Therapeutic Faith.
March 31, 2013 12:43 PM   Subscribe

Do you have faith in your therapist's sense of certainty?

I have been seeing my therapist for six months. It has taken me a long time to find a therapist that I felt comfortable with. I consider him intelligent and wise. My gut feeling is that he is a rare, great therapist.

Long-standing issues I've brought into therapy include: my relationship with parents, life growing up, sibling relationships, exes, physical health issues, friendships, depression, emotion regulation, and living in a new city. Most of my problems, however, revolve around how I grew up (and the scripts I inherited), and my relationships with men. This therapist works with slightly more men than women, has been practicing for over 20 years, supervises new therapists, and leads various types of DBT groups. Much of my trust for him is based on his experience working with men and DBT groups.

A month ago, I lost two important people in my life. (On top of losing five important relationships last year.) The first person was a married friend, Adam, who said he loved me. Adam also confided that he had a terminal illness and had enrolled in a clinical trial. He said he wasn't planning on sharing any of this information with his wife, family, and close friends. Finally, he said that one way I could help him improve his chances of survival, according to his team of doctors, is to have sex with him. I said I could not. After 3 months of talking about Adam in therapy sessions and providing "data" (e.g., emails, records of conversations, etc), my therapist stated almost matter of factly, "I think Adam is lying."

My impression is that therapists do not usually make such strong statements or evaluations about other people in the patient's life. Or do they? It has been almost three months since my therapist has said this and I am still having trouble "believing" that my friend Adam is lying.

The other person I lost was a friend, John, I had started dating a few weeks before I began seeing my therapist. John couldn't meet my needs for emotional connection. At the beginning, he said he didn't want to love anyone, and he didn't want me to love him. Towards the end of the relationship, I had many nights where I couldn't sleep and was dealing with the fallout with Adam. I asked John for support, but it was minimal. However, John revealed that he would love me unless he did something about it soon. I began to find myself loving John, too -- and didn't tell him until after he broke up with me. (Much more to the story, of course, but I will only provide basics for the main theme of this thread.)

During the relationship, I felt like John was using me for sex. My therapist said, "I don't think that's what's going on at all. I think John cares deeply for you, but he doesn't have the skills to be with someone who has strong emotions."

My therapist said that I handled the break-up very well. My therapist also said that, given the circumstances in John's life, there will likely be a reconnection because I didn't burn a bridge. Also, my therapist expressed strong certainty that John's ex will leave this country. I tried to remind my therapist that John's ex might leave, and he said kindly, but firmly, "No, she will leave. And John's landscape will change when she does."

For the most part, though, my therapist does not make strong statements about much. He is good at listening and not judging. (I've had therapists in the past who judged my behavior right off the bat, or diagnosed other people in my life without asking more questions. This therapist is definitely a question-asker and data-collector.) I am trying to keep in mind that this therapist has worked with enough types of people to "see" what is really going on -- and sees things that I am unable to see right now, being stuck where I am.

Thus far, my therapist has only stated three or four things strongly in a prophet-like way, which he seems to want me to know as fact. With most other things, he points out how there is uncertainty because of the many variables involved.

My many questions:
-How do you take your therapist's own certainty about things in your life? Or better yet -- how do you take your therapist's certainty about what will happen in the future?

-Do therapists have this certainty because they see certain things play over again and again and again in their patients who share key qualities?

-Do you revel in the certainty as part of the therapeutic process?

-Do you wait for more data coming in from your own life?

-Do other therapists have some supremely solid insights that we, as patients, really can't see at the moment?

-Have your therapist's insight proven to be true over time?

-Do you have experiences where your therapist was dead wrong about their predictions?
posted by mild deer to Human Relations (19 answers total) 4 users marked this as a favorite
 
Best answer: My encounters with therapists have been infrequent and brief, and therefore I feel unable to judge whether your therapist's behavior is typical or not.

