Psychotherapy: The Good, The Bad, and The Dangerous
In our lives there will be many wonderful times. Because we are here to grow, we may also face stress, loss, and hardships. Some of us will suffer abuse, neglect, poverty, or financial strain. Others will face challenges in marriage, parenting, or mental or medical illnesses. Accidents, war, crimes, or “acts of nature” may undermine our sense of safety. None of us will escape the loss of a loved one. At such times, competent psychotherapy can help us cope, heal, and live well.
What is psychotherapy? It is not a “schmooze”; it is not advice; it is not friendship; it is never a romantic relationship. Therapy is a relationship practiced within carefully protected, supportive, and safe boundaries. Like the other “helping professions,” therapy is both art and a science.
There are many therapy “modalities”: Some focus on shaping our thoughts and behaviors to create internal and external health; some use the connections between our minds and bodies to bring harmony; others focus on helping us understand our internal worlds, freeing us to make informed choices.
Some modalities encourage healthy communication between spouses or guide parents and children. Others are geared for crisis, trauma, or life threatening conditions. Thanks to tremendous strides in research, we understand more about why some modalities are safe and effective while others are best abandoned. All modalities require technical skill and sensitivity by the therapist.
Good therapy can be a life saver: Bad “therapy” can cause deep emotional scars and wreak havoc on our lives and relationships. Bad treatment can drain financial resources and undermine our emotional growth.
Here are some additional things to consider when interviewing a potential therapist:
A therapist should:
Be educated and trained by an accredited institution;
Be supervised by a more experienced practitioner, or have regular peer supervision;
Regularly attend professional workshops and trainings;
Keep up with the research on and practice of effective therapies;
Have expertise with your particular problems;
Be on time for appointments, return phone calls, and work in a professional setting;
Encourage or insist that parents wait for their children in an adjacent waiting room, or join a session;
Explain the rules of therapy and confidentiality to adults and children, making clear that they are free to repeat anything said by the therapist to whomever they choose;
Respect the client’s religious and cultural sensitivities;
Provide needed paperwork;
Consult regularly with colleagues and experts;
Create a sense of safety to work at the client’s pace;
Be emotionally present, patient, and persistent;
Be kind, calm, empathetic, insightful, and REALLY listen.
Unfortunately, not all therapists are good and trustworthy. It’s important to recognize “red flags” that signal inappropriate, abusive, and potentially dangerous approaches.
A therapist should not:
Regularly miss, cancel or be late for appointments;
Be casual about session length. (Sessions should be 45-60 minutes, less for young children, and up to 90 minutes for EMDR);
Meet outside of an office setting without a clear medical necessity;
Fail to return phone calls;
Answer non-emergency calls, eat, talk on the phone, or text during sessions;
Discuss other clients with you;
Discuss you with anyone other than a supervisor, or use your name publicly;
Fail to refer you elsewhere when your problems are beyond the scope of his/her expertise;
Talk excessively about his/her personal life;
Express anger towards you;
Fail to keep track of where you are in your therapy and healing process;
Fail to help you set and attain goals within a reasonable time frame;
A therapist should NEVER:
Lock the doors or otherwise make your exit difficult;
See you at late or odd hours when no one is around;
Discourage a child patient’s/client’s parents from remaining on the premises, take a child off the premises, or invite or take a child to his/her house;
Tell you “you are more special” than other people/clients;
Shop, dine out, or run personal errands with you;
Ask for personal favors;
Push you to disclose or discuss anything before you are ready;
Touch you or your child in any way that is uncomfortable;
Conduct “therapy” in a bedroom;
Yell, or be insulting, angry, or impatient;
Claim to “have a knack” for doing therapy without training;
Contact your relatives or friends without your permission;
Threaten to tell family members or others that you are troubled and a liar if you reveal what is taking place between you and the “therapist”;
Insist that your problem is because of a lack of faith;
Pressure you to remain in “therapy”;
Ask for gifts or loans of money and other objects;
Encourage you or your child to stop, or start, taking medication without a full evaluation by a competent medical specialist;
Insist that you or your child come multiple times a week for many hours;
Charge above the maximum rate for someone with their degree of education and experience;
Pressure you to remain in or return to a situation in which you or your child(ren) are at risk of physical harm;
Do anything that makes you feel uncomfortable or unsafe without a clear, therapeutic, and scientifically supported purpose.
When we seek medical care, we want the “top.” We should be no less vigilant with mental health practitioners. Do your research: Ask straight and probing questions. Reputable therapists should be willing to talk about their training, supervision, and professional experience. They should never insist that you trust them or follow them blindly.
If you are in a therapy that feels uncomfortable, listen to your inner voice. Stop immediately and seek consultation from a specialist who has no direct relationship to your therapist.
Ilana W. Rosen, MSW
The breakdown of therapeutic boundaries, referred to as the “the slippery slope,” is often subtle and gradual and thus can be difficult to detect and understand. Many behaviors of a potentially abusive therapist may be appropriate in a healthy therapy. For example, a therapist may appropriately, from time to time, use his/her personal experiences to illustrate a therapeutic point. A therapist may also be willing to cut fees as a way of accommodating your limited budget. A therapist may even occasionally accept a small gift from you, so long as the purpose and meaning of the gift are explored and understood. The frequency and intensity of these behaviors may mark the difference between safe and unsafe therapeutic boundaries.
The following boundary violations are danger signs that something may be seriously amiss in therapy. When these or other behaviors that make you uncomfortable occur, do not hesitate to question what is taking place, express your discomfort, and, by all means, seek an outside opinion. In addition, ask the therapist to stop the behavior: Tell a friend or family member what is happening: Keep careful notes on what is happening, along with all cancelled checks, insurance payment notifications, answering machine tapes of calls from the therapist, and gifts she/he has given you. If any of these behaviors continue, terminate immediately and file a complaint:
The therapist talks about his/her personal problems, including sexual relations with others.
The therapist makes sexual or suggestive jokes.
The therapist asks questions about your sex life when you are talking about an unrelated issue.
The therapist suggests seeing you outside the office or professional setting (e.g., dinner, movies, home visit).
The therapist offers to cut fees, see you for extended sessions with or without fee, and wants to reschedule you to be the last patient of the day.
The therapist tells you not to talk about your therapy with anyone else, that therapy is a secret.
The therapist talks to you about his/her other patients.
The therapist tells you, explicitly or implicitly, to stay away from friends and family.
The therapist touches, fondles, hugs, or otherwise makes overt physical contact with you.
The therapist offers food, alcohol, or drugs.
The therapist gives you gifts or accepts them from you without discussion about their meaning.
The therapist suggests that you trust him/her absolutely.
The therapist asks you to work for him/her or solicits your advice on business, investing, or other area of your expertise.
The therapist requests detailed information on your finances.
The therapist uses fines or other types of punishment for infraction of his/her imposed rules.
The therapist seeks to borrow money, your car, or other of your belongings.
The therapist shows up at your house or suggests that your house would be an appropriate place to meet.
The therapist tries to get you together socially or romantically with his/her other patients.
The therapist threatens you in any way, such as the threat to tell others -- including your family members -- about you, to say that you’re crazy or to reveal confidences you have shared in the therapeutic context.
The therapist promises to be your caretaker and/or to protect you from others.
The therapist justifies any of the above behaviors by telling you that you are special, that he/she has never felt this way about a patient before, and that the boundary violations occurring are okay because of the special and different nature of your relationship.
When you express discomfort with any of the above, or any aspect of therapy, the therapist becomes angry and/or tells you this is your problem and/or part of your illness, rather than discussing your discomfort openly.
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