When to Call Out Your Therapist
by Stacie McLean, LMHC
I am insanely lucky. The group of folks I work with are a fabulous collection of intelligent, people-loving, kind, and stand-up professionals. We all strive to hold each other to a high standard of care and give straight feedback when we see something that can be improved. It’s good for the group, good for clients, and good for our growth as clinicians.
The key message here is that a therapist who knows what others are feeling and thinking about their work is a happy, productive therapist. A good therapist will take your feedback in stride. We know that even frustrated, impatient feedback is happening for a good reason, and we want to know what it is. If we feel the need to get defensive, we keep ourselves in check as we wonder, “What the heck is going on??” Client feedback can make or break a course of therapy.
I’m organizing ways to advocate for yourself into two categories. The first is the soft-boiled category, things that inadvertently put you off but can be resolved through a little self-advocacy. These are times I urge you to speak up and let me in on your thoughts, as a productive outcome is likely. The second is the hard-boiled, deal-breaker category. In these cases, it’s up to you to decide if you think you can or should confront your therapist, but you should definitely find a new therapist!
In any case, if a therapist becomes defensive and doesn’t seem to want to hear you or be transparent with you about his or her process, it’s time to shop for a new therapist. I don’t hesitate to explain myself! Even if you ultimately decide you’re like a different provider, if you don’t feel like I’m safe and transparent, we aren’t going to get much done before you give up. I don’t mind if my personality isn’t a good match for you, but I’d really be doing something wrong if I turn you off of counseling altogether.
The Soft-Boiled, or Small Therapist Missteps
1) The therapist doesn’t seem to really hear what you are saying.
This can happen for a number of reasons, most of which are entirely fixable. First, there may be cross-signals between the way the therapist communicates and the way you express concerns. One or both of you may come to the therapeutic relationship with different feelings about what it means when people shake their head, sit in silence, vent in frustration, or other nonverbals. Regardless, I want to know if you feel unheard.
Suggested feedback: “I’m not sure I’m really getting my point across. Do you feel like you’re getting it?” A good therapist will either say, “I’m confused, let’s try again,” or repeat back their understanding of what you’re saying and confirm that it’s right.
2) The relationship therapist seems biased against you.
This can happen because it’s early on in therapy and the therapist hasn’t gotten the whole story yet. If you feel like you need to share things without your family member present, say so as soon as possible. Many therapists build individual sessions into their relationship work at the beginning to make sure there is nothing hinkey going on. If yours doesn’t and you need it, ASK. Apparent bias can also happen because sometimes a person’s anger can’t be soothed until they feel heard. I may need to repeat back an angry, “It just doesn’t feel like he EVER gets it!!” That doesn’t mean I buy into it as the truth, but it does mean I need to validate the person’s emotional reality so they can calm down. They can’t get to the hurt if they’re still fuming. If the bias seems to linger, please let us know! We may need to recalculate the route.
Suggested feedback: “This doesn’t feel balanced. I feel pretty blamed, here.” A good therapist will address your concern immediately and you should feel at least somewhat reassured by the response.
3) The therapist is always running more than 5 min late.
On occasion, we’re going to be late. Even the most time-conscious therapist sometimes has a crisis dropped in her lap at the end of a session and we cannot send distraught people away if they are unsafe. Sometimes we have to field a crisis call between sessions for someone who’s gone missing or is acutely suicidal. Sometimes, despite our best efforts to regulate emotion and time sessions, a couple breaks out into an explosive fight in the last 5 minutes and we have to simmer it down before we close. Rest assured, we’ll do the same for you. However, if the therapist is regularly impinging on your time and you can’t stay the extra 10 minutes to make up at the end, please say something. We want you to be happy with our services. If we need to restructure our time to make sure we’re ON time, then it’s on us to do that.
4) The therapist just doesn’t seem to be a good fit for you.
This could be either a soft-boiled or a deal-breaker. Sometimes the therapists just needs to know that you’d like a more structured treatment plan, or you really would rather just talk, or a therapist’s well-meaning self disclosure isn’t helpful to you. We can be surprisingly flexible in our treatment approach. But we do need to know how you feel so we can make the changes you need. I know it can be hard to confront us, but we just might be able to make things better! If my response to your concerns doesn’t reassure you, it’s probably a sign that we’re not a good match. At that point I am happy to help you find another provider who can really get you.
The hard-boiled: Deal-breakers
You are never obligated to help a professional fix their behavior. If you have a solid rapport and feel like your therapist will take your feedback well and address the problem constructively, please do so! If you feel like the relationship isn’t a safe space for you, it’s ok to just bow out.
