In psychotherapy, collusion between patient and therapist can seriously undermine the therapeutic process. These are dynamics that consciously or unconsciously involve both parties and can hinder progress. If you find yourself in such a situation, here are some types of collusion you might recognize and what to do about them.
Common Types of Collusion
➼ Symbiotic Collusion
Example: A therapist, gratified by feeling indispensable, began taking the patient's calls even outside of work hours, reinforcing the patient's emotional dependence. This created a situation in which the patient could not make autonomous decisions without the therapist's support, compromising the path to recovery.
➼ Complementary Collusion
Example: A patient with severe control problems approached a therapist who, to avoid conflict, tended to make decisions for the patient. This reinforced the patient's lack of control, preventing personal growth and resolution of the underlying problems.
➼ Persecutory Collusion
Example: A therapist unknowingly took a critical attitude toward a patient who constantly felt judged and inadequate. This reinforced the patient's negative feelings, making any therapeutic progress difficult and keeping the patient in a constant state of victimhood.
➼ Fusion Collusion
Example: A therapist shared personal details of his life with a patient, creating confusion of roles and boundaries. This led the patient to see the therapist more as a friend than a professional, compromising professionalism and the effectiveness of therapy.
➼ Avoidant Collusion:
Example: Both patient and therapist systematically avoided difficult topics, such as past trauma, focusing instead on superficial issues. This avoidance prevented the patient from addressing and resolving deep issues, blocking therapeutic progress.
➼ Eroticized Collusion
Example: A therapist developed an erotic relationship with a patient, severely compromising professional ethics and treatment. This led to a number of legal and ethical problems, and the patient suffered further emotional damage.
➼ Idealizing Collusion:
Example: A patient idealized the therapist, seeing him as infallible. The therapist, enjoying the excessive admiration, did not correct this view. This prevented the patient from developing a sense of autonomy and seeing the therapist as a human being with his own imperfections.
Recognizing and addressing collusion is critical to maintaining the integrity of the therapeutic process and promoting real healing. If as a patient you notice any of the forms of collusion described, it is important to remember that it is normal and right to have these feelings. Therapeutic work is precisely about analyzing, integrating, and resolving these issues. Here's what you can do:
Recognize your feelings: It is essential to acknowledge and accept your feelings without judging them. Feeling uncomfortable, confused, or frustrated in a therapeutic relationship may indicate that something is wrong.
Communicate with your therapist: Talk openly about your feelings and concerns. A good therapist should be willing@ to discuss any difficulties and work with you to resolve them.
Ask for supervision: If the problem persists, ask your therapist to consult a supervisor. This can help identify and correct any collusion dynamics.
Consider a second opinion: If collusion seriously compromises your course of treatment, consider consulting another therapist for a second opinion.
Reflect on yourself: Reflecting on how collusion dynamics may mirror other relationships in your life can provide an opportunity for personal growth.
Find outside support: Talk to a trusted friend or family member about your concerns. An outside perspective can help you see the situation in a different light.
Document your experiences: Keep a journal of your therapy sessions and emotions. This can help you identify patterns and provide concrete evidence if you decide to address the problem.
Reassess the therapeutic relationship: If you notice no improvement after addressing the problem, you may need to reevaluate whether continuing with the same therapist is the best choice. Don't be afraid to seek a new therapist if you think it is necessary for your progress.
Consult an ethics committee: If you have concerns about collusion or other ethical issues in your therapy, consider consulting an ethics committee for further advice and support.
The goal of therapy is to help you heal and grow, and a healthy therapeutic relationship is critical to this process. If necessary change therapist to help you achieve this goal.
For more information and specific cases, you can consult sources at Psychology Today (https://www.psychologytoday.com) and Cambridge Core (https://www.cambridge.org).
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