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
I had a great male therapist that I considered a friend first, and a therapist second. At one point he started eating his lunch during our sessions, and I thought it kind of strange. Then I realized that I’d revealed that I had stopped eating and I saw his behavior as an encouragement for me to eat food. So I started bringing food to the session and called it my “food therapy”. I still miss him.
With another very attractive female therapist I would often find myself catching glances of her body, And when she abruptly discontinued our therapy, I assumed it had to do with the sexual tension. Although it may have been due to an uncomfortable disclosure I made about one of my sexual tendencies.
But we never discussed that issue or my own difficulties with expressing sexuality. I think she was uncomfortable with these issues herself. So she couldn’t have been of help to anyone with these issues.
Something I particularly hate about therapists who claim to follow Lacan is that, all of a sudden, they decide you have said something really crucial (sort of a Freudian slip) and they tell you it is time to finish the session, no matter if you have just spent only 10 minutes or less talking. They may claim this is part of the therapy, but I only get the feeling they are taking advantage of the patient=client. I’m not going to buy that, sorry! To me, the session time should be agreed in advance and they will never convince me of the ethics behind that action. If they only spent 10 minutes with you (or even less) I sometimes feel as telling them. “0.K., then, today I’ll pay you 10 euros instead of 40, since you have only spent a quarter of the time with me!” Just imagine a tutorial lesson that finished in advance just because the teacher claimed his pupil already knew the lesson.To me it is very similar, maybe because I am a devoted teacher!!!
Sorry, for talking about euros but I’m writing about my own experience in Spain. I think it’s a real rip off! Anyhow, with our important crisis, I have no more money for therapists, after having spent more than 30 years trying all the different approaches. I just wanted to find out if this is common practice in the U.S., where I spent 2 years more than 20 years ago. Lovely country, indeed.I sometimes drem with going back. Thank you for listening.
I agree with the clockwatching…one therapist did that to me and it became clear that she was more concerned with the dollar per minute amount than with the therapy going on so i never went back to her again.
I’ve had many, different therapists,
throughout my life, over the span of
22 years. I’ve come to learn that I trust women professionals much more than men, as I’ve been hurt and abused by men in powerful, professional positions. My most recent therapist is #12 – Obsessive note-taking! She writes down everything! If I tell her I coughed 40 times the previous evening she’ll
write it down! I’ve also had a pdoc
from India that did not believe in deodorant and to sit in there with him for almost an hour was hell on wheels! A therapist I had (but she recently passed away from lung cancer 3 years ago), used to tell me
way too much about her own life and lifestyle. We eventually stopped talking about my problems and issues
and suddenly started talking about politics and world peace! lol. She was a nice woman, but after 7 years of therapy, I had enough and had to see someone else, that I could start
fresh with.
I had a therapist who passed gas. geesh. Two visits was all i could handle.
Another (new, youngish, master’s level, probably little or no real life experience — but I was in my 20s myself so what did I know?) — whom I barely had begun to even speak with 10 minutes into the first session who loudly and vociferously proclaimed that because I had been spanked as a child that was definitely ABUSIVE — it was CHILD ABUSE! I couldn’t hear a word she said after that.
Maybe it was abusive, but at the time I wasn’t ready to hear it expressed and proclaimed that way from the top down/outside in versus my coming to an understanding and my own inside out discovery process based on research, knowledge, facts, information as well as self-knowledge and my own journey.
and i had a friend — a victim of sexual and physical abuse with deep father abandonment issues — whose married male therapist in Boston proceeded to HAVE SEX WITH HER!!!! and then soon abandoned her, of course.
also, after knowing so many (all?) the friends and colleagues with crazy screwed up nutso or wacko issues and behaviors in undergrad and grad school who got either phd or master’s level counseling/therapy licenses, i learned that it’s really really difficult to find a good therapist who actually knows what they are doing who don’t have their own subconscious agenda that they work out through their clients.
it’s possible, but very difficult. there’s a lot in this article and especially in the comments to make you think it’s almost impossible to find a good therapist.
I’m much more inclined to advise others to find someone (based on the recommendation of numerous others) who is quite mature and highly experienced, who is more likely to have a clinical degree/Ph.D (but not always) who will first share what their approach is, whether they specialize in the areas you’re working on — and someone who is recommended by others who actually experienced success and made positive changes not just indulged in therapeutic self-indulgence.
and you have to trust your own level of comfort, challenge, awareness …
but that’s just me.
Good post and very shocking and interesting reading the comments.
