At the risk of appearing pompous and egotistical, I’m going to take a big leap here and criticize some in my profession. I do so not because I feel I am a perfect therapist, but because I hear so many tales of psychotherapists, social workers and counselors that make me angry and disappointed at their very obvious lack of professionalism.

Here are a few examples of incompetent therapists in action:

  • In the first session, the therapist asked the patient to hire the therapist’s daughter.
    • A clear boundary violation that the patient, correctly, took offense to. He quit the therapist immediately.
  • Therapists who talk excessively about themselves.
    • I heard about one therapist who told a suicidal teenager about her own teenage daughter’s suicide. True story! This therapist should never have taken on a case that triggered her emotions in this way. It should have been referred to someone else immediately. She should never have self-disclosed in this very harmful way that could have triggered this teen into acting on her suicidal thoughts.
    • Another patient told me she made no progress because the previous therapist spent most of each session talking about herself, her children, her weight loss issues, her marriage, etc, etc.
  • In the first session, a therapist told a couple to get divorced.
    • Making a judgment about a relationship of many years based on a few minutes of reporting by the couple is impetuous and possibly harmful. A therapist is, generally, not to be a judge or advice giver. And certainly not in the first session. The goal of therapy is not to have a therapist give advice or run a person’s life, but rather to lead the patient toward skills to be more self-efficacious, not less.
  • Patients report seeing a therapist for years and not making any progress.
    • In the first session, when I ask if a patient has been to a therapist before, I then ask what they learned or what helped. Many, many people answer: nothing. Certainly that can be a function of the patient’s defensiveness or inability to make emotional change. But I’ve had these same patients tell me: “I’ve learned more in this first session than I did in years of therapy with other therapists.” Ethical professional behavior requires that a therapist refer patients to another therapist if they are not making progress in a reasonable amount of time.
  • One therapist saw a couple for two years without having had any training in marital therapy. The couple made no progress, the husband had moved out and they were on the verge of divorce when they came to see me. They had come to believe they were “hopeless and unfixable.”
    • While it is impossible to gain specialty training in every area of mental health, therapists are ethically bound to be aware of their weaknesses and not take on patients that they are unqualified to treat. Look for a therapist who specializes in your issue.
  • Many therapists do not discuss emotions or help patients address how they experience emotions.
    • Going deep into the physical experience of and belief system about emotions is the only way to make progress in therapy. My rule is: A good therapy session should leave you somewhat emotionally affected. If you never feel wrung out or cry in therapy, it probably wasn’t worth your time and money.
    • Many therapists have never been in therapy themselves and so feel uncomfortable dealing with emotions. A therapist should have worked through his or her own issues with emotions, especially the emotion of shame, so they will be comfortable dealing with your strong emotions.
  • Beware of therapists who allow you talk endlessly about other people.
    • Therapy is about you. Certainly relationships in your life are important, but if, at some point, the therapist does not make you address your own emotions and behavioral choices, then therapy just becomes a venting session about others and you will make no progress on your own issues. Not surprisingly, your relationships will also not change.
  • Therapists who fail to show, run late or cancel appointments frequently.
    • Unprofessional. Enough said.
  • I have shared office space with therapists whose sessions with all patients involve repeated, loud laughter throughout nearly every session.
    • Certainly laughter is healthy and appropriate in the therapeutic relationship, but therapy is not a social relationship. If every session involves extended story-telling and humor, then I would question the value of this style of therapy. If a patient feels the need to entertain the therapist with humorous anecdotes at every session, this is actually a theme to be explored:  “I notice that you like to come to every session with a story for me to laugh at. Is this a pattern in your other relationships? What does this mean for you?”
  • In contrast, patients have reported that the therapist never smiled at them and was “stone-faced.”
    • Warmth, acceptance and compassion are essential traits of any therapist. Long gone are the days of Freudian “blank screen” facial affect styles for psychoanalysts. How can a therapist explore and encourage a range of emotions in patients without also expressing those herself?
  • Many therapists who treat children never meet with the parents after the first session.
    • Child behavioral problems are nearly always the result of parenting styles that are permissive or authoritarian, or lacking in emotional connection. How is it possible to assess for inappropriate parenting and lack of attachment without meeting with the parents and directly questioning them? How can a therapist conduct parenting education without meeting with the parents separate from the child? How do you build attachment between parent and child without family sessions?
  • Therapists recommend patients consider medication.
    • There is no known biological, functional or genetic cause of “mental disorders.” Psychiatric medications do not “cure” a “medical illness,” such as an imbalance of neurotransmitters. Psychiatric medications have many short-term and long-term hazards. Therapists who encourage use of medications are not educated on the current state of the profession and are endangering their patients.

These are just a few of the inappropriate behaviors therapists can engage in. Fortunately, I’ve never directly encountered the most common complaint registered with licensing agencies:  Sexual relationships between a therapist and patient. Clearly, this boundary violation is never appropriate and a violation of the licensing laws in all states.

When selecting a therapist, find one who is professional and trained in your area of interest, but also warm and accepting. Trust your intuition. If the first session does not feel comfortable, seek another therapist. Do not be afraid to tell the therapist you are doing so.

I end each intake session by telling the patient: “The therapeutic relationship is very subjective and personal. If you feel this relationship is not appropriate for you, I will completely understand and will not take it personally. Would you like to schedule another appointment or can I refer you to another therapist?”

As in any field, there is a range of quality in the mental health treatment profession. I encourage you to keep looking until you find a therapist who helps you progress with your emotional health in a timely and professional manner.


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