50 Warning Signs of Questionable Therapy & Counseling
February 12th, 2008 |
The items listed below are significant red-flags and important information for anyone in therapy or considering therapy. If any of the following red-flags appear during the course of your counseling, it may be time to reevaluate your counselor or therapist. Should you recognize one of these red-flags, the first step, in most cases, is to discuss your concern with your counselor. Try talking candidly about what’s bothering you. A good therapist should be open and willing to understand your concerns. If your counselor doesn’t take your concerns seriously or is unwilling to accept feedback, then it’s probably in your best interest to consult with another therapist about it. Most therapists mean well and are willing to take accountability for their own “stuff.” So, it’s also important to give your therapist the benefit of the doubt…all people make minor mistakes. And sometimes what people think is their therapist’s issue, is actually their own. These “blind spots” can be the most difficult to see and are well worth taking about with your therapist.
It’s also important to note that the following red-flags have varying degrees of significance. Some of them are very serious violations of ethical standards, such as a therapist attempting to have a sexual relationship with a client. There is no exception to this rule and if you find yourself in such a situation you are advised to report to the state professional licensing board and consult with other professionals. However, a number of the red-flags listed below do have “exceptions to the rule” and depend partly on the context. For example, it’s generally unacceptable for therapists to have dual relationships with their clients. So if a counselor is treating the neighborhood barber for his depression, the counselor goes to a different barber to avoid confusing the “client-therapist” relationship. However, in small communities it can be impossible to avoid certain dual relationships. Ethical guidelines are flexible enough to take this, and some other exceptions, into account.
In no particular order, it is a red flag if you find that your:
1.Counselor does not have sufficient and specific training to address your issues and/or attempts to treat problems outside the scope of her practice.
2.Therapist is not interested in the changes you want to make and your goals for therapy.
3.Counselor cannot or does not clearly define how she can help you to solve whatever issue or concern has brought you to therapy.
4.Therapist provides no explanation of how you will know when your therapy is complete.
5.Counselor does not seek consultation with other therapists.
6.Therapist makes guarantees and/or promises.
7.Therapist has unresolved complaints filed with their licensing board.
8.Therapist does not provide you with information about your rights as a client, confidentiality, office policies, and fees so you can fairly consent to your treatment. Note: The information provided to new clients by therapists differs by state and licensure requirements.
9.Counselor is judgmental or critical of your behavior, lifestyle, or problems.
10.Therapist “looks down” at you or treats you as inferior in subtle, or not so subtle, ways
11.Counselor blames your family, friends, or partner.
12.Counselor encourages you to blame your family, friends, or partner.
13.Therapist knowingly or unknowingly gets his or her own psychological needs meet at the expense of focusing on you and your therapy.
14.Counselor tries to be your friend.
15.Therapist initiates touch (i.e., hugs) without your consent.
16.Counselor attempts to have a sexual or romantic relationship with you.
17.Therapist talks excessively about himself and/or self-discloses often without any therapeutic purpose.
18.Counselor tries to enlist your help with something not related to your therapy.
19.Therapist discloses your identifying information without authorization or mandate.
20.Counselor tells you the identities of his other clients.
21.Therapist discloses that she has never been in her own therapy.
22.Counselor cannot accept feedback or admit mistakes.
23.Therapist focuses extensively on diagnosing without also helping you to change.
24.Counselor talks too much.
25.Therapist does not talk at all.
26.Counselor often speaks in complex “psychobabble” which leaves you confused.
27.Therapist focuses on thoughts and cognition at the exclusion of feelings and somatic experience.
28.Counselor focuses on feelings and somatic experience at the exclusion of thoughts, insight and cognitive processing.
29.Therapist acts as if she has the answers or solutions to everything and spends time telling you how to best fix or change things.
30.Counselor tells you what to do, makes decisions for you, or gives frequent unsolicited advice.
31.Therapist encourages your dependency by allowing you to get your emotional needs meet from the therapist. Therapist “feeds you fish, rather than helping you to fish for yourself.”
32.Counselor tries to keep you in therapy against your will.
33.Therapist believes that only their counseling approach works and ridicules other approaches to therapy.
34.Therapist is contentious with you or frequently confrontational.
35.Counselor doesn’t remember your name and/or doesn’t remember your issues from one session to the next.
36.Therapist does not pay attention or demonstrate he’s listening and understanding you.
37.Counselor answers the phone during your session.
38.Therapist is not sensitive to your culture or religion.
39.Counselor denies or ignores the importance of your spirituality.
40.Therapist tries to push spirituality or religion on to you.
41.Counselor does not empathize.
42.Therapist empathizes too much.
43.Counselor seems overwhelmed with your problems
44.Therapist seems over-emotional, affected, or triggered by your feelings or issues.
45.Counselor pushes you into highly vulnerable feelings or memories.
46.Therapist avoids going near any emotional or vulnerable feelings.
47.Counselor does not ask your permission to use various psychotherapeutic techniques.
48.Therapist tries to get you to exert overt control over your impulses, compulsions or addictions without helping you to appreciate and resolve the underlying causes.
49.Counselor prematurely and/or exclusively focuses on helping you to appreciate and resolve the underlying causes of an issue or compulsion when you would instead benefit more from learning coping skills to manage your impulses.
50.Your counselor habitually misses, cancels, or shows up late to appointments.
If there are other warning signs or red-flags you’d like to add to this list, feel free to make a comment and we’ll consider adding it to the list.
© Copyright 2008 by http://www.GoodTherapy.org Therapist Columbia Bureau - All Rights Reserved.
95 comments so far
This is a good, comprehensive list. Thanks for taking the time to write these down!
It is a great list, I agree. And, I think it is useful for both client and therapist. Sometimes as therapists we do need to be kept on our toes. I think I’ll post this list in my waiting room for my clients and in my office for my own reminders.
My daughter goes to a therapist, and I am glad to see that this therapist seems to follow this list very well. She has made a huge difference in my daughter’s life and I am very, very grateful for her. Some of the items on the list I actually laughed at, such as answering the phone during a session. But, I am sure that if it made the list, someone somewhere has done it. But, I’m glad I haven’t had personal experience with this item-that would be very frustrating and maybe even embarrassing.
I would be concerned if a therapist’s degree proved to be from a non-accredited institution, or if his or her only training relevant to the problem being treated was through workshops outside of a degree program. I would also be concerned if the person presented as credentials “diplomates” or other certifications offered by self-credentialing membership associations rather than by national professional organizations, or claimed board certifications other than those managed by national professional associations.
A therapist who sees a remarried couple when one of the partners was in counseling with the same therapist with their former spouse.
Should a good therapist in the beginning stages of the therapy request a historical summary of the client in order to provide good counseling? I have a friend in counseling and the therapist did not ask for historical family information. This friend comes from alcoholic family…..Should we be concerned?
Not necessarily. Actually there is no research evidence to suggest this is important, although it is common and the norm in therapy practice. Many excellent therapists will skip this information in order to use the time to simply get started solving problems. Often problems can be solved without the history.
It is important to track if therapy is helping and if the client feels understood. If either of these things is not happening by the third session, research indicates a good outcome of therapy is considerably less likely.
If your friend feels it is important to tell his/her story and social history, it is worth while to speak up about that. The therapist should be able to adjust.
Not necessarily. Actually there is no research evidence to suggest this is important, although it is common and the norm in therapy practice. Many excellent therapists will skip this information in order to use the time to simply get started solving problems. Often problems can be solved without the history.
It is important to track if therapy is helping and if the client feels understood. If either of these things is not happening by the third session, research indicates a good outcome of therapy is considerably less likely.
If your friend feels it is important to tell his/her story and social history, it is worth while to speak up about that. The therapist should be able to adjust.
If a person is from an alcoholic family and the therapist does not know addictions, I suggest they refer to a qualified clinician! That individual is an Adult Child Of Alcoholic (ACOA) and that is huge! That brings a host of other issues that must not be over looked!!!!
I would be wary of a therapist who is limited to one type of theraputic approach. For example, the therapist may say, “I’m a cognitive therapist,” goes to cognitive therapy conventions, is an active member of various cognitive therapy associations, etc. etc. Or Transactional Analysis, or Cognitive-Behavioral, or what have you.
Not to sound condescending, but some therapists are overdependent on specific methods to compensate for their lack of skill in other methods, and end up steering the therapy to fit their method, instead of vice-versa.
The really skilled, successful therapists I’ve seen have been eclectic, and are able to provide whatever approach or approaches are effective with their clients. So for me, if a therapist says, “I’m a whoopeekipperedherring therapist,” that’s a major red flag.
Therapist makes sweeping statements of fact using words like “Never”, “Everyone”, ‘Always”;’ “You behavior would bother anyone”
Therapist takes sides in couple therapy using personal point of view; “Your behavior would bother me too”
I was checking to see if it’s right that your Therapist tell’s you on the phone that she can’t se you any longer cause it’s to hard and she is not going to do abuse Therapy after 7 years leaves you flat with no referals nada nothing. She told me she was going to write me a letter and send me a referal and has a gift ect…it’s been 25 days and again nothing. I want my case notes from her and I have written 2 times a letter requesting them and nothing. I need some advice.
