Should I break up with my psychoanalyst?

October 8, 2007 5:19 PM

I'm having a difficult time working with my psychotherapist. Is this normal, or should I end it?

Background: I'm a woman in my thirties with a history of depression, drug abuse, eating disorders and alcoholism. I have a very strong personality, but have always had lots of friends and loved ones. I am living in a city I love, devoted to a high-stress, high-prestige career, and dating a wonderful guy. I have been in and out of therapy since I was in my teens.

Upon moving to my current city, I entered intensive psychoanalysis. I see my therapist twice a week for 45 minutes. My therapist has a PhD, advanced training beyond that and professional accolades up the wazoo. She and I frequently get into loud arguments where voices are raised, accusations fly, and I end up in tears and rattled for the rest of the day. For example, today she told me that she is sick of my sense of entitlement, that I can't take responsibility for myself, and that I bully her and treat her badly. This is not uncommon.

My previous therapists were mostly the kind where you talk about yourself and they sympathize and maybe do some light CBT. One of these helped me get sober, and I was very attached to her. However, having had therapy for more than 15 years makes most MSWs or garden-variety therapists useless for me. I suspect that my therapist is right and that I tend to railroad people who can't stand up to me, which again makes it hard to find a good therapist.

My question is this: is the kind of adversarial conflict I'm describing normal for psychotherapy? She would say that my questioning of her methods is me detaching from therapy and placing blame on to her rather than taking responsibility for myself doing the work. Half of me thinks she's absolutely right, and the other half of me thinks she and I are just not suited to each other and that I'm paying $300/week to be in an abusive relationship. This is the fourth time this year I've considered quitting. I'm basically terrified of my therapist (hence the anon), but on the other hand I know I have made more serious progress in the last year than the 10 years previous. Any insight would be appreciated, particularly on how to deal with this type of therapy if I do decide to continue. Throwaway email [e-mail].

posted by anonymous to health & fitness (22 comments total)

I don't think that sounds ideal.

What's key to me in your statements is the part where you said that you have a strong personality, and your therapist says that you bully her.

To be honest, if you have an intense personality, I do not doubt that you "bully" her, at least in her perception. But for you to get good stuff out of a therapeutic relationship, you need to find a shrink who is stronger than you are, and wouldn't say (or indeed feel) that you bully her. It's only when you feel safe in knowing that your shrink can handle your shit that you can really let your guard down and do the work.

Did that sound mean? I didn't mean it to. I have had a lot of therapy, and where your main conflict might be described as "I think my personality is too strong for most shrinks", mine might be "I am secretly convinced that I'm brighter than most therapists, so I don't trust them to see through me."

(Just so you know that I'm as loopy as anyone.)

For me, it's vital to feel completely safe with my shrink. Sure, maybe my shrink pierces through my bullshit and says "There you go again, trying to manipulate me--" but I need to feel safe when that happens.

I don't know. It's up to you, but I don't think I could do the work if I felt emotionally unsafe in their office. It would upset me if I felt that I couldn't talk to my therapist about our concerns about our relationship.

And I kind of wonder if you and your shrink haven't accidentally "lucked" into a sturm-und-drang style relationship that is very familiar to you both, with your intense personalities.

Good luck!
posted by thehmsbeagle at 5:35 PM on October 8, 2007 [3 favorites]

Other than you being rattled for a while after a session, I'm not seeing how this is bad for you. I'm sure it is, or you wouldn't have posted the question, but feel free to e-mail me to clarify (I can post your clarification).

You said "I have made more serious progress in the last year than the 10 years previous" which sounds like the harsh approach your current therapist is taking is working for you. What does she say when you bring it up? Does she interact with all her patients this way? Do you have a particular personality that responds to her method?
posted by amtho at 5:43 PM on October 8, 2007

However, having had therapy for more than 15 years makes most MSWs or garden-variety therapists useless for me. I suspect that my therapist is right and that I tend to railroad people who can't stand up to me, which again makes it hard to find a good therapist.

