WE NEED TO TALK ABOUT BAD THERAPY

If you’re reading this post or subscribed to my Substack, there is a pretty good chance that you have 1) gone to therapy, 2) wanted to go to therapy or 3) suggested someone you know go to therapy. And as a person who has been in and out of therapy for 30 years, I love this for all of us. Therapy is an incredible resource that has the power to truly change our lives, relationships and neural pathways. And I’m thrilled that in recent years, we have gotten more comfortable openly talking about the benefits of seeking help from a mental health professional.

But something that I don’t think is discussed enough is how to know if your therapist isn’t helping or, in some cases, might be causing you harm. This conversation is especially necessary because therapy isn’t a clearcut routine where you can check to see if your therapist is doing everything right and following a checklist. It is more of an artform than a science and when you combine that with the inherently unequal power dynamic between the “expert” and the client, it can be difficult to recognize when the person you are paying tons of money simply isn’t good at their job. Because that’s the hard truth--a lot of therapists STINK.

I was thinking about this conundrum the other day and it prompted me to share my thoughts on Twitter:

I had NO idea that my off the cuff tweet was going to start a viral conversation with over one thousand comments and 14.5k quote tweets. But it’s now obvious that people have been wanting to talk about what constitutes Bad Therapy and share their own experiences.

So for this week’s post, I thought I would breakdown some of the most common themes so we can all be more informed when it comes to picking a good fit and not wasting time or money on someone who doesn’t deserve either.

Here it goes:

RED FLAG: Doesn’t Respect Client Confidentiality

Client confidentiality is a big deal in the mental health world and there are only specific times it can be ethically broken. (For example, if you inform your therapist of your intent to hurt yourself and/or someone else. Or you disclose that you have witnessed or committed elder, child or dependent abuse). Otherwise, no one else should be hearing your conversations. Another sign that your therapist might not be taking confidentiality seriously is if they share details of their other clients with you in a way that feels overly invasive or identifiable.  

RED FLAG: A General Lack Of Professionalism

While therapy is a place where you don’t need to follow decorum or present a certain way, the same is not true for your therapist. So if they are doing things that distract you from the hard work of showing up and processing your emotions, that isn’t a good use of your time. And will likely make it more difficult for you to respect them or their opinion.

RED FLAG: Can’t Remember Anything About You

Look, I’ve had great therapists and psychiatrists get confused every now and then—they are human after all. But if you consistently feel like your therapist can’t pick you out of a line up or you are constantly having to repeat yourself that is a not going to be an efficient way to get better. It also makes you feel like they don’t care about you, which is super detrimental to the therapeutic alliance. Therapists are supposed to write down client notes after every session to keep track of your progress. That is a bare minimum part of care.

RED FLAG: Unwelcome Physical Contact

There is a lot of debate in the therapy community about the role of touch. Some clinicians are against all forms of it while others believe that in some cases it can have a healing quality (for example a hand on a shoulder while you are crying). That said, if you have stated you don’t want them to touch you and they still do, that shows an unethical lack of boundaries. You want to feel safe with your therapist and that can’t happen when they break your comfort zone.  

RED FLAG: You Feel Like You Have To Take Care Of Them

Your relationship with your therapist is unlike any other relationship because it is not meant to be a two-way street. Therapy is the one place where you don’t have to concern yourself with the other person’s feelings. A good therapist will be able to take care of themselves through self-care, their own therapy and consultations with their peers. So if you feel like they can’t handle what you are telling them or their emotions take up more room than yours, that is a pretty good sign to cut the cord.

RED FLAG:  Sharing Too Much Of Their Own Lives

Most therapists have moved after from the Freudian idea of being a blank slate, but there should still be a good/clear reason for any self-disclosure. If you find your therapist randomly sharing things with you without a clear purpose or are trying to make you follow in their own footsteps, that isn’t a great sign. That said, some therapists will self-disclose to help you feel more comfortable or connected, but if that isn’t the case then their self-disclosure isn’t doing it’s intended job.

RED FLAG: They Bail

This type of behavior can actually get your therapist in trouble with the licensing board because it is so abhorrent. Therapists have a certain duty of care that requires them to give their clients a certain amount of notice before terminating therapy as well as providing their client with accessible referrals. If your therapist abruptly ends your sessions or disappears on you it can seem like you are the problem. Let me be clear, it is not. Nothing shows greater incompetence than this type of behavior. I would even encourage you to report it to their licensing board so they can’t continue to cause that kind of harm in the future.

RED FLAG: Pushing A Specific Agenda

Some therapists will try to present themselves as secular and accepting of all groups, but if you get the sense that they are trying to change your sexuality, gender presentation or religious beliefs that is not okay. Sometimes it might not be as blatant, but you will still feel judged for certain parts of yourself. Good therapists treat their clients with unconditional positive regard. Bad therapists will make you feel like a fuck up (who is maybe going to hell).

RED FLAG: They Don’t Feel Like The Right Fit

This one is the trickiest of all to spot because good therapy is often uncomfortable. You don’t want every moment of a session to be your therapist praising your actions and letting you avoid anything that you don’t want to talk about. I often dreaded going to therapy because I knew it was going to be hard and uncomfortable, but I still felt loved and cared for. That said, there are a lot of reasons you might not be the right fit with someone. Maybe you want more directive advice while they deliberately veer away from giving any. Maybe you have a certain disorder that needs a certain type of treatment other than talk therapy. Maybe they remind you too much of your father. There are a multitude of reasons you might want to keep looking and none of them mean therapy with the right therapist can’t work for you.

One way to figure out if your current therapy is working is to talk about your treatment plan and your progress directly with your therapist. A good therapist wants feedback from you and won’t take offense if it isn’t all glowing. Sometimes ruptures that are properly addressed and repaired can lead to an even better working relationship. However, if your therapist gets defensive when you bring up any concerns, that’s something to pay attention to.

I’m so thankful to everyone who shared their experiences. It’s obvious that this is a conversation that needs to keep going because the more we know about bad therapists the easier it will be to find and appreciate the good ones. (Who actually exist! I swear!)

If you want to hear more (horror) stories, you can find the full Twitter thread here.

xoxo,

Allison

JOURNAL/COMMENT PROMPT: What are some signs your therapist is actually good at their job?

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