Q&A with a Therapist Part III: We're all Humans Here

Humans, including therapists, can be complicated and messy.

In my last blog post on the process of therapy, I promised I’d be back in two weeks with some juicy process-related questions. And then…I got really sick.

Does getting sick bring up stuff for you? I know it does for me. As we’ve all experienced, getting sick is physically uncomfortable, and it’s hard to be tuned into myself when my body feels icky. Mentally, all sorts of thoughts about my worth and productivity run through my head. And, I have some fun family history and attachment stuff wrapped up in illness as well. Because of all that physical, mental, and emotional gunk, being under the weather really knocked me for a loop last month.

Anywhoo, getting sick meant I “dropped the ball” (noticing a judgemental thought there) on writing my blog post for its “due” date. After I got better I went into a cycle of avoidance, procrastination, dread, and being hard on myself. But now I’m back! And we’re on to part three of my Q&A with a therapist installment.

These questions are the “hot potatoes” I mentioned in my last post. We’ll address what to do if therapy isn’t working, how to handle your therapist pissing you off, and what we therapists like to do in our spare time. Let’s start from the top!

1. What if therapy isn’t working?
This is a question that might seem simple at first glance, but is actually pretty darn complicated. When therapy isn't working, a few things might be going on:

• You and your therapist aren’t on the same page regarding your goals/hopes/expectations for therapy. 
  You probably came into therapy wanting certain things to change in your life, or wanting to feel differently about yourself or a particular situation. If you don't quite know what you'd like to see change or you and your therapist aren’t communicating clearly around those changes, then it makes sense that therapy feels stuck and like it’s not working. 
• You might be in the “seesaw” stage of change.
  Stages of change were developed by Prochaska and DiClemente through their studies of people attempting to quit smoking.¹ These stages are now pretty widely applied across therapy models. If you’re in therapy, you are probably at least in the second stage of change, contemplation. By going to therapy you’ve acknowledged a need or a problem and you’re taking action. The frustrating part of the contemplation stage of change is that it’s like a seesaw—you know you need to do some stuff differently but are finding it hard to put those steps into action and make changes in your outside-of-therapy life. 
• You’re leaving your tools at the hardware store. 
  This is one of my favorite Russ Harris metaphors. He talks about therapy as a hardware store full of shiny new tools. It’s easy to forget that therapy is one hour out of the 168 hours in your week. If you purchase your shiny new therapy tool and then leave it at the hardware store/in the therapy room, you’re not going to gain any experience using it where it counts i.e. in your day-to-day life. 
• You and your therapist aren’t a great fit, or you’re ready to move on to a different approach or style. 
  One of my mentors in Durango often talks about how different therapists are appropriate for different phases of people’s lives. So, it could be you’ve “outgrown” your therapist in some ways. Or, it could be that your therapist doesn’t fit for you in general due to their personality, their therapy approach, or their therapeutic style. Some people need a gentle therapist, while some people need tough love. Some people benefit from a very structured and skills-based therapy, while other people benefit from a more fluid approach. There’s no real right or wrong here, just what works best for you. 

No matter the reason things are stuck, it’s important to bring up your thoughts and feelings with your therapist. Your therapist should either help you get clear on what would work for you or give you some recommendations for other approaches that might fit better with your challenges, personality, and learning style. If it feels scary to do this in person, you can think about doing it in writing. You don’t need to go into all the details in an email or a text, but even just saying something like “hey, I’m worried therapy isn’t working for me” can open up a conversation. 

2. My therapist really pissed me off. What do I do now? 
Ooh, another juicy one. So many of these questions are multilayered. I’ll address this on a couple of different levels:

• Did your therapist do something unethical? 
  Unethical actions by therapists include really f**ked up stuff like sexual misconduct or breaching confidentiality. Therapists are guided by ethical codes, as well as legal standards and precedents. Legal standards and ethics lay out pretty clearly what is and isn’t ok in the therapeutic relationship. Sure, there are ethically muddy areas, but things like hitting on clients and breaking confidentiality are clear no-nos. If you think your therapist has done something unethical, you can report them to the state ethics board. If you’re being harmed by a therapist, ask for help in removing yourself from the situation. 
• It wasn't unethical, it was rude.
  Perhaps your therapist didn’t do anything unethical. But, because of the whole “therapists are human beings” thing, maybe he or she did say or do something hurtful. I know I’ve had moments as a therapist when I wish I could take back the words that just came out of my mouth, or change the way I handled a certain situation. Because of the power dynamic inherent in therapy, it can be really hard to tell a therapist you’re upset with them. This is another situation in which writing can be helpful—if you’re not able or willing to bring it up in person, could you write a letter and slip it under your therapist’s door, or send an email? I know I am always looking to grow and improve as a therapist, so if I’ve said or done something hurtful and someone I’m working with tells me that, I can reflect on my behavior and change my actions in the future. 
• Is any of your anger transference? 
  Does you being pissed off at your therapist mirror a pattern you see in your life outside of therapy? If you’re in therapy you likely have some willingness to do a bit of self-reflection. I’m not saying this in a blaming or gaslighting way, as sometimes therapist behavior can be downright atrocious. But say you're in therapy because your relationships often go up in flames, with you storming out the door yelling and never coming back. It might be that some of the anger with your therapist is based in whatever pattern makes relationships challenging for you. Therapy is great interpersonal practice so if you notice a pattern it would be well worth working through it with your therapist. You might still decide to see someone else afterwards, but at least you gave yourself the chance to express yourself in a healthy way.

3. Is my therapist just lounging in the Bahamas in her spare time?
Ok, I’m guessing that’s not really your question. What I’m trying to get at with this one is that therapists don’t just finish therapy school and then coast for the rest of their career (well, maybe some do, but the ones I know aren’t like that.) Most therapists are pretty enthusiastic about personal and professional growth, and therefore continue to seek learning and training opportunities long after they complete their schooling. Plus, we’re actually required to do so—in Colorado, therapists have to complete at least 40 hours of continuing education for every two year licensure cycle.

That concludes my Q&A with a Therapist series. Honestly, it was a bit of a struggle to get through this one. (That whole human being thing rearing its pesky little head again.) As usual, I'm open to comments, questions, and feedback, and you can always schedule a call with me to learn more. 

References
1. The Transtheoretical Model of Change https://en.wikipedia.org/wiki/Transtheoretical_model

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