Thank you
I was checking to see if it’s right that your Therapist tell’s you on the phone that she can’t see you any longer it’s to hard and she is not doing abuse Therapy after 7 yearsand no warning. She left me flat with no referals nothing. She told me she was going to write me a letter and send me a referal and has a gift ect…it’s been 25 days and again nothing. I want my case notes from her and I have written 2 times a letter requesting them and nothing. I need some advice.
Thank you
Under HIPAA, you have a right to your treatment records, and I think it’s supposed to be within 2 weeks.
You might not want a referral from someone who behaves like this.
I am very sorry to hear of your experience of therapeutic abandonment, considered to be one of the most egregious problems in field of psychotherapy. If you feel you have been abandoned by your therapist or are in any other way being treated unethically or unprofessionally, you can report your grievance the therapist’s licensing board. This should be fairly easy to find online be searching for “your state” and “the therapist’s specific license or title” and the word “board.” There are thousands of great therapists out there; be sure to shop around and follow the guidelines on this site and others in selecting your next counselor or therapist. I hope you will not be too discouraged by this experience which is unusual and fairly rare I would say and that you will find another therapist very soon.
I don’t agree with all of the 50 red flags on the website. I think if you the therapist cares about you, tells you he or she can help you, and you see yourself making some progress, then keep going back. The answering phones during session, this happens with my therapist. On the other hand, when I have a problem and need guidance, he answers the phone almost 24 hours a day. Even during other patients’ sessions. So when he does this for other people during my session, I think that’s okay. I would say though if you are seeing someone and you don’t like their behavior, let them know and talk about it. Or go visit other therapists as well and look for a good fit. Ask around for referrals and ask what the therapist will be able to do for you or what positive outcomes you can hope to achieve in counseling. Then stick it out.
I have another perspective about answering the telephone during sessions. I am a therapist who recently reentered therapy with an analyst who leaves his phone on during all sessions, so that he “doesnt miss his phone appts”. The impact on my session was devastating. The phone rang excessively right in the middle of my discussing how difficult the therapy was for me. When he got up and said “I may need to take this” I was so angry I could barely speak. He did not take it, but when I asked what would happen if he did need to take it, he replied that I would need to step out of the room. I immediately imagined that if he asked me to step out, I would walk out and never return. It would feel humiliating to be asked to “step out”. All I can say is that I cannot imagine being in the middle of a really difficult moment, even more than I already was and having the phone ring and ring. As a therapist, I am always apologetic and quick to act when I accidentally leave the ringer or my voice mail on and there is a disruption in a therapy session. Sometimes intrusions are unavoidable, they happen. But how can one ever really relax into a session, knowing that the therapist is allowing the intrusion? I will discuss this further with this therapist, but am losing hope about a positive outcome.
add:
therapist falls asleep!
Lisa:
Your analyst sounds like a narcissistic and rather incompetent person. Please consider expressing your emotions to him and then finding another therapist.
A very informative and helpful blog here.
Thanks for this excellent list! i feel more prepared to find a therapist now that i know the warning signs of bad therapy..
I would add that you should also expect some sort of clients’ rights statement and an Informed Consent document from your therapist. We post our client rights document and privacy statements in the waiting room and keep copies there for clients. In addition, all of our clients receive, read, and then sign and informed consent document, a copy of which is also in our waiting room and on our website. (see http://www.Center4FamilyDevelop.com ).
My Therpist still will not give me my file or any pictures ect. she said I would hav to get an order from the court. I think she is scared at what she put in her notes or something…don’t get it..She did everything wrong when she terminated our sessions and she knows it. I have never felt so bad she left me now with bigger issues. I feel ashamed that I ever went to her and confided in her regarding my abuse, I feel like she was the bigger abuser and to start all over will kill me to much stuff.
I am sorry, RI, to hear about your difficulties.
If the you were seen with a partner, then the therapist would need consent from all involved, or their guardians. If the file only concerns you, then under HIPPA regs you are entitled to view the file and make or have made copies at reasonable cost. If there is a lawsuit pending, that may complicate matters.
I hope this helps.
regrds
My therapist is a lovely woman except she has on numerous occasions started to cry during my sessions (not sobbing! but tears). She is very professional in every other sense although this to me is inappropriate and very unprofessional obviously leaving me feeling very uncomfortable! Would be interested to know if this has happened to anyone else? I have stopped my therapy with her, it got too much.
Hi Violet, I really appreciated your comment about therapists who cry. I want to let you know that I think it’s actually a sign of health when one can cry and feel empathy and tenderness. For therapists it’s important and natural to have empathy for clients, the experience generally helps people in therapy to open their hearts to themselves. Of course, some therapists cry because their own soft spots and unfinished places needing attention to a degree that interferes with the clients own work… I can’t tell for sure from what you have told me if this is a case of a therapist needing to clear some feelings up for themselves or you feeling vulnerable or something else altogether. For example, you may have also felt like she pitied you. Whatever the case, I believe that your therapist was pushing your button by crying, but that it is your button. My hunch is that this could be a wonderful opportunity for you to explore your feelings about being vulnerable. I tell my clients when they start therapy with me that it’s possible during the course of therapy that they may develop a desire to quit. A client’s aversion to run from therapy as fast as possible is often protecting the most important and vulnerable material. So I highly encourage you to talk with you therapist about how you are triggered by this, rather than stop therapy. Finding a therapist who is less triggering could be less productive for your therapy and there may be many gifts and treasures to discover by exploring this. Noah
I will echo what Noah has said and so not repeat those excellent points here.
I will add that the sharing of emotion (technically called intersubjectivity) can have a very positive and healing effect for persons, especially those who have experienced trauma and who may feel alone, uniquely violated, and defective because of the abuse. Sharing affect with a client can make the emotions less disturbing and help the person feel understood on a very deep level.
Regards
Art
15 yrs. ago I went to a LCSW about issues within my marriage of 2 yrs. She learned she was pregnant by the 2nd visit we had and from that point on I became the listener during our sessions. Needless to say some of the issues I had involved our infertility & her constant talk of how happy she was about her news became difficult for me to hear and did not help me. After my 6 visits to her at $75/ea. (even w/insurance I considered it a sizable investment on my part) I finally explained to her that we were not achieving anything of value to me and told her that it would be the end of “my therapy” with her. I was not trying to surprise or hurt her feelings, but she was aghast in surprise. Needless to say, the whole thing gave me pause to consider therapy again, but I did during a time when both my Dad & mother-in-law were suffering cancer & sent to their respectives home admitted to hospice on the same date. It was a much better experience with the therapist I got 6 yrs. ago. Knowing the time I would need to spend with parents made it clear to both me & my therapist when we were done. I would return to her, but to be an informed therapy consumer takes alot of work. With lack of clear thinking & forgetfullness being part of my problems now I am reluctant to trust or test my abilities to get therapy care again, although I would like to do so. Are professional geriatric care managers a trustable resource to help one select therapy providers? I have concerns about conflicts they may have much like the drug trial researchers who also maintain private practice. I still have insurance, but co-pays are considerably higher now. Cost-effectiveness is key for me.
A decent source of referral is your PMD (primary care physician). You could also consider asking trusted friends.
hope this helps.
Please add to your list
Therapist uses your insurance to committ fraud then blames you for being impulsive and indirect when you turn him into the insurance company…. after “banging your head on the wall” for 7 months for him give the money back to the insurance company to allieviate the fact that you are now conspiring with him to defraud the insurance company since you know he did it.
I went to a therapist for almost 4 years. She helped me see that I needed to have my partner in therapy too. Her whole program is based on finding your truth and being in truth so this was considered brave work. My husband did not want to go to this therapist because he felt she and her partner husband were cultish. They have a book and a forum. She warned me about other therapists, but I found some one for marriage counseling. Meanwhile I still saw my therapist. Our sessions ended up being a dissection of the marriage counseling. She finally announced to me that I needed to make a choice to really dig in or not become enlightened. She said I was backtracking and that some of my forum posts showed “narcissistic presentations.” I told her that no one had the right to tell someone if they were becoming enlightened or not.She said her training made her especially capable of making these judgements. There were also comparisons on the forum of peoples work made by the husband/wife therapy team, like “so and so is making an amazing discovery while many of you are digging your head in the sand.” This was written as cowardly. This felt like control by threat. I finally did leave the original therapist, but I have struggled with the quitting and feeling like a coward ever since. Does this seem kosher?
Another indication of an unskilled councellor may be, one that is too much on “your” side.
While they intend to support your self-esteem, validate your experiences, and build your confidence; they can create an inhibition on your part to reveal less attractive thoughts or behaviors of yours, for fear of losing their positive regard towards you.
Also, concerning a therapist reflecting the emotional content of the client’s communication.
Sometimes client’s are so removed from their own experiences, they are unsure what emotion they do feel as a result of the experience.
