Leslie,* age 30, came to therapy to deal with a bully boss. Her new manager was making her life miserable, and she needed some coping skills. Leslie chose Dr. M because she was within walking distance and because she was impressed by Dr. M’s Ivy League PhD. In the first session, Dr. M did a detailed history of Leslie, and then told her that her problem wasn’t her boss, but her unresolved issues with her mother.
Although Leslie protested that she had already dealt with her alcoholic, abusive mother before in therapy, Dr. M insisted that the issues were much deeper than work stress. Reluctantly, Leslie agreed to focus on her relationship with her mother.
After several months, Leslie’s problems with her boss worsened, and she could barely sleep or eat. Dr. M told her that she wasn’t working hard enough on her issues, and asked her to increase her appointments to twice weekly. Exhausted and desperate, Leslie said yes.
A number of weeks went by, and Leslie’s friends began becoming concerned about her. She was a shell of her former self, lacking her usual confidence and positive attitude. They were particularly distressed to see that Leslie now needed to call her therapist around every little issue. Finally a friend bravely told Leslie that the therapy was making her worse, and that she needed to go in a different direction with Dr. M or find a new therapist.
Leslie’s story, while extreme, is not uncommon. I have seen many “Leslies” in my career. Psychotherapy, like all professions, can be of great help to people. But it can also cause harm.
The same can be true with physical therapists, or chiropractors, or physicians. Their techniques can transform lives. But they can also make problems worse.
How can consumers of therapy avoid some of the pitfalls? How can you not end up in Leslie’s shoes?
First, let’s look at some of the red flags for Leslie’s treatment with Dr. M. First off, Leslie chose Dr. M based on logistics and Ivy League credentials. While it may be helpful to find a therapist close by, perhaps this shouldn’t be the number one factor. Also, the therapist’s experience, ethics, and personal style are generally more important than where they went to school and whether they are a doctor or a master’s level therapist.
Next, Leslie came to therapy with a definite goal — to get help with an abusive boss. But Dr. M ignored her request, and came up with her own agenda.
Now there may be times when the therapist will point out that other issues exist along with your presenting problem. There was nothing wrong with Dr. M suggesting that Leslie’s problems with her boss may be related to her abusive mother. Exploring this issue briefly may have been useful. However, Dr. M should not have dismissed entirely the reason why Leslie was coming for help.
When Leslie got worse rather than better, Dr. M didn’t consider that the therapy may be causing problems. Instead, she asked Leslie to come more often. While there may be times when it is appropriate to come twice weekly (for instance, during an emergency), the risk is that it can build too much dependence on the therapist, and put the client in a child-like, regressed state. Good therapy should foster independence, confidence, and resilience.
So how can you find the right therapist and not end up in Leslie’s situation? Here are some tips:
1. Trust your instincts, and don’t talk yourself out of your concerns. No therapist is perfect! However, if you feel uncomfortable around the person, then take this seriously. And don’t disregard inappropriate behavior (for instance, taking phone calls during sessions; poor boundaries in a home office, such as introducing you to spouse or kids; the therapist inviting you to a social event, etc.)
2. If something doesn’t feel right during the therapy, speak to your therapist. A good therapist will be open and interested in your concerns. If the therapist gets overly defensive, accusatory, blames you, or ignores your concern, this is a definite red flag that you may not be in a safe place.
3. Don’t let the therapist talk you into doing anything that makes you uncomfortable: e.g. going twice weekly to therapy if you don’t want to and you aren’t in crisis; remaining in therapy even when you have said you feel ready to stop, etc.
4. Be careful about overly focusing on the past. While it may be useful to connect the dots of your past and your present, too much talking about old disappointments and traumas can put you in a depressed and anxious state. Simply put, talking over and over about a bad experience will leave you feeling bad!
5. Notice if therapy is making you feel better or worse. Most traditional therapists will tell you that you may have to get worse before you feel better. I don’t agree.
There’s a kernel of truth because sometimes a particular session may not leave you feeling better. However, in my opinion, the therapy in general should be leading in a positive direction: towards increased optimism, hope, coping skills, and confidence.
6. Be careful if you are feeling more regressed. Leslie ended up in a dependent, regressed state. She couldn’t make a decision without consulting a therapist! Therapy should make you feel more independent, not dependent. Yes, you may become attached to your therapist, and there’s nothing wrong with this. However, at the same time, you should be stronger in your “adult” side and becoming a more capable person.
*Please note that all references to clients are composites, with no identifying names or information.