During therapy

I keep doing what the therapist says but I don’t want to

I just sort of went along with it really

This section has been written to provide some information and advice for situations when you might find yourself going along with your therapist’s recommendations as to what might be helpful even when you don’t want to. (If you’re continuing with therapy when you would rather stop see ‘I keep going but I don’t want to’).

General issues
An important aspect of the process of therapy is the issue of power in the relationship between the client and the therapist. In therapy, there is often an initial power imbalance because a therapist has a lot of knowledge, expertise and training in a particular area, and may have some additional trappings of authority, such as a job title indicating seniority or expertise. While this might be part of your reasoning for seeking out a particular therapist, it may also mean that you assume that -because of their training or title - the therapist will automatically know the solutions to your difficulties. Alternatively, it might mean you feel obliged to do what they say: 

"Well, they're the expert"

Regardless of the therapy setting (NHS/Private, Individual or Group) it is important that you feel involved in and consulted about therapy and are sufficiently enabled to choose to not engage in any processes that you don’t want to. 

Therapy techniques
The psychological therapies used in clinical practice rely on theories and models to account for the ways in which people become distressed and what it is that keeps them feeling that way

Once your therapist has completed your assessment they will usually come up with a plan for therapy that is based on the theories and models that 

a) they have been trained in and use in clinical practice and

b) that apply to your situation or problem (this is sometimes called the ‘formulation’). 

It’s important that your therapist takes time to ensure you understand the plan that has I didn’t know what was expected of me. He asked me the same questions over and over again. I couldn’t do the homework because I didn’t understand it. I just felt confused all the time. been developed, and that you agree to it.

Therapy should not start without your informed consent. It therefore helps if it makes sense to you and that you see it as a credible way of helping you with your situation or problems. 

Certain therapy processes and techniques, such as exposure, are often very difficult, raise some intense thoughts and feelings, and are potentially upsetting, which means that you might be reluctant to engage in them. For many people, however, this can be a necessary aspect of therapy. It is important that you understand the reasons your therapist is asking you to undertake these techniques because it is necessary for you to give informed consent. This is an ethical principle that means that your voluntary and informed permission for treatment must be sought and provided. (http://www.nhs.uk/Conditions/Consent-to-treatment/Pages/Introduction.aspx

Questions to ask yourself:

  • Do I understand the therapist’s explanation for my problems?
  • Do I agree with them?
  • Do the processes and techniques make sense, and will they change my experience or problems?
  • Am I willing to do them? 

Questions to ask your therapist:

  • What theories and models are informing your understanding of my situation or problems?
  • How do the techniques we are using work?
  • What improvements can I expect? 

If the processes and techniques that you are trying aren’t helpful see our other information sheets on ‘Therapy isn’t working.

Abusive therapists 

From our current understanding of this area it seems as though abusive therapists are fortunately rare. This observation, however, shouldn’t hide the fact that some clients experience abuse from practicing therapists. These experiences may be the therapist exploiting their position of power in order to act in their own best interests rather than those of the client.

Inappropriate therapist behaviours can range from talking about themselves and their situations too much My counsellor tended to speak mostly about herself and her family, rather than listening to me. in your session through to wider issues such as employing clients, borrowing money, developing inappropriate friendships, and having a sexual relationship with the client. 

All these behaviours violate the professional role of the therapist and constitute malpractice.  Even if the client falls in love with the therapist, or doesn’t feel abused at the time, these behaviours are wrong and shouldn’t be happening.  They are violations of the therapist’s professional role and constitute malpractice. 

Fortunately for many of the most commonly available therapies there are published lists of therapist skills and behaviours (‘competences’) that can be referred to if you have any doubt about the legitimacy or relevance of anything your therapist is doing. (See Should my therapist be doing this?)