Last Updated on March 25, 2021 by Valarie Ward
So you’ve decided that it’s time to seek out a therapist to deal with your mental illness or other concerns you might have in life. That’s great!
But therapy requires hard work. Your therapist may ask you to do homework, which may involve confronting things that are uncomfortable or frightening. It is your responsibility to take your mental health and self-improvement seriously, and do whatever work is necessary.
Your therapist is your guide in this self-improvement process, and you should trust their expertise. However, there are some things to keep in mind as you try to find a therapist that is a good fit for you and your needs.
This criteria may seem obvious–of course it’s your therapist’s job to listen to you! But there is a difference between lending a listening ear and really believing what you are saying. When you bring up concerns, like asking whether you meet the criteria for a different diagnosis, do they brush those concerns aside? When you tell them that you are depressed and having trouble functioning, do they take this seriously, or do they tell you to just eat some chocolate and you’ll feel better?
Your therapist should be actively listening to you without judgment, and should never minimize your problems or concerns. They might not always agree with your perspective or opinions, but they should always be willing to afford you a level of dignity and honesty about your situation.
If you are letting someone else direct you in your self-improvement, it is absolutely crucial that you trust them. One factor is listening, as mentioned above; it is difficult to open up to someone if you’re worried they won’t take your concerns seriously.
Another factor of trust is patient confidentiality. Per patient privacy laws (HIPAA), your therapist can only tell your friends or family about things you discuss in therapy if they have your consent, so long as you have the capacity to allow or object to sharing that information.
That said, there are a few reasons a therapist is allowed to talk to your friends, family, or law enforcement officers about things you’ve disclosed in therapy:
- If you are incapacitated (unconscious, experiencing psychosis, or intoxicated)
- If you present a “serious and imminent threat” to yourself or to other people
- If you are reporting ongoing abuse to yourself or another person
- If they receive a court order
- If you are a minor (though minors can ask to sit down with their therapist and caretaker to establish boundaries of privacy)
If your therapist breaks this patient confidentiality, or has otherwise broken the American Psychological Association’s code of ethics, this is a serious breach and you may want to file a complaint. In North Carolina, this complaint would go to the North Carolina Board of Licensed Clinical Mental Health Counselors.
Establishing rules of trust and confidentiality is one important boundary. However, you and your therapist should have other boundaries as well. It is inappropriate for you and your therapist to be friends outside of the client-therapist relationship–including being friends on social media. In addition, it is usually inappropriate for a therapist and client to exchange gifts.
There are also emotional boundaries that a therapist is expected to keep. For example, even if a therapist has been through something similar to you, it is not healthy for the therapist to disclose that information or any other difficult things they have been through; the therapist’s job is to listen to you, not to talk too much about themselves or to burden you with their problems. And while some clients appreciate the level of empathy shown when a therapist cries as a result of information they’ve disclosed, others feel that their tears place an unfair burden on the client where they’re expected to comfort their therapist.
Your therapist should also respect your religious, spiritual, or political beliefs, regardless of their own.
Put simply, people usually go to therapy so that they can feel better (or do something better). Your therapist should believe in your ability to make the changes you need to improve your life, and should believe that the changes they’re suggesting will actually help you.
This also goes back to respecting your religious or spiritual beliefs. If your religion or spirituality gives you a sense of hope, purpose, or joy, your therapist should not try to talk you out of those forms of hope you have in your life.
You and your therapist will usually come up with a treatment plan for you during your first few sessions. However, with time, you may come to feel that you need to focus on one area more urgently than another.
Receiving criticism can be hard for everyone–even your therapist. It can sometimes be difficult for a therapist to hear that the treatment plan they made for you isn’t working out. But it’s crucial that your therapist is willing to listen to your needs and make changes as necessary. After all, your therapist is on your side and committed to your self-improvement!
There can sometimes be a social gap between a therapist and their client that limits their capacity to understand what you’ve been through. For example, a therapist who does not use social media, particularly if they are from an older generation, may not be able to understand how issues of online harassment or abuse can be frightening or isolating. In addition, a therapist from a wealthy family may find it difficult to understand the specific burdens of a patient that is impoverished.
This is not a rule, and it is not necessary that your therapist be in your exact socioeconomic position to understand you, believe you, or empathize with you. That said, your therapist should at least show a willingness to learn more in order to better understand your unique life circumstances.
Therapy is very difficult work. It can be easy to criticize your therapist using items on this list and use that as a reason to stop going to therapy. However, if your therapist is making you uncomfortable, I encourage you to try to share your concerns with them directly and see if you can come to a solution (unless they have committed a serious breach of ethics).
Even if you are not able to come to a solution and your therapist feels you would be better suited seeing someone else, they may be able to use what they know about you to recommend you to a colleague who they think would be a good fit.
Finding a good therapist can take time and patience. Good luck, and don’t give up!