As therapists, we want you to open up to us. To trust us enough to tell us things you may have never told anyone else. We want you to explore your deepest, darkest places and deal with things you may not even be aware that you were dealing with or avoiding. However, as therapist, there are some things that we keep from you and here is what I consider to be the top five.
1. “Sometimes You Bore Me.”
As therapists, we get paid to listen to other peoples problems and that may seem like an easy task, but it’s not. Sitting and listening to someone talk for 50 minutes can be mentally and emotionally draining, especially when the person talking is going on and on about something that is irrelevant to why they are actually in therapy. Sometimes it is hard to shut out our own internal chatter and (I feel guilty to admit this) it’s easy to start daydreaming or letting your mind wander instead of being attentive and present.
When I find this happening, it’s usually a clear sign to me that I need to redirect the client, or that whatever I am doing isn’t working and I need to try a different approach. Some clients however simply aren’t that interesting.
I remember running into a fellow therapist at the coffee machine saying she needed some extra caffeine because her next client was “a snoozer”. Fortunately, this is a rarity and not the norm, but if your therapist looks bored, it’s a good chance he or she is and it could be a clue to both of you that you aren’t really working on the real problem at hand, but dancing around it.
2. “You’re All Better, But I Want You To Keep Coming Back Because I Need Your Money.”
Therapist in private practice depend on their clients to make a living so, sometimes, even when therapy should come to an end, after the problems have been resolved, a therapist will keep rescheduling you to come back, even if you run out of things to talk about. They don’t want to let you go or to discharge you because that is taking money out of their pocket, so they will continue rescheduling you to come back as long as you or your insurance company continues to pay them.
Speaking of which, most insurance companies will only pay for a certain number of sessions so a therapist may want you to keep coming back until you’ve used up all your sessions and then, rather you are better or not, they may stop seeing you. That is unless of course you have the money to pay out of pocket, which can be costly. Most therapist charge anywhere from $75 to $200 an hour.
If you feel like your work is done with the therapist, but they continue rescheduling you to come back, it’s okay to bring this up to the therapist, to stop going to see the therapist or to get another one if you feel like your therapist is using you. A good therapist doesn’t want their client in therapy longer than necessary, even if discharging that client is going to take some money out of their pocket.
3. “Your Secrets Are Safe With Me… Sort Of.”
As therapist, we want you to feel safe talking to us and tell you that everything is confidential and we like to think that it is, but there are somethings that may not be confidential such as when someone talks about killing themselves, someone else, abuse, neglect, etc. Also, courts can demand to see our records in the event of a court case such as an employment dispute or divorce proceedings. As therapists, we generally fight to keep our records private and only release what we absolute must, but while we promise confidentiality, there are exceptions.
Also, therapist often consult with other therapists, but usually we keep names and irrelevant details out of the discussion. It’s not uncommon for therapists to discuss patients with friends and family even, but in those cases names and details are always kept out because violating confidentiality is against the law and a therapist can be sued if it’s proven that he or she violated their clients confidentiality.
4. ” I May Need More Help Than You Do.”
Therapists are human. Sometimes therapists have problems consciously and unconsciously that they may not be able to deal with on their own, yet they still show up to the office everyday to help others. This isn’t necessarily a bad thing, but it can be. If your therapist is not in the right frame of mind and doesn’t know how to let his or her own problems go once face to face with a client, a litany of problems can occur.
Therapists aren’t supposed to give advice, but often we do and if your therapist is going through their own life situations, they may give you some very bad advice, not be present or make some very unhealthy decisions.
I’ve heard stories of therapists crying and confiding in their patients as if their patients were there own personal therapists, leaving the patient confused. I’ve also heard of therapist who were so cold and bitter while going through a divorce that they couldn’t be objective and empathetic when listening to their patients talk about their own relationships.
I’ve also known enough therapists who went into counseling and psychology (probably unconsciously) to help themselves and ended up being therapists who were just as neurotic, unstable and mentally unhealthy as many of the patients they were supposed to be helping.
This is where issues come into play like the therapist who slept with his or her patient, or had some other unhealthy, inappropriate dual relationship with a patient like having a patient temporarily live with them or being overly and unprofessionally involved with a client.
It is often advised that therapists have their own supervisors or therapists to talk to so that they can keep their personal and professional lives separate. Fortunately, most of the people I knew would make bad therapist ended up going into other fields.
5. “You Will Get A Diagnosis Rather You Deserve One Or Not”
Unfortunately, in this day and age of managed healthcare, everyone that has insurance has to get a diagnosis in order for the therapist to get paid. Sometimes this is easy because the patient obviously fits a certain diagnosis like depression or anxiety, but sometimes it’s not so obvious.
For example, when a patient is just dealing with typical life stressors that don’t meet criteria for a mental health diagnosis, the therapist will have to make a diagnosis fit if he or she wants to get paid.
Sometimes therapist will go for a “soft” diagnosis, like adjustment disorders, but some insurance companies won’t even pay for a “soft” diagnosis, so an adjustment disorder with depressed mood may be unnecessarily upgraded to major depressive disorder, single episode. Your therapist may never tell you that you have been diagnosed, but you have been and at some point, if you care, you should ask what your diagnosis is.
A major part of my job is to diagnosis clients and everyone that enters my door leaves with a diagnosis if they didn’t have one already. I am always surprised at the number of patients who are referred to me with a current diagnosis, but when I ask them if they’ve been diagnosed with anything they either say “no” or “I don’t know”. These people are walking around with a diagnosis and don’t even know it.
6. “This May Hurt”
Most therapists won’t tell you up front that therapy can be emotionally and mentally painful. Most of the time we go to therapy because we are dealing with or avoiding some type of mental pain and we as therapist want to help you find it, confront it and deal with it. It can be pain that you know, like a recent divorce, or pain that you didn’t even realize was there, like how much you miss your dad that abandoned you when you were 3 and you haven’t thought of in over 10 years.
You may also come to some conclusions while you are in therapy, conclusions that may be difficult like ending a relationship, telling your mother how you really feel about the way she raised you or learning to say no to people you’ve always said yes to. A good therapist will be there with you and walk you through that pain, but most won’t tell you upfront how much this may hurt, otherwise, you might not go through with it.
Most therapists are good people who are in this field for the right reasons, not for the money (which isn’t great in the first place, but can be made), the power (some therapist like having a “God Complex”) or any other selfish reasons. Still, like in every profession there are good therapist and bad therapist and knowing how to identify a bad therapist can not only save you time and money, it may keep you from coming out of therapy worst off than you started.