Psychotherapy is full of both extraordinary potential benefits and some possible pitfalls. We’ve discussed some of those things in past entries. But there are some things in psychotherapy that …
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thanks for this doc
Oh my gosh this hit home on the first item. I went once to a therapist as part of a clinical study. We had to go to be sure any suicidal people didn’t get in, I suppose.
In any case, this woman started YELLING at me and ordering me around within 2 minutes of my arrival. Astonishing. I was so very grateful that I wasn’t there for therapy. I just shut up and agreed with everything she said for 5 minutes, and bingo, I was in the study.
What on earth she does with real patients is just frightening, and they need to feel free to leave a so-called therapist like that woman, should they encounter one when they are seeking help.
I don’t really understand the point of articles like this. What good is it to give clients a list of expectations for therapy? For example, in item #1, you stated, “Therapists who act or talk in a judgmental manner should be avoided.”
This is such a ridiculously subjective concept – and, by the nature of subjectivity, clients are extremely likely to use this sort of idea to justify their resistance. I don’t think it’s very wise to tell potential clients, “Hey, if your therapist is judgmental, ditch him!”, but rather, “If you feel judged by your therapist, ask yourself: is this person actually judging me, or could I be misinterpreting the situation? And if so, why would I be misinterpreting?”
Maybe because therapy has gotten a bit too deep, or because you have issues with authority figures, or…whatever, any of the normal reasons clients demonstrate resistance. But to just give blanket statements about therapy is plain foolish.
Good article…I am at a crossroads with my therapy at this time. I am no longer depressed, anxious, or suicidal–thank God… I did ask my psychologist if I should stop therapy because the “crisis’s” were over. I also asked if there were any reasons for me to continue. I have been suicidal off and on for the last 13 years and I finally revisited my past and dealt with it. Such relief! He said he felt there were things we could work on, but it was at the end of our session. I know his motivation is not money because he is through the VA(I’m a Vet). Soooo I asked HIM to come up with things he has noted that I need to work on–I have a blind spot still with emotions, etc. I gave HIM an assignment! We’ll see what he says… But, as I said, this is a type of therapy that I’m not familiar with because up until recently, it has been crisis management.
I believe that it is not useful or advisable to try to define out these questions for prospective therapy clients, and to dismiss them as something “not to worry about.” Each of these is an important issue for each client to work out with each therapist. Is the therapist being judgmental? Or is the client assuming that they are doing that, and what does that bring out about the client’s own judgments about him or herself. And what about silence, or boredom? Does the therapist just allow silence to go on and on? Does the therapist appear bored or disengaged? It needs to be addressed, in the session. How therapy works, or what kind of therapy is being done is also a real issue. And as for clock-watching, a working agreement about the time boundary is one of the most important negotiations that can take place between client and therapist. I have had patients report to me that their therapists fell asleep in the session, would not explain what kind of therapy they were doing, were late for sessions, yet were all too frequent clock watchers in the sessions. In good therapy, these issues all may have to be addressed at one time or another, rather than “pre-dismissed” with a “don’t worry about it.”
Thank you for this article. I have been going to therapy for about 8 months and this really helped to clear up a lot of questions in my mind that I was afraid to ask–actually, tho’t was too stupid to ask! Those are the exact questions that I’m sure runs thro’ most clients’ minds at one time or the other. So, from a client’s point of view, I really appreciate this information and it has given me some idea of how this whole thing is supposed to work. It also is helpful because, being clients, this whole issue of being in therapy is confusing at the least. Thank you Dr. Grohol!
I appreciated this post.
Another reason we therapists watch the clock (other than having good boundaries and wanting to end sessions on-time) is that it helps us to make therapeutic choices in-session about which threads to pursue. For example, I may choose not to follow-up with a question if I know there isn’t proper time for my client to process a deep issue or feel contained enough when the session ends. It would be poor judgment to ask a loaded question that could take a client to a very deep and vulnerable place with just four minutes left in the session and then abruptly end things. I find that knowing where we are in the hour helps me to assess which of my questions to ask and which to put on hold for the next time.
I’m glad you posted this and think it will be very helpful. I still have trouble with the first one, though I know my therapist is trustworthy.
I also appreciate what drkkolmes added. I’m sure your clients appreciate your sensitivity. As a client, I check the clock occasionally for parallel reasons. I don’t want to bring up a topic that I know is emotionally loaded when there might not be enough time to process it with the therapist. One of the last things I want to do is fall apart as time runs out. Worse than that would be for the therapist to say something at the very end that may have shown she totally misunderstood me, gave me a new devastating insight, or that I needed to talk through. I would hate to crash and have an unsettling and difficult week until the next session when we could talk it through.
I may also intentionally bring something up at the very end of the session when I know we won’t have time to talk about it. I do this when I know it’s something I need to talk about, yet I know if I wait until the next session I will again not be able to bring it up. Knowing time is running out gives me the freedom to let the therapist know of something important to me, while at the same time giving me some breathing room before talking about it.
I think it’s worthwhile to point out that while therapists ought not judge their clients (for being gay vs. straight, Republican vs. Democrats, rich vs. poor), clients are paying therapists not to be compensated friends, but for their considered, educated, and wise professional psychological judgment.
Lack of judging does not mean lack of judgment. And sometimes, the exercising of judgment and imparting of it in a therapeutic setting can feel like judging.
for Dr Howard… Patients may still feel these things even though this article reassures us that we don’t have to worry about them. This article is so helpful because these are issues that can cause a patient to discontinue therapy, or barely even get started. Of course, anything and everything is something to talk about in therapy, but it takes a bit of time in therapy to understand that it really means anything, including these things addressed here.
Thank you for the article, Dr. Grohol. I have been in therapy nearly 3 years and still have these worries. I appreciate your willingness to talk about them here and to offer kind reassurance.
As a client, I think it’s really important to talk to your therapist about any uncomfortable emotions that come up in session. I had fears of my own therapist judging me, so when I expressed this to him, I discovered this was mainly because of the large about of shame and guilt I felt about my life. So much of what we periceive coming from our therapists is really a matter of projection, not all mind you, but if you’re with a good therapist, it often is.
The key to making your therapeutic experience the best it can be is to communicate with your therapist about everything you’re experiencing in session with him/her. If your therapists accepts your emotions and helps you explore them, or admits it as a failing on their part for bringing them up–you’ve got a keeper.
I say this as someone who had both a fantastic therapist and one that fell short– it helped me appreciate the former.
Of course the therapist has to keep and eye on time but to be seen doing so is just bad practice. Specially as there are a million ways to check the time without beeing seen. And that goes for being judgmental too. It’s the therapist’s problem so why should the patient spot it? Bad practice if he does.
lol ya reckon? I was sitting with my psychologist on the floor once and I was looking at the wall across the room not her. She took this moment to do this pretend little flicky thing with her wrist to be able to glance at her watch quickly. Like she pretended she was brushing her hair behind her eyes but when she brought her hand down she flicked her wrist slightly, had a quick glance then rested her arm where it was before. Now I never ever ever look people in the eye so my peripheral vision has become quite refinded and I lifted my head slightly when she did it and I said, “So what IS the time?” She said, “Did you see that??” So Im not sure there are millions of ways for therapists to check the time without patients knowing.
I like this article Doc John. I do agree though for number one that a client should explore first when the therapist is really being judmental or if it is perceived but not real. If the therapist is being judmental then I agree ditch him/her.
The therapeutic process is both frustrating and fascinating at the same time. I love reading your thoughts about it.