Psycho-Babble Psychology Thread 537858

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Lott: How informed should the client be?

Posted by All Done on August 5, 2005, at 13:10:19

http://www.dr-bob.org/babble/psycho/20050801/msgs/537844.html

Ms. Lott,

First, thank you very much for being here this week. I think you can see how much we all appreciate your book. For many of us, I believe it has made a huge difference in how we approach therapy and we can feel more comfortable opening up and sharing things we would otherwise be afraid to share. Things that can really help our therapy progress.

Unfortunately, for some reason, I got it in my head that you were here until Sunday, so I'm still in the middle of re-reading your book and I haven't been through all of the threads here, yet. So, if you've already answered this or something similar, just let me know.

After I read "In Session: The Bond Between Women and Their Therapists" for the first time, I talked to my therapist about what I learned about transference and I expressed a bit of anger that he hadn't shared some of this information with me in the beginning of my therapy. I had only been seeing him for about five months, so I didn't feel like I was in the dark for too long, but I think it's likely he never would have brought the topic up himself. Don't get me wrong, he explains a lot to me and is very forthcoming when I ask questions, but he doesn't offer up much.

Do you think therapists feel that if they share with the client what she might experience ahead of time, something might be lost? And, admittedly, at first, I thought there was no way I could or would experience transference after I found out how it works. Kind of like believing in Santa after you find out he doesn't really exist. Needless to say, I quickly realized regardless of how informed I am, I still can and do experience transference.

When I see my general practioner, he doesn't just start poking around and testing without telling me what he's doing, how he's going to do it, and why. Aren't there even rules about informed consent? Why do you think therapists kind of leave us in the dark when treating us?

Thanks for your thoughts on this and, again, thanks for visiting us.

Laurie

 

Re: Lott: How informed should the client be? All Done

Posted by gardenergirl on August 5, 2005, at 15:33:53

In reply to Lott: How informed should the client be?, posted by All Done on August 5, 2005, at 13:10:19

Oh my...just had to comment on this. The first time I realized I had transference going on with my T, I just couldn't believe it. I arrogantly thought that there was no way that *I* would experience that. Not with what I know about therapy! Ha!

My reaction literally was to say, "Holy transference, Batman!"

Glad I got more humble.

But you do make a very good point, Laurie, about informed consent. I bet the more psychodynamic/psychoanalytically based therapists might not want to "clutter the therapy field" by talking too much about what might happen. But it is a responsibility.

About the best I get to with my clients is to "warn" them that sometimes they may come in the door feeling okay and leave feeling cruddy. And that's okay, as long as they can contain the cruddiness adequately. But that therapy is not always going to make you feel good after each session. Buyer beware.

gg

 

Re: Lott: How informed should the client be? gardenergirl

Posted by Daisym on August 5, 2005, at 16:58:02

In reply to Re: Lott: How informed should the client be? All Done, posted by gardenergirl on August 5, 2005, at 15:33:53

I think we've had a thread here about the usefulness of catharsis and how most people think if they could just admit or discover this ONE thing - they would feel better. Miraculously better. I've referred to it as the "after-school special syndrome" because on those movies everything gets tied up neatly in two hours.

I think that the basic stuff should be written out on a take home sheet - like emergency call numbers and payment stuff. And I think there should be an overall discussion about what therapy might feel like and what typically happens with that particular therapist. If both parties know it is a time limited undertaking, that should be discussed too.

And all that said, I know that clients don't divulge for awhile what they might be really struggling with, so the unknowns go both ways.

 

Re: Lott: How informed should the client be?

Posted by deborah anne lott on August 5, 2005, at 21:08:27

In reply to Lott: How informed should the client be?, posted by All Done on August 5, 2005, at 13:10:19

Of course there needs to be informed consent in psychotherapy but just what the therapist should say initially is not so obvious. I think that a therapist should say that some clients develop strong feelings for and about their therapists and that these often have to do with earlier relationships. I don't think a therapist should necessarily go into a lot of detail because people have to be free to react individually. Some people don't develop strong feelings, at all. But I think therapists say too little partly because there isn't the science behind most therapies that there is behind a medical procedure such as heart surgery. A surgeon can tell you what the side effects usually are; how likely you are get better; etc., but therapists don't have these kind of statistics. But they should say more. I've seen some handouts that some therapists could patients at the beginning that are very good but I don't think there's any standardization about it right now. And different schools of therapy have different philosophies. I think there should be greater regulation of informed consent in therapy and therapists should be held more accountable for disclosing more.

