Wednesday, January 23, 2008

Poll Results: It's Hard to Talk About ......... in Psychotherapy

From our sidebar poll:
72 (31%)
Professional Fees/Payment
59 (25%)
The therapeutic relationship
90 (39%)
8 (3%)

Votes : 229

My vote went towards Professional Fees, in case you wanted to know. When people don't pay, it's still stressful, and I still feel awkward about asking to be paid. For a lot of people there's a discomfort about psychotherapy of "I have to pay someone to listen to me." If I have to ask to be paid....well.... it's a reminder that I'm here for reasons besides my total devotion to patient care (--I got bills, too)...and if I have to ask to be paid repeatedly, well, it can make everything feel pretty uncomfortable.

Okay, sometimes it's hard to talk about the therapeutic relationship. But as the shrink, it's never hard to talk about sex or meds.

Feel free to chime in....


Rach said...
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Rach said...

Chime I will... Money, I don't mind talking about. Maybe because I do understand how valuable the psychotherapy is to me, and therefore, how appreciative I am of my therapist's time and energy. No problemo.

With Canada being a socialized health care system, it becomes a grey area in terms of feeling resentful towards the government and taking it out on the psychiatrist because he happens to be the one sitting right there. I tend to blog about this one a lot, because it annoys me to no end.

Medications - not an issue, because it's a vital part of the treatment process, and I will go to the end of the earth and back to try and get the meds aligned and working for me.

The other two: Sex and the therapeutic relationship... Both are equally difficult to discuss.

Somewhere in blog land there's a post on lying to your therapist, and the stress that causes the therapeutic relationship. The issue of transference seems to be forefront in my own mind at all times, but I'm never quite sure how to raise that issue, or if it's even appropriate to do so (is what I'm feeling transference, or am I just totally insane?!)

Sex... well, if one is comfortable with the topic of sex to start with, then it's probably significantly more comfortable to discuss within the context of a therapy session. But for those who have had trauma, bad relationships, negative sexual experiences, concerns about their own sexual identity, etc, etc, discussing sex (even with a therapist that you TRUST!) is a stumbling block for and to treatment. Which of course, can effect the therapeutic relationship...

Dinah, are you sorry you asked?!

Mel said...

My blog called "Things I Don't Tell My Doctor (but probably should)".

Its a work in progress I suppose. Don't know if I should mention this to her at the next appointment.

Awake and Dreaming said...

When I was in therapy and when I am with clients I definitely have the hardest time talking about the therapeutic relationship.

I think there are a few reasons for this. First of all, talking about a relationship with anyone is awkward. It's awkward when you do it with your mom, your boyfriend etc... but with someone who you see as having a power imbalance it can be very hard. And hard to measure what possible consequence might be.

On the side of the therapist, I find it a little intimidating to talk about the therapeutic relationship, but part of that for me will I hope come with experience. I'm still nailing down who I am as a social worker and becoming more comfortable with new roles and skill sets.

Either way, what I'm trying to say, is that it's hard on both sides to talk about the therapeutic relationship.

Anonymous said...

sex, by far and away sex. as an example, at one point i asked my psychiatrist whether cipralex would cause sexual side effects. he asked why. i replied because... i'm going to go with because. as a more recent example, i recently started marvelon and my pharmacist said that i should know that it will react will my epival/depakote and lamictal. i really should tell my psychiatrist that i am taking the birth control pills because they will affect my medications (which i don't have problems talking about.) the reason i am not talking about it is that my psychiatrist is old enough to be my father and it would just be weird to talk about sex.

Anonymous said...

I voted for sex.
I think it would be fine to talk about for most people, but when there are "issues" surrounding sex (like Rach already said), a therapist even mentioning the word is enough to make you want to gauge out both eyeballs.

Anonymous said...

Interesting to see the different perspectives vis a vis patient/client and shrink. The therapeutic relationship and sex from the patient’s viewpoint, and money and the therapeutic relationship from the shrink’s. In some ways the therapeutic relationship is surprising, it’s the very basis that differentiates therapy from any other relationship such as friends, partner, family etc. But in other respects, it’s like the elephant in the room. We know the very nature of the relationship and why we are there - there are multiple reminders that reinforce it (payment, appointment times, the power imbalance mentioned by Erin). Despite being surrounded by these signs, there still seems to a reluctance to openly talk about the relationship, well at least on my part anyway.

