Psychotherapy is a unique relationship, a kind of connection that is unlike any other kind of relationship a person has in their life. In some ways, it can be more intimate than our most intimate relationships, but it also paradoxically values a vestige of professional distance between therapist and client.
Therapists, alas, are just as human as the clients they see and come with the same human foibles. They have bad habits, as we all do, but some of those habits have the very real potential of interfering with the psychotherapy process and the unique psychotherapy relationship.
So without further ado, here are twelve things you wish your therapist didn’t do — some of which may actually harm the psychotherapeutic relationship.
1. Showing up late for the appointment.
Therapists will usually charge a client for an appointment if they fail to cancel it with less than 24 hours notice. Yet some therapists seem perfectly oblivious to the clock when it comes to showing up on time for appointments. While the occasional lateness may be excused, some therapists seem to be living in another time zone altogether and consistently show up late for their appointments with their clients — anywhere from 5 minutes to even two hours! Chronic lateness is often symptomatic of poor time management skills.
2. Eating in front of the client.
Unless you have enough for everyone, eating and drinking during a psychotherapy appointment is considered ill-mannered. Some therapists offer clients the same access to coffee or water that they themselves enjoy. (If you’re going to drink something in front of a client, make sure you offer your client the same.) Eating while in session — by client or therapist — is never appropriate (it’s therapy, not mealtime). And asking, “Do you mind if I finish my lunch while we get started?” is inappropriate — clients don’t always feel comfortable enough with expressing their true feelings.
3. Yawning or sleeping during session.
Yes, believe it or not, there are therapists who fall asleep during session. And while an occasional yawn is a normal component of our daily functioning, non-stop yawning is usually only interpreted one way by a client — they are boring the therapist. Therapists need to get a good night’s sleep every night, or else they cannot be effective in their job (which requires constant and consistent attention and concentration).
4. Inappropriate disclosures.
Inappropriate disclosures refer to the therapist sharing a bit too much about their own personal difficulties or life. Most therapists are warned about doing too much disclosure in session with their clients, because it’s the client’s therapy, not the therapist’s. Therapists shouldn’t plan their vacations while in session, go on endlessly about their graduate school training or research topics (especially if they were focused on rats), or share how much they enjoy their summer house on the Cape. Therapists should keep personal disclosures limited (even when the client asks).
5. Being impossible to reach by phone or email.
In our ever-more connected world, a therapist who doesn’t return phone calls or an email about an upcoming appointment or insurance question stands out like a sore thumb. While no client expects 24/7 connectivity to their therapist (although some might like it), they do expect timely return calls (or emails if the therapist allows that modality of contact). Waiting a week for a return phone call is simply unprofessional and unacceptable in virtually any profession, including psychotherapy.
6. Distracted by a phone, cell phone, computer or pet.
Therapists will often ask their clients to silence their cell phone before entering session. The policy has to go both ways, or it shows disrespect to the client and their time in session. Therapists should virtually never accept any phone calls while in session (except for true emergencies), and they should turn away from any other distractions, such as a computer screen. In a world that increasingly values inattention and multi-tasking, clients seek refuge from such distractions in the psychotherapist’s office.
7. Expressing racial, sexual, musical, lifestyle and religious preferences.
Although an extension of the “too much disclosure” bad habit, this one deserves its own special mention. Clients generally don’t want to hear about a therapist’s personal preferences when it comes to their sexuality, race, religion or lifestyle. Unless the psychotherapy is specifically targeting one of these areas, these types of disclosures are usually best left alone. While it might be fine to mention something in passing (as long as it’s not offensive), a therapist who spends an entire session discussing favorite musicians or love of a particular religious passage is not likely helping their client.
8. Bringing your pet to the psychotherapy session.
Unless cleared and okayed ahead of time, therapists should not bring their pets to the office. While sometimes therapists see clients in a home office, pets should stay out of the office while they are in session. To the client, a psychotherapy session is a refuge and a place of peace and healing — pets can disturb that peacefulness and calm. Pets are generally not an appropriate part of psychotherapy.
9. Hugging and physical contact.
Physical contact between client and therapist must always be expressly spelled out and okayed by both parties ahead of time. Yes, that includes hugging. Some clients are disturbed by such touching or hugging, and want no part of it (even if it’s something a therapist might typically do). Both therapists and clients should always check ahead of time with the other before attempting any type of physical contact, and respect the other person’s wishes. At no time is a sexual relationship or sexual touching appropriate in the psychotherapy relationship.
