Therapist as "accountability buddy"?
February 2, 2023 6:57 AM   Subscribe

I've had eight sessions with a therapist. He's kind and supportive⁠—but fairly passive. Also (and this is quite important), his per-session rate is very reasonable. I don't want to switch to another therapist, and I'm trying to figure out a way to get more out of this therapeutic relationship.

I get the sense that some people enter therapy because they're at a total loss about how to fix their problems. That's not me. I have some specific ideas about what I need to do to improve my life. But the problem is that I have historically not been able to actually act on those ideas. At best, I make half-hearted attempts and then give up.

So my thought is that I can go to the therapist and say, "I'd like to do X, Y, and Z. However, I don't think I can do them without your help in keeping me on track, motivated, and making steady progress. And I'd like your advice to help me past any stumbling blocks I might encounter." I've already made some subtle hints about this possible approach, but he didn't pick up on those hints.

I can see two possible ways that he can react. In possibility #1, he's glad that I'm taking the initiative and will support me in my plan. In possibility #2, he thinks that I'm being uppity and not deferring to his expertise—like, "If you already know what to do, then why did you even come to me for help?". I have issues with assertiveness, so I'm a bit apprehensive of possibility #2.

Thoughts from people who have gone through something like this?
posted by akk2014 to Human Relations (10 answers total) 2 users marked this as a favorite
Best answer: It’s very normal to go into therapy with specific goals, along with ideas of how you might achieve them and what kind of support you need from your therapist. I think you should go in and tell him basically exactly what you wrote for us here, that you have a set of goals and you have some specific types of support you’d like, and that you’d like your sessions to be focused on the support and execution of those goals. This will almost certainly be uncomfortable for you (it is for me, too!) but I don’t think there’s any other way through it. You do have to tell him what you want and need because the evidence up to now suggests that he’s not going to intuit it automatically. Doesn’t mean you have to be impolite, and it might even be an opportunity to explore the feelings that are arising around it to boot.

If he responds well to that, great! You’ve got a partner in your work and you can monitor how effective it is in the coming months and adjust accordingly. If he doesn’t respond well to that, then you know he’s not a fit for you anyway — if you’re not making progress toward your goals, the affordability of his rate doesn’t really matter, because the money you’re spending isn’t getting you what you need.
posted by Kosh at 7:07 AM on February 2 [3 favorites]

I had this problem and my therapist pointed out that what I needed was a coach, not a therapist. So I’m trying that.
posted by corvine at 7:13 AM on February 2 [14 favorites]

Best answer: This is totally appropriate to bring up with your therapist, and most therapists would appreciate it (speaking as a therapist). They then should make clear with you if they are able to work with you in this way. I don't necessarily think that what you are expecting is coaching vs. therapy; it really depends on the therapist's style and how flexible they may want to be.

Therapy is supposed to be collaborative; therapists are not experts on you, we just have specified training that may or may not be what you are needing.
posted by bearette at 7:37 AM on February 2 [7 favorites]

Best answer: among many other things, my therapist is an enthusiastic accountability buddy. ask for the help you need, as stated. at worst he can decline.
posted by j_curiouser at 7:50 AM on February 2 [1 favorite]

Best answer: My therapist is a great accountability person, and I've even told her that that's one of the most valuable things I get from those sessions. I've been in therapy/treatment/recovery for so long that I pretty much know all the things, I just need someone else there to make it real, or I will end up procrastinating.
I've already made some subtle hints about this possible approach, but he didn't pick up on those hints.
Nooooo, that won't work! Be completely upfront about what you need. That's really what the trust building phase of the therapist relationship is all about, coming to the point where you can trust them enough to be honest and not-subtle.
In possibility #2, he thinks that I'm being uppity and not deferring to his expertise
He's not your dad. He's a contractor that you're paying. If he thinks you, the patient, are being uppity, and he treats you as such then he is a bad therapist and you should leave because he is harming you by recapitulating the abuse patterns you're vulnerable to.

That probably won't happen tho, possibility #2 is your fear talking. You're not alone in that, I find it very familiar.
posted by Horkus at 8:10 AM on February 2 [3 favorites]

Best answer: I definitely get anxious talking about the therapy process with my therapist. What if she says no? What if I hurt her feelings? What if I somehow... get in trouble?? Writing this out it's obviously irrational, but the feelings are real.

Having said that, when I do discuss the dynamics of therapy, my therapist is always very attentive and responsive. My wife is a therapist, and she often encourages me to do MORE processing the therapy relationship with my therapist. For her, those 'relational' conversations are both welcomed and also can be transformative for getting to deeper emotional issues, as we often reveal truths about ourselves more deeply in the interaction than we would in just describing interactions that we had.
posted by latkes at 8:21 AM on February 2 [2 favorites]

Echoing corvine's comment above that it seems like you need a coach, not a therapist. While different therapists and coaches employ different modalities, it was once explained to me that therapists tend to focus on the past (trauma, relationships, family of origin issues, etc.) that need to be unpacked so you can get to the "why" of things. Whereas coaches focus on the here and now: what are your goals, why are they important to you, what is a first step you can take toward that goal, let's create a plan with doable, actionable steps, etc. I know some therapists do that as well, but coaches are specifically trained to be all about helping create plans, taking actual steps toward your goals and keeping you accountable.
posted by hapax_legomenon at 10:21 AM on February 2 [1 favorite]

Best answer: I think if a therapist is doing their job they need to be helping you create a structure outside of the therapy session that promotes your recovery. A big part of that is acting as accountability to make sure you're making changes.

Honestly if a therapist wasn't able to provide that I would sort of think it was laziness or lack of organization masquerading as professional snobbery. That's been my experience in the past.

This is something a therapist should provide, it is completely in their job description unless you're going to someone who is a hardcore psychoanalyst or has another esoteric specialized approach-- so I would just ask directly and if he doesn't do it find someone else.
posted by Res0ndf7 at 10:26 AM on February 2 [1 favorite]

Tough love incoming, possibly misguided. Take what you need and leave the rest, etc.:

When I read your post, I resonated with "I know how to fix my problems, I just don't do it". Consider whether the behaviour of not fixing your problems even when you know how is your problem, and placing the demand for working around that onto your therapist/coach might be the avoidance of fixing the problem. If so, enacting the avoidance may not be the best use you could be making of your therapist's time or skills. There might be an opportunity to go deeper here.

There's a possibility that you might be subconsciously wanting to place the therapist or whomever in a position of responsibility for whether or not you get the things done. This is a form of transference, and a good therapist will pick up on this, which is what yours may be doing by not taking your hints. (Or they may be bad and lazy - you'll be able to tell which by raising the issue of why they are not picking up on your hints with them - but it's not the case that all good therapists should take an accountability role if their clients wish).

I'm saying this because this is what I have done and am still prone to doing. Leaning on my coach/trainer/therapist which feels good in the moment, but when the situation inevitably changes and they can't provide the motivation I think I need, I fall off the wagon, and it's somehow their fault.

(Coaching is for when you know how to do the thing, and are motivated to do the thing, and want to get better at doing the thing. It doesn't sound like you're there yet, although you can shortcut it for a bit if you need - just be aware that there is still the deeper work to do.)
posted by cogat at 11:36 AM on February 2 [6 favorites]

In addition to what cogat wrote above, the therapist could also help you clarify whether part of “I know what to do but I just don’t seem to do it” is caused by problems with executive function, often present in neurodiversity.
posted by meijusa at 5:21 AM on February 3 [1 favorite]

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