Did you or someone you know have a good or bad experience in therapy? As much as I love my field and working with families, I have to admit that there are often few good therapists who wholeheartedly engage in therapy with clients. There are really good therapists, mediocre therapists, and some really bad therapists in this world. It takes time to find the right therapist. Many people would agree that most therapists fill voids that most of us have such as a void of a parental relationship, sibling relationship, grandparent, or good friend. For most of my child and adolescent clients, I often end up fitting into the role of mother, aunt, or mentor. For many of you, a therapist may fill similar voids or other voids such as loneliness, grief, low self-esteem, or self-identity. But sadly, for some clients, there are therapists who also seem to play the role of jail warden (being very strict and unreasonable), police officer (often pointing out negative behaviors in an authoritarian and intimidating fashion), or Judge (leading counseling sessions in a confrontational manner). Therapists like this often lack etiquette, professionalism, appropriate boundaries, and even compassion. This article will discuss and review some of the things that some therapists think are appropriate to say (or think about) clients.
Therapy is a difficult endeavor for everyone involved. Therapists often struggle, the family struggles, and clients struggle. Most people have a difficult time opening up due to preconceived notions, a bad experience with therapists in the past, or rumors about therapy. As a result, it’s very important that therapists ensure that their clients understand that they have their best interest at heart. We, as therapists, should also make sure that our client feels safe, understood, and challenged enough to grow. Clients should also be given an opportunity to discuss their history of mental health services and their experience with them. This is a great way to help clients detach themselves from the preconceived notion that ALL therapists are bad or intimidating. Unfortunately, just like in any other field or profession, the mental health system includes a wide variety of people from different cultures, cohorts, ages, and levels of experience. It’s important that clients research their therapist, get input from others on an agency (and weigh the pros and the cons of the information you receive), and ask lots of questions during the initial intake or session. This will ensure that you are making the right decision about a therapist once you decide to choose.
Sadly, “bad therapists” are almost just as prevalent as good therapists. It often seems easier to find the “bad therapist” than it is to find a good therapist. In fact, many “bad therapists” tend to meet criteria for narcissistic personality disorder, sociopathy, or other personality disorders and tend to be very social and “outgoing” at times. These type of therapists often have large numbers of clients. But there is a lack of empathy, compassion, and concern among these therapists. It’s scary to think that there are more therapists like this than good therapists. But believe me, there are some really good professionals who truly care about others. It just takes time to find them.
To help you weed through the chaos, I created a list, from experience and complaints from clients, of bad therapists you should watch out for:
What bad therapists think:
- You should be forced to talk: I have seen this in many therapy positions over the years. It’s sad to think that many families and even therapists believe that clients should be forced to engage in therapy (forcing a client to engage may include intimidation, unnecessary confrontation, or something similar). I say absolutely not. Therapy is not a time for client’s to feel overwhelmed, burdened, or forced to do anything in therapy. Some people, especially children and adolescents, need to be encouraged or prompted to engage and shown the benefits of engaging in therapy. Forcing people to talk or open up often ends up backfiring on both the therapist and the client’s family. Some client’s become resentful, begin to project negative emotions onto the therapist, or becomes fearful of the therapist in such a way that the therapist becomes an abusive or negative authority figure. When I work with my young clients, I explain to parents that the therapeutic journey does not happen overnight and although there are usually so many questions and concerns that need to be addressed, forcing a person to address the issues typically doesn’t work. A good therapist will alternate between challenging a client (asking questions, applying some pressure, and putting the “ball” in the client’s court) and allowing a client to take their time.
- You should either take medication or don’t take medication at all: Most therapists are highly uneducated about medications unless they have worked close with a psychiatrist or have received training on medication. Because of this, many therapists hold a black and white view of medication and will encourage clients to either take medication or don’t take medication at all. A good therapist will educate themselves to medication management, provide brief education to clients, and explain the pros and cons of using medications. Therapists should also refer a client to a psychiatrist or nurse who can help explain the pros and cons of medication.
