44 thoughts on “When Good Therapy Turns Bad

  • May 24, 2010 at 12:54 pm

    Good therapy also has many bad moments in it. It’s not all “warm and fuzzy.” In fact if the therapy doesn’t make you a bit uncomfortable and upset then I’m not sure if it’s working. And/or the client has significant issues to work on.

    1 & 2 maybe linked. It’s difficult to tell from the beginning whether or not a client will be “triggering” for the therapist. And in fact, I think it’s really the therapists responsibility to be in therapy to resolve those issues before going into therapeutic practice at all. Or specialize in problems that won’t be triggering. For example, if you would be triggered by a rape victim and you can’t shake that, become a school psychologist or something like that.
    If they somehow figure out after a few sessions that client will trigger them , they maybe drop them unexpectedly.

    5. Also, by suicidal what do you mean? Actually approximately 1/4 of all clinical patients (in the US), have suicidal ideation, so there is really no way to avoid them or sent them all to the hospital.

    Some good points though.

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  • May 26, 2010 at 9:38 am

    Would absolutely agree that the therapist has a responsibility to deal w his/her own issues first. If these interfere w the provision of good, client-centred therapy, then the therapist isn’t ready/able to enter into a theraputic relationship in which there is a risk that s/he will take or be given too much power. And good therapy often sucks– one of the signs that it is WORKING is that you are talking about and dealing w/ things that bother you.

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  • May 26, 2010 at 11:45 am

    You are so right Mary, good therapy does suck, rather than feeling warm and fuzzy. For me that warm fuzzy feeling for me tends to emanate when I have a breakthrough of some sort and understand myself and my triggers better and sit in the situation rather than react to it. That is personal growth. Also for me, today, realising that the therapy is the trigger rather than the therapist.

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  • May 27, 2010 at 12:09 pm

    I set boundaries around non-payment issues and will terminate clients who make no effort to pay on bills over appropriate period of time. I consider this a “good therapy” position but not all agree.

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  • May 27, 2010 at 12:53 pm

    after reading this, i realize i have a GREAT therapist. major thank you to my therapist 🙂

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  • May 27, 2010 at 4:36 pm

    After many years of therapy, I would not want to change to another therapist and dredge up the past to a new one; only if there are therapists who deal in the present. Like, what did I do today to help me think clearer or what will I create for the rest of today? I am an integral part of my therapy as I also find new ways to maintain a positive outlook. When I am depressed, I can feel a little knowing that this one won’t last long even if the thoughts try to tell me it will. For me, therapy has always been the trigger rather than my therapist.

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  • May 27, 2010 at 11:50 pm

    Yes Tammy, I agree with you. First and foremost it is a business and if you don’t get paid how can you stay in business? But that doesn’t mean the therapist doesn’t care. Some therapists give discounts to clients who are experiencing financial hardship but working hard at understanding themselves. I’d like to see more lawyers doing that.

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  • May 28, 2010 at 9:09 am

    Absolutely agree, Sonia. I find most therapists are willing to do a fair share of sliding scale care or pro bono work, but we all have the experience of clients who want much of us for nothing, and for me, that becomes a dependency issue. If it cannot be resolved therapeutically, I will terminate the relationship with a referral to a free mental health clinic as my fees are clearly stated on my original practice disclosure. I find that is also “practicing what I preach” about self-value, but this is found to be somewhat harsh in my group of practicioners. I find that interesting after 20 years in the art and science of mental health. Thanks for your insight.

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  • May 30, 2010 at 6:11 pm

    I’ve been in therapy with the same counselor for several years. I have been in and out of various hospitals with both suicidal ideation and actual attempts.

    At one time I felt as though we were working on things and making progress. But for a long time, I feel like I’m just going in there and telling what my week has been like without any real therapy going on. I feel cheated, ignored, whatever…I feel at this point that I am wasting valuable time. Unfortunately, I live in a severely underserved area and am on Medicaid which many providers do not accept. There are long waiting lines for all of the therapists and doctors in our area and people are now being referred to a larger city about an hour and a half south of us! I don[t feel as though I can afford to relocate my therapy, but am very frustrated with the level of care I am receiving. For crying out loud, my therapist is almost always at least 15 minutes late for my appointments!