10. Inappropriate displays of wealth or dress.
Psychotherapists are first and foremost professionals, and any displays of wealth and style should be discarded in exchange for dressing in an appropriate and modest style. A therapist slathered in expensive jewelry is a put-off to most clients, as are blouses or dresses that show too much skin or cleavage. Too casual of dress can also be a problem. Jeans may suggest too casual an approach to a professional service that the client is paying for.
11. Clock watching.
Nobody likes to feel they are boring to another person. Unfortunately the therapist who hasn’t learned how to tell the time without checking the clock every five minutes is going to be noticed by the client. Most experienced therapists have a good sense of how long a session has gone without having to look at a clock until late in the session. But some therapists seem obsessively compulsive about making note of the time, and the client notices (and internally, they may tell themselves what they’re saying isn’t really important to the therapist).
12. Excessive note-taking.
Progress notes are a standard part of psychotherapy. Many therapists do not take notes during a session because it can be distracting to the process of psychotherapy. They instead rely on their memory to cover the highlights of the session after the session has ended. Some therapists, however, believe they must capture every detail of every session in their notes, and obsessively note-take during sessions. Such constant note-taking is a distraction for most clients, and some may find that the therapist uses the behavior to keep an emotional distance from the client. If note-taking is done during session, it should be done sparingly and discreetly.
222 comments
One thing I really hate about therapists is when they say, “So…how does that make you feel?”
I think to myself…
“DUH!? How do you think it makes me feel????”
When you are upset about something, why ask this? It is OBVIOUS YOU FEEL upset/sad/mad, etc. COMMON SENSE.
I’ve been to many therapists in my lifetime and they always seem to use the same phrases over and over. Sometimes it feels condescending or just a plain stupid question to ask.
The generic phrases are old and I wish they would learn to talk to their patients on a more “personalized” level.
I guess I’ve had better luck. That stinks. Reading through the list, I actually laughed aloud…none of my various therapists has ever done anything like this. One of my biggest complaints has been that the therapist talks too much…but that’s really about it.
my therapist i swear she looks at the every 10 min. that bugs me to death, then she’ll answers her cell phone.
I briefly saw a psychiatrist who told me her whole life story–repeatedly. Every comment I made triggered a long story about her life. I stopped going to therapy because it seemed like such a waste of time to spend most of the session listening to her talk about her own experiences, which really didn’t have much relationship to my problems, so hearing about them didn’t help me to deal with my problems.
What a great post. I burst out laughing as soon as I saw the therapist yawning picture. As a therapist I try hard to be professional at all times which I don’t think has to mean stand off-ish or stony faced. There’s a line, though, and you draw it quite well.
Very nice list–I might have to disagree about casual dress though. The east coast is probably a bit more dressy. Here in New Mexico business casual is considered jeans and a nice shirt (cowboy boots are optional). If you’re the governor–add a bolo tie.
@Elvira… Agreed. You can’t help but stifle a yawn here and there throughout the day. But if a therapist is yawning 10 or 20 times in one session, that’s excessive!
@Laura… Agreed… clothing styles vary widely from region to region, and I almost didn’t include that sentence. But I have seen therapists dress-down a bit *too* much sometimes. But you’re right — in some parts of the country or with some therapists, jeans might be perfectly fine and acceptable.
I really liked this list. The not eating point is interesting though… more the rigidity of saying that eating in-session is never appropriate for clients. True, I would never eat in front of my client, but on very occasions with clients who have had to rush in late to therapy in between appointments, or who have blood sugar issues, I would not discourage them from having a snack in-session, if necessary. I would like my clients to be able to take care of themselves, and I’d prefer that to having a client starve herself through a session, thinking it’s not allowed. Of course, we might end up talking clinically about self-care if this happens a lot.
I had a therapist ask me if I could not eat my snack in session. I found this to be ridiculous. If I were a therapist I would be fine with the clients having a snack or making allowances for special occasions/conditions. I would rather have the clients be able to fuel their bodies because therapy can be exhausting. So I very much so agree with you and I think your compassion is commendable!
thank you for specifically saying: AT NO TIME is a sexual relationship or sexual touching appropriate in the psychotherapy setting. I just wish our colleagues who find out this behavior has occurred with a prior clinician gets reported, if not by the patient then by the clinician it is reported to, as we as clinicians have not just an obligation but a responsibility to report impaired colleagues.
Not an option, but an expectation. If anything else, to help the healing process for the patient and to reteach the patient what is right. It still goes on and it is nothing less than obscene if others know of it and do nothing!
