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Friday, August 3, 2012

The Imperfect Therapist, Part III

Clients assessing the therapist

                                              Sculpture by Christine Kaiser

  Sometimes a therapist may look more flawed than they are.  
People come to therapy with certain expectations---sometimes they are happily surprised, sometimes they may feel they are not getting what they were looking for.

In this last case, we therapists sometimes receive criticism.  It has happened to me a few times.  When it is warranted, I am fine with it.  When it  isn't, I find it really hard to take.  But, the therapy session isn't the place for the therapist to become defensive...!  So, I feel it is actually much easier to take a deserved criticism as feedback and an opportunity to improve than it is to try to redeem yourself when a patient has complained inappropriately.  How do you stick up for yourself?  Difficult to do.

One time I got told that I didn't give enough direction and that I was more of a "listener type".  Actually, as therapists go, I am probably on the more talkative end of the spectrum (you may have figured that out if you've looked through this blog at all---lots of posts in a shorter time than most...!)
I am not one of those, "uh-huh, yes, ummm", silent type therapists (and I have also received compliments on that from other patients).  I am more of an engaged in an exchange type of therapist than most.   So, this felt quite unjust.
 I do listen though.  I have to know what the actual problem is and that takes some attention and time.  As a matter of fact, I often have to restrain myself because it is so tempting to tell people what to do which is not our job.
I do give suggestions however.  And, this comment seemed particularly undeserved as it was a case wherein I had made more suggestions than usual and really tried to work out a plan of action with the patient, only to have it ignored.
(Have you ever noticed how sometimes a person does something themselves and then blames another?  Very common.)

Of course, most people don't necessarily understand how therapy works, even some who have partaken of it for a long time.  When I go to therapy myself, I am not only working on myself or my own issues but, I am taking full advantage of the process.  Of course, that's because I know what it is.  
It would be a benefit to patients or potential patients to learn about how therapy actually works and why it helps, what a therapist's role is, and how the patient can make the most of their experience!      (Here is a post on that topic:
I don't believe in keeping therapy a mystery or a secret---that's one reason I do this blog---the more you can understand how the process works, the better position you are in to take the full benefit.  Here is another post on how you can best benefit from your therapy process: 
Some people are more difficult to help than others:   
  • Some come to therapy---a place, by definition, for change---very resistant to change.  
  • Some present themselves to a therapist for help with a thorny problem and then withhold some of the pertinent information, leaving the therapy process handicapped.  
  • Some repeat the same problem over and over but never apply in their life what insight or decision was arrived at in any of the sessions.  
  • Some want things to be different in their lives but are interested only in 'tea and sympathy'.  
  • Some would like it very much if others in their life would change but refuse to try anything differently themselves (even how they think about something).  
  • There are patients who lie to their therapists sometimes which, of course, makes it impossibly difficult to help appropriately. 
  • I have even had someone say, at the end of a session, wherein we developed a detailed plan about how to deal with a difficult family member, "Oh, I just wish she'd just stop causing problems."  It was clear to me at that point that none of the planning we had done was going to be applied.

Nonetheless, we therapists in such situations usually keep trying, every week, to think creatively about the patient's problem, to come up with a new angle of approach, and to maintain our compassion for the person before us.

You can imagine how hard it would be to take criticism in one of these scenarios...!

Lest I end this view on one of the challenges of being in the therapist role on a sour note, I will share with you a wonderful bit of an assessment I received today from a young client of mine---a cute teenager:  She said:  "I like it that this is like a conversation and I am not feeling like I am getting the 3rd degree!  I like having a regular weekly meeting even though I don't always have a crisis, it's nice to know this is here for me in case I do.  I'm glad we can laugh together sometimes I feel like you really care."
That little girl made my day! 

Please share your feelings in a comment below or in the reaction boxes.  

(This is Part III of the series, The Imperfect Therapist, which has continued to attract many readers; the second post in the series is here:


  1. Perhaps when a client is thought to be resistant it is because the client really does not know what to do. And I find you people are much more enamored of your insights and interventions than I am.

