Sometimes a therapist just isn’t that into you. After all, a psychotherapy relationship isn’t just about teaching cognitive-behavioral therapy techniques, or analyzing dreams. It’s about a human connection between two people — one person in need, and the other person who is there to act as a wise guide, teacher, and supporter through a process of change.
Most therapists are pretty good at what they do. But even a good therapist may not always be the right fit for you. It’s similar to when you interview for a job where you feel like your resume is a perfect fit for the company, yet you don’t get the job. Perhaps the interview didn’t go as well as you thought, because the employer isn’t just looking for the best candidate — they’re looking for the person who will be the best fit for the team at the company.
Therapists aren’t always self-aware enough to acknowledge that sometimes they may see a client who isn’t the best fit for them (and bad therapists will never acknowledge such a thing). Hey, they’re human and sometimes they miss their own signs.
So here are five sure signs that it may be time to dump your therapist, and find one where the fit is better.
1. They don’t remember key facts about you or your life.
The average therapist has a caseload that can be anywhere between 25 to 45 patients each week (yes, some therapists often schedule more patients than they have time, since inevitably a few will cancel or reschedule). But no matter how many clients a psychotherapist has, they should not be forgetting key details about you or your life.
This includes the basics (are you married? have children? go to school or work full-time?), as well as other important things (a traumatic event you’ve already told them about; an upcoming event or situation that’s causing you stress or anxiety). That’s ostensibly one of the reasons a therapist writes a progress note after the session. But if the therapist needs to scribble a few notes during the therapy session, that’s fine too. As long as they use those notes to remember who you are and what you’re there for the following week.
2. They take sides (triangulate) in couple’s therapy.
Couple’s therapists are trained to do to counseling with two people at the same time. Usually it’s to work on communication skills — helping each person learn to really listen and hear what their partner is saying, as well as to open up and share one’s own feelings and thoughts in a non-judgmental environment. A good couple’s therapist will work hard to mirror things being said and ensure each side is really hearing the other — the emotional, nonverbal content as well as the message.
Therapists who do marital or couple’s counseling shouldn’t ever get in the middle of an argument or fight between a couple. They should, in effect, never take sides or work to triangulate the relationship. This is Couple’s Therapy 101. A couple’s therapist who does this with you should be dumped faster than a hot potato.
3. They look at the clock more often than they look at you.
As I noted two years ago, clock watching is not only an annoying habit, it’s a sign of a therapist who is more interested in how much they have to go with you than what you’re saying. Sure, therapists have to keep track of the time and glancing once or twice at the clock as the session is getting near the end is not uncommon.
The therapist who is looking at the clock 5 minutes after you’ve started session however is sending a clear signal — you’re boring them. This is not a good fit for either therapist or client.
4. They regularly start their sessions with you late, but end them on time.
Most psychotherapists see their patients for 50 minutes (not an hour, see rant below). If that’s the agreement between you and the therapist at the start of therapy, that should be something you hold them to as therapy progresses. If you notice your therapist is showing up later and later for each appointment (first 2 minutes late, then 5 minutes late, then 7 minutes late), that’s a clear nonverbal message. Especially if they expect to end the session on-time (since their next appointment is also waiting).
A good therapist will stick to their schedule. Sure, they may be running late one week here or there, but you shouldn’t be penalized for their scheduling snafus. Professionals expect this from one another, and so clients should expect it from their therapist.
As an aside, I don’t know who came up with the phrase “the 50 minute hour,” but it’s about as nonsensical as the “low calorie, great tasting dessert.” An hour has 60 minutes. Not 50. Not 45. Not 40. Therapists should stop talking to people about the 50 minute hour. No other profession pads its time in this way to explain the other 10 minutes is devoted to “paperwork” for the patient.
5. They suggest you meet outside of therapy for social reasons.
While there are situations where meeting outside of the psychotherapy session is warranted — such as offering to help with a legal situation, court date, or even a hospital visit — they should all be directly related to your life or treatment. Any situation that suggests primarily a social component — that is, the therapist just wants to see you and talk to you (or engage in some sort of liaison) — is verboten.
Professional therapists do not meet their clients for coffee or a drink after work, because therapists aren’t your friends. It is a professional relationship that often has a strong emotional component. This emotional component can lead to a therapist acting in inappropriate ways that are both unethical and inappropriate.
6. They suggest touching or taking off your clothes is a part of treatment.
You’d think I was kidding about this last one, but sadly, I’m not. Every year, psychotherapists lose their license for acting inappropriately in session, including for inappropriate touching (usually involving sexual behavior) and disrobing. These are not components of legitimate, recognized psychotherapy techniques.
If your psychotherapy suggests one of these things, not only should you dump them, you should also seriously consider filing a complaint with their state’s licensing board. Psychotherapy primarily involves talking, and virtually nothing else. There are some notable exceptions, for instance, for children, play therapy is a recognized treatment, and when practicing relaxation exercises, you may be asked to close your eyes and focus on imagery or your breathing.
But taking off your clothes or having a psychotherapist touch you is generally not a recognized form of psychotherapy.
What signs have you noticed that it was time to dump your therapist?
Share them below!