@Keely… Rare exceptions can be made for any rule, of course, but I think it’s important to clearly delineate that therapy works best when both parties are focused at the task at hand and not distracted by things like food, cell phones, or pets.
@therapyfirst… Indeed, it was unfortunate I even needed to write those words, but I thought that sadly it does happen, and people need to be reminded that a therapist is wrong to make sexual advances (or worse) toward their clients.
This is a long-brought on rebellious comment. How about when you are psyco-diverted and brought disengaged Like, your situation in a drug-forced /concerned inappropriate situation.. my “psychiatrist” completely disarrays just about any fact, that I have -good reason- to disagree with the doctor’s assessment. The real BURN is that’s like a shrink saying “sucker,its not my problem!” a BS, BS situation..
I would like to add “Ending the session too abruptly or early”
Sometimes a therapist needs to guide the client into closure instead of just getting up when time is up. I’ve had a therapist stand up when I’m in the middle of asking a question or advice. It was unprofessional and made me feel, as the client, unheard and unimportant. Also, ending a session early seems like a big no-no. Especially if you or your insurance is paying for that time.
I had a therapist who fell asleep during every session. It turns out she was actually taking too many pain pills after foot surgery, but I didn’t know that! I would be sharing intimate details of what was bothering me and look up and she would be sawing logs. How rude! Needless to say I stopped seeing her. My therapist now is wonderful. We talk about therapy interfering behaviors and if there are any, we work them out. She is the best.
Interesting article!
Although I do find that I partially blame the educational system for this lax and crude behavior. It is wide consensus among “conservatives” on the issue that the educational system is not suppose to provide an individual with internal moral codes or ethics, but rather just to teach and introduce the learner to “book-knowledge.” While I do partially agree with this, I do not agree that colleges and graduate schools/professional schools of psychology should be exempt from helping their students to be polite and uphold good etiquette. The APA obviously created the code of ethics for a reason.
Perhaps this is a great warning of what colleges and graduate schools/professional schools of psychology should consider implementing in their curriculum.
While going through college in psychology and now graduate school, I have yet to see any classes that prepares an individual for professionalism and that helps to navigate values into one’s career. Where do prospective psychologists and therapists learn to become the ethical individuals they should work to become? Schools should be partially responsible for this.
I once heard someone say: “A degree makes you a doctor, but it doesn’t make you qualified.” Maybe there is some truth to this =)
You made a good list of behaviors to avoid while counseling. I’d like to add my personal experience with seeing a counselor for 3 years.
While the meetings are supposed to last 50 minutes, ours often lasted 2 hours or more. Half of that time was spent by the psychologist telling me all of her problems! I would put off bringing up my own issues, because I didn’t want to appear rude or uncaring.
Lol oh man been there done that. I once had a t just sit there and nod, she had the “Mhmm”‘s She woundn’t say ANYTHING else other than mhmm… she was older about to retire I believe… Also she had a wig… for some reason that stands out in my mind… ah old frayed wig. I didn’t like her too much.
What a great post – and great comments! I still can’t believe that any remotely appropriately qualified therapist would do any of these!
I have never met a therapist yet who would spend the time telling me their own problems but if they did I would immediately run for the hills.
I’d be interested as to any opinions on when these are just “annoyances” such as (perhaps) falling asleep in session which can just about be excused as countertransference *maybe* and things that should be reported to the appropriate governing body. Obviously any sexual behaviour needs to be reported as someone mentioned above.
It is very difficult I think for clients to know when to leave a therapist because of unacceptable behaviour and when to report said behaviour to prevent damage to others who are treated.
Once again, great post.
Unreal that people/therapist would think anything on this list was ok to do. I guess I’ve been lucky in my pick of doctors.
One experience I had though with an AA “therapist” that made advances on me when I was there to talk about my husband’s drinking problem. Needless to say that was my last session with him but unfortunately it never occurred to me to report him.
I have a friend who goes to a therapist who eats during the season, has THREE dogs wandering around, is chronically late (my friend actually waits in her car outside in the parking lot until she sees her therapist arrive rather than go into the waiting room)!!!
I could not believe that my friend did not express that these behaviors were distracting to her (they were) & were not conducive to her having helpful sessions. She still sees this therapist.
I’ve been to many therapists. I have bipolar disorder. One therapist told me on the 3rd session that she thought I shouldn’t be on medication as medications “blunted my emotions.” I was amazed as without medication I would not be able to participate in therapy at all. Previous to being on medication for bipolar my emotions were so extreme that attempts at therapy were pretty useless as I was usually crying uncontrollably through the sessions & made no progress whatsoever.
