Bad therapist
What A Therapist Should Not Do
Talk therapy can be a valuable source of help and positive change for many people. However, therapy does not always go well. There are many reasons for this. Poor professional and ethical practice is one possibility. While bad behaviour occurs amongst a minority of therapists (1), it can have a huge impact on therapy experience and outcomes.
Topics in this article:
High standards and therapist influence
Society should expect a high standard of behaviour from therapists. You take time to find someone to work with. So, you should expect a professional service. What’s more, sessions should always be safe for clients. Not only are these requirements a matter of ethics and treatment effectiveness, but they reflect the powerful position held by therapists. Some reasons for this power include:
Therapists work with vulnerable people
Therapists have specialist knowledge and skills
Therapists acquire sensitive information about clients
Mental health professionals give opinions and make decisions that have major health, occupational, financial and legal implications for people
There is an interesting debate about the nature and extent of power between therapist and client. Here are some example opinions on this topic.
Signs of a bad therapist?
Therapy usually involves some discomfort. People can even feel worse before improving. This makes sense given therapy involves challenging tasks such as:
Directly confronting difficult topics
Hearing someone challenge our assumptions
Attempting to change long-standing thinking and behaviour patterns
Some discomfort is inevitable. Furthermore, therapy needs to be challenging in order to trigger new learning (2). However, your therapist should guide the process to prevent overwhelming distress. For example, I have written about notice, name, and normalise.
A therapy session naturally creates unease, so we should always consider the source of this comfort rather than immediately blaming inappropriate therapist actions.
The therapeutic relationship
Good therapists know that the therapeutic relationship is key to effective therapy (3). Specific features make a relationship ‘therapeutic’. Here are some examples:
Negotiating treatment goals
Regularly providing feedback
Directly addressing any problems that arise with the process of therapy
Being equal partners in therapy
Here we see an emphasis on ‘power sharing’ and a clear focus in sessions. A poor therapeutic relationship might indicate questionable therapist behaviour. However, there are other signs as discussed below.
A rocky therapeutic relationship may be linked to the difficult nature of treatment. If the connection between you and therapist isn’t right, think about the potential source of this discomfort. Is it the therapy work itself, or how the therapist is acting?
What are boundaries?
We all have personal boundaries- things we will not do, actions we won’t allow from others. Boundaries are important.
Boundaries in sessions refer to rules, limits, and standards placed on a therapist’s actions. There are many reasons to have boundaries:
Clearly defines the therapist role
Helps to keep both client and therapist safe
Ensures ethical practice (e.g., reduces the chance of a conflict of interest)
Promotes duty of care towards clients
Here are a couple of boundary examples:
Therapists should not take on another type of relationship with their client (e.g., friendship, financial)
Therapists should not excessively discuss issues irrelevant to therapy (e.g., events in a therapist’s life).
Boundaries also involve type and frequency of contact. Unnecessary phone calls, for example, might be a cause for concern.
Some approaches to therapy allow for boundary-stretching in some circumstances. However, we generally shouldn’t see therapists consistently breaking these parameters. Ideally, boundaries are identified and discussed early in therapy.
Breaking confidentiality
When does a therapist have to break confidentiality?
Therapists should never breach confidentiality unless they have an important legal or safety obligation to do so. For example, a therapist may need to break confidentiality when a person is in immediate danger. Information sharing requirements and practices differ between services. For instance, certain settings require court reports to be prepared. These reports are often viewed by multiple parties.
In all circumstances, you should be told about documentation and information-sharing arrangements.
Giving advice or making decisions
Therapists shouldn’t make decisions for the client because it is the client (not the therapist) who lives with the consequences. Therapists should help you develop your decision-making and problem-solving skills (e.g., take you through a pros and cons exercise), but not tell you what to do. Therapy is not intended to be a substitute for your autonomy.
In addition, a therapist should not give advice outside their scope of expertise (e.g., providing medical advice). Any advice provided should be aimed at helping you make sound decisions for yourself.
Going outside area of expertise
While therapists should stay within the bounds of their skills and experience, it is important to progress professional abilities. Therefore, therapists should seek extra support and supervision when moving into unfamiliar territory.
Sexual behaviour
Never. This should never occur. Any form of sexual advance or behaviour during therapy is unacceptable.
Any unprofessional behaviour
Other unprofessional issues would be listed in this category, such as:
Consistently being late for sessions
Not returning calls in a timely manner
Failing to demonstrate active listening and other fundamental skills
Harsh, critical, judgemental or insulting behaviour
Sessions are supposed to be supportive environments. Anything less than this is a problem. For example, feeling judged would be a major issue.
What you should never tell your therapist
A therapist-client relationship should be collaborative. There is something wrong if you feel the need to hide important information. A therapist needs all relevant information in relation to the issue you are addressing. Often, a client fears negative judgement if they reveal something that’s been kept concealed (e.g., ‘You will think I’m crazy’).
However, there would be a huge problem if information is used with harmful intent. For instance, using information to manipulate or coerce you. So, if you feel reluctant to reveal information, think about why you feel this way. Embarrassment is common, but fear of manipulation should raise a red flag.
How to break up with your therapist
You have the right to choose your therapist. Sometimes there is an appropriate time to move on. You also have the right to end sessions if unhappy with any aspect of treatment.
However, I would recommend you think carefully about the reasons for ending sessions. As discussed above, discomfort is often an unavoidable part of therapy. Breaking up with your therapist is a good way to avoid this discomfort. But you will only need to face these problems with the next professional.
But, unprofessional behaviour is a good reason for ending sessions. Directly communicating your intention is the best approach. Of course, you could just stop showing up. But, you don’t develop an ability to communicate uncomfortable messages if you ghost your therapist. A therapist may also have safety concerns if you stop sessions without notice.
A clear, simple message to your therapist is best. An explanation is not mandatory, but it may help the therapist take lessons from the situation.
You might want to make a formal complaint after being subject to serious therapist misconduct. All therapists should be registered with an appropriate body. These organisations are usually the appropriate place to make complaints.
I hate therapy
Something has definitely gone wrong if you are saying this. Again, think about the reason for this attitude. Is therapy tough, or are you concerned about unprofessional behaviour?
Related topics
Read some advice on starting therapy.
Here is some more information on what you can’t say to a therapist.
Summary
This list of behaviours is not exhaustive, but is supposed to give you a feel for what unacceptable behaviour looks like. Don’t feel afraid to speak with someone you trust when concerned with your therapist’s behaviour.
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References
(1) Brin Fs Grenyer & Kate L Lewis (2012) Prevalence, Prediction, and Prevention of Psychologist Misconduct, Australian Psychologist, 47:2, 68-76, DOI: 10.1111/j.1742-9544.2010.00019.x
(2) Cozolino, Louis. The Neuroscience of Psychotherapy: Healing the Social Brain (Third Edition) (Norton Series on Interpersonal Neurobiology) (pp. 10-11). W. W. Norton & Company. Kindle Edition
(3) https://www.apa.org/monitor/2019/11/ce-corner-relationships
