We all know good therapy when we experience it, that warm fuzzy feeling where we are heard, understood, validated and start healing from the inside. But what about bad therapy, what does that feel like? And what if bad therapy turns ugly and ends in termination? Here are five reasons why good therapy turns bad and ends in termination.
1. Countertransference – when a client triggers the therapist’s issues.
It has been a long established rule of good therapists never to take on a client who will trigger personal issues. The therapist who has been raped may not be able to cope with the raped client. The therapist with children who finds out her client is a paedophile or the client who triggers off mother-issues with the therapist who has not resolved her own childhood. These well-meaning people can sometimes unwittingly do more damage than good if they have not received their own therapy or supervision.
2. Without warning, without explanation and without any further contact.
This is cruel and unusual punishment for the client. I don’t get this. I have had many an email from former clients of terminating therapists, readers of my blogs, who are desperate for answers many years down the track. Surely they deserve closure. Usually a therapist is the last port of call for people who have exhausted their family and friends but still need satisfactory conclusions to their problems. So they pay a therapist to bounce off ideas and issues, end up overwhelming their therapist for whatever reason, who then terminates them immediately. So where do they go from there?
3. Abandoning the client with abandonment issues.
Most long-term, emotionally volatile clients have rejection, abandonment and anger issues. Myself included. Sometimes therapy can become a self-fulfilling prophesy. In the Freudian theory of repetition-compulsion we are compelled to repeat the past with significant others. We create in the therapy room the same conditions in our outside life. The good therapist should know this, be on the look-out for it and have an action plan to deal with it. The good therapist should not take transference personally. Clients do get angry in therapy and it is up to the therapist to work out who the client is actually angry at. One cannot abandon a client the same way one cannot abandon a newborn baby. Marsha Linehan with her Dialectical Behavioural Therapy has the right approach when she says that the only reason a client gets terminated is if they miss four sessions in a row, other than that the client is always right.
4. The Doppelganger effect.
I am a client, a mother and a daughter and I have a daughter, a mother and a therapist. I am familiar with the dynamics of power in these relationships. Sometimes when client and therapist are evenly matched a power struggle can ensue. This is not unlike those mother/daughter power struggles of which I am intimately familiar. Only the therapist, like the mother, holds the balance of power. A good therapist like a good mother however will mostly concede and let the client/daughter think she has won. Power might corrupt some, but absolute power wielded correctly, efficiently and with loving/kindness has the power to regulate, facilitate and heal.
5. The Suicidal client.
This is the most difficult client of all. The one all therapists dread. The good therapist will make a contract with his/her client along the lines of please ring/fax/mobile/text/email me before you kill yourself. Simple isn’t it? But it does work. I have the greatest admiration for therapists who can hold their suicidal clients till those feelings pass. But unfortunately some therapists refer their clients on or section them off to a psychiatric hospital, which is of course a necessary step. A good therapist cannot help a client if he/she is suicidally successful. But a great therapist is there afterwards when the client gets out of hospital and resumes therapy without therapeutic judgment. The not-so-good therapist leaves the client, heaves a sigh of relief and moves on.
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From Psych Central's website:
PsychCentral (May 23, 2010)
From a great blog. Highly recommended!!!! « letterstomyshrink (February 12, 2011)
Last reviewed: 23 May 2010