird rupture with this guy, paying as you do, and for what?

If you feel you said things you didn't mean, were unclear which led him to misinterpret, or were intentionally hurtful, I would explain or apologize. If not, I would try to let it go.

I accidentally insulted my pdoc once by saying he wasn't a doctor but a pill therapist. I meant: "Doctors are evil. You are not evil, so you're not a doctor. I also can't feel slightly safe here if I remember you're a doctor. You talk with me and prescribe, so you're a pill therapist." Pdoc thought I said: "You're just someone who pushes pills." He said something like "I hope I'm more than that" or "I hope I do more than that" and we (me and the nurse that was accompanying me) explained it was actually a compliment.
And I apologized by email a few weeks ago because I hadn't been very polite during the appointment (raising my voice and interrupting him). In my defense, I was agitated, frustrated and he was scaring and triggering me ('playing doctor' as I call it in my mind, as in, wanting to use an evaluation tool that I've had bad experiences with in the past). His email back simply read "OK!" which was a bit of a disappointment - I'd hoped for something like "no apologies necessary" or "perfectly understandable".

If the relationship is important to you I don’t see anything wrong with coming partway to the center, unless you believe that this guy is a jerk that you don’t want to see again. My t’s have on occasion gotten ruffled over things like this but in the big picture they do go out of their way for me so I try to cut them some slack if their egos have a moment of tantrum.

It just depends if it is worth it to you. Overall have they come through or done their jobs well?

Dude. No, don't apologize for that. He should apologize to you if anything. Whether you're angry isn't the issue here (except in that your feelings are always the issue), the issue is he needs to get a grip. His feelings are really not your problem, that's the main point of therapy versus, say, friendship. He should know that.

As an aside, little makes me more ragey than the notion of therapeutic holding. I'm a fan of therapy, yes. It has helped me tremendously. But therapists way overestimate their ability to provide enough support in their extremely limited context. They essentially drop you every week. So they need to get the fuq over themselves. Of course you don't feel held by their sorry fifty minutes. Of course your imperfect but caring parents hold you more.

Y'all are seriously the best; thank you for all of your thoughts and advice.

I don't think I'm going to apologize--I think that his reaction was out of proportion to my comment, and was likely related to how smug and successful he was feeling in that moment until I burst his bubble. But I am going to try to figure out why that happened.

The reason I keep working with him despite the fact that our interactions are often fraught (and sometimes in a way that seems contrary to my understanding of what a therapist should be) is because my t trusts him, and I trust her. She's very willing to acknowledge his multiple faults, but she still trusts him. So I think I'm going to ask both of them about why the hell some of these things have happened and why they are okay or not and to think seriously with t about whether i should just find another pdoc. I'm hesitant to "fire" him solely because we have conflict--that seems sorta dumb because conflict can be a part of useful therapy (right?). And also I think that my reactions to him are in part transferential, related to feelings I have about other male authority figures in my past and present. So maybe there's work that can be done there.

I dunno, y'all. This s#!t makes me tired.

I LOVE this post. This is exactly what they don't understand. They think fifty minutes with them is all good for the next week or holiday season.

It is not okay for t or pdoc to express their emotions indiscriminately in session. They should only express emotions that will be therapeutic for the client, which in my opinion was not the case here. Any other emotions should not be expressed in session.

I thought the t was just acknowledging what the OP said.

"I do better when i dont see you."

"Thats rather a slap in the face, isnt it?"

The OP wasnt asking for a reduction in sessions, or how to improve the sessions. The t was just acknowledging her petulance? Which i think is fine on both sides. Its just the truth.

That is not petulance - and it is not a slap in the face. Good lord if that guy found that statement to be a slap in the face - he would gotten the bejesus knocked out of him in the first 5 minutes of talking to me. He was fishing for a compliment he did not get - and then HE got pissy.

I considered it "petulance light". She said slightly huffily. Almost petulantly, one would say. If only one knew wtf petulant meant.

If anyone was petulant in that exchange - it was the md.

IMHO the response to "i do better when I see you less often" or something has to be that bland curiosity that seems to make up much of their jobs:

"Oh?"
"How do you understand that?"
"Tell me about that"
"What specifically goes better for you?"
"What did you notice about your mood during that period?"