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  • May 31, 2010 at 2:11 pm

    I practice TIR, Traumatic Incident Reduction. We have all had our traumas but of course some have  ‘outside normal experience’ events which could shock and/ or trigger. Our training involves drills which look for buttons to press and you won’t pass the drill till no reactive buttons can be found. We owe it to our clients to keep our ‘case’ out of the session room or we should not be there. It takes training to ” be there” for the client but that is part of our neccessary tool set without which we cannot create a safe space for client healing. Been reading on a PTSD site the indifferent and even shocking treatment by some therapists of their clients. Not all therapists have the training or even the inclination to work in the demanding area of traumatic stress  but to terminate a client ( some by texting!! ) without care and sensitivity bears witness to the fact that they are simply not cognisant of the prerequisites needed for the business they are in. Most clients would understand if the therapist consulted with the them in the process of selecting an appropriate person to refer the client on to.  

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  • May 31, 2010 at 8:19 pm

    Dear RG,
    I had a look at that site and I thought I would post the link to it.

    http://www.tir.org/

    Really, clients get terminated via text message? What about process or debriefing or simply winding down and dealing with lingering issues before moving on.

    How traumatic is that? Unbelievable.

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  • May 31, 2010 at 8:23 pm

    Hi Paula,
    Have you discussd with your therapist the fact that you are not getting better and that when he is late it upsets and frustrates you?

    Perhaps you could talk to him, or write him a letter and read it out to him in therapy, that it’s all gone stagnant and is not helping.

    It is your therapy and you have a right to voice these concerns.

    I just hope you get your 50-55 mins even though he is late. Perhaps he is running 15 mins all day and you are part of that. It is still not good enough though.

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  • June 1, 2010 at 11:34 am

    Thanks for posting the TIR link Sonia. What I was focused on there was that rather than when good therapy goes bad, I was seeing multiple accounts of the process being bad from the outset. People are being turned off therapy and not coming back for months, even years. This might be a pity for folks who oughta have some things sorted or could well do with some meaningful therapy, but for trauma sufferers this is really serious. People can do downhill and become desperate. Clients unfamiliar with good therapy were blaming themselves! Interesting that in Applied Metapsychology of which TIR is a major component, we have a procedure we do where a new client has had disappointing/damaging/ineffective etc therapy in the past where we repair the situation, kind of rehabilitate their willingness to receive help and have done with past therapeutic mess-ups. How heartbreaking to think that, that which is supposed to be aiding progress and for traumatic stress, facilitating recovery, is actually creating more trauma for the person to deal with.

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  • June 1, 2010 at 11:59 am

    Sonia (and others),just on that, I started a thread on that forum in which I strongly encouraged people to audition prospective therapists as someone who has an understanding of and a track record with traumatic stress, who is happy to explain the methods they intend to use, who acknowledges that it is a unique condition in that the sufferer has NO say when symptoms (like nightmares and flashbacks – replays of traumatic incidents)are going to manifest and that therapists are service providers, that clients should expect(demand!)good service and good value from them. To not defer to their judgement too much till they have proved themselves. They are fallible operators and people should not suppress their own intuition in assessing whether they oughta be there. And I touched on the fact that referrals should be regarded as well meaning rather than informed and that referees would surely appreciate being told when a referral turned out to be wholly inappropriate.
    Best to all.

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  • June 1, 2010 at 9:06 pm

    I have had so many BAD therapists that I am fed up with this profession. I had one whose license expired when I started with her (found out when I filed a greivance). Many just sat there just repeating what I said but no feedback. I have mostly resolved my issues more from books I read and from some friends. I needed to get in touch with my emotions after dealing with numerous traumas as well as rebuild my self esteem. I have resolve both on my own and now have no respect for a profession that has little accountability. I wish I could have a job just sitting on my ass pretending to listen and get paid handsomely.

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  • June 4, 2010 at 10:39 am

    As a therapist I have found that regardless of technical aspects, patients want to be heard–and this includes process oriented self-disclosure which I have found to be very powerful and sets the stage for the therapeutic relationship truly becoming a template for change/insight/relationship healing.

    I purposefully have taken fewer clients, since I found I got burnt out when I spent more than 20 hours or so working with people. I have worked primarily with M.A. payment people over the years, although M.A. pays less than most HMO’s, they seem to provide more sessions and flexibility, which many people could use, particularly with so many issues both present oriented and lingering emotional trauma and the like from their past.

    I am frustrated that I see some very Financially successful “therapists” that in private don’t seem to care that much about the people they work with, they meet with 30 people a week and just focus on money, and take pride in not allowing people’s stories to affect them. I struggle to not allow some people’s misery to haunt me at times, and don’t think I will ever be able to be Mr. Spock as a therapist, I think about clients at home, particularly when major things are going on in their lives.

    I see many therapists that think Therapy means, opinion giver, and they don’t base hardly anything they say on any of they myriad of theories/schools out there–but just their personal biases, this drives me crazy–sitting in team meetings listening to people spew out nonsense about clients they don’t even know, I ask them what theoretical basis they base their conceptualization on…usually these folks don’t read/study it seems, perhaps that’s why they present so arrogantly.

