If you have specific feelings about the therapist (like how they might respond to or interrupt your presentation or how they part their hair), it’s usually best to take note of and file your gut reaction at first. It’s not necessarily a sign that this therapist is wrong for you.
There may be underlying issues in these feelings that can add richness to the therapy if you can push past them. However, if something particularly bothers you and it persists, address it with the therapist. They should be able to roll with criticism and use it to focus more effectively on your needs. Extreme defensiveness from the therapist can be a red flag.
Here are some good questions to ask yourself after a few sessions:
Who’s doing the talking? (You should be.) It may take three or four sessions before a working therapeutic relationship is established and you feel engaged. If it takes much longer, that needs to be dealt with as soon as possible. If the therapist doesn’t bring it up, you need to.
The best approach may be to state your feeling, describe the specific behavior that causes you discomfort, and verbalize what you would like the therapist to do about it. For instance, “I feel my concerns are not being addressed when you give such lengthy responses. I need you to give me more chances to speak in the session.” (Not a bad assertiveness technique to use for many life situations outside therapy as well.)
Is there work being done? After a few sessions together, can the therapist articulate a treatment plan? Not necessarily a formal plan, but is there a sense of working toward a goal and some gauge for knowing that you’re making progress in that direction?
For example, a therapist might say “Over the next two sessions, I think we should focus on specific situations that happened during the week that caused your anxious feelings” or “A good goal for the next week is to see if your anxiety level goes from a 9 to a 6 when you are think about speaking with your boss.” Notice the specificity in both, and the use of a scale of discomfort in the latter.
Is the therapist giving advice? (They shouldn’t be.) This may seem counterintuitive—“I came for help!”—but the role of the therapist is not to make decisions for you but to empower you to make better decisions for yourself. Suggestions are fine: “You might try taking a walk in the park every day for stress relief.” “Have you tried meditation?”
But these should not be mandated activities (unethical) and the therapist should never express disappointment that you failed to follow through on the suggestion (unprofessional). There are technical terms for feelings the therapist raises in you, and it is always worth discussing.
Does the therapist follow up with you from week to week—how did that interview go? did you manage to take that walk you wanted?—in a way that’s not judgmental or guilt-inducing. “Last time we spoke, you talked about looking for ways to reduce your stress. How did that go?” Questions like this reflect their engagement with you.
As you go along, a good therapeutic relationship is one where you feel that you’re beginning to internalize the questions and problem-solving approach voiced by the therapist. You’re aiming, in the end, not for perfection, or to be a completely different person, after all, but to acquire skills and competencies to deal with the ups and downs of life.
“Treated Well” offers guidance on getting effective treatment for yourself or a family member. Coming Soon: “Red Flags to Watch For,” “How to Find Affordable Care,” “A Quick Guide to the Alphabet Soup Following Therapists’ Names”
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