One Type of Therapist Not To Trust

woman-531212_640There are websites for therapy consumers with “check-lists” containing warning signs of questionable and inappropriate behaviors by therapists you should watch out for.

What is and isn’t acceptable or ethical in therapy is not always based on objective sets of rules such as professional ethical code. Oftentimes, it’s a matter of opinion. I might judge ethics in therapy somewhat differently from how others do it. For instance, if I wanted to make a list of therapists to avoid, the type of therapist who would top my list would be the one who suggests, explicitly or implicitly, that you have “trust issues” at the onset of therapy .

They usually make this suggestion whenever you disagree with their opinion on your situation, as if disagreeing with someone is the same as a lack of trust.

I don’t want to say that it is never appropriate for a therapist to talk about trust issues if they believe this is important in your case, but the concept of trust shouldn’t be twisted and misrepresented to serve the therapist’s agenda.

A competent, ethical therapist knows that trust has to be earned. They would never demand your trust, especially early on in therapy.

Many people come to therapy with the history of trauma and they should get all the time and space they need to feel safe and comfortable enough to start trusting the therapist. Mistrust of others in those who have been mistreated in the past are a normal protective mechanism and, as such, shouldn’t be interpreted as something pathological.

Besides, there is a difference between not trusting someone’s intentions and not trusting their competence. If the client doesn’t trust the therapist’s competence, that is not a “trust issue” but rather a normal consumer judgment. And, most certainly, a difference of opinion is not a trust issue either, and when the therapist presents it as such, I recommend you to fire them immediately because they are too insecure about themselves and have too big of an ego to be doing therapy work.

When your therapist forces the issue of trust at the forefront of discussions in the beginning of therapy without giving the thereapy process a chance to unfold naturally and giving you the opportunity to get comfortable with it, the therapist is either incredibly incompetent or incredibly controlling or both. In all of those cases, it won’t serve your interests to keep seeing them. Don’t waste your time and money and, most importantly, don’t stay in the situation that may be potentially harmful for you. You deserve better.


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9 Responses

  1. anonymous

    Thank you for this information. Do you have a recommendation for a patient when a new therapist (one whom the patient has seen only once or a few times) assigns the patient a new diagnosis (different from what the patient has had from other therapists) and which does not seem correct to the patient? The new diagnosis might relate to trust issues, for example, whereas previously the patient was viewed as having an anxiety disorder.

    • Marina Tonkonogy

      Thank you for your comment and my apologies for delaying a reply. Somehow, your message got lost in my mail and I only discovered it now.

      In the situation you describe, my suggestion for a patient would be to discuss their objections to a new “diagnosis” with a new therapist, if it doesn’t seem to reflect how the patient experiences their mental conditions.

      I am generally skeptical of the idea of diagnosing people in counseling. I think, I talked about it a little bit in my other posts. Psychotherapy, by all standards, is not a valid medical science in the same sense as the rest of the medical profession that treats physical ailments. It doesn’t use objective measurements like blood and urine tests, X-rays, CAT-scans, biopsy etc. A “diagnosis” in psychotherapy is a label based on a purely subjective opinion of a particular therapist about what the patient’s mental problem is. As such, opinions are always debatable.

      This was one of psychotherapy critiques that “post-modern” psychotherapy, which was started by the feminist movement, had of the traditional “medical” Freudian model. One of the post-modern psychotherapy approaches called “solution-oriented” denounces the idea of diagnosing entirely. At the same time, it recognizes that diagnosing clients is a part of the existing professional requirements.

      As a compromise solution, therapists who practice this approach propose that therapist and client come up with the diagnostic label collaboratively. They believe that client is the biggest expert in their own conditions and that therapist shouldn’t use a diagnostic label that doesn’t feel right to client. Solution-oriented, post-modern approach sees the client-therapist relationship as equal and collaborative, not authoritarian and hierarchical. Solution-oriented therapists believe that there is no basis for therapists to assert their expertise because they don’t operate with the same level of objective expertise as medical doctors.

      That said, I believe, most therapists these days understand that psychiatric diagnoses are primarily used for insurance purposes and that they are not real in the same sense as other medical diagnoses. Therefore, this is just a formality that doesn’t affect therapy in any way.

      Some diagnoses though may be stigmatizing such as bipolar, borderline, schizophrenia and some others. If you feel the diagnosis will create problems in your life, definitely talk with your therapist about it. At the same time, keep in mind that certain mental states and behaviors like hallucinations, mania, obsessions and compulsions are what they are, meaning that they are real and not disputable. If they are present, they WILL warrant certain diagnosis like schizophrenia or bipolar. In those cases, an ethical therapist shouldn’t change the diagnosis just because a client believes that it’s incorrect. When a client is hallucinating, a therapist has to give a diagnosis of schizophrenia, even though a client may not like it.