I’ve just updated our blog in response to this post on WHY, aside from bad training, therapists can become ineffective.
Some of this stuff is simply inexcusable though, who trains these people?!!
What I hate is when they give you the “therapist look” and you feel like they can see right through you! My therapist, at one point said “So how’s Grade Nine going for you?” I’m 12 and in Grade Six. Obviously she’s not too observant.
I have an addiction and had joined a group specifically to work on this issue. Several sessions in, one of the group members, a married man, came over to my house with substances and proceeded to get wasted and attempt to sleep with me. He was a wreck and it all ended up with me having to drive his wrecked self to his house about 45 minutes away very late. I reported this transgression to the therapist. It ended up that I got kicked out of the group until, as the therapist said, I got better boundaries. The guy was retained in the group. Notice, I did not use the substances, I did not go to somebody’s house uninvited and attempt to seduce them on false pretexts, and I was working in the quite expensive group twice/week in order to get better boundaries. I really felt bad about the whole thing.
I have had many annoying therapists. One conducted sessions at her home, and repeatedly left the session to deal with the tantrums of her 3-year old. Later we met for lunch at a restaurant after her OB appointments, and the sessions were puncuated with ordering food and interactions with the waitstaff as well as eating. When I quit, she said I should keep her to write perscriptions! Another therapist had narcolepsy. One constantly bragged about his perfect relationship, which later deteriorated and I listened to his horrible wife and new boyfriend stories. He also wanted me to falsify the reasons for the visits so he could bill my medical insurance rather than workman’s comp. The one who takes the cake advised me to become a fugitive from justice when I got arrested for drugs that belonged to my then boyfriend – presumably because the only drug deal I ever committed was helping him get cocaine for his wife who “loved it.” That one also insisted that I falsify claim info to Medicaid so he could bill for the maximum number of sessions for my family of four (when he saw only me). He said I had to do so or I would have to pay for the other sessions…as a mother of three on welfare at the time, I did not have the means, so I went along with his scheme. He also said my drug dealing boyfriend’s drug dealing and fantasies about having sex with my children were okay. I should have fled from the boyfriend and the therapist…and later I did. I testified against him at the Hawaii Psychological Association at the urging of a subsequent therapist, and he somehow escaped discipline – later he was in the headlines for Medicaid fraud and somehow he beat the charges! His wife (the cocaine-o-phile) called to ask how I could do such a thing to her wonderful husband who only helped people. My most recent experience with a therapist was wonderful, lasting your years. I can happily report that she did not sleep or yawn, talk about herself, try to bilk the insurance company, brag about how wonderful her life was, judge me for my disclosures, and she was never late.
I am the client who posted about her therapist inviting me to be her friend on facebook. Perhaps I should qualify that further. I was in despair and she was in rescue mode. It was a professional facebook and not her personal one. I deleted her as a friend because of transference issues. I am a long-term client and she was desperate to help me. Over 13 years of depression we have both transformed my life into a better one. She has made many therapeutic errors and apologised for most of them. She admits she has counter-transference issues as well. I still see her and believe she has an important role in my life. She is a very experienced and well-respected clinical psychologist.
Ok, in this case – I’m talking about a psychiatrist. While I have no problems with her, in fact – this is the first psychiatrist I’ve *ever* felt comfortable with in a very long line of psychiatrists, I like her. I DO however have a major problem with her *extremely* unprofessional secretary/receptionist. Let’s call her Debbie.
A little background history on myself is that as a child, I was diagnosed with OCD and Major Depression. Years passed and the list grew to include GAD, Panic w/agoraphobia and social anxiety disorders. I feel this is important to spell out as these these last three disorder directly effect how I interact with others.
In befriending a few other patients who see this same psychiatrist – it has been discovered between us that “Debbie” has been caught in numerous lies (the biggest one being that our Dr. would be out of the country for a couple of months) – has, on many occasions rescheduled appointments due to overbooking, has (which to the best of my knowledge is illegal) taken the liberty to refill prescriptions with local pharmacies over the phone – and worst of all, she is unpredictable. One day, she’ll be the sweetest person you’ve ever met – the very next she’ll be someone whose lights you want to knock out. Definitely Jeckyll and Hyde syndrome.
My problem is that I’m disabled, On Medicare, a medicare advantage plan and medicaid. I’m afraid that if I complain – all three plans will drop me faster than you can blink. Has anyone else had this issue? If so, how did you deal with it without losing your coverage?
