A question-- on bad therapists.
Jul. 17th, 2009 11:26 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
Note: This entry is not meant to discourage anyone who might be thinking about getting into therapy. For there are many excellent and helpful therapists out there, and even the people complaining about them often said "while this therapist was awful, my current therapist is great!" But I am hoping to learn more about how to be better at my job, and knowing what not to do is very useful.
So, yesterday I spent some time Googling the phrase "terrible therapists" and seeing what I found. This list featured a number of the main ones that people mentioned, including the therapist:
*falling asleep during the session
*talking too much about him/herself, especially about his/her trauma
*touching the client and/or trying to make the relationship sexual
*showing up late
*taking phone calls or otherwise letting him/herself be distracted during session (worst story I found online: the therapist had locked her mother (who had Alzheimer's) in a car just outside her office, and watched her mother over the client's shoulder-- and at one point, ran out of the session to go sit in the car with her mother, who was trying to unlock the door. Dear GODS.)
Other things people mentioned in online discussion forums included the therapist:
*imposing his/her religious views on the client (whether Christians wanting the client to pray with them, or therapists who do things like "turned down the lights, lit some healing herb incense, and started to waft it around the room.")
*telling clients something along the lines of "cheer up, it's not so bad! You're young! At least you didn't get raped! You can get over these feelings if you put your mind to it!" etc. Which are sentiments which might be supportive if said with empathy-- but the way these people describe it, it sounds more like a denial of their pain or their right to their pain than an offering of hope for their eventually feeling better.
*sitting in silence, particularly at the beginning of the session (Interestingly, this is a technique which has often been recommended to me by supervisors. The idea is to let the client guide the session without the therapist's imposing his/her ideas. But I think that if you don't explain that that's what you're doing, and why, it just leads to people feeling socially awkward and uncomfortable, as many, many, many people on the forums complained about feeling).
*not giving advice/feedback to people who want it
*giving advice/feedback to people who don't want it
*giving bad advice, or overly simplistic advice ("imagine your anxiety as a piece of feces, and flush it away down your toilet! Now it's gone!") or advice that clearly won't work for this person
*seeming to not remember what the client told him/her about in previous sessions
*not recommending medication when it would be useful
*insisting on medication when it would not be useful, or to the exclusion of other treatments
*criticizing the client-- implying strongly that the client is in pain because there's something wrong with him/her, or because s/he is choosing to be
*refusing to work with a client who self-injures, or who will not sign a suicide contract (this is also something supervisors have recommended to me. It's in part a way to prevent liability, and to prevent therapist burn-out. Which are, like, worthwhile, but people on the forums seemed to find them really unempathetic.)
*not investigating possible medical causes of physical problems, but insisting that they are psychological
*insisting that s/he is right and the client is wrong
*seeming overly formal, distant, and/or anxious
*seeming to play "games" to make the client admit something, show anger, etc.
An overall theme I noticed is that a bad therapist is one who seems to not "get" you, and to not care about you-- whereas someone who honestly does care and understand can be forgiven lapses. Best example is therapists crying; some people praised their therapists for tearing up when the client talked about something really sad, as they felt that it meant the therapist was really with them, really empathized, cared and understood. Other people criticized their therapists for crying, as they felt this meant the therapist "had issues and could not listen to some one elses' in a professional manner"-- that the therapist was crying about his/her own pain, not the client's. Similarly, a therapist with good rapport can (and, I believe, often should) respectfully point out when a client's behavior is contributing to his/her situation-- but it must be done from a stance of "hey, person I care about and respect, want to hear about a way you could have more power and control and make your life better?" rather than "this is all your fault, and that's why I'm better and smarter than you." And a good therapist will usually know the client well enough to judge which way s/he will take it, and be sensitive to that.
But what else am I missing? What bad experiences have people had with therapists? What would you recommend a therapist do or never do?
--R
So, yesterday I spent some time Googling the phrase "terrible therapists" and seeing what I found. This list featured a number of the main ones that people mentioned, including the therapist:
*falling asleep during the session
*talking too much about him/herself, especially about his/her trauma
*touching the client and/or trying to make the relationship sexual
*showing up late
*taking phone calls or otherwise letting him/herself be distracted during session (worst story I found online: the therapist had locked her mother (who had Alzheimer's) in a car just outside her office, and watched her mother over the client's shoulder-- and at one point, ran out of the session to go sit in the car with her mother, who was trying to unlock the door. Dear GODS.)
Other things people mentioned in online discussion forums included the therapist:
*imposing his/her religious views on the client (whether Christians wanting the client to pray with them, or therapists who do things like "turned down the lights, lit some healing herb incense, and started to waft it around the room.")
