I’ll be the first to admit that there are a lot of bad therapists out there. It is especially maddening to good therapists because it makes the profession look bad as a whole. It seems that people will put up with a lot from their therapist and often horrible therapists have thriving businesses because clients are afraid to leave or think that this is just how therapists are. At the same time, I want to emphasize that the things listed below are just “warning signs” and ultimately the decision to fire your therapist is up to you and you alone. If you have concerns about your therapist, you should discuss these concerns with him or her early on in counseling. I understand that it can be hard to stand up to your therapist but he or she may not realize that these habits are upsetting to clients if clients never bring it up.
The therapist talks about their own problems in sessions
This is by far the largest complaint I hear. Clients have reported to me that sometimes they spent entire sessions just talking about the therapist. I think there is a lot to be said about “building bridges” or giving a brief illustrative example of how you solved a similar problem, but venting your own problems to your clients is grossly inappropriate. If a therapist is doing this, it’s either to eat up time or because they themselves need to be in therapy. I’ve always wondered how these therapists would react if at the end of the session the client asked the therapist to pay her $100 for having acted as the therapist.
Discourages you from writing an online review of his/her skills as a therapist
People use websites like yelp to review everything from restaurants to, well, therapists. These websites are great for allowing people to make informed decisions about services they might want to buy. This can be especially helpful for investigating a therapist given the level of commitment one makes when entering the therapeutic relationship. Yet, there seems to be a number of therapists that are uncomfortable with this. I have been hearing stories lately of therapists making clients sign an agreement that they wont write an online review. This should be a red flag. Ask yourself, why does this therapist not want people publishing reviews? Are a lot of their clients unhappy with his or her performance?
If you do decide to write an online review of your therapist, please try to be specific. Don’t just write “he was terrible” or “she was nice.” It is more helpful to both consumers, and the therapist if he or she reads it, to know 1. what type of therapy was it (individual, couples, family, child) 2. how many sessions you saw the therapist 3. what you sought care for 4. what were the specifics (ie “fell asleep during sessions”, “doesn’t return phone calls”, “shows empathy and genuinely cares about her clients”.
Falls asleep during sessions
I didn’t believe this one at first, but I’ve heard it so many times that I have to believe it’s true. There is one therapist in particular that I’ve heard this said about him over and over again. Surprisingly, I know that this therapist in particular has a very successful practice despite falling asleep and other bad behaviors. In any other profession if you fall asleep on the job you get fired. For those of you that are putting up with a therapist who falls asleep during therapy, I want to emphasize that there are plenty of therapists that are alert and energetic!
Just a note: On the outside, therapy may seem to be passive process, but it actually does require a lot of mental work and really is a skill. A therapist must listen to what a client is saying, listen to what the client isn’t saying, apply psychological theory and interpretation, and then formulate a plan or strategy all at the same time. Although it may look like your therapist is just sitting there and nodding, there is a lot going on mentally.
Doesn’t return phone calls
I return all phone calls by the end of the day. If I get a phone call after 7pm, I return it the next morning. I don’t find this to be particularly difficult and most phone calls only last two minutes anyways. And yet, this is a common complaint amongst therapists. If not returning phone calls is new behavior from your therapist, consider that your therapist may be going through a temporary personal stressor (sick family member, death in the family, etc), and due to professional boundaries, wouldn’t be able to explain themselves. If however it habitually takes your therapist a week to return an email or phone call, this is unacceptable. It’s indicative of someone with poor time management or too many clients.
Frequently double books or forgets about appointments
You would think that with that big appointment book in front of them that therapists would be able to keep their appointments straight. The reality is that clients randomly call to reschedule and the next thing you know you’ve double booked or forgot they called. Clients also get confused about their times. They lose their appointment cards, forget what time they agreed on, and will sometimes unfairly blame the therapist to avoid having to pay a no-show fee. I must admit that in the beginning of my career I sometimes goofed my schedule. I then got smart and developed a system for myself. First, I try to keep clients at the same time and day each week, and I don’t move their appointments unless I absolutely have to. This is also good for helping clients to remember. After each appointment, before the client leaves, I simultaneously write them an appointment card and write it in my book. My clients get handed that appointment card whether they want it or not, because that way I KNOW that they were told when their appointment was. If a client calls to reschedule and I’m away from the office, I’ll say “I’m away from appointment book right now. Could you email me and then I’ll get back to you by the end of the day?” I’ve noticed that a lot of therapists don’t go over their schedule until the end of the day and trust that they’ll be able to remember. Unfortunately, I’ve found that unless you write something down right then and there, you’ll forget.
If your therapist frequently double books or forgets (not just the occasional ‘goof’), this is a sign of bad organizational skills, as well as disrespect towards clients. At the same time, if you are frequently cancelling, rescheduling, or changing the times of your appointments, you need to own your contribution to the problems. Therapists are only human too and will become confused or frustrated if you can’t commit to a set day and time. Leaving an email or voicemail to change an appointment without getting a confirmation from your therapist is not okay.
Doesn’t ask for feedback or listen to your input
Therapy is tailored to the individual and constantly modified with each session. In order to do this, therapists need to hear your feedback and input. The research has shown that clients rarely volunteer this information on their own and feel especially hesitant to say anything negative. That is why it is so important for therapists to initiate by asking something like “how do you feel things are progressing?” “Is it okay if we work on such-and-such next session?” or “Do you feel we’re focusing on the things you want to focus on?”. I’ve found that the more feedback I get from clients, the faster they improve. A therapist that doesn’t think that your opinion is important is less likely to succeed in helping clients achieve what they want.