Taking “Debbie’s” attitude into consideration – namely the Jeckyll & Hyde Syndrome, I, along with the others feel that she should DEFINITELY NOT be working with the public – much less psychiatric patients. NONE of us want to complain to our state’s psychiatric board out of fear that this will land our Dr. into a world of trouble – yet, something has to be done. Any suggestions?
I very briefly, (i.e. twice), saw a psychiatrist who seemed angry that he had chosen psychiatry as a profession. I was sorry that he hadn’t chosen a discipline with greater rewards and a more tangible outcome, like orthopedics, but he should have gotten over it.
as a therapist I would suggest if your therapist is licensed and indulging repeatedly in these behaviors, report them! your state board of behavioral sciences should know. or check state offices.
therapists have to be accountable for their actions, that is the only way this profession will grow and remain true to the clients we serve.
“Counter transference” issues?
How about professional boundaries!
Look some of the things that these guys are doing are simply criminal or criminally negligent.
It seems like there is no one place to report on inappropriate behavior either. This must clearly change.
As far as medication is concerned you are putting your life in some one else’s hands and every one should get second and third opinions.
I once went to a family therapist and what she did to my family was astounding; she began yelling at me anout soem of my creative budgeting when we were very poverty stricken. I left with my family and she yelled after us..”are you coming back?!” “Are you coming back?!”
Of course we did not go back there. Another time we had a family therapist who refused to se my children because she said that they were disrespectful, this was through Catholic Charities. We sure could have used some help, whether or not the children were disrespectful. Perhaps it would have helped us behave better.I will never forgive her or that previously mentioned therapist, for the damage that they inflicted on my family.
Re the lateness issue: My psychiatrist has an almost constant lateness issue that I’ve learned to put up with; I bring paperwork or a book with me to wait, or just show up 5 minutes late. He’s never called looking for me – he just opens his door as I’m walking in. That being said, he once told me that he would charge for lateness. I turned around and remarked that I should charge him for being late! He was NOT impressed.
… and that’s just the beginning of it.
The truth is though, that the little things like that have to be overlooked because he has been absolutely incredible and helpful over the last decade +.
I practice Chinese Medicine and have to endure the stigma of being a possible “quack” despite having an advanced degree in a profession that’s been practicing medicine since European “kings” slept in the same room as their animals. Posts like this, though, remind me that all the professions are riddled with unprofessionals. It is sad that the culture is such that I struggle to keep a regular patient base while people who EAT during an appointment with someone are allowed to practice.
In my 20’s (1984) I went to see a psychiatrist for bulimia and he asked me if I was breast or bottle fed. He had white spittle on the side of his mouth. I never went back because I thought he was coming on to me.
I saw a psychiatrist once (and only once) who revealed personal details about his other patients far too readily. He didn’t use names, so it perhaps wasn’t a technical breach of ethics, but did get as specific as telling me other patients’ gender, age, issue, and when they came in to see him. I learned at least the first three of these about three separate patients in a single hour’s visit. Now, I understand that talking about other patients’ experiences can make a new patient feel more comfortable. There is a difference, however, between speaking in generalities (“some of my older patients don’t do well on this drug, but that shouldn’t be a concern for you”) and specifics (“a young woman came to see me yesterday morning who simply did not want to continue living”).
Furthermore, we got side-tracked for about 10 or 15 minutes talking about completely unrelated personal things. He asked me where I lived, so that he could explain what his policy was regarding running into patients outside of the office, and, upon learning that I lived less than a mile from him and had gone to the same high school his children attend, proceeded to initiate a long game of “do you know the [name] family?” (The amount of personal information he revealed about other patients is perhaps more impressive, given that this exercise took up a quarter of the time.)
Finally, there was only a set of flimsy French doors that separated the two therapy rooms at this particular practice, which meant that I could hear enough of what was happening next door (while actively trying to ignore it) to know that whomever was getting therapy was having problems in the sexual department. On the way out, since I was there partially out of concern that I might have ADD, I got to spend 15 minutes discussing schedules with the psychiatrist and the receptionist to figure out when I might be able to get in to see the psychologist for testing. This discussion occurred, loudly, in the very non-empty waiting room. I did not keep the appointment we were finally able to agree upon.
Oh, and I almost forgot to mention – my mother is a schizophrenic who struggled with the disease, and some misdiagnoses, for a LONG time before finally getting the proper diagnosis and the medication that allows her to function normally. The diagnosis did not happen until I was almost 20, so clearly, dealing with my rapidly deteriorating mother was a big part of growing up for me, and something that I would certainly mention on a first visit to a psychiatrist. Based on nothing more than my quick 10-minute recap of my mother’s disease and its effect on me, this guy had the gall to claim that her diagnosis was wrong and that she was probably bipolar after all (bipolar having been one of the previous misdiagnoses). How he could think it appropriate to make a diagnosis of someone he has never met, whose medical history he’s never read, based on 10 minutes of anecdotal evidence was unbelievable. Especially in such a tricky field.