One therapist I saw would frequently run out of the forms I needed to file my insurance claims (yet I doubt she would accept it if I would run out of checks often & not be able to pay her). What irked me about this was that she was dressed like a fashion model with all the accessories & fancy shoes (revealing pedicures were done frequently) & a body that had regular trips to the gym so she obviously could remember these “important” things. Somehow my things weren’t very important to her.
I see one of the annoying things mentioned was being too flashy in dressing. I thought it was just me as I have very low self-esteem & have some issues with my looks & felt very inferior to her. One of my “problems” was that my mother committed suicide was I was 15 (she also had bipolar) & my father told me she did it because she was losing her looks (she was 45). So somehow with this therapist spending so much time & energy on her looks seemed to confirm that a woman’s value was indeed her looks. I’m sure she didn’t know she was sending that “message” to me, but it does seem all these behaviors are not just annoying but sending a “message” to the client about how the therapist isn’t interested or is bored or is self-involved, etc.
I guess I got lucky. My therapist does none of these things. I have been to a handful of therapists in my life, and I don’t think any of them did anything on this list except for maybe the clock watching, and that is to be expected sort of.
I had a female therapist who was gorgeous and knew it. She sometimes wore revealing clothing that was hard to take your eyes off of if you were a man. I told her it was distracting me and she proceeded to process me on that issue. I just said, don’t wear that in front of me! Period!
Also the “what are you feeling is annoying. And when they are stumped by what to say or do and they won’t admit it. Just say, “I’m not what to say now or I am going to have to think about it and then respond.”
Last thing which was a major upset for me. My THerapist terminated me from group therapy over the phone with no final closure or discussion. I came close to filing a complaing against her. Her response, “you are taking this too personally.” Agghhh!
As a patient myself I completely agree with this list and have run to some extremely rude therapists. I had a couple of them that would constantly eat in front of me thru out the entire session. And another telling me all about they’re personal lives when I’m the one thats the patient not them! I’m there to talk to them about how I feel , not to sit there and listen to they’re life stories! I’ve also been told by my last two therapists that I don’t know what I’m talking about ,that it’s all in my head(even though I know it’s not!)-I’m not STUPID!!,and that I’m full of B.S. and I’m not joking about any of this! There are lots of therapists out there that shouldn’t even be working as therapists because they’re completely insensitive and EXTREMELY RUDE AND DISRESPECTFUL to they’re patients and there’s absolutely no excuse what so ever for being that way! I pay good money to go talk to these people!
I had one therapist who seemed overly concerned with whether I liked her or not. She would frequently ask me if I liked her, how I felt about her, and she would give me small gifts. I was uncomfortable with it all, but I was very young, only 18 and I did not know what to do. I would have preferred she stayed so neutral and clinical. I had trouble telling her what was really going on because I did not want to spark one of those, do you like me discussions. Now that I am older and in therapy again, I have a therapist that is really good. Sometimes she overly obviously checks the clock and she is always a little late, but she is very available in between sessions and overall is great. She always has water with her in the sessions and drinks out of the bottle frequently. I guess I have noticed it a lot so maybe it is a distraction but she has a long drive to get to the office I see her at which she comes to this office only one day a week so I guess I just think that is okay then. Overall she is very very good and I have healed so much in the 11 months with her. She used to write a lot of notes the first three or four months but now does not write any. The change bothered me but now I am used to it and it is okay. I think she had to stop so she could see me nod or shake my head since I sometimes forget to actually say yes or no.
In response to funnyguy’s comment- I don’t blame you- these people are suppose to be professionals! No one what so ever should be allowed to dress that way in a “professional setting”. I find that absolutely disrespectful, completely insensitive,and rude ! I can’t believe a company would ever hire someone like that. I would report that person no matter what he/she said to you. She has no right what so ever to do what she did to you over the phone(common courtesy and respect for the patient) and apparently this one doesn’t have any of that.And as far as taking it too personally, thats a bunch of junk! You have every right as a patient to be able to walk into a therapist’s office and feel comfortable around that person not having to worry about what that person is wearing and how much of they’re body they’re showing off! That is soooo unprofessional it’s not even funny. To me, therapists need to dress with alot of common sense! They’re not going out to a club dancing, they’re going to work! I really think you should see if you can find a different therapist because apparently this one has no respect for you as a patient and go ahead and report them.
