Couch 237: Social Rules

I am not expecting this to be a popular viewpoint, but I am actually with the therapists here. It is about the client. And a danger of talk therapy is it becomes about the therapist. A lot of abuses and pain in therapy occur when the therapist becomes the focus, not the client. Good therapists will keep that in mind.

It's fine to care human to human, no one expects otherwise, but it's like if my students notice if I'm off or sad one day. They don't bring it up and neither do I--it will interfere in both our roles in that relationship. (Whereas if they seem off or sad, it might well be my job to bring it up depending on the circumstances.) I did mention my mother to my students, but that was to explain some changes I had to make to the classes, not to invite their concern. What I'm saying is that of course a client will likely notice if a therapist is off, but if their goals in therapy are to work on themselves, the best thing they can do for both themselves and the therapist is maintain that focus and not shift focus to the therapist. Not bringing it up doesn't make you cold or uncaring; it means that you realize you are the most important thing in your life.

It would be different with a friend or co-worker you noticed was off, and therapists are neither.

I'm not sure how to say this without rambling but I will try to come to the point.

I think that a lot depends on the therapist and the therapist's orientation if they allow "their stuff" to come into the "room/Zoom session" in therapy. I know for me it is easier if my therapist keeps her stuff to herself. Now my long term T that got MS, she eventually had to tell me that she got MS because she was missing sessions and I knew that was not like her after many years together. I guess there was no way around that. Now my current therapist tells me way too much of her own stuff for my liking. For example when she was checking up on me last weekend she made sure to tell me that she had been sleeping all weekend because she got her 2nd Covid booster. It's almost like she *wants* me to respond in some sort of friend way to comfort her or something. I think I did tell her that I hoped she felt better but I was baffled by the information. She was checking on me, but she kind of made it about her. That sort of blurs the lines of therapy for me and makes me uncomfortable. Not that I told her that but I thought it really loudly! I do better with therapists who keep their stuff separate as much as possible. I tend to end up with messy boundaried therapists though. It just leaves me confused and befuddled. Just my take. My 2 cents for what it is worth. Probably not worth much but I'll post it in case it helps anyone. BTW most of my Therapists have been "eclectic" in their orientation. Kit

I have asked my therapist what was going on and/or she has told me when she was a little "off." It's usually something like not sleeping well the night before. (Obviously if she were really unwell or extremely upset she would take the day off.) For me, it is sometimes about making sure I'm not doing something wrong or irritating her or causing her to push away, so it's useful information to have. This is something that comes up with other people in my life too, where they have been preoccupied or frustrated because of something else and I assume I'm the problem. So in that way it has been therapeutic for me to check in and then realize it's not me (and reflect on why I thought it was), although I do see where too much emphasis on the therapist's feelings or life stuff could be a very bad thing.

Well, that was quite the session! Multiple tornado warnings going off on each of our phones, followed by his wife calling in the middle of the session--"I need to answer this, it's my wife"--and then proceeding to talk to her for a few minutes while I sat there feeling really awkward. I made a gesture offering to go in the hall, but he waved me off.

She wanted him to stop the session and move to an interior area (due to warnings), as his office has lots of windows. We were in the middle of a discussion about the therapeutic relationship, with 20 minutes left, and it didn't look too bad outside, so I asked if we could stay in the office a few minutes. He said sure and "I like violent weather." Me: "Me too." Then I said, "I don't want your wife to be upset with you though." Dr. T said: "I don't always do what she tells me to do" and laughed. Which was also a little awkward!

There was some wind and a few rumbles of thunder (including after I said something sort of ominous), but then it mostly blew by.

We talked about other stuff the first 20 minutes of session, but then moved to the email. In a nutshell, he was confused by my email and wondered why I would send something "nonurgent" after our conversation. And it did irritate him some--this was 10 steps to New York instead of 1 (his number for the check-in texts about in-person). I did my best to explain, including the concerns stemming from ex-MC's frequent cancellations and what that turned out to be. And he seemed to get it. I said how I mostly just wanted him to understand and sympathize with why I want to know what's going on, how that would help, even if he's unwilling to tell me, and he said that he both understood and sympathized.

It was just kind of messy, with lots of tears on my part and his seeming maybe a bit harsh and puzzled by me. I said how I was worried that now I was stuck, that even if I was concerned about the relationship or something else in my outside life, I couldn't email because I knew it would bother him. And he said it was still fine to email, that his policies haven't changed. I offered to pay for this last email, and he said he wouldn't charge for something that short. I said I could pay for future ones or agree to not email next week, but he said I didn't have to do that, how it was fine to still email if I want. (I still will do my best not to email for a stretch of time, barring, say, a need to switch an appointment or something like that).