- Confrontations and arguments are 100% healthy: Some people take their own anger and disappointments out on their clients. As sad as this is to say, there are some therapists who use the issues brought up in therapy with a client as an excuse to yell, scream, or challenge the client. It’s almost like a stress releaser. It’s displacement (a term that Sigmund Freud came up with to describe a defense mechanism). The therapist is unable to explore their own issues and will displace negative feelings onto their client. This may occur during phone conversations, during sessions, or over payment of services or insurance.
- I need to answer the phone, respond to email, and complete some paperwork while talking: A day in the life of a therapist can truly make you feel out of control. A typical work week for me easily adds up to 60hrs per week and perhaps more! But I certainly recognize that when I speak with my young clients, their families or treatment teams, I must put everything else aside. Phone calls, paperwork, insurance calls, voicemails, meetings, notes, etc. must all take a backseat once the client comes into the office. A therapist who is “multi-tasking” is not tuned into their client. In fact, current research suggests that “multi-tasking” is not effective when trying to complete important tasks. Research suggests that we should tend to one thing at a time. A good therapist will sit calmly, help the client explore feelings/thoughts, and facilitate therapy. A client should never feel ignored.
- I will give my diagnostic impressions but I cannot spend time explaining things or getting agreement: Because I work with so many different families, I must provide psycho-education almost every session on the diagnosis, medication choice, discharge goals, treatment goals, and aftercare. This education includes me speaking with the families about the pros and cons of therapy and helping them develop realistic expectations. Sadly, many therapists fail to provide this education, often feeling they are not adequate or trained enough to do so. Other therapists simply don’t want to take the time to educate clients and their families. It’s easier to report to clients and their families the information received from other therapists or a psychiatrist and move on. A good therapist will know how to guide you. A good therapist will also give the client the opportunity to disagree or agree with certain aspects of treatment.
- You don’t need to read or understand it, just sign: Have you ever been to a doctor’s office for a check-up and asked to sign multiple forms that you just didn’t understand? Were you told “this form is just so I can call your other doctor, sign and date here”? I have. The scary part is that many therapists or agencies ask clients or families to sign forms but never fully explain them or walk you through reading the forms. I am guilty of this myself at times. The day has been long, I am tired, the family or client looks overwhelmed, and I just want the process to be over. I will typically summarize the form and ask for a signature and date. A good therapist will help the client understand important details, encourage them to read the form, and ask questions. And…don’t forget to ask for copies when necessary!
What bad therapists say:
- You NEED to start talking: Again, forcing a client to talk never works. Clients should be challenged (which includes addressing, directly, an issue or thought pattern that is the obvious problem), not forced to talk.
- Why do you do that?: Clients should never be asked “why do you do that?” in a condescending fashion. This statement can be reframed and better stated as “can you tell me why you struggle with this” or “can you tell me why you do these things?”
- What’s so hard about it?: Some therapists (and psychiatrists) lack a great deal of bedside manners. It’s okay to ask a client why they are struggling but this question should be asked appropriately. A therapist should say something like “why are you struggling with this? Can you share that with me?” or “Can you help me see why this is so hard for you?”
- You aren’t trying: It’s okay for a therapist to point out that they notice a lack of motivation, but it is not okay to say “you aren’t trying.” Someone might disagree with this theory but most therapists would agree that this statement can be stated with more poise. Many therapists are guilty of feeling frustrated with some of their clients, but this frustration should never come out in poorly chosen words. We all have to learn to cope better.
- Sit down: Some client’s, due to anxiety and uncertainty or ADHD symptoms, talk and open up more when they pace or walk around the office. There may be times when a client should be asked to sit so the therapist can concentrate or have a decent conversation. But I don’t particularly approve of a therapist who yells “sit down, please!”
As you can see, the above statements are not necessarily inherently bad. The problem is the tone of voice and word choice. The behaviors listed above are real problems because these behaviors are often found in therapists who are sued by clients for violation of ethics and legal codes.
Every therapist is different so it might take a while to find the right one. Look around online for therapist reviews. If your therapist has what is called an NPI (National Provider Identification) # you can go to the NPI website and look them up. Some demographic information is provided. You can also do an Internet search of their practice/agency and don’t forget to ask around. Word of mouth can be powerful.
As always, I wish you well
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Photo by Mai Le