That’s awesome Lily! I’m glad to hear everything is falling back into place for you. As for me my new therapist just rocks! And she has done soooo much for me in the last 7 months that I’ve been seeing her 🙂 Now it’s to the point where I can talk to her openly not have to worry about anything. I’m one that doesn’t trust people easily and takes a while for me to get there and she respected that and didn’t push me .
A recent trend locally is for certain referral sources to ask me as the therapist to contact the potential client to arrange an initial appointment. This usually ends up with multiple phone messages, and also puts the responsibility on the wrong person to initiate therapy. I wouldn’t expect my child’s pediatrician to call me to arrange his next appointment, I don’t expect any other professional for that matter to make the initial contact, so it seems pretty inappropriate for it to be expected for psychotherapy or counseling. However, if I want to work with families from these sources, I get to make the initial contact calls. Making return calls to voice mail, etc. becomes cumbersome and frustrating, and puts the “being impossible to reach” part in a different perspective.
my appointments were at 1:00 pm and my therapist used my time EVERY week as her lunch hour, even though my binge eating was a major issue. she would also inject her insulin first, not shielding herself at all. she brought food she said her cook made for her (!) and would lecture me about eating better. meantime, I gained 70 lbs on depakote and she said to stay on it, as the “mood stability” was more important than weight control! She discounted my fee, so I felt too grateful to object.
I am amazed about the list of therapists’ behaviors and fully understand the clients’ issues in sharing their discomforts. I had a therapist who would nod off repeatedly during therapy. He was, unknown at the time, developing dementia. That means I spent a lot of time and money talking with someone who was not “present” in the moment. A later therapist, whom I loved dearly and made huge strides with, would on occasion begin to blink and nod off. When this happened I always shut down. I couldn’t continue to focus on the discussion and sharing my thoughts. In both instances, I would never have considered saying anything about this behavior. I had enough time confronting issues with their support. How could I ever think of addressing this with either of them?
Confrontation was not forte’…
my current therapist answers the phone and it is annoying. my previous one who was great might have answered but said right away i’ll cal you back no conversation just i’ll call you back. i’d rather that than the stupid phone ringing or blinking. but this one has a whole conversation and it seems someone calls almost every session
it is tacky to dress like hooker at any job. talking to a therapist should be as comfortable as talking to your bestest friend in the entire world. people don’t have enough good and best not to mention bestest friends that is why we need therapist not enough people stop the world and just listen just because they are your friend and well there are just some people who give horrible advice and are to chicken to tell the truth or tell the truth but won’t tell you what they want you to do about it
it is the therapists basic job function to stop the world and listen.
I am bi-polar with varying traits of different personality disorders (like everyone else in the world). I have been going to therapy for decades with lots of different therapist. Initially when going to therapy I agree with the above comments BUT based on my age, experience with therapists and the length of time I have been going to therapy, I believe the following comments stated above 1, 2, 4, 6 and 7 (within reason) are perfectly reasonable and works better for me. I had gotten to the point of not considering that my therapist is a person too. For my personal development the current therapy that I am receiving helps me to develop better listening and empathy skills with my therapist. Also, I feel like I am treated like a real person instead of a “sick” patient. The relationship feels like it is more on a peer level in which my therpist is a life coach. This type of therapy is a HUGE improvement as far as I am concerned.
One of my therapists slept all the time. I felt just like what was in the article. He finally retired and I was referred to another Dr who is great!
Also, a Dr I went to for my ADHD son complained when we were 5 minutes late due to construction. He hardly counseled my son who had expressed not living anymore. All he did was give Adderal which my son wouldn’t take and signed him off as okay. My son took his life 7 months later.
Thank you for taking the time to encourage clients to demand a better standard of care when it comes to therapists. I have been practicing for 35 years and I am very concerned about how loose many therapist have become. Our clients often come to us in a very vulnerable state and are not able to be good consumers of health care. Let’s continue to raise our own standards of care.
Dr. Mikol Davis
I had a psychiatrist who took notes on his computer in session. He also asked me “what do you think we should do?” Since all he did was prescribe meds for me with no therapy I could have emailed my sessions in. I wasn’t the one in the relationship with an M.D. with the knowledge of the benefits and side effects of different medications and dosages so how was I to know what was best? I staunchly deffend my control over my body and treatment but I was paying for his “expertise” not just a signature on a prescription. What a racket he has going – he spend a whole 10 minutes with me and billed the insurance for a full session and charged me the full co-pay.
yikes! My last therapist had seven out of twelve of those habits, plus one not listed–she was obsessed with billing issues. Sometimes, she would take up 15 minutes of a session working out billing matters and insurance knots. She truly valued me as a client, I’m sure.