 

Re: Lott: How informed should the client be?

Posted by deborah anne lott on August 5, 2005, at 21:10:00

In reply to Re: Lott: How informed should the client be? gardenergirl, posted by Daisym on August 5, 2005, at 16:58:02

Daisy makes a really good point -- therapists can't read a client's mind. Yes, therapists should say more but clients should also be more forthcoming about what's going on.

 

Heheheh, wouldja believe I got an opinion?

Posted by Racer on August 6, 2005, at 12:54:01

In reply to Re: Lott: How informed should the client be?, posted by deborah anne lott on August 5, 2005, at 21:10:00

Another thing to keep in mind is that there are a lot of people out there who don't *want* to know anything about the process of therapy. They're not the sort of people who come here, but some do show up in the therapist's office, do work on whatever issues brought them there, but don't want to see behind the curtain.

Same way there are people who go to the doctor's office, get the prescription for antidepressants, and take them. They don't want any more information than "take one pill with food."

They wouldn't be here, since they probably wouldn't have much to say about therapy, no matter how much they had to say in therapy.

Just another thought...

 

Re: Lott: How informed should the client be? All Done

Posted by Dinah on August 6, 2005, at 21:15:59

In reply to Lott: How informed should the client be?, posted by All Done on August 5, 2005, at 13:10:19

My son's play therapist gave a handout that included the basics of developing feelings for your therapist (in one paragraph or less) and how you should feel free to talk about it.

Her whole handout was great.

 

Re: Lott: How informed should the client be? Dinah

Posted by gardenergirl on August 6, 2005, at 23:34:54

In reply to Re: Lott: How informed should the client be? All Done, posted by Dinah on August 6, 2005, at 21:15:59

Welcome back, Dinah. Hope you had a good vacation.

I wonder if your son's T would mind you sharing the gist of the handout with us? Or at least with me? (laughs selfishly...)

gg

 

Re: Lott: How informed should the client be? gardenergirl

Posted by All Done on August 7, 2005, at 1:09:50

In reply to Re: Lott: How informed should the client be? All Done, posted by gardenergirl on August 5, 2005, at 15:33:53

> Oh my...just had to comment on this. The first time I realized I had transference going on with my T, I just couldn't believe it. I arrogantly thought that there was no way that *I* would experience that. Not with what I know about therapy! Ha!
>
> My reaction literally was to say, "Holy transference, Batman!"
>
> Glad I got more humble.
>
> But you do make a very good point, Laurie, about informed consent. I bet the more psychodynamic/psychoanalytically based therapists might not want to "clutter the therapy field" by talking too much about what might happen. But it is a responsibility.

To be fair, there is something to be said for therapists who answer questions freely once the client brings the topic up. I guess I just would have liked a little heads up.

> About the best I get to with my clients is to "warn" them that sometimes they may come in the door feeling okay and leave feeling cruddy. And that's okay, as long as they can contain the cruddiness adequately. But that therapy is not always going to make you feel good after each session. Buyer beware.
>
> gg

It's funny because my initial version of my question included the word warn in parentheses like you did.

Pretty early on, my T did tell me that I might feel worse before I feel better. I guess I was just a little blindsided by the erotic transference. Then again, can you imagine what I would have thought if he would have explained that to me in the first or second session?? Hmm, this is such a fine line for therapists.

(Good luck, gg! Well, not that you need luck, you're going to be just fantastic. :))

 

Re: Lott: How informed should the client be? Daisym

Posted by All Done on August 7, 2005, at 1:14:49

In reply to Re: Lott: How informed should the client be? gardenergirl, posted by Daisym on August 5, 2005, at 16:58:02

> And all that said, I know that clients don't divulge for awhile what they might be really struggling with, so the unknowns go both ways.

Very true. And like I just said to gg, I can't even imagine what I would have said or thought if my T tried explaining transference early on before I even realized myself what I was thinking or feeling.

