How to Recognize a Bad Therapist

Many people have had bad experiences in psychotherapy. There are the therapies that go nowhere, the therapists who do not appear to have the skills to do their job, and all sorts of other complaints. For many of us, it can be hard to decide whether it is our fault or our therapist’s fault that our therapy is simply not working.

I have given a lot of thought to this issue because I have met a number of therapists who turned out to be inadequate or untrustworthy. I am sure that the same is true for every profession. I have written this post in the hope that I can help people find the right therapist and avoid expensive therapy that is going nowhere.

When I think of the bad psychotherapists I have encountered, I find that most of them can be loosely grouped into three categories:

• Predators
• Poorly Trained
• Inexperienced

Sexual Predators

These are generally male therapists, but not always. This is a greater risk when you are doing some of the more intimate types of bodywork that involve the therapist touching the client. Not all sexual predators set out to take advantage of their clients. Some are simply self-indulgent or have their own psychological difficulties. Here is a typical example that is a composite of different stories that I have been told.

Lisa and Dr. Cole

Lisa is a very attractive woman with Borderline Personality Disorder. Her new therapist, Dr. Cole is very well known and has published many professional papers. He has excellent credentials. So, when Lisa began to feel as if he was starting to flirt with her, she chalked it up to her imagination and her own need for male attention.

However, when Dr. Cole started to pay her compliments about her looks and clothing and kept bringing the topic around to her sex life, she became very uncomfortable. But Lisa was like a wilted plant that needed watering. Despite her misgivings, she enjoyed being seen as attractive by Dr. Cole.

As the year went on, the sexual tension between the two of them increased, as it was stoked by Dr. Cole’s compliments and inappropriate attention. Eventually, it became more overt. He offered her a hug when she was upset, and it turned into a definite sexual overture. He kissed her and caressed her body over her clothing.

Lisa convinced herself that all of this meant that the two of them were in love and that this transcended the rules about therapists and clients dating. Now, almost every session ended with them hugging, kissing, and touching each other.

Although Lisa still began her sessions by talking about her issues and she was still paying in full for her “therapy,” all she was really getting was a 50-minute flirtation that culminated in a make-out session. Soon they were spending most of her sessions on his couch ardently kissing each other.

The whole thing came to a halt the day Lisa asked when they would be seeing each other outside the office. Dr. Cole suddenly grew cold and backed off. He explained that it was impossible for them to meet outside his office.

Lisa was shocked and asked: “Don’t you love me? I thought all of this meant we were supposed to be together.” Dr. Cole said: “You are a lovely young woman who has had a very hard life. I have been comforting you and helping you feel more secure. I am sorry if you imagined this was more than that.”

Lisa went home in tears and was too embarrassed to tell anyone what had been going on during her so-called therapy sessions. She felt that everyone would just think she was making the whole thing up because she was the one with problems. She never went back. The whole incident became one more traumatic experience and another reason to feel she was unworthy of being loved.

How to deal with potential sexual predators:

1. If you think your therapist is flirting with you, say something like: “This feels too flirtatious to me. Your comments about how attractive I am are making me uncomfortable.”

2. If your therapist is very focused on your sex life and asking for details (and you are not in couple therapy or sex therapy), you can ask: “How is this relevant to my problems?”

3. If your therapist frequently touches you or offers a hug, and it feels unnecessary or inappropriate, it probably is—even if it is well-intended. Tell your therapist that you are looking for therapy, not a hug.

4. Your therapist is not legally allowed to date you or see you outside of your session (with a few exceptions like emergencies). If you think an in-session flirtation will lead to a real relationship, you are mistaken. Stop the therapy before you get hurt.

Poorly Trained

Most people who go for therapy are unaware that most types of licensed mental health professionals in the United States are allowed to do psychotherapy without actually studying any form of therapy well enough to really know how to do it properly. A lot of therapists are simply winging it and hoping for the best. They may be supportive and good listeners, but they have no idea how to handle specific problems when being sympathetic is not enough.

Resistant Thomas and His Perplexed Therapist

Thomas came to therapy with me and in the first session told me he needed a little push sometimes. That was an understatement. He was unusually resistant to any interventions or suggestions. He tended to ignore my feedback and evaded most of my attempts to have him stay on topic or talk about his problems. When I pointed this out, he acted surprised.

I knew Thomas had been in therapy before, so I asked him how that therapy had gone because ours was going nowhere. Here is an abbreviated version of his answer.