Basically they can say any damn thing as long as it's keeping the focus on the client and what the client said. "Let's make this about my ego" is not really a game therapists get to play. Frankly "I do better when I don't see you" is such a mild thing to say, it's like a nice slow pitch for them, no?

Let's say the client is being petulant, it's probably better not to take the bait and still be calmly present and blandly curious about their feelings rather than reactive.

Well, maybe some background on where im coming from on this will help? For the past ten years with current t, every time he announced a vacation or just a day off for the dentist, before i could stop myself i would emit some squeal of delight. Yay or yippee or good. It is STILL a point of contention, that i did it in the past, and that some vestige remains in the present.

But i dont APOLOGIZE for my reaction. My reaction is my reaction. I feel relief when he is gone. We both know the transference is strong and i felt relief when my parents left for work, or for the evening. And he says it doesnt exactly feel good to hear someone cheer that he will be gone. Which of course makes me laugh harder.

Earlier i compared t to aerobics class. This is more like a yoga class and somebody farted.

LMAO! You're killing me.

Good analogy too because yoga classes are IME so often such overserious, humourless environments and yet farting really is intrinsic to yoga (pawana muktasana = "wind-releasing position" for eg.)

Most of the relationships i've had with healthcare practitioners have been freakishly dysfunctional and infantilizing. None more so than with therapists, or anyone attempting to dispense mental-emotional-spiritual health.

At this point i would never expect interactions with people like therapists, physicians, psychiatrists to be satisfying or healthy.

And "working through" problems in such relationships now strikes me as pointless as digging a hole in the ground and then struggling in the hot sun to fill it back up.

I agree that you shouldn't apologize. Your p-doc seems overly sensitive.

I'm having a similar experience with my marriage counselor. Won't go into it all here, but the relevant part is how on a phone call last night, he told me that some things I'd said in the past month have hurt him. And also that he's felt frustrated with me on numerous occasions. I told him that I thought therapists were supposed to deal with those sorts of feelings on their own time, rather than sharing them with clients. He disagreed. I feel like it's making the therapy about him, not me (and H). I also had some strong transference for him for a long time and kind of idealized him. Lately, I've been more critical of him and standing up for myself, and it's like he can't deal with that. He's used to me treating him like a god or something. He gets very defensive, and when I called him on that, he admitted it's a problem of his. But apparently he wasn't self-aware enough to realize he was doing that and correct it/apologize for it without my pointing it out (on numerous occasions).

OK, will stop hijacking your thread. But basically, I feel like therapists should keep their feelings out of it unless it will serve the client. Both in your case and mine, it did not. (And MC has said before that I shouldn't care about his feelings...)

I keep questioning myself about the incentive to continue ; I keep agreeing with your posts, and kind of clinging to them like a life raft, but something I don't understand wants more of the process even while I distrust it. All I know is I am a mess lately, when I have always been very high functioning in work and relationships. I feel brokenhearted about my T, but nothing happened except I abruptly stopped believing that we had any kind of precious relationship. I take stock of all the secrets I told in the name of learning to set aside defenses, and I wonder if I will recover equilibrium or make it through the process and I miss the defenses . I think the aspect of therapy in which you pretend as if you have this higher love ("agape") while at the same time holding in mind it is contrived, you pay for it, and you both have significant others and real lives is very unnatural. It feels intimate inside the moment , so it is like you then betray that intimacy over and over in your real life, then you go into therapy and betray your real life with this crazy gazing eye to eye intensity. It's like going to a really good movie, and suspending disbelief in order to fully enter its universe, except you are a character in the movie and so is T and it feels real until some inevitable practical moment smacks you in the face . I am just not sure it is wise to be so intimate with someone not showing up as a real person.

Yea, well put, couldn't agree more.

Also the eye gazing thing... found it totally nuts when i finally stopped to think about it. Seems this sort of direct eye contact can really destabilize people. And confuse too, since it's so incongruent with the situation (artificial, paid relationship). Seems to bypass rational thought and telegraph all sorts of messages that are not intended. And then thearpists wonder why the client is getting the "wrong idea", and frame this as a sure sign of an attachment "disorder" or some such excrement. Playing with fire.