thoughts on who has the control in therapy

A comment from Patricia on my previous entry mentioned that having the control around when she attended therapy gave her a sense of ease around building the relationship. That got me thinking. I don’t think I’ve ever felt in control in therapy. It’s not given me a sense of having any power in the relationship lately until this termination with TL. The first ever official therapist I saw (not counting my guidance counselor in high school) was 1) a requirement of the work-study program at school, 2) was assigned to me, and 3) refered me to another therapist in the program by the 2nd session because of countertransference. 18 therapists later and I’ve only voluntarily initiated termination with 2. All others were either time-limited by school terms (internship guidelines), or I was terminated for “liability”… Oh, and one was ill for an extended period so I saw someone else in the interim. When the original therapist returned, I took the option to stick with the one I had been seeing while she was out… so really only felt in control of major decisions a small handful of times. I guess you could also count the two therapists I never got past the intake with. One was atrocious in first five minutes of the first session, and the other took 3 sessions to cement that we were not going to click (neither handled self-harm or suicidal thinking well).

Aside of not feeling in control of the relationship all that often, I rarely feel like I dictate the path of the sessions (though in reality I do that almost every session. I wonder what keeps me feeling not in control of it?). I constantly defer to the clinician’s focus after an initial overview of what’s bothering me. If they narrow in on something that I don’t necessarily think is more pressing than something else, I don’t often try too hard to change the focus back to what I consider important. Yes, there are times I will insist on addressing something, but it usually takes a huge amount of effort and time to attempt to assert myself. I don’t feel like I am the expert in my life. It’s weird…

On the flip side, I have never felt the need to dictate where a client’s session should go or what they should address. In my professional role, I had aways believed the client was the expert in what needs addressing, and what direction therapy should take. They are paying me to be a sounding board and to offer support through difficult times, but what we addressed was always totally up to the client. Also, aside of scheduling logistics, the frequency of contact was pretty much up to the client. They controlled when and how often they showed up for appointments, and would have controlled when they terminated (for the most part… until I fell apart and ran away. Then they were S.O.L… and I still feel pretty shitty about that).

How can I hold those both true? How can I as client feel the therapist has all the control, and as therapist always feel the client has the control? Maybe it has been my experiencing of the therapeutic relationship early on. Maybe being indoctrinated into having no real control over choice in therapist or choice in termination time perpetuates my inability to feel in control over it all. As a clinician, I could not and would not force my clients to see me. As a client, I could not dictate the end of therapy until relatively recently. Things with JG didn’t click well, so I was ok with my then-wife insisting I stop therapy. I hadn’t become attached to JG, so walking away was easy. I simply did not reschedule one time after having to cancel because of weather… With Dr. C, I was moving across the country so I was the one to say I’m leaving. The termination with TL did not start out in my control (because I had not planned on switching therapists again so soon if I wasn’t moving again), but I ultimately took control. I know it was her intent to have me feeling like I had a choice in it, like it wasn’t a forced and sudden termination happening on her time-line. At the start of therapy with her, I had talked about how difficult it had been to terminate with De. I had also brought up that D before her had sprung immediate termination on me about a month earlier than planned. TL had the flexibility, so she did her best to allow me to set the pace of our termination… It’s been the easiest ending to a therapy relationship in a long time. It certainly has not been easy, but it has also not been as devastating as the others have been of late. I’ll have to remember to mention that to the new therapist, so they can get a message to TL to say “thanks”…

There’s definitely something to be said for feeling in control of your therapy. I keep trying to remind myself that I hire a therapist, so in that respect, I am more of a “boss”. My client self has only recently remembered that I can hire them or fire them as I see fit. It’s not necessarily that simple, but I need to remind myself I have more control than I think. When you grow up with others always in control (and no safe way for you to gain any), you forget that it is even a possibility. (attachment can also make it feel like there’s no control, but that will be a topic for another post some day…)

Anyway, that’s not exactly where I wanted to go with this post, but I have lost my original direction… Maybe I need to start creating outlines like I used to do for major papers in school. That way, when I go off on a tangent, I have something to refer back to in order to keep on track. Who knew my h.s. writing courses would come in so handy later in life?

Oh, I know. I meant to touch on having trust issues, which makes it difficult to open up in therapy. Lately, by the time I acknowledge trusting the person I am talking to, they are headed out the door for new adventures. I never really pictured opening up to someone because I could choose to never see then again if I wanted to. I know that there’s a measure of safety in speaking with someone you don’t see daily (their judgements won’t impact your life as strongly as those of the people around you day in and out), but I never realized I could walk away from therapy. Aside of feeling that the clinician is in control, my desperate need to have a safe person/place for all the ugliness keeps me feeling a slave to it. There’s something very validating and comforting in knowing someone is professionally required to be accepting and trust-worthy…

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