My first experience with a therapist was back in 1982.
During my first session, she ate the rest of her lunch, and sniffled through the entire hour without benefit of a kleenex.
The day of my second session, she called to reschedule an hour before the appointed time.
During my actual second session, when the conveniently-located-at-her-side phone rang, she not only answered each call, she’d talk ten minutes a pop. (I had nothing better to do, so I timed them) When the hour was up, she asked, “Would you like to schedule next week’s appointment?” I answered, “No. Just charge me for a half session today since you were on the phone the other half.”
I never made a third appointment.
i had this Therapist that was never on time. If appointment was 8:15 AM she would not come out an get until 9:00. I told her one day why make the appointment 8:15 if you’re going to wait till 9, she said to me she alway has to do paper work
Let me say first that I have found a wonderful, empowering therapist who has created a nurturing space in which I can heal my wounds and clear my life’s trauma’s.
Formerly, I had a therapist that is currently facing disciplinary action from the State Licensing Board for not only some of the “bad habits” dislayed above, but also for improper billing (insurance fraud), improper termination of the therapeutic relationship, excessive self disclosure, and other non-sexual boundary violations.
He was always late for sessions that were at his home office. I would show up on time, sit waitng for him for 10 to 15 minutes, or sometimes he’d be in the office when I got there and would leave to attend to his personal needs for 10 to 15 minutes. When the session went over the “official ending time” by 10 minutes he would let me know how giving he was by allowing a longer session! Reality was he had only given the standard 45-50 minute session. Of course after a short time he would be checking his watch seemingly every few minutes. Yes, a clock behind the client and one the client can see are immensely helpful (my current therapist’s model) in eliminating the clock watch issue that I found very disturbing and distracting…I felt unimportant, and that I was taking up too much of his space(time).
During many sessions he did most of the talking…informing me just how important his “mission to enlighten” the world was.I learned a lot about him and why he thought he was here to “wake up the world”. I learned about his abusive childhood, about how he manages his family, about scratches and dents in his cars,what movies he recently saw and tv shows he watched as a kid, and all sorts of other things… I am not kidding! Many times I felt like I was his therapist.
He at one point said that there wasn’t anything he wouldn’t share about his life with me (this had become obvious!) and that was his finances. Hmmm. At the time he said this, and unbeknownst (sp?)to me, he was ripping off me and my insurance company saying he was seeing me twice a week, when at most it was once a week and more frequently, three times a month.
After confronting him regarding the “billing problem” we initially made a “deal” that he wouldn’t bill my insurance company until he gave back all the sessions he “stole”. He broke this agreement (and betrayed my trust …again) by continuing to bill. When again confronted he claimed he had made some bad investments and that his “wonderful” family wasn’t so stable…that his son was “suicidal”. Essentially he was manipulating me with a “sad” story, tears and all, so I wouldn’t turn him in. He said he was “sorry” but there was no remorse, I do beleive he was sorry he got caught. Upon my further questioning and investigation it turns out he was also double billing my ex-husband. There are many more details but in short, I eventually reported him to the insurance company and Licensing Board. That decision took months and was one of the more difficult I’ve had to make due to the intimate nature of the “therapeutic” relationship. I was badly hurt and wounded.
This therapist had treated me just like many others have in my past!
This realization though has become my key to healing and redesigning my life… of overcoming powerlessness and victimization, and be-coming powerful and creatively expressive.
I thank my current therapist for providing the space and safe environment for allowing the healing to occur!
At first, tHIS SOUNDS like my situation. I don’t know if there was insurance fraud as I didn’t really look at the EOB much. Would he happen to be in the Southeast US? There were 3 times, at least, that sounded sexual, without a doubt. He gave less family details. But too much discussion directly and indirectly about my appearance. He was very different, to the point of strange. And I really didn’t appreciate him thinking I owed it to him to listen to his personal details. Somehow that was so incredibly horrible.
I have a colleague who takes notes during sessions. It is her way of saving time. If she takes notes during sessions she doesn’t have to do it between appts. It is important to aks your thx why s/he is taking notes. If it is a memory issue just a few jots will do it.