99 comments
Thanks for this post, John. It is essential reading.
I would like to add some other reasons people should leave their therapists, based on interviews with patients:
7. If your insurance is starting to run out and just about that time, your therapist starts to wind therapy down in order to end it with the very last approved payment. Of course by that point, it is a bit late.
8. If your therapist calls you names, insults you, attacks you, or does other verbal abuse.
9. If your therapist tells you that you will need to trust him/her absolutely without question.
10.If your therapist tells you that you will need to be in therapy for the rest of your life, preferably with him/her. (Run for the hills).
11. If your therapist doesn’t do a written evaluation at the start of therapy.
12. If your therapist doesn’t do a written treatment plan with you. (I know that this has received a lot of flack from therapists, but to me, this is the only way to ensure that patient’s goals are the focus of therapy.
13. If you have multiple providers involved in your mental and physical care (including addiction as well) and your therapist says: Just see me. You don’t need to see all those other people. One-stop shopping may not be in your best interests.
There are more. Those are just a few zingers.
I had a therapist who TWO YEARS into our sessions still didn’t have a plan … I know because she asked me if I wanted to make one up for her.
I quit going soon after. Most of the time was spent talking about her horses and other such things in any case.
HAHAHA! Thanks for number 10! (begins running for the hills)
I just ended a 4 year relationship with my therapist after we were having a phone session she allowed her husband to be present not even tell me, she has sent her husband to my house and has told him confidential information without asking me first.She wants me to be part of every training she is teaching. She was a great therapist in the beginning than she lost sight of whose therapy it really was. There was no boundaries and I now see that I should have sat some. I was very upset that she would not even acknowledge her own bad behavior and say I’m sorry. Therapy was always about her suicide task force, trainings she was teaching. When my son suicide she did not even acknowledge it, didn’t want to talk about it but she had no problem gossiping about it to her husband. looking back it was a sign of a questionable therapist the day she involved her husband in my therapy.
Is it advisable to have a therapist that is providing individual therapy for me and my wife also a good therapist to provide couple or marriage therapy? I feel there might be a tendency for the therapist to triangulate in favor of the spouse that the therapist feels needs separation or divorce, based upon their individual therapy sessions in order to address the individuals needs, rather than the marriage as a whole. I feel there might be therapy conflict when same therapist treats you as an individual and then morphs into a couples therapist.
As a new therapist, with 9 years experience as a social worker I agree. TX plan is essential, it keeps the case focused, and allows the client and therapist to buld Strong theraputic alliance. Maintains boundaries, and allows the therapy progress. Your right there are 60 minutes in the hour. At Always Changing Thearpy and Counseling Services LLC, we strongly recognize the need and have the flexability to work with the client. We believe in short term therapy, Not orever therapy..
I’ve seen a number of therapists and quit for a variety of reasons. In on case, I decided that I was not comfortable that she had a profession relationship with my mom i.e. that she worked out of the same office once per week, although I trusted that she would not violate my confidentiality, I didn’t want my mom coming to her with problems related to me.
I saw another therapist would was very helpful with family therapy but was not able to help me individually given her orientation. I needed a therapist who would hold me accountable for prescribed behavioural changes.
another reason is when you have had bipolar illness for over 30 years and the fool decides he can teach you about it……..also, your meds have been working fine for 3 years and the fool decides he knows better. Next time I think I shall start the conversation by saying I have had bipolar for over 30 years, read every article on it, know what meds work and don’t work so may I explain it to you?
Nice one Syviatoby! I know what you mean, my Dad went and did a course on mental illness and then started telling me he knew more than I did about my mental illness and others! Well EXCUSE me! I dont think so! He may have done some basic theory but Im the one who has done the prac! Like LIVING for years with this illness and having spent countless hours in hospitals talking with other people with all sorts of different illnesses and have seen them all in crisis moments. Mental health is a totally different world and even one such as your therapist has no idea what it like.
Yeah, I definitely agree. I think, though, with #6 it’s usually more complicated than that. It usually starts very slowly with smaller boundary breaches as they test the waters. My therapist talked to me a lot about trust. He came and sat next to me and took my hand in his and asked me to trust him, he seemed compassionate and concerned. It starts with slow boundary violations – a hug that goes just a little long, an off color comment, an off hand remark about a sexual experience he had had. Things that gave me pause, but at that time the good he was doing allowed me to overlook those less obvious boundary violations. By the time he invited me on a trip with him I was very socially isolated, deeply depressed and dependent. Predators are good at what they do, and he was patient. I saw him for a year before he completely crossed the line. I wasn’t his first victim, and I’m afraid I won’t be his last.
I am not sure about 6. My therapist usually hugs me at the end of the session. I like the physical connection. Touch can be healing She will also hug me a the beginning of the session if she hasn’t seen me in awhile or during the session if that seems appropriate. Sometimes she also pats me on the shoulder at the end of the session too. Granted this only happened after we had been in therapy for 10 months and after I said it was ok.
There is clearly no romantic connection. We are both in committed relationships with men.
I have to agree here — #6 is grossly mis-worded and possibly mis-guided as it seems to link “touch” with “sexual exploitation” as one and the same. I know this is not what John meant, but it’s this kind of language that freaks out clients and therapists alike about normal human interaction. I talk with therapists overseas on a regular basis who just laugh at us over this stuff.
