Excerpts from the book by Dr. Margaret Thaler Singer and Janja Lalich
The Therapeutic
Relationship
The relationship between patient and therapist is unique in important ways when
compared to relationships between clients and other professionals such as
physicians, dentists, attorneys, and accountants. The key difference is present
from first contact: it is not clearly understood exactly what will
transpire. There is no other professional relationship in which
consumers are more in the dark than when they first go to see a therapist.
In other fields, the public is fairly well informed about what the professional
does. Tradition, the media, and general experience have provided consumers with
a baseline by which to judge what transpires. If you break your arm, the
orthopedist explains she will take an X ray and set the bone; she tells you
something about how long the healing will take if all goes well and gives you
an estimate of the cost. When you go to a dentist, you expect him to look at
your teeth, take a history, explain what was noted, and recommend a course of
treatment with an estimate of time and cost. Your accountant will focus on
bookkeeping, tax reports, and finances, and help you deal with regulatory
agencies.
Consumers enter these relationships expecting that the training, expertise, and
ethical obligations of the professional will keep the client’s best
interests foremost. Both the consumer and the professional are aware of each
person’s role, and it is generally expected that the professional will stick to
doing what he or she is trained to do. The consumer does not expect his
accountant to lure him into accepting a new cosmology of how the world works or
to “channel” financial information from “entities” who lived thousands of years
ago; or for his dentist to induce him to believe that the status of his teeth
was affected by an extraterrestrial experimenting on him. Nor does the patient
expect the orthopedist to lead him to think the reason he fell and broke his
arm was because he was under the influence of a secret Satanic cult.
But seeing a therapist is a far different situation for the consumer. In the
field of psychotherapy there is no relatively agreed upon body of knowledge, no
standard procedures that a client can expect. There are no national regulatory
bodies, and not every state has governing boards or licensing agencies. There
are many types and levels of practitioners. Often the client knows little or
nothing at all about what type of therapy a particular therapist “believes in”
or what the therapist is really going to be doing in the relationship with the
client.
In meeting a therapist for the first time, most consumers are almost as blind
as a bat about what will transpire between the two of them. At most, they might
think they will probably talk to the therapist and perhaps get some feedback or
suggestions for treatment. What clients might not be aware of is the gamut of
training, the idiosyncratic notions, and the odd practices that they may be
exposed to by certain practitioners.
Consumers are a vulnerable and trusting lot. And because of the special,
unpredictable nature of the therapeutic relationship, it is easy for them to be
taken advantage of. This makes it all the more incumbent on therapists to be
especially ethical and aware of the power their role carries in our society.
The misuse and abuse of power is one of the central factors in what goes wrong.
Questions to Ask
Your Prospective Therapist
Ultimately, a therapist is a service provider who sells a service. A
prospective client should feel free to ask enough questions to be able to make
an informed decision about whether to hire a particular therapist.
We have provided a general list of questions to ask a prospective therapist,
but feel free to ask whatever you need to know in order to make a proper
evaluation. Consider interviewing several therapists before settling on one,
just as you might in purchasing any product.
Draw up your list of questions before phoning or going in for your first
appointment. We recommend that you ask these questions in a phone interview
first, so that you can weed out unlikely candidates and save yourself the time
and expense of initial visits that don’t go anywhere.
If during the process a therapist continues to ask you, “Why do you ask?” or
acts as though your questioning reflects some defect in you, think carefully
before signing up. Those types of responses will tell you a lot about the
entire attitude this person will express toward you – that is, that you are one
down and he is one up, and that furthermore you are quaint to even ask the
“great one” to explain himself.
If you are treated with disdain for asking about what you are buying, think
ahead: how could this person lead you to feel better, plan better, or have more
self-esteem if he begins by putting you down for being an alert consumer?
Remember, you may be feeling bad and even desperate, but there are thousands of
mental health professionals, so if this one is not right, keep on phoning and
searching.
1.
How long is the therapy session?
2. How often should I
see you?
3. How much do you
charge? Do you have a sliding scale?
4. Do you accept
insurance?
5. If I have to miss
an appointment, will I be billed?
6. If I am late, or if
you are late, what happens?
7. Tell me something
about your educational background, your degrees. Are you licensed?
8. Tell me about your
experience, and your theoretical orientation. What type of clients have you
seen? Are there areas you specialize in?
9. Do you use hypnosis
or other types of trance-inducing techniques?
10. Do you have a
strong belief in the supernatural? Do you believe in UFOs, past lives, or
paranormal events? Do you have any kind of personal philosophy that guides your
work with all your clients?
11. Do you value
scientific research? How do you keep up with research and developments in your
field?