Part of good treatment is attuning to the client’s needs. If your therapist has not noticed that you find the note taking distracting you are seeing someone without sufficient empathy .
I saw a psychologist at my university’s counseling center when I was around 20 years old. I showed up for one session on time but was told by the receptionist that the doc would be late b/c she had taken a job candidate out to lunch. The doc ended up missing all but five minutes of the session. She took me to her office only to confirm that I would be in the following week – no apology, no attempt to reschedule for that week, no recognition that she had wounded me. I encountered her outside of therapy a few times, and when I said hello, she stared at me blankly until I slunk off. She also never explained the policies of the college counseling center, i.e., max number of sessions, and I was too anxious to ask, so I worried the entire time that she would suddenly cut me off. When I finally decided that I felt better, I asked her about termination. She didn’t want to talk about it, just said that I could leave the session then (about 5 minutes in) or could stay the whole time. I elected to stay, probably to her chagrin. Several weeks later a crisis developed in my life and I called her for support. She flatly refused to see me and hung up. Her behavior was completely despicable and unprofessional, for the reasons I mentioned as well as many others. I wish I had known then that I could have contacted her supervisor to complain and/or the licensing body in our state. My hope is that she was a fairly new therapist at the time that I saw her, and that the many years (20) that have passed since then have given her an opportunity to grow and learn.
I do healing work with people,which sometimes involves therapy. I am grateful for these comments made by clients and therapists about what needs to be change.
I think the criticisms are very real and true. There are many therapists who have an intellectual and cold,detached approach who are unsuited for the work and simply enjoy telling others what to do. There are others who really need therapy themselves and are living vicariously through their clients, spilling over onto them, and overempathizing, with poor boundaries. There are many who actually really care about others and do the work because of that.
Generally I think training for therapists is very poor. And as time goes on most training is oriented towards how to interface with insurance and the medical establishment (using drugs). I think there is a great future in the self-help movement,12 step programs, and people helping others because they have a natural gift. Also internet and other peer support groups can fill in the gaps. There are groups that can be started using art,writing,dream work,dance, and theatre in healing ways- with out having a therapist “in charge” and asking for money.
Clients need to get empowered.
From what I see therapy seems to be a dying and an unsuccessful profession, too oriented towards money and trying to get people to fit into they system. I think clients can make alternative approaches to this conservatism. That is what I did and do- as a former “client” and a person who helps others.
I am curious as why you did not my comment from this morning…it was about 1000am or so. Was the scenario too real or too much for the intention of your article? If you ever do an article on the subject “when therapy goes very wrong, or becomes completely dangerous and harmful’ you are free to use it there.
A therapist doing several of the items on your list at once is on the “sloippery slope” to doing damage to a client and is surely at least being disrespectful to the client and performing a dis-service to the profession
@Maggie – Posts flagged by the software for whatever reason need to be manually approved, which can take up to 12 hours (especially on the weekends, sorry). It’s there now.
When meeting with my therapist, I would sometimes take my two little dogs with me, since they were my “family”. My therapist approved, and loved dogs and was not allergic to them!
While discussing the emotional pressure of the holidays, one therapist, whom I promptly dropped, discussed the suicide of a friend and wondered that her therapist didn’t see the signs. Forget HE didn’t see her suicidal signs either, that I was seeing him for depression.
Here’s a thought:
Maybe mental health clinicians have fallen into the trap of ‘hear the lie enough and it becomes the truth’ regarding the overdependence of this stupid paradigm of “biochemical imbalance model” that demands medication for all.
Perhaps it is time for ALL therapists to step back and decide why you went into this profession and do it the way you were responsibly and correctly trained in the first place. Treat people in the ethical, moral, and clinically correct way, or get out of the field. And patients need to remember that problems most often did not happen overnight, so stop looking for quick fixes, be it pills or some simplistic mantra, and go into therapy accepting the committment of time, money, and energy to improve yourself and move forward positively.
I am so sick and tired of hearing person after person asking for “the right medication”. Comfort and contentment isn’t packaged in a capsule, folks. You may pleasantly surprise yourself with some honest, direct discussions in an unbiased, objective environment of correct psychotherapy. It works, if you give it a chance.
Wow, therapyfirst, with that rigid, dogmatic, self-righteous manner, you must be – MY MOTHER!