They may have removed themselves from the experience because the emotion was too painful. Seeing the therapist express the “emotion” that they fear having, may be painful for them.
Depending on wether the client is ready to explore that emotion relating to their experience, they may move forward with the exploration, or away from the theraputic relationship.
Often, when the therapist models emotion, as a result of the client’s disclosures; this display of emotion may give validation and permission to the client to themselves feel, or have a corrective emotional response to the causitive event.
It seems to me that many children suffer a sort of dissociation from their feelings as a result of parental rejection, hostility, anger and displeasure; and try to defend and appease their parents by not showing an emotional response that would only further inflame their parents, or caregivers.
Therefor, the therapist in demonstrating the emotion, can help the client in articulating the problem.
Also the emotional response of the therapist, may be the “gut” reponse to more than just the words of the client, but the entire communication of the client verbal and non-verbal, of which the client is not aware; and at times the therapist is not yet aware of, until the emotional response is explored by both. The therapist then becomes a surrogate for the client’s emotions.
This is especially true of dealing with trauma to “the child” within the client.
Young children can suffer much abuse before they become able to well represent what has happened to them in verbal form. In order to remember an event, or the situations surrounding it, one needs a system to record it in one’s memory. Without being able to use language, there are very limited ways to record this, which tends to be the reason many people do not remember their early childhood.
Even in early childhood, critical and abstract thinking are not available to record what has happened to one, and so the cause and effect of situations often can not be remembered by an individual in a way they can make use of.
What was not put into a person’s psyche verbally (or logically), and is not represented in their memory verbally; needs to be removed in the way it was put in. Often only the emotion can be used to pull that experience out, in order to look at it, and deal with it, grow, and move on.
Jalaina
Jalaina,
You make a number of excellent points here. I would like to just under score and amplify one, if I may. As is often the case with children, especially those who have experienced chronic early maltreatment within the caregiving relationship, adults may have difficulty knowing what they feel or experience. In those instances, it is very important and helpful for the therapist (or parent with a maltreated child) to reflect back what that person believes the client or child is experiencing/feeling. When asked, “what do you feel,” you may get, “I don’t know,” which may be true. In many ways, this reflecting back of the emotion and experience is what occurs in a healthy parent-child relationship and is an essential part of the development of a healthy and secure pattern of attachment. The developing infant and child comes to know what the child feels by seeing it reflected in back from a responsive, sensitive, insightful caregiver.
Art
Hows about therepists who ignore the issues you want to talk about, and press on things you dont regard as important? I had a therapist who kept trying for things in my childhood or family,, and I had to fight to try to talk about what I wanted to talk about
I also have had a few unfortunate experiences with professionals who are supposed to help, and never hurt. My psychiatrist of 9 years terminated by sending me a form letter – she actually just put my name after the Dear… part. That was it. The damage she did – it was one of the hardest things for me to handle. I just can not understand why anyone, but especially a professional, would treat someone like that. Needless to say, I now have more trust issues than ever. Does anyone know if this is something that could be reported? Thanks.
Dear Mara,
In thinking about the termination through the letter, I have a couple of questions. One, had you been seeing this psychiatrist regularly? ie weekly or every other week? Two, has there been a long time since your last appt. or did you either cancel and reschedule or not show up for appts? Sometimes a clinician cannot have a patient on their caseload who is not keeping appts. It actually becomes a liability for them. They have no choice but to terminate after several attempts to schedule or contact you.
If she is leaving her practice entirely, a letter may the way she notifies a large case load.
If you have been seeing this psychiatrist regularly, I would indeed imagine that you would feel hurt by this kind of notification. This is worth discussing with her. She would need to know the impact of this letter on you.
It is clear though that you do feel hurt by this, so I encourage you to contact the psychiatrist to express yourself.
has anyone had their therapist ask ‘you don’t mind if i eat my lunch, do you? i haven’t had the chance to, and i’m really hungry!’ i was floored, and so spent my 50 min. w/ her eating a sloppy roll-up. and she was my meds mgmt counselor…. notice i said ‘WAS’!
I also had a therapist that would sit and wait for me to say something and get mad that I was not working at it. I would ask her if we could draw or do something else that would help me to feel more comfortable and her response would be “we already tried that and that does not work with you” she also said she was not that kind of thearpist and I should go see someone else. As i worked with her futher she changed a lot she was not warm and fuzzy any longer but hard and mean. When she did dump me she said she no longer looked forward for me coming to see her, and i became harder to work with…..blah blah….she also told me that she no longer wants to take sexual abuse cases it’s to hard on her…well, the damage he did was more than I could bear. When I did discuss this with her she told me I have a personality disorder (were did that come from?) out of the blue? put the blame on me. I want to sue her for my money back I’m totally serious..9 years at $100 an hour. and she left me worst than ever It’s a crime to do this to people..how do they get away with wrecking your life and you give them money? she was nice for a long time then turned on me like it was my fault I lost all faith in Therapist it’s all lies.
These have been excellent issues and a very good discussion. I think that a therapist should be cognizant of their client’s process and respond in a manner to elicit a constructive discussion. It is important to be in sinc with the client’s manner and style of relating and to connect with the client and then help the client look at their manner or relating in a therapeutic and helpful manner.
regards
art
Keep in mind there are differences in Shrinks.
Investigate alot before you entrust your care, because it’s your Personal Risk you are handing them your mental health. Good Psy. is wonderful, a bad experience affects you for Life.
As moderator of this blog thread, I decided to post the above comment by Trace because her second paragraph is quite supportive and valid. However, Trace’s second sentence was incorrect and potentially slanderous. I removed it.
Here’s what she wrote:
“LCSW are (just) Social Workers w/a Masters Level and not as much experience and are not held to Ethics as strictly as PSYCHOLOGISTS who hold Doctorates. Also, be aware there are some Social Workers who have Drs in other fields.”
Here’s why I removed it:
LCSWs can have just as much or more post graduate training in psychotherapy as any psychologist. Also, the idea that social workers do not adhere as strictly to their ethical guidelines as psychologists do to theirs is false and terribly misleading. Not only is it a generalization to speak of any group in such black and white terms, it’s an incorrect characterization about professional Social Workers. In fact, the ethical guidelines for Social Workers are highly respected in the field of mental health as an enormous effort to prevent harm.
Any other LCSWs or folks from other mental health professions want to chime in?
Sure admin, chiming in here about the LCSW vs. psychologist choice, and speaking as a psychologist…. The research is very clear neither discipline is better than the other in terms of therapeutic effectiveness and this finding is across disorders. Years of experience is also not at all correlated with effectiveness. The caution to “investigate a lot before you entrust your care” is fine as long as the client is not second guessing their own judgment. What predicts a good outcome is the client’s judgment of the goodness-of-fit between client and therapist, as well as the client’s judgment of improvement in the first three sessions.
I would like to echo the administrator’s comments. But before I do, I don’t understand why the administrator posted the material that was deemed incorrect and potentially slanderous? Why not just post Trace’s edited post with a note that parts of it were deleted for the reasons stated?
In any event, the administrator is correct. If one goes to the website for the National Association of Social Workers and reads the code of ethics it is every bit a stringent, specific, and highly ethical as that of those who belong to the medical professional and psychology profession. In addition, the “not much experience” is also incorrect. Those with a MSW must do an internship that accounts for about half of the required 60 credits. A MA in psychology, for example, only requires 30 or so credits and no internship. An MFT or MA in counseling may have different requirements. To be licensed (LCSW, for example) usually requires passing a National test, presenting verification of a certain number of years experience (varies by state) and letters from supervisors.
I’d be interested to hear from MFT’s, MSW’s, and LPC’s on this site.
regards
art
Thank you for the site and the interesting topic.
First let me clarify.
I’m an MSW in the process of completing my licensing hours (3200) post degree.
I will complete those hrs in March or shortly after March of 2009 and begin preparing for my LCSW tests.
In the State of California there is a written and an oral exam. The oral exam is now a written series of Vignettes. I will also take the “single” National Exam. (This is by choice as I work for the federal government and could just take the national exam and leave it at that). But California does not participate in the SW national exam so you MUST take California two exams to practice in California. I still don’t really need to take the exam but it is a challenge so I will push myself to do it.
It has taken me 6 years (counting 4yrs undergrad) to complete the degree alone. And two years minimum to complete the post degree 3200 hours of supervision. That’s 8 years and now I’m looking at two separate tests (3 actually). Mind you I have been working in the field long before & during my degree quest. As a case manager and addictions counselor.
Now as for the degree it self.
It was required that I complete a minimum of 80 units. Of those 80 units not one unit of the internship is counted as a “class” or part of the 80 units needed to graduate. It is counted as Hrs.
In social work this is a true internship and it is part of the curriculum to qualify for the MSW degree. Very much like the medical degrees.
You must complete during your degree! an internship of 1080 hrs minimum.
This is usually completed within two years but in some cases with approval from the academic standards board at the University, you can extend the degree to three years.
