Therapy and Counseling – Five Basic Things You Should and Should Not Get
By Christopher O Michael
These are just the very basics–this does not get into any given therapist’s methods or theory. We are talking simple therapeutic courtesy and bare-bones requirements. If your therapist or counselor is not offering you the basics or is offering things that should not be happening, then they might consider a new profession and certainly you might consider a new therapist or counselor. They either have not themselves been on the client end of the therapy interaction, have not been with a respectful therapist, or did not learn despite training and example, which would be the worst possibility.
I wrote this article after having heard one of the most pathetic stories about a doctoral-level therapy / counseling practitioner I have ever heard–short of actual abuse or other illegal behavior. I am not including most things that should be in the practitioner’s code of ethics or the law. Those things, however, are sometimes violated too.
In therapy or counseling you should get:
1. The absolute, undivided attention of the therapist or counselor on YOU (with some occasional and minor lapses being acceptable and probably expected…). Furthermore, you should be unconditionally prized and supported (within reason) and the therapist or counselor–again, within reason–should not ‘judge’ you or your behavior so much as he or she should explore and call your attention to things he or she notices.
2. A relatively quiet and private atmosphere that remains consistent in terms of location is usually very important. Some therapists may take you to locations specific to your problems in order to work on them, but the majority of contact should be private and consistent. For example, a therapist or counselor might occasionally take you onto a bridge in order to address your bridge phobia or fear of heights.
3. Informed consent to therapy so that you know what therapy involves and does not involve and are still willing to participate. The therapist or counselor’s office policies and usual procedures should be outlined, as well as the times that he or she can or must break confidentiality. Informed consent can, to some degree, also help you to know when the therapist has truly violated a boundary.
4. Clear discussion of fees and fee arrangements, including what happens when sessions are missed, any insurance arrangements, and so on.
5. Although depending upon the type of problem being treated this may actually become a repeating and important part of the therapy, in nearly all cases the therapist should apologize or otherwise make things right–or at least productively explore what happened–if something has led to negative feelings.
Things you should not get–please note that even wonderful therapists and counselors occasionally slip up on these, but if it occurs too frequently there are problems that need to be dealt with–perhaps starting with your departure…:
1. A therapist or counselor whose main focus in the session is his or her self. There are many therapists out there who talk amazingly frequently and constantly about themselves! If there is a lot of this, it is NOT normal. Run away. Unless there is some therapeutic reason, more than brief and social personal sharing about the counselor or counselor’s acquaintances, friends, or family should be a red flag about a possibly self-centered or temporarily stressed practitioner who uses paying clients as social time-fillers, friends, or ego-supports. Even ‘gossiping’ and getting the client’s ‘oh my’ reaction is a sign of this if there is no good clinical reason for the disclosure. Finally, such persons may basically use paying clients as therapists / counselors!
One good reason for therapist self-sharing might be to give limited and appropriate information about how someone else–including the therapist–learned from and coped with something very similar to what the client is going through. Also, late in a long-term treatment a bit more revealing from the therapist is perhaps more acceptable, but not a constant focus. Another acceptable time for a therapist or counselor to share about him or herself is when they use their own inner feelings about you or your situation to help you learn something about yourself or your situation. However, a good counselor will be cautious and sensitive in how they use such information.
2. Changes in the conditions or fees unless discussed with and agreed to by you. I have seen it done by excellent therapists in terms of raising fees or changing the financial rules in the middle of a course of therapy or training, but I do not agree with the practice. Especially if work has been going on for some time, the client is now more likely to agree to the change even if he or she does not really want to–because an intimate and valued process has started. Therapists who need to raise fees should do so with new clients. Fees and other financially related rules are a surprisingly sensitive area for both therapists and clients, and once set should usually be left alone. If you are having serious financial trouble, however, the therapist should offer a lower fee or other temporary arrangement rather than simply terminating therapy or counseling only because of the financial issue.
3. Therapists who answer the phone, text, email, etc. during a session–unless it is for a purpose that will immediately help the client, or unless the therapist or counselor is literally ‘on call’ for a birth or a death. I cannot even come up with the words for this one. Rude does not suffice. It is enough that we have to endure loud (and personal!) conversations in beautiful surroundings, movie theatres, and fancy restaurants, but in a process in which the client pays for calm, undivided, intimate attention to his or her deepest concerns? My jaw hurts from dropping open whenever I hear this one.
4. Therapists who take care of delay-able personal needs during the session. Filing nails, looking in a compact or mirror, constantly fixing his or her hair, checking their schedule, eating, using the restroom (like a 5-year-old on a car trip…he / she should have done that beforehand–unless the therapist is so sick that he/she probably should not be at work anyway), and on and on. Drinking water or drinks is usually less disruptive, but if done it is nice of the therapist or counselor to ask you if you would like something.
5. Therapists who are frequently quite late and do not make up the time, or who otherwise do not respect the therapy hour and overall process of the therapy as a whole. Your therapist or counselor should be taking regular vacations or he or she will not be as effective. However, that does not mean that he or she should be vacationing every two months for 2 weeks at a time if you are having serious problems at that time.
Hopefully, you do not run into these last 5 ‘should nots’ on your journey, but if you do I wish for you the strength and savvy to find yourself a better treatment situation. The first 5 ‘shoulds’ are moderately common to find in most therapists, which is the good news. However, given the outrageousness of some of them, the last 5 ‘shouldn’ts’ are surprisingly common! Here’s to avoiding them if possible.
Dr. Chris Michael is a licensed clinical psychologist practicing privately in Laguna Hills, California. He specializes in therapy with the gifted, talented, and creative, and with those dealing with serious mental illness, and also performs clinical and forensic psychological evaluations.
Dr. Michael graduated with his Ph.D. from the University of Tulsa, a respected APA-accredited institution. He took his internship in clinical psychology and post-doctoral fellowship in forensic psychology at Patton State Hospital, a large high-security mental health facility. For more information about mental health, Dr. Michael’s practice, or to consult Dr. Michael, please feel free to visit his website http://www.michaelpsychological.com
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Tags: Bare Bones, Bridge, Code Of Ethics, Contact, Counseling, Counselor, Doctoral Level, Illegal Behavior, Minor Lapses, Private Atmosphere, profession, Reason, Therapy Interaction, Undivided Attention