  2. Anonymous

    This is a general question rather than a response to this post. I realize that your goal is primarily to use what you have learned to help ensure that clients/patients are better informed about psychotherapy and in a better position to self-advocate. Do you know if any therapists of any type are among your followers or readers? While I realize that a well-trained therapist might be familiar with some of the information, it seems to me that the feedback and ideas you present from patients and former patients might be of interest to professionals and might give them some sense of how people have felt in certain situations. I found this site easily on line and began to read. I wonder if any therapists have shown an interest.

    • Marina Tonkonogy

      Yes, therapists have read my website and some of them have commented. I actually have been thinking about dedicating a section of the website to professionals where I’d explain things to them from a client’s perspective because, God knows, this is something that professional training has been lacking and they need it badly IMO. I often find myself wanting to train professionals in an entirely different way from how it’s currently done. The big problem is that there is an enormous amount of denial within the profession about the fact that its methods are deeply flawed and there are some serious systemic problems that could add to clients’ suffering rather than ease it. I know of very few professionals who recognize the problem as systemic, but, unfortunately, even they are not committed to making systemic changes. They could talk about the problems here and there but I don’t know of anyone making any consistent effort to bring the issue into public awareness, not to mention to start some kind of activism to push for changes, which is disheartening, to be honest. And the rest of them..are willfully ignorant to what’s going on. The denial is so deep that when they see my website they prefer not to even acknowledge it. Just a couple of them cared enough even to argue with me on how the system works and only one left a somewhat positive feedback because they were harmed in therapy themselves, but even that person denied that there was a systemic problem. They saw it mostly as a problem of some “bad apples” in the overall good barrel. This is a very typical reaction of someone who made a decision to stay with the system even though they were harmed by it. Because when you are completely honest about how flawed the system is, you will have a very hard time continuing to be a part of it. So, yes, I think you are right, it’d be a good idea to start a series of posts for professionals but I suspect there would be virtually no one who would benefit from that at this time. The collective level of denial within the profession is very high right now for my insights to be recognized for what they are. At this time, I feel the consumers are much more receptive to what I have to say and show much more interests in it.

  3. anonymous

    I think that the systemic part of the problem is that when a patient is dissatisfied or unsure about the treatment, he/she may have tremendous difficulty getting advice or clarification. Of course, the first step is to try to talk to the therapist. However, that takes courage because when you confront or question someone, the atmosphere can become hostile quickly, and hostility from the therapist. is the last thing that someone in psychotherapy needs.

    I wonder if and hope that Feedback Informed Therapists (someone mentioned here in another post) are trying to take the patient’s feelings into account in a very positive way.

    If a patient has had a bad experience as I did, there are professional boards and state licensing boards, but there may not be anyone to talk to about how to achieve a less extreme solution or resolution or closure. Some therapists do work for groups or for hospitals or other organizations which ask for feedback from clients, but I think that most therapists are independent practitioners without any oversight or supervision – unless they have personally sought that. So there is support or encouragement for patients who provide feedback.

    I found that when I tried to talk to later therapists about my experiences, I hit a brick wall One therapist did try to talk to my therapist to try to get a sense of things, but had no success. While they wanted to see me and help me with my diagnosis, subsequent therapists seemed to prefer to avoid discussing my past therapy experience and were not helpful. I honestly think that they were afraid of causing a stir, or, they saw me as a complainer.

    Another therapist eventually called my family doctor after one session and said that I was a person who had problem with therapists. My family doctor made it clear to me that he did not think I was benefitting from therapy and he expressed negative and even angry feelings about psychotherapists.
    That was the end of my psychotherapy, and I think that was a good thing.

    That family doctor has retired, and I now see another trustworthy family doctor. If I were to seek psychotherapy in the future for myself or a family member (which is highly unlikely since it has been about twenty years), I think I would try to keep my family doctor in the loop.

    Also, at this time in my life, I would talk to my family members about a problem with a therapist or with any physician. At the time when I had the problem years ago, my family was under stress (due to an illness, etc.), and I did not feel comfortable discussing the situation.

    But for me, psychotherapy had become the problem.

    I do not know if posts specifically for therapists would be well received. Only those who recognize that a problem exists with themselves or within the profession would benefit.

    Thank you for your work and writing on this topic.

    • Marina Tonkonogy

      There is a lot in your unfortunate experience with therapists that I and other former clients can relate to. This is just to let you know that you are not alone in this.

      Feedback Informed Therapy that you are referring to, which was mentioned in other post on this website , would be a wonderful way to resolve some of the systemic issues of therapy. It would not resolve all of them but it would resolve some of them for sure. I think, this is one of the directions where mental health activism should go, but, unfortunately, there isn’t much activism in the field of mental health and the one type of activism that exists only addresses the issues of psychiatric drugs, not talk therapy. Things will change when more people start talking publicly about their harmful experiences with therapy and therapists but we are not at that point yet.

