Improving the Experience of Therapy for Clients

10 Ways Therapists Go Wrong
Jessica Spence, Social Worker Helper, August 22, 2013.

It’s not uncommon for a client to enter my office with previous experiences in therapy elsewhere. When meeting a new client, I always make sure that I ask: “Tell me what you liked or did not like about therapy before. What worked? What didn’t work?”

I don’t want to offend a client in the same way another therapist may have and I really don’t want to waste time trying interventions that just don’t fit.

Here are some of the ways therapists have gone wrong, according to clients I have asked:

1. “They made me talk about _____ when I really needed to work on ______." 

Missing the mark.  Sometimes it is hard to not push our own agenda as therapists, especially when our knowledge and experience is telling us what clients really need to work on. Having buy-in from the client is crucial.  I think we explain why it may be important to discuss a certain topic, then clients are more receptive. Another common complaint here is digging up the past when unnecessary.

2. “They were late all the time.”
I have trouble understanding this one. Barring crisis situations, therapists need to respect and model time boundaries. I think 15 minutes is reasonable, but I’ve heard stories of clients consistently waiting over an hour. Frequent cancellations are another common complaint.

3. “I left their office feeling worse than when I came in.”
I think this could relate to unnecessarily digging up the past, but it also has to do with hope.  Of course there will be sessions where problems aren’t solved in 50 minutes, but homework and talking about future improvement is important. Effective therapy can bring up uncomfortable feelings, but hopefully with informed consent and some discussion, clients can learn to accept temporary discomfort as part of getting better.

4. “They wanted to pray during sessions.”

I hear pretty frequently about situations where the therapist tries to bring religion into therapy unsuccessfully. Many clients find religious practices to be a helpful adjunct to their treatment. However, we need to take care to be culturally competent and respectful of others’ religious beliefs. Remember that freedom of religion also means freedom to have no religion for many people.

5. “They relapsed.” or “They invited me to use with them”.
Self-care is so important for therapists, especially when they are in recovery from substance abuse or mental illness themselves. It can be really damaging to a client’s confidence that they will get better if even their expert therapist has failed. It is okay for therapists to have problems, but we are also responsible for demonstrating how to cope with these issues.  If you are having an acute substance abuse or mental health problem you need to get help, even if that means leaving your job until you are well enough to return.

6. “They fell asleep”
This one is hard for me to believe, but I’ve heard it several times. We all have clients who are depressed, flat, monotone or dull, but there is no excuse for falling asleep during a session. If you are so exhausted that you risk falling asleep during a session, then you need to get a strong coffee or cancel appointments for the day and rest up!

7. “It was too expensive.”

This is one that most therapists can’t avoid.  Truth is that overall, therapy is a luxury for most people. Offering sliding scale or case management to get appropriate healthcare resources can help.

8. “They didn’t seem accepting of _____.”
Just fill in the blank with anything remotely controversial. I’ve heard of clients who felt their therapist didn’t respect their sexual orientation, mixed race relationships, spiritual beliefs, culture, politics, you name it.  I think most therapists view themselves as being open minded, but everyone has their own bias and it can really show to sensitive clients. Refer to another provider if you need to.

9. “It seemed like they wanted to talk about their own problems.”

Sounds like a pretty classic self-care issue. It can be really helpful to disclose to clients your own experience, but this needs to be done very carefully and ideally after consult with a supervisor or colleague. If a client gets the feeling that you need them to listen to your problems, they probably will end up feeling like you can’t handle their issues. Not to mention feeling neglected themselves.

10.” They abandoned me.”
This is a by-product of our mental health system that has left too many therapists with the experience of showing up to work only to find a note on a locked door saying the company has closed. It is unfortunate that this happens because it can be so damaging for clients.  My first two jobs as a therapist ended abruptly and despite my attempts, I was forced to say goodbye to my clients with very short or no notice. I felt so guilty and awful that I wasn’t able to even make referrals for some clients to get set up with a different therapist elsewhere.

Ideally terminating the therapeutic relationship should involve wrapping up unresolved therapy issues, transferring to a new therapist, referral for community resources and a session to reflect back on the experience and say goodbye.  It is so rare in life that we get appropriate goodbyes in our relationships, so what a great experience to have if you can provide it.

I think what is most important is that we ask clients about their experiences and approach therapy as a collaborative process.  Checking in with clients periodically throughout treatment provides an opportunity for feedback.  If we are unaware of where we are going wrong, we can’t fix it.  What have your experiences been with helping clients who have dealt with some of these wrongdoings?