I have to say, though, that based on what you've given us, I certainly agree with your therapist's assessment of Adam's behavior. At least I've never heard of a terminal illness where extramarital sex (!!!) improved the odds of survival. Certainly it's a convenient illness if it is real.
posted by crazy with stars at 12:56 PM on March 31, 2013 [17 favorites]


Effective therapists state their convictions in questions. It makes no sense to make a pronouncement if you aren't going to own it. Effective inquiry promotes buy-in and allows you to not have to choose between your therapists view of the world and your own. I am making a distinction between therapy and psychiatry in which you may want a psychiatrist to make a diagnosis. My sense is that therapists are no more skilled in making predictions about human behavior than anyone else and from my perspective it's not part of their job.
posted by Xurando at 1:05 PM on March 31, 2013 [1 favorite]


Best answer: In my experience, (good) therapists aren't so much making predictions in the sense of, "this kind of person always does XYZ in the end" but rather projections in the sense of, "Given this person's current choices and behavior, it looks like he's on this type of trajectory, which will probably take him to XYZ place." If they know something about the person's career/industry, culture, etc., they'll bring that knowledge into the projection. It's less about saying, "I know what's going to happen" and more about saying, "I can see what direction this person seems to be headed."

It may be that your therapist speaks in a way that implies he's certain about a prediction rather than conveying that he's trying to give you insight into patterns and trajectories.

With regard to the Adam situation--keep in mind that your therapist explored this with you for three months. I suspect that at some point he thought it would be useful to you to get some pushback about believing him, because Adam told you at least one bald-faced lie (that his doctors say that your sleeping with him could improve his health). I've had a therapist let me go down a path for a while without questioning me, and then finally say, "OK, so you've been telling me X story and drawing Y conclusion, but I have to say, I'm not seeing Y: I'm seeing Z." For me, that's been really helpful, even though it's sometimes jarring and even unpleasant. You can, of course, always ask your therapist why he brought it up, or why he thinks his interpretation is correct.
posted by Meg_Murry at 1:21 PM on March 31, 2013 [9 favorites]


It's common to state a strong opinion as a fact. Your story about Adam is a good example. I agree with your therapist: Adam was lying to you.

Am I mathematically certain? No. It's by far the most likely explanation though. With a scenario like this, where you have already given Adam your trust, and you are biased toward wanting to believe him even with an improbable story, I can certainly understand giving you a simple, unhedged, unqualified, "I think he's lying".

> Do you have faith in your therapist's sense of certainty?
> Do other therapists have some supremely solid insights that we, as patients, really can't see at the moment?

Words like "faith" and "supreme" suggest a surrender of your own judgment that I could never recommend. From what I read, your therapist sounds like a reasonable guy who has your best interests at heart. He's still a human being who will make mistakes sometimes. I think you can continue to trust him in general without putting absolute faith in everything he says, even when strongly worded.
posted by mattu at 2:04 PM on March 31, 2013 [5 favorites]


Best answer: Do other therapists have some supremely solid insights that we, as patients, really can't see at the moment?

Sometimes people who aren't even therapists (my friends, my family, my boss) have insights on things that I just can't see in a given moment. But they don't always share those insights in ways that are the most beneficial to me or that will reach me most effectively.

A good therapist will not necessarily be better at the insight part (although they might), but should be better at sharing that insight in the most therapeutic way (which usually involves helping you get there on your own). But if you're just not getting to the obvious place of obviousness, it isn't out of line to share a more direct opinion on the situation.

Adam is feeding you such a ridiculous line of transparent bullshit that I admire the therapist's skill and restraint in waiting three months to make that statement. This is why I am not a therapist.
posted by jeoc at 2:59 PM on March 31, 2013 [11 favorites]


I'm a therapist although not anybody here's therapist.

I could imagine a scenario where Adam is not lying -- one where it turns out that Adam's doctors said that tongue-in-cheek, and Adam is either relating the story minus the humor, or Adam has no sense of humor. I could even imagine Adam's doctor(s) saying that without humor, if Adam said something about wanting to sleep with you, and it having something to do with his will to live, or something, and the doctors earnestly believing in the power of Love, or Sex, or....something. I don't know. Some doctors say (and believe) really stupid things.

However, your therapist is most likely correct that Adam is lying, or at least severely distorting, about The Power Of Sex with you.