    Therapy can be an amazing experience, but also a frustrating and exhausting one, I for one struggle financially so I can actually be present for all my clients, rather than fill up all my time with multiple jobs–at the sake of becoming distant/aloof or some sort of counseling robot.

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  • June 6, 2010 at 11:17 pm

    We obviously need more professionals like you Ben. Being heard can be more than half the healing process. I too avoid the wise advisor position in favour of the person centred approach. The problem with evaluating, interpreting etc for people is 10 therapists will give 10 different interpretations/sets of advice, all a reflection of their individual experiences which may or may not relate to the client. As to burnout, if you feel comfortable dropping me a personal note, I have some info that you may find helpful. healing [at] engineroom [dot] biz
    Again, what you said earlier supports the client’s right to audition their therapist and sack ’em if they won”t listen. In some cases though, people may not have a lot of choice as to who they can see.
    Best to all.

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  • July 27, 2010 at 8:44 pm

    Yes, Ben, I agree with RG…you sound like a wonderful person as well as a good therapist!

    I’ve only had one therapist who listened to me objectively and tried to help me in the best way possible. He was very caring and compassionate.

    I don’t work in the psychiatric field, but it seems to me that some people could try to be more like Ben and my old therapist.

    I benefit greatly from interaction with a person who doesn’t bring their own biases into a therapy session. Some therapists are good listeners with empathy for their clients. Others are simply in it to make money, not to actually help their clients.

    I visited a new therapist today for the first time since 2004. She was nice enough, but as Ben said about some therapists, she had a slightly cold attitude.

    I had the feeling that she didn’t care about anything I said. I will give her another chance but her attitude bothered me a little bit.

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  • August 10, 2010 at 3:51 am

    I was with a therapist for 2 years both individually and in group. I was referred by a good friend who saw this therapist too. She practiced modern analytic and object relations. I dealt with some painful transference issues with her and wasn’t sure she was capable of handling it appropriately.
    A tragic event then happened when my friend killed himself in the therapists office. She fired me from therapy and the group over the phone. I was outraged and deeply hurt. But understood she was terrified of what might happen to her as a result of this tragedy and I knew too much of the story about it. As she put it, ‘Its very complicated emotionally’, it will take a long time to work out./

    2 years later I realize that style of therapy isn’t right for me. I’m not sure which one is but I’ll continue to look. Also termination is very important part of therapy and it must be handled with care, respect and dignity for the client. If it isn’t handled right it can cause some serious emotional harm to them.

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  • August 11, 2010 at 12:52 pm

    Hey Therapists, this is how my therapist terminated me.
    I quit therapy two years ago because my therapist “thought” I was suicidal, I was not, never ever talked about it….so she took it upon herself to call the local police to check on me . The police broke into my house and handcuffed me!She lied and told the police that she was my Psychologist ( she was a social worker) that was not helpful! I figured with her poor assessment of my mental state, I was best left alone out there. I really wanted to turn her into the State Licensing Board, but I didn’t want my mental records to been opened to non- professionals. I did not have to energy to battle with her.

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  • August 20, 2010 at 7:29 pm

    How do you resolve a relationship with a therapist when he did not terminate properly?

    I moved to another city and my therapist did not approach the termination with any thought or even simple compassion. He did not talk to me about the upcoming termination, he never helped me find another therapist in my new city. It was almost impossible to get a list of medicines from him and I was very unclear about what his role was because we had never talked about it and he said conflicting things.

    I was and still am, completely bereft and alone.

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  • September 2, 2010 at 3:54 am

    Great post Sonia. I was one of the folks in cyberspace that blogged you last year about this issue. So BRAVO!

    to client abc…my termination nightmare was also by a LCSW. She terminated me on the phone. She used law enforcement to protect herself against the Licensing Board not me. But if you change your mind you can report down the road. It is very simple, it’s all done online.
    I realized LCSW’s are only in a 2 year program and one is spent on learning about social services.
    They are dangerous because they can really cause harm.

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  • September 16, 2010 at 5:26 pm

    Thanks Julia for your comment on reporting a nightmare therapist. Hopefully I will be able to do this.

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  • November 13, 2010 at 10:51 pm

    As a suicidal client, i’d love to know why my therapist didn’t refer me to a mental hospital. I mean c’mon. Suicide is suicide. And i’m supposed to just go home as if it’s some kind of joke. Being at home like always won’t solve it.

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  • November 13, 2010 at 10:56 pm

    Being in the same surroundings as per usual will only help exhaust me mentally.

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