When we were at 50 minutes, I was like, "Can I stay for another couple minutes please?" and he nodded. I was saying how I just wanted everything to be OK in the therapeutic relationship, and he said that it was from his end. I was also saying how I wanted him to like me as a client, to not be an annoyance, and he said, "You don't want to be a burden?" Me: "Yes." Him: "You're not a burden." Me: "OK, thanks." When I left, after the good-byes, I said again, "Everything is OK?" looking him in the eyes. Dr. T (holding eye contact): "Everything is OK." Me: "OK." (These are times when I really miss the handshake part.)

Will respond more later to posts, like this evening (have to finish a bit of work, then pick up D and take her to get her Covid booster, as the storms continue outside--sigh...).

HUGS LT. That sounds very emotionally tiring of a session. I often get emotionally exhausted after sessions--I don't know if you do. I'm sorry it was kind of messy but I am glad that Dr. T gave you the reassurance at the end. I hope you can hang onto that through the weekend and feel okay and secure within the framework of your relationship with Dr. T. and I hope you are safe in the storms and that you get everything done you need to do today. Sending you hugs, Kit

Thanks, Kit. I can definitely get emotionally exhausted by sessions, too, especially when I cry a bunch, like I did today. And it can lead to a sort of physical exhaustion, too.

I'm going to do my best to hang onto that feeling through the weekend and resist the temptation to check in, as that would potentially just make things worse.

Honestly, I just don't see how being concerned about a T being 'off' enough that it comes into the session is making it all about them. I mean, wanting to be sure my T is okay and can be present enough, at their best enough, to help me is making it about me. Isn't it?

I agree with this. And I said something similar to Dr. T, how part of this was my caring about him as a person. And part was also wanting to know that he'll be there for future sessions, that it won't affect my therapy.

ETA: He did say he appreciated that I cared.

Hugs to all of you!

I think it's normal to be concerned about what's going on in a Ts life some. My T is usually very open about whatever is going on, so I don't have to wonder. I really appreciate that. Sometimes it can backfire though, like "I have to cancel our phone call, I gotta see a patient at that time" really backfired. But in a way, it also made me somewhat more secure, I think it's important to state the truth while not being hurtful. For me it wouldn't work if a T didn't want to say something at all, we're both humans and our lives exist after all...
However, I don't think Dr. T is upset about it too much LT, it seems he has a very different interpretation of 10 steps to NY compared to some of us!

....and, further, isn't the T rather the one making it about them in the first place, when they do allow 'their stuff' into the room which causes us to be concerned about them? As in, if you don't want me to ask if you're okay, then don't sit over there acting like you're not. Just thinking out loud. Er, through my keyboard. ymmv.

Halfway through the workday!!! Well, more like 5/8th of the way through the workday. This three day weekend can't come fast enough!!

After 2 weeks of telehealth, I now have to go a week w/o sessions with L. Thankfully, T is on backup, and I'm doing well with the move thanks to my sister. But I hate it when L goes away. I know the sadness is there because of the good things in our relationship, but it still sucks.

Hugs, Scarlet.

LT, I think the most important factors in your expressing concern and anxiety about your therapist's well-being are being lost. I don't think the useful consideration is about the nature of human caring or where the focus of the therapy is flowing or whether he is annoyed or whether clients can comment on a therapist's life, etc. These sound like distractions to me and in that sense they do take the work away from being about you.

For me, the therapeutic work here would be about the interpersonal interactions in the relationship e.g. what are my projections here? Is my concern for his well-being actually an expression of concern for my own well-being? If I think he is struggling, am I actually the one who is struggling?

Similarly, the intrapersonal dynamic is potentially being highlighted for you. Are there aspects of your self who are worried that you are going to let yourself down? Is your inner critic questioning your mother self? These are guesses of course, but the conflict and concern which is showing itself in the relationship could be a reflection of your inner conflict and concern.

It doesn't sound like he treats your anxieties and concerns as information which both of you can use to help you understand your internal world. He sounds stuck in an anxiety-reassurance loop with you which isn't working for you - mostly because he can't even reassure you sufficiently. I think identifying patterns or being aware of replays (such as the ex-MC stuff or parental relationships) goes some way to explaining the familiarity of your anxieties, but it doesn't sound like it is deep enough to really help you get inside those feelings and find a new course for yourself.

This is a very long winded way for me to say that I get the impression that he repeatedly misses important information and opportunities.

Hugs, Scarlet. Do you have something scheduled with T?

It's maybe besides the point, but IMO if a T has something big going on in their life, and it is affecting them so much that they tear up in session, they're not capable of focusing on the client in that moment. It would be better to cancel the session entirely.

