Backseat Drivers and Therapy

[Jazzey]

Backseat Drivers and Therapy, Part I
Dr. Ryan Howes
September 17, 2009,

Well-intentioned loved ones can butt in and screw up a perfectly good therapy. Or they can give needed support. Or they can lend perspective to a harmful therapy situation. How do you tell the difference?

Jane has something brewing: "I've been talking with Sally about our sessions. She thinks exploring my past is a waste of time and that my whole problem started with my ex-boyfriend Jim. She says Freud was misogynistic bigot and no one believes in him anymore. She also thinks I have ADD and wants to know your opinion about Ritalin."

Boy, it appears Sally and I are really at odds. Our treatment plans, theoretical orientation and therapeutic techniques are diametrically opposed. Sally and I have locked horns in a bitter ideological conflict. We could debate some of these points for hours and never come to a peaceful resolution.

Wait a minute. Who is Sally? Why does she have such a say in what we talk about? And most important, how does Jane feel about our work?

Of course, Sally is Jane's friend. They've been friends for many years and Jane trusts her opinion. They share everything. Sally's been in therapy several times and majored in psychology, so Jane looks to her for advice. Sally wants to help Jane get the most out of her therapy, so she's kibitzing - looking over her shoulder, backseat driving. This well-meaning gesture can complicate and disrupt Jane's therapy.

As stated before by me and my fellow bloggers, the therapeutic alliance is extremely important for successful therapy. Jane and I working together on her issues in an atmosphere of trust and collaboration is the backbone of our work. When a Sally enters into the picture, the alliance can be undermined. Jane may start questioning our work and feel torn - to whom should she listen? Now, rather than getting down to the business of working on herself, she's sidetracked by divided loyalties.

Some of the people I've worked with report feeling awkward, annoyed and irritated when those close to them ask about their therapy. Others feel the questions convey love and interest in their life. And some clients actively solicit opinions about their therapy to help them know what their feelings about it should be, or to validate what they already feel. Therapy doesn't exist in a vacuum - it's tantalizing to talk about this hour with others during the week. If you do, you'll inevitably hear their feedback. Everyone has an opinion.

Before I dive too deep into this series, I'll state the big caveat: if something unethical or illegal is going on, please tell someone. Discuss your concerns with your therapist first, and if that doesn't resolve the issue, call your therapist's boss or licensing board and let them know what's happening. If you're not sure what's ethical and what isn't, take a look at their professional Code of Ethics. If a boundary is being violated, it's probably mentioned there.

In this brief series I'll try to address what happens at the intersection of therapy and loved ones. I hope to leave you with an understanding of what is helpful for clients to disclose to others, what isn't, and what to do about overzealous backseat drivers. I'll cover the confusing area of adolescents in therapy as well as give tips to those with loved ones in therapy.

I'll be working from one general thesis: as long as the therapy is ethical and effective, it's best to keep the details of your sessions between you and your therapist. Why?

• Diffusion of energy: I've heard this from clients before: "something you said last week really ticked me off (or got me thinking, or confused me), but I talked to my friend and I feel better. So, what should we do today?" We just missed a great opportunity to dive into juicy material. Because you blew off steam outside the session, we are deprived of the opportunity to learn and grow in this room. You may feel better, but I don't have any greater understanding of the problem and we don't have the shared experience of resolving it.
• Assertion: No matter how collaborative the therapy, it's still a challenge to confront the therapist in the here and now. Many clients come to therapy wanting to work on their ability to confront. Why waste this opportunity?
• Therapist growth: Your therapist is a human and a professional, always growing and evolving in her work. If she made a poor choice, it would be great for her to hear about it. It's not your responsibility to educate or train your therapist, but she should be willing to learn from her mistake and provide better service to you.
• Developing self: I've mentioned people who tend to live life by committee. Rather than exploring and trusting their own opinion, they'll survey friends and family and adopt theirs. While occasionally helpful, making most decisions this way is disempowering. I'm interested in Jane's opinion of our work, not Sally's.
• Avoiding triangulation: In too many families, direct communication is substituted for a triangle: A tells B who tells C. This is a very common but ineffective way of communicating. Sometimes it's repeated in therapy (especially with teens): client is upset with therapist, client tells loved one and loved one leaves a stern message on therapist's voicemail. The therapist, bound by confidentiality laws, can't even acknowledge the client is in treatment without consent. When the client speaks directly to the therapist, it eliminates the triangle and gives the client a chance to deal with the situation directly.

