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How To Really Talk To Your Therapist: Four Collaborative Steps

By Steven A. Frankel, M.D.

People who go into therapy frequently report good experiences where the patient feels understood and well-supported by the therapist, who uses his or her therapeutic skills to facilitate a discovery and healing process.

But what if your therapy frustrates you? What if your therapist is off base and you don't seem to be making progress? What happens if you can't communicate with your therapist? Here are several tips for getting more out of your therapy by learning how to REALLY communicate with your therapist.

  1. Take ownership of your therapy
    It's tempting to believe your therapist has all the answers, and it may seem easiest to let the therapist make all decisions about treatment. You might even feel afraid of asking questions or discussing concerns about your therapy.

    Remember that therapists are human beings and have the same flaws as the rest of us. Therapy is a subjective process, and the therapist can only give his or her own subjectively colored opinion, which has been shaped by his training and life experiences. That viewpoint may not always be the right one for you.

    As the "consumer" in the therapy partnership, it's your responsibility to look after your best interests and to be an active participant in your therapy. If something isn't working, it's up to you to talk about it with your therapist. The message is clear: Take your therapist off the pedestal and take ownership of your therapy.

  2. Plan out what to say in advance
    As an active partner in your own therapy, you may need to express concerns, ask questions, or even give your therapist negative feedback about how you believe the therapy is going. Confronting your therapist with your concerns may be difficult, but it can be made easier if you plan out what you want to say.

    Before talking to your therapist, take a few minutes to organize your thoughts. Write down your concerns, the specific changes you want to request, and any questions you want to ask. Next, review what you've written with an eye for how you are planning to express yourself. If your tone or words are accusatory, it may be difficult to have a productive conversation with the therapist.

    A useful way to phrase your statements is with "I" language, such as "I feel confused" or "I see things this way." You will want to make it clear that you are not necessarily putting the therapist in the wrong; you are simply talking about how therapy is working or not working, from your perspective. "I" language feels much less confrontational than outright criticism, and keeps the door open for discussion and negotiation without the other person becoming defensive.

    For example, you might say, "I feel like my therapy isn't going very well and I'm not sure we're on the same page; can we talk about that today?" This is more likely to set a positive tone than, "This just isn't working because you don't understand me!"

  3. Keep your wits about you
    After you've planned out what you want to say, it's time to have the conversation with your therapist. You should try to remain as calm as possible. You will, of course, have strong emotions, but letting your emotions take over will prevent you from having a constructive discussion.

    Keep in mind that you and your therapist are on the same team. More than anything else, you both want to work to help you achieve your personal goals. Unless something is very wrong, your therapist is not likely to be "against you."

  4. Enlist a third party to consult with you and your therapist
    If the therapist stands firm in his recommendations for your therapy, and you still do not agree, what can you do? Your first reaction might be to find a new therapist. While this could be the right decision, there is another option you may want to try first: getting another opinion. You and your therapist could decide to invite another therapist to join you as a consultant.
The consultant in this situation works collaboratively with you and your therapist to provide a fresh perspective, allowing you to move beyond your communication impasse to a direction you can both endorse. Once his job is completed, the consultant removes himself and the therapy pair goes back to "business as usual".

You and your therapist have already invested your time and energy into the process and you are both committed to the same goal: helping you achieve your objectives for emotional growth and healing. If and when a difference of opinion does occur, rather than giving up and walking away, it is usually well worth the effort to try a collaborative solution first.

Good therapists usually welcome a patient's active involvement in his or her therapy. Seasoned therapists are aware of the extent to which their observations reflect opinion rather than fact. Therefore, they tend to be delighted by the possibility of finding creative solutions to therapy impasses, generated together with the patient.

If, as a patient, you don't find yourself encountering this kind of openness, and your attempts to encourage your therapist to take you seriously fall on deaf ears, then it may be time to find a new therapist who can better support you in your goals.

Steven A. Frankel, M.D. is the author of four books describing collaborative psychology, including his most recent book Evidence from Within: A Paradigm for Clinical Practice. He has been a practicing psychiatrist for over thirty years. A graduate of Yale University Medical School, Dr. Frankel is board certified in both general and child psychiatry. He is an Associate Clinical Professor at the University of California Medical School and founder and director of the Center for Collaborative Psychology in Kentfield, CA.
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