How do I confront my therapist who is also essentially my boss?
March 26, 2014 9:31 PM   Subscribe

I live in a mental health treatment center where my therapist is also my "program director". A program director here is basically someone who oversees your treatment and has say over things like when you can and cannot start working or volunteering.

She can be a moody person and can sometimes be very condescending (i.e. "you pants have holes in them, you're not wearing those tomorrow), treating us like little children who need to be reprimanded like it's catholic school (sometimes when there's nothing to "reprimand"!).

After a few things that happened today, I felt really inspired to finally confront her about this. I'm afraid, however, because she's my therapist and she's been a good one and I feel like I would be "betraying" her if were to call her out/it would ruin our relationship and my stay here.

For reference here are the two main things that triggered me today:

1) She walked into work today already upset because she thought we were supposed to be somewhere already. We'd gotten a call before she got in and informed her that we instructed to stay where we were until further notice. She didn't apologize or say "oh, woops, gotcha" or anything and stubbornly said "well you need blah blah blah so get going" and it was very clear that she just wanted to be upset about something (for the record, we, the patients, are a very, if not too compliant bunch).

2) I have to take my morning meds in front of her. There's a box of meds in the morning. Sometimes my meds are in the box. Sometimes there with her. I looked in the box for the meds this morning. She snips "why are you looking in the box? You take your meds in front of me." All I say is "I was checking to see if the meds were in there." And then retorts like she never heard me "Why would the meds be in there? They're always out here." I ask her why she's getting upset over this technicality? She says "I'm not upset, I just want you to know that the meds are not in the box and that there's no reason for you to look in there".

Should I let it go and enjoy a kind of unhealthy peace or confront her and...I dunno?

Thanks everyone.

If I do talk to her, should I just be straight up and use words like "condescending" and "controlling" or go the "I" statements, route?
posted by tunestunes to Human Relations (23 answers total) 2 users marked this as a favorite
That sounds horrible, and not recovery-oriented.

What are your options? What happens if you quit the program?
posted by jaguar at 9:37 PM on March 26, 2014 [3 favorites]

Does she have a supervisor with whom you can speak about her unprofessional behavior?
posted by lettuce dance at 10:09 PM on March 26, 2014 [1 favorite]

I haven't done inpatient before, but I have put up with some incredibly patronizing people in the service of getting my meds before. It depends on the power balance; if you have the option to go elsewhere, you've got more power to be frank about what you don't like. If it's not voluntary, then I'm going to guess it'd go about as well as when I was depending on public mental health services and objected to the provider I was seeing, when doing so got me three months without my anxiety and ADD meds and a new provider who was no better. When they're set on seeing you like a child, then objecting to being treated like a child seems to automatically be treated like noncompliance, and if you don't have other options, that's a bad place to be.
posted by Sequence at 10:14 PM on March 26, 2014 [4 favorites]

Ah, I was confused when you said she was your "boss" at first. She's your therapist.

After a few things that happened today, I felt really inspired to finally confront her about this. I'm afraid, however, because she's my therapist and she's been a good one and I feel like I would be "betraying" her if were to call her out/it would ruin our relationship and my stay here. (emphasis mine)

Can you switch therapists? Sometimes it's not a good fit. Heck, sometimes therapists themselves do this. Go to whoever is in charge of the program and ask.
posted by sfkiddo at 10:18 PM on March 26, 2014

I also haven't been in this kind of setting, but because of the power dynamic, and given the examples you've shared, it doesn't seem that you would be likely to get a reasonable response from a moody and condescending therapist outside your given roles. But if you feel she's a good therapist during actual therapy, maybe she is strong there, at least, and might think to put her 'professional' hat on in that context. Like I wonder if addressing this within an actual session, using I statements, might twig her to thinking about things in a more professional and empathetic way. Like maybe if it's framed within that discourse, it'll occur to her that she could be e.g. burned out, or that some understood dynamic is happening. I have no grounds for supposing that would work, though, it's pretty reachy.

Is there a patient or mental health advocacy group in your residence, or even in your general area? If you are not in a position to leave, maybe they can advise you on your best approach or options. Can you document behaviour?
posted by cotton dress sock at 10:39 PM on March 26, 2014 [2 favorites]

You should definitely aim higher in your relationship with your therapist than to maintain an "unhealthy peace." So if you do want to maintain a relationship with this one, then I would say a conversation is definitely in order.

That said, I think it's usually beneficial to approach anyone in the spirit of conversation rather than confrontation, at least the first time.

