Dear Therapist:

Here is a question I've been troubled by for a while. Many times, people will send their kid or spouse to therapy, but the kid or spouse is somewhat in denial or confused. They may see reality in a twisted way or be somewhat lying to themself or only see their side of the picture due to their emotional/mental health issue. When they sit and talk to the therapist, they are only giving over that twisted picture of reality and the therapist will then guide them according to what they hear, which is sometimes a ridiculous view of reality and if the therapist asked anyone else in this person's life, they would get a drastically different picture as they all see how messed up this person is. Often, (as I've experienced with a sibling and heard other accounts) they get awful advice that only makes the problem much worse, through no fault of the therapist, since this is what he heard and is falling for, hook, line, and sinker! Have therapists thought of this obvious and common issue, and is there a way around it?  

Can I protect my adult-sibling from getting the ridiculous advice by me or my parents having a short talk to clue the therapist in on reality, or does that break confidentiality? 

Response:

Your concern is in no way unusual. Clearly, everyone has a different point of view, and it can be difficult for a therapist to determine the reality of a situation with information that may be limited by the client’s inaccurate perceptions. The question is whether a client’s perceptions are significantly skewed, and to what degree this matters.

When someone is “sent” to therapy, a number of concerns can exist. The client may not understand the reason for the referral, and may therefore focus on things other than what was intended by the person sending them to therapy. The client may feel attacked, causing them to fight the process. They may have a differing view as to what the problem is and how it should be resolved.

When it is a family member who sends the person to therapy, the issue becomes more complex. If, for instance, I were to coerce my wife into seeking therapy, the purpose would be to deal with the issues that I have identified. However, as her spouse, I am far too close to the situation to be objective about her needs. Perhaps I play a large role in what I view as her maladaptive behavior. Perhaps the family system is causing the problem, and family therapy is necessary. Perhaps I am blinded to her perspective due to my own denial.

What constitutes “awful advice?” Does this refer to therapeutic strategies that help the patient, but may cause further family rifts? Or are you referring to specific directives offered by the therapist with regard to the larger situation? If the latter, I would question whether a therapist should be offering “advice” in the first place? Therapists are not gurus; they are not necessarily experts in the sense that their life advice is better than that of a rabbi—or an electrician for that matter.

When someone sees a physical therapist, they follow their guidance with regard to the specific exercises that can help them to rehabilitate their body. Similarly, psychotherapists use proven techniques to address emotional issues. Just as we shouldn’t necessarily heed the life advice of a physical therapist, we shouldn’t simply accept the advice of a psychotherapist. Therapists are not in the business of dispensing specific advice tailored to specific situations. “Advice” should generally be limited to direction and guidance with regard to particular strategies designed to help reduce unwanted symptoms.

Regardless of how the therapy process is begun, it is the therapist’s job to help the client deal with the issues that confront them. The client’s perspective should be the therapist’s main focus. Focusing on the perspective of someone else can serve to alienate the client. This will almost definitely cause the therapy process to become useless. It can also cause the client to be wary of future therapists and therapy.

When a family member believes that the therapist requires information that is not being provided by the client in session, they can reach out to the therapist. It would be best for them to first discuss this with the client. For the most part, therapists should try and obtain as much information from as many parties as possible. This helps to provide  a more comprehensive view of the issues. However, except in some very particular types of situations, this should be discussed with the client. Not doing so can result in loss of trust and negation of the entire point of therapy.

The therapeutic relationship is of utmost importance. In order for progress to be made, a client needs to feel that they are being heard, and that the therapist is there for them. Sometimes this can appear to family members like the therapist is going along with everything that they are being told. In fact, a good therapist will help the client to identify problems and possible solutions. Sometimes, however, trust needs to be built over time so that the client will have the incentive to work on their issues with the support of the therapist.

Sometimes, the work that a person does in therapy appears to make the problem worse. The question is whether it is worse from the client’s perspective or from that of someone else. When a client feels that they are being helped, this often helps to alleviate family issues as well (though this may take some time to occur and to be acknowledged). Sometimes, however, the family’s goals may not coincide with that of the client. When this happens, the question becomes whether part of the issue lies in the family structure and relationships. If the family needs healing as well, family therapy may be indicated.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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