  2. Dear Anonymous. I was hesitant to publish this post because I thought some people might read it and feel bad. But, I have had so much wish expressed from my readers to know what goes on behind the scenes that I took the risk. I'm sorry if it bothered you in some way. And, I agree with you that clients, especially clients new to the process don't know what to do---I think I did say that in the post. Also, we therapists definitely do not always get it right so I am mostly not so enamored of myself. But I do feel really good when a session does go especially well. I want to help and, the purpose of my blog here is to inspire, inform and support, not to be destructive in any way. Just goes to show you that, indeed we therapists are imperfect.

  3. I feel ashamed at how much I've criticised my therapist; sometimes when everything else is falling apart it seems easiest to point out the things he isn't doing right (in my opinion at that moment in time which may not be my thought really at all) or some of the anger I have towards myself comes out turned towards him. I worry about how he takes it when as your example showed often what we say can be very unjust. I think he really does understand what is going on though and does know my real thoughts about him; yet it still can make it uncomfortable and something I need to work more on. I wonder also if sometimes we gravitate to criticism to avoid something that is much harder to face and doing that feels somehow safer. Thanks for sharing what it is like on the other side in this.

  4. How do you define an appointment that goes well? I have seen one of you people for almost two years and still do not get it. I read the links to you other posts, but it does not make sense to me.

  5. Caz, thank you for your supportive and thoughtful comment. I've been thinking as I've been reading these recent comments on these 'imperfect therapist' posts about how there is not only an essence to a person but also an essence to a relationship. Sometimes things go wrong, or there is a misunderstanding, or we say something we don't mean. But if the essence of the relationship is respectful or caring or hopeful. or, whatever it is, that is usually known by both people and felt. So, it is the metamessage not the one little awkward moment or disagreement that perseveres and sustains each of us in each relationship.

    1. Thanks Paula, I like that idea of the essence of the relationship. Sometimes we first need to work out what the true nature of it is; and then hold on to that.

  6. Dear anonymous. I will have to give some more thought to this comment. But, off the top, I'd say I know (referring to your question about defining an appointment that goes well) by seeing a shine in a client's eyes or a bit of welling up. Or, sometimes the client will say "that was right on the mark" for example. Or, a client will ask for a hug at the end of a session. Or, I am able to help a client get to some feelings that have been pent up for years-in that case, they will leave the session kind of wrung out but feeling relieved. So, those are a few of the ways that I know.

  7. Thank you for replying. I have never left an appointment relieved so perhaps there lies the rub for me. I also doubt there has been any eye shining and I know no welling up or on the markedness has occurred. I have no urge to request hugging from the one I see.

  8. Dear Anonymous, I have put a lot of thought into your dilemma. I realize it's got a number of aspects. We probably can't do it justice trying to assess the situation in a blog format. So, here are my suggestions:
    1. If you haven't already, talk this over with your therapist. 2. Find a well-reputed therapist in an away area, make an appointment for a one-time consult about this issue. 3. Begin searching for a therapist more suited to you: You can usually do a small phone interview. Many therapists will give you a 20 minute free intro. session to meet them before committing to treatment. Look for someone with whom you feel you could be trusting eventually. I am hoping for resolution for you!

  9. I have never posted on a blog so I was not sure how to "sign in" so therefore I guess I am Anonymous Also (AA...but not an issue) I am in a slightly similar situation as Anonymous in that I feel that my lack of understanding the process is really getting in the way the progess. I have seen my therapist for over 2 years, and I have made many positive changes. But I cannot understand attachment and it's importance to the relationship. It may be the rigid boundaries that I have set in place: I know nothing about him, I don't know what his issues are or if he has been in therapy, he may even like his parents. I am thinking that after 2 years maybe a little disclosure might help. I like the idea you stated to Anonymous about finding a well reputed therapist far away for a one time consult. I am going to do that just to get a different view. Thank you so much.