1) The therapist isn’t clear about his rates.
It needs to be written, signed, and agreed-upon at the outset of therapy.
2) The therapist breaks confidentiality.
This is one of the two biggest ethical no-nos (the other being sexual misconduct). Please review the HIPAA documentation you were given at the outset of therapy so you know when the law allows and requires confidentiality to be broken. Everything else requires your written permission.
3) The therapist makes you feel fuzzy around her feelings about you.
Is it starting to feel like more than a professional relationship? This is the second cardinal no-no of therapy. Confront or bow out. This is ALWAYS bad for clients, even if it seems to feel flattering at the time. Report to your state’s health department if there are any obvious romantic gestures, such as inappropriate touching, unwelcome suggestive comments, or invitations to meet outside of therapy. Even if you are in that place where you are craving your therapist’s attention (and who doesn’t at times?) you will always be the one who gets hurt and they will always end up with the upper hand. This is why this type of relationship is strictly verboten.
On the other hand, an invitation to attend a public life event such as a wedding, funeral, baptism, or graduation is not generally considered inappropriate if it is at your request. Therapists are generally allowed to attend the ceremony but can’t stay for the party. You may also request your therapist support you at an especially scary doctor’s appointment, though you will have to take separate vehicles. Different therapists have different policies about meeting outside therapy. Private recreational meet ups are always, always off-limits.
4) The therapist is clearly not accepting of your spiritual beliefs or basic moral values, or pushes their own on you.
I have had clients tell me, “My last counselor told me my religious beliefs were my problem.” My response is invariably a befuddled look and a, “WHUT.” This can be deeply invalidating and make you afraid to disclose your more vulnerable uncertainties and questions. It’s perfectly okay to tell your therapist that you’d rather find another practitioner if you just can’t see yourself getting comfortable.
If there is a difference in value systems, a good therapist will beat you to the punch and say something like, “I have to tell you that I have a personal bias against abortion that may unintentionally influence my work despite my best intentions. I do NOT want you to feel judged or pushed. If you don’t feel totally supported, I am very happy to help you find someone who is a better fit.” Another way a therapist might put it is, “I feel like working with abortion is outside of my competence. It’s better to help you find someone who is very experienced with it.” Both of these statements are the therapist’s way of telling you that they don’t want to send subtle disapproving signals to you that might actually make your distress worse. Worsening your distress is NOT what we want to do!!
If a therapist starts telling you what to think or believe before they even get to know you, it’s generally not a good match. Plus, we understand that an atheist client is going to feel super uncomfortable in an office full of Jesus pictures, and a Christian might feel pretty put-out trying to be vulnerable in an office with Buddhas or crystals. Your comfort is my concern!
5) The general list: could be time to move on.
Here’s a quick list of things to look out for that may signal it’s time either confront or bow out. Therapists are generally prohibited from: proposing or accepting business partnerships or deals with clients, accepting or giving gifts of more than nominal cash value, trying new techniques on you without informing you they are experimental, cutting off contact with no follow-up, accessing your personal information (such as your social media profiles) without good clinical reason, interacting with you online except for agreed-upon email parameters and use of practice software, giving or receiving car rides with clients, giving medical or legal advice, doing therapy with friends or family, recording you without your written permission, or writing letters on your behalf unless they are specifically related to the counseling problem, within the therapist’s scope of practice, and based on clear, in-person observation. For example, I cannot write letters saying that my client is a good or bad parent; I am not a parenting evaluator. I might have personal opinions on the subject, but I can’t write a letter about it.
6) A short note about what we CAN do that might surprise you.
There are a few things we are generally allowed to do that you might not love, but you should know about. We can and MUST break confidentiality in cases of harm. This varies by state, but in WA, authorities must be notified of imminent danger to self or others, abuse or neglect of a child, and abuse or neglect of a vulnerable adult. We are also generally allowed to refer you to another provider without your agreement if: We don’t feel competent in treating your concern, we don’t receive payment, we become unable to work, working with you creates a situation that would violate someone’s rights or confidentiality, you make us feel threatened, you harm us or our property. We are also allowed to consult with other professionals about your case as long as we don’t identify you, though we should tell you at the outset that we do this.
As a general rule, your comfort and safety and that of the community as a whole is of paramount importance to a good therapist. It really helps us to do our jobs if you can let us know when what we are providing is different that what you need. Maybe we can resolve it, or maybe we can’t, but in either case, we want to make sure you are getting the best care available. We invite and depend on your feedback! You are never responsible for fixing a therapist’s behavior, but if you feel like you can speak up, a good therapist will be grateful and make you feel glad you said something.