Also let me just say that the MSW degree is still the ONLY degree in the mental health field, except psychiatry. That requires the student to attend a major university. ALL other degrees have online courses that have been approved by their respective boards/professional organizations.
The standards for the MSW degree are huge. For good reason, the MSW degree is also the oldest mental health degree and profession in mental health, except psychiatry. In the years to come you will be seeing more and more (DSW) & PhD in Clinical Social Work there are many programs now and more coming.
I have therapist I rely on that is an awesome guy. He is a PsyD and a wonderful therapist and person. I have had other therapists of different degrees but we just seems to be able to connect on many levels and I think that’s what people should be looking for when attempting to get help with very personal and private issues.
The ability for two people to relate and communicate on even ground with trust and honesty. This process takes time, patience and requires focus on the relationship. Credentials are very important as well as licensing.
What is a LCSW? ——–
The American Board of Examiners in Clinical Social Work (ABE) sets national practice standards, issues an advanced-practice credential, and publishes reference information about its board-certified clinicians.
Clinical Social Work Defined
Clinical social work is a practice specialty of the social work profession. It builds upon generic values, ethics, principles, practice methods, and the person-in-environment perspective of the profession. Its purposes are to:
Diagnose and treat bio-psycho-social disability and impairment, including mental and emotional disorders and developmental disabilities.
Achieve optimal prevention of bio-psycho-social dysfunction.
Support and enhance bio-psycho-social strengths and functioning.
Clinical social work practice applies specific knowledge, theories, and methods to assessment and diagnosis, treatment planning, intervention, and outcome evaluation.
Practice knowledge incorporates theories of biological, psychological, and social development. It includes, but is not limited to, an understanding of human behavior and psychopathology, human diversity, interpersonal relationships and family dynamics; mental disorders, stress, chemical dependency, interpersonal violence, and consequences of illness or injury; impact of physical, social, and cultural environment; and cognitive, affective, and behavioral manifestations of conscious and unconscious processes.
Clinical social work interventions include, but are not limited to, assessment and diagnosis, crisis intervention, psychosocial and psycho-educational interventions, and brief and long-term psychotherapies. These interventions are applied within the context of professional relationships with individuals, couples, families, and groups. Clinical social work practice includes client-centered clinical supervision and consultation with professional colleagues.
Adopted 12 Feb. 1995
All rights reserved.
Dear Barry,
Very nicely stated. Thank you for taking the time here. The MSW is a “professional degree” (as are the dental, medical, and law degrees, for example), designed to prepare someone for the profession. The MA, MS, and Ph.D. are “academic” degrees. As you mention, the internship standards are pretty intensive and the requirements for licensure are also very stringent.
regards
Art
Your so welcome Art.
Yes the MSW degree is just that, a professional degree.
Which is a little different than an academic degree you mentioned.
That being said, I do think that it is extremely important that we (in the mental health field) know what others do and what their qualifications/skills/talents happen to be.
Mainly, for the obvious purpose of referral and using our strengths in the mental health field as professionals to better help our clients.
We all know people who may be of a different degree or background that excels in a certain type of help they can provide a client. I think there should be more focus on coming together in our profession and using our strengths/talents to help our profession and improve our client outcomes and professional stature within society and with other professionals.
No one wants to think that they have nothing to offer a client. But, all to often that is the case.
I think it is imperative that we as profession begin to operate similar to the medical profession. They form medical groups and they have their specialists in certain areas who like what they do and do it well. There should also be some front line general practitioners in our field.
Mental health groups of all backgrounds would help facilitate this, much like medical groups. I’m a firm believer that all of our degrees and backgrounds are important and have a place in treating our clients. But we all must be able to recognize our own limitations. Whether it is personality, skills, education or personal background.
I’m giggling about the post that asks about the Therapist who eats. My Old Therapist would make me wait for 20 minutes cause she was starving as I read an old magizine she chomped on her to go lunch..when she was finished she would come out and get me. She would finish our sessions and charge me the same even though she was eating…I asked her “what I have to buy you lunch too?” man after paying $150.00 plus lunch no wonder I don’t see her any more. What a rip
I agree AK
It is a rip—Move on!
Find another therapist that is a professional.
Sometimes it takes a few shots at finding the right therapist for you.
I personally would walk out of the session or prior to the 20min being up if my therapist treated me that way. That’s what appt’s are for it is your time not the therapists.
No excuse.
On Dual Relationships. The above statement of “. . it’s generally unacceptable for therapists to have dual relationships with their clients . . . is outdated and inconsistent with the standard of care of psychologists, social workers, counselor, or psychiatrists. Dual relationships can be unethical and illegal, they can also be unavoidable or even mandatory, yet some dual relationships are clinically beneficial. We need to be flexible and learn that the meaning of dual relationships can only be understood within the context of therapy. Dr. Ofer Zur
In regards to the LCSW vs Psychologist …. I admit that I have been wary of Social Workers due to some of my professional experiences with Social Workers … and was quite dubious when I began therapy with a LCSW …. but after 2 years of weekly sessions, I have no qualms about my therapist. I note, however, that it is not so much the training that has been important as it has been the connection we were able to establish ….
Deb,
I think you make a good point, which is that the relationship between you and your therapist is what is essential to getting help and benefits from therapy. (Always assuming your therapist is licensed and appropriately trained for your issues).
regards
Hi. Good site.
I have been seeing a counselor for 16 years for many family events. I cannot afford to see her now. when i told her this she told me that she thought i should not leave therapy. she told me to only pay what and when i could She knows I see another counselor as well through my psychiatrist. I am not sure what to do. I feel guilty but I am more comfortable with her. Also the second counselor keeps her uneaten lunch supplied by the drug reps in her top drawer to munch on between appts:)
I appreciate the opportunity to share my experiences. During my 4th brain injury recovery I too was hugged after each session without being asked. I have a hard time with boundaries and confrontation so I discontinued therapy without explanation even though I really needed further help. I am online seeking that help now after 7 years and noticed this blog. Also going way back to high school, the so-called counselors should not be allowed to advise ‘D’ students to “give up on college and go to a trade school” no matter what their skewed opinion is. What I needed was to overcome fear and devise compensating learning tactics. Since then I have earned a 3.7 GPA at a computer trade school, scored a 97 percentile on the nationwide GATB (General Aptitude Test Battery) and had my IQ tested at 149. I doubt those counselors could match that. I regret skipping college due to my fears, lack of understanding my brain injuries and listening to really bad advice from ignorant school guidance counselors. Think about adding the following item to your list. They should not discourage you from honorable goals.
Dear Denise:
If you believe that your treatment has been beneficial and you believe in your counselor’s clinical competency, then I strongly encourage you to allow your therapist to work with you.
I have gratitude for many clients that show dedication and trust in their treatment with me. Some work harder than others, some more internally motivated than others. I strongly believe that I have an ethical responsibility to continue to see internally motivated clients although their ability to pay has changed. Do I owe that same loyalty to those who are only externally motivated? No, because it would be a disloyalty to keep someone in therapy that is not clinically progressing regardless of their ability to pay. If a client is committed and loyal to their treatment, then yes, I would (and have) reduced their fees to what is reasonable for that client at that time.
As I know the above commits will ruffle some of my collogues feathers, I do want to say I do not believe in “free” therapy because I believe clients must be financially invested in the treatment process even if it is a nominal fee. I believe it is clinically significant to the client’s treatment as well an avenue for me to support the community that I live. In the event that a potentially new client cannot afford the services, there are many community counseling services that receive funding for those who are financially limited and in need of therapy.
As these economic times have become fragile in the past year, I have had a couple of very motivated clients who have been laid off from their places of employment and they have lost their health insurance by no fault of their own. Many clients have issues of past abandonment with authority figures or persons they had entrusted. I believe that refusing to see them in their time of financial crisis would be ethically irresponsible and clinically would be considered to be an issue of abandonment.
So, Denise, it looks like you have a great topic for your next session…how has this issue revealed clinical significance on your issues you are addressing in therapy?
PS-I love this forum! Very thought provoking as a therpaist and excellent real life continuing education. dp
To add another to the list: A therapist telling you not to talk about certain issues, i.e. abuse, political beliefs, death etc, because they are inexperienced to work with the issue /s, or the issue brings something up for them.
My exgirlfriend’s therapist is too personally involved with her. Didn’t let her go everytime she tried to quit therapy and I was never let any involvement in the process.
Supposely the woman gave her one diagnosis to then change it. They are obssesed with each other and that leads nowhere.
Not my problem anymore, thank God Im away from crazyness and I wish now the therapist knows FOR REAL the kinda bullshit she’ll be exposed to from now on…good luck dudes
Therapists are allowed to do whatever in the world they want and noone can hold them accountable for anything. It is plain bullshit that you can file a complain and hold them accountable.
Noone should have that much power.
i saw a counselor who answered his phone four times during my session. he kept apologizing, and then taking the calls, making appointments, etc. This is a sign of poor organization in my opinion, distracts from the work at hand, and is terribly disruptive. i was revealing very heartfelt things when he kept having to stop. Enough. If there’s an emergency going on, then tell me before the session. If there is not one, then the likelihood of it occurring and your being able to do anything about it during the 50min we are together is unlikely. Please answer the calls between appointments, at night or in the morning. Being always available is not helpful, and a lot less productive.
