Couch Surfing: When a Therapist Says It Isn’t a Good Fit
Most clients know what it feels like when they meet with a therapist and it isn’t a good fit. Maybe you leave the initial session feeling misunderstood or knowing that the therapist’s personality or style isn’t a good match for you. Maybe the therapist reminds you of someone in your life for whom you have negative feelings. Or maybe you can’t stand her office or the location, or you recognize that the fee she charges is more than you can reasonably afford.
But what about when you think it’s a good fit and the therapist doesn’t? This can be uncomfortable — particularly if it doesn’t match your perception of the connection you made. When a therapist tells you that she or he doesn’t think it’s a good fit or she doesn’t believe she is the best person to help you, this can understandably be a little confusing. Maybe it even feels like a rejection.
There are multiple reasons why a therapist may not believe it is a good match, and unfortunately, we often don’t offer detailed explanations to clients. Sometimes there are good reasons for being less specific about it.
Here’s a way to decode what it might mean if a therapist tells you she thinks your relationship is a poor fit.
- The therapist recognizes that you’re dealing with treatment issues that are outside the scope of her competence or expertise. She is not sure she can help you. It is unethical for therapists to practice outside of their area of competence, and even if you both felt a good connection, she is doing the proper thing by referring you to someone else.
Another aspect of this could be that your therapy needs are greater than what she feels her practice can provide. For example, you need twice-weekly sessions and she can only fit you in once a week, or you need a much lower fee than she is able to offer.
- The therapist realizes that there are dual relationship issues that could complicate the clinical relationship. She may have another client who knows you well and she thinks that this could potentially create messy feelings or boundaries for you, the other client, or even herself.Sometimes it can be acceptable to work with two people who know each other well, but other times it isn’t, depending upon the relationship(s) and treatment issues. Perhaps another client is not the source of the dual relationship, but your therapist believes she knows someone in her personal life who has a connection with you. That might prove to be a conflict.
Since therapists cannot disclose client lists to anyone else, it is safer to refer someone out than to play investigator.
- The therapist may have strong responses to you that would complicate the relationship. This could range from feelings of sexual desire to feelings of strong dislike. Sometimes the therapist can work through these responses (called “countertransference”). Obviously, however, this is about the therapist and has very little to do with the client. Anything that would interfere with the therapist’s role as clinician, ability to maintain objectivity, or potential to be empathic and create a good bond with you would be a good reason to refer you to someone else.Other forms of countertransference may refer to conflicting regarding lifestyle, sexual orientation, or religious affiliation. If this is the reason for a therapist deciding you’re not a match, she is doing you a favor: these responses can subtly or not-so-subtly infiltrate the therapy.
- Your treatment issues may hit close to home for a therapist at a particular time. This is similar to countertransference, but it’s less about the therapist’s response to you and more about the issues you are seeking treatment for. For example, a therapist who is still grieving the recent death of a parent may realize that it’s not the best time to see new clients dealing with grief and loss issues. Such personal issues generally are not disclosed when offering a referral.
- Many therapists strive to keep balance in their caseloads. For example, if every client we saw each week was dealing with a major trauma, it might be hard to avoid experiencing compassion fatigue or secondary trauma. Finding balance is very important to people in helping professions to prevent burnout and to ensure quality care to their clients. Many therapists even put this kind of mindfulness into who they schedule on which days, to ensure balanced days and being able to be fully present with all of their clients.
- Therapists have the right not to work with people if they threaten our safety or the safety of our office, our colleagues, or other clients. Threats may be direct or indirect. Clients may say or do things that intimidate others without ever being aware of it. Many therapists work with clients over time to develop the trust necessary to provide feedback about the impact they may have on others in their lives. This can be an essential and extremely useful part of treatment. However, if you’ve done something in an early encounter that made a therapist feel unsafe, he or she may feel it’s best to refer you out without providing that specific feedback. You will not have the appropriate time or context to process it together and it may feel hazardous for the therapist to do so.
Remember that it may take some time and investment for you to find a therapist who you like and who is the right match. Of course, if a therapist deems that it’s not the right match, she should let you know this as soon as possible so that you can get the best care and find the right fit with someone else. Don’t get discouraged and try not to take it too hard if it isn’t a match. Most times, it will have little to do with you personally. Good therapists will offer to give you referrals if they think the two of you shouldn’t work together. And sometimes a mismatch or a rocky beginning can still help lead you toward a therapist who is the right one for you.
Kolmes, K. (2010). Couch Surfing: When a Therapist Says It Isn’t a Good Fit. Psych Central. Retrieved on August 26, 2016, from http://psychcentral.com/blog/archives/2010/03/08/couch-surfing-when-a-therapist-says-it-isnt-a-good-fit/