*telling clients something along the lines of "cheer up, it's not so bad! You're young! At least you didn't get raped! You can get over these feelings if you put your mind to it!" etc. Which are sentiments which might be supportive if said with empathy-- but the way these people describe it, it sounds more like a denial of their pain or their right to their pain than an offering of hope for their eventually feeling better.
*sitting in silence, particularly at the beginning of the session (Interestingly, this is a technique which has often been recommended to me by supervisors. The idea is to let the client guide the session without the therapist's imposing his/her ideas. But I think that if you don't explain that that's what you're doing, and why, it just leads to people feeling socially awkward and uncomfortable, as many, many, many people on the forums complained about feeling).
*not giving advice/feedback to people who want it
*giving advice/feedback to people who don't want it
*giving bad advice, or overly simplistic advice ("imagine your anxiety as a piece of feces, and flush it away down your toilet! Now it's gone!") or advice that clearly won't work for this person
*seeming to not remember what the client told him/her about in previous sessions
*not recommending medication when it would be useful
*insisting on medication when it would not be useful, or to the exclusion of other treatments
*criticizing the client-- implying strongly that the client is in pain because there's something wrong with him/her, or because s/he is choosing to be
*refusing to work with a client who self-injures, or who will not sign a suicide contract (this is also something supervisors have recommended to me. It's in part a way to prevent liability, and to prevent therapist burn-out. Which are, like, worthwhile, but people on the forums seemed to find them really unempathetic.)
*not investigating possible medical causes of physical problems, but insisting that they are psychological
*insisting that s/he is right and the client is wrong
*seeming overly formal, distant, and/or anxious
*seeming to play "games" to make the client admit something, show anger, etc.
An overall theme I noticed is that a bad therapist is one who seems to not "get" you, and to not care about you-- whereas someone who honestly does care and understand can be forgiven lapses. Best example is therapists crying; some people praised their therapists for tearing up when the client talked about something really sad, as they felt that it meant the therapist was really with them, really empathized, cared and understood. Other people criticized their therapists for crying, as they felt this meant the therapist "had issues and could not listen to some one elses' in a professional manner"-- that the therapist was crying about his/her own pain, not the client's. Similarly, a therapist with good rapport can (and, I believe, often should) respectfully point out when a client's behavior is contributing to his/her situation-- but it must be done from a stance of "hey, person I care about and respect, want to hear about a way you could have more power and control and make your life better?" rather than "this is all your fault, and that's why I'm better and smarter than you." And a good therapist will usually know the client well enough to judge which way s/he will take it, and be sensitive to that.
But what else am I missing? What bad experiences have people had with therapists? What would you recommend a therapist do or never do?
--R
(no subject)
Date: 2009-07-17 05:27 pm (UTC)In childhood, when in therapy for pretty disturbing sexual trauma, my first therapist rebuked me for not wanting to reenact the thing with dolls, then suggested if I couldn't show it to her, it didn't happen. Twenty-five years later, I have the scars to prove it did, but I was too mortified to "reenact" the incidents, and moreover already perceptive enough to grasp that dolls aren't real and nothing can hurt them, so what's the point?
My second, court-appointed, vaguely qualified therapist (I was eight) was a postfeminist, Steiner-doll, herbal-obsessed loony who needed more therapy than she gave -- but did introduce me to Indian food and gazpacho, as she believed in taking sessions out of the office, and what can you do with a pathologically fearful child but go and eat somewhere? The problem with that particular therapist is that she instilled a feeling that it was Time For Me to Be Okay, and that Hoo Boy Had I Failed because I wasn't okay yet. I was just about walking without pain yet, and she said it was time to mooooove on and put it aaaaalll awaaaay.
In high school and college, therapy was mandated as a condition of pharmacological assistance, which I thought I might need considering my grandmother is on lithium, my uncle on Wellbutrin, and a couple of my aunts spent the seventies on Thorazine. I seemingly broke the bipolar mold in favor of unipolar depression with thwacking PTSD, but my therapist and pill psychologist bounced me from medicine to medicine without listening to me at all (and the therapist, in this case, had a reset button for each session -- it was as if nothing had happened at all last session, and she sat in silence while I squirmed and made awkward conversation and ate through half the session that way). At one point, the psychiatrist -- and I do wish I could remember his name, so as better to decry him on the Internets -- put me on a daring, new, powerful antipsychotic. It was like reducing my brain to a silent, cool, black, blank puddle and then dropping in a rock, where rock = ordinary everyday stimuli. It was the closest I had ever come to killing myself, and he kept me on it for a month, just to see.
So yeah. Um. You've entered a useless profession, and should rather had joined the Peace Corps.