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How to Spot Questionable Therapy

I recently started listening to a new podcast called "Very Bad Therapy".  I just started, but the hosts (clinical counselors), interview other therapists and people who have been in therapy about bad experiences with therapy, questionable approaches, and times when therapy has been downright harmful.  It's about "what goes wrong in the counseling room and how it could go better, as told by the clients who survived."

It can be hard to take that step...to make that phone call...to vulnerably reach out and ask for help.  It can also be scary.  We read website bios and directory listings hoping that we will find a therapist that in their language and unique style sound like they will speak to us...and be able to really help.  Unless we've received a highly trusted referral, we never know exactly what to expect.  Like online dating profiles, therapists often put their best foot forward when writing or speaking about the work they do, but how can we ever really know that they're as competent as they sound - and truly able to provide the safe, nonjudgmental, and objective space that's so crucial in the therapeutic setting?  How can we let them know they'll be a good fit for us and what it is we are looking for? Well, we often don't.

Although there are things you can do to screen for a good fit (see more about that here), you sometimes don't know for sure until after you've met with a new therapist a few times.  That being said, there are things you can look out for early on...signs of questionable (or even bad) therapy that might help you move on and away quicker instead of wasting too much time, money, or energy in unhelpful therapy.  If you end up working with someone that doesn't work for you, continue your search. I know it's discouraging to start over, but there are plenty of good therapists out there.