In Part II I'll discuss why backseat driving happens and give real-life examples. Stay tuned.

Ryan Howes, Ph.D. is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

 

[Jazzey]

Backseat Drivers & Therapy, Part II: Why & Examples
Dr. Ryan Howes
September 30, 2009.

In Part I we covered what backseat driving is and why it might disrupt therapy. Today we'll ask why people backseat drive and give a few real-life examples.

It's an inevitable issue in long-term psychotherapy. Therapists are ethically and legally bound to keep information confidential, but clients can say whatever they want. Those close to the client are curious about the therapy, especially if the outcome has personal relevance for them. They'll ask how the therapy is going, show interest in the therapist's interventions, even suggest topics for the client to discuss. Once in a while, this is helpful. Sometimes it complicates the work.

So why do loved ones kibitz on your therapy? There are many possible reasons. Maybe the interested party wants to be included in your life. Some have a sincere desire to help. Others may have a fascination, a fear or a fundamental disagreement with the process. Or they believe they could do it better. They wish to be involved, but whether it's as an aid or a hinderance is sometimes difficult to discern.

Some would say backseat drivers have control issues. Maybe that's true, but I think it's more about the fear of the unknown. Therapy is a mysterious black box. While our lives open up on Facebook and Twitter and reality TV, therapy maintains a shroud of secrecy. It's tantalizing for outsiders to imagine what really happens during those 50 minutes. They want to know what you really think, how you really feel, and how those thoughts and feelings are handled. Particularly if that hour has an impact on their life. The exclusion can feel like rejection. Underlying the comments are questions: "What aren't you telling me? Don't you think I can help? Am I not enough for you?"

There's an online forum called PsychLinks where clients, therapists, students and others gather to discuss all things related to psychology. A few weeks ago I solicited the experiences of clients and backseat drivers. Several were kind enough to share their stories, which span the helpful/harmful spectrum. Their revealing responses helped me understand these issues on an even deeper level. Here are a few quotes:

People that meet me and find out I'm in therapy are often shocked and tell me I have no problems and I just need to hang out with them more.

Throughout the process, my mother in particular wanted all the details of those sessions (to the point that I was expected to call her after each session to recount the session) ... she would tell me that my psychologist was an idiot ... my psychologist was making this into a bigger deal than it need be. The psychologist was aiding me in staying in the 'victim' role.

I have a friend who [says] that I just need to get over myself, I have nothing to be depressed about, it's all in my head (I suppose it literally is - ha!), etc etc. Needless to say, I mention NOTHING to her anymore.

i don't much talk about being in therapy because it would be too hard to explain to people. i guess it depends on who it is.

I think in one sense, it is reassuring to us, but also gives us an opportunity to further process a therapeutic experience and gain other perspectives. I also like to brag about my therapists because I think they are simply the best and absolutely amazing : )

i've been asked if maybe therapy is just making me dwell on things and maybe it's not necessary - that i'd do better without.

... no real back seat drivers for me, thankfully at the first sign of it i would just shut down about the subject, and it would become a no go zone with me.

... my therapist encouraged me to make brave steps into the world, and when I talked about this to the 'friend' she discouraged me. e.g. I would talk about a new project for my work, the friend would tell me all the reasons not to do it, thus puncturing my enthusiasm.

I'm very, very fortunate. It appears that finding the right therapist the first time around is not necessarily typical, and somehow I managed to do it. Frankly, it's probably more fortuitous than winning the lottery.

My gratitude to the members of PsychLinks for their candid responses. I was struck by how subversive the "support system" can be. In my practice I've certainly seen helpful aid, annoying intrusion and invasive butting-in, but the enmity represented here is an eye-opener. This is a small sample of what happens at the intersection of loved ones and therapy, please feel free to share your own experiences. In Part III I'll delineate the types of backseat drivers

Ryan Howes, Ph.D. is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

 

[Daniel E.]

Backseat Drivers & Therapy, Part III: Types
Psychology Today blog: In Therapy
By Ryan Howes, Ph.D.
October 6, 2009

Backseat drivers take many shapes and forms, from helpful to hostile. In Part I we discussed why backseat driving is a problem, in Part II we looked at why people backseat drive and gave several real-life examples. Today we're breaking down the most common backseat drivers.