There is actually very little data that supports the “slippery slope” argument – the idea that socially appropriate or non-erotic touch leads to erotic touch and sexual exploitation.
As a good rule of thumb, touching by your therapist e.g. pats on the back, hugs, etc. should be seldom and by invitation of the patient. Patients whom have been traumatized in someway are VERY sensitive to ANYONE touching them and it can send them over the edge. No therapist worth their salt would do this! It’s always best to let the patient initiate a hug thereby giving consent.If your therapist is the ” touchy/feely” type, you would be well-advised to seek a new therapist.
Actually, a therapist who touches a client with autism risks initiating an incredible meltdown right there in the office. So that’s an example of how even non-sexual touching can be bad. In dubio abstinii.
Also, something to add is if your philosophy of therapy doesn’t mesh well with your therapist. For example, I am very pro-CBT and one of the first therapists I saw was psychodynamic. Needless to say, it didn’t work out.
You know more about their personal life than they do yours.
So true! I had a therapist who would spend most of the hour telling me about the trials of her job, how tired she was, difficulty she was having with her staff and a recap of the meetings she had over the week. I liked her-and she was generous with her time. If I needed another appointment during the week she would make herself available, but most times I wouldn’t have needed it if we had kept the conversation about the work I was doing and not hers.
Hugs are the one exception to the touching rule, as long as either you or the therapist has asked if giving or receiving a hug is okay. A therapist that hugs you without asking first is being disrespectful.
Richard Zwolinski’s additional signs are right on the mark too!
A hug? What about a kiss? My therapist asked for a kiss after a very emotional session and and before I could answer, had his tongue down my throat! It was shocking to say the least.
A kiss??? Absolutely not! Your therapist is definitely crossing the line. I would refrain from continuing to see them – for sure! It blows my mind that psychiatrists, therapists and the like go to school to become professionals; and still some act like idiots. How is it that they weren’t picked up on anyone’s radar in the healing professions?… Even Heaven has a gate-keeper!
Is this in the APA rule book that hugs are okay? Do we need to measure the exact distance we’re sitting apart? Tired of the boundaries preaching. I have a pretty good idea what my therapists spiritual, political and some personal views are. Mine are probably at the other end of the spectrum. So what and who cares? I’m in it to get help and that’s all that matters. Your gut and common sense rarely fail you.
LS, I’m assuming you’re talking about my comment about a hug since I’m the one who mentioned it. If you read what I wrote you will see that I wrote a hug that “goes too long.” Nowhere did I say I’m talking about just a regular hug which is not wrong – I’m not talking about that. You’ll know it if you get an inappropriate hug, it’s uncomfortable.
Anyway, back to what I was trying to say about # 6. It’s highly unlikely that any patient/client comes in and out of the blue is invited to take their clothes off. These situations are usually slow, and insidious. If people are continually uncomfortable with things the therapists/psychiatrists are doing, trust that inner voice.
Am personally not so keen with rigid “my way or the highway” types. After a few weeks of seemingly unproductive sessions, I had reminded a couples therapist of our initial request when we first came to his office, that we were seeking some help and tools for dealing with “conflict resolution” in our relationship. Finally, after a fair bit of “hemming and hawing”, we managed to get an, “oh no, I don’t do that here!” Nice, and thanks for letting us know, after we’ve already wasted a few hundred bucks!
a.As Zwolinski says above, if your therapist won’t provide you a written treatment plan. (I’ve still not heard a single cogent argument as to why all patients shouldn’t get these revisable plans within, say, four sessions of starting their therapy. How else can therapist and patient measure progress?)
b. You find yourself thinking more than thrice that the experience of therapy isn’t worth the money you’re paying or the time you’re putting into it.
I recently had to dump my T, who I believe was gifted in many ways and who understood me in a deep way. But his behavior was beyond bizarre. I could write a book about it (and I have on the community boards), but in a nutshell, my T was just hostile. Really, really angry. Some days were better than others, and he often came up with astonishing insights even during sessions where something was obviously wrong. Compounding the problem was his habit of denying it. When I called him on his anger (not enough room here to list the symptoms), he would blame shift the problem to me. When I begged him to try to understand that I couldn’t continue therapy with a therapist I didn’t trust, he came back with: “Well, trust is one of your issues! You don’t trust anyone, so that doesn’t say anything about me!” I finally had it after a year and a half, and told the guy I wasn’t coming back. – Kim
Sad: No. When I wrote the comment, only the first comment was there. I just now read your comment. I was simply responding to the article. The way comments work on this blog is that the writer has to approve the comments so a bunch of comments are released at one time.
Well my therapist for the past three years until yesterday was actually a nurse who did meds and therapy in the same visits.
So my reasons for firing her yesterday:
*overmedicating me, ADMITTING I was overmedicated, but refusing to take me off any medication and only prescribing more and more
*prescribing the most expensive drugs on the market and luring me in with free samples and then leaving me hanging when she runs out with a $500 a month price, when a close cousin to the drug is on the $4 generic list and she didn’t even bother to try it first.