I had a psychiatrist that kept all his pts. waiting 2 to 3 hrs. His pts. filled the waiting room. After 6 years of seeing him for med. checks of 10 to 15 minutes; he suddenly sent a letter to all his patients that he was dropping all his outpatients and keeping his job at the mental hospital. No dr. in his office would take any of us and there is a shortage of psychiatrists in Richmond, Va. where I live. I gained 70 pounds on his meds. and he never cared. I doubt he noticed. I think psychiatry is often a joke today. I had one that could not understand my English and I could not understand his Spanish accented English. What a joke! Medicare pays for stupidity.
John- Thank you for manually approving the post! Software glitches…the bane of existence we share with computers!
Have you ever noticed how the word
THERAPIST is spelled?
THE/RAPIST………
The worst offense to me is how a new therapist or psychiatrist treats the diagnosis made by the previous one. I accept that the search for the correct diagnosis is a long one, and I am happy to find a professional who thinks they’ve identified something that they can help with. Since I first went into therapy at 16, I’ve been diagnosed with ADHD, anxiety, depression, anorexia, “carbohydrate addiction” (?), bipolar I, bipolar II, and now borderline personality disorder, in addition to being told by one doctor that there was nothing wrong with me (she refused to prescribe the same medications that had stabilized me for several years). That has certainly been frustrating and confusing enough, but again, fine if they think they have a better treatment in mind for whatever I’m going through.
What I find so irritating is that when a new doctor is evaluating me for the first time, almost inevitably they show little respect for the diagnosis of the last, and reassign the problem in about 10 minutes. It’s true that this is somewhat of a relief when you yourself suspected your previous doctor was a wacko. But it is disconcerting when you did have a good relationship and trusted their judgment. It is quite terrifying to sit down with a doctor who says, after 5 minutes, “I am completely abandoning the drug treatment plan you have spent over a year calibrating because your previous doctor had it completely wrong.” And in a way, it’s hard not to take that a little personally, because of course you too were “duped” into believing in the treatment and diagnosis, etc.
In one sense, I greatly appreciate that, especially since I am usually coming to them for a change. But when you’ve heard your previous doctor called an idiot so many times, it’s difficult not to think of your current doctor as a “future idiotic doctor of the past.” Just wish they could be honest but have enough of a bedside manner to give credibility to their colleagues and in turn the entire profession.
I would have to travel over an hour to see my therapist. On more than one occasion she canceled on me once I had reached her office. That pissed me off to no end.
I’d like to add that she took on WAY too many patients too. That is why I left her office. I felt like a number in line to her. She has so many patients she hasn’t noticed that I haven’t been back in two + years.
Talking too much was a huge issue for me. Maybe it was part of my therapy to get strong enough to tell my psychiatrist to shut up and let silence happen.
I find all the posts interesting. Most of my therapists have been very good, as have my psychiatrists been excellent too. Part of the reason for my success with my providers – I actually *interview* them before I start any treatment/clinical relationship. I want to see the resume and credentials. I want to see them in action and the interview gives me that opportunity. They are “working for me” so why wouldn’t I treat the initial contact with them similar to a job interview? Even though it involves my “feelings/emotions”, I use my commonsense since it is also a business matter.
I can add a few:
My therapist totally forgot about my appt a few weeks ago.
She’s always late…when she shows up.
She forgets to call when she says she will. And I sit around waiting for her.
She also forgets to call in prescriptions or calls them in wrong.
And she can also go on tangents about her own life when i mention something ….. i think she’s a waste of time and money….i’ve just been seeing her too long to try someone else!
In my 20s I went to a free counselor (phD candidate) at my university counseling center because issues with my school and career choices had left me depressed.
He immediately gave me the MMPI, a long psychological test usually given to people with serious psych problems, without explaining why, and we never discussed the results. (Perhaps it helped his research? It sure didn’t help me). He told me that therapists were like “little Gods.” He also told me what a good therapist he was.
As our sessions progressed he would jump to conclusions that felt judgmental and even accusatory. When I told him that stress sometimes caused me to throw up and that this had been happening frequently, he said I had an “eating disorder.” When I told him I had once gone to a dance put on by an LGBT group, he said I was gay. When I said that in my last relationship, the guy and I would have sex instead of really communicating, he told me to watch my “sexual appetite” and that I was “promiscuous” (I was not) because perhaps I had been “sexually abused as a child.” (Wronggg. Um, who was the one preoccupied with sex?)
Finally, one day, he asked me to guess his age. He was quite a bit older than me, and I guessed too old. Then he asked if I were attracted to him. When I said I was not, he asked WHY (to be nice, I said I didn’t like facial hair, but it was a lot more than that!).
