Human Error In Talk Therapy
Finding a therapist can feel as intimate as dating and as much of an investment as buying a car. So once we think we've found a therapist who makes for a good fit, the built-up exhaustion from the long and vulnerable process (especially in the midst of a mental health crisis, if that's what galvanized the initial search) makes the idea of switching providers intimidating and risky, but you may discover it's ultimately necessary.
A therapist's unique personality and tastes shouldn't have any bearing on the care they provide—the whole point of talk therapy is establishing a space for reflection on the patient's part. But because therapists are human, it can occur.
John Crowe, L.C.S.W. (and father to the author), noted why feelings of judgment from the therapist onto the patient are a major warning sign.
"Beyond violating boundaries, a patient can't make a mistake in therapy," he said. "One of the first tasks of the clinician is encouraging patients to look beyond those value judgments in their thoughts and feelings."
Use your words
If a therapist impresses upon the patient that their sentiments (rather than behavior) are somehow wrong, that's a huge red flag. While not all feelings are accurate, all are valid and much of the work therapy requires hinges on a foundation of self-acceptance over shame.
Cognitive behavioral therapist (CBT) Avigail Lev, Psy.D., draws a clear line between a therapist's own emotional work and projecting those issues onto patients.
"Most people have some sort of baggage and/or trauma in their life," Lev said. "The role of the therapist is not to hide the fact that they are a human being. Their role is to be able to hold and contain their emotional triggers in a way that still models effective coping, and staying consistent with values."
This infraction can occur as covert judging or in the more nuanced form of projecting beliefs onto a patient. When a trusted authority figure with medical degrees hanging on their wall puts words in our mouth, it can be difficult not to defer to them. Our original feelings haven't been validated, and are now being erased before we can fully understand and investigate them.
If you leave therapy feeling burdened by pointless busy work or were spoken over and misunderstood, those are also huge warning signs.
As with any medical intervention, therapy is supposed to achieve results. Those results won't happen overnight—it may take years, and what will eventually heal can at first hurt—but healthy therapeutic care should bring goals to fruition. John Delatorre, Psy.D., explained how a lack of such direction in therapeutic care can be detrimental.
"One of the biggest failures would be in initially not having a clear understanding of what goals the client has with regard to completing therapy, and without that clear understanding, a client could feel 'stuck' and [as if they're] not making any progress," he said. "Therapy should never be viewed as a 'forever' aspect of their life. A good therapist wants to give the client the tools to function effectively and get the client living their lives."
As a "soft" science, mental health is difficult to quantify. That said, progress can be tracked and a client typically feels when the care becomes redundant. Rather than becoming stuck in a loop, a therapist and client should have a clear agreed-upon treatment plan with short- and long-term goals. These can be established in the first session and expanded upon later.
Another mistake is for a therapist not to respond as we need them to. While no one is a mind reader, the right therapist handles their own communication as a tool to be honed and not a personal flaw to protect. Lev outlined a therapist's options for tweaking communication to benefit our interactions, both in and outside of therapy.
"There are many ways to tell whether a client needs challenging or nurturing in the moment," Lev said. "If a therapist is doubting [what] the client is needing, then the therapist can just ask the client whether they're needing validation, problem-solving, support or skills."
The question of challenging or nurturing is a common pitfall in communication—it's the argument that happens when someone offers advice to a person who just wants to be heard. However, a therapist is a trained professional who should know enough about communication to avoid such gaffes.
While not all feelings are accurate, all are valid and much of the work therapy requires hinges on a foundation of self-acceptance over shame.
As with any other relationship between two humans, resolving problems can strengthen the relationship, a phenomenon known as "rupture and repair." If a therapist messes up—whether in the aforementioned ways or others—evaluate your feelings first.
How much of a problem is this, and can you move past it?
How much does their mistake reinforce personal problems you've disclosed?
For example, if a patient with acknowledged abandonment issues is stood up repeatedly by their therapist, that's not a good match. Then again, if the issue was a one-off and you have trouble with blame and practicing forgiveness, the mistake can be a part of a valuable learning moment.
Rapport through growth aside, a therapist is only sought out if a person wants to resolve difficulties in their life. On that basis, a therapist's office shouldn't represent a hotbed of issues for you to overcome.