You decide to go to therapy cause you're a little unsure of yourself. Gotcha.
Wait a minute, what if your therapist seems worst off than you? What makes you think your therapy won't be?
Few therapists are aware that trauma often leads to a sensitivity to light and sounds. If you're squinting and your therapist hasn't noticed, well what else isn't being picked up?
Or else the lights are turned down so low that they create a moody, vaguely romantic atmosphere.
Having the lights so low they're creating a romantic feel can be downright confusing and unsettling. It would be natural to ask yourself, is there an agenda here?
Man oh man. That feels good. NOT.
I'm continuously amazed that therapists don't think clients notice moments like these. Likely the glare of the radar would be too bright...
Did you notice that the therapist didn't personally connect with you? Even if you agree about the state of the weather, this therapist's attitude seems contrary and not very welcoming.
In fact, I'd say that this therapy is starting off from a place of deprivation. It prompts me to wonder if, or how, the therapist's ambivalence will show up later in treatment?
The therapist chats about her own problems - the gory details around recent surgeries are best (...so you can learn empathy by empathizing with her?)
How twisted is that! Personal overdisclosure by a therapist is a red flag for poor boundaries. Head for the nearest exit!!
You are the consumer here and the light shines totally on you. Disclosures on the part of a therapist are only appropriate when they support the therapy - not detract from it.
The therapist keeps you waiting and you overhear her laughing with someone on the phone. She doesn't bother to hide her disappointment at having to end the call.
"Yeah, I gotta go now" (aka "this would be a great job, if it wasn't for the clients").
How special do you feel now? Seriously, this boundary slippage is a red flag.
Good therapists are aware of their impact on others. This includes the impressions they are creating outside the normal parameters of the consultation office. A therapist who is aware of these dynamics can be better trusted to have good boundaries.
Oblivious to personal space.
The therapist sits in front of the door - the most powerful position in the room - so that when you leave you have to pass directly in front of him.
This therapist is so tuned out, he has no awareness of personal space. It doesn't occur to him that someone might feel uncomfortable treading so close.
Heads up I say!
You don't count.
The therapist has a picture of "The Scream" (by Edvard Munch) in the office and when you complain, she brushes it off by suggesting you are overanalyzing.
The more activated we are, the easier it is to become triggered by cues in the environment. A therapist needs to create a place of safety and this includes hanging appropriate artwork.
Not only that, the fact that you have raised an issue like this suggests that you are taking good care of yourself. A good therapist will honour and support your initiative.
This situation is also a great opportunity for your therapist to join you in deeper self-exploration.
Can you imagine how it might have gone if your therapist immediately removed the artwork and helped you work through your feelings about the image?
I don't know about you, but it sure would impress upon me that my needs matter and count for something.
Being tuned out. Part 2
The therapist keeps lifeless plants and flowers in the office (so you can resonate with a feeling of despair and hopelessness?).
How can she possibly resource you into a place of abundance if she doesn't twig to the lack of life surrounding her? Huh.
It's your fault.
The therapist doesn't return voicemail messages for at least three days, then calls up and complains that you're difficult to reach.
Tacky, very tacky. Even if you happen to be hard to get a hold of, the therapist should still play it cool. What would you like to hear: "Well, you were really hard to get a hold of." Or, "I'm so sorry, I haven't been able to reach you." Each statement has a very different connotation. What works best for you?
Not only that, there's an implied suggestion that the therapist is feeling "put out" by mere act of contacting you. This kind of power tripping is unconscionable.
Personal contacts, no matter how they occur, are part of the therapy process. A good therapist is always aware of this dynamic.
The sit-down-dance Part 2
Let the set-ups begin!
All kidding aside, the way you're introduced to the therapy routine often predicts the flow of things to come. It's important to remember that the connection between a therapist and client is a finely attuned interaction.
So, when you're looking for a therapist, notice closely how he relates to you. Does she pick up on things that make you feel more comfortable? Or, less comfortable?
Do you feel safe? Do you feel heard? Do you feel he empathizes with what you said?
So, I have a story published. I go to see my T and she ushers me in the room quickly and says "Is that my copy?" I say no, it's the only one I have right now." She says "Well, can I buy it from you?" I just look at her, not sure where the conversation is going. "I'm going to the hospital in a few days to have my leg amputated, so I won't be able to get out to buy it."
WHAT? Rush - rush -rush goes the session. "I'll call you to let you know I'm okay. I'll be back in the office in three months but I will do phone consults if needed."
Off I go, spinning all the way home. Three months turns into six months with a phone call or two in-between telling me she won't be available for phone consults after all.
Now I'm not cold-hearted, nor 'that' self-absorbed and I'm certainly trying to be understanding to the overwhelming issues that she has faced but . . . the ball is in my court now and I'm supposed to call her for an appointment "when I'm ready." WTF? Just another abandonment issue in my head. (okay NOW I'm self-absorbed, lol)
Confused and blah
Wow...that's unbelievable....hard to put words to it.
