We take a conflict-averse approach to bad therapy experiences in New Zealand, and it’s not serving us well. Counsellor Sarah Zimmerman explores what we should do instead.
This article explores general dissatisfaction rather than serious misconduct.
It’s 2023. We talk about therapy now. Or at least, more of us do. And we’re getting increasingly “psycho-literate”; more clued up about the concepts and theories that underpin what’s happening in the therapy room, and what good practice does and doesn’t look like.
This is fantastic. For one thing, it makes clients much more powerful: rather than the therapist practising a mysterious “dark art” that we feel obliged to go along with, we now have a clearer sense of what to expect, and what’s not on.
And yet I can give a list of conversations I’ve had with friends and acquaintances about therapy that was very much not kosher. Not in an “obvious malpractice” kind of way, but more “they patronised me”, “they wasted my time”, “they judged me or my choices”, “they messed me around with timing or prices”.
Concerns generally fall into two camps: either the therapeutic conversation itself is unsatisfying, or the therapist’s general behaviour is.
In the latter category, here’s a selection of real examples: a counsellor eating a salad during a session (!); counsellors checking their texts; a teenage kid coming home from school into the lounge/therapy space mid-session; and a therapist giving the client a tour of their house and craft projects during the client’s session time.
In the “unsatisfying therapeutic conversation” category, I can share my own example of going to a super expensive therapist and having them spend the first session reading out information sheets they could have sent me before the session, for me to read myself, for free. Or the time I went to EAP and shared that I was feeling stressed and noticed I was spending money impulsively, to which the therapist suggested I try shopping at op-shops. (Where do you think I’m impulsively spending my money!?)
None of these examples are “strike them off!” material. But all of them do damage to the therapeutic relationship, whether it’s through not being attuned to the client, showing a lack of respect for the sanctity of the therapy space, or just being odd and making us wonder, “can I trust this person to hold my stuff?”
None of the people who shared their stories with me raised their concerns with the therapist; most ended up sitting through the sessions not saying anything, including me. But counselling is expensive – or limited if you’re on funded sessions – and we’re not there to mess around, so resolving these problems is imperative if therapy is to be fruitful.
Why is it so hard to speak up?
In one of my own crap therapy experiences, I later found out my supervisor had been to the same therapist and also not said anything. This leaves the therapist unaware that the service wasn’t great, so they continue to offer that same crap service to other clients. And my supervisor and I are counsellors – we should be braver than average on this stuff!
I don’t think my supervisor and I are unusual in that New Zealanders seem to be chronically conflict-avoidant. But specific to the counselling scenario, why is it so hard to say something?
Two words here: power imbalance. The power imbalance in a therapeutic relationship is very real, and it’s the therapist’s job to help ease it. A good therapeutic relationship is deeply collaborative, yet many healthcare settings still make us feel like an insignificant inconvenience, and we can transfer that feeling into therapy, no matter how nice our therapist seems.
Clients also sometimes worry their concerns aren’t “big enough” or legit. On this point I say: it’s good to speak up regardless. The relationship with your therapist is the number one predictor of success in therapy, so if there’s something getting in the way of that, it needs to be addressed. Small stuff is generally easier to talk about, so get some reps in with the light weights while you can! And hey, maybe learning not to minimise your own experience is part of your therapeutic work, so here’s an opportunity.
We may also have had previous, non-therapy experiences of raising feedback and having it go very badly. This is both a reason we don’t speak up, and a reason we (ideally) should, as therapy should provide an emotionally reparative experience of this scenario.
Why it’s so important to say something
It’s scary to think that if we raise a concern, it may kick off a litigation process where we have to back up our points to “prove” that the therapy was empirically inadequate. Plus, we’re looking for therapy: we’re probably needing a bit of support, rather than another battle or headache.
However, if we go along with whatever’s bothering us, not only do we waste a bunch of cash, but we’re essentially agreeing that it’s OK to be judged, patronised and so on. This is probably the stuff you went to therapy to sort out, so paying someone to entrench the issue sucks.
I’ve touched on it above, but speaking up when therapy isn’t working for us is critically important. These ick moments are actually a crucial part of the therapeutic process. “When you talk through misunderstandings with your therapist, it gives you the opportunity to witness a damaged relationship being repaired,” writes clinical social worker Stephanie Hairston. “This is something many people never experience.”
That’s right: this isn’t a peripheral topic before you get back to “doing therapy”. Raising a concern is doing therapy. If this conversation goes well, it can turbo-charge your progress.
Assuming that you’re seeing a competent, qualified therapist (check they’re registered!), my top recommendation is that you raise it with them directly. Ugh, I know.
If this is terrifying, it can help to have a script before you go in. You might say, “I have something I wanted to talk about today, and I’m super nervous, so I wrote it down. Um, it’s about our counselling sessions. Can I read it slowly and then we talk about it?” There are loads of resources online about how to have this conversation, so make use of that if it helps to give you some ideas.
You can even (depending on contact arrangements you have with your therapist) email or message them a heads-up before your next session, if that helps to break the ice.
At this point I should point out that, while therapists are providing a service, that service is, at its heart, an experience of relationship. Relationships can be awkward and patchy. However, your therapist is trained for these conversations, and if they go well, they can be incredibly helpful experiences for you both, and your relationship will definitely be stronger for it. Result!
What happens if I don’t trust them to take it well?
Perhaps, depending on your read of the situation, you don’t trust your therapist to handle feedback well. If you felt so unimpressed with your initial session that you don’t want to spend your own cash explaining when you’re pretty confident they’re not going to get it, then we’re looking at other options.
The next level of escalation is politely giving your feedback to the practice manager at the service where your therapist works. Obviously if your therapist works for themselves, this isn’t an option, but it’s a good choice if you have it.
I’ve been on the receiving end of this, where a client gave feedback to my supervisor, as they didn’t feel comfortable telling me themselves. I was grateful that they had, and it led to some big reflection and learning for me. For the avoidant among us, this lets the service know that something was off, without you having to have the conversation face-to-face. If this is the maximum you can muster – and for many of us this would take a huge amount of courage – then do that.
If the therapist’s behaviour felt inappropriate to the point you want to give feedback to the person’s regulating body, the process can be more formal. A friend of mine recently shared that she’d had a crap therapy experience but didn’t make a complaint because “I didn’t want to be dragged into telling my story repeatedly and arguing my side.” This is fair.
If a formal complaint is something you’re considering, you’ve got the option of enquiring with the licensing organisation (for example, the NZ Association of Counsellors) about the process of making a complaint before you make any commitment to proceeding. You can always choose not to once you’ve got that information.
In short, there are lots of different ways to raise your concerns. One key thing to remember, though, is that your therapist is human. They’re exposed to the full gamut of life’s stressors, and they have off days. There can be a temptation to blame and take a punitive approach when we feel upset, but (good) therapy is not a scripted, clinical science, or a tidy, quantifiable service. Yes, we might use scripted exercises and tools, but fundamentally we’re working with the human spirit.
That doesn’t excuse malpractice. But done well, giving feedback is an opportunity to experience an alternative to the blaming, cancelling, and accusation that’s common in our world. If you’re able to connect with your therapist and work through your concerns, this is a precious opportunity to be listened to, and to collaboratively work out how else to operate so it works for both parties. Try telling me the world doesn’t need more of that.