*She was dead-on with the one you listed about being late for appointments and still ending on time. Of course her excuse was that I was on my lunch break and I had to get back to work. Yet she still charged me (or my insurance, and I paid a percentage of it) nearly $200 bucks.
*We just hit a brick wall in therapy and were no longer making any progress
*She was not trained in DBT and I’m Borderline (and also Bipolar)
*She treated the Bipolar but basically never even tried to treat the Borderline (and then wonders why I still have symptoms, often blaming the impulsive symptoms that were probably Borderline on another manic episode, but I wasn’t really manic)
*Recently she billed me incorrectly and I had to explain it to her a million times how this check paid for this visit and my insurance screwed up so this is how much is left. I’m an accountant but honestly it really wasn’t that difficult.
*When I was unemployed for 9 months and having severe financial difficulties – which were a main source of my depression – she never even offered a sliding scale, and I even asked. She charges $194 per session which is over double what anyone else I’ve been to charges, even a psychiatrist with a more advanced degree than her only charged $90. Since I had insurance, she refused to lower her rates, but my insurance was a deductible and percentage so the more she billed, the more I paid. I never understood why she couldn’t just bill the insurance less. Maybe there’s a rule about it. I don’t know.
*This was my mistake, but I brought my husband to her for marriage counseling after we got nowhere with some other counselors. But her mistake – trying to dig into his childhood when he clearly wasn’t going to tell her anything and then cutting off couple’s counseling because he wouldn’t open up. I believe there’s other ways of dealing with our marriage issues than pulling up the crap his family did 20-30 years ago
*Focusing way too much (in my personal therapy) on my childhood and neglecting to notice what I am doing TODAY. Sure, my mother didn’t show affection, that’s why I am this way…so what. I can’t change what my mother did, but I can change what I do, with help.
*Prescribing Zyprexa for over a YEAR to someone who was already over 220 pounds and at risk for diabetes. And not even trying another drug. I gained 75-80 pounds and my blood sugars were in diabetic range
Ok I need to stop now. I’m happy with my decision. I don’t want to be angry with her, I just want to feel better and move on.
I remember my most recent frustrating stint in therapy. I decided to quit because it increased my anxiety.
My talk therapist:
* she would downplay traumatic events- ie losing my home to a fire. I remember describing running out of a burning building, and she said “oh you were actually home when it happened?” on our second last appointment.
* I went to tell her about a rape I experienced and she kept downplaying it to “being taken advantage of.” When I suggested “why not call it rape?” she’d act uncomfortable, and downplay it again. Had I told her the actual details she would of changed her tune. This resulted in me leaving out what happened.
* crying about a traumatic life event in her office, and feeling tearful, socially phobic and then being told, “you are obviously manic” without showing a single symptom.
The psychiatrist was even better:
* I admit my case is confusing. I started seeing her, and I think I was really stressed about, and angry. I feel traumatised in my care. So I was very anxious at the appointment.
* she dx’d me bipolar in one 20 minute appointment.
* I had some confusing dx history, but for the most part, my main history said I was not bipolar. They spent the most amount of time with me. Another dx from a psychiatrist, at a different hospital declared me bipolar, but they refused to tell me (although I had seen them for dx clarification purposes only- I had only two appointments), and no one told me for months what he thought- that I was bipolar and non-compliant.
*I was obviously frustrated by my treatment. SO the doctor took this piece of information, Ignored where this dx took place, and said I have been treated all along as bipolar. When I mentioned my main treatment did not treat me for bipolar at all, she backpeddled, became flustered, and then said, rather sheepishly, “you must’ve forgot they dx’d you as bipolar.”
Yet no where in my treatment there did they say that. I went back and checked with them even, and they said no.
She then tried to up my antipsychotic dose.
*I find it interesting that I started this process out thinking I had something else wrong, always to shoehorned into a label, with symptoms and issues I don’t actually have.
*This doctor also thought I was developing a benzo addiction because I took .25mg to .5mg of clonazepam (under her suggestion too!) to help with anxiety during job interviews and life stresses. This worked well. A few weeks later she suggested I was developing an addiction pattern and using klon to self soothe (uh it is supposed to relieve anxiety- no? Shouldn’t it have a soothing affect?)I had not increased dosage either, I went with her suggestion on how to use it (daily), and took it prudently. Addiction?
*She then began going in the direction of me having tried “so many meds” and that I am treatment resistant. I admitted I had some very brief trials of meds- which I responded to poorly (usually they were atypicals- and suggested to me first over a benzo to treat anxiety, and get this- social phobia! ha ha ha ha.)
*So she began freaking that I am “running out of options” and prescribed seroquel even though I tried it only briefly prn, and found it useless.
*Oddly I have not tried more than a few meds for more than a week because how I reacted, or because something did not jive with how I was feeling, and why I should be taking an AAP, or lithium for anxiety only. I wanted proper answers for my dx, and treatment. No one can give me any so far.
I can’t wait until the bipolar era dies down.
WOW – your case points to a couple classic examples of what’s wrong with the system.