The next session, he told me I no longer needed therapy. I said I wasn’t ready to stop. He scheduled me for another appointment, but when I went, he didn’t show up. I left the office in tears, with the receptionist trying to comfort me. Never heard from him.
You get what you pay for.
I really like my therapist. She is sometimes 5 minutes late (due to another client’s session running late or misc reasons) but if I really need that extra 5 minutes during my session, she’ll be sure to give it to me.
I laughed about the yawing thing. I’ve had appts. with my therapist at various time slots. I notice she tends to yawn quite a bit during the appts. around the lunch hour. I figured this is just common. I get 8 hrs sleep but still yawn like crazy after lunch. It doesn’t bug me, but if it starts to, I know to avoid her appts. after lunch! 🙂
My t has done of those things, HOWEVER, he has sexualized our relationship (no sex); hundreds of sexual innuendoes, not to mention TOUCHING me, throwing me on the couch more than once….pulling my wrists towards him (I landed on his chest), etc., etc…..I’ve done a ton of research on transference/countertransference.
I think those are silly words, unless they are the Fruedian terminology (your t, or anybody else reminds you of someone else and you react to them the way you would have reacted to the person the t reminds you of…..Clear?! LOL
transference/countertransference is present in ALL relationships.
Anyway….some of the things my t has said: WE find it hard to end the session, and WE find it hard to say goodbye. You are in my heart and in my head. If I were not married, I would probably go for it.” 100’s of more leading me on statements like that.
I went to him ( because he is also a pastor 🙂 ), and my church was going to vote me out of membership (they did) if I didn’t agree to reconcile with the abuser of a 31 year “marriage”—we developed a personal relationship.
I’m waiting for the 10 most annoying/bad habits of patients post. I’m sure a few of these commenters will qualify..
Several comments on the many blogsI have read:
1st- As a person working in the therapy world I find it amazing the expectations some of you have for a therapist. A big part of therapy is talking. We all agree on that. But there are “cues” that are used to help the client think about their situation. “What do YOU think about that?” or “How do YOU feel about” or “What are you FEELING right now?” Is not for the therapist. It is for the client to hear themselves answer the question. It is for you the client to realize just how you feel at the time. A time to reflect with your therapist your inner thoughts that you may have only thought and not talked to someone about it.
If you have read any of the newspapers, NAMI (National Alliance on Mental Illness), magazines you would see how there aren’t enough Psychiatrists, Psychologists or Therapists to go around for every one. If you need futher care there often isn’t places for you to go to. For every client we have we have another 30-60 minutes of paperwork and phone calls we need to do to process your claim. Often we don’t have or can afford a person on the staff to deal with the issues. We deal with all sorts of crisis all day long. We have times we need to prioritize our services. Yes, there are times we shouldn’t eat infront of you but we do. Please remember we are human too and need to take care of our selves. There is definately a specific professional boundary that needs to be preserved and respected to our clients. I am sadden to read how many therapists don’t honor the professional boundaries.
I can not emphasize you as a client need to claim some responsibility to your therapy. You are in control of your therapy. We as therapists can only do so much for you. As a team the client, physician and therapist we all need to make it clear the client is the center of the relationship. In otherwords the person that should be working the hardest is the client. Listening, working outside of therapy on your goals and homework. Therapy sessions are a time to look at what and what does not work for you as a client. As a team we work on options that YOU work on to practice if it is right for you. If you don’t commit yourself to work on change and educate yourself therapy won’t work. If you choose to not educate yourself on your diagnosis and read about your signs and symptoms to help you understand your situation you are hurting yourself. Therapists are NOT miracle workers. We are a part of a journey of HELPING you develop coping skills to make your life satisfying. We can help you get there IF you are willing. Ask yourself why you are in counseling and what you want out of it. Every couple of months ask yourself if you are making progress. Advocate for yourself. Take notes during your sessions and journal on them after the session. Read your journal before you go to your appointment. Remind yourself of why you are there and what your needs are. Instead of walking into the therapists office and complaining about your past week, talk about what type of help you feel you need due to last week’s challenges. Ask what you could do differently. Work on your issues. Commit yourself to taking time to work to create a life you want. Ask for guidance and if your therapist is unable to meet you and guide you to your goals, it is time to decide if this is the type of therapist you need. Therapy is not meant to be fun. It is a working relationship. Working towards the goal for a happier life. It is hard work. But having a therapist you trust you can build a foundation for your life one brick at a time. We all have challenges in our lives. Commit yourself to change. Advocate for yourself. Move forward in your life. Look ahead for inner peace.