Back to the Therapist of Certainty -- I'm one of those sometimes. Sometimes I regret saying what I said, other times I don't. Sometimes things just seem so clear that you want to share that with the patient, especially a patient who tends to doubt her own reality about things. Of course there are more subtle ways of getting one's point across, but we're human and sometimes we just feel we're Right and most of us got into the field not just because of intellectual interest and wanting to "help," but because we *like* our little sense of power in our little office. (Is this horrible? well, there it is anyway) (yet another Certain Truth blurted out)

I agree with the poster up there who said, in effect, "it's more grist for the mill" -- that is, tell the therapist how you feel about his Certainty. After all, you're asking Us what we think about the therapist's certainty -- a kind of looking toward us as the authorities, to evaluate the therapist as an authority. Maybe you need to work on your own UNcertainty, rather than the therapist's Certainty -- that is, maybe this is an "issue" for you (trusting in your own perceptions and intelligence vs. looking toward authorities) that goes beyond your question about therapy.
posted by DMelanogaster at 3:56 PM on March 31, 2013 [3 favorites]


I think your therapist is right about Adam. It is VERY strange that he would have a life-threatening condition and have told only you, and not his wife, friends, or family. It would be very selfish, put an immense amount of pressure on you, and also make it nearly impossible for you to verify his story. However if his doctors really believed it was ALL UP TO YOU, surely they would get in touch with you, or have him bring you in for an appointment so they could explain how the sex would save his life. It all seems very manipulative and dishonest to me.

+++++++++++++++++++++++

I generally try to take a trusted therapist's opinion into account, or take a wait and see approach. Sometimes they are wrong, sometimes they have limited knowledge. Like if I tell my shrink "I had pizza last night; I think I have a serious problem with overeating," and they say "You're so hard on yourself," because I haven't explained that last night I ate the entire pizza, three quarts of ice cream, and a tub of liver pate with saltines. In that case I consider that it's up to me to give them all the information, just like I couldn't expect my accountant to accurately do my taxes if I didn't provide him with all my tax docs.

Now I'm hungry. But not at all motivated to do my taxes.
posted by bunderful at 4:47 PM on March 31, 2013 [1 favorite]


My therapist occasionally makes pronouncements. Sometimes they really help clarify things for me or shake me out of some delusion I'm having. (Your example with Adam seems like this to me.) Sometimes they do the exact opposite. She'll state something fairly unequivocally and I'll push back. She also sometimes gets a bit bossy with advice, and it has the same effect. I've been seeing my therapist twice a week for two years, so presumably she's had to use all the tools in her chest, so to speak, to keep it lively.

When I first started seeing her, I was in a terrible place, and so I just kind of agreed with everything she said (though I didn't always do everything she said to do), even if I wasn't convinced at the time, because I didn't trust my own judgment. Over time, I've gotten better, and I'm more familiar and comfortable with her, and I have no problem answering a flat out assertion from her with a similarly blunt counter-opinion. Also, sometimes having her state something very plainly can help me work out my feelings about something, agree or disagree, or show me that the way I have been framing it is inaccurate or missing details (like if he is convinced John's ex is going to leave the country, maybe you were over-stating that possibility such that he made the assumption).

It's all part of the therapeutic process. Ultimately whether you believe or don't believe him, trust or don't trust him, is almost irrelevant; it's how the two of you negotiate that space and what you learn from it for application in the "real" world.
posted by looli at 5:14 PM on March 31, 2013 [2 favorites]


I've been thinking about this question for a while. It's very clear to me that Adam is lying - extramarital sex is not going to heal his secret illness; that just doesn't make sense.

So, it makes sense to me that your therapist would tell you that he's lying presented as a fact. But, it raises questions about your judgment; why didn't you realize this was untrue, do you have other problems with your judgment? I would talk to you therapist about whether he thinks you generally have problems with judgment, and whether that's part of why he's giving you concrete answers, rather than asking you question. Maybe he started off with the more typical asking you questions to lead you to answer them yourself, but you just didn't get to the answers, so he felt you needed him to step in and give you some important information (note that I am just speculating).

On to your specific questions:

-How do you take your therapist's own certainty about things in your life? Or better yet -- how do you take your therapist's certainty about what will happen in the future?