How about when you cancel someone’s sessions without a word? With my last (and so far only) therapist, I missed one appointment that I told her I would most likely miss (I told her that it was a bad idea to be scheduled then), I contacted her a few days later after working up the courage to email her…she NEVER contacted me again. At all. How unprofessional is *that*?
Depending on what credentials your therapist has, every patient/client has the right to file a complaint to the Board of Health Professions in your state.
At present, therapists can be
clinical social workers (with an MA or PhD);
professional counselors; (MA or PhD or EdD)or,
psychologists; (PsyD or PhD)
Psychiatrists (MD) are more in the business of “medication mgmt”, which as many of your noted in your responses, does not consist of therapy.
At the first session, a therapist MUST provide you with an informed consent document that includes a description of who they are, what they do, and how they do it. Moreover, you should all be told how you can make a grievance against a therapist if you believe your rights have been violated.
Please check out the individual Code of Ethics posted on the websites of the APA, ACA, and the NASW (American Psychological Association, American Counseling Association, and the National Association of Social Workers).
Then, to file a grievance for an ethical violation, please visit your state’s Board of Health Professions. In my state, Virginia, there is a link to submit a grievance right on the site.
Good luck.
“so, how does that make you feel?â€
As a therapy client and a friend, the question “how does that make you feel†has driven me crazy. On such occasions it seemed to me it should be pefrectly obvious what i am feeling, so asking it seemed idiotic, as if the questioner was at a loss for a normal human response and just inserted a pat pop psychology question to seem interested. But while people might use it that way, this question is invaluable. Despite my initial anger, if i trusted the person enough i would try to answer and begin checking with myself, explaining how exactly i am feeling. “I feel like he does not love me†is not a feeling, it is thinking. “I feel angryâ€, yes, that is a feeling. Belive it or not, some people are unaware of their feelings–they might say they are sad, but as they keep talking they actually describe a feeling of anger. Sometimes, when you might assume they are angry they may just feel saddness, or nothing at all. So this irritating question is actually helpful to make sure you and the other person are on the same page. What might make you feel jealous may only feel sad or even indeifferent to another, and there would be nothing wrong with their response–it is their reality at the present moment. There is no correct anser to “how you are feeling?â€.
More importantly, when you actually go beyond the feeling’s name –“anger”, “fear”, etc–and allow yourself to experience the quality of the emotion (imagine explaining it to a martian who knows nothing about feelings)–how it actually feels in the body, or what you imagine it’s color, texture, maybe even sound, might be for you at that moment, your experience becomes much more clear both to the listener and to yourself. Ofentimes, as i keep paying attention to it and trying to describe it, the “feeling†or problem suggests its own resolution, or important connections to my past, or it begins to change and unravel as i observe it –so, when i stick with it and can endure the pain of it, i can get a very healing perspective of the nature of my mind, emotions and reality in general. (Art Therapy uses such prolonged attention to feeling states in a more fun and non-invasive, non-verbal way, decribing your feelings in movement, sound or visual art. )
I have experienced such valuable break-throughs triggered by “how does that make you feel?†many times. They were invarriably accompanied by my huge initial irritation at the question.
If we expect the therapist to agree that something feels this way or that or expect him to imagine how we feel just because we think it is obvious, the possibility of healing is diminished. No one knows how you feel but you and sometimes even you don’t quite know until you look patiently inside.
I also have to say that it is perfectly OK and absolutely necessary to call bullshit by its proper name. As a client, it is difficult for me to stay with uncomfortable emotions, so, with hindisght, i have engaged in a lot of BS–distraction, not remembering my homework and not doing it at all, talking a lot about something that is a complete distraction from the problems i have committed to working on, entertaining my own therapist with witticisms and funny stories, etc, in order to pass the time (this was completely unintentional and probably even necessary sometimes–perhaps avoiding too much pain that i felt i could not handle at the moment) But, unintentional or not, it happened. Not all of us benefit or grow by completely supportive counselling that does not challenge us–a challenge can help heal us if we respond to it–accept it, reject it, whatever, but be aware and real about it, rather than pretending it did not happen, go home and stew. With a few exceptions in cases where clients are severely debilitated, every therapist, no matter how appropriate or not, no matter how suportive or challenging, even no matter how skillful or not, presents us with an opportunity to stand on our own two feet and take responsibility for our experiences and our life. That is the wonderful thing about a therapeutic relationship–we are there because we have made a pact to get to the truth– we want to be whole. Whole means if you are uncomfortable with confrontation, you actually practice confronting, if you are uncomfortable with responsibility you practice taking it, if you are in pain, you practice how to handle it.