Anonymous said...

I am not understanding the "therapeutic relationship" thing. I mean, WHAT therapeutic relationship? Maybe I am missing an essential element of psychotherapy, but I have never really felt that there IS a "therapeutic relationsip." They provide a service which may be beneficial to me. It's not what I would call a relationship. Do you have a "therapeutic relationship" with your dentist, your plumber, a college professor from whom you took a class? No. It is possible to get a benefit out of therapy without feeling any kind of personal connection to the therapist. (Maybe I should bring this up with my therapist!)

Money is a non-issue ... I always pay my bill and all that, and I recognize that this is a service for which I pay, just like anything. Medications are probably the easiest thing in the world to talk about. Sex is a little awkward to discuss, so I voted for that.

Anonymous said...

Therapeutic relationship is crucial to me. I need to 'click' with my therapist or it's just not going to work out. It's more than just liking the's also feeling that they 'get' what I'm talking about and that they're giving valuable feedback in return. I appreciate a good therapeutic relationship when I find it. I don't mind talking about the therapeutic relationship because it gives me a chance to tell my therapist that she's doing a good job.

Money's never an issue because my insurance pays the bills. I don't even see them. (I know I'm very, very fortunate).

Sex is what I voted for. I absolutely hate talking about sex in therapy.

Aqua said...

For me it is the therapeutic relationship that heals. On the surface my pdoc represents every male and every authority figure I have ever encountered. The difference is in how consistently he is a positive male and authority figure role model in my life.

As a child I was terrorized, humiliated, hurt, let down, dismissed and diminished by the man I was supposed to trust the most. He was also a policeman, the ultimate symbol of an authority figure. It doesn't take a genius to figure out why I have such a difficult time in any relationship where I perceive a power imbalance.

When I met my pdoc I was so scared. As a pdoc I felt he had so much power over me. Over the years we have worked together towards a common goal; my wellbeing. He always treats me like an equal, never "telling" me what to do, instead he provides me with information and guidance, he values my opinions and we make all treatment decisions together.

I feel like his consistency, his being the opposite of what I have always understood an authority figure to act like, his trustworthiness, his never being punitive and his always being supportive, empathetic and thoughtful; I feel as though his relationship with me is helping me overcome my fears in this area. He makes me feel safe, when I rarely feel that way. Changing my fear of power dynamics in relationships is a huge and difficult task for me. That is why the therapeutic relationship I have with my pdoc is definately the most important thing for me.

NeoNurseChic said...

I mentioned that I'd brought up the poll with my psychiatrist. He and I discussed how each of those things could truly fit in the context of the therapeutic relationship - or at least why they are difficult to talk about due to the therapeutic relationship. It was actually a very good conversation, even though it led to a lot of anxiety on my part.

The other day I told my psychiatrist that I was frustrated with him because he wasn't really saying anything. I never say stuff like that and now feel quite badly about it, although I don't think he took it personally. It was the day after I got the trial stimulator on Monday, and I wasn't feeling very well as I was trying not to take pain medication, so I wasn't myself. He was saying, however, that perhaps the reason I'd felt better lately in terms of depression/anxiety, was that I'd been more willing to open up about difficult things. Perhaps this is true.

Take care,
Carrie :)

Sarebear said...
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Anonymous said...

i would like to see a post from one (or all) of yous talking about why the therapeutic relationship is hard to talk about, the different aspects of it and what is the most difficult topic within the therapeutic relationship to discuss. and how you approach situations where the relationship needs to be talked about.
what comes to my mind when i think of the therapeutic relationship as something that would be hard to talk about, would be telling my therapist things like how much i trust & rely on her, etc. things that would make me feel vulnerable to say. i would be interested to hear about other situations too, esp from the shrink's point of view.

Anonymous said...

Onefortheroad's suggested post is something I'd like to read too.

Sarebear said...

I did some writing on the therapeutic relationship a while back.

Actually, since my psychologist has been so open to discussing it, our therapeutic relationship, I can completely understand why it'd be a hard or uncomfortable thing for many mental health professionals to do.

April said...

Can someone address two of those options combined---sex and the therapeutic relationship. I guess in the transference sense, but how to address this with your shrink. I'm working on it, but I get uncomfortable. Other times I feel it's better just to rip of the band-aid and get honest about it. Assuming my dr's had this conversation with other patients I'm being silly for being so uptight about it... ?