***Before getting started, I'd like to clarify: I do think it's helpful for clients to talk about therapy. What I was clumsily trying to recommend in (now revised) Part I is clients with a specific question or concern for the therapist will ideally take it straight to her instead of triangulating, diffusing, etc. When among trusted friends or loved ones, clients should feel free to talk about what they're learning in therapy, what they find difficult and what's confusing. They can discuss how hard it is, how they're growing and whether or not it's worth it. I'm glad PsychLinks and other support forums exist; I want people to share their experiences and learn from one another. But when it comes to direct conflicts or misunderstandings, I hope the support system suggests you: "ask your therapist about that." I addressed this issue in a previous post called Say Anything, which I hope clears up any confusion. More on this in Part IV.

Back to the issue of the day. Backseat drivers are any influential people with opinions about your therapy. As loved ones, they have some power and can use it to help or harm. Many fall in the "help" category, but not everyone. As far as I can tell, there are eight types of backseat drivers. Here's what they do, what they want and what you might hear them say:

Threatened: On the lookout for negative evaluations about them from the therapist. Wants to know what the therapist thinks about their role in the client's life.
"I suppose your therapist sided with you regarding our argument?"
"Is she going to tell you to break up with me?"
"Now you start exercising?! I told you to do that months ago!"

Curious: Fascinated by the mysterious world of therapy. Wants to know what happens in intricate detail.
"So what kind of things do you talk about?"
"And then what did he say?"
"Call me right after your next session."

Hostile: Uses participation in therapy as a weapon. Shames the client about being in therapy. Wants control.
"You're nuts. You need some serious therapy. Now."
"There's another thing you should talk about with your therapist."
"You know what? I don't care. I'm not the one in therapy. Tell it to him."
"When do I start reaping the benefits of your therapy?"

Freeloader: Fears going to their own therapy so they mooch off yours.
"So did you tell your therapist about my anxiety? What does she think?"
"Yeah, this is a confusing problem for us. Maybe your therapist can figure it out."
"Can I come to a session with you?"

Peanut Gallery: Psych major, therapy client or other bystander who knows how to help you better than your therapist. Wants to say "I told you so" or "my therapist is better than yours."
"She's using reflective listening? This is an empty chair situation if I've ever seen one."
"I could teach you CBT techniques. You need him to address your father wound."
"My therapist hugs me and tells me it'll be okay. Does yours?"

Avoider: Won't acknowledge therapy due to their own shame about the issue. Wants therapy to go away because it makes them uncomfortable.
"You have your (finger quotes) appointment at 6pm, correct?"
"You'll be done after six sessions, right? I think maybe our insurance only covers that many."
"I deal with problems privately. Why don't you?"

The Parent: Wants help. Wants a different perspective. Wants their kid to be healthy. Wants to trust the therapist. Afraid to hear they've done something wrong.
"Yes, I tried that already and it didn't work."
"So maybe this is just a normal phase that she'll grow out of?"
"If you don't stop that right now I'm calling your therapist."

Helpful: Has a sincere desire to support and assist your process. Wants to aid, not interfere.
"So what are you learning about yourself?"
"If there's anything you'd like to talk about, I'll be here."
"If you feel that way about your therapist, maybe you should talk to her about it."

Stay tuned for Part IV, where we'll look at what you can do about backseat drivers, and what to do if you are the backseat driver.

Ryan Howes, Ph.D. is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

 

[David Baxter PhD]

Backseat Drivers and Therapy, Part IV

Backseat Drivers & Therapy, Part IV: What to Do When backseat drivers become unbuckled
by Ryan Howes, Psychology Today
November 5, 2009

The point here is pretty simple: it's your therapy, you can share with others as much or as little as you want. Here's what to do with the unsolicited opinions.

This is the fourth and final post in the series to help you manage intrusive loved ones in your therapy. It builds on posts highlighting the pitfalls of backseat drivers (Part I), some real-life accounts of this problem (Part II) and eight common types (Part III). By the way, I found a great post on handling actual backseat drivers. Most of what they say applies here minus the references to GPS, riding shotgun and new car smell.

Most of the time, backseat drivers aren't really an issue in therapy. Loved ones generally care about your wellbeing, respect the work you do in your therapy and offer support if you need it. But there are good reasons to cover this topic thoroughly: when backseat drivers are a problem, they're a real problem. The impact can range from minor annoyance to total annihilation of your therapy.

