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Thursday, March 1, 2012

Look Before You Leap/The Imperfect Therapist, Part II

How Are You Supposed to Think About Your Therapist

 Therapists, with all their training, schooling, continuing education, therapy of their own, ethical standards---all of it that allows them to get to that chair and to stay in it---are still, fallible human beings.  We do make mistakes.  A lot is expected of us.  And so, most of us are very careful.   We are prone to look before we leap.  Even so, even with all of our communication skills, a therapist can say the wrong thing.  A therapist can miss the point.  A therapist can challenge the patient in a way that isn't helpful.
The intention is good.  Successful outcomes are how we build our reputations.  Satisfied clients continue to come to us and send us their friends and family members.  In addition, many of us take a personal interest in our clients and are really invested in helping them resolve whatever problem they came with.  Beyond compassion, sometimes we come to really care that a client feels well and grows in the way that they want to and develops the kind of gratification in life that they wish for.
So, most of the time, we try really hard.  We come to the office in the best condition - emotionally, physically, psychologically, spiritually, - that we can muster.  We give each and every hour our best.  There's not much room for sloughing off for therapists.  You can't really have a bad day at work and just slide through one day or take it easy.
And, yet, even with all that trying, and paying attention, and being selective, we still make mistakes.  Usually it's about making the wrong choice.

You'd be surprised how much thinking goes on in a therapist's head during any one session.  So, often there are a number of directions to possibly follow; the therapist has to make on-going choices.  It is a conscious effort to follow the client's lead while, at the same time, trying to offer options that might be helpful or more productive or provide a learning opportunity.  Inevitably, some of those choices that the therapist makes will be wrong.
Also, we forget how powerful our position is with the patient.  By that I mean that this person has trusted us with their innermost concerns and feelings; that makes them vulnerable, i.e., in a vulnerable position in relation to the therapist.  Handle with care!
 However, some people don't in fact feel that way in therapy.  I have had more than one person say, "Don't handle me with kid gloves, just give it to me straight."  And then others will be so sensitive in the situation that one wrong word from the therapist and they are devastated.  So, the therapist has to try to know which person is which Sometimes even with true good will and every intention of being helpful, a therapist will say something that is taken by the client as a criticism or a failure in sympathy.
While part of our task, as therapists, is to see beneath the surface, some people have quite a different inside from their outside.  For example, the personality presented to the world may be competent, confident, and outgoing while the inside is quiet, sensitive, and thoughtful.  It can take some time to get to know that inner part and no one, even a therapist may get it all, absolutely right.
It might be unexpected to hear that nerves are much more exposed, usually, in couples counseling than in individual therapy.  When your primary partner is there, often the most important person in the world to you, and they are there because your relationship is in trouble, you are on edge.  The dynamics in these sessions are complicated, or, can be.  Sometimes the deep disappointment in the marriage or the wrath at the partner get turned on the therapist.  It can happen in a New York minute!   So, these sessions are sometimes really loaded and tense.  Thus it is incredibly easy to step on someone's toes.

In the individual sessions, there is just a simpler scene.  Not as many surprises for the patient to handle, less fear of getting hurt, and more sense of control about topics and how the course of the session will go.  And, yet, in this case, the relationship with the therapist becomes more central.  So, an error on the beloved therapist's part can be taken really hard by the patient.

Unless, the same kinds of problems with your therapist are happening again and again, I say give her/him a little room for getting it wrong sometimes.  Bring it up.  Discuss it.  Maybe you can come to a new understanding.  Maybe the therapist has to own a mistake.  An apology may be in order.  Or, perhaps you'll find that you misunderstood.
A lot of missteps by the therapist means you got the wrong one.  But one or two, less than perfect acts or statements, should be considered within the reasonable realm of human error.  The best part is, this is one place where you should be able to say it, say how you felt or feel about it, get heard, and have a useful discussion.

The last thing I would ever want to do, so I expect other therapists feel the same, is to hurt one of my patients.  I am there to help.  I do my utmost to be attentive, supportive, kind and constructive.  Any mistakes are just that, unintended.  So, I expect that this is generally true (of all therapists).  If your therapist said something that hurt your feelings, try, at least once, to talk it over.  Here's hoping you get a happy resolution!

(To see part one of this series, click on, )


  1. I find that there are often times when I end up feeling hurt by my therapist. Sometimes these are things that really are something that needs to be addressed (therapists do make mistakes, get things wrong, blow it big time etc); other times no matter what my therapist did or said I was going to feel hurt because I came into the session carrying too many other emotions or because what we were discussing is such a touchy subject. It would be really easy and often feels preferable in some of those times to run away, to end therapy to move on; and yet, in talking about the problems or hurt it has helped me. I'm also learning that it's a pattern that can happen in other relationships and this is one place where I can work on how to respond differently and stick with it. The hurts horrible as they are can lead to healing. At the same time I have heard examples of people in therapy where it's just too big a problem or not a good match or connection and time to find someone else; thankful that isn't the case for me.

  2. Dear Caz, "hurts...can lead to healing" could be the title to a post! You are learning about yourself in therapy which is difficult, as you said, but also, wonderful. Despite the struggles you seem to have a good, trusting relationship with your therapist. I'm glad for you!

