Empty Psychotherapist Chair
More and more Americans, especially in California, New York, Chicago and other sophisticated areas, are seeing a psychotherapist. In fact, as many as 38% of Americans are seeing or have seen a therapist.
Let’s talk about psychotherapists: Psychologists, marriage and family therapists, licensed social workers in private practice and psychiatrists, to name a few. (Psychiatrists are actually the people in this group least likely to practice psychotherapy, since they mostly prescribe drugs.) Most psychotherapists are consummate professionals, well-trained and educated.
But not all of them are good. Some of them are criminals, some are drug addicts, and some have sex with their patients. Some of them are just plain incompetent. If you’re seeing a psychotherapist for any reason, here are some of the reasons you might consider switching or firing.
1) The first reason you might want to fire your therapist might be because your therapist is not a real psychotherapist. Most states have licensing boards, like the California Board of Behavioral Sciences, that identify licensed social workers and marriage and family therapists, among other psychotherapists and mental health professionals. (Psychiatrists and psychologists have their own, different boards.) Visit their web site, and it tells you whether your therapist’s license is current, years of experience, if the therapist has ever been censured or suspended by the board, and if they’ve been convicted of a recent crime. If your therapist is a sex therapist, a relationship therapist, or just a plain old therapist and you can’t get him or her to name the board under which they’re licensed, they’re not a real psychotherapist. Unfortunately, anyone can call themselves a psychotherapist in most states and they won’t get arrested, but it is unethical.
2) Your therapist is a current or recent criminal. Most state licensing boards check criminal records, and even if your therapist has committed a recent felony, they may still be listed. But that listing will probably tell you that the therapist has lost their license. If that felony has been expunged, however, that information may not be allowed on the listing, and the therapist may be allowed to practice, and in fact may be more effective with certain types of clients.
3) Your therapist wants to sleep with you, date you, or be your friend. “It is a crime in California for a psychotherapist to have any sexual touching contact with a client or patient. Fines up to $5,000, and jail or imprisonment for up to three years, are possible penalties.” The therapist-client relationship is powerful. How you feel about your therapist is called the transference. How the therapist responds or reacts to those feelings is called countertransference. You may come to idealize your therapist in a romantic way or want to become a friend, but if the therapist allows a personal relationship you should look elsewhere. In California your therapist shouldn’t (ethically) have a social relationship with you until at least two years after the therapy ceases.
4) Your therapist is a drug addict or alcoholic. If your therapist shows indisputable signs of impairment, fire that therapist immediately! Such signs include slurred speech, frequently canceled appointments, forgetting everything that happened in previous sessions, mood swings, explosive anger, bloodshot eyes, deterioration of physical appearance, unusual smells on breath, body, or clothing, tremors, and/or impaired coordination. (We’re not, of course, talking about evidence of social drinking or smoking marijuana.) Remember, though, that some of these things could signify dementia, which may occur with older or psychotic therapists; you should probably leave a therapist like that. Dementia is not common, but personality disorders like Borderline Personality Disorder or Narcissistic Personality Disorder are more common than you might imagine.
5) Your therapist is gouging you financially. If your therapist is constantly raising rates or charging fees that are way out of line with the rate your friends are paying, you may want to switch. This is a touchy subject, and many therapists use a sliding scale in which they charge poorer patients something like $20 an hour and richer patients $100-300 or more. While all of this is perfectly legal, use your common sense and make sure you’re not being squeezed because the therapist needs money. But I wouldn’t be surprised to find out that people like Woody Allen pay their therapists $500 or more for a 50-minute “therapeutic hour,” and to them it’s worth it and not unethical.
6) Your therapist has no “theoretical orientation” or “world view.” One of the first questions you should ask a your therapist, if you haven’t already, is what type of psychotherapy they practice. Examples of common theoretical orientations are Cognitive Behavioral Therapy (CBT), Narrative Therapy, Solution Focused Brief Therapy, and Psychoanalytic and Psychodynamic Therapy like Object Relations. Therapists in California are expected to be able to switch to a different type of therapy if the original therapy isn’t working. Simply describing their orientation as Talk Therapy, or “eclectic,” is, in my opinion, not sufficient.
7) Your therapist has no knowledge of drugs, addiction, or psychopharmacology. While your therapist need not be an expert in these fields, he or she should be able to recognize if you’re abusing drugs or alcohol, which renders the therapy almost useless, and distorts the diagnosis, unless of course you’re being treated for those things and Substance Use Disorder (SUD) is the diagnosis. Moreover, he or she should at least have sense enough to look up the prescribed drugs you’re taking, since they may affect the course of therapy in a significant way.
8) Your therapist’s life appears to be a mess, and they’re more worried about their own problems than yours. We’re not talking about messy offices here. If your therapist is constantly interrupting sessions to take phone calls, if abusive lovers or lawyers are a big part of the picture and bill collectors are calling in the middle of sessions, you probably need a new therapist. In fact, answering phone calls in the middle of sessions is pretty rude, no matter what the reason.
9) Your therapist has cultlish beliefs and engages in “magical thinking.” You’re paying to see a professional psychotherapist, and you should expect modern, professional treatment. In Western Psychology, there are certain types of behavior that are considered abnormal and your therapist should be ready to deal with and recognize them. But this is a thorny area: For example, in certain cultures, communicating with dead relatives is not considered an aberration. Your therapist should also be culturally sensitive and recognize that certain behaviors and beliefs vary from culture to culture.
10) Your therapist is advising you on things that have nothing to do with psychotherapy or they are not trained in. All licensed therapists have a “scope of practice” and a “scope of competence” (two different things), which are usually defined by the board under which they are licensed. If your therapist gives you stock market tips, legal advice, or medical advice that has nothing to do with mental health, you have a scope of practice problem. And if your therapist is using hypnosis and has no evidence of training in that field, that’s a scope of competence issue, and unethical.
The above are only ten of a number of reasons you should consider switching therapists, and there are probably at least 20 more, many of which are just common sense. Violating your confidentiality is a big one and probably deserves a whole article. Not defining goals or not making any progress after years of therapy may be a big red flag.
Don’t rush out and switch therapists based on this article. You may have built a strong long-term relationship with a great therapist and certain minor issues might be forgiven. But if you see a pattern that makes you uneasy and you feel as if you’re wasting your money, then trust your instincts. There are a lot of great therapists out there, and you don’t have to stick with your therapist just because you’ve been seeing him or her for years or they’re in your network