Most clients are flying blind. They have no idea what is okay or not okay in therapy, are not told how the process is supposed to work, don’t understand how to tell the difference between “hard work” and emotional or psychological abuse by the therapist, and are often confused and bewildered–and if the client is under 25, it’s just ten times worse. “Working on your issues” can be a dangerous thing considering the amount of faddism and pseudoscience that can take place in therapy–remember the whole satanic ritual abuse fad of the ’80s? When the therapist makes up nonexistent issues in order to encourage you to feel sick, scared, and dependent and then orders you to “work on them,” the results can be pretty wretched.
Therapists are not just human like the rest of us but in my experience are some of the sickest puppies I’ve run into. Buyer Beware! Therapy can be dangerous to your mental health.
Re Crystalee’s above comments:
I agree with most of your points, and in the end, if we didn’t have this medium (internet), then I truly believe patients would be more amenable to the boundaries and expectations of psychotherapy. But, alas, since so many have opinions and now trumpet them at sites like this, and in my opinion, a lot are characterologically affected, we read more so of the bad than the good. So, for the innocent and green in experience, therapy when provided by responsible, trained, and grounded providers, has a positive impact until proven otherwise.
Also, this pathetic drive for fixing biochemical imbalances by recklessly pursuing meds has cheapened and demeaned the process.
Just watch the responses to this comment if you think I am wrong.
therapyfirst, cert psych MD
@therapyfirst…. The problem with any treatment (in mental health especially, whether it be therapy or meds) is that no one can tell you what’s going to definitely work for any given individual with any given disorder.
So I encourage people to try out different things and don’t let themselves be herded down any one particular path, just because one particular professional may have recommended it. If you’re on meds, try adding therapy to the mix.
But likewise, many people benefit from medications, so if you’re not seeing any progress after months of therapy, medications might also be an appropriate option to consider.
But unlike medications, psychotherapy is virtually always dependent upon the skills and experience of the therapist professional. And because of the nature of the type of problems people seek therapists out for, it is probably the only experience that can all too readily cut both ways — either help a person out a great deal, or set them up for additional hurt or of not being heard.
If a plumber comes to your home and screws up the faucet, you call her back and she fixes it. If a therapist screws up in therapy, not only will she often not fix it, she (and the client) may not even realize that she screwed up, or the extent of the screwup.
Dear Therapyfirst, I did a google search on you and you are a serial opinionist throughout the internet, spreading your own particular brand of sunshine over Therapy World. On your opinion on the rights of the mentally ill to medication; it reminds me of the Pope visiting Africa and telling these illiterate, starving mobs of poor people that condoms are evil and help spread AIDS.
Dr Grohol:
I have never said people should not be on medication, but as a practicing psychiatrist involved in different elements of mental health, I can say with strong validity that over 80% of patients come into mental health services demanding, not asking mind you, meds, and basically blow off any and all recommendations for therapy. And if that is the basic expectation of patients in this era, I am going to go on sites like this and others and give a different opinion to hopefully encourage those who do not know all the details to mental health what they should realistically expect, therapy AND meds where warranted. My alias say first, not only, so pay attention to this please.
And to what appears to be my most recent nemesis in this medium, Stranger than Fiction, take your shots and demean me as best you can, I just hope the educated and aware readers will see through those who are just commenting away to diminish the value of mental health care, probably because it failed you, and for that if I am correct, I am sorry it did. This specific post has had a long thread because it raises a good point: therapists are not gods or controlling beings, but trained people who are trying to help others help themselves, and unfortunately some who allegedly get credentialed to practice therapy probably shouldn’t. I like the post, have shared it with colleagues, and hope others will come here and read the post and the threads and take home what they need.
What they don’t need are a bunch of nasty, vindictive people who can’t negotiate issues that should be negotiated. I just hope the blog author does a better job of moderation than what I have experienced at other sites this past year. And, in the end, that is what is wrong with the medium of the internet, people just foam away and no one really wants to set limits, because, ALLEGEDLY, that is not right for the internet. I think that is why it fails as much as it helps.
Just my opinion, as I have finished my comments with often at other sites I have commented on. Thank you for the opportunity to express it!
Dear Therapyfirst,
I am most qualified to comment on therapy and medication. I no longer take medication because it didn’t work for me. But I believe it works for a great many others. I have had 13 years of therapy which has worked. So I am on your side. Ironically enough my therapist emailed me this link.
However, you are pushing your opinion down my throat and I am choking. Which reminds me of the way my mother used to negotiate life with me.
Honey attracts more flies than vinegar.