I trust my therapist. I can't think of specific examples where she's made predictions about the future, but I think if she made a reasonable prediction about the future (like, you will eventually find a job) I would believe her.

-Do other therapists have some supremely solid insights that we, as patients, really can't see at the moment?

Sort of. I'm not a therapist, but it's hard to see things that are going on in your own life somethings. My therapist has absolutely identified patterns in my life that I couldn't see myself, but that I recognized as true once she explained them to me.

-Have your therapist's insight proven to be true over time?

Absolutely, yes. Like I said, she doesn't generally make predictions about the future in the "This will happen" format, but she does suggest that if I do X, it will result in Y. And sure enough, if I do X, it results in Y.
posted by insectosaurus at 7:35 PM on March 31, 2013 [4 favorites]


Therapists come across all kinds of situations, repeatedly. I would trust the judgements that yours has made. His assessments are probably based on a lot of experience.
posted by jenfullmoon at 8:35 PM on March 31, 2013


Response by poster: Thanks for your thoughtful answers; I read them over a few times. I really can't express how much I appreciate your comments.

Let me jump in here with responses to some common responses I'm seeing in this thread:

Judgement
Yes, I absolutely have had a life-long issue trusting my gut feelings, my perceptions, and my judgements about people and situations (this goes back to childhood stuff). I automatically give people the benefit of the doubt. I trust that people are being genuine with me. Adam has become one of the best friends I've ever had in my life, so I'm emotionally invested in his truth-telling to maintain the friendship. I also don't have other close friends where I'm living right now, went through multiple crises last year where Adam helped me through them, and am still recovering from all of that. Anyway, my therapist can see that I have trouble accessing my gut feelings, and most sessions end with me saying, "You're not going to tell me what you think because you want me to think about it for myself, huh?" And I usually do. I'm slowly starting to hear my gut feelings about things.

Certainty About Things
Also, yes, I have been having trouble sitting with uncertainty. In the last three years, I have been through: my ex-husband disappearing while I was physically disabled, miscarriage, family estrangement, extended homelessness, loss of two good friends. It was a lot. After this breakup with John -- my only other close friend other than Adam -- I feel utterly alone right now. All I want is some certainty to help me feel safe, that I will reconnect with an important person soon. However, I also see how this discomfort is an opportunity to talk to my therapist about how his sense of certainty affects me.

My Reactions in Therapy
Although I want to believe what my therapist says about reconnection and I don't want to believe him about the lying, I am upfront with my therapist about my mixed feelings. I also "push back" with lots of questions. For example, "What makes you think there will be a reconnection?" or "These are the other things that make it possible for me to believe that Adam is telling the truth..." And my therapist says he is proud of me for bringing up so many different sides of these issues. But given what I have shared and the depth of my sharing about Adam and John, my therapist said he felt confident about those (few) things I mentioned above. All in all, I would say that I don't believe or disbelieve everything my therapist says. But in these two particular issues where I'm most vulnerable right now, I feel drawn to taking his opinions as fact.

And now I want to respond to two comments in particular:

DMelanogaster wrote: Adam's doctors said that tongue-in-cheek, and Adam is either relating the story minus the humor, or Adam has no sense of humor. I could even imagine Adam's doctor(s) saying that without humor, if Adam said something about wanting to sleep with you, and it having something to do with his will to live, or something, and the doctors earnestly believing in the power of Love, or Sex, or....something. I don't know.

Adam can read people fairly well, and I don't think he misinterpreted any humor on his doctors' parts. He said that his survival can largely be helped by me because he has never felt known by anyone other than me. That is, his closeness to me, his perception of what role I play in his life, and his feelings for me have led his doctors to "count" me as playing a huge role in his survival. And all of this seems highly plausible to me, given all of the research I've ever read about one's perceptions about their social relationships affecting physical health.

and: ...or at least severely distorting, about The Power Of Sex with you.