Dual Relationship?
Is it an ethical violation for a therapist / licensed counselor to facilitate and pressure a patient/client to move into their apartment-condo community?
Is it an ethical violation for a therapist/ licensed counselor to socialize and fraternize in the capacity of “drinking buddy” with a patient/ client?
my therapist keeps telling me to write my feelings. at the end of the session she always wants to copy my notes. i’m not sure why? she also has a tape recorder in her office, when i ask her about it she says its not on but i have seen other tapes on her receptionists desk. why would she need to tape our sessions?
I was seeing a therapist for depression, anxiety, and numerous emotional issues. I noticed she did not write down much during our sessions, but I didn’t say anything. When she couldn’t remember that I had a son, or other important things pertaining to my life I wondered if she really was paying attention to anything I was saying. During one of my sessions she asked if I wanted some tea (she was seeing me at her home) as she was going to make some, I said no thank you. She then said “While I’m gone I want you do close your eyes and think of the worst thing that has ever happened to you.” I did as I was told, my mind was racing through so many experiences it was a bit overwhelming. When she returned with her cup of tea she sat down and brought up a completely different topic, with no correlation to the prior subject. I waited awhile thinking she’ll get around to asking me what I came up with while she made her tea, but she never brought it up. I didn’t understand so I said “Aren’t you going to ask me what the worst thing that ever happened to me was?” She replied “Oh yes what did you come up with?” I stood up and said “I come here for help and you cannot even remember important things I’ve shared with you about my life, if I have a child or what we discussed the last time I was here and today you ask me to close my eyes and thing of the worst thing that’s ever happened to me, WHY??? So you could go get a cup of tea, obviously it wasn’t of any importance to you, but I do believe what you just did was one of the worst things I’ve experienced in a long time! This will be my last session.” I have learned a great deal from that experience and what I need from a therapist. I appreciate this website very much, and am glad you posted warning signs to help educate us as patients. Being vulnerable and needing a qualified therapist to understand “YOU” and your specific needs is extremely vital in the recovery from a fragile soul. God Bless you, and may your hearts be healed so you can enjoy the beautiful things life has to offer each and every one of us.
I don’t understand, I started on supplemental disability insurance and then my therapist all of a sudden after two years wants to start on a treatment plan. I got the feeling i’m out the door. They are also not taking any new medicare or disability patients. I do see another therapists off and on now and they keep asking me if i am seeing her. I think they will drop me if i am. I don’t think they can drop me if i am not see any other therapist, someone told me this was abandonment. I know medicare is next to nothing but my doctor is great but to see her i have to see her therapist so it’s a catch 22 .
I too was seeing a therapist for a number of years. I had a good relationship with this person, and started to heal. As I developed other supports, that the average person would have, such as friends, a faith community and a chosen family, the therapist naturally stepped into the background. Then the friends died, the faith community kicked me out and the chosen family left and moved out of the country. I was still seeing the therapist, at the time, but the therapist has not given me an appointment in over 15 weeks, prefering instead to have me check in by phone (leave a message) and would call me back and leave a message. Granted I was not being charged for this, but found it highly annoying. I had an outstanding balance due, which was scheduled to be paid from the next paycheck and I went out on disability, and the payment was delayed only until the disability payments started coming in. The therapist has now been paid. However things have deteriorated to the point where I no longer feel comfortable talking to this person….all this stuff has happened in my life and I have not had a face to face appointment in 15 weeks or more, and this “leave a message and I will call you back in 24 hours” is a joke. It’s more like if I get a call back, it’s a week or two weeks later. I am grieving, I am experiencing spiritual abandonment, I am on disability and just had surgery, and I can’t get an appointment with a therapist who I have been seeing for a number of years? I am all done
As a new LPC I am glad I found this forum. I think it is a great way for both professionals and consumers to keep up to date and really see the concerns people are having. What I find so distressing is that many professionals are not helping their clients understand the therapy process, and what its all about. In my own opinion, I don’t believe in keeping people in the dark about what is going on with their treatment, that is beneficial to no one. I am saddened to have read so many accounts of unprofessional behavior. I always encourage people to be informed consumers, and to know the different ways that you can file a complaint if you feel that you have been a victim. I also encourage people to keep the dialogue open if you feel that something is off about your therapist, or your therapy. Sometimes, it can be very beneficial to openly discuss your concerns about certain behaviors, such as the eating during sessions, taking phone calls, excessive wait time etc.
As an MSed and LPC I had to complete a masters degree of 60 credit hours from an accredited university, plus over 700 clock hours of true internship experience. After this was completed, in order to be licensed by the board in the state of Ohio, I was required to pass the National Counselors Exam,and background check. From my experience I have learned that while there are many different helping professions such as psychologists, clinical social workers, clinical counselors, and psychiatrists, their degree and experience is not always going to tell you how they will be in sessions. How you connect with that person is going to tell you.
I think every therapist brings something different to the table, just as every client does. Sometimes you won’t click with the first therapist you see, don’t resign yourself to feeling that you are stuck. You have every right to find a therapist that you feel comfortable with. With that in mind though, make sure that you give someone a chance, sometimes it just takes a little time for the therapeutic relationship to grow.
“We cannot stop the waves from rolling in, but we can learn to surf”
I want to file a claim on my therapist, she makes me sick she took advantage of me and raped my soul. How can these so called professionals get away with this behavior…??? I can’t wrap my head around it…why I stayed as long as i did was out of pure malnipulation, she was making me feel like I needed her or I would not surive…what a bunch of crap she had me so stressed out I would pull my hair out in bunches, have night terrors, rip at my feet due to stress, made me go on anti- depressents or she would not treat me any longer ( i did and went off them, witch my DR. told me to) Threaten to take me to the hospital or call the police if I disasociated on and on…I was abandoned by her she was more interested in play acting at the rennaniance faire. I just feel sorry for her clients she has now….
Very useful list of considerations and discussion.
One recommendation I would not completely agree with is the suggestion of getting a therapist referral from your medical doctor.
In my experience, many or most medical doctors make referrals more on “political” than clinical grounds – they are often likely to refer you to someone they know from someplace, rather than making a referral on the basis of knowing the person’s clinical work. A regular doctor, in my opinion, has more or less no special ability to make a therapist recommendation. And – of course there are exceptions.
Better – if you know someone who has a therapist s/he likes and respects, seek a referral from that therapist. Or see if anyone you know knows a psychologist or social worker, as these professionals know therapists and their work.
While most of these seem excellent warnings, there do seem to be a number of contradictory examples, or examples that seem too vague.
I mean it seems like on the one hand you say watch out for the therapist who tries to move you out of your comfort zone and watch out for the therapist that doesn’t.
Therapists ought to have both the experience and the practical knowledge that allows them to move towards painful issues at a pace suitable to each individual.
But for us to judge a therapist without the same experience and training seems like it would be too easy to prevent useful therapy from occurring. Often we don’t have the objectivity to judge whether a therapist is being unnecessarily harsh or pushing too fast.
I guess what I’m saying is there are many things listed that make for sound advice, such as warning against therapists who are unnecessarily rude or attempt to date their patients. However other things seem too close to what could be necessary treatment and as patients we probably won’t be able to judge whether the therapist is doing their job or acting inappropriately.
I think that is somewhat true. However, it is important that as a patient, I click with the therapist. If I am challenged to the point where I don’t care to go back, or I feel a strong sense of shame from the words the therapist uses, and there is no looking into these feelings, just blame coming my way for not being committed…I think I need to listen to my instinct that says, “I no longer feel safe to be vulnerable.” If I can’t let my feelings out, or my inner child feels censored…where the heck is the therapy? When we are pushed too far, and the therapist refuses to back down, there is a problem. The therapist who promotes their own agenda misses the cues. This could happen to any professional, but to not claim or own it is untherapeutic.
Greetings,
Usually when a client goes to a therapist, the first order of business is to find out what the CLIENT’S goals are. A good therapist knows they can’t force someone to be something they do not want to be. A good therapist knows that if the goals being worked on, are NOT the CLIENT’S GOALS, the the client will NOT do the necessarry work to acheive them.
So unless a therapist just wants to knock their head against a brick wall trying to force “what the therapist thinks the client SHOULD want” down the client’s throat…then they will FIRST find out the client’s goals.
This being said, often the client doesn’t know what they want…or is vague to the point of lack of direction for what they want…or is ashamed of what they want… and so say something “else” as their goal (a good therapist would suspect this, then or soon afterwards, but is NOT a mind reader)…or the client’s goals change during therapy. All of this causes the therapy to not be effective, or AS effective, as both should want it to be.
SO both the therapist and the client should reiterate often during the course of therapy, what they understand the goal of therapy to be. The therapist should teach this to the client from the start.
Therapy should help the client, know how to do therapy on themself…and eventually not need the therapist.