      Also, if the practice of getting regular feedback from clients gets promoted and pushed by activists, many therapists (I think, the majority) in the beginning would resist it vehemently both for legal and emotional reasons. From a legal standpoint, a documented feedback would put the therapist in a vulnerable position if the client decides to file a complaint or to sue. It’s much easier to build a legal defense when a complain is a matter of “he (she) said vs he (she) said” and there is little documentation to base a complain on. The feedback system would give the client’s case more weight because if the negative feedback was consistent for some time and this has been documented, the therapist would have to explain what he(she) did to resolve the problem. With no feedback there is no need for the therapist to do anything to address the client’s dissatisfaction. From an emotional perspective, a negative feedback is seen by the therapist as a failure, which hurts his (her) ego, and when the feedback is documented, which means that other people could potentially see it, it hurts even more. When the only way for the client to express their dissatisfaction verbally in private settings, the client’s experiences can be easily invalidated, dismissed or presented as symptoms of the client’s “illness”. As you well know first hand, client’s gaslighting is a typical response therapists give to a negative feedback.

      You also have a first hand knowledge of how subsequent therapists react when the client tells them about previous negative experiences in therapy. They don’t want to hear it, which is very strange and doesn’t make sense at all when one tries to use logic. Logically, if the client tells me that she had a negative experience with the previous therapist, I, as a therapist, would want to know about it as much as possible in order to avoid the same mistakes her previous therapist made, and, if I believe the client’s experience is due to how she interprets things, or, in other words, it’s her issue, I’d still want to know about what was going on in her previous therapy in order to have as clear picture as possible to decide how I should work with her.

      The only logical explanation of why therapists don’t like to hear about clients’ previous experiences in therapy is that it may remind them of their own weaknesses and incompetence. By design, the client/patient is perceived as “sick” (otherwise, he/she wouldn’t seek help) and, therefore, he or she is always wrong and not to be trusted, and so therapists tend not to think critically of their colleagues when they hear clients talking about bad experiences in therapy. They tend to believe that negative outcome was likely the result of the client’s resistance to “treatment” and such.

      You are correct in saying that client’s dissatisfaction doesn’t have to be resolved in extreme fashion such as complaining to the licensing board or filing a lawsuit. Fist of all, such extreme measures don’t resolve anything anyway. Those actions are taken precisely because the client often has used every opportunity to resolve the problem with the therapist directly or through mediation. People file complains and lawsuits when there is no other option left for them to resolve anything and the extreme measures are taken only because when the therapist is found guilty this, at least, validates the client’s dissatisfaction and proves that the client wasn’t crazy to feel what they were feeling.

      I believe, therapist-client conflict resolution is a serious matter which has to be addressed mostly through mediation. There has to be independent agency doing this kind of mediation. They shouldn’t be affiliated with licensing boards or therapists’ professional organizations.

      • anonymous

        I reread the post on Feedback Informed Therapy. The writer had a very positive experience, and I think that FIT would be helpful in many cases. However, I wonder if completing these questionnaires prior to and after every session might be time consuming and eventually somewhat of a burden for some patients as well as the therapist who reads them and incorporates them into practice.

        • Marina Tonkonogy

          I don’t know. Of course, everyone is different, people have different needs, including what they need from therapy and how they would like to give therapists a feedback and if they want to do it at all.

          I know that I, as a client, would love to have an opportunity to give my feedback after each session, not necessarily prior each session, as my goal for each session may not always be so specific that I would be able to pinpoint what I want to achieve on the upcoming session and or to identify how I feel prior the session and put it in the form. It’s much easier to reflect on what has already happened, what you liked and didn’t like and what you’d like to change than to identify what exactly you need to get out of the next session. So, for me , a questionnaire after each session would work perfectly but not before. Also, I wouldn’t be able to reflect immediately after session. What would work for me is if I could take time to reflect after each session and to fill out the online questionnaire any time before my next appointment. If therapy is conducted weekly this weekly feedback would be important to me as a client and as a therapist. Because, as a therapist, I would like to know how my clients felt after our meeting as much as I, as a client, need to communicate to my therapist if I am being helped by what they are doing. So, no, for me personally, giving a weekly feedback to a therapist, as well as reading a weekly feedback for a client wouldn’t be a burden at all, but rather a very helpful thing.

          But there might be people who would find that burdensome. I think, it might be best to give a client a choice of how often they want to give a feedback. Once a month might be an optimal frequency because it’s enough time to get a general sense of whether the therapist is being helpful. If people don’t want to give a feedback at all, this is something that I, as a consumer, have a hard time understanding because to me it means that they don’t want their therapy to improve and, in that case, I’d wonder what exactly they are looking for when they go to therapy. In any case, feedback is not something that should be legally mandated, of course. Every mental health clinic/agency and every practitioner would decide for themselves if they want to implement the feedback system and every consumer would decide for themselves if they want to have that system in their therapy. If they don’t, they would simply choose to work with practitioners and organizations who don’t implement the feedback system, that’s all.

  4. anonymous

    I meant to say there is “not support or encouragement for patients who provide feedback”.

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