The decision to pursue mental health care in and of itself can be difficult and overwhelming. It can be all the more frustrating to initiate this process and then find that you and your therapist are not a good fit. Unfortunately, a mismatch in personality between the patient and the therapist often results in patients discontinuing therapy altogether.
On the surface, the therapeutic relationship appears purely professional and business in nature. After all, your therapist is being paid to provide you with a service aimed to improve your mental health and well-being. However, in order to successfully improve patients’ mental health and well-being, it is vitally important that the patient and the therapist “fit” with one another in terms of personality and approach. DeAngelis (2019) notes that a healthy therapeutic relationship “is essential to helping the client connect with, remain in, and get the most from therapy.” DeAngelis (2019) further notes that the health of the therapeutic relationship is just as important as using the right treatment method.
But, what constitutes a healthy versus unhealthy therapeutic relationship? Moore and Gepp (2021) give some insight into factors that generally contribute to an unhealthy therapeutic relationship. Specifically, they note that therapists who behave in unethical manners and are liberal with confidentiality do not generally establish emotionally safe relationships. Similarly, patients should be wary of therapists who engage in dual relationships and overshare details of their own personal lives.
Additionally, if your therapist does not acknowledge and respect your values, responds to your questions, and judges/shames you, it is unlikely that you will experience significant growth in therapy (Moore & Gepp, 2021). Further, while it is normal to occasionally leave the therapy session feeling worse than when the session started, this should not be a regular occurrence (Moore & Gepp, 2021).
When evaluating whether or not your therapist is a good fit for your needs, it can be helpful to consider your treatment goals and whether or not you are moving toward those goals (Greenstein, 2018). While it is unlikely that you will meet your goals in just a few sessions, you should feel that you are moving in the desired direction. Your therapist should also check in with you and ensure that you are happy with your treatment regularly. Further, if you express that you do not feel that you are making progress, your therapist should adjust their approach accordingly (Greenstein, 2018).
Your therapist should also help you to understand your diagnosis and treatment options. Additionally, your therapist should also be working with you to learn skills to improve your communication patterns and relationships. You should regularly walk away from your sessions with new skills and coping strategies to try and integrate into your daily practice (Greenstein, 2018).
The importance that your therapist treats you as an equal can not be overstated. I always tell my patients that they are an expert on themselves and their lives. As such, they know what works best for them. As a provider with a wealth of knowledge in the field, I’ll make suggestions and teach coping strategies, but if they do not work for them, then we go back to the drawing board to figure out what will be helpful. Your therapist also needs to exhibit the ability and effort to understand the cultural barriers that you face that will impact your treatment and life outside of therapy (Greenstein, 2018).
At this point, you may be asking yourself what to do if you do not feel like your therapist is not a good fit for you and your needs. Feldman (2017) gives us some direction on how to determine if your therapist is a good fit for you in the first 1 to 2 sessions. Specifically, Feldman (2017) recommends asking your therapist what their approach is to clinical work so that you can determine if their general approach matches your personality. Additionally, it can be helpful to ask about their experiences and training with your particular diagnosis and symptoms (Feldman, 2017). Finally, Feldman (2017) notes that it is important that you feel that your therapist is both trustworthy and likable in order for you to make progress toward your treatment goals.
After asking yourself these questions and reflecting on your therapeutic relationship, you may come to the conclusion that your treatment is not progressing as you want. There are a few options available to you in this situation. You may consider addressing your concerns and feelings directly with your therapist (Moore & Gepp, 2021). This can be a valuable experience for you, especially if your therapist truly listens to your concerns, validates them, and changes their approach.
However, if your therapist does not positively respond to your concerns, or you find it too overwhelming to confront your therapist, it may be helpful to find a new provider (Moore & Gepp, 2021). At no time are you obligated to continue treatment with a therapist that you do not feel is a good fit for your needs. While it may be helpful to have a termination session in finding closure in the relationship, it certainly is not a requirement.
At the end of the day, therapy is a service that you are dedicating significant time, money, and emotional energy to. You have the right to expect that your therapist meets you exactly where you’re at and walks beside you on your journey to improved mental health. If you feel that you are not getting what you need, it can be helpful to first address your concerns with your therapist. If you are still feeling unheard and your needs are being unmet, it is likely time to find a therapist who better fits your personality and your treatment needs.
About the Author
Dr. Montes is a licensed clinical psychologist and co-owner of Cognitive Behavior Therapy Center in Chesapeake, VA.
References
DeAngelis, T. (2019, November 1). Better relationships with patients lead to better outcomes. Monitor on Psychology. Retrieved April 24, 2023, from http://www.apa.org/monitor/2019/11/ce-corner-relationships
Feldman, D. (2017, October 30). Five questions to decide if a therapist is right for you. Psychology Today. Retrieved April 24, 2023, from https://www.psychologytoday.com/us/blog/supersurvivors/201710/five-questions-decide-if-therapist-is-right-you
Greenstein, L. (2018, February 14). How do I know if my therapist is effective? NAMI. Retrieved April 24, 2023, from http://www.nami.org/Blogs/NAMI-Blog/February-2018/How-Do-I-Know-if-My-Therapist-is-Effective
Moore, M., & Gepp, K. (2021, September 13). Not for everyone: 8 red flags you're with the wrong therapist. Psych Central. Retrieved April 24, 2023, from https://psychcentral.com/lib/red-flags-a-clinician-isnt-right-for-you