12. Do you believe that
it’s okay to touch your clients or be intimate with them?
13. Do you usually set
treatment goals with a client? How are those determined? How long do you think
I will need therapy?
14. Will you see my
partner, spouse, or child with me if necessary in the future?
15. Are you reachable
in a crisis? How are such consultations billed?
After the Interview, Ask Yourself:
1. Overall, does this
person appear to be a competent, ethical professional?
2. Do I feel
comfortable with the answers I got to my questions?
3. Am I satisfied with
the answers I got to my questions?
4. Are there areas I’m
still uncertain about that make me wonder whether this is the right therapist
for me?
Remember, you are about to allow this person to meddle with
your mind, your emotional well-being and your life. You will be telling her
very personal things, and entrusting her with intimate information about
yourself and other people in your life. Take seriously the decision to select a
therapist, and if you feel you made a mistake, stop working with that one and
try someone else.
How To Evaluate Your Current Therapy
What
if you have been in treatment a while? What do you ask or consider in order to
help evaluate what is going on? The issues below may assist.
- Do you feel worse and more
worried and discouraged than when you began the therapy?
Sometimes having
top access one’s current life can be a bit of a downer, but remember, you went
for help. You may feel you are not getting what you need. Most important, watch
out if you call this to your therapist’s attention and he says, “You have to
get worse in order to get better.” That’s an old saw used as an exculpatory
excuse. Instead of discussing the real issues, which a competent therapist
would, this response puts all the blame on you, the client. The therapist
one-ups you, telling you he knows the path you have to travel. It’s an
evasion that allows the therapist to avoid discussing how troubled you are and
that his treatment or lack of skill may be causing or, at the very least,
contributing to your state.
- Is your therapist professional?
Does he seem to know what he is doing? Or do
features such as the following characterize your therapy:
·
The therapist arrives late, takes phone calls, forgets appointments,
looks harassed and unkempt, smells of alcohol, has two clients arrive at one
time, or otherwise appears not to have her act together at a basic level.
·
The therapist seems as puzzled or at sea as you do about your
problems?
·
The therapist seems to lack overall direction, has no plans
about what you two are doing.
·
The Therapist repeats and seems to rely on sympathetic
platitudes such as “Trust me,” or “Things will get better. Just keep coming
in.”
·
The therapy hour is without direction and seems more like
amiable chitchat with a friend.
- Does your therapist seem to be
controlling you, sequestering you from family, friends, and other
advisers?
·
Does the therapist insist that you not talk about anything
from your therapy with anyone else, thus cutting off the help that such talk
normally brings to an individual, and making you seem secretive and weird about
your therapy?
·
Does the therapist insist that your therapy is much more
important in your life than it really is?
·
Does the therapist make himself a major figure in your life,
keeping you focusing on your relationship with him?
·
Does the therapist insist that you postpone decisions such as
changing jobs, becoming engaged, getting married, having a child, or
moving, implying or openly stating that your condition has to be cured and his
imprimatur given before you act on your own?
·
Does the therapist mainly interpret your behavior as sick,
immature, unstable? Does he fail to tell you that many of your reactions are
normal, everyday responses to situations?
·
Does the therapist keep you looking only at the bad side of
your life?
- Does your therapist try to
touch you?
·
Handshakes at the beginning and end of a session can be
routine. Anything beyond that is not acceptable. Some clients do allow their
therapist to hug them when they leave, but this should be done only after
you’ve been asked and have given your approval. If you are getting the
impression that the touching is becoming or is blatantly sexualized, quit the
therapy immediately.
·
Are you noticing what we call “the rolling chair syndrome”?
Some therapists who begin to touch and encroach on the bodies of their clients
have chairs that roll, and as time goes by they roll closer and closer. Before
you realize what’s happened, your therapist might have rolled his chair over
and clasped your knees between his opened legs. He may at first take this as a
comforting gesture. Don’t buy it!
- Does your therapist seem to
have only one interpretation for everything? Does she lead you to the same
conclusion about your troubles no matter what you tell her?
You might have
sought help with a crisis in your family, a seemingly irresolvable dilemma at
your job, some personal situation, a mild depressed state after a death of a
loved one, or any number of reasons. But before you were able to give
sufficient history so that the therapist could grasp why you were there and
what you wanted to work on, the therapist began to fit you into a mold. You
find that, for example, the therapist insists on focusing on your childhood,
telling you your present demeanor suggests that you were ritually abused or
subjected to incest, or that you may be a multiple personality – currently
three very faddish diagnoses.
--Excerpted
with permission from “Crazy”
Therapies: What Are They? Do They Work? By Dr. Margaret Thaler Singer and
Janja Lalich.