My advice is this:
a) Always remember, a degree does NOT make anyone a good psychiatrist or therapist. A degree is only as good as the person using it. If they don’t have “it” to begin with, they never will no matter where they go and get their degree.
b) A good therapist, is a good listener and will always affirm your feelings afterward. They would never say the things your therapists told you – especially where sexual abuse is involved. It is not a therapist’s job to judge you.
I hope that you do find the help you need and the hope you deserve. Give up on the bad therapists, but never give up on yourself.
LS, my apologies for jumping to conclusions.
The therapist takes phone calls and answers questions from family and/or friends when you haven’t signed a release.
The therapist imposes their religious beliefs on you.
My 1st therapist was always threatening to dump me if I didn’t do everything the way she wanted me to. Don’t go to a certain meeting, or go to the doctor, or do things her way? She’d dump me. Yet at the same time, she sent conflicting messages about how “she wasn’t going anywhere.” So I was constantly trying so hard to do everything perfectly in therapy so I wouldn’t lose her. In the end, she dumped me out of nowhere one night, and I am still not sure why– it devastated me and left me with worse PTSD symptoms than I went in with.
Great additional comments and signs to look for everyone! Thanks for sharing these… there really are quite a few to be aware of as you’re going along in therapy.
When a therapist of devout faith pushes his faith onto you and ends up almost convincing you that you need an exorcism. (yea, it’s true…but at least I figured it out before the exorcism)
Hmm, here’s one no one has mentioned: Phones.
Never putting the phone on silent is one sign, and that’s bad enough. Forgetting to turn down the volume on the answering machine, so he has to jump up every session to mute it, is worse. Not changing his behaviour even after you’ve discussed with him how much this upsets you, that’s definitely where you get off.
My T tells me about her stuff for about 10mins then askes about me. I mentioned that she had a strange looking sculpture and as she was previously an artist she started to describe what it means to her, should she not have been asking me that????
I’ll add…it’s time to dump the therapist when he commits insurance fraud! Strangely enough however, the Licensing Agency in Connecticut didn’t find this to be a violation of the Standard of Care….go figure! Caveat Emptor!
You forgot one: Falling asleep. I had a regular appointment at 4:00 in the afternoon. My therapist’s eyelids started getting heavy during at least 3 different sessions. I started talking louder to wake him up.
I understand my issues were not very excting, but give me a break!!
“You forgot one: Falling Asleep….I started talking louder to wake him up.”
Hahahaha
That therapist sounds like a putz
As a therapist, I find many of the remarks made here very disturbing, but not surprising. I’ve heard them elsewhere. I’ve been a clinician for forty years and shocked to see young therapists never exposed to treating major mental illnesses, schizophrenia, bipolar, severe personality disorders etc. etc…., not to mention limited understanding of psychodynamics and complexities of psychotherapy. It’s shameful, indeed.
To add, the demand on therapists to quickly make diagnosis, immediately formulate a treatment plan (without really knowing the patient) reeks of irresponsibility and perhaps real negligence. I’m afraid what many here rightly complain about is another example of our broken and care less system.
Like another author here I spend time in Europe. I sing his remarks that others laugh at us as clinicians. Americans being consumed symptoms, distributing advice as if it’s a medication.
I almost forgot! I to once saw a therapist that seemed irritated that I was sobbing about the loss of my grandfather. She stated, “that’s over with, we need to talk about your marriage”. I walked.
All of this leaves me to wonder who’s behind the eightball?
OH, the biggest one: not believing your main diagnosis is “real”.
I was diagnosed with MPD/DID (was probably poly-DID but things are much better now) in 1998. To be disbelieved without even asking anything about my life or experiences (I’ve had male therapists in tears after me talking about ONE thing that happened to me) is disrespectful and insulting beyond belief. To all of us.
When most of your time is spent on your therapeutic relationship. When your therapist tells you that u cannot use social media of any kind to discuss any aspect of therapy. When your therapist tells you that you are lying When a therapist “checks up” on you or otherwise uses investigative tools to look you up. When a therapist needs to write down neary everything that you say and refers back frequently. These are big red flags. Run, run far and fast or u’ll be totally messed up before u know it.
When my therapist talked more about his life during our sessions than I got to talk…was I his therapist, but paying him? Nope, dumped…
When an earlier therapist regularly started “the hour” at least 20 minutes late and occasionally nodded off. Sorry if I bored you.
As a therapist is a trained professional charging for a professional service I’ve always thought a valuable way of assessing them is to ask oneself if they’re actually offering something above and beyond what any reasonably intelligent person could offer. If you could get as much advice, insight, relief, etc. chatting with a relative or neighbor, I’d say your therapist isn’t providing an effective service.
kicking patient out of room to let another patient in and still charging the same amount? is this wrong?
Though therapists are supposed to train to recognize their own foibles, psychotherapy easily can hold all the hazards of any interpersonal relationship, plus a number more that are products of the artificial, unequal institution, it is. Therapists can be so invested by their own theories and role-playing that they miss they’re behaving like (to use a nonjargon word here)…a jerk.
A therapist who is so convinced that he is ‘right’ about everything, that he is unwilling to genuinely consider the legitimacy of of what you are trying to convey. I think this is especially harmful when the client has mustered up the courage to call to the therapist’s attention something about the therapeutic relationship that is becoming problematic for you. I wish I had run as soon as I saw that.