A couple times I've thought something seemed off with my T and asked him about it. He has usually said he's fine, or on two occasions admitted there was something going on (and I learned what it was later on) but quickly redirected the conversation back to me. I think it's perfectly natural to care about your T as a person, and yes, it's a relationship with two sides, but it's still meant to be for the client's benefit.

especially for Velcro and Polibeth

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I would agree with this. He said at one point today how he wondered if my email was a test of sorts. Well, OK, so what if it was? Isn't that something we could explore? Like, what is going on with me there?

I tried to explain some of it, but not sure he got it? As in how if I feel disconnected from someone important to me, I try to find a way to make the connection again, even if it means pushing the other person and risking rejection. Which apparently he finds to be annoying. But it seems an important pattern to examine. His annoyance (sorry, "irritation" comes first though, it seems).

I had this thought just now after reading your post. I doubt he'd go for this. But I wonder what might happen if for, say, a month (some set span of time), he would be OK with me just emailing whenever I had the desire to do so, no comment on it being irritating (he's only said that recently), maybe no charge, or perhaps a set charge for the month? And he'd agree to respond to them, as long as they weren't too excessive. And we could sort of see how things play out?

I find when he is responsive in a supportive way to my emails (and in session, I guess), I suddenly feel less of a need to send them. It's like if I know I send something, he'll say something kind and supportive back (how he's generally been during the pandemic), then I can almost tell myself what he'll say. And I don't need to reach out.

I don't know if that makes any logical sense at all, but I think it has to do with feeling secure in a relationship. And I felt pretty secure with him for a long stretch there, and now that security feels very threatened. So I'm trying to get back to that safe place, but it's irritating him, and he's not responding in a safe way, so then I try even harder to get to that place, and he's even more distant.

You make some other good points, too, but this is just what my brain went to in reading your comments. Hm, maybe I feel like he has changed in some ways since resuming in person? In certain ways, I feel more connected, but in other ways, he seems more distant.

I'm even thinking of ways he replied to emails a few months ago, where he seemed fine with him. Even "non-urgent" ones, like when I was at my parent's place at the beach, and he encouraged me to go out and do something despite Covid risk. And I emailed to tell him I went out to a taproom for a couple hours. And he replied enthusiastically about it the next morning. That's a random example, I don't tend to send him those kinds of emails. They tend to be brief requests for support, like finding out D's assessment scores, stuff like that.

Is there some reason my emails have become irritating now? I would say he was putting up with it and not saying anything, but he has always said he'd let me know as soon as something became irritating, and he prides himself on being honest. So what changed? Does he think that because he sees me in person usually (except Wednesday...which is a big part of why I emailed), I shouldn't get any extra support? Or am I just bothering him in some other way right now, so anything I do is irritating? Maybe he's really not OK with my wishing him a happy birthday? This really started around that time, it seems.

I would ask him, but I don't know if he's self-aware enough to realize. He'd likely claim he hasn't changed, but he *always* replied to my emails in the past, and he needed a request to confirm over the weekend (like 30 hours later) to respond to one--then it was just "confirming receipt"--and this most recent one he took >24 hours to reply to and just said "confirming receipt." Usually he'd at least say something like "Thanks for sharing. We can discuss more in session," but generally more than that, like "I'm sorry you're struggling with this. I know it's very difficult to hear news like that." and then something.

I worry he's just sick of me. But maybe, in the words of singer Matthew Sweet, I'm just "Sick of Myself," and he's picking up on and projecting that?

LT, I think you're making really good therapeutic use of this 'stuff'; well done.

Nah. I can't afford a session with T unless it's an emergency. But she's available for pro-rated phone calls if I need. Plus as many emails as I need.

Thanks, Artie! If only Dr. T could see it the same way...like this is part of the work, and I'm making discoveries. Instead of my currently being an irritation. I know that's not the only way he sees me, but it feels like it right now. I did ask today if he had caregiver fatigue (something we've discussed in other contexts) regarding me, and he confirmed that he didn't.

I was just looking back at my emails over the past 3 months, and it does seem I've become more needy, though it was originally due to stuff with D, like her assessments. And he was very empathetic. I feel his tone shifted maybe 10 days ago? I'm not sure if it was something I did or said or potentially some outside thing.

I'm glad she can still give you that at least! It's funny how T's are so different about emails....

Thanks for the hugs, everyone. And so sorry about your kitty, Pollibeth. My kitty of 14 years escaped in February and is still missing. It is an awful, awful thing to go through. I feel your pain.

No, I would not expect a response to that sort of email. I would assume I would see the person and it could be discussed then if it needed to be. In general, I don't find "thanks" to be of any use as a response unless I just gave them something or that sort of thing.

No I don't think so.
It is possible to both care and not mention it. Mentioning it in this sort of fashion does, to me, put the focus on the therapist and the client wanting to be seen as good or caring or special
or X -unless you really want to discuss why you have an urge to talk about the therapist- so you saying why and what it means and then parsing through that but without the therapist explaining anything about their life.