In Therapy

A user's guide to psychotherapy

Backseat Drivers & Therapy, Part I: Introduction

When individual therapy gets crowded

Well-intentioned loved ones can butt in and screw up a perfectly good therapy. Or they can give needed support. Or they can lend perspective to a harmful therapy situation. How do you tell the difference?

Jane has something brewing:

"I've been talking with Sally about our sessions. She thinks exploring my past is a waste of time and that my whole problem started with my ex-boyfriend Jim. She says Freud was misogynistic bigot and no one believes in him anymore. She also thinks I have ADD and wants to know your opinion about Ritalin."

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Boy, it appears Sally and I are really at odds. Our treatment plans, theoretical orientation and therapeutic techniques are diametrically opposed. Sally and I have locked horns in a bitter ideological conflict. We could debate some of these points for hours and never come to a peaceful resolution.

Wait a minute. Who is Sally? Why does she have such a say in what we talk about? And most important, how does Jane feel about our work?

Of course, Sally is Jane's friend. They've been friends for many years and Jane trusts her opinion. They share everything. Sally's been in therapy several times and majored in psychology, so Jane looks to her for advice. Sally wants to help Jane get the most out of her therapy, so she's kibitzing - looking over her shoulder, backseat driving. This well-meaning gesture can complicate and disrupt Jane's therapy.

As stated before by me and my fellow bloggers, the therapeutic alliance is extremely important for successful therapy. Jane and I working together on her issues in an atmosphere of trust and collaboration is the backbone of our work. When a Sally enters into the picture, the alliance can be undermined. Jane may start questioning our work and feel torn - to whom should she listen? Now, rather than getting down to the business of working on herself, she's sidetracked by divided loyalties.

Some of the people I've worked with report feeling awkward, annoyed and irritated when those close to them ask about their therapy. Others feel the questions convey love and interest in their life. And some clients actively solicit opinions about their therapy to help them know what their feelings about it should be, or to validate what they already feel. Therapy doesn't exist in a vacuum - it's tantalizing to talk about this hour with others during the week. If you do, you'll inevitably hear their feedback. Everyone has an opinion.

Before I dive too deep into this series, I'll state the big caveat: if something unethical or illegal is going on, please tell someone. Discuss your concerns with your therapist first, and if that doesn't resolve the issue, call your therapist's boss or licensing board and let them know what's happening. If you're not sure what's ethical and what isn't, take a look at their professional Code of Ethics. If a boundary is being violated, it's probably mentioned there.

In this brief series I'll try to address what happens at the intersection of therapy and loved ones. I hope to leave you with an understanding of what is helpful for clients to disclose to others, what isn't, and what to do about overzealous backseat drivers. I'll cover the confusing area of adolescents in therapy as well as give tips to those with loved ones in therapy.

I'll be working from one general thesis: as long as the therapy is ethical and effective, it's best to discuss conflicts or concerns directly with your therapist. Why?

  • Diffusion of energy: I've heard this from clients before: "something you said last week really ticked me off (or got me thinking, or confused me), but I talked to my friend and I feel better. So, what should we do today?" We just missed a great opportunity to dive into juicy material. Because you blew off steam outside the session, we are deprived of the opportunity to learn and grow in this room. You may feel better, but I don't have any greater understanding of the problem and we don't have the shared experience of resolving it.
  • Assertion: No matter how collaborative the therapy, it's still a challenge to confront the therapist in the here and now. Many clients come to therapy wanting to work on their ability to confront. Why waste this opportunity?
  • Therapist growth: Your therapist is a human and a professional, always growing and evolving in her work. If she made a poor choice, it would be great for her to hear about it. It's not your responsibility to educate or train your therapist, but she should be willing to learn from her mistake and provide better service to you. 
  • Developing self: I've mentioned people who tend to live life by committee. Rather than exploring and trusting their own opinion, they'll survey friends and family and adopt theirs. While occasionally helpful, making most decisions this way is disempowering. I'm interested in Jane's opinion of our work, not Sally's.
  • Avoiding triangulation: In too many families, direct communication is replaced by a triangle: A tells B who tells C. This is a very common but ineffective way of communicating. Sometimes it's repeated in therapy (especially with teens): client is upset with therapist, client tells loved one and loved one leaves a stern message on therapist's voicemail. The therapist, bound by confidentiality laws, can't even acknowledge the client is in treatment without consent. When the client speaks directly to the therapist, it eliminates the triangle and gives the client a chance to deal with the situation directly.

In Part II I'll discuss why backseat driving happens and give real-life examples. Stay tuned.

 

Ryan Howes, Ph.D., is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

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