So if someone is continuously falling asleep while i am talking, i would make a loud startling noise, stop therapy and deal with the issue. And also accept the possibility that i just might be boring the therapist to sleep because i keep talking about the same thing the same way over and over again, even after our 10th session–either they did not help me get out of my maze or, despite their help i am still in a trance. So a sudden loud noise, say, a Fart:), might help both of us snap out of it.
Interesting list. I’ve had a couple therapists and the note-taking never bothered me. It was actually beneficial to my particular condition.
However, I must be the exception to the rule, because I have no problem whatsoever calling my therapist on his ‘ticks’. I feel it’s my duty as a patient and in my treatment to facilitate the environment so it fasttracks my healing. Call me brash, but I’m not waiting around for things to change. I do my own research into medicine/psychology and I express my opinion the best way I understand, and this helps bring up important issues in therapy.
If your therapist is worth his salt, you won’t be ashamed to express yourself, and a therapist who makes you feel uncomfortable isn’t worth your time, because therapy is hard enough as is without being self-conscious of yourself. Give yourself a chance, find someone you feel good with.
For instance, I posed a solution to my therapists clock-watching tick, that he post a clock directly behind the patients chair at eye level. So one could see the clock without diverting eye attention. It’s a great tactic to manage time and not cause the patient any loss of face.
Soon into our sessions, I noticed he had a rather somber message on his answering machine. I felt obligated to tell him how utterly depressing it was. I think not only of myself but the other patients who feel terrible enough, people with severe depressive disorders.
By and by, perhaps by taking these small steps; I think it will confront the major issue of therapy work in and of itself. The neccessity of the patient to assert themselves and start taking positive actions to determine their adaptation to their situation. Will the patient apathetically sit by, or will they assert themselves and determine their own terms of redemption? The therapist shows you door, but we must walk through it.
As a therapist, I’m most annoyed by all the paperwork that takes me away from my clients. I believe it’s annoying to them also. But, in public mental health facilities paper work is added daily! I have to sit most days with a full clip board of “stuff”. One client needs this another needs that and it breaks up listening and the healing process. I wish clients would write to their health insurance companies, the mental health governence in their communities etc., and complain about excessive paperwork and what it does to their treatment. Some therapists get paid only for an hour session and not for all the paperwork. So they pass that on to the client by having a 45-50 minute session. I know I didn’t get into the field to push papers!
The thing that frustrates me the most is when I have been going to therapy for some time and the therapist can’t remember important things that I have talked about in previous sessions and I have to take time to bring them up to speed again. It makes me feel unimportant, that the things I have revealed aren’t that important to discuss.
I also hate therapists that are habitually late. It makes me feel really unimportant, that I dont really matter and that I am wasting their time.
My therapist constantly ate her lunch when I was there. I thought it was inappropriate at the time. She used to say, “I have no time for lunch, so I have to eat as I work”.
I didn’t know what to say, really. I didn’t want to ask her not to eat!
Wonder what I could have said?
Later on, I found out that the reason she “had no time for lunch” was because she did not have a paid lunch hour and didn’t want to take the break, so in other words, she would have missed the money.
Wow, has this thread taken off. While I am glad to see people weigh in about experiences, thus showing that therapy is being utilized, I am a bit disappointed to not read more people relate positive experiences with the process.
I will say this, for what it is worth: my field began it’s downfall when it foolishly, if not stupidly, accepted managed care forcing psychiatrists out of the therapy loop.
Studies have shown to this day that there is a certain sizeable population that would benefit from one provider engaging the patient in therapy and medication, where responsibly indicated. My colleagues are morons and turncoats for allowing this to happen. And that is the nice way to put it!
As another provider said above, the field is diminished when people who are not credibly trained put out the “shingle” and claim to be practicing psychotherapy, when what they are doing is anything but effective treatment. This is a craft as much as a profession, so for those who are looking for treatment, do not hesitate to ask about credentials, experience, and expectations by the provider in what to strive for in service. Anything less, be wary, if not look elsewhere.
And, if you have been in therapy and felt it was beneficial, do not hesitate too much to offer a referral if the source looking for a therapist is genuine in seeking help. The best referral is one of experience.