I have several.
1. When your therapist puts words in your mouth. I have repeatedly said in session that I don’t feel empty, and never haves. However, she said I was just today. Aarrrrgh! I was so angry I almost threw a pillow. I corrected her again and she seemed most annoyed. Tough.
2. When she keeps putting you in double binds. She has told me repeatedly that I need to ‘get out there’ and get more social practice, and yet at the same time she says I’m in a lot of pain, and people don’t like being around those in a lot of pain. Eh..o-k. So, you want me to ‘get out there’, but people aren’t going to like me when I do? So what the heck do you want me to do? She gets very annoyed when I call her on that stuff. She gets annoyed any time I call her on her crap.
3. She’s pulling the same crap she’s accusing you of doing. My therapist tells me I”m fighting her, but she’s doing the same thing to me! Arrrgh.
4. There’s never an agenda for the session.
5. She only speaks in generalities. My therapist will only give me stupid vague advice like “lower your expectations” or “don’t be so critical”. Eh..and how do I do that? Don’t ask, cause you’ll just get the fluster n’ glare machine.
6. She keeps insisting you make appointments, when she herself has said she doesn’t see the sessions going anywhere.
7. When she keeps accusing you of not trying new things, but won’t give you anything specific to try. Just crap like “keep an open mind”.
8. There are no measures for how well you’re doing. When she gets really annoyed for an assessment (because she never gives you one voluntarily).
9. When you’re questioning her competence after three months.
Hey Anon – about half the items on your list apply to my therapist too! The truth is they really don’t have any answers. The whole thing is a house of cards. Sounds like you were catching on and she didn’t like it.
One therapist closed her eyes while I was talking…like falling asleep! When, after the third session of this, I pointed it out to her…she denied it! How to make your client feel as though THEY have a problem!
Next therapist was totally unemotional…anhedonic.
Her affect was totally flat. She would not let me express any emotion either, or talk about anything that bothered me, or would dismiss things when I did. She made comments to the effect of ‘get over it’, ‘it’s in the past’, ‘why should that be bothering you’, etc. She was totally dismissive. At first I thought perhaps this was a new therapy technique….then realized she was the one with the problem!
Too many cooks in the kitchen, made a mess out of my life. Two weeks after I left my therapist, he contacted my salon solicitating information about me. Only one family member knew I had an appointment. Some of these people are just in it for the power trip.
I found some interesting information on Common Ethical Issues Encountered in Psychology as listed:
1) Lack of Informed Consent
2) Invasion of Privacy
3) Coercion to Participate
4) Potential Physical or Psychological Harm
5) Use of Deception
6) Violation of Confidentiality
– Apparently they’re more interested in obtaining information ruthlessly. Perhaps they’re awarded incentives…
I’d really like to talk to someone about #6… it’s happening to me, but it’s confusing, complicated, and I don’t know what to do.
Why would a therapist want to meet my husband after work hours? He was at her place of work helping someone else,and he brings up he need to see someone and she offers to see him at another place and after work. I find this to be wrong. Can anyone help me?
I just started seeing a therapist recently for help dealing with marital issues. The last 2 sessions (he is male ..I’m female) he has started sharing more and more about his own marital issues. He also made a general sex joke and used the term “horny” in reference to how I was feeling. He gave me a hug at the end of the session. I laughed everything off at the time but can’t shake the feeling of uneasiness and decided I’m not going back. Am I overreacting? I’ve never been to counseling of any sort so I have nothing with which to compare.
Confused,Don’t go back! I’m going through hell right now after things similar happened to me in therapy but ended much worse. I didn’t see the warning signs. I realize how I was manipulated and I’m in the process of filing a suit against the therapist and have reported him to the state. Protect yourself and our marriage find a female therapist.
I find calling the Crisis Line to be more helpful then my therapist was. They listen, give feedback, and help me make important decisions to change my life. If I am confused, they help me figure that out too. I only call when I am in crisis which is too often, but it is always helpful. If they are not helping, I thank them, but call another time and talk to someone else. However, so far, they have a very good track record. PLUS they are FREE!
We are debating if we should change therapists for our teen. I gave a detailed family history emphasizing a diagnosis of a close family memrber. 4 months of therapy later and no definitive diagnosis for our child, I mention the family members diagnosis again and the therapist tells me she had not known that?!!! This therapist said we were both “crazy” after our child said I was crazy for disagreeing with a statement he made. We were all speaking calmly. Needless to say I have lost a bit of faith in this therapist.
I knew I should not have continued with my therapist when she spent the first 10 minutes of every session ranting about my insurance company. She flat out refused to spell my name correctly, after I asked her to several times (it’s a common name) saying she was not “detail oriented.” I came in with an important life goal with a deadline and she insisted I recount to her every detail of trauma in my life and work on that instead of helping me to focus on the goal. She gave me personal recommendations for people such as yard workers and house cleaners, that worked for her, who were not professional and I never used again.
Please note, the code for a therapy session that is used for billing is 90806 which is defined as 45-50 minutes of face to face contact. There is no “padding” of the therapy hour to finish paperwork. You are provided with the time you and/or your insurance company pays for. The 10 minutes the therapist uses for paperwork is on their own time.
