Ask Betsy
The advice column where you get to ask me anything you want, and I get to tell you exactly what I think.
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Good Person but Bad Therapist?
quote
April 8, 2013
Dear Betsy,
I've been seeing a therapist for almost six months and I like her as a person, I'm not sure we're getting anywhere. I wish I knew what good therapy was supposed to feel like. Maybe I've been watching too much of the Sopranos, but I was hoping she would challenge me more. Am I expecting too much?

Signed,
What have you done for me lately

Dear What,

After thirty years of practice, I can confidently say that most therapists are good people. So the likelihood of you finding one who means well, listens carefully, and cares about you is excellent. But these characteristics alone--while critical--do not guarantee good therapy.

Let me give you an example from my own practice, where I often see clients who have seen other therapists. "Martin" called to schedule a couples session with his wife "Carol" because the they were having problems in their marriage. One thing I do before I see clients is have them complete a detailed intake questionnaire, which I read before their first session. This saves time, and it gives me lots of information a person might not think to mention in person.

When I read Martin's Intake, the first thing I noticed was that he'd been seeing a psychologist on and off for ten years. I could also tell that he was profoundly depressed, had never been treated for depression, and probably had a pretty serious drinking problem.

The first thing I did when we met was ask Martin about the work he'd been doing with his therapist--a well-respected psychologist in town. In particular, I asked him how much the two of them had talked about his depression or alcohol use.

I'll never forget his answer: "He never me asked about either... but I've always sort of wondered about both."

I was stunned. How could a psychologist work face-to-face with a man for ten years who was clearly depressed and completely cut off from his wife and kids, without once talking to him about his depression or alcohol use?

This was blatant negligence. And it was especially appalling because the information was so easy to obtain. It was all there in black and white, information I had gotten before ever meeting Martin. What had they been doing in therapy all those years?

The amazing thing was that Martin didn't realize he was getting bad therapy. He liked his therapist and described him as a good guy, someone he trusted and considered to be "kind of a friend."

Obviously, having a good relationship with your therapist is important. In fact, according to a review of the literature on the benefits of therapy going back to the 1980s, almost all studies confirm that the quality of the relationship between the client and therapist is the most important factor in successful therapy, regardless of the techniques or methods used.

But a good relationship with your therapist is not the only criterion for evaluating therapy. Martin's therapist was a good person. But he was not a competent therapist. Without treating Martin's longstanding depression and blatant alcohol abuse, there was no way for couples counseling to succeed.

So if liking your therapist isn't enough, what does distinguish good therapy from bad?

Here are two lists to help you evaluate the quality of the therapy you're receiving. The first describes what I think is Good Therapy. The second, what I think is Bad.

Good Therapy:

  • Consistently makes you feel cared about, understood, and energized about your own ability to improve the quality of your life.

  • Challenges you to look at yourself honestly, and do what it takes to live in ways that are consistent with your highest values.

  • Helps you see patterns of thinking and behavior that are outdated, inconsistent with your values, or destructive in your personal or professional life.

  • Increases your ability to recognize, regulate, and express feelings in a healthy and balanced way.

  • Is a collaborative effort between you and your therapist that is driven by your goals and needs, rather than by your therapist's agenda or biases.

  • Involves work between sessions.

  • Never loses sight of your mental, physical, relational, and spiritual health.

  • Includes regular check-ins to monitor progress and suggest experiments that will help you move toward your goals. My check-ins sound something like this: "So, tell me what are you taking out of today's session, and what you're going to work on between now and the next time I see you?"

  • Ends therapy as soon as possible, rather than when your money runs out."


Bad therapy:

  • May make you feel cared about, but doesn't challenge you to see yourself more clearly or change behaviors that are inconsistent with your highest values.

  • Ignores or overlooks disturbing or destructive habits in order to maintain a conflict-free therapy environment.

  • Leaves you feeling judged, pressured, or manipulated into doing things that don't feel relevant or right for you.

  • Feels unsafe, unproductive, or unprofessional in some way.

  • Feels like it's meeting your therapist's needs more than your own.

  • Rehashes old issues and doesn't lead anyplace new.

  • Over or underestimates how distressed you are, so you feel pathologized or insufficiently supported.

  • Usually ends with phrases like: "Well, we're out of time... Should we set up our next appointment?"


If anything jumps out at you after reading my lists, I'd talk to your therapist about your needs, concerns, or unmet expectations.

Most people go to see therapists when they're feeling vulnerable or confused. It's important to remember that therapists are just people. We have our own blind spots, fears, and varying levels of experience, comfort, and expertise.

Your therapist sounds nice. But what's most important is that you are getting what you need from your time together. If you have any doubts, concerns, or questions, bring them up at your next session. I would expect her to be willing to address those issues head on, without becoming defensive, and either change course, or refer you to someone who is more qualified to meet your needs.

Best of luck,

Betsy