How do I know if my therapist is wrong for me?

A 2022 Update

I’m 10 years into my practice and updating a few articles I wrote early in my journey as a therapist. I think this one mostly stands up. Therapy is often awkward at first and after 6-12 sessions, you should know whether you find it productive. That said, I’ve come to think of therapist-client fit much like yoga teacher-client fit. Some teachers are better than others at giving advice on how to get into a pose, not because they’re better teachers, but because their style works better with how you think.

It’s difficult to tell how good a therapist is going to be based on experience or a particular technique. Check out Common Factors research that suggests many of the primary mechanisms of change in therapy are not method-specific. More experienced therapists are also not always better. Only deliberate practice over time seems to improve outcomes and skills.

So I suppose much of my original advice stands: Find a therapist who has an unrestricted license, screen them for basic competence (I have some advice on how to do that too), and try them out. If you’re not feeling it after 6-12 sessions, try someone else.

The Original Article

There is bad therapy and then there is therapy that isn't a good fit for the client/patient. Signs of a BAD therapist would include those who do not disclose legally- or ethically-required information to their clients, those who breach confidentiality without acceptable circumstances, those who engage in harmful relationships with their clients (romantic or other), or those who practice outside the limits of their license. I might say that a "less-than-what-you-should-expect therapist" might have poor diagnostic or risk management skills, engage in minimal continuing education, or readily employ treatments without any evidence-base. These are the therapists that you can probably weed out with some good questions during the first few sessions - but that's another blog entry altogether. In fact, you should check out the Very Bad Therapy podcast if you want horror stories.

Therapy is almost always awkward (at first)

It is much more difficult to identify therapists that are "not bad, but bad for me." Therapy is strange and awkward for most clients, at first. Where else in your life do you walk into a total stranger's office, answer personal questions about topics you may be very embarrassed about, and ultimately walk away knowing little to nothing about the person you're talking to? It's weird. A good therapist will probably push your buttons and make you feel uncomfortable sometimes. It can be normal to dread going to therapy, to feel angry before going, or to want to quit.

So how do you know whether your discomfort is therapeutic and normal, or a sign to seek care elsewhere?

Reflect before deciding

1. Consider what brought you to therapy in the first place. Define the problem. You and your therapist should have talked about this at the outset of your therapy and regularly throughout treatment.  

2. Think about what you were doing - what your life was like - when you started therapy. How did your problem impact what you were doing on a day to day basis? Does your therapist seem to be clear on this experience?

3. Have you given therapy a good six to twelve weeks so you can settle in, get to know your therapist, have a shared definition of the problem, and a direction to start moving? 

4. Now with the above-topics in mind, consider whether what you were doing six to twelve weeks ago has changed or improved so that what you're doing today is more in line with what you would LIKE to be doing. Have you noticed any changes in your behavior, feelings, or thoughts?

If you believe you have made some major changes with some assistance from your therapist, it could be that the discomfort you feel in therapy is therapeutic. It could be that your therapist is pushing your buttons in a way that is helping you. That said, those moments of discomfort should probably be MOMENTS and not your entire interaction with your therapist, by about 12 weeks. If after 12 or so sessions, you still feel very uncomfortable, it may be time to ask for a referral to someone else. 

A good therapist should always be willing to provide you with referrals to other professionals who may be a better fit for you. I think as a group, we want to find clients the right care for them, even if it's not with us.