Thomas: I defeated my last therapist. He was so stupid. He had no idea what to do with me. In the beginning, he asked a lot of questions, but when I fell silent, he stopped talking.

Me: And then?

Thomas: That was all. He really couldn’t figure out what to do with me.

Me: What finally happened?

Thomas: Well, I won.

Me: What do you mean?

Thomas: I just stopped talking. He eventually gave up and stopped talking as well. We just sat there silent for months. Eventually, my insurance ran out, so I ended it.

Me: How is that winning? You came to therapy to work on your life problems and instead you played games. You wasted a year of your time and made no progress.

Thomas: I never thought of it like that. I just enjoyed defeating my stupid therapist. He ran out of interventions and I knew it. I wanted to see how long we would go without him throwing me out.

My conclusion was that Thomas’s last therapist was inadequately trained to deal with someone as resistant as Thomas. When his few therapeutic tools did not work, he was stymied. He continued taking Thomas’s money but stopped even trying to do therapy.

The therapist also made the mistake of not formally acknowledging to Thomas that his therapy was going nowhere and that they should consider termination. If the therapist did not want to give up, the proper thing would have been going into supervision with a more experienced therapist to discuss how better to approach Thomas’s resistance. Sitting silent for a year was not the answer.

I do not recommend purposely thwarting your therapist’s attempts to help you, as Thomas did. However, if you are willing to work in therapy, but you do not seem to be getting anywhere, you might want to pay attention to what your therapist is doing or not doing to help move your therapy forward. If your therapist seems to be at a loss about what to do or says the same few things over and over, you may want to check out the person’s training.

How do you avoid a poorly trained therapist?

1. This is fairly simple. Look for a framed certificate from a three-year post-graduate training institute on the wall with the other diplomas.

2. If you do not see one, ask your therapist where he or she trained, what type of therapy your therapist is trained to do, and how many hours of training your therapist has in that form of therapy.

3. Look up that therapy on the Internet and check if it is relevant to your problems. You would be surprised at how many therapists are doing a type of therapy that is not designed for your problems.

4. After getting this information, ask your therapist any questions you still have about his or her training. You have a right to know what you will be paying for.

5. If you have a serious problem that is a bit out of the ordinary, like a personality disorder, a phobia, or severe trauma, you may need a specialist in that area. Most therapists are like family physicians. They know enough to treat common anxiety or a reactive depression but are not trained to deal with anything more complicated.

Inexperienced

All therapists start out as beginners. Very few beginning therapists are very good. Some, of course, maybe naturally better at connecting with clients and more creative than others. And, they may make up for their lack of experience by being very enthusiastic, inexpensive, and eager to do a good job.

Having said that, beginners make blunders. They are still learning. Just as there is no substitute for training, there is no substitute for years of experience. However, if your problem is fairly common and simple, you may find a beginning-level therapist adequate for your needs.

Sara and Corinne, Her Counselor

Sara was a sophomore in college and had just been dumped by her new boyfriend. This was also her first time living away from her family. She was not managing very well. She had gained 20 pounds. and was drinking too much. She was very anxious and depressed.

One of Sara’s professors suggested that she go to the free student counseling center. It was staffed by graduate students who were getting their Ph.D. in psychology. Sara was assigned to Corinne. Corinne was about five years older than Sara. Sara was Corinne’s first client. Corinne had been given a bit of training in supportive psychotherapy—listening, soothing, and empathizing—and some very basic instruction in the principles of CBT (cognitive behavior therapy).

Sara was not told that she was Corinne’s first client or that Corinne was practically untrained. It was not much therapy, but at least Sara could talk to Corinne, vent her feelings, and ask for advice. Sara was relieved not to be on her own and considered Corinne to be the caring older sister that she had always wanted. Corinne was delighted that her rudimentary skills were adequate for her first client’s needs.

How do you avoid inexperienced therapists?

You need to ask questions:

1. What degrees do you hold?
2. Are you still in training?
3. How many years have you been doing therapy?
4. Are you in supervision with a more experienced therapist?

I generally recommend that people see a psychotherapist who has a minimum of five years of post-graduate experience. If you have a very complex problem, I recommend 10+ years' experience. All other things being equal, the more experienced, the better the therapist is likely to be.

Punchline: Most psychotherapists are well-intended and have sufficient training to be helpful to their clients. Unfortunately, some therapists are bad at their job. They may be unethical, unmotivated, or insufficiently trained. As you are likely to be investing a lot of time, energy, and money in your therapy, you may want to make sure that your therapist is trustworthy, well-trained, and experienced enough to be helpful to you.