Based on my previous post about the usefulness and necessity of anger at one’s therapist in the treatment — rather than abandoning the treatment in these moments — it was brought to my attention that a follow-up could be helpful to explore when switching therapists may be a good decision.

It can’t be overstated how complicated of an issue this really is. What makes changing therapists so complicated is understanding the greater picture of what’s triggering the urge to leave. Is it something the therapist is specifically doing? Is a pattern being re-enacted by the client — with the therapist –that happens in their own lives outside therapy as well (a very common phenomenon that can actually enhance the treatment)? Is it a dynamic that’s triggering past emotional states that could actually be useful to understand in the treatment? Is the client wanting to leave the therapist for actually not being a good therapist, or is it more about the difficulty of facing the negative emotions within an overall good treatment? And so on.

Basically, how does a person determine when the therapist is problematic, versus when the difficult emotions of an otherwise positive treatment are triggering a desire to leave?

In my opinion, the simple answer is: When the therapist consistently (on a regular basis) and obviously impedes forward movement of the process of the treatment, then it’s time for a conversation, and possibly a change. Keep in mind that negative emotions can still be present in a forward-moving treatment. But if it feels like the therapist is having a direct hand in consistently impeding your treatment, this is a problem.

Here are some things to consider:

  1. Therapist leaning on Client — if there’s a pattern of your therapist using you for emotional support, such as talking about their own life issues at length, bringing in their own relationship or family problems, and seeming to vent to you, this could be an issue. Sure, therapists are human and have lives, however, your therapy isn’t the place for the therapist’s life issues to be sorted out. It’s one thing if a therapist discloses pieces of their lives in the service of your treatment, but it’s another thing if there is a repeated pattern of the therapist venting or sorting out their lives in your therapy.
  2. Sexual Boundary violations — If the therapist makes sexual advances, this is an ethical violation, and comes with many consequences to the treatment.
  3. General Boundary Violations — Other non-sexual boundary crossings need to be considered. For example, if the therapist suggests meeting outside of the office for coffee, or to socialize in ways not related to the therapy. However, even this isn’t automatically an “issue” (some therapists do experiential therapy that may extend beyond the office).  The main question here is: what’s the reason for this request? Is this in service of your therapy, or is this a need of the therapist to make the relationship more personal and casual, even if not overtly sexual.  Other general boundary violations could be things such as the therapist advising you on things that are outside of their realm of expertise, or asking you for advice based on your job or area of expertise, or advising you on how you “should” live, or dress, and so on.
  4. Therapist is Chronically Unfocused — This isn’t as simple as looking tired. This refers to more clear lack of focus. For example,  if the therapist answers their phone (aside from emergencies), responds to texts, listens to messages during sessions, gets up repeatedly, and in other ways interrupts the sessions to deal with other things. Of course, at times things come up that require urgent attention, and it’s good to not base this on one occurrence. But if it seems constant, this can compromise and disrupt your treatment, and you may not be getting a level of attunement and care needed.
  5. Therapist is Unreliable — If your therapist is often significantly late, canceling sessions last minute, or canceling for several weeks at a time without notice, or is otherwise preoccupied in a way that impacts your ability to have your therapy, then this is an issue.
  6. Feeling consistently unheard or unsafe in the room — if a client is attempting to bring up issues with the therapist and the therapist continuously defends themselves, or otherwise makes the client feel insignificant and unheard, this can be troubling. Even if there is a therapeutic lesson to be had, if your therapist is consistently shutting you down when you’re trying to open up and trust them with your vulnerability and emotions, this can shut down the client, and therefore, the treatment.

Keep in mind, therapy is a human process. Emotions can come up between both people in the room. Some flexibility of humanness is recommended (aside from actively sexual advances, in which case one time is too many). But if negative patterns develop to the point where it’s getting in the way of having a treatment that makes sense for you, then it should be brought to the therapist’s attention (even just doing this can be a positive benefit to your treatment). If you continue to feel unsafe, unheard, or otherwise at odds with the therapist after attempting to work through this together, then a change to another therapist may be necessary.