Stopping therapy: We have ways of making you talk
Walking away from therapy is a big step, but what if your analyst tries to stop you? Their methods of persuasion can be intense – and not always ethical, reports Rhodri Marsden
Rhodri Marsden is the Technology Columnist for The Independent; he has also written about crumpets, Captain Beefheart, rude place names and string. He's also a musician who plays in the band Scritti Politti, and won the under-10 piano category at the 1980 Watford Music Festival by playing a piece called "Silver Trumpets" with verve and aplomb.
Tuesday 17 June 2014
Having spent six months overcoming a period of depression in private therapy sessions, Gemma felt ready to stop. But when she raised the issue with her therapist, she met resistance.
"For two months, I told her that we need to cut down or stop altogether," she says, "and every time it would be diverted into a discussion about why I'm not willing to spend £60 a week on myself." The absurdity of the situation reminded Gemma of trying to cancel her contract with Sky. She says: "I contacted them eight times. They'd tell me that changing to BT would be a bad idea; every time, I ended up saying that I'd 'have a think'."
While the Murdoch empire kept her firmly in its clutches, Gemma's therapist was unintentionally piling on the anxiety. "She would say that I was 'abandoning' the sessions and I didn't understand why she was using that kind of language," she says. "It was awful."
Therapists will tell you, quite rightly, that the opposite scenario is far more prevalent (people are ready to leave therapy but are too scared to do so), but Gemma's experience is not uncommon; a feeling that they're caught up in a cycle of attending expensive therapy sessions that no longer give them any benefit. Whether it's because of timidity and lack of assertion on their behalf – or overbearing behaviour on the part of a therapist – the results are counterproductive, according to counselling lecturer Nicola Blunden.
"The client should be in charge of the whole process," she says. "Otherwise, how are they going to benefit? They have to want to be there, or it's a waste of time for everybody."
While the kind of issues experienced by Gemma are possibly atypical, the number of stories told to The Independent points to more than just a statistical blip. "I made no progress in individual therapy," says Sally, "and I felt very challenged by [my therapist]... she called me 'passive aggressive' and basically wouldn't allow me to leave."
This Catch-22 scenario, where expressing resistance to therapy is interpreted as a sure sign you need it, was also felt by Harriet ("He called me for three days, telling me I wasn't in the right mind to make such a decision"); Claire ("He persuaded me to attend a closure session, which he spent telling me how fucked up I would be without him and how I was wrong to want to stop") and Natasha, along with her now ex-husband ("We both told her twice we were not going to continue with counselling, but she carried on scheduling appointments and actually passing judgment. It was very odd.")
The ethical framework issued by the British Association for Counselling & Psychotherapy is clear on this issue. One of the principles emphasises "the importance of developing a client's ability to be self-directing within therapy and all aspects of life", and "the value of voluntary participation" in therapy.
"Client autonomy is absolutely paramount," says consultant psychologist Carina Eriksen. "The therapy is meant to empower them, not disempower them. A good therapist will keep a conversation going about where the therapy is going – is it benefiting the client?"
Blunden agrees. "I give guidance on how long therapy might take, but I don't require commitment. They don't even have to sit there for the entire session if they don't want to! Any pressure on a client to continue would seem to me to be exploitation; by making a decision about future sessions, you're removing a client's autonomy."
Evidently, there are good therapists and bad therapists, but some of the bad ones seem unable to leave their own needs outside the room – whether personal, emotional or financial. "You have to shelve all of that," says Blunden. "You know when you're crossing a line, ethically." Occasionally, clients can see that line being crossed. Emma described how she was persuaded to have weekly sessions by a private psychotherapist. "At £97 a session, it was a stretch to do it monthly," she says, "but she pushed for weekly, although you could see her heart wasn't in it. I think the hire of the office in central London was crippling her."
As an unregulated profession, psychotherapy can generate ethical tension between the duty of care and the requirement to earn a living, but the needs of the therapist simply have to be suppressed within the context of treatment, according to one therapist who wished to remain anonymous. "Part of my income is generated by private practice," she says, "and if people say they're leaving, then of course I experience a twinge of worry. But you can't force people into therapy."
That doesn't stop some people from trying. Joanne recounted three occasions on which she tried to leave therapy. "The first was when I didn't have enough money, but my therapist told me that we should perhaps explore this sense in general that I don't have 'enough' of things. The second time, he immediately raised a massive problem to do with my mother – he basically dropped the "M" bomb – which made me think he was right; that I needed to continue! It was as if he'd said, 'Yeah, not so great now, are you?'" Joanne didn't feel that her therapist's motives were financial, but believes he was primed to look for problems rather than strengths and unable to support the idea that she'd made progress.
"He was implicitly saying that I couldn't cope on my own. It was really unsettling. I think that people who go into that profession are helper types," she continues. "They get a sense of being needed, so it must surely affect them when someone says that they don't need them any more."
Issues that are personal to the therapist (Are they needed? Are they doing a good job? Are they even boring the client?) must be dealt with within the clinical supervision system, according to Blunden. "Ninety-nine per cent of the time, the client gets better, they see progress, then they feel that the sessions are no longer rewarding, they want to stop, and you agree," she says. "When that doesn't happen, it's your job to unpack that in supervision." But some evidently don't. It's as if the therapy is more important to them than it is to the client. "He was telling me about all the sessions we would need before actually stopping," says Joanne. "It genuinely felt like I was dumping him."
As Blunden says, you never "graduate" from therapy; you never get to a point where you feel that you're "fixed". But while that could conceivably play into the notion of therapy continuing for perpetuity, she believes quite the opposite. "As therapy is never 'done'," she says, "people should just leave when they want to."
The unique relationship and balance of power between therapist and client is something that's endlessly tricky and it's one that Gemma has now only just managed to conquer.
"I've extricated myself now," she says, "but at the last session, my therapist was saying she could tell I was really angry with her. I wasn't – I just didn't want to be there."
And are you still with Sky? She laughs. "I'm afraid I am, yes."
Some names have been changed
If you're thinking of leaving therapy
* Ask your therapist whether they feel you are at risk of significant harm if you end therapy now. If the therapist does think so, take their concerns seriously.
* If the therapist does not believe you to be at risk, you could ask for some time to come to your own decision.
* If you feel that your therapist is not adhering to the BACP ethical guidelines, trust yourself and take a break from therapy, or choose a new therapist. You are in charge of the process, you have every right to be sceptical and have no responsibility to protect the therapist from your dissatisfaction with the work. A good therapist will respect your decision, will work with you to further your autonomy and will have no personal investment in what you decide to be best for you.
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