Now, there are a group of clients whose main goal in therapy is to hear themselves validated. This, they feel, gives them the courage to continue. The energy, the esteem to face life.
Often the therapist will believe that so many other tasks could benefit the client more than just validation…just making the client “feel better” for the moment. BUT, a therapist can not get a client to work on something, IF they do not want to do this. AND, a therapist can’t trick someone into doing the work either.
At this point, the therapist might feel frustrated about not being able to move forward, being stuck in what they feel is an unproductive level, and the therapist’s “own agenda” might contaminate the sessions.
A good therapist, will be aware of when this is happening to them. A good therapist will often be in therapy themselves to help themselves face, and deal with their “own agendas” and the “pain” they feel in doing therapy for others.
(Because beleive me, doing GOOD therapy is emotionally BACKBREAKING work. Which tends to make me suggest that a good therapist will NOT have eight hours back to back sessions during the day. Very few people can do their maximum best work, for eight hours straight.)
If the therapist trys to confront the client on areas the client has not agreed are areas they want to improve…this may feel like an ambush.
If the therapist has not prepared the client to do work on these areas, and the client is coming mainly because they want a “PROFESSIONAL FRIEND”, the client may well feel attacked, abandoned, put down, cheated, mislead.
That client has come to the therapist for one thing, the thing that makes them “feel good”, that is comfortable for them; and the therapist is trying to change the “rules.”
I personnally think of “feel good” therapy as the kind of “therapy” that a massage is. It makes you feel a little better for the moment; BUT it does not do the prime task of therapy, which is to make you your own therapist, someone who eventually will not need another person as a crutch to cope with the world.
Some people are not looking for “therapy” per se. They are looking for a home; a surrogate parent, family or friend. A place to dock their boat when life feels stormy, and is out of control.
They want a permanent place to be told that they are “OK” even if they are not. Told they are “pretty/handsom” even if they are not; or could be better. They want a place to feel soothed, valued, and accepted.
As for “clicking with the therapist”, I think when people start looking for a therapist, they have to realize all therapists are not created equal.
No more than you would marry the first person you dated (as all dates would be equal) would the first therapist you saw, have the likely hood of meeting your particular needs and style.
Also, sadly, sometimes after you have been married for a while, you may have grown beyond your mate, and wish to move on.
This said, “moving on” is different event, than the client and/or therapist becoming frustrated ; when a client who fears to do the next steps in the path to their goal, leaves the relationship to start over with another therapist.
The fault here would be with the therapist, because the minute that the therapist starts feeling frustrated, the therapist should re-check to see they are going in the direction the client wants. The therapist should help the client see what is happening in their relationship, not just leave the client wondering what IS going on. (If the therapist realizes that they are not capable of helping the client grow to the level the client wants; the good therapist should offer to help the client find the person who can.)
Sometimes this means confronting the client, but with the VERY things the client says they want. The goals may need to be re-thought, or new goals added after this is done.
When the client “faces the facts” that they are resisting moving in the direction they said they wanted to move, this will often be painful. BUT, know this happens in many, many cases.
People tend to soothe themselves for not being “as good” as they think they should be, by saying they want to be “that good.” When really, what they want, is to continue to do exactly what they have been doing.
It is the conflict between the conscience and the ID, and is normal. It is up to a good therapist to make this understandable and workable in therapy.
We have all gotten “STUCK”. One part of us believes in our changing, wants it. The other part finds it embarrassing, overwhelming, and impossible. The good therapist will recognise the battle that both the client and therapy will be in, when “moving forward” is tried, and will be as prepared as they can be.
Sometimes the therapist hopes the client will have developed enough “trust” in them to move them through the past behaviors and thoughts to the new behaviors and thoughts.
If the therapist is relying on trust alone, and there is not enough trust established, the client may leave therapy. It will be the therapists mistake, but the client’s loss.
Everything a good therapist does, SHOULD, be like an indredient added to a recipe. Everything should be with a purpose in mind, and an anticipated result.
If the therapist confronted the client; the therapist should anticipate the result, AND be ready to deal with the result, they intended to create.
Before the therapist confronts, the therapist should know the client well enough to be able to anticipate the result. An exception to this would be, if the therapist has not been able to find a way into a resistant client, who may not be there voluntarily, and may use confronting as a tool to try to uncover some insight into what makes the client tick.
Now, as for ending a session and feeling like you have been hurt, or punished, or shamed…
In the end, it is the therapist’s job to know the limit of their time with the client. This means, therapy is like doing a load of clothes. You have to know how much time you have not only to wash them, but to dry them. You realize if you don’t dry clothes you have washed, the clothes may mold and be ruined.
The same is true for therapy, if you leave the client holding a bag full of bad feelings at the end of the session, the client may quit therapy.
Just so, a good therapist, needs to plan the session so that if painful feelings will be experienced, the good therapist needs to make sure they will have enough time to help the client make sense of all of this and see the achievement they have made by working on the painful areas. By the end of the session the good therapist will have re-established the patient’s sense-of-self, in a strengthen form.
Ever heard when you are trying to strengthen your physical fitness, that you have to “feel the burn”. Same is true in therapy. You break the muscles down to a degree, in order to rebuild them. AND just like exercise there is a warm up, and a cool down period.
You will often KNOW IF YOU HAVE A GOOD THERAPIST, mainly by the fact, that at the end of a session, you will feel “LIGHTENED” of some of your burden. You may feel happier, able to cry where you were not before, more hopeful and so on…instead of feeling “beat up” and worse than when they came in.
This said, IF you have been having a GOOD and productive relationship with your therapist in general, and you have ONE or a few sessions here and there where you leave feeling not much better or even upset; the therapist may have had an off day…like us all. You will need to confront the therapist, each time this happens, and see what THEY say, then act from there if you are satisfied…or not, with their explanation.
When a therapist gets angry…or has any emotional reaction to something in therapy…a good therapist always explores what is causing this. A bad therapist will say, the client MADE me feel this way. So to have good results, you will not only need a good therapist, but a good client.
When YOU have an emotional reaction to something that happened in therapy, take a look at it. Discuss it with your therapist. See how they react. Do they help you come to terms with it, or leave you hanging. Geuss which one is a sign of a good therapist.
It is just a rule of human nature, that people don’t like to change. So, people wanting to grow, need to take a fair look at themselves and ask, am I resisting because I don’t want to do the work? Am I angry because someone is telling me this?
Lots of people go to therapy, expecting the therapist to do the work. Clients often expect that because they have put in the time sitting there “in therapy” talking and listening, they will come out better, smarter, changed.
Sorry doesn’t work that way. Therapy is WORK. HARD WORK.
You face things you would rather not, you experience and re-experience hurt, shame, awful heartbreak. You have to readdress those miserable painful issues that damaged you in the first place. Some of which you did not even realize at the time were happening to you.
Generally, pain comes before change. It’s like the birthing process. A baby coming throught the birth cannal is not just slipping happily through. It is an exhausting, painful (for both sides) difficult path. Even a baby chicken hatching out of the egg, has to FIGHT to get his new life. In therapy, one attempts to find themselves and “give birth” to their NEW self.
A therapist CAN’T do the work FOR you. You have to decide what you want, what you are willing to work for. You have to decide how much you can take, at what time.
You have to tell your therapist what THE GOAL is. So make sure you are clear on what you are telling your therapist you want from them. Another common behavior of humans is to “expect someone TO KNOW” how and what you feel.
“I told her to go…she should have known I wanted her to stay.” “I told him that presents were not that important to me, he should have known I did not want an iron.” Depending how smart your therapist is, how attuned to who you are, you may have to be very, very specific. “HEY GUY, I’ll ask you what kind of person I am, and you say WONDERFUL!” “I’ll ask you if I was right, and you say YES!”
Realize each therapist has different tallents, or lack of tallents. One might be intelligence. If you happen to be a gifted person, probably only another gifted person will be able to lift you beyond yourself. It is said, that one can only truly teach to the level they have themselves reached.
Consider this, all you need to get that degree is a passing grade. Some schools may pass on D students, many pass on C students.. There are only a few A students in any bunch. They show their diploma, not their grades.
If you were an A student, you may need a therapist that was too. So if you need speed, get a Masseratti, not a VW, to get what you consider a “good” therapist.
Every body learns best in different ways. Processes information in different ways. We tend to feel best understood, and understand others that function in the manner we do. So you may need to search for a “fit” to feel that you have a “good” therapist.
Hope this helps finding a good therapist, and getting the good therapy that you want.
Jalaina
Hi Jalaina
I do agree with much of what you are saying.
Although grades in graduate school are not the same as in undergrad.
Here is a sample of grade requirements for grad school:
The 78-unit curriculum of the MSW degree program provides the mix of academic, experiential, and research experiences essential for MSW degree students. Students must maintain a program grade point average of 3.0 (or a letter grade of B on a 4.0 scale) and meet the knowledge, skill, and professional performance competencies outlined by the program. The minimum acceptable grade for required (core) courses is a B- (2.7). Grades in selective courses must be a minimum of a C (2.0). Courses with grades falling below the standards set for required and selective courses must be repeated. Students are financially responsible for the cost of repeating courses where grades obtained do not meet the minimum standards.