Just an opinion, from a psychiatrist who wishes to be able to practice therapy more often than able these days.
therapyfirst, board certified psychiatrist
i’m lucky my psych is great. He listens and trusts me.
I once had a therapist who would ask me to help her with her computer during session. She also had me bring in my dog for several sessions because she liked dogs. She would feed him apples. Needless to say, she did not last long!!
I have had a lot of bad psychologists and psychiatrists, I’m sorry to say. One of them ate pretzels and candy in front of me (she did offer some to me, but I still felt it was inappropriate), told me about her sex life (intimately!!!) and family life, and even confessed the receptionist had asked what was wrong with me, and she told her, figuring she could look in my records, anyway, if she wanted to know!!! That’s a violation of my privacy rights!
I’ve also had pdocs and psychs who yawned and seemed rushed.
I find too many don’t seem to actually listen. I’d like a doctor who shows some sympathy and emotion, not acting superior or smug. I can pour my miseries out, and all I get is a nod and a change or addition in prescription. How about, “I really hate that you’re going through this. I may not be able to do more than write you prescriptions, but I want you to know that I care, and I’ll do my best to help you achieve as normal a life as I can.” Knowing that I’m not just another experiment in medication and that my feelings and suffering matters would go a long way in making me feel like I’m being heard and have support.
Wait until your therapist asks you to join her as a friend on her Facebook and you see photos of her you wish that you never had. Needless to say I deleted myself as a friend.
I walked away from two therapists after my first session. I had come in tears and total distress to the first one and he had me sit in his waiting room and fill out a ream of paper with very personal questions before I even saw him–that did not feel good at all. In session he refused to answer my questions about his spiritual beliefs, which was important to me in order to figure out whether I can relate to him. So I never went back. The second was a lady dressed to the hilt with a load of large metal accessories like belts, earrings and bracelets–she clanked as she moved looking like a strange walking Christmas tree, bit it was only Easter, plus she had difficulty remembering what i had said just a few minutes before–i never went back there either.
Generally, however, i don’t agree with the premise of this article, that therapists’ bad habits: “interfere with the psychotherapy process and may harm the unique psychotherapy relationship.” If you’ve stayed for more than a session or two with the same therapist, I am assuming that your interviewing process went well and you have decided to give it a go and do your best. Effective therapy is not entirely about being listened to and holding your hand. You don’t have to like and approve of your therapist in order to benefit from their work, sometimes exactly the opposite can be beneficial. If your therapist is good, they will appreciate your comments on all of the above 12 and more annoying habits and use them in the process to 1. become more aware of how they come accross and self-cotrrect if need be (they need feedback too!) 2. help you explore your annoyance at them for possible clues and solutions to your own underlying personal issues–invaluable!! as well as 3. deepen the honesty and rapport in the therapeutic relationship, which is essential for therapeutic progress.
Aside from sexual advances that are absolutely inappropriare, anything that happens during therapy is fair game to talk about and is useful, because it helps the client to deal more authentically and effectively with their life. If you can resolve annoyances with your therapist, who you know will not get angry at you, walk away of make you feel stupid–they are there for you!–then you can resolve these issues anywhere in your life. Quite possibly you have come to therapy precisely for such issues, no matter what the surface problem might be.
The entire therapeutic relationship is a tool for growth and anything that happens in therapy–from someone being late to eating, watching the clock, feeling unimportant or not agreeing with someone’s dress code is all a rich opportunity for mutual growth and healing.
I feel that this well intentioned article has, among other things, given an opportunity for people to vent their pent up and unresolved frustrations. Venting and sharing horror stories is good, but in the end what you make of your therapy is what You make of your therapy.
Misha, I totally agree with both points. “How does that make you feel?” is both annoying and helpful. I think, for me, it’s annoying BECAUSE it’s so hard to actually identify my feelings. Thanks for the post.
My therapist could never understand why I got so upset when he ran over with the preceding patient. He would say “I’ll make it up at the end.” It was never about the minutes. I thought he cared more about the other patient than me. He would argue it point by point. That he spent time on the phone with me. That he sometimes took more time with me. As though we should just do a minute by minute exchange. It still hurts as I type this.
I have a psyc that is beyond comparison. Have had various ones since I was 12 yrs. old, thanks to ol mom. He does not of the above things–remembers what we talked about in the last session. He does share, sometimes, what has happened in his personal life. It has helped me to remember that he is a human being, also. Wish every one could have some one like him. Thanks, Doc.