  1. Your therapist talks too much. If your therapist is talking - like all the time! - that's a problem. Therapy is supposed to be a place for you to talk, for you to process, and for you to discuss what's going on in YOUR life.  There are definitely times when it's important for therapists to speak, too.  They need the opportunity to reflect back what they're hearing, to provide general feedback, and to provide education in areas they are well-informed...but they probably shouldn't be doing more talking than you except for some rare exceptions.
  2. Your therapist doesn't say enough.  Although it's your space/place to talk about the things you are struggling with, your therapist should play an active role in the process.  Some are more or less passive depending on their style (and there's not anything necessarily wrong with a therapist that talks less), but if you're not hearing your therapist share their thoughts and observations (or prompting when appropriate) then that's probably a problem.
  3. The therapist seems distracted. Your therapist should be tuned into you and what it is you have to say.  The time you have reserved is for you.  Covid changed some things and forced therapists and their clients into the virtual setting for a while.  This, by nature, led to some inevitable distractions, as therapists (like the clients they work with), had to deal with managing a professional life along with the distractions at home (like dogs and kids)...but there's now been plenty of time to sort that out.  Whether in person or online, therapists have a responsibility to dedicate their focus and attention to the people they are helping.  Aside from some really rare exceptions, your therapist should not be answering their phone, checking texts, or being less than fully present in session.  If a therapist is aware of something that might take their attention away from you, they should be communicating and providing some explanation as to why.
  4. You feel judged.  In order to feel comfortable sharing all parts of yourself with a therapist, it's important that you don't feel judged.  Whether it's habits you engage in, use of substances to cope, the lifestyle you live, your preferences, your beliefs & worldview, your culture, your sexual orientation or gender, or any other aspect of  your life, your therapist should be approaching their work with you from a completely nonjudgmental place that makes you feel accepted no matter what.  Just because you're feeling judged doesn't necessarily mean that your therapist is in fact judging you, but we humans are pretty good at detecting that sort of thing.  If enough is going right with therapy, I'd definitely recommend bringing it up and talking about it. Maybe it's something you can work through.  Maybe some of your insecurities or assumptions are leading you to feeling judgement even when judgment isn't present.  Either way, that doesn't change the fact that your feelings are valid.  If it's something that you don't feel can be worked through, try to find another more inclusive and less judgmental therapist.
  5. They introduce questionable techniques - We as therapists should be leading with evidence-based approaches for helping people - sound research-backed strategies for treating problems.  Some therapists also incorporate things that aren't so evidence-based...and that's okay as long as they are transparent about this and are sure you're cool with incorporating some less conventional methods.  What a therapist should not do, however, is introduce things into the process (such as religion or spiritual practices) that they haven't made fully clear in the initial stages of informed consent and in their marketing.  Part of informed consent involves letting clients know what kinds of techniques they use and what to expect in the process.
  6. They forget too much stuff.  Therapists are human.  They forget stuff.  They won't remember every detail about your life and that's okay.  They might even ask you to refresh their memory every once in  a while and that's expected too.  A therapist forgetting stuff becomes a problematic if they are mixing up your details with other people, don't remember much about what you've been working on, or regularly forget important details.
  7. They don't have room in their schedule to see you consistently.  It's important if a therapist takes you on as a new client that they have the ability to see you at least once per week for a while.  Maybe you don't need weekly sessions or maybe they've made it clear before working with you that their availability is limited and that they might only be able to see you every couple of weeks.  That's cool.  But when you're reaching out for help working on an issue, it's NOT cool if once you've gotten started the therapist doesn't have any session times to offer in the near future.
  8. They seem overly emotionally affected by your story.  Don't get me wrong - empathy is a much needed trait for therapists. It's not uncommon for therapists to get a little bit emotional and to feel some of what you're feeling.  It's okay for that to be outwardly obvious. You want to see that they care.  You want to see in how they engage with you that they are involved and concerned...that they are having some kind of an appropriate response to whatever it is you are dealing with...but if you feel like your therapist is having a hard time hearing your story or breaking down because of whatever's come up for them in their relationship with you, they might have some stuff to sort through on their own.  
  9. They have to cancel or reschedule too frequently.  It's inevitable that things will unexpectedly come up from time to time with you or your therapist that require having to cancel an appointment or to reschedule it.  It just happens and this should be expected every so often...It shouldn't happen too often, though, unless your therapist has already informed you of something in their life (such as a health or family issue) that could potentially intervene with them making appointments as scheduled more often than what would usually be considered reasonable.  Generally speaking,  you should expect that your therapist will show up to your sessions and show up on time.  You should also expect that they'll give you as much heads up as possible when this can't happen with some options for when they can meet with you instead.  If your therapist is not showing up, constantly showing up late, or cancelling too frequently, they're disregarding your needs and not supporting you in the way that you deserve.
  10. They don't seem to understand your problem.  If your therapist doesn't seem to understand your issue or if you know more about it than them, this might be a "red flag".  We are ethically obligated to only work within our scope of practice and area of expertise.  This means we should only be working with people who we are well-informed as to how help and referring out to other therapists when we find ourselves unsure how to help about the primary issues you are dealing with. 
  11. There doesn't seem to be continuity.  I like to ask client's about previous experiences with therapy when they show up for their first session.  One of the major complaints I hear is that there wasn't a whole lot of follow-up or follow through on problem areas to be addressed or things discussed last session.  Although it's totally acceptable for you to change the topic if something has come up or if there's something else you'd rather work on, therapy should have a certain level of continuity.  We should be checking in on work that's been done and following a rational flow. If you've been working on a particular problem and finding that your therapist is changing the subject or shifting the focus too often without checking in on past sessions or where you're at, you might be less inclined to feel like you're on a clear path that's getting you somewhere.
  12. They overshare about themselves. Don't get me wrong.  Unlike some therapists who prefer not to share anything about themselves, I'm a big fan of some self-disclosure on the Therapist's part when appropriate and when I think something a therapist has to add about themselves or about their experience will help the client.  I'm even open to the idea of sharing some personal things about myself so that my clients can know a little bit about the human that they're working with.  That being said, there's a line.  Therapy is not for or about the therapist.  You should be the focus and if your therapist is spending too much time talking about themselves or their problems (especially if they are unrelated to what you're going through), they might be serving themselves and their interest more than they are serving you.
  13. They have poor boundaries.  Boundaries are important in the therapeutic relationship.  The relationship between therapist and client, although very personal, is also professional.  Ethical guidelines make it clear that having a "dual relationship" or relationship outside of the therapy setting is something that can be harmful to the people in therapy.  Although it's certainly more than okay for your therapist to be friendly, for you to care about one another, and for the relationship with your therapist to feel sort of like a friendship at times, it's different in some key ways that are meant to protect the safety and "sanctity" (for lack of a better word) of the relationship.  If your therapist suggests seeing you outside of the office (for anything without a clear therapeutic purpose) or if they are calling or texting about things not related to your therapy, they probably have poor boundaries.  This is rare but not unheard of.  
  14. They're not helping you work on what you came to therapy to work on.  In the beginning of therapy, you'll likely share the kinds of things you want to work on.  Throughout the course of therapy this might change.  Although it can be helpful for a therapist to guide the process at times, it's ultimately up to you where you want the process to take you and where you want to go.  If you're finding that your therapist is changing the subject, suggesting that you work something else, or not willing to explore the deepest (and sometimes darkest) places you might want to go, they're following their own agenda and possibly even avoiding talking about things that THEY don't want to talk about.  
  15. They push their values or beliefs.  As Therapists, we are supposed to meet people where they are at.  It's not our role to impose values, beliefs, or attitudes on the people we are working with - no matter how strongly we might feel about those things. An openness to a diverse range of people and opinions is crucial.  Your therapist should be helping you get to where you want to be - not to where they want you to be - and should not be imposing their way of thinking or believing on you. Some pushback on issues and/or beliefs is sometimes helpful, but good judgment needs to be made on the part of the therapist as to when that's appropriate and when it's not.  
  16. They give too much advice or tell you what decisions to make in your life.  There's a common misconception that therapy is a place where you go to get advice.  Instead, regardless of a therapist's style or approach, they should be guiding you through a process of helping you understand your problem, yourself, and how to come to your own conclusions about where to take your life.  Although therapists shouldn't be giving too much advice, this isn't necessarily a hard rule.  I'd be lying if I didn't ever tell a client what I might do about a situation if I were them - but I'm also careful to acknowledge that I can't know what's best for them - and much more likely to help them explore different options (and to maybe point some options out that they have not considered).  Although receiving skills, tools, and strategies for coping with difficulties from your therapist can be very helpful, it should not be the case that they're telling you what to do regarding an important decision in your life that you might be struggling to make. 

To wrap this all up, no therapist is perfect.  They make mistakes, struggle with boundaries every once in a while, overshare, forget details at times, and struggle to meet the high standards and expectations that they are called upon.  I know I do...and that's okay.  What's not okay, though, is when you're seeing too many red flags, not feeling heard, or not getting the support that you really need and should expect.  

Whether you've had good therapy in the past, bad therapy, or no therapy, we hope you'll give us a chance.  We aren't perfect, but we'll do everything we can to show up in a way that makes you feel valued no matter who you are, where you come from, or what you're struggling with.

Float on Counseling is located in the Carrollwood area of Tampa.  We offer in person and virtual sessions to people who are physically located in the State of Florida.  Shoot us a text, give us a call, or send us a message and Summer (our scheduling coordinator), will be happy to help you find a therapist best suited for you and your needs.  Our phone number is 813-515-9602.

Joel Schmidt, MA, LMHC

 

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