Exactly. Thank you, Barbara. I start on time. I finish on time. My clients know that we meet for 50 minutes because we talk about that during the initial appointment. This allows me to treat all my clients with respect.
That 10 minutes between appointments allows me time to emotionally “end” the appointment that I’ve just had before meeting with the next person. Having time to do that allows me to be fully present with each of my clients.
This is not padding an appointment (rant ended!)
Does this go for Medicaid too?
Exactly! That 90806 is now 38-52 minutes. The “average” typical therapy session is MEANT to be about 45 minutes. When mine go closer to 40 minutes, it’s because the client was late and I’m not going to penalize the next person by allowing someone to eat into their appointment time. If a client is so late that we can’t get at least 38 minutes in the session, then I cannot charge their insurance company for a regular session – that would be insurance fraud.
Therapy sessions are not meant to be an hour. They are commonly scheduled an hour apart so that the therapist has a few minutes in between 45-50 minute sessions…and to allow some flexibility so that we can still see those clients who show up late.
I think that a 50 minute session is fine. I also believe that the client should be told that a session is 50 minutes when they come into their first appointment. I prefer that my therapist has that 10 minutes to write notes, eat or go to the bathroom. I really appreciate that my therapist takes care of himself, sets boundaries and is transparent in his communication.
My first experience of therapy was initially a very positive one until after 2 years the therapist terminated the therapy due to her moving abroad ….. I did my best to accept this very upsetting set of circumstances but ended up utterly traumatised as the ending was completely mismanaged ( in stark contrast to the rest of the process which had been highly effective ) and further compounded by denial that I had been poorly served when I attempted to raise the issue with other therapists from the same practice. (big mistake!)
In the course of looking for help to recover from this experience and to continue my process for the issues I had originally sought help for I saw a total of 7 therapists none of whom were able to help me or else I just couldn’t connect with them in any meaningful way – as a result I became very attuned to bad practice e.g poor time keeping and not being believed were the two most common reason in my experience and I was able to trust myself and get out fast
However I’m pleased to say this tale has a happy ending as after a lengthy period of not actively seeking help I decided to give it another shot and the difference with my new therapist is truly astounding …. I have been with her for 3 years and feel so very fortunate to be in this therapeutic relationship where I feel safe and supported with someone who has the knowledge, skill, insight and understanding of my issues evidenced by the phenomenal progress that I have made ……and on a very human level cares about me!
My husband and I have been seeing the same therapist for both individual personal reasons as well as marital. Recently my husband has been going to his own individual sessions and I had stopped going on my individual ones because of just being busy, we also hadn’t felt the need to meet for couple’s therapy again until recently. My husband and I had a blow up so I made an appointment to go in and see the therapist that same day for an individual appointment, then later that week we went in as a couple. I was thrown off by the vibe change in therapy those last two sessions, compared to our many previous meetings. These last two times I felt a distinct shift coming from the therapist as far as outwardly protecting my husband and a kind of hostility toward me.
Let me first say that our therapist is in close age to my husband’s and my age, she is single, my husband is physically attractive (I think) and he is a great guy; truly. Even though we are in therapy, I realize how wonderful he is and I am always being told by various women what a “catch” my husband is because he is so giving, is very masculine, and yet very helpful around the house (laundry, cooking, repairing, cleaning). That being said, I never ever felt anything weird about going to our therapist and felt she was very good at her job…until very recent. Since my husband has started going to her regularly, I know they have had contact outside of the sessions. It’s hard to explain..nothing sexual but stuff like information transfer of various subjects over email…almost like friends. My husband mentioned something concerning government contracts in session and the therapist mentioned she was interested in contracting through the gov. so my husband said he could probably send her some info. I believe it has all been really innocent, but feel that because of that “friendly” interaction and then him having private sessions, that perhaps inadvertent feelings may have started building toward him. Could I be wrong?
I have really been struggling with this because I don’t understand how the therapy vibe could have changed so much, unless it’s a change in feelings by the therapist. Any suggestions?
Although I like my therapist as a person, I believe it’s time for me to move on. Among other things, last session she hit me between the eyes, just as I was leaving, with a comment that was out of left field and had no foundation in fact. She stated that I don’t complete things because I recently backed out of a class and decided to not continue with a PTSD support group. I backed out of the class because my hours at work were changed so it was impossible for me to take the class. And I discontinued with the PTSD group because my neighbors were in the group, which made that very uncomfortable for me. These are valid reasons for “not completing” both of these things. In addition, I do complete things and have a master’s degree and post graduate certificates and certifications to prove it. I felt the comment was antagonistic because it was made just as the session was ending, therefore; I was not able to respond or defend myself. I have enough garbage to sit in, I don’t need my therapist adding to the pile by upsetting me with antagonizing comments out of left field that have no foundation to them.
