Quick Post: Finding a Good Therapist

As usual, this is not a quick post. All references to therapists i use the she pronoun just to make it simple, so assume “she or he” when you see it.

People get very confused about whether they like their therapist, if they are supposed to talk about things they don’t like, and especially how long to put up with a therapist they don’t like.

Here are a few quick tips:

Scenario 1, the perennially dissatisfied patient: you think you don’t like your new therapist, but you have never liked any of the therapists you’ve tried out. There was something wrong with each one. In this case, just not liking her is not of a sign you need to find a new therapist. Be aware that you probably are looking for some kind of perfect therapist that doesn’t exist, so hang in there with her, and make sure to keep talking in your sessions about what specifically you don’t like about her. Is it her approach, what she says or doesn’t say, something really specific or something vague that probably means you don’t trust her and have to be patient, as you are not used to trusting any therapist. This is one of the few scenarios where the therapist may be right to challenge you to stay with her and tolerate your discomfort.

Scenario 2: the therapist with bad boundaries: believe it or not, I’ve actually heard awful stories about people’s former therapists. If you feel ignored, not listened to and frustrated, trust those reactions and look at the evidence. Here are some things you should never put up with: your therapist always answers her phone during sessions and talks with other people during the time you are paying her for. If you complain and she keeps doing this, leave and get another therapist. Your therapist talks a lot about herself, and it usually has nothing to do with what you’re talking about. Bad boundaries. The only time your therapist should say anything about her own experience is when it relates to your issue and you feel comforted, seen or relieved after she shares with you. Otherwise you do not need to put up with a therapist with such poor boundaries. Or, she talks too much about her other patients for no apparent reason. If it feels like she’s acting like your friend, look into what she’s doing. If she’s just giving you some harmless advice about dating or ways to cope with your anxiety or asks you to call her if you’re about to engage in some kind of destructive behavior, these are actually normal ways to work with someone and do not indicate a boundary problem.

Scenario 3: tricky one. You know you want an active therapist and do not tolerate the anxiety of sitting saying nothing. You explain at the beginnng that you have too much anxiety or trauma and can’t bring things up and need to work on it but you do eant her to ask you questions to help get you talking. Your therapist waits for you to talk, even if you sit quietly for the whole session. Especially if you let her know you need help from her to talk. If she won’t break the ice with some kind of “I’m wondering what’s on your mind?” after a few minutes of silence, her orthodox approach is no good for you. Find someone who can meet your needs.

These are the most common complaints about therapists and the most easy problems to recognize. More complicated problems include, the paradoxical therapist. Complaints sound like, “She asks me how I feel about something and then seems to judge my feeling”, “she asks me something and then interrupts me or disagrees and tells me what I should be thinking.” These are red flags that things aren’t great and you need to speak up quickly and complain, and then see how you feel in the next few sessions. Another one involves “she seemed to be purposely acting like my dad to make me react and told me she was doing that to help me but I didn’t like it.” Sounds crazy but I’ve heard stories like this. Another one is the overly infantalizing and warning therapist. “I told her about my self-destructive behavior, and she made predictions that I’m heading for another suicide attempt” or something like that. It would be better for her to ask you more questions about your current behavior and how you feel about it.

There are definitely other problems that you might encounter, so try to trust your gut feelings. If you don’t feel comfortable enough, you may just have a bad fit and need to try someone else. If she’s a woman, try seeing a man to notice if gender makes a difference. As I said before, in cases where you get very picky and don’t like anyone you try, then you need to look at your trust issues. In most of these other bad scenarios, the patient tends to stay too long because they are afraid to confront the therapist. The best thing to do is be honest. State what behaviors you don’t like, and that you are going to try someone new for those reasons. If you can’t say it to her face then at least email her…

There are also many complaints I hear about psychiatrists, actually more about them than about therapists. Basically you are paying a high fee and the session should last at least 45 minutes long. The psychiatrist should ask you lots of questions at the beginning, and any time you are trying a medication for the first time, she should have you return in one week. She should answer any questions you have clearly. There are no stupid questions about medications, and you have a right to know about them. After you are stabilized on medication, your psychiatrist should see you about once monthly unless you’ve been working with her for years and don’t change medications frequently. She should be asking you about your job or lack of job, your relationships, areas of stress for you, any trauma history, your sleep and eating, how therapy with your therapist is going…Basically, the session should include her checking in and finding out about how you’ve been doing since the prior session. If you feel like she just throws prescriptions at you, that’s not good enough. At the end of each session, you need to make the appointment for the next session. Don’t let her say, “Just call me in a few weeks, and we will set something up.” A lot of medications mess up short term memory, plus most psychiatrists have a very busy schedule, plus many people will put off future appointments for various reasons , so you need to know when you leave the session, when you will see your psychiatrist again. Make sure she tells you about vacations and covering doctors in case you have a crisis or run out of medications. Remember you are paying a lot and deserve to feel like a satisfied customer…


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