The minimum grade in regular classes is a B-.
Selective courses are courses apart from the regular curriculum of your choice.
This is pretty standard for all disciplines in today’s world.
I am looking for a therapist / social worker who is willing to do telephone therapy and who will bill Medicare. Some professionals believe Medicare will not cover phone therapy, but they do. I just need the Medicare papers to sign.
Anyone here willing? Or know of someone? (someone good– I’ve had my share of bad therapy before)
Main issues: 1. prior abuse ; 2. now physically ill, disabled, bedridden and unable to go out to “get therapy” 3. life-adaptations and adjustments as my health condition worsens
I deal fairly well with my emotions / problems on my own but need some help / direction with some areas. Previously learned coping skills wear out fast when in this kind of life situation; would like to find some new skills to last at least few years more before having to develop another new set.
Not sure how to connect to someone here (if anyone is willing); possibly the Admin could give my email address to a professional interested in working with me?
Lifes
There is a psychologist in Vancouver who professes to be a lot more than she is in the field of traumatic stress/psychological trauma. She denigrates other psychologists, although not to their face. She thinks she is the best. She is extremely convincing. She can display BPD-like symptoms and if she apologizes it will be with a very qualified apology – she doesn’t really see anything wrong with what she does. Given she works with people with BPD and personality disorders her own problems should be well addressed. She isn’t even aware of all of them. She never bothered getting professional supervision. Hopefully she is now. She has serious boundary issues and had a serious occurence that happened with a psychiatrist at VGH Out-Patient Psychiatry where action needed to be taken. Some in the therapy community know, many more don’t. They should. Be careful and if you think you are doing therapy with this woman, run.
I feel that my therapist has judged me on my weight, being a stay at home mom, and not driving. She asked me what I weighed in high school, I told her, and she said, “So you were bigger than all the other girls.” She said I’m not a real stay at home mom because I don’t drive.
I always feel worse about myself after every session. She canceled three sessions in about 4 months last year; I had to wait another month after my scheduled appointment to see her again.
If I wanted someone to tell me what a loser I am, I would call my mother in law. She’d tell me for free.
I have experienced 2 incidents that I feel hindered my therapy. I was in therapy for 3 1/2 years for the treatment of DID with my first therapist. FIRST PROBLEM – I was hypnotized without being informed. I confronted him when I realized it, but it kept surfacing during therapy and I feel contributed to the problem I had with transference because I felt violated by my therapist and kept seeing him as the person who violated me during childhood. SECOND PROBLEM during the 3rd Christmas, I gave him a %50 gift certificate to a book store. After the holiday vacation he returned it and said “Clients with your diagnosis have a history of overstepping boundaries, not that Ive experienced that problem with you in the past, but I think it may be starting and I intend to stop it before it gets out of hand” as he handed me back the gift certificate. That statement made me feel more worthless than I felt before I started therapy, and was the reason I left therapy with him, and the reason I will never have therapy again with a male therapist.
More to add to the “Warning List:”
Therapist falls asleep.
Therapist throws a tissue box at you, (instead of offering one).
Therapist laughs at what you wrote in a journal.
Therapist repeatedly insists on a specific diagnosis, even when client has proof otherwise.
When I was young, I was served liver and onions. It was absolutely horrible. I gagged and gagged while trying to eat it; tears even came to my eyes. UGH
After that terribly unsatisfying experience I did not conclude that all food is terrible and that I just could not ever eat food again.
I did conclude that that particular dish did not meet my needs in any way whatsoever and that I would not be going back to liver and onions one more time.
I do wish that the patients on this list and elsewhere who have had terrible, undesireable, gag-worthy, tear-provoking experiences with therapists would not blame all therapists or all therapy for their terrible experiences. It would be an absolute shame to miss out on Ben & Jerry’s chocolate ice cream with the fudge and brownies in it because I didn’t like liver and onions and decided never to eat again. and it would be a shame to miss out on the awesome opportunities and wonderful growth available in therapy because you had an experience that was displeasing in the past.
My therapist….
feels too maternalistic, protective, weirdly admiring of me. All the offers of ride homes I never asked for or accepted (I don’t drive, it’s a short walk home, etc.), offering her daughter as a house sitter, (Yeah, we turned that one down fast.), asked if my husband could build a dog ramp for her dog like he built for ours, ‘Oh! I’d pay him of course!” He said no.
She has been pushing ‘The Alexander Technique’ on me and I was wary. She finally was going to pick me up at work and take me to watch her session, I wasn’t thrilled but had a hard time saying no. It might work and I didn’t want to hurt her feelings. The session was canceled by a severe storm two months ago and I haven’t heard from her since. I have a book of hers, I need to return but I’m dreading the session. I’ve seen her a few years now, right now is the worst I have felt emotionally and psychologically w/no outside event (a death of a family member, loss, etc) in my life.
I keep flashing on her telling me how ‘intimidating’ and ‘Billy Badass’ (Her words) I was when I first came in but now I’m so gentle and soft and tenderhearted, like she BROKE ME, bridled me, tamed me or something. I don’t feel any more subdued, gentle, serene. And, to be honest, I was and always have been as intimidating as the family dog.
There’s more, (a session w/a visiting family member that went horrible, she lost control of the session in a few minutes and allowed my brother to stay a few hours after I had to leave) but what do you all think so far?
Kim
Mail the book back, or put it in a sealed manila envelope and leave it in someplace where she can pick it up, and send the therapist a note.
If you have reason to believe that an effort to achieve closure by having a good bye session will leave you feeling worse (pressured, criticized, demeaned, drained) — don’t go. There is no point in making yourself vulnerable in a place you don’t feel safe.
You should never leave a therapy session feeling bad in this kind of way.
I’d say the best thing to do is write a respectful letter telling her you’ve decided not to continue your therapy at this time. Either tell her why very briefly — “I am aware I need a therapy situation in which the professional boundaries are managed differently,” for example — or just thank her for her help (even if somewhat insincere) and be done with it.
Hi,
I’ve returned to therapy after having been out of it for more than five years. I’m just needing a sounding board and to figure out some crap but I visited someone yesterday and am wondering if he’s going to work.
He had TWO phones, his cell and the regular one and while we were doing the initial question and answer eval his cell phone and also the regular line rang constantly. I ignored it and kept talking, but he finished the eval and said he had been expecting an important call and would I mind if he just checked his cell phone real quick and then when he got back we could chat for awhile or I could just come back.
I said, ok, and he went and came back in like two minutes and apologized. He sat down and we talked for like 20 more minutes but the whole time the phones were absolutely ringing like mad!
I realize from this site(and I consider myself a pretty experienced client/patient) that I should have said, will these phones be turned off or put in the other room during our regular sessions?
I have an appt with him next week so I will see, and I will say something if they go off, but I’m kinda feeling like he might not be the right guy.
Thanks,
Sally
There needs to be some kind of work shop for therapists on abandoning a client with no resolve or closure, thats just damaging to the client.
My former therapist decided to abandon me after 3 years of therapy, because I was suicidal and he didn’t want to deal with me any more. He sent me an email making it sound as though I had terminated therapy and now he won’t even let his answering service take a message from me. He use to encourage me to call during a crisis and we would even text back and forth and then one day he just started acting really strange towards me, saying things that would hurt my feelings, but I was never sure if he meant them that way or not and the way he terminated to therapy feels like it was more of a personal attack instead of just deciding he couldnt help anymore. I really think he wants me to be hurt. Its really thrown me into a downward spiral and I feel like all of the progress I made has just been beaten out of me. I dont even know what I did to make him decide he hates me so much. But it makes me question therapy and it makes me leary about trying to find another therapist. I think psychologists should be aware of the impact they actually make on their clients and avoid causing them more harm.
When is unilateral termination by a therapist ever ok? Any and all answers could be healing.
Thanks.
Other red flags:
Counsellor blames you while making excuses for your family, friends or partner. (related to #11 & #12).
Counsellor doubts, second-guesses and challenges your EVERY thought, opinion and course of action, regardless of its significance to your issues.
Counsellor ignores your explicit requests to focus on a specific issue during a session, and instead keeps returning to other issues.
Counsellor assumes that because you are upset/unhappy about a situation, you don’t understand it and you don’t know what to do about it. (You can be upset about something and understand it quite well and know exactly what to do – these things are not mutually exclusive.)
My T wanted me to join an ongoing group for “socialization skills”. I had uncomfortable feeling about it, but chalked it up to my needing social skills. Last week I discovered one of our members was a registered sex offender, and my T knew. This was not ever disclosed to me at any time. We found out he reoffended and returned to jail. I suspected this was a sex offence and searched the sex offender registry, only to find a picture of my group member (the member was into child porn), who now has my phone number (we were encouraged to exchange phone numbers). I have quit the group, My T thinks I’m over reacting! I think he acted unethically.
when he or she makes promises to help you in a certain amount of time but doesnt and claims shes too busy to help .
never ever returns yoor phone calls .
feeling of dread up to a week before an appoitment then feeling better afterwards the appointment is over
never returns uyour phone calls.
feeling of drEAD BEFORE AN APPOITMENT , THEN FEELING BETTER AFTERWARDS
I have been a therapist for 20 years, and I was really upset by this article.
