I Never Expected That!
There are some things which happen in therapy that most consumers never expect to happen. The unexpected issues can be some of the most difficult issues to talk about, but also the most important. In this section, I'll deal with two types of unexpected issues. First, I'll talk about the more normal unexpected occurrences. By 'normal,' I mean common experiences that occur which you should be concerned about, but should talk about. Next, I'll address some problematic issues which may warrant taking some action or finding a new therapist. Finally, I'll discuss a couple of issues that could fall into either category, depending upon the situation.
'Normal' Unexpected Experiences
The central theme you'll see in this section is "it is important to talk to your therapist about this issue." Most of the time, these topics are uncomfortable to discuss with your therapist. These topics are also often uncomfortable for you therapist. However, most good therapists recognize that these issues are important to talk about, even though they are uncomfortable.
Anger at Your Therapist: It is common to become angry at your therapist, at times. In most incidences, this is part of a normal, healthy relationship and can work to facilitate therapy. All therapist make some mistakes, and it is natural to become angry about these. However, at other times, your anger may be due to misunderstanding your therapist, because it reminds you of something from your past, or a variety of other reasons. Regardless, talking with your therapist about this can help understanding your anger and work through it.
Disappointment in Your Therapist: Disappointment often comes early in therapy. Particularly in the United States, we tend to expect quick, efficient results. We see what appear to be quick fixes often on Dr. Phil and other TV talk shows. But quick fixes don't always work. Additional, therapy, even when successful often doesn't look like what you expected. Disappointments may also occur if your therapist is late for an appointment, has to cancel for some reason, or goes on vacation when you really need him or her. All these things are important to talk with your therapist about.
Sexual or Romantic Attraction Toward Your Therapist: Again, this is fairly common, even though most clients believe it is inappropriate to have this feeling. Additionally, clients are often embarrassed about having these feelings. When in a close relationship where you are being vulnerable and sharing very private thoughts and feelings, it can be very natural for a romantic attraction to develop. When this occurs, generally it is important to talk to your therapist about this, particularly if you are in a longer form of therapy (6 months or longer). Talking about your attraction can help make sure appropriate boundaries are set and prevent this from interfering with the success of therapy. It is your therapist's reasonability to make sure that nothing happens from the sexual attraction. If, when you share your feelings, your therapist suggests acting upon these feelings, then it is time to end therapy and report this to the local licensing board immediately. However, most therapists will try to help you understand these feelings while making sure appropriate boundaries are set in the therapist relationship.
Problematic Unexpected Experiences
This is not intended to be an all-encompassing list, but rather a list of the more common issues I've heard from clients who have previously been in therapy with other therapists.
Your Therapist Suggests a Romantic Relationship: This is one of the worst violations of the trust which can occur in a therapy relationship. It is never appropriate for a therapist to have a sexual relationship with a current client or even someone who was a recent client. Most state laws and ethics code state that a sexual relationship should not occur for at least 7-years after the ending of therapy and that even then the therapist must be able to demonstrate that it is not exploitative. Because of this, it is not appropriate for a therapist to even discuss a sexual relationship as an option in the future after therapy has ended.
If your therapist suggests a romantic or sexual relationship, there are a couple of important steps to consider. If you are clear about what has occurred, then you should contact your state licensing board as soon as possible to file a complaint. In some situations, it may not be clear if this is what your therapist was suggesting. If so, try to clarify with your therapist. If your suspicion is confirmed, then you should end therapy and report this the the state licensing board immediately. If you are unsure and uncomfortable with what happened, it may be best to end therapy and discuss this with another therapist.
Some clients feel uncomfortable filing a complaint for a variety of reasons. At times, there could be fear of retaliation from the therapist. At other times, there may have been a mutual attraction so the consumer feels it is partially their responsibility. At other times, there is gratitude for the help and healing experienced in therapy. Keep in mind, it is the therapists responsibility to maintain appropriate boundaries, not yours. All licensed therapists at any level should be aware that this is a serious ethical violation. It's also always important to keep in mind that this therapist is more likely to have been inappropriate with other clients and your complaint may be able to help protect them. If you fear retaliation, then it may be beneficial to discuss this with another therapist or someone at the licensing board.
Your Therapist Unexpectedly Ends Therapy: Therapists should not abandon their clients. While there can be some legitimate reasons for a therapist abruptly ending therapy, such as being diagnosed with a terminal illness, most of the time they should give you plenty of advance notice. If they end before you are ready to end, they should provide you with referrals including contact information to other therapists (listing 3 other therapists is often thought of as the standard). If you therapist does not provide you with adequate time or does not offer referrals, the first step is to discuss this with the therapist. If you do not feel the situation was resolved, you may consider contacting the state licensing board.
Your Therapist Pressures You into Continuing Therapy: If you tell your therapist you are ending therapy before they believe you should, a good therapist will discuss this with you and may even encourage you to continue therapy. He or she is also likely to help you think through the consequences of dropping out of therapy at this time and may give a referral to other therapist you could continue with. However, they should not pressure you into staying or use scare tactics to try and keep you in therapy. For example, they should not state, "if you don't continue in therapy, you will probably end up being suicidal and killing yourself." In most situations, this can probably be resolved by telling your therapist directly that you don't appreciate them pressuring you to continue in therapy. If they continue to pressure you after telling them you don't appreciate this, you may want to consider contacting the licensing board.
Your Therapist Does Not Honor Your Decision to Seek a Different Type of Therapy: You have the right to choose the type of therapist you want to see and your therapist should respect this, even if it is just the first session. I make it a practice to always share some about my approach to therapy in the first session or, sometimes, prior to the first session on the phone. I will also make sure all they are aware there are other approaches to therapy. My goal is to find what is best for the client, not to convince them that I am the best therapy for them. Not all therapist provide this much information and it is not necessary for them to do so. However, if in the first session or many sessions in to therapy you decide it is not the right fit, your therapist should respect this. As when you want to end therapy before the therapist feels you are ready, it is good for the therapist to share their concerns about switching therapists, but this should not come in the form of coercion to stay in therapy with them. As in the situation above, most of the time this can be resolved by telling your therapist directly that you don't appreciate them pressuring you to continue in therapy with them. If they continue to pressure you after this, you may want to consider contacting the licensing board.
Is this Normal or Problematic? Other Unexpected Therapy Experiences
coming soon.