Your answer is in this paragraph. Also, why do you stay? Most people would just stop going to a therapist they really dislike or whose methods they think just don't work. You're sticking around for some reason. Therapy isn't mandatory, as you well know. You choose to go and you are choosing to keep going. And I would add that no therapist charges $300 bucks an hour out of the gate - clearly your therapist is as experienced with patients like you as you are with therapists.

To specifically answer this question:

Is the kind of adversarial conflict I'm describing normal for psychotherapy?

It can be, certainly. A dear friend of mine fought with his therapist twice a week for a year and a half, much like yourself, after his father died and he began having difficulty with his relationship with his mother and with his professional and personal life. The conclusion he drew after he left therapy was that his therapist knew something he'd always suspected about himself - he rarely stuck up for himself directly and, instead, manipulated people and situations to get his needs met. His therapist forced him to deal with conflict directly, get angry and have a concrete, immediate target for his anger - the therapist himself - and would not allow him to play the role of placator, peacemaker, yes-man or martyr. He hated therapy, frankly, because he couldn't use a smile or sweet words to keep everyone at arm's length. He had to actively deal with his feelings, some of which he'd spent alot of time, effort and drug and alcohol benders trying desperately to avoid. And yet he credits his therapist for helping him change his life.

If you think you're being abused, call the cops, stop going to therapy with this person, or complain to whatever entity oversees your therapist. Or stay and fight with your therapist. Maybe you need to fight with somebody other than yourself for a change.
posted by TryTheTilapia at 5:50 PM on October 8, 2007

Find a new therapist. A counselor doesn't have to be your best friend, but does need to be someone you can communicate with.
posted by Item at 5:54 PM on October 8, 2007

This is the fourth time this year I've considered quitting. I'm basically terrified of my therapist (hence the anon), but on the other hand I know I have made more serious progress in the last year than the 10 years previous.

You've answered your own question, right there.

I despise the American cult of the "coach," but here it seems appropriate. Do you want a coach that makes you feel good and coddles you, or do you want one that pushes you, challenges you, and makes you improve despite your weaknesses? It sounds like you've got a challenging coach here; you should stick with her.
posted by jayder at 5:57 PM on October 8, 2007

> Maybe you need to fight with somebody other than yourself for a change.

+1. I've had this kind of relationship with a few of my friends who abused drugs and alcohol and/or were coming out of bad situations. They had realized by this point that it was bad to hate themselves and that they were hurting themselves. But they had built a really nice, thick bubble around them that was distorting reality. Since I enjoy popping bubbles, this worked ... or it didn't, or I mishandled it, and I lost a friend. I've always thought of my therapist as someone who I pay to be my friend and to have my best interests at heart... it's one of the relationships that I truly feel is honest and bare. (That alone should tell you why I have a therapist, of course.)

Hey, look, if you don't want to do it, don't do it. But if she's continuing to treat you and she comes as highly rated as you think, maybe she actually does know what's best for you? I've found that expensive highly rated doctors actually do know something from time to time in my past few years of catching up with deferred health issues.

Question: Have you told her about how you feel after you leave?
posted by SpecialK at 6:02 PM on October 8, 2007

I'm annoyed at all the wrong answers above. All of you people who started out by referring to "the counselor" or "the therapist" have missed an important point: the asker's care provider is a highly trained psychoanalyst, which I dare say none of you have ever encountered or you wouldn't have called her a counselor or a therapist.

Confrontation - sometimes rather aggressive - is part of the analysis. The asker's reactions to the confrontation are not to be examined to see whether they give a reason to stop the analysis; they are provoked intentionally in order that they can be interpreted, and their interpretation is the core of the analysis.