3. “therapist does not define clearly how she is going to help you” – well, sometimes I do not know at the beginning of therapy how to help someone. It is an unpredictable journey. Sometimes I am not sure what the cause of the distress is. Rather than provide unnecessary explanation, I prefer to continue and explain as we go.
4. “therapist does not define when therapy is complete” – the goals of therapy change many times during therapy. What is important is to listen to client when he feels it is complete, rather than artifical definition.
11-12 “therapist blames family or partner”. Well, what about parents that are – or were – abusive physically, emotionally, sexually? What about a woman in a domestic violence situation?
27-28 – “therapist focuses only on cognition or only on emotions” I start from where the patient is. For highly intelectual and defensive people it may be easy to start from cognition, and later access their emotions. Otherwise they may escape. Others may benefit from starting to deal with their emotions. Why is it bad?
37 “therapist answers phone”. I am guilty of that. My husband is frequently out of state, and I am the only one who can answer for my children. Of course, I make sure it will be very short yes/no answers. I do not think anyone was ever offended.
41-42 — you cannot win. You are either too emphatic, or not enough.
44 – “therapist is affected emotionally”. Am I supposed to be made of wood? Of course I am affected emotionally.
48-49 – With addictions and compulsions it is more important to learn to control the problem, rather than to “understand” it. Only later it makes sense to understand to causes. i can have therapy with somebody for years, but it will do nothing if he continues to drink.
Who wrote this article? Is that person a therapist?
Hi Michelle,
I read this article and have a total different take on it than you…I think it’s an excellent collection of warning signs. I was so shocked by some of your comments that I felt compelled to defend the author and to protect those people who might be considering therapy from some of your misunderstandings…
Here are my responses to Michelle’s comments:
#3 Of course therapy is an unpredictable journey, but the therapist should have some sort of framework for helping people which she/he can share with their client. Too many talk therapists simply let their clients talk, emot, and go in the same circles session after session without ever getting anywhere. A good therapist should be experienced enough to communicate how they actually help people to change. If you don’t have a framework for doing therapy or don’t know how to communicate the basic process you might consider getting some consultation or training to better shape your overriding understanding of how the therapy process works. Seriously!
#4 If you read this one logically you’ll understand that providing the client with an “explanation of how you will know when therapy is complete” DOES include the therapist expressing to the client that the client may know or feel when the therapy is complete. Too many therapists never talk about the ending of therapy, don’t make termination okay; this is a disservice to the client. You’re right that the therapist cannot predict the therapy pathway in advance, but an experienced therapist will communicate, with good timing, what it could feel like or be like for the client to overcome, move past, or heal specific issues…as those issues arise.
#11 and 12 There is a difference, Michelle, between acknowledging a perpetrators responsibility and blaming. I think that most therapists would agree that a client stuck in anger and blame is not a client who has healed from their abuse. Sure, anger and blame is often a part of the process, but isn’t the outcome of healing to have moved past the blame and anger?? I think so indeed! A therapist does a disservice to the client by joining with the client in blaming another.
#27 & 28 I agree with you here Michelle. It’s great to start where the client is at. But I don’t think the author of this article is saying that she or he does not do that. The author is simply stating that it’s a red flag when the therapist “focuses on thoughts and cognition at the exclusion of feelings and somatic experience” OR “focuses on feelings and somatic experience at the exclusion of thoughts, insight and cognitive processing.” In other words, a useful therapist remains conscious of both, takes a middle path, holds a balance… Sure, you can meet a client where they are at, but could it not be useful for someone stuck in their head to learn to be in touch with their body and their emotions?? And vice versa, is it not useful for someone with a histrionic personality constellation to learn to access their more rational and logical capacities?? I would say yes to both, and I think the author here is trying to say that also…
#37. I think you’re either fooling yourself (denial) or simply ignorant about what goes on inside clients if you truly believe none of your clients have been impacted by you answering the phone during their sessions. I suggest you consult with other therapists about this. I think answering the phone is a big no-no which can undermine the safety of the therapeutic relationship…especially for clients with particular relational woundings.
#42 and 42… When did this become about winning Michelle? Don’t you agree that some therapists fail to empathize, connect, and relate emotionally to their clients…hide behind the veil of professionalism a little too much? Don’t you also agree that some therapists have their own unfinished business that causes them to have their exiled /unconscious stuff triggered and, in turn, causes them to over-identify and over-empathize with their clients? I think this is certainly the case and I agree with the author of this article that therapists need to be able to open their hearts without over identifying and becoming blended with their own pain….If the therapist can’t stay centered in Self, the client won’t benefit!
#44 the operative word here is “OVER,” meaning too much… As with many of these warning signs, too much of one thing, is not always a good thing. Of course therapists are affected emotionally, but if the therapists own stuff is getting triggered during a session, then the therapist is going to be less effective… The healthy therapist does his or her own work so they can stay empathetic, emotionally connected, but not overwhelmed, over-emotional, and over affected. Imagine how it would feel for a client to see their therapist breaking down? It’s like having the tables turn, losing the steady “rock” that helped you weather the storm… And now the client is worried about the therapist’s well-being and doubting he or she can help you… Sure, it can be okay to experience tears and sadness for a client and depending on where the client is at, it may be helpful or unhelpful for the therapist to show that he or she was affected and moved by the client…
#48-49 Michelle, I think you’re confused… The author, I don’t think, would disagree with your statement that “With addictions and compulsions it is more important to learn to control the problem, rather than to “understand” it”… the author is simply stating that it is a red flag when a therapist does one approach without the other…she’s not talking about which approach or focus comes first.
I think you’re statement, “Who wrote this article? Is that person a therapist?” is fantastically rude of you. Your comments don’t demonstrate that you’ve really understood what the author was saying and I think you’re the last person who should be leaving such a rude comment…
Dam I hate it when therapists talk about how many years of experience they have! You think “years of experience” is going to necessarily make someone a good therapist? Such a bunch of ego BS.
I have just got away from a therapist who embarked nearlly all 50 of the items on this list, he played havoc with my head and i want to say if your going into therapy, keep the list in mind!
well excluding the thing about sexual advances, still clocked around 45
how about a therapist who stops seeing you because you where admitted to a hospital because of sucide threats.
WARNING, WARNING, Therapists who, for their own self-serving purposes, use hypnotic techniques without warning the client (who has severe PTSD), causing the client to black out for an hour and 15 minutes, waking to what sounded like an age regression, being in severe pain and continues to be. Technique verified by a famous professional. Maine OLR did nothing after complaint filed. Therapist lied about session. Lost my job, lost my will to live, lost everything. Therapist assaulted client; her peer group and her supervisor, a well-known psychiatrist all know, and did nothing. Therapist lied about session, but proceeded to drop hints of what happened during that black out session. Since I can’t remember, what the hell am I suppose to do with that? The pain is tremendous. I hope this therapist’s life sucks as much as mine. Someday she will be accountable for what she did! My mother may have raped me, but this therapist committed a worse crime because she was suppose to be a professional; she was suppose to follow the social workers code of ethics! She left me in harm’s way and only cared about herself.
I met with a counselor very recently. I found him on a male survivor website.He took 2 phone calls, was 45 minutes dleayed for our meeting as well as pursued his own agenda. He made assumptions about me after 45 minutes, and then made horrible claims as to my intent. I left there feeling raped and more tarumatized then before I got there.
I have found that the national ass of social workers; the amercian ass of social workers, the offices of licensing and regulation; and even the police and attorney general’s office, have no care as to the bad therapy that is rampant in this country. it is always the therapist’s word(who’s right) against yours (and you are always wrong). The therapist can even lie, delete notes, whatever. I think this is an epidemic and the code of ethics is a crock because it seems these therapists do not have to follow or be held accountable. The OLR here in Maine won’t even do anything about a therapist not fowarding records. Here is what they consider a disciplinary measure: a therapist took in a client’s cat because the client was in the hospital. They severely disciplined this therapist. This is sooo much worse than what my therapist did – hypnotic technique causing a blackout and extreme, excrutiating pain. NOT!!!! Who the hell are these a-holes running these organizations?!!!!!
Re: phone – I find it unworkable if a therapist answers the phone during sessions, and as a patient in such a situation the knowledge that the therapist was poised to disrupt the interaction unpredictably whenever she “needed” to answer the phone would make me wary of going into sensitive or vulnerable territory. I think people should be able to count on not being abandoned (during the framework of the appointment time)if they’re encouraged to “be open.”
I suppose that a patient who truly does not mind is okay with such a therapist. Though part of me also says — some of the people who “don’t mind” may not mind because they are too used to not knowing what they need, which from my point of view is not so great.