My therapist has conceded that it is possible but highly improbable that Adam has a terminal illness to the degree that he has portrayed it to me. He also says that even if Adam has a terminal illness, I don't owe him sex. (Adam has said that I owe him his life.)

bunderful wrote: However if his doctors really believed it was ALL UP TO YOU, surely they would get in touch with you, or have him bring you in for an appointment so they could explain how the sex would save his life. It all seems very manipulative and dishonest to me.

I confronted Adam about this a few times. (Confront is probably not the right word -- I asked him if I could go to a doctor's visit with him sometime.) On different occasions, he said that I couldn't because it was "a tightly controlled clinical trial" where he was to go alone, couldn't bring anything with him, etc. He also said that his doctors "decided to exclude [me] from the trial from the very beginning." He has provided statistics that his doctors came up with in different scenarios where I "help" him or don't help him. If I help, there could be up to about 60-70% chance of survival. If I don't, it is 5-30%.
posted by mild deer at 9:08 PM on March 31, 2013


Best answer: Finally, he said that one way I could help him improve his chances of survival, according to his team of doctors, is to have sex with him.

I just spit my tea.

I agree with an above poster that your therapist actually has shown remarkable, nearly inhuman restraint in waiting three months to question this.

I want my therapist to have an opinion. I talk to a therapist because I think they have insight I might not; they might help me see things a different way; they can walk me through my habits and my thought-processes and help me understand how I can be more productive with them. Of course there is a place for the client coming to conclusions on his/her own - a person is not going to wholly put to use information that they are simply agreeing with for the sake of agreeing; it is much more effective for your belief that Adam is an ass (because he is) to come from your own observations. But the therapist is also not going to (and I wouldn't want him to) intentionally withhold information that, to an outside party, is glaringly obvious and has strong potential to hurt you if you don't see it. Therapists (good ones) are people whose life-work is observing, understanding, and adapting the human growth process. It is not supreme or amazing for them to often have decent insight on what certain cues and behaviors usually mean. (usually, again, not 100% certainty, but you can get pretty darn close the more information you add in.)

Adam has become one of the best friends I've ever had in my life, so I'm emotionally invested in his truth-telling to maintain the friendship.

I'm sorry, that's an extremely hard thing to have to come to terms with, but perhaps your therapist can see that refusing to come to terms with it simply because it would be emotionally hurtful is crippling your ability to move forward in the real world.

Adam has said that I owe him his life.

Adam is psychotic.
posted by celtalitha at 12:42 AM on April 1, 2013 [8 favorites]


There was a case in California where a man told a woman that she had a disease that only sex with him could cure. Outcome? Rape conviction. There are no sex-curable diseases.
posted by prefpara at 4:03 AM on April 1, 2013 [3 favorites]


I confronted Adam about this a few times. (Confront is probably not the right word -- I asked him if I could go to a doctor's visit with him sometime.) On different occasions, he said that I couldn't because it was "a tightly controlled clinical trial" where he was to go alone, couldn't bring anything with him, etc. He also said that his doctors "decided to exclude [me] from the trial from the very beginning." He has provided statistics that his doctors came up with in different scenarios where I "help" him or don't help him. If I help, there could be up to about 60-70% chance of survival. If I don't, it is 5-30%.

I feel for you. It sounds like Adam is really important to you because he is your sole source of emotional connection right now.

But this just doesn't ring true. And on some level I think you know this, because you've said no to him.
posted by bunderful at 5:50 AM on April 1, 2013


Nothing in this world is absolutely certain. We have to treat things which approach certainly as certain, or we'll never get anything done. For the purposes of real life, we can treat it as certain that Adam was lying when he told you this ridiculous bullshit. Your psychiatrist dealt with this well. Try to reduce the presence of Adam in your life.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 8:48 AM on April 1, 2013 [3 favorites]


Finally, he said that one way I could help him improve his chances of survival, according to his team of doctors, is to have sex with him.

It sounds like you might be unusually bad at seeing the truth, so a good therapist might be more likely to make pronouncements like that with you than with other patients.
posted by callmejay at 9:46 AM on April 1, 2013


Finally, he said that one way I could help him improve his chances of survival, according to his team of doctors, is to have sex with him.

