Who Knows What’s Best for Me: My Therapist or Me?

Dear GoodTherapy.org,

I have been in therapy for four and a half years. Although I’ve made major changes in my life, I’ve not yet tackled the initial problem which took me to therapy in the first place. I feel like I get mixed messages from my therapist. Sometimes he encourages me to be more open, other times to “not go there.” I want to work through some difficult baggage, but today he said it’s acceptable to put a metaphorical Band-Aid on a wound and carry on limping through life.

I get the feeling he’s holding back when I want to go forward. It feels like he doesn’t trust me to be okay while doing the work. It took me a very long time to learn to trust him, and it feels a bit hypocritical if he can’t take the same risk trusting me. I’ve invested so much to get to this point, only to stall at the last hurdle.

I know if a therapist doesn’t have experience in certain areas, it is unethical to say they can help when they can’t. I have a dissociative disorder, and where I live there are no therapists experienced in treating dissociation. Changing therapists is not an option. I’m at as good a place as any at the moment, but cannot fix this by myself. I don’t want an expert, I want someone “good enough” to hold my hand and walk me through it.

I’m torn between pushing forward toward healing or trusting his judgment and accepting the idea of limping through life with a Band-Aid. If I had a choice, I know which option I would choose. Ultimately, who knows what’s best for me, my therapist or me? —Going Nowhere

Dear Going,

Thank you for writing in with such a rich, complex question. Before I address it, I’d like to take a moment to commend you on the strong commitment and incredible work you have already done in therapy. You say you had to work hard to learn how to trust your therapist and have worked over the course of several years to make major life changes. It is no wonder you are ready to take this work to the next level. You’ve seen what you can gain from committing to the process and you want even more.

First, I’d like to jump into some potential issues I see developing in the therapeutic relationship. People share things with their therapists that they wouldn’t share with anyone else, but they still often feel they can’t, or shouldn’t, comment on their experience of the therapist and the process of therapy. These are things that need to be discussed in therapy. You say that after working so hard to learn to trust him, it feels hypocritical that he does not trust you. I would strongly encourage you to speak to him about this. I’m concerned the trust you worked so hard to develop will be eroded if you harbor resentment at his lack of trust in you. This could create a fracture that only deepens and becomes toxic to the therapeutic relationship.

Another potential threat to the therapeutic relationship is the lack of alignment in regard to therapeutic goals. Goal-setting in therapy is ideally a collaborative process. While collaborative, it should be largely driven by what the person in therapy wants to gain from the work, with the therapist ensuring the goals are realistic and healthy. Again, here’s where I would encourage you to have an open conversation with your therapist about the goals you would like to begin working toward. If he disagrees with that direction, he should be able to tell you why.

Goal-setting in therapy is ideally a collaborative process. While collaborative, it should be largely driven by what the person in therapy wants to gain from the work, with the therapist ensuring the goals are realistic and healthy.

This leads into the ethical issue you mentioned. You are correct in your understanding that it is unethical for a therapist to treat someone with an issue or condition they lack experience and training in. This might very well be why he is pulling back. Again, this should be an open conversation. If he is hesitating to move forward because he lacks the expertise, he should be transparent about that. If that is his concern, perhaps you can talk to him about the possibility of him engaging in his own supervision. While there might not be any therapists with expertise in dissociation in your area, he can be supervised remotely by a therapist who does have the expertise.

The idea of remote supervision leads to me raise the possibility of remote work for you, too. I know you say changing therapists isn’t an option; I wonder if that is purely about availability or if you hesitate to change therapists for other reasons (i.e., needing to establish a therapeutic relationship with someone new). Telehealth (or online/distance therapy) is becoming a fairly common answer to a lack of qualified professionals in a given area. Perhaps there could even be a way that a new, remote therapist with expertise in dissociative issues could work with you and your therapist. Certainly, both therapists could consult as you transitioned from your current therapist to a new one, but maybe a team approach could be employed and you could work with both. In such a situation, there would need to be a clear agreement between the three of you regarding roles and boundaries for the arrangement to be ethically sound.

The bottom line is this: You are the expert on you. You want to take your work to the next level in order to achieve greater healing and change than you already have. You deserve to have the opportunity to do more than limp through life.

Best wishes,

Sarah Noel, MS, LMHC

Sarah Noel, MS, LMHC is a licensed psychotherapist living and working in Brooklyn, New York. She specializes in working with people who are struggling through depression, anxiety, trauma, and major life transitions. She approaches her work from a person-centered perspective, always acknowledging the people she works with as experts on themselves. She is honored and humbled on a daily basis to be able to partner with people at such critical points in their unique journeys.

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