I love my job and do not take it for granted that those who are reaching out to me are doing so in great vulnerability. I respect that vulnerability. It is what motivates me to be present with clients authentically, putting curiosity, professionalism, and ethics into action. And you may think “yes, that sounds nice, but what exactly does that look like?”
At my practice, I work hard to:
be clear in my administrative and therapeutic communications
respect your time by consistently and reliably showing up on time and with goodwill
exercise good judgment through studying, continuing education, connecting with knowledgeable professionals, and seeking confidential supervision
earn and maintain trust by deeply considering what each person brings to therapy
keep my focus on your concerns and goals & strive to work at your pace
explore myself and my perspective, as well as take good care of myself so that I can be present and effective when I am with you
While every therapist makes mistakes or has a bad day,
there are therapists who are not therapeutic.
In most cases, except those that are grievous, I recommend you tell your therapist your concern about them. A good therapist will listen to your concern, and work to either make amends or communicate their own limits, both of which can provide you with information about whether to continue your relationship with your therapist or not. While it would be uncomfortable if your therapist is unable or unwilling to hear your concerns, such a conversation will provide you information about what to expect, and not expect, from that person.
This is not an exhaustive list, but here are some red flags (warning signs) to look out for in your relationship with your therapist:
Dual Relationship: Your therapist should not be looking to you to provide anything other than payment, showing up on time, and engaging in the therapeutic process. If a therapist wants to hang out with you, wants to employ you in some way, or is attempting to get you to supply something to the therapist, they are creating what is known as a “dual relationship.” The most egregious example of a dual relationship is a therapist having a relationship with a client that is sexual or romantic in nature. In this latter instance, file a complaint with the therapist’s professional board. This is inappropriate even if it is the client that initiates the relationship. Dual relationships are ethically inappropriate and do not respect the therapeutic alliance.
*Exceptions (to less complicated dual relationships) are sometimes made in communities that are very small, where people cannot help but know each other in more than one setting. There is some nuance here to consider as well. Some people perceive others’ actions in ways that are not intended. And some therapists are more personable than others. If something feels uncomfortable to you, it may be helpful to share this and/or move on from the relationship. The ethical codes of the American Association of Marriage and Family Therapists (AAMFT) specify that therapists are never supposed to enter a romantic relationship with clients, while other professional associations have different codes.
Not respecting your autonomy to make choices: A therapist should not display a lack of respect for your autonomy. If a therapist has become fixated on you making a certain decision, this could signify a lack of respect for your autonomy. This can be different than a therapist providing you with skills to handle a situation, encouraging appropriate behaviors, expressing concern about choices, or challenging your thinking on a topic, which can all be normal parts of the therapeutic process. While a therapist can respectfully disagree with choices, attempting to force you to do something is inappropriate. You are in a vulnerable position as the client, and that vulnerability requires respect, not compliance.
Inappropriate use of power dynamics: If a therapist is focused on being “right” rather than empowering you, they are making their perspective the focus of therapy. When a therapist cannot or will not explain their thinking or perspective to you, but is insisting that they are right, this is a red flag and could highlight someone with issues related to power dynamics, and who may not have the ability to make your concerns central.
A couple or family therapist is inappropriately aligning with one person in the room: In Couple and Family Therapy we say that the relationship between those in the room is the client. Ideally, we are working to help those in the room understand one another, and while there may be times we need to help one person be understood more than others, overall we are working on the relationships. If it seems your therapist is consistently and inappropriately taking sides and is lacking awareness of this, it may be time to move on.
*There are exceptions to this, such as domestic violence that involves extreme use of power, control, and violence (i.e. domestic terrorism), in which one person can be the source of a lack of safety that needs to be ameliorated before actual therapy can begin.
A lack of confidentiality: Licensed therapists must act in accordance with HIPAA and their professional board. You should expect privacy in session and confidentiality outside of session in all communications. Examples of not adhering to confidentiality include a therapist identifying another client to you, sitting in a coffee shop during your telehealth appointment, or not safeguarding your files. If you have ever had the experience of a therapist not acknowledging you in public, this may be because they are respecting the confidential and professional nature of your relationship. Respecting client confidentiality is necessary for creating a safe environment to explore.
Consistently inaccurate listening and reflecting: A good therapist will work to understand you, with empathy. This means that the therapist will work hard to ask you relevant questions, noticing – not avoiding – details that you share and show through behaviors. In general, a therapist should not just be sitting there saying nothing. Therapy is generally about helping people understand themselves and others, and a therapist who is not able to regularly and accurately reflect what you have shared will be limited in how much they can help you.
Criticism or sarcasm, judgmental, shaming: If a therapist is critical, sarcastic, judgmental, or shaming of you or others in the therapy session, it is likely time to find a new therapist. These behaviors create a lack of safety, are not therapeutic techniques, and do not promote change effectively. However, a therapist helping you to notice your responsibility in a situation can be a normal part of therapy.
Inappropriate self-disclosure: While some therapists reveal aspects of their personal lives in appropriate and effective ways, self-disclosure can also be used inappropriately. If a therapist is sharing extraneous and/or unrelated personal information, asking you for advice, or looking to you for support, then they are not respecting the therapeutic relationship. Some styles of therapy rely on self-disclosure more than others. If you do not want a therapist who uses self-disclosure, tell them and see how they respond to get more information about what to expect from that therapist.
*I use only very limited self-disclosure in my practice.
Unprofessional behavior: Consistency, reliability, competency, goodwill, good judgment, and honesty all create a trusting therapeutic environment. A therapist who does not take responsibility for missing an appointment, who asks questions for their personal interest rather than in service of your therapy, or who is dishonest, cannot offer the trust necessary for a healthy therapeutic alliance. Because therapists know intimate details about your life, using the bond you feel toward them to excuse inappropriate behavior is manipulative.
*People have different levels of comfort regarding timeliness, use of language, and dress. And therapists are people with their own ways of being. I encourage you to listen to yourself; If the therapist’s way of being is uncomfortable for you, another therapist may be a better fit.
Dismissive, not taking your concerns seriously: If you express concerns about something that the therapist is doing or saying, pay attention to how your therapist responds to you. Do they use the communication skills they have taught to you during therapy? Do they take your concerns seriously? If a therapist dismisses your concerns, changes the subject, responds defensively without a more curious follow-up, or is not able to meet your needs, it could be a sign that it is time to move on from the relationship.
All therapists make mistakes, but a therapist who is willing to notice and consider a mistake is showing a willingness to be vulnerable with you. Sometimes therapists do not know they have made a mistake and so it can be helpful for the client to tell them. Ideally, when a client is vulnerable enough to share their perception of the therapist, the therapist can attune to the client’s experience and respond empathically. The relationship between the therapist and client is often central to personal change. A therapist making repairs in the relationship with a client can be impactful in the therapeutic process. However, if harmful actions or words are egregious, or repetitive, or show malice or indifference, or are self-serving, these are all red flags and signs that it may be time to terminate the relationship with your therapist.
Ending the therapeutic relationship for any of the above reasons is challenging. Your therapist likely knows deeply personal information about you, but if they are not respecting what you have already shared, it may be best to cut your losses sooner rather than later.