That doesn't mean you have to dance around what you mean trying to start every sentence with "I," but maybe give her the benefit of the doubt that she will hear how her actions affect you and actually appreciate the feedback enough to learn from it.

If that doesn't seem possible to you now or she is unable to have a respectful conversation, then I agree with other posters that it's likely time to see about switching therapists.
posted by loveatfirstsite at 10:40 PM on March 26, 2014

Can you update at all to say whether you're in treatment voluntarily or not, and what your goals are? If your main goal is to get into a more independent living situation then I think the best way to do that would be to keep your head down. If you are there voluntarily then I think discussing using I statements is the way to go. She probably won't apologise but she might think about and modify her behaviour somewhat. Plus addressing issues head on does wonders for self esteem issues so if this is one of your issues then I think it best to have the conversation.
posted by hazyjane at 11:54 PM on March 26, 2014 [4 favorites]

If your therapist is also doing double time as program manager/house director, you've a problem with conflict of interest. On one hand she needs to manage the house, keep it running smoothly, make sure that folks are on time, taking meds, etc. That's a very different role than "therapist".

Given that the organization that operates the facility is taking this dual role approach (probably due to financial restraints), it's unlikely that you'll be able to fix this. And, given the personality you describe, I suspect that confronting her behavior would merely escalate the situation.

Personally, I would take a pragmatic (and less that ideal approach)... If you sincerely feel that the therapy she provides you with is helping and appropriate, you might want to focus on that part of the relationship with her, and attempt to let the rest roll off your back. The goal is to get better and move on, not repair flaws in how the facility is managed or structured, not your job.
posted by HuronBob at 3:37 AM on March 27, 2014 [4 favorites]

"How is this helping my treatment?" Ask both her and yourself this when you feel you need to. Focus on that part of it. Listen to what she says in response. It doesn't matter if she's condescending or controlling if it has a place in your treatment. If she can't articulate that place, then yeah, maybe ask someone higher in the chain for a change. If she apologizes for being snappy or whatever, then accept the apology and move on.
posted by Etrigan at 4:27 AM on March 27, 2014 [6 favorites]

What kind of therapy is this? And in what sense is she "good at it?"

In my world (which may be very different from yours) a therapist who can't deal with confrontation, even irrational or over-reacting confrontation, is not good at it. I say this for two reasons. The first is because we're only hearing your side of it. Telling you not to wear pants with holes in them doesn't seem so egregious to me and you may hear it as more condescending than it actually is. But the second reason is that a therapist who can't handle it when her patient isn't a model of mental health should not be a therapist. If you could consistently be that "model" you probably wouldn't need treatment.

So, to answer your "how" question, it shouldn't matter all that much how you say it. But discuss that you feel afraid of telling her when you do, and do it in a session.
posted by Obscure Reference at 5:27 AM on March 27, 2014 [4 favorites]

oh, christ. This is so bad I don't know where to even start.

First off, it's abuse of you and I assume the other clients. Not starve, beat etc abuse, but it is a form of abuse of power.

Secondly, she sounds like she is not only disrespectful, but outright contemptuous of the people in her care.

I guess document stuff, date, time and incident.

If you are able request a switch of therapists.

Follow the chain of reporting. Hopefully when you checked in they gave you something like a client bill of rights, and who to report problems to, including an external ombudsman that will accept anonymous reporting. Use that.

Could you update what country/State(Provence) you are in?
posted by edgeways at 5:30 AM on March 27, 2014 [6 favorites]

To continue your analogy, sometimes you have to put up with a less than ideal "boss" in order to do a "job" that you really like. In this case your "job" is your mental health, and if you think she is helping you with that, and is good at that, you may have to put up with some moodiness and condescension.

That said, it is definitely possible for a "boss" to be so bad at being a "boss" that they make it hard or impossible for their "employees" to do their "jobs", and that may be the case here. It may be that her negative behavior is affecting your "job" performance, in which case it might be a good idea to bring it up carefully to her or (even better) her supervisor.