Believes that they are the “expert” in all aspects of your life
I want to be extra careful in clarifying this one. A therapist should expertise in psychology or counseling. That is a given. However, you are really the only expert on yourself or your child. The therapist only sees you for an hour once a week. Telling people what to do is not what therapy is about. In the end, you are really the only person that knows what’s best for you. The therapist is only there to provide guidance and and help you to find your own solutions. A few years ago I was working with a family that was struggling with angry and misbehaving children. There were a two other therapists working with the family. I was a therapist to one of the children, while another therapist was acting as a parent aid. The parent aid kept insisting that the mother use a behavior chart, despite the mother’s protests that she didn’t think the behavior chart was something that she would be able to use consistently. The parent aid became quite insistent and forceful a behavior chart was the only solution and even threatened to file neglect charges. A therapist is not there to tell you that you “should”, “must”, or “have to” do anything unless someone’s life is in danger. Therapy is about capitalizing on what you already do well and making gentle suggestions.
Doesn’t have you lead sessions
I believe that therapy is about what you want, not what the therapist wants. If you don’t want to work on your trauma in today’s session, you don’t have to and shouldn’t have to explain yourself. This goes back to being your own expert. Although I always plan for sessions, if a client’s agenda is not to work on those topics, I need to be flexible enough to adapt. That is your hour and you can use it however you wish. If you want to use the session just to vent or talk about something not relevant, that is your prerogative. I can make suggestions on what to work on this session, but they are just suggestions. This is especially important if the focus of therapy is trauma. A therapist pushing a client too hard to talk about their trauma risks re-traumatizing the client.
Wants to be your friend
Therapy is the very definition of intimacy, and when I say intimacy, I don’t mean sexual. Intimacy refers to a sharing of your deepest thoughts and an emotional vulnerability with another person. It is the deepest empathy and unconditional acceptance of you as a person. For some people, their relationship with their therapist may be the first time they have ever experienced a truly intimate relationship. I can understand how people could confuse this for friendship or love. However, the the therapist is not your friend. Friendship is a relationship of give and take, whereas the therapist is only giving in a therapeutic relationship. This is not to say that the therapist doesn’t care about you. Any therapist will tell you that they care about their clients and it takes a great deal of effort for the therapist to not get too attached to them.
A good therapist tailors their personality to fit the needs of their clients. In other words, the person you see in therapy is just a persona. When your therapist is outside of the office, they are likely very different people whom have their own problems and issues. You would probably be disappointed by the person your therapist really is. If you met her at a party, you might even not like her! The mission of therapy also doesn’t coincide with friendship. The goal of therapy is to help a person reach a point where they no longer require therapy, whereas the goal of friendship is to foster and prolong the relationship. You can see how being friends with your therapist can keep a person from making progress in therapy.
Given this, good therapy does not include interaction outside of the office, exchanging gifts, receiving invitations for social gatherings, personal touch (except for maybe a “goodbye hug” at the end of therapy), the therapist disclosing information about herself that is too personal, and most importantly, therapy NEVER includes sex. Having sex with your therapist, no matter who initiated it, is sexual abuse. I recommend contacting your state licensing board and filing a complaint and then seek a competent therapist to help you deal with this issue.
The therapist pushes medication on you
Any therapist that keeps up on the research knows that therapy (when done properly) is just as effective, if not more so, than medication. Read my “Therapy Works” and “Medication is not a cure all” articles to find out more about this. The only times I would strongly recommend medication is if a person is suicidal or in danger. Many clients don’t want medication, and for good reason. You are really your own expert. If the therapist suggests medication and you decline, that should be the end of it.
Is against decreasing sessions
The goal of therapy is to end therapy. If a client tells me that they feel ready to decrease sessions, I take that as a compliment and an indication that they are getting better. I think most therapists feel the way I do. Unfortunately, it seems that some therapists foster a relationship of dependence on their clients and feel threatened by a client wanting to decrease sessions.
Is seeing several members of the same family
Part of what makes a therapist special is that they are able to approach your issues as a third party. Unlike your friends and family, the therapist has no bias towards you. When a therapist is seeing several members of the same family, a bias exists, confidentiality is threatened, and the therapeutic relationship becomes strained. It is not uncommon for therapists to see more than one member of a family. For instance, a therapist may see a woman individually and then also do couples counseling with her and her husband. A client may recommend her therapist to her sister. However, I don’t think a therapist should be seeing more than two people in the same family unless there is very good reason for it. A therapist who insists on seeing all members of the family individually is acting unethically.
Commits insurance fraud
The insurance companies have been making it harder for therapists to make a living, but this is no excuse for fraud. When people commit fraud, it usually takes place as “bending the rules” so to speak. You may even be aware that your therapist is doing this and be okay with it. Some examples are when a therapist changes your diagnosis to something “harsher” in order to get the insurance company to approve more sessions. A therapist may bill a couples counseling session as two individual sessions to get paid double. A therapist may also bill a lengthy telephone call as an in-office session since the insurance companies don’t pay for phone calls. Even though you may be okay with it or even encourage your therapist to do this, you have to wonder if they are willing to bend the rules to commit insurance fraud, what else are they willing to do?
Don’t give up!
If you have had bad therapists before, don’t give up. Keep looking. There are plenty of good therapists out there. If you live in the Boston area and are searching for a competent and professional therapist, please give me a call. I am a licensed mental health counselor with a private practice in Boston, MA. I offer very flexible appointment times and would love to meet with you! Please call me or email me at 774-240-5550 firstname.lastname@example.org to make an appointment or find out more information.