When therapy isn’t great: good psychotherapy vs. bad psychotherapy

by Dec 2, 2012Bad psychotherapy

Therapy isn’t always kismet.   You sift through the practitioner’s websites, meet up with a couple, and choose the one you like the best.  Or the one that’s on your plan.  Or the one whose office is nearby.  After about six months, you may end up realizing…it’s not great. Here are a few things to think about when therapy doesn’t go well.

Do you feel safe to say what’s truly on your mind?

If there was ever a place to speak your mind, it’s in your therapist’s office. She will do better work if you give her the real story. Let’s say you know you need to tell her something, and you just can’t bring yourself to do it. Give her a head’s up that you are struggling. She can become more active now and help you say your piece. Often, patients wrestle with embarrassment, especially around needing things you know (or at least think) the therapist can’t give you. It’s no fun feeling this way, and maybe the first thing to do is to acknowledge how shame operates in the halls of your mind. If too many things are forbidden, shame can constrict your life.

A symptom that cropped up last month will resolve sooner than something that’s been around for years.

Perhaps just recently you’ve been compulsively playing video games. Your sleep is suffering and your performance at work is sliding. You’ve always gamed, but this is something new. If you’ve gotten yourself to a therapist soon after the onset of the compulsion, chances are good that is can be resolved sooner rather than later. On the other hand, if you’ve been gaming compulsively since you were a kid, this will take some time to unravel.

When you are unhappy in your therapy relationship, tell your therapist.

Perhaps he said something that hurt you. Perhaps you didn’t feel heard. You came in wondering what to do next and it has been a while and nothing has changed. Sometimes, telling your therapist is the only thing you need to do. Things get clearer, and misunderstandings get straightened out.

Another option is to go for a consultation to another therapist. Here’s how this works.  Talk to your therapist about what feels wrong.  Perhaps he or she has some ideas.  Tell her that you’d like to try a consultation with another practitioner.

Look for someone who is supervising and teaching.  Try to find someone more experienced than the therapist you are seeing now.  Tell this person what’s going on. It may be that you are at an impasse.  You might not necessarily leave the ongoing treatment, but at least you’ll have a second opinion and some clarity. It will bring something new into the process.

If the impasse feels familiar on your side, I encourage you to stay put and work it through.  It’s truly amazing how we can create exactly the situation we were trying to learn how to escape.  It doesn’t feel very good, but it’s an important opportunity to finally understand something that’s been dogging you for years.

Elizabeth Singer is a therapist and anger management specialist in New York City

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