It occurs to me that there'd be a very real danger here for vulnerable clients seeing such a therapist...how they might get hooked into a negative transference with her...hoping for the therapist to eventually come through. Cause I can see how her behaviour might feel familiar to someone who suffered early neglect and/or ambivalence.
I guess the only up-side is that maybe it's a good thing you are no longer her client.
I am currently in therapy, and my therapist's husband just had surgery. We had an appt. last week, but had her receptionist call me to cancel the appt. As of today, the therapist has not called to rescheduled (as the recpt said she would). I called her office twice, and both times she left a msg on my cell. She says that she does not know when we will get together, but she does see other clients.
I feel as though she does not want to see me and that she does not see my issue(s) as relevant to her. I understand her husband had major surgery, but I am taken back that she still makes an effort to see other clients and not me.
What should I do???
If this therapeutic relationship does not work, this is it for me. I don't have the time and/or patience to be mistreated like this by a healthcare professional. I am really hurt and appalled at the same time. Sorry to write so much, but I am upset. Thanks for taking the time.
CeCe (Massachusetts, USA)
Hoping for Healing
Dear Shrinklady, Thank you for this column. It is very thought-provoking. I have the sit-down dance going on in my sessions; I just brought it up as an issue last week so I felt validated to see it here.
My counselor (an intern) was not conscious that he was moving his chair back each week, and he acknowledged that the practice (the backwards "voyage") was upsetting, but the bottom line is, that he seems to need considerably more distance than what feels comfortable to me. He's willing to not slide the chair back but his solution is to move the chair back before I get to the room, so I don't see him moving the chair.
I'm not sure this will feel that much better. The distance still feels like it is too far.
What is a reasonable distance for sitting during counseling? Am I just too sensitive to this? I think the other thing that makes it worse for me is that there is only one choice of where I can sit, a stationary loveseat that is in itself a problem not just because it takes away any volition I have about how far away I am seated, but also because I have spine injuries and it doesn't offer good enough support for my back.
I'm thinking of sitting on the floor next time and seeing how that feels. I'll probably have a rough time getting up from the floor, but I think it would be worth a try anyway, just to feel a little less trapped.
What do you think? He has many good qualities and has been accommodating in general. We've worked out some other things with good results. But I'm having a tough time with his chair exodus and his need for what I feel is excessive space -- it reinforces every bad feeling I already have about being unacceptable.
Thanks in advance for your kindness and help.
Hoping for Healing (Florida, USA)
I have been reading all of the above and i have to say i have found it very interesting, I myself am a trainee counsellor, i am in my last year. I have to be honest i recognise myself in alot of what you have said, in some ways i was possibly at times a wobbly therapist but what i have to say is that whenever i have had moments when i have let my own stuff cloud my session with my client, i will always take it to supervision to look at what is going on for me and i will always discuss it with my client.
At first i used to really beat myself up about getting it wrong but i have now come to realise that is what makes me real and human and i believe as long as it does not effect my client ( which as of present i dont believe it has ) then these are all experiences i will hopefully learn from and hopefully will allow my client to trust me more.
Emily W (East Sussex, United Kingdom)
Sounds like you're on the right track Emily including understanding that we are only human. That's a tough one especially when you're earnest about doing well for your clients. We can be our own worst enemy sometimes.
Yeah, and it's hard to take an honest look at ourselves. I always liked that about this profession - to do it well and to improve upon one's skills you have to keep up with your own emotional work.
I like to think - if I stay open - I will learn from clients. That's why I encourage folks in therapy to bring issues to their therapist about how the work between them is going.
Thanks for your honesty,
My Dr.'s keep moving, one just across town without telling me. The others moved out of state, one therapist went back to the VA (may be a real need there now), one felt getting back in the saddle was the only way, next, point blank told me she didn't feel safe in the same building, much less in the same office and there was a special hospital for guys like me 200 miles away.
Can I be that bad, I'm a old man (55)?
Harold (IL, U.S.A,)
Hi Harold, an old man at 55? Hey, I'm 58...nothing old about that!
What's happening to you is wrong. No doubt about it. Clinicians are ethically required to give patients - that means you - lots of advance notice if they are planning on making significant changes.
Foremost, they need to avoid dumping their countertransference on patients. When they give you little notice or express concerns for their safety in exaggerated forms - that's their stuff - i.e. their countertranceference.
However, I may be able to explain a few things that will help you decipher events.
I'm going to assume you've done a tour of duty. Like many others returning from the armed forces, you may be suffering from PTSD or at least, certainly high activation.
High activation tends to make people look scary. The muscles in the face are tightly bound and the energy of the body communicates fear.
And this is aside from anything you might say or do.
In the absence of disconfirming information, human beings tend to interpret the worst case scenario because we're wired for survival. So you may be a pussy cat on the inside but if your energy has been "groomed" for aggression, it's the aggressive stuff that folks pick up and they back off from.