The asker needs to let her analyst know that she's having trouble getting past these particular emotional interactions and would appreciate a little more support. A good analyst can change her tack as the winds of the patient's tolerance shift.
posted by ikkyu2 at 6:14 PM on October 8, 2007 [1 favorite]

I can't answer your question but I can't stop thinking about Robertson Davies books, especially this one. There are a few hostile but therapeutic interactions and one that is explicitly psychoanalysis. If you make it through the first two books of the trilogy, you'll get through most of what I'm trying to draw on to answer your question.
posted by salvia at 6:29 PM on October 8, 2007

Thanks, ikkyu2. I've been in psychoanalysis with a psychoanalyst for almost 8 years now. I actually call my psychoanalyst by her first name or "my therapist" when referring to her. She doesn't seem annoyed by that at all.

Maybe you could consult your own psychoanalyst about why you feel the need to constantly frame your opinions in opposition to those of other well-meaning posters in threads where their personal experience might be of help to the OP. I find that really annoying.
posted by TryTheTilapia at 6:37 PM on October 8, 2007 [1 favorite]

ikkyu2 - thanks for the clarification. I always assumed that "therapist" and "analyst" were synonymous.
posted by amtho at 6:39 PM on October 8, 2007

I'm annoyed at all the wrong answers above. All of you people who started out by referring to "the counselor" or "the therapist" have missed an important point: the asker's care provider is a highly trained psychoanalyst, which I dare say none of you have ever encountered or you wouldn't have called her a counselor or a therapist.

What nonsense. My most-recent shrink was a psychoanalyst, and both he and I referred to him as shrink/therapist/etc. And - shocking! - he never passed out from rage out when we did so.

In my experience psychoanalysts do not routinely confront you. While your experience may certainly vary, it seems silly to imply that all analysts can therefore be expected to behave a certain way, and that this certain way is helpful and appropriate for all people. As silly as say... me declaring that all analysts sit quietly and wait for you to break down and bring something up, because this has been true in my experience.

Your response really ignores the core issue, that not all styles of therapy are appropriate for all people. Therapists psychoanalysts are not infallible, and are very capable of making errors.

In my turn, I'm annoyed that people are encouraging the OP to question her own feelings of discomfort and trust an authority figure with a diploma on her wall for no other reason than that she said so. How very odd.
posted by thehmsbeagle at 6:39 PM on October 8, 2007 [1 favorite]

i guess the question you need to ask yourself is whether it's worth the short-term pain. it seems to me that if you can let the interactions go, it will be like going to the gym--not fun, but the results are worth it.

talk to your therapist about what she's doing. tell her that it seems to be working, but you're having trouble recovering your balance after these sessions and that maybe it would help if you understood why these interactions were happening and strategies for coping with the fallout. i think if she's responsible, she will explain. otherwise, fire her.
posted by thinkingwoman at 6:57 PM on October 8, 2007

ikkyu2, you're pretty much our resident medical expert and I respect your opinions deeply. That said, check this out. The words counselor, therapist, and psychoanalyst can easily and correctly be used in place of one another.
posted by Item at 7:54 PM on October 8, 2007

but on the other hand I know I have made more serious progress in the last year than the 10 years previous

Honestly, given that, why are you even asking this question? It's working. Keep at it. She's not there to be your friend, she's there to help you heal yourself. If the price for progress is the occasional weepy afternoon... so what?
posted by Malor at 8:34 PM on October 8, 2007

Well, I don't know jack about the medical field, but if I had a psychoanalyst, I'd probably refer to him or her as my "therapist" just because "psychoanalyst" is such a scary-sounding word. Like I'm so violently brainsick that I need to be strapped down every session. So, if people are calling their analysts "therapists," it's probably not cool to assume they're just mouthing off bad advice.

But back to the question at hand, I'd let her know how you feel. Again, IANAD, but maybe that's what she wants you to do? Even if not, I can't imagine being terrified of your psychotheracounselyst is very productive. Maybe your sessions would be more productive if she eased off a little.
posted by katillathehun at 9:06 PM on October 8, 2007

and that I bully her and treat her badly

Everything else aside, this is startlingly unprofessional. Since when is it about her feelings? One thing a good "therapist" just doesn't do is make the session about her own feelings.

