My Therapist Isn't Perfect. Now What?

[joeylittle]

As much as I want my mental health care providers to be everything I need them to be....they are human, so they are going to make mistakes.

I used to think about these mistakes or blunders or missteps in terms of tolerance: what am I willing to tolerate or overlook because the gains outweigh the negatives? I do still think in that way, but now there's this added question - do I say something?

An example: my therapist is prone to saying he will do something and then not doing it. I am sure he means well in the moment - but he forgets. This has happened with recommendations he's said he will give me, articles, recordings...but also when I asked him to re-send me our safety contract, he forgot. And that was tough. I did work up the courage to remind him - but it was really hard for me. And in some ways, I can see that I maybe learned a skill from that (?), but in other ways, I just don't want it to be that hard when I'm in that rough of a place.

And then, I think I'm being entirely too whiny and self-involved.

The latest: he is away on vacation (that's fine) and emphasized very strongly that I should still not hesitate to call him, that he's still taking crisis calls, I'm not the only client he is doing that for, and it's not my job to protect his time off. (I really have a hard time with the 'bothering' people negative thinking, and so it's challenging for me to hear what he is saying and accept it).

At our last session, he said he would send me an email reminding me that I should call him when I needed, as well as the list of things he requires me to call about.

Of course, he's forgotten to send the email. I'm handling it a little better than the last time, trying to take it as an opportunity to keep it in perspective, be neutral, avoid judgment or interpretation. Ok, fine. But, really? Again?

I don't want to make it a bigger deal than it is. But there's no denying that I'm developing unhelpful thoughts around this trait of his. And what is strange is that it would not be an issue if he wasn't making it an issue, if that makes sense. I think he's a great clinician, with solid boundaries, a good work ethic...and I'd expect him to do the things he says he will do the majority of the time. But I think his track record is something like 20% of the time, he follows through.

Anyone have stories to share of the things their therapist does that are moderately disturbing? Majorly disturbing? Do you overlook it? Talk about it?

 

[Chava]

I used to think about these mistakes or blunders or missteps in terms of tolerance: what am I willing to tolerate or overlook because the gains outweigh the negatives?

Lots of helpful perspective. I quit my last therapy a few years ago because the therapy just wasn't super helpful. My therapist was actually really nice, maybe a little too sarcastic at times. I just needed a different angle (trauma vs eating disorder focus). My current therapist had a hurtful response to my canceling when I was sick once (she really maybe thought I was lying, which would not be unlike me if overwhelmed and not willing to face something important, but I really was in urgent care that morning). We did talk about it. She admitted she was angry because she wanted to see me so we could work on this stuff and that she didn't respond well. She made no excuses for herself but admitted she could see how I was hurt. Before that conversation I was about one wrong breath from quitting. But that would not have felt right either. The therapy is helpful and she is a good therapist.

It's important to look at all the help we get from therapy, if it's the right therapy, in a big picture view. If we can tolerate imperfections from our therapists, that's a helpful lesson in itself in being able to relate to others and not quit relationships over basic human imperfections.

I don't have the follow-through issues you mention with my therapist. But I've had a couple good friends like this and a boss....they DID mean well but I really sensed some level of ADD (I suspect pretty common among musicians...or maybe just general scattered attention). What helped, though stressful initially, was finding ways to remind them or check back without feeling like I was horribly nagging or needy (I hate that feeling). And they were always fine with me double checking because they knew they dropped the ball. I learned to let go of things that didn't matter too much and put out short reminders for things that did matter. Did I like being in this position? No. But they all had to put up with my rambling, confusing ways of getting to a point sometimes. We all make small compromises and changes in order to be in any relationship. It's just not possible otherwise.

 

[City Slicker]

Hey @joeylittle - I don't have first hand experience going through this with a therapist but I am in the middle of reading 'The Body Keeps the Score' by Bessel Van Der Kolk. I wanted to pass this on in case any of it is helpful.

I just finished a part in the book where he is describing how a client of his confronts him about something he does and I found the way he says she did it to be really empowering. I am quoting with some of my limited memory as I don't have the book right here.

He says that he used to tell clients that had been sexually assaulted by adults 'it wasn't your fault' and, 'he was the adult, he was supposed to keep the boundaries' etc. One day after saying this yet again one client finally and simply said to him, 'you know Bessel, after seeing you and trusting you for over two years now I feel I can say this to you. I know it's important to you to be a good therapist. When you say that to me about it not being my fault, I don't say anything. I know I am supposed to feel better because as a sexual assault survivor and a woman, I am supposed to take care of your needs, but when you say that to me it only makes me feel worse and that no-one will ever understand what happened to me'.

I liked how it supported the therapist acknowledging her recognizing his intent to be a good therapist and even better it acknowledged her ability to stand up and step out as her own advocate when things were feeling nasty.

He goes on to say that he indeed changed as a result of the client bringing it to his attention.

 

[darrenS]

i treat my therapy as a professional relationship , if they say something i find concerning, i call them out. If they say something thats not helpful or not for me, l let them know. If they suggest a different approach , i ask them to explain it in detail , so i can weigh the pros and cons. I am one that will not encourage interaction outside of the session, otherwise at times they will push the boundaries and sometimes it will be for their own reasons and not mine.

