Should I keep my therapist?

How can you tell a good therapist from a bad one? Should you keep your therapist or look for someone different? Here are some guidelines, taken as excerpts from the book Seeking Safety, a Treatment Manual for PTSD and Substance Abuse pages 261-3 by Lisa Najavits:

Psychotherapy can be enormously helpful to many people, but it can be one of the most difficult treatments to evaluate. It consists of treatment techniques that vary greatly, and its effectiveness depends on the personalities of both you and the therapist as well as on the relationship you develop together. Although psychotherapy is based in science, it is also an art. Unlike other areas of medical care, it is not typically a “procedure” that gets uniformly applied the same way for each person.

Remember that good psychotherapy is available, and as with most good things in life, you ‘ know it when you see it.’ ” … If you have had a bad treatment experience, try not to give up on treatment or blame yourself. Respect and validate your feelings, and search until you find someone you feel better about.

“Evaluate your treatment after the third session. Research indicates that how helpful a psychotherapy feels by the third session stays largely consistent throughout treatment even years later. If you have had three sessions with a therapist and the treatment feels unhelpful, you may be better off finding someone new than sticking with it.” (p. 261)

Expect some ups and downs as long as the treatment feels helpful overall. Be aware that there are likely to be times when you feel angry or disappointed by the therapist. This a normal part of psychotherapy.  But if it feels like an ongoing problem or frequently feels too intense, you may need to evaluate it more. If you have generally felt helped by the treater, it is usually advisable to stay in the treatment and try to work it through (which may provide you with a real opportunity for important growth). If you have generally not felt helped by the treater, then it may be advisable to leave. (p. 262)

Remember that your life decisions are your own, as long as you choose safely. If a therapist gives you advice to stay or leave a particular job or relationship, to confront your abuser, to go to AA, or any other major advice, view it as input that you can accept or reject (as long as you are safe). (p. 262)

One of the most common complaints about psychotherapy is that the therapist is kind and supportive, but does not promote growth (e.g., give direct feedback, help identify important issues to work on, help you develop new skills). A good psychotherapy is both supportive and growth-producing. If you feel you are just talking a lot but no moving on in visible ways in your life, or that the therapist is “nice” but not really helpful, you may want to find someone who has more to offer you.

Stay in treatment as long as it feels helpful. How long does psychotherapy last? Most psychotherapies end because the patient decides to leave rather than because the therapist suggests it. As long as you are safe and functional (e.g., not suicidal, not actively abusing substances, able to take care of your responsibilities), the general guideline is to stay in treatment as long as it feels beneficial to you and you want to attend. Talking with the therapist about your wish to leave, getting feedback, and going through a termination process can all be helpful. But as long as you are safe, it is up to you when to be in treatment and when to leave. If you decide to end a treatment, do not feel guilty, ashamed, or bad about it. If you are not currently safe, as described above, you may need to stay in treatment until you feel more stable or at least until you find a new treatment.

Especially (my emphasis)

Be wary of treaters who…

Convey that impasses in treatment are all your fault…

Give you the sense that their needs are being met rather than yours…

Convey harsh negativity…

Insist that you stay in treatment that feels as if it’s not working for you…

Thank you Dr. Najavits.

Additionally, be aware that for a licensed therapist to initiate sexual activity is always unprofessional and is illegal in California:


About jamesmatter

Marriage and Family Therapist (MFT) in private practice in San Francisco. I work with adults, adolescents, and couples, with focus on substance use and abuse and co-occurring disorders (having both a mental illness and an addiction).
This entry was posted in behavioral health, change, choices, mental health, Recovery, Therapy processes, Uncategorized. Bookmark the permalink.

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