What If I'm Not Satisfied with My Therapist?

by Carol Campbell, MFT

So let's say you decide to get some therapy. You find a licensed clinician to work with, set up a schedule of regular appointments, and begin to pour out your heart to this person who until recently was a complete stranger. Therapy can seem like a pretty one-sided operation. Even after some number of sessions, it may still seem as if you don't know much about the therapist besides the color of his eyes or her taste in office furnishings. What if you start to feel as if this has not been a good decision after all? What if you start thinking you are not satisfied with your therapist?

Here are some questions that may be helpful to ask yourself:

• What Is the Nature of Your Complaint about the Therapist?
   
  If the therapist is repeatedly late for your sessions, takes phone calls in your presence, talks about other patients, falls asleep while you talk, or is eating a sandwich during your session, your complaint is about an inconsiderate and unprofessional clinician. You might try requesting reformed behavior, but declining further treatment from this person would also be reasonable.
   
  If your therapist is telling you about her own spouse or children, comparing your issues to his own journey through life, or telling you that you remind him of someone he knows, your complaint may be about a therapist using you to process his or her own emotional issues, rather than be available to help you with yours. Time to part company.
   
  If your therapist is seductive, makes suggestive comments, wants to hold your hand, or suggests that you move your sessions to a more comfortable room, you may be dealing with a grossly unethical therapist, and you are on very risky ground. Sexual communication or behavior with the therapist is an egregiously awful outcome, and is grounds for the clinicians' loss of license to practice therapy. Leave!
   
  However, if your complaint is that your therapist is not saying what you want to be hearing, then things become a lot less clear cut. You might have a legitimate complaint about the therapist for her being insensitive or for misunderstanding you or even for being simply incompetent; but it also could be that you are just looking for a good defense to protect yourself from hearing what the therapist is saying, because no one wants to hear what may feel like the unvarnished truth. It's a lot easier to trash the therapist than to face responsibility for our own contributions to making a relationship unpleasant.
   
• How Can I Tell If I'm Upset with the Therapist Simply Because He Is on to Something Negative about Me, and I'm Humiliated to Have Attention Drawn to It?
   
  Have a little compassion for the poor therapist! It's her job to help you look at things objectively, but especially early in treatment it's mighty hard to be objective about ourselves. So the patient's tendency when confronted with an uncomfortable comment is to feel hurt, to lose the ability to actually think about what is being said, and instead to attack the therapist. What a brilliant solution! The topic can then morph into a critique of the therapist's technique ("You shouldn't have said that in such a long sentence – I can't follow what you said!" Or, "You should know I can't hear that on a day I have a project due!") instead of a chance to do the difficult work of therapy.
   
  It is not the job of the therapist to say anything for the purpose of making you feel better. In fact, my view is that it's not the job of a therapist to want anything for you, even to want you to be happier or be able to save your marriage or stop cutting yourself. The job of the therapist is to be with you while you figure out what it is you want. If you come to therapy expecting that it is the job of the therapist to be an expert who should tell you what you should want or how to solve your problems, you will need to face some serious disappointment. Occasionally some form of problem solving may legitimately creep into therapy, but in my view, problem solving is not what therapy is fundamentally for.
   
  Therapy is hard and sometimes painful work. Therapy requires the courage to trust a professional, and to try to learn from what she says when she describes what she sees happening in the room. For example, let's say Jason comes for therapy to deal with relationship problems with his family. He enjoys his time with the therapist, and has a hard time when the sessions end, believing he should only have to leave when he is at a good stopping point. (If the therapy is going well, it is highly likely that a patient will resent the ending of the sessions and want to have more control over them.) The therapist keeps firm boundaries concerning time, and even though Jason is just about to make another comment to wrap things up, the therapist says: "We are out of time for today." What does Jason do?
   
  If Jason has been able to make his way in life without proper emotional regulation regarding other people's boundaries, he might be royally angered that the therapist doesn't say, "Oh, I'll just give you a few more minutes today." Jason could feel humiliated that he can't manipulate the therapist into collapsing the time boundary. So then Jason might "act out" – which is to say, he might do something, rather than just thoughtfully tell the therapist he is feeling hurt and angry. So he might not show up at his next session. He might go home and treat his wife badly, dumping his anger onto another convenient target. Or he might come in loaded for bear next session and attack the therapist for being cruel and heartless by not extending the session. In other words, he might start telling himself there is something wrong with the therapist, rather than be brave enough to look at what is underneath his expectation that the rules should not apply to him. Jason is having trouble dealing with the reality that life is not fair, and sometimes he cannot have what he wants.
   