I enjoy a great relationship with my therapist but we both know its a professional relationship , and as such i will pick and choose what i think is relevant. The fact your therapist encourages you to contact him whilst your in crisis may seem helpful , but in reality its not. It gives them an out or other things you may need like regular solid sessions and it sets you up to stay in crisis mode.

I have always had great concerns about what may constitute professional boundaries, sometimes therapists will have as much dependency on feeling special , by the number of clients they treat , they are human and just because they are trained does not mean they have their own demons or altruistic reasons.

 

[Jane.l]

My T does the same thing, it's been a problem, I would recommend telling your T because quite often they don't realise they have done it. To me a very important part of therapy is consistency, and I think that doing what you say you are going to do is part of that.

I have had a few sessions with my T talking about how I feel when he 'forgets' and how we manage moving forward because it undoubtedly will happen again - once I brought up how often he does it, I could see he was genuinely surprised - so I would bring it up .

@City Slicker great book!

 

[Kintsugi]

I would definitely say something. I met with my new T twice in the first week I saw her, after being out of trauma therapy for the better part of a decade, and the reason I forced myself to do this was that she had a trait I considered a deal breaker emotionally. She often lapsed into speaking with loud declaritive sentences. Too many loud declaritive sentences. Like seven in a row without letting me respond. I wound up in tears at the end of our first session and was completely perturbed.

The next session, we talked about my emotional response. I told her point blank pretty much exactly what I just wrote here. And you know what? She has earned my trust a thousand fold by controlling that tendency 100%. I was getting all kinds of worked up the last time I saw her, half shouting my grievances about my world, and I saw that before she spoke, she took a good breath, and out came a wonderfully soft voice, sparing of words, asking me open-ended questions. She managed to be just so zen.

I was very, very impressed. And it has improved my trust in her just so greatly. I'm thrilled by being heard. I hope you find the same effect if you choose to confront your T about this irritation.

 

[Deleted member 1860]

I think you have a right to feel upset! Why? Essentially, your therapist is LYING to you. Maybe its not intentional, but at the end of the day, when someone says "I will do XYZ" and they don't do it, that statement becomes a lie. You add up many of those, and it means that the person is untrustworthy and there isn't much reason to put any faith into them.

Ok, look at it this way. I think we all want to believe that our therapists care about us, and its not just about getting paid for those 50 minutes, right? Well, when a therapist says they will do something *outside of session* and they don't (repeatedly), this essentially tells us (subconsciously) that the therapist only cares about getting his/her $$$ for the session, and that we aren't worth of their care outside of this timeframe.

Long/short, you have a right to be pissed.

Its the same as any other professional telling you they will follow through with it and they don't. And honestly, in the real world, in a paid professional type of situation, YOU CAN SUE for someone not following through with what they say!

Would it be acceptable for a doctor (MD) to not order those specialized tests for you after he promised you? NOPE!
Would it be acceptable for a financial planner to fail to follow up on getting you information for your investments after he promised? NOPE!

Ok, so I was going to make a whole long list of such professionals but my mind is tired.

My point is that when someone, a professional, promises you something, they damn well follow through with it. Why are you accepting this let down? Its his JOB to follow through when he says he will do something as a part of his profession. Its not a matter of you being too picky or particular or demanding.

Bottom line, when someone says they are going to do it, it is PERFECTLY reasonable to expect them to do this.

And can I go so far as to say that this T isn't all he's cracked up to be? Maybe in session he is fine, but repeatedly failing to follow through on promises can severely hinder healing in someone who has been traumatized and has trouble trusting people. (Is this you?) If someone has trust issues, how is this sort of therapeutic relationship supposed to be healing?

Discuss the issue with him. If he can't change, then maybe he shouldn't be making promises he can't follow through on. Maybe he's not aware how severe the issue is? (Giving him the benefit of the doubt in that maybe he's a ditz, absent minded, etc.)

 

[Seasounds]

@joeylittle ,It sounds like you feel let down by your therapist, and that you like your therapist.

I think he's a great clinician, with solid boundaries,

From what you have described, I would disagree: a great clinician needs good therapeutic skills and good diagnostic skills, but they also need to to be able to demonstrate congruency between what they say and what they do. And a great clinician, who has good boundaries, has someone else cover for them, when they are on vacation, and a good clinician doesn't frequently respond to non-urgent phone calls and emails out of session. Better put, they separate their personal and professional lives.

Providers are human, and hopefully they are working on themselves. It seems like your Provider has ego/hero needs. Being that people often don't change, and depending on the amount of conflict you want to initiate, I would either say, nothing, and stop asking, or say, "Respectfully, you have mentioned you'd do certain things, but you haven't. I know you mean well, but I feel ___(let down?, angry?). Can you either do the things you have said you would do, now, in this session, or just stop telling me that you will do them?"