I take issue with your objection to the “therapeutic hour”. My time is valuable and my rates are based on the “therapeutic hour”. In addition, insurance companies require us to bill using a service code and the service code reflects the amount of therapeutic time I spent with the client. Using the service code that provides a full 60 minutes of therapy requires special authorization and I have not yet found one that will authorize such in the absence of extenuating circumstances and even then they will not authorize it for more than a session or two at a time…some will not authorize it under any circumstances. I am on more than 20 insurance and EAP panels…I know what I am talking about! If someone wants to pay me out of pocket for additional time or if they want to negotiate a rate on based on 60 minutes of therapy time, all they have to do is ask. Articles with misguided information like this are a huge setback for the profession. NO WAY would an attorney spend 60 minutes with a client and only get paid for 45…why should I? My time and services are just as valuable.
I don’t care how much time a therapist spends with a patient (as long as both parties agree to that set time ahead of time, “Our appointments will be 45 minutes in length.”).
What I object to is therapists referring to it as a “50 minute hour” — a nonsensical phrase. It’s a 50 minute appointment, plain and simple. 50 minutes is not an hour, just as 31 ounces is not a quart, and 1990 pounds is not a ton.
You don’t go to a doctor and have them say, “Oh, our next appointment will be 20 minutes, but I’m only going to spend 10 minutes with you. The rest of the time is for my paperwork.” They say, “Our next appointment is 10 minutes,” plain and simple.
I do not use the term “therapeutic hour”. I use the term “session”.
I have been to two appointments – intake and one therapy. Both were a half hour. In a half hour normal? I will be checking my insurance statements to be sure they are being billed for a half hour.
He asked me what was going on and I began reading from my stream of consciousness paper I wrote, he interrupted me and began referring to a handmade diagram on causality (which I agree with). He did spend the therapy session lecturing me, however he said next appointment he would let me talk more.
I also have him a form the insurance company sent that asked for his clinician ID and he kind of balked at that. I know paperwork must be the bane of clinicians’ existence, but he made the statement, “well, they’ll get it when they get the bill.” I had to tell him I wasn’t sure the insurance would pay for out if he didn’t send it in.
The jury is still out on how I feel about him, but my main question was for appointment length.
The term “therapeutic hour” is antiquated…and your article should educate people to that end…not perpetuate it’s use.
Hi,
I had a question. I’ve been seeing a psychologist who has recently informed me that his cancellation policy is one-month’s notice.
My initial thought was that this was unreasonable as I’ve never heard of this amount of time required in any profession. That said, I’m by no means an expert in psychology or it’s policies so figured I would ask. Is this the norm or is it considered within normal range?
Thanks!
Thomas
Nice piece, overall. I take exception to number six, in that not only are there current valid theories that include therapeutic touch, but there is a history of this practice that extends back to Freud in the modern era and even further back to antiquity.
More recently, Edward WL Smith (primarily gestalt orientation) wrote “The Body in Psychotherapy” (1985), in which he made the case for including the body in assessment and via “body interventions” in his model for an organismic approach to the “therapy task.” EMDR includes tapping on the client’s knees or shoulders as an alternative to eye movement.
From the bodywork end of things, techniques for eliciting and reprocessing traumatic material stored in the body’s tissues, such as Upledger’s SomatoEmotional Release exist.
That said, any form of therapeutic touch—whether a specific technique or a symbol of the constancy and presence of the therapist in a tough moment (e.g., touching a client’s arm or back)—should be consensual, deliberate, appropriate, skilled, clear, well-boundaried.
In the case of more complex therapeutic touch (e.g., mouth work associated with CranioSacral Therapy and SomatoEmotional Release), it is important that preparation occur over one or more sessions in advance. The preparation should include discussing the purpose, process, means, concerns, and questions. The most crucial component is devising a strategy for how the client will indicate that s/he would like the therapist to pause or stop, and rehearsing that process. Even with that in place, it is incumbent upon the therapist to be acutely attuned to the client throughout the work, because it is impossible to predict when someone may freeze or be emotionally overwhelmed and unable to activate the agreed upon signal. (I hope it goes without saying that techniques like these should only be performed by people with the proper credentials and license.)
In addition to body therapies that facilitate the reprocessing of repressed emotional materials and memories, or provide evidence of the supportive presence of the therapist, there are also forms of touch that can be used to calm and excessively or chronically over-aroused central nervous system (e.g., CranioSacral Therapy, Polarity Therapy, Reiki), some of which can be taught to the client for ongoing self-care.
The knee-jerk reaction that provokes some therapists and non-therapists to equate all touch with inappropriate or sexual touch is unfortunate. There can be tremendous benefits to including touch in psychotherapy.
I had a wonderful professional therapist.
However, I had to pull my child out of an outpatient drug treatment program because of the therapist running the group. My child was under 18 and had signed a release allow medical info to be shared with me. There never seemed to be an end to the therapy, I was asked to support ( or basically force) my child to go but when I asked the therapist for any update or information about my child’s progress I just couldn’t get an answer. When I had finally had enough and told they guy I was pulling my child out he launched into a rant about his reputation being ruined and he felt he was being taken advantage of. I also found out ( much after the fact) that he allowed my child to leave several sessions without my knowledge. In the end I had to get copies of all my child’s medical records from the program in order to find out exactly what my child’s issues were in order to figure out how to proceed with treatment somewhere else. Unbelievable.
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