As you've seen, to many people in the thread, this is a completely impossible statement. There is no other explanation for this, in my range of experience (which also includes being cognizant of other people's experiences through having a wide social network and working at MetaFilter for a decade) where this is anything other than a lie perpetrated on someone who is either unusually trusting or unusually gullible. So, my interpretation of Adam based on what you have said, is that he's a manipulator and is lying to you in a way that is cruel. It seems that you need other people in your life who can give you a reality check on this so that you can get some perspective on what your therapist is telling you. You seem isolated which is a dangerous situation to be in when someone is trying to manipulate you. However I assure you that any other therapist you would go to would have the same "Adam is lying" reaction to this, as we all have.
posted by jessamyn at 12:24 PM on April 1, 2013 [2 favorites]


He also says that even if Adam has a terminal illness, I don't owe him sex.

I think this is really important, and something you should take as 100% factual. There is literally nothing, no situation or condition or anything, that would cause you to owe anyone sex. Ever. And your gut is rightly ringing alarm bells when Adam implies otherwise.

When someone is in need and asks you for something high-stakes, they still need to respect your autonomy and dignity--like, say, if Adam needed a kidney and you were the only potential donor match among his family and friends. It would be reasonable for him to say, "Please consider this," and, with your permission, to set up a meeting between you and his doctor so that you could discuss the situation with a specialist. It would be unreasonable for him to say, "You owe me my life," and refuse to give you access to his doctor. You deserve to be treated with respect by friends, even if they want something from you and you refuse.

Maybe your therapist could help you find a support group that could help you to learn and practice this stuff, and or a support group aimed at helping people cope and rebuild after losses such as you've experienced. Going back and forth with Adam will do you no good.

I know that you want to believe Adam, but it sounds like you care so much about him that you're looking for ways to interpret his lies and manipulation as truth and friendship. For whatever reason, he's not acting as your friend. He's telling you a manipulative mix of truth (maybe he's truly ill, maybe he really does like you a lot) and lies (the clinical trial, his doctors' secretiveness). If you were going to be a care-provider (of sorts) within the context of a "tightly controlled" clinical trial, the researchers running the trial would not want to exclude you from meeting with them: they'd want to bring you in to interview, screen, and educate you about your role in the study. You will not get the truth by pursuing this further with Adam.
posted by Meg_Murry at 1:19 PM on April 1, 2013 [5 favorites]


I confronted Adam about this a few times. (Confront is probably not the right word -- I asked him if I could go to a doctor's visit with him sometime.) On different occasions, he said that I couldn't because it was "a tightly controlled clinical trial" where he was to go alone, couldn't bring anything with him, etc. He also said that his doctors "decided to exclude [me] from the trial from the very beginning." He has provided statistics that his doctors came up with in different scenarios where I "help" him or don't help him. If I help, there could be up to about 60-70% chance of survival. If I don't, it is 5-30%.

I just wrote a giant comment about how there is absolutely no clinical trial that would work this way, based on ethics and previous research and the scientific method and funding... But I won't bore you with the details. The only way Adam is telling you the truth is if he has fallen in with scammers who are charging him a lot of money to be in a fake "clinical trial," and they are telling him whatever he wants to hear so that he'll keep giving them money.

Given that he has decided not to tell anyone else in his life about his diagnosis, I don't think that's the case.

Maybe your therapist could help you come up with some questions to ask yourself when you're not sure whether to trust something someone says. Some that I use are "Would that person get some kind of benefit if I believe their assertion?" and "Does this person make excuses every time I ask for details?" and "What are the actual facts I can personally verify, that support or refute what this person says?"

Regardless. Even if this guy was telling the truth about his situation (he's not, but if he was), you would not owe him sex. Meg_Murry made that point really eloquently above. And I have to say, one of the other questions I use to evaluate things in my life is "Has this person lied to me or tried to take advantage of me in the past?" If so, they don't belong in the "best friend" category. Not even close. I hope you can work with your therapist on breaking off this relationship. It's hard, especially when you feel like you've been burdened with a lot of losses recently. But keep in mind that you won't be losing a friend, only the illusion of a friend. Adam has not been a friend to you.
posted by vytae at 3:08 PM on April 1, 2013


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