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?