Only you can decide if and when that threshhold is reached, and I'd suggest you think carefully about whether or not the bad parts of her performance are bad enough to jeopardize your mental health treatment. Are there family or friends who are supporting you through this that you can talk to? They may be able to help you determine just how good of a therapist she is for you. Be well.
posted by Rock Steady at 6:00 AM on March 27, 2014

I would never confront someone, in any situation, unless I had a contingency plan for what to do if the confrontation is received poorly. In other words, you need to be prepared (and able) to leave this facility before you confront this woman. If that's not the case yet, work on that first.
posted by telegraph at 6:17 AM on March 27, 2014 [5 favorites]

Therapeutically confrontation is a good thing. Of course she'll watch how you handle it but being able to communicate needs, wants and feelings is huge progress for many people. Especially if does hinge around living independently or navigating a job.
Based on the population she serves this approach may be more authoritarian based due to the types of jobs the clientele are most likely to get after leaving the program. (Uniforms, written up for being late, following directions quickly and order based on rules that don't always make sense) Is it fair, probably not.
Navigating this is actually therapeutic in some ways. Try to think of it as a learning experience and remember this is temporary.
Good luck.
posted by AlexiaSky at 6:27 AM on March 27, 2014

I am a nurse with psychiatric experience. I am not your therapist, and I wholeheartedly disagree with the way she's been treating you.

This person sounds like she's acting very unprofessionally. You should absolutely escalate/go up the chain once you have a way out of this place. As others have asked, are you voluntarily here? Do you have a set end date?

The way she's enforcing these rules is awful, but the rules themselves will most likely exist in any setting like this. At facilities I have worked at, we absolutely tell patients what they can and cannot wear, for a variety of reasons that we classify under the umbrella of safety.

Patients cannot look in any receptacle holding medications until I give it to them; from what you're describing, it sounds like other patients might have medications in that some box? In which case, it could be a confidentiality violation or it could be a concern that patients-- in general, not just you-- might take the wrong medications. Even if it was just your medications, they have to be given to you to make sure it is the right medication, dose, route, time, indication.
posted by RainyJay at 6:54 AM on March 27, 2014 [7 favorites]

I used to have a boss like this. I liked her a lot but she could be very snippy and sarcastic. She was in a mood one day and I said, "I get it, I made a mistake, you don't have to be sarcastic about it."

She was APPALLED that I thought she was sarcastic, I have never seen anyone back down and apologize so quickly in my life.

In this instance, I think you can bring these things to her attention in a healthy and respectful way.

"That sounds sarcastic to me and it makes me feel bad."

"The way you're speaking to me sounds disrespectful to me."

It's about how you are perceiving her statements. It's okay to say, in the moment, that something she's saying, or the way she's saying it is disrespectful or sarcastic or nasty.

But I wouldn't go in to meet with her about it.

Another tack you can take is to bring this up in thereapy with her, "I really like you as a therapist. I do find it difficult to navigate the difference between you as my therapist and you as my director. Can we talk about that here?"

If she's open to it, then explain how tone or words can seem abusive to you, give her some room for contemplation. If she gets defensive, you can say, "this seems to have touched a nerve with you. I wanted to bring it to your attention as an impediment to my care plan, not as an attack on you personally. In fact, I find your defensiveness here very uncomfortable."

Just be honest and talk about how what she's saying or doing affects YOU.

Good Luck!
posted by Ruthless Bunny at 6:57 AM on March 27, 2014 [7 favorites]

Let's pretend for a moment that this is just a boss. My advice would be: don't confront her about the way she is feeling, or mention that she seems to be upset, or speculate about her emotions whatsoever. This will alienate her and she can basically always "win" that argument. Stick to this comment of hers about the box:

There's a box of meds in the morning. Sometimes my meds are in the box. Sometimes there with her. I looked in the box for the meds this morning. She snips "why are you looking in the box? You take your meds in front of me." All I say is "I was checking to see if the meds were in there." And then retorts like she never heard me "Why would the meds be in there? They're always out here."

If what she says is objectively not true as in this case, you can respond by saying, "Wait a minute, sometimes they are in the box." Often you can't really identify the problem with a conversation like this while it is going on. Then (possibly better anyway) approach her later, ask to have a conversation about that incident, and say, "I was confused by what you said about the meds because..." In other words, have a conversation about what was going on where you point out clearly what your thought processes were. This may establish that your expectations at the time were in fact reasonable. I have done the equivalent of this with a boss, and it has gone well.

All of the above is, again, thinking of her as just a boss, which of course she is not. If this were a therapist in a traditional sense, I would think they would be interested in WHY you have a certain sense of what is going on between you emotionally, and that that would be fruitful to explore together. I am a bit perplexed by the arrangement you've got here. Is this the same place you discussed in a previous post? Having this person approve (or not) your progress through the mental health center and out of it does not seem that conducive to really working things out in therapy. Your therapist should ideally be an ally, not someone who has the power to reward or punish you. Although I think realistically this is something that happens in institutional or supervised settings.
posted by BibiRose at 7:04 AM on March 27, 2014 [2 favorites]

I don't know what to recommend, but I want to say that you have eloquently described the situation, highlighting the difficult position sooo many people are in who are seeking help. A lot of people only ever experience compulsory "mental health services" that are very different from voluntary, private therapy...and it's the only experience of "help" they may ever get. (Not saying your situation is compulsory.) It also describes what public education looks like for a lot of children.