What you need is a therapist who can get behind how you present in a session. Someone who sees you for who you really are.
Please try to understand that when disconnections happen as they have for you with these string of therapists, we're primed to make it about ourselves i.e. we tend to think "there's something about me that's not okay".
And we can't figure that out unless we are working with a therapist who's attuned to us and self-aware enough to figure out the dynamics to help us through.
You are a fellow traveller and deserve so much more!
And one more thing Harold. I hope you'll take the time to learn what body-based therapies have to say about treating trauma. I certainly have benefited from going deeper and growing bigger and I wish the same for you!
Thanks Smilin, these are super!
tres is right. A therapest told me over 15 years ago that she knew that I was on speed because she was a recovering addict and could just tell by my restlessness, blah , blah.
I was NOT on speed!
And GEE, talk about not getting a clue, I'm ADHD. Two sessions.
I've had therapist anxiety ever since and have not received help. My life is now a complete disaster. I'm still having trouble seeking help.
Hi Buk, I was so put off by your therapist's actions, it's taken me a while to pull my thoughts together so I decided to chat with my good friend and colleague, Dr. Carole.
Both of us were shocked by your therapist's presumptions that her experience was yours. And we don't feel that she gave you enough credit for knowing yourself well.
Mostly we're concerned that this experience has shut you off from seeking the help you deserve.
So, here's the piece your therapist likely did not know about. If she had we hope she would have had the chutzpah to see you for who you are and not be so caught up in her own perceptions transferred onto you (i.e. countertransference.)
What we're learning from neuroscience - and it's certainly revealed in therapy practice - is that trauma (i.e. anything that overwhelms an individual's nervous system) causes high activation and this shows up in many ways...ADHD, anxiety, eating disorders, addictions etc.
It tends to look the same on the outside. We can appear tense in the face, have restless legs, maybe look spacey and have problems staying focused. Generally, we're just hyper overall...maybe even twitchy.
That pretty much describes me a few years ago. However, I was fortunate enough to find a therapist who "got me" and was able to see me below my activation.
So what I'm wanting you to know Buk is that while the misplaced diagnosis feels hurtful, we bet that the misattunement between you and your therapist is more of what still haunts you.
If that's the case, here's what we're "hunching". Is it possible that your early history may have gotten triggered by this therapist's response to you?
You see, an event as you described and one's reactions to it, can be powered up by a relational history that was less than optimal. It might explain for instance, why it's been so tough for you to get back in the game.
This points to all the more reason to secure the quality of connection you need with a therapist. An attuned therapist will help you move past this event and shift more fully into your future.
All the best,
Shrinklady & Dr. Carole
Often if people do not connect with a therapist in thier first attempt in the pursuit of help they will not make another attempt for HELP. So information and advocacy are critical.
tres (PA, USA)
1. The therapist has visible difficulty staying awake during the session, exhibiting yawns, heavy eyelids, nodding, and then lifting the head up with a jerk. I'm very sorry if he experienced insomnia the night before or had to stay awake all night in an emergency room, but it was unprofessional as well as rude to not be able to maintain consciousness during our session. Way to make the patient feel her problems are trivial and boring...
2. The therapist has less thorough knowledge of psychopharmacology than the patient. Some of us patients have been in treatment for years, and have developed an intimate understanding of our meds. It's disconcerting to come up against a professional who knows less about the drugs she's prescribing than her patient. Way to make the patient feel insecure in the therapist's ability...
Smiling Allie (New York, US)
Wow after reading this I know more than ever that my therapist of three years really isn't good for me. I feel it's too late though... I am so attached that it would be bad for me to leave. He isn't the type I can talk to about what I think of him in terms of his interaction with me. He always blames me and my issues. His boundaries were so tight in the beginning and he made me feel bad about wanting to know more about him. Now its mostly about him. He wouldn't care if I left but it would devastate me.
Anonymous (Texas, USA)
Wow - the signs of a wonky therapist is HILARIOUS. I know, it's sad.. these things occur but the way it was written truly gave me a big laugh!
I recently had a therapist who I did like but she was really one of those 'over disclosing' people and I just wasn't sure how best to handle it due to various circumstances surrounding the way I get therapy services and such. Whatever the case, this is really quite creative...
Butterfly Warrior (California, USA)
Shrinklady, I loved your "Signs of a Wonky Therapist." I think my therapist is amazing and it was wonderful to hear you validate all the reasons why I think she is so special. She isn't perfect, (who is?) but she is completely attuned to me and when she does make a mistake, she admits it and makes sure that we discuss it until we both feel ok about it.
It was so hard for me to believe at first that someone would really want to pay as much attention to what I said and how I said it and my body language, as she does. I am learning that her interest in me and our relationship is real and sincere and that I can always count on her to be truthful and caring and loving.
Thanks for helping me realize how lucky I am to have found the real thing.
puppy lover (California)