  Or let's say Wanda is in her session, explaining the details of last night's argument with her boyfriend. The therapist listens, and then comments: "So you felt so hurt yourself that you felt justified in trying to hurt him back." Wanda may be wanting something more along the lines of sympathy: "Oh, you poor thing! You must have felt like killing him." She can get that from her best friend, but her therapist needs to describe to Wanda what she is actually doing. The therapist in this case did not say, "I think you are a terrible person for yelling at your boyfriend." There is no judgment implied – just a statement of fact as the therapist understands it. But if Wanda is unconsciously guilty for mistreating her boyfriend, she may hear the therapist's comment as simply criticism, not as an accurate description of what happened. At that point Wanda may become angry and disenchanted with the therapist. From there it is a slippery slope to focusing on shooting the messenger, not finding an objective place to stand to actually think about the therapist's observation.
   
• What If I Don't Think I Am Making Good Progress with this Therapist?
   
  This is also a tricky matter to evaluate, because not everyone progresses in the same way. For some people, getting angry with the therapist might be a huge step in the right direction, because they have repressed their anger for a lifetime and are finally mobilizing it in a productive way. For other people, progress might look like becoming much quieter than they normally are, which could also elicit the patient's anger toward the therapist if they are accustomed to thinking of themselves as needing to be aggressive.
   
  Some questions to ask yourself after a few sessions might be: Am I thinking about things now in ways that are different from before? Has there been a decrease in the symptoms that caused me to seek therapy in the first place? (Unfortunately sometimes symptoms need to get worse before they get better.) Do I have the sense that the therapist is in my corner, even if she bugs me by being therapeutic instead of socially sweet or kind? Do I feel generally respected? In at least part of my mind, do I like being with the therapist?
   
  A zero score on all these issues would suggest maybe it's not a good fit.
   
• What Do I Say when I Want to Quit?
   
  The first thing to do is to tell the therapist that you are not happy with how things are going, and why. "I have given this a couple of months, and it doesn't seem to be helping me reach my therapy goals. My wife and I are fighting more than ever now." Then see what the therapist says. A competent clinician will be interested in understanding your point of view, and be willing to examine her own participation in the relationship to see how she may have let you down. She can help you talk about the issue in a way that maintains your respect and dignity, and does not blame you for not trying hard enough. Sometimes a discussion like this leads to a much clearer understanding of positive changes that the patient either has not been able to see, or unconsciously feels she cannot afford to acknowledge for some reason.
   
  The decision as to whether or not to stay in treatment is always your decision. Beware the therapist who tries to berate you into staying. But it is also true that manipulative patients often say they are thinking about quitting as a way to try to get the therapist to break the therapeutic neutrality, to pull words of praise or affection out of the therapist, and to put their own anxiety into the therapist so they don't have to feel it themselves.
   
  A related issue may arise when the therapy stirs up difficult feelings in an intensive psychotherapy: suggesting reducing how often the therapist and patient meet. Requesting a cut-back in the recommended frequency of sessions is generally a sign that the patient is unwilling to let the therapist direct the treatment, in which case actually terminating the work may be the kinder decision. When a therapist works intensively – i.e., seeing the patient multiple times a week – it is for the purpose of enabling the patient to develop a therapeutic and temporary dependence on the therapist. It is essential for that schedule to be adhered to in order for the patient to feel sufficiently safe and cared about. A reduction in frequency once established can be so painful (especially to the infantile aspect of the patient's mind) that the therapist might be wiser to discuss termination altogether. Many times the patient will then return to treatment at a later time when he or she can commit to the prescribed schedule.
   
• What If I Simply Do Not Want to Work with this Therapist?
   
  Then you need to have a proper termination. If you have been meeting for more than just a few sessions, you would be wise to meet at least one more time to go over what you learned, what you were disappointed in, and whatever else you want the therapist to know. Then you both say goodbye. A competent therapist will treat you very kindly through this process and send you on your way unburdened by any responsibility to take care of the therapist's feelings. No therapist is able to work well with every single person, and no person can be expected to like or benefit from every single therapist.

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Carol L. Campbell, MFT, is a licensed marriage and family therapist providing psychotherapy and psychoanalysis for individual adults and couples in Palo Alto, California. She has degrees from Brown University and Santa Clara University and has been licensed since 1991. Carol is a graduate of the Palo Alto Psychoanalytic Psychotherapy Training Program sponsored at Stanford by the San Francisco Center for Psychoanalysis and was a candidate at the Psychoanalytic Institute of Northern California in San Francisco from 2010-2011. She is also a clinical member of the California Association of Marriage and Family Therapists and the Northern California Society for Psychoanalytic Psychology.