In the words of a real client from the PsychLinks forum:

the trouble with friends and family is they don't necessarily fully appreciate the therapeutic relationship and don't understand how it works unless they've been in their own therapy. it's easy for them to criticize and say how your therapist is wrong. i think it's tough, i think if you know you have a good therapist and they are a good fit for you, that you need to take the comments with a grain of salt. however, if you are still in a very vulnerable place (dealing with depression and anxiety), it becomes a lot harder to know if their feedback is on target or not.​

It's a dicey issue, one that can be difficult to navigate. As we therapists repeat ad nauseum: trust in the relationship is essential for successful therapy. When trust exists, therapy tends to progress. That's the ideal. But the trust is challenged when:

1. The therapist behaves unethically. I suggest you peruse the APA Code of Ethics to see what I'm talking about. This is not when the therapist upset you because he challenged you to face a fear or forgot your dog's name or suggested something that didn't work. I'm talking about the big boundary violations - inappropriate sexual behavior, extortion, needlessly breaking confidentiality, etc. If these issues occur or are about to happen, talk to someone in a position of authority. The therapist's boss, the police or their licensing board come to mind.
2. The client rehashes everything they do in therapy to their friends. Everyone you talk to will have an opinion which may result in more confusion. Sometimes it's best to keep this material between you and your therapist. For example, if you didn't understand what your therapist suggested last session, this is a good thing to talk about in therapy. If your therapist reminds you of your creepy aunt, this is prime therapy material. If you feel like therapy is the only interesting thing in your life to share with friends, you've got a topic for therapy. I invite you to risk trusting the therapist to see if the process and relationship can answer some of your questions, rather than running everything by the committee.
3. Loved ones undermine and sabotage therapy. Even well-meaning friends may not realize their comments can stall or derail your work. This is sensitive, personal work, and one harsh critique can do plenty of damage. If you know your minor concerns about therapy will be met with "I told you so" and "she's a quack," maybe it's best to save your questions for your therapist. A friend may ask "how's your therapy going?" and you can answer with "good, I'm learning ___ about myself." No one can dispute what you're learning, and you can keep the nitpickers at bay by giving them less to criticize. Someone hounding you with questions you don't want to answer might be quieted with "my therapy is very personal, if there's something I'd like to talk about I'll let you know." And if we're talking about a really toxic opponent to your therapy, you may need to say something like "it looks like we disagree about the value of therapy. I hope you'll respect my wish not to debate this with you. If not, I'll need to leave."

Clearly, trust comes at a high cost. If there's something terribly wrong with the therapy, report it. If there's a minor conflict, talk it over with your therapist. And if loved ones are intruding, tell them to back off. As it is with many issues in therapy, this is not a black and white issue. There are certainly times when eliciting support or discussing questions about therapy to a friend is a great thing to do. These might be times when you:

• had a breakthrough and want to share it with someone
• wonder how to bring something up to your therapist
• want to talk about what it's like to be in therapy
• talk through a concept or technique you learned
• want someone to hold you accountable for a new behavior
• look for objective feedback on changes you've been making

And so on. The intersection between therapy and loved ones will always be a little messy, such is the nature of relationships. It's important for you to know that you have plenty of control over that intersection. You can keep the two at their stoplights or mix it up between the crosswalks.

Two final notes about backseat drivers:

Parents and Teens
Backseat driving takes the front seat when working with children or adolescents. Occasionally, kids or teens seek out therapy on their own, but most of the time concerned parents bring their child to therapy to address issues they believe are problematic, and the kid may not agree. Parents might have specific ideas for the goals, procedures and session-by-session topics within the therapy. While these suggestions can be helpful, the teen may have a different goal, and the therapist a different approach. Problems are inevitable.

Here's one possible solution. When working with teens I meet with everyone to clarify the goals of therapy and how we'll work to reach them. I'll tell the parents I prefer to keep the material between me and the teen unless the information includes potential harm to the teen or anyone else. In order for the teen to feel safe, they need to know I'm not acting as a double-agent for the parents. Otherwise, they won't trust me and therapy is a waste of time and money. Whatever the parents say to me is fair game for me and the teen to discuss, whatever the teen says stays between us (with the above caveat). When everyone is clear on that arrangement, therapy runs fairly smoothly.

Note to Loved Ones
So what if you are Sally? How can you best support someone going through therapy? I'd suggest a blanket statement like: "I don't want to get in the middle of your therapy, but if you ever want to discuss what you're learning about yourself, I'll listen." If she takes you up on it, do just that: listen. If your friend or loved one seems to be experiencing roadblocks or has questions about the process, avoid chiming in with your own advice or opinions about the therapy. Instead you might tell her to "be sure to mention that to your therapist."

Ryan Howes, Ph.D. is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.