I relate to you problem in a certain way. My need for any kind of attachment, my fear of loss, and my lack of self-confidence, resulted in idealizing a provider who was smart, clinically, but the provider brought their own problems to therapy. (My provider's problems, were different than you provider's,) For a long time, I kept me engaged. I'm good at adapting. I didn't recognize bad boundaries because my parents had bad boundaries and never followed through with promises. i also didn't know what "professional standards regarding boundaries" were.

Eventually, since the provider always challenged my feedback, I just privately acknowledged the 'misbehavior' as the provider's problem, and stopped expecting the provider to change. After some time, as I grew to realize that my provider was letting me down, and that it was disrespectful, and painful, and that it didn't help my self-esteem, I found another therapist.

Question:

• Do you want to accept the therapist, as they are, or
• do you want to talk to the therapist, again, or
• do you want to find a new therapist?

All options are viable, as long as you are getting what you want from your therapist.

• Do you feel respected?
• Do you feel let down?
• Is your self-esteem growing or diminishing, by how the therapist treats you?

Like your post. Will share therapeutic blunders later today.

 

[scout86]

My T has ADHD. He knows it, I know it, I may have a touch of it myself and we talk about it. He forgets a lot of the same sorts of things you're talking about. So do I. It can cause problems for me, professionally and personally. I kind of appreciate it when people call me on it (at least if they aren't mean about ti!). It encourages me to work at doing better. I have a ton of "work arounds" because I know what works and what doesn't. Current bills, for example are stuck to the wall by my desk, with most pressing on top, so I see it and won't forget to pay it. I encourage my clients to make appointments by email by flat out telling them "If I listen to a phone message, I often do it while I'm driving and by the time I get a chance to return the call, I will probably have forgotten I need to return the call. If you email, it's staring at me every time I check my email and I WILL remember to reply to you." So, if my T forgets something that's important to me, I'll bug him about it. Might tease him about it a little too, but I mention it. It doesn't bother me as much as it probably would if I didn't have the same problem.

Anyway, your situation is 100% familiar. I think your usual ways of looking at it are fine and I do the same thing. But I also think mentioning things, like that, that bother you is good. First, because the 2 of you can't solve a problem only one of you is aware of and second because it's good practice "expressing your needs". If you can't do it with your T, who CAN you do it with?

BTW that cow never fails to make me smile!

 

[Chava]

@scout86 the few adults I know who have diagnosed ADD/ADHD are similarly terribly forgetful. And how I assume it somewhat in cases where people seem eager and like they mean it but don't follow through well, or are incredibly inconsistent (not like aloof). One was not diagnosed until her 50s because she had adapted to her own life. It was that others were pointing out the level of stress she was creating at times (just not showing up for appointments, double-booking, losing stuff, forgetting meetings). She was brilliant and delightful, but difficult to work with at times. I went miles out of my way to ensure she'd show up for a major event. Easier after diagnosis and whatever help she got. Anyway, we can't diagnose others, but totally fair to call them out on patterns of behavior that affect us when we are supposed to be working together...in many cases they don't see but the awareness can help.

Ditto on e-mail too. I have not been diagnosed ADD but I need more visual and tangible reminders. Sticky notes even all over my bathroom mirror (a former therapist wanted me tested but I went to the psychiatrist purely to get some bupropion for smoking instead). @joeylittle it sounds very frustrating. Can you e-mail him reminders? And then tell him how personally challenging it feels for you to be in the position of reminding him? That shouldn't be your job. I understand it to a point since I work with many scattered profs and musicians. But I can understand it would be much more challenging in a therapeutic relationship...hopefully you can let him know how hard this is for you..??

 

[SeaQuel]

I find that things that need to be addressed - yet aren't - will find a way of reappearing, in one shape or form or another, before they are dealt with. If I'm still bothered by something a few weeks later, then I know it's time to address it or I will not be able to move forward. There have been things that my therapist hasn't followed up on (yet). She may not see time in a linear fashion, and I'm ok with that as long as it doesn't affect my personal well-being or the therapeutic relationship.

Example: I asked my therapist to read some studies so she could give me her clinical opinion about something; she hasn't yet. I was hopeful she would provide some immediate feedback, but as the weeks went by, I decided I was fine with it just the way it was. I don't need an immediate answer, and in fact, I just wanted to have that intellectual exchange at that time and have now moved on to other things. Maybe when something else comes up in a few months or years from now, she'll remember our conversation about topic x, and it will be then that she reads the studies. Maybe she'll never read them, and that's ok, too.

The point I'm trying to get across (and probably failing miserably) is that it "depends." In your case, you are referring to something that directly affects both your personal well-being and your ability to trust the therapeutic relationship. For those reasons, I would encourage you to address this with him. You are not being "whiny" in the least. This is a reasonable request and deserves his follow through. He will never know this is an issue - and won't be able to work with you on it - unless you make him aware of it.

 

[jaccat]

Mine has dyslexia. When I first started with her she was quite open about it, she explained she makes few notes because of it, relying more on her memory. She's not good with names, sometimes she'll talk about a character from mythology say, and have to rely upon me to provide the name. It has caused issues. She has told me she'll lend me stuff to read and then forgotten about it. I put up with it. If it was something I thought really important I'd remind her. I'd loved to have seen those books, but its not a great loss.