Now I’m going to discuss some of the things that can be suggestive of poor therapy, but which sometimes can be worked through. This isn’t a complete list — I am sure you can add lots more things.
Dual relationships. What this means is having a therapeutic relationship and also another, separate kind of relationship with the same client. Licensing boards and professional organizations are moving more and more toward banning all double relationships. Canada is looser about this, maybe because so much of Canada is rural.
Banning dual relationships is probably a good idea because it is hard to keep your client’s well-being in mind when you are simultaneously relating in another way. Certainly therapists should not have another financial relationship with their clients on the side. This means no hiring the client to paint your house or do your books, no trading lobsters for appointments, no accepting gifts. If a client wants to give a gift, it should have no monetary value – a hand-made card or a poem is fine.
In small isolated communities, it’s almost impossible to avoid dual relationships. People are spread out and there is only one therapist, one carpenter, one doctor, and so on, for miles. If a dual relationship is the only alternative to no therapy at all, it should be discussed at the beginning and some plan should be put in place to avoid pitfalls. Sometimes that’s all that is needed to set boundaries and make for a good working relationship.
There’s another circumstance that I don’t know very much about, and that’s ministers, priests, or rabbis who are also counselors. I don’t know how the different denominations ensure that the two roles stay separate. If you are considering working with a religious counselor, it would a good idea to ask about this.
Poor boundaries. The therapist asks for your help in personal matters, leans on you for comfort, or tries to be so giving that you end up being taken care of in inappropriate ways. The therapist is neither your savior nor your child – a therapist is a reliable, trustworthy coach who meets you where you are and always keeps your best interest at heart.
Flakiness. The therapist is consistently late, forgets appointments, often calls at the last minute to cancel or reschedule, or doesn’t return keep phone appointments in a crisis. Or messes up the bookkeeping. Or forgets important facts about you. Forgets to tell you about vacations. Once or twice is forgivable, but a lot? You need consistency, not chaos.
Over-stepping their knowledge. The therapist says he or she has expertise which he or she doesn’t. I’m not only talking about padding a resume; I’m talking about giving medical or legal advice or diagnosing somebody (like your parents) who they have never met. A therapist should be honest enough and confident enough to admit to not knowing something or not being qualified on a particular subject.
Suddenly changing the ground rules. Sometimes changes do need to be made, but they should be thoroughly discussed ahead of time. It’s not helpful to change the fee with no warning or to state that there will no longer be phone calls in a crisis. If you feel that the rug has been pulled out from underneath you, it will take a lot of time to rebuild your relationship.
You can see how any of these issues, if poorly handled, could prevent trust from forming in the beginning of the relationship or mess things up in the middle of therapy. You relationship with your therapist is the basis for therapy and it should be treated thoughtfully and respectfully at all times.