I don't know if there's a word for it that summarizes it nicely, but there are "systems" in which people who are supposed to be being served are positioned as "bad and not-knowing" vs the "all-knowing, benevolent experts" whose actions and motivations cannot be meaningfully questioned. It eats up everyone.

I knew a therapist who worked in such a system for awhile but did not problemetize her clients, she treated them respectfully. Her coworkers were convinced that because she was not a burned-out bitter professional, she must be getting all the "easy" clients. When it was demonstrated that she was getting the same kinds of clients as everyone else, they assumed she wasn't intelligent -- they thought she was too dumb to understand how awful it is to work with the clients. The reality was, she valued the clients and treated them with dignity. She enjoyed working with them. She didn't burn out (but she did stop working there.)

I hope things get better for you. You shouldn't have to tiptoe around your therapist, and your every move shouldn't be interpreted as data about you by health professionals.
posted by vitabellosi at 7:15 AM on March 27, 2014 [6 favorites]

Is your boss the same one you asked about in this post?

Also, I'm curious to know what kind of therapy you're currently involved in, so that we can better understand the power dynamics involved? This seems to be more complex than just a simple boss/subordinate or therapist/client relationship...
posted by Tsukushi at 7:21 AM on March 27, 2014

It sounds like you are in a very structured therapeutic community setting. I think it is perfectly acceptable to say to her that you do not like how she speaks to you at times. It doesn't matter that she is your therapist or your boss. I am not a 100% clear about the boss aspect in this situation but I don't think it really matters. Using I statements such as I don't like your tone - It makes me feel blah blah, is perfectly acceptable. It will give you experience in conflict resolution that you are going to need to navigate once you graduate from your treatment center and demonstrate that you are willing to take risks and stand up for yourself in more healthy ways. It will give her the chance to look at herself which we all need to do when working with others.

As far as the rule following goes. You need to follow the rules or you will get confronted and/or possibly held back. We all have to follow rules and learning how to do that is very much part of this type of process. No sniveling about whatever. Follow the rules or suffer the consequences.

I hope this doesn't sound harsh. I am basing my response on having worked in this type of setting in the past.
posted by cairnoflore at 10:36 AM on March 27, 2014 [1 favorite]

I'm not sure that the people advising you to confront your supervisor/therapist are aware that you are in what appears to be a fairly restrictive (locked?) mental health facility.

You absolutely do not deserve to be treated like a disobedient child in such a facility -- as I said, it's not recovery-oriented -- but mental-health facility staff treating patients/clients that way in such settings is distressingly common, and if most of the staff at the facility is treating clients in such a way, then you are extremely likely to get labeled "noncompliant" with your treatment or "decompensating" if you in any way stand up for yourself.

It's a stupid stupid stupid outcome, but I have seen it happen often in places where I've worked as a therapist or case-manager (I do try to object, strenuously, when I see it happening, but in some places the culture is just toxic and unlikely to change).

I would very much suggest keeping your head down, following any and all rules (however stupid) given, at least to the extent you can without damaging your mental stability and becoming depressed. Likely, part of what they're "grading" you on is your ability to "comply with treatment," which, in toxic situations like this, can often mean your complete subjugation to what they think you should be doing. If you can think of dealing with and ignoring your supervisor's irrationality/power-trips as part of your treatment goals, maybe that could help?

All that said, if there is a staff person there (doesn't have to be a higher-up) who does treat you and other clients with respect, you might want to ask them what the process is for filing a grievance with the state/province. Or you can keep your head up by thinking about how you will file that grievance once you're out of the facility.
posted by jaguar at 11:22 AM on March 27, 2014 [6 favorites]

After reading your last question about your boss/therapist, I'm wondering whether there are ways for you to get out of this program or at least get a different therapist.
posted by salvia at 9:59 PM on March 27, 2014 [2 favorites]

bring it up in therapy. good therapists want to hear you say how you feel. its also a place where it would be proper to discuss your feelings about how she sometimes treats you. if that doesn't work, go to her boss.
posted by Ironmouth at 9:50 AM on March 28, 2014

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