 

Re: Lott: How informed should the client be? deborah anne lott

Posted by All Done on August 7, 2005, at 1:21:29

In reply to Re: Lott: How informed should the client be?, posted by deborah anne lott on August 5, 2005, at 21:08:27

Thanks, Ms. Lott. What you said makes a lot of sense to me and it helped me to understand why it would be pretty tough for a therapist to explain everything in detail right up front. Takes away some of my frustration.

Thanks, again, for visiting Babble. It was great to have you here!

 

Re: Heheheh, wouldja believe I got an opinion? Racer

Posted by All Done on August 7, 2005, at 1:27:00

In reply to Heheheh, wouldja believe I got an opinion?, posted by Racer on August 6, 2005, at 12:54:01

> Another thing to keep in mind is that there are a lot of people out there who don't *want* to know anything about the process of therapy. They're not the sort of people who come here, but some do show up in the therapist's office, do work on whatever issues brought them there, but don't want to see behind the curtain.
>
> Same way there are people who go to the doctor's office, get the prescription for antidepressants, and take them. They don't want any more information than "take one pill with food."
>
> They wouldn't be here, since they probably wouldn't have much to say about therapy, no matter how much they had to say in therapy.
>
> Just another thought...

I agree that there must be people who would rather not know about the process, but I wonder...other than those forced into therapy, isn't it in the therapy client's nature to want to know more as opposed to accepting something as is?

But I understand your point. Maybe *I* just can't imagine feeling that way. :-]

 

Re: Lott: How informed should the client be? Dinah

Posted by All Done on August 7, 2005, at 1:29:33

In reply to Re: Lott: How informed should the client be? All Done, posted by Dinah on August 6, 2005, at 21:15:59

> My son's play therapist gave a handout that included the basics of developing feelings for your therapist (in one paragraph or less) and how you should feel free to talk about it.
>
> Her whole handout was great.

Was it different because she's dealing with a child? I wonder how different a therapist/child client relationship is.

Nice to have you back! Although I am pouting a bit because I leave for San Diego tomorrow and won't have internet access until Thursday. :(

 

Trying to remember... All Done

Posted by Racer on August 7, 2005, at 10:17:29

In reply to Re: Heheheh, wouldja believe I got an opinion? Racer, posted by All Done on August 7, 2005, at 1:27:00

> >
> I agree that there must be people who would rather not know about the process, but I wonder...other than those forced into therapy, isn't it in the therapy client's nature to want to know more as opposed to accepting something as is?
>
> But I understand your point. Maybe *I* just can't imagine feeling that way. :-]

I can't remember how I felt when I ws in therapy before, but I don't think that it ever really mattered to me what was happening behind the curtain. I knew that I had to talk about what was going on for me, what had happened in the past, and work out how to move on from it all. That was enough for me then, I guess.

Now, I know a lot more, but I'm not sure that things like transference really matter much to me now, either. I'm aware of them, but mostly I'm more aware of trying to let go of some of my fear, so that I can get at what's behind it. If that requires some transference, so be it. I try not to analyse the process, in favor of moving through it, whatever it contains.

If I were thinking about the process itself, I would get obsessive about it, and probably fall back into trying to diagram it, etc. But that's me...

 

Re: Trying to remember... Racer

Posted by Dinah on August 7, 2005, at 10:34:11

In reply to Trying to remember... All Done, posted by Racer on August 7, 2005, at 10:17:29

I'm a stubborn soul. I couldn't relax into therapy at all until I had thoroughly researched it and found out the techniques they use. I just refused to have my brain "manipulated" in ways I didn't understand.

Of course, I learned they aren't Svengalis or anything. And of course, my therapist also modified the standard repertoire when I kept asking him if he were mirroring me, or whatever. Now I sometimes wonder what on earth it is that they are good for, but I remember that seeing him helps me when I feel really bad. But darned if I know why. So.... finding out all I could didn't help all that much.

Other than to stop him using many of the stock therapeutic phrases. Which I sort of like because it feels like he's on his toes more.

 

Re: Lott: How informed should the client be? All Done

Posted by Dinah on August 7, 2005, at 10:35:46

In reply to Re: Lott: How informed should the client be? Dinah, posted by All Done on August 7, 2005, at 1:29:33

Oh drat. And I was hoping to have a chance to chat with you. :(

I imagine today will be crowded with family and packing, but maybe we can arrange something when you get back?

Are you going for fun or business?


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