  10. Dear Anonymous Also, I'm glad I inspired your 1st comment on a blog! Maybe I'll become the 1st blog you join as a member---I'd be delighted.
    In my way of thinking about therapy, if you wonder about your relationship to your therapist, it is 'grist for the mill', meaning something to bring up in a session sometime. As for, self-disclosure on his part-some people want to know more about their therapist and some don't. Most ther.have some sort of internet presence now so you might find out more that way.
    Sounds like you might like to deepen your therapy experience. But, at the same time, you've made positive changes you said, so you do have progress. That's not nothing. Good for you!

  11. Being on my job, I’m constantly expecting for some criticism or feedback from my client or in my customer. For me, it seems, it is just a lesson from them. By the way, this post is great! I enjoyed reading this.

  12. Therapy sites: Learning or, at least trying to learn is probably one of the best attitudes you could have when facing criticism at work.
    I am very gratified that you enjoyed reading the post!

  13. My first psychotherapy experience (2 1/2 years working with a psychiatrist) had a harmful outcome in that it replicated the emotional wounds I'd suffered in my family of origin, though thankfully those familial wounds didn't involve serious abuse. Years later I sent a letter to this psychiatrist and among other things said this, "Relationships are complex, and I certainly don't have all the answers. But I do think there should be the space to voice your feelings and needs and be heard with sensitivity and respect, and I also feel there has to be a sense of understanding, appreciation, and care (empathy) to survive the conflicts and hurtful things that inevitably happen. I didn't feel genuinely appreciated or cared for in our therapy relationship, and during our conflicts I often felt blamed and rejected. The antecedents to those feelings may have been part of the emotional baggage I brought with me to therapy, and I am sensitive, but that doesn't invalidate those feelings or mean my perceptions weren't accurate." So yes, the "essence" of the therapy relationship is crucial for a positive outcome. And while I agree therapists are human and shouldn't be held to expectations of perfection, sadly there are some who cause harm without necessarily being unethical. It may be lack of training or experience, a reluctance to deal with their own issues, failure to utilize supervision, burnout, etc. Consumer education is one way to help clients/patients avoid bad therapy, so I encourage you to continue blogging about how the process works, Paula.


  14. Dear Kelley. Thank you for sharing your story---very generous. Yes, sadly these things do happen. Believe it or not, it has happened to me. The 1st time I was very young, not a therapist yet and when I did begin my training I vowed to try to never, ever do any harm. Part of the problem in these unfortunate things happening sometimes is that the therapist has not spent enough time in the patient's seat him/herself. Therapists are human, have their own f. of o. issues, etc. They must work on their own issues to be qualified to attempt to help others. I'm glad you wrote the letter. You took care of yourself when you did that!
    (Thanks for the encouragement at the end of your comment)

  15. You're welcome, Paula. I rarely leave comments, but I wanted to share my experience after reading this series of blog posts. Even though I don't have problems with authority, and I'm reasonably assertive, I still felt largely responsible for my failed therapy. I'm sure that's true for other people as well. I did realize some of my therapist's behavior wasn't appropriate (repeated frustration, defensiveness, occasional sarcasm, etc.), but on an emotionally level it was very hard not to shoulder the blame since the therapist supposedly has the knowledge and expertise to help you, and you only see them in the very limited context of the therapy setting. I know I began to question my perceptions, and fantasied about being a fly on the wall during his sessions with other clients/patients to see how he behaved with them. I also started reading books written for therapists to figure out what was wrong. The power inequality and frame that exist to facilitate the psychotherapy process make it extremely difficult for a client/patient to determine who needs to own responsibility for what when problems develop, especially since many people seek therapy because of interpersonal issues. The vulnerability inherent in such an inequitable relationship poses potential risks, and I feel consumers of therapy should be made aware of those risks. Being informed about the process, understanding what promotes a good match and therapy alliance, knowing what behaviors are inappropriate or boundary violations on the part of the therapist, and researching the type of therapy that's shown to help with your specific problem are all important. So thanks again for helping get this kind of information out there.

  16. I enjoy the repoire I have with my current therapist. We are both straightforward and it helps. I need her to be a real person and to be straight with me. Some people might expect this to be harsh and unusual but I respect someone who is honest and can just be straight with me. I couldn't stand the passive listening type. Thanks for the post. My therapist sometimes asks me if there is anything she needs to change in order to benefit me. I appreciate it.