Things I Wish My Therapist Would Say to Me...

Recently I listened to the following podcast (https://podcasts.apple.com/us/podcast/things-i-wish-my-therapist-would-say-to-me-but-never-does/id1454057950?i=1000436780353) in which the host, Jeff, discusses an article he read called "Things I Wish my Therapist Would Say to Me but She Never Does" by Linda Acus (https://www.mcsweeneys.net/articles/things-i-wish-my-therapist-would-say-to-me-but-she-never-does). While I agree with Jeff on many of these, I thought it might be interesting to respond to each of these based on my counseling style. So, here goes...

"So here is what your problem is"
As Jeff states on the podcast, there are many ways in which therapists do say this to clients, it is just worded very different. My job is to bring attention to the areas you may not see that are leading to difficulties, however, directly saying it in this way may lead to defensiveness or denial. It is better to work with the client to get to their own place of understanding.

"I'm not supposed to say this, but you are my favorite patient"
Just like anyone, therapists will have their preferred clients for many different reasons. If a therapist finds themselves giving preferential treatment or looser boundaries with certain clients, this is something that needs to be discussed with a supervisor or consultant. Those behavioral preferences could be a sign of issues within the therapist that they are not addressing and are often more harmful to the therapeutic process that you may think.

"In fact, I wish we could be friends..."
Of course, this is not something that is allowed. In Florida, specifically, there are strict rules about engaging in dual relationships with clients. The reason the therapeutic relationship works so well is because of the one-sided nature of it. If therapist and client were to become friends, it could break down the ability of the therapy to be helpful for the client.

"I don't actually exist outside this office so it's physically impossible for us to ever run into each other in real life. However, please know that as I await our next session in the existential goo located in that closet over there, my thoughts are consumed by your profound insights on life and incisive put-downs of your family members."
Obviously there is a chance that you may run into your therapist in the "real world", especially if you both live in the same community. It feels awkward to the therapist because we are not allowed to initiate conversation or even acknowledge that we know the client. Even if the client approaches us, it is to be brief and minimal. For clients, this may feel hurtful that the therapist did not acknowledge them or was brief, so it is best to discuss any encounter in sessions. The second part of this statement is where I disagree with Jeff. I do think of my clients between sessions - I take time to process our sessions and write case notes, I spend time reviewing and preparing for our next sessions. In addition, things occur during the week, both in professional and personal activities that make me think of concerns with clients or even interventions I may use with them. Insights and connections about client situations do not always occur within the session time.

"I keep a running top ten list of your best zingers..."
Many of my clients over the years have been funny, some hilarious. I don't believe that humor is a necessary part of our work together, however. Humor can be used to distract from real issues or could be used by clients to get therapist to "like" them and see only their positive attributes. Humor can also be self-depreciating in nature. It is not my goal in therapy to get my clients to laugh or ask them to make me laugh. While laughter and humor can be a large part of some individuals' healing process, it is certainly not necessary across all cases.

"I'm really not supposed to give advice but you should really think about doing stand-up comedy..."
Therapists do not give advice, or at least shouldn't. A lot of what is processed in sessions and discussed may seem like advice because therapists may be working to get clients to make their own decisions and move forward with makes them feel fulfilled and content. Giving advice to a client doesn't help them make decisions for themselves, it makes them reliant on the counselor. Besides, what if I gave a client advice and it did not turn out well? I wouldn't want them to feel resentful of the therapeutic process and terminate any work we could accomplish together.

"Have you ever considered that these kinds of conflicts keep occurring in your life because you're so pretty? Like too pretty? We call this 'pathological prettiness' in the biz - I call it 'the biz' sometimes.."
This type of compliment is a tough one. For the most part therapist are not going to give compliments other than to praise areas of therapeutic growth and movement toward goal attainment. This compliment in particular is regarding the attractiveness of a client, which makes it even murkier. A therapist should not make comments about a clients' physical appearance unless there is a potential therapeutic concern (eating disorder, hygiene neglect, sudden changes, etc.) and even in those cases, it needs to be done in a caring and supportive way.

"No I don't think you are a narcissist."
You know, I might actually say this to a client... especially if they are feeling like they are being self-centered when they are actually only taking care of their own needs. And only if it was a specific word they were using to describe themselves that did not fit any differential diagnoses.

"No I don't think you are needy."
This is really an opinion and therapists aren't there to give personal opinions, only clinical ones. There do need to be boundaries within the therapeutic relationship. The therapist should let a client know when they are close to or in the process of crossing those boundaries.

"No I am not bothered by your questions."
This is another that I might say. I tell clients that they should ask questions. If we are discussing a topic or I am inquiring about something and they are unsure why, they should ask. I am more than happy to let clients know where my trail is headed and my clinical justifications for what we are discussing and processing. In addition, I let clients know that they may ask me questions about myself. Some have asked personal questions and I let them know when we hit a boundary I am not comfortable crossing. Most ask minimal questions and those that do are usually about professional expertise.

"Honestly, I should be the one paying you."
If a therapist could say this then it is likely they have crossed a boundary and perhaps made the relationship more two-sided than it should be. That being said, I do feel that as a therapist, my clients teach me things every session. I am a better therapist and more equipped to work with new individuals because of my clients. I am always humbled and filled with gratitude because of that.

"Oh it's been three hours? I completely lost track of the time..."
I am not good at tracking time. I do not go over the hour, however, that would be an issue. Sometimes there is a good flow of process occurring and it is hard to just turn that off. In addition, keeping within the therapeutic hour (45-50 minutes) is a good boundary to have with clients so that the therapeutic relationship stays healthy and helpful.

Hopefully you learned something about me as a counselor or perhaps the therapeutic experience in general. These thoughts are common and natural for clients to have. So do not stress when you have them and do not worry if you do not. Each person's experience is different.