It's never too early for the therapist to condescend

These days, many therapists call their patients "clients". Patients as a class are "mental health consumers" or some such thing. You know what they say: "The name's the thing." This stuff is all more or less benign, but something more insidious seems to have seeped into the system which is related to this idea of an "active patient" - you know, one who takes responsibility for her own healthcare (except that health professionals become annoyed when a patients actually tries to do that).

What I am referring to here, is the notion whereby the therapist tells the patient at the outset of therapy that she (the patient) is the boss. Here's a typical scenario:

Therapist: Okay, we did your intake last session, and now I'd like to briefly go over a couple of the principles and concepts I abide by when dealing with patients. First of all, the patient's the boss! You're in charge!

Patient (hesitates, sensing a snow job): What exactly do you mean by that?

Therapist: Well, for one thing, it means that in our sessions, we will talk about something, say a specific issue, only if you want to talk about it.

Patient: Okay, sounds good.

.....[twenty or so minutes elapse; the discussion has moved on to issues the patient currently has]

Therapist: So, you are ruminating about work..about how you perceive that some of your co-workers are giving you a hard time.

Patient: Yes, but I'd rather not talk about it anymore right now. I think talking about it a lot will make the rumination worse, in the long run.

Therapist (sensing that the patient is ruminating right in front of him): But..I sense that this is really causing you a problem - you seem very bothered by it...

Patient: Can we talk about something else?

[At this point, the therapist starts to look annoyed, and tries to think of what to say next. The patient then realizes that the fact that she doesn't want to talk about the work issue is really bothering the therapist; then she recalls the therapist's earlier statements about principles.]

Patient: Uh..remember when you said I'm the boss?

Therapist (hesitates, then turns beet red): But..hmmph!..it's really important! It's important to me! Ooops..I mean, it's important to you!!

Patient: Was that a Freudian slip? Actually, at this point, I have diagnosed you..this only half-way through the second session.

Therapist: Really? What's wrong with me?

Patient: You suffer from "Phantom Symptom Transference Disorder (PSTD)". What this means is that you become obsessed with a behavior which you believe the patient is experiencing, then you "transfer" the behavior such that it becomes your own. For example, in this case you yourself are, at this point, intensely ruminating about how my work issue should, in your opinion, be my top priority right now.

Therapist: Is there any hope that I can improve?

Patient: Yes, the solution is readily available to you. Take 500 cc (one half liter) of cyanide tonight, and see me next Wednesday. Don't worry if you forget the session, though...I won't be annoyed...