And no one says "psychoanalyst" unless they want to sound like a character in "catcher in the rye."
posted by drjimmy11 at 11:49 PM on October 8, 2007

One thing a good "therapist" just doesn't do is make the session about her own feelings.

Unless it is to elicit some kind of reaction on the part of the analysand. I am guessing you are unfamilar with the terms "transference" and "countertransference". There are bigger games than ego psychology.
posted by Wolof at 12:36 AM on October 9, 2007

The OP sent me this to post:

Thanks everyone for your helpful insight (in addition to the always interesting debate over nomenclature, which I am sidestepping). Ikkyu2 is right in that I am in psychoanalysis and I was looking particularly for insight from other analysts or analysands on how to deal with this type of confrontational therapy (although I appreciate all the advice offered). I tend to agree with everyone who posted that if this is working for me, I should stick with it, although that is easier said than done when I am beating myself up (figuratively) over something that happened a week ago in therapy.

I get the feeling that this type of confrontation does not happen with most of her patients. I think my therapist sees me as a particularly difficult case, and in fact I suspect she dislikes me. I could be wrong about this, but she certainly does not provide me with positive reinforcement, and when I have asked her for that, she has been dismissive every time. I am beginning to think I am a fundamentally difficult person and this is making me feel very bad about myself.

In terms of the harm, being upset for a few days may not sound particularly difficult for most of you, but I have never encountered this type of confrontation before and it throws my balance off significantly. I spend a lot of time outside of therapy worrying about therapy. My therapist has not explained transferrance to me, although I have done some outside reading on it, but there seem to be surprisingly few resources for analysands on how to deal with the emotional fallout of the process. My analyst does not seem to think that explaining the process to me is necessary, and none of my friends can relate since none of them are in analysis and the process seems bizarre to them. So that is the kind of insight I was looking for.
posted by amtho at 9:29 AM on October 9, 2007

To the OP: This explanation of psychoanalysis might help you. It talks about transference, both what it is and how it will surface in psychoanalysis, from a patient's viewpoint (scroll down to "What Happens in Psychodynamic Psychotherapy?").
posted by occhiblu at 11:49 AM on October 9, 2007

Also,
My analyst does not seem to think that explaining the process to me is necessary
seems pretty much standard for psychoanalysis. The analyst isn't there to explain anything or to explicitly teach you anything (unlike other therapy modalities), but to help you explore your mind on your own.

Also also, "dealing with the fallout from transference" is the therapy. It's not an unwanted by-product of the therapy, it's the whole point. So you're not going to find a guide, really, for dealing with it; you're paying this woman specifically in order to learn, firsthand, how to sort through it on your own.
posted by occhiblu at 11:56 AM on October 9, 2007

i'm surprised you're making progress. how are you making progress if you're afraid of her? i just got out of therapy because i felt my therapist was cold and judgmental. i couldn't decided whether or not to leave. i always felt worse after the sessions, but more importantly, i felt i wasn't getting anywhere. if you actually feel like you've made a ton of progress, it might be what you need. although i still don't understand how you'd make real healthy progress given the "abusive" relationship. what does progress look like to you? what are your goals of therapy? in the end, i figured there are probably a number of really great people, and since my therapist didn't strike me as such, it was time to move on, which, incidentally led me to my current amazing therapist. it sounds like you want someone who challenges you, which your past therapists didn't, but i just can't imagine screaming battles ever being good therapy.
posted by It ain't over yet at 6:26 PM on October 9, 2007

Your therapist can challenge you and be difficult, but most importantly, your therapist has to like and respect you.

If you feel that your therapist does not like or respect you, then you should consider a new therapist.
posted by bitteroldman at 4:36 PM on October 10, 2007