  3. Recently I was on the verge of suicide when I was put in contact with a substance abuse counselor. I only managed to get clean for a month and remained suicidal but knowing my counselor cared made me think I could somehow start to fix my life. A few days ago she told me she didn't know how to help me. She also calls less frequently and I realize it must seem like I don't want help. I told her that meetings and counseling weren't enough help right now but she said I can get sober if I want. I'm a meth and opiate addict that struggled with depression long before drugs. My life is a mess and I seriously don't think I will ever be okay and most of the time want to give up. When she said she didn't know how to help me I felt like I wasn't worth the effort to keep trying. It didn't seem like I was getting better but in my own way was starting to think I mattered. Now I feel lost and stupid and have stopped trying to get off drugs. She was so important to me because I stayed alive because she wanted me to. I am still going to try again at getting off drugs but know I'm all alone and won't reach out. I know I'm silly for depending so much on her and understand that I must be frustrating to deal with but she said the wrong thing and has given up on me. I don't blame her in fact I told her in the beginning that she would stop caring about me but I was really hoping someone would stick it out with me.

  4. Anonymous---Don't give up on yourself. There IS help for addiction. You said you told your CD counselor that counseling wasn't enough. Will you consider looking into some inpatient treatment programs? Just go online and start calling around. There is a place for you. Addictions can be dealt with. Your situation isn't easy but, at the same time, it isn't impossible. Don't give up!

    1. I would like to go to an inpatient rehab but it isn't possible. I currently live with my mom and stepdad like a loser and have to hide the fact that I'm using. I went from living on my own and being responsible to this awful person I don't recognize. I ruined my credit and am in debt so deep that I wouldn't know how to begin to fix it. I have a job and make too much money for state programs but spend every dollar on drugs. I lost my truck and all my possessions. I cannot pay for rehab, cannot charge it, cannot borrow the money and my family would not help even if they knew how desperate I am. My family knows I'm suicidal but they just want me to keep it to myself. I'm such a disappointment and embarrassment and I can't stand any of it. I have my college degree yet wait tables and get no where. I really feel hopeless at this point and don't think I even deserve to get better.

    2. The low cost to no cost in patient rehabilitation treatment programs are usually government funded. Also, usually the county you live in has a County Mental Health program where therapy is available again according to what you can afford. Here is a website you might take a look at:
      There are always 12 step programs which are available everywhere and are free but you have to go to the meeting clean and sober.
      When people are depressed, it is hardest to take initiative. You have to make yourself try again based on the belief that you will feel differently than you do now in the future.
      I wish you recovery and a healthy future. You must take the 1st step. Find help for yourself in your local area. Best, Paula

  5. Yes, therapists are fallible human beings and that, I believe, is part of the magical and life-enhancing 'dance' that takes place between us and our clients. It can often surprise clients that we want to enter into a truly human relationship with them - one of equality. It is not "the professional" meeting with "the service user" (like when we visit our doctor): it is two human beings engaged in a meaningful partnership. Ultimately, our clients want to know that they are in contact with another human being, not simply "an expert".

    And, as fallible beings, we need to attend personal therapy as well as (on a more regular basis) professional supervision, in order to ensure that we are as present and as supportive as we can be. It is all about the quality of the therapeutic relationship and about offering an environment which is as accepting, as non-judgemental and as honest as possible. That's why we need to know ourselves.

  6. Hi Steve. What an excellent description of what the therapy relationship isn't supposed to be and how it should be. I think my favorite part is the last 2 sentences. Thank you for your comment.

  7. Do you think a therapist that doesn't feel the need to reassure the client of the relationship or that they care values the client/cares about the client as much as a therapist that does take time to offer reassurance?

    My therapist has said she feels no duty to reaffirm her caring. She said her showing up on time every week and seeing me through is proof enough. She's said that i could probably find a therapist that would give me reassurance about the relationship but that she is not that type and she doesn't think it will help me.

    On the one hand, i get where she's coming from. No assurance would ever be enough type of thing. But her method means that I get almost nothing. I never even hear anything positive that she might think of me. She only ever seems to reflect back to me her perceptions of my problems, my faults that need to be fixed in therapy.

    It's kind of just wearing me down.

    1. Dear Heather. I've been thinking about your comment and decided the topic was worthy of an entire post. So, look for that; it's called The Best You and will be on the blog next week.
      Without knowing the whole picture, it wouldn't be right for me to assess what your therapist is doing. But, I will say this, the last line you wrote is very telling.
      The question is, are you getting help from your therapy? Do you feel like you are in a productive process? Do you find your trust in you therapist is growing? Please think about these questions, look for the post on your topic, and let me know how things go for you. Paula

    2. Paula,
      Thank you for your reply. I look forward to your post.

      I do feel like I'm getting help/in a productive process. But this is also my first real, long-term therapy attempt,so who's to say that I couldn't be doing better, faster in some other environment. I recently began allowing myself to talk to my therapist about my ED which I had been shying away from for 2 years. She and others might think this is an indication that my trust is growing, but I just feel like it's a product of me feeling so defeated/not caring anymore. Noting else to talk about sort of thing.

      I feel like this is getting long, so I will just say that my therapist has said once (when I asked) that she cared about me as a person. She answered as if it was obvious, so maybe I should know. How is hearing it one time supposed to sustain it in the face of always working on my bad habits/characteristics? If I did something for her to like me as a person, it would seem that I can easily undo the process.

    3. Maybe she likes you because you are worthy of being liked, and not for anything you did. Maybe you can't undo it.

  8. Thank you for this article. I appreciated it. I think learning that your therapist is human and will mistakes is normal. I've had not so effective therapists to effective therapists. They come in all shapes and sizes.

    As I read this now I imagined a scene in my head of someone breaking down and yelling and then crying, begging for help. A therapist gives their hand and says, " I will help you. I will guide you, but in the end you are the one who has to do the work."

    A good therapist is someone you can trust and who pushes you to new heights in effective ways.