Mistakes therapists make
Although some clients see therapists as infallible superhumans, they are really just mortals prone to making mistakes like everyone else. However, therapists must be highly aware of potential errors, as they can have a damaging and lasting impact. Here are seven common mistakes made by therapists and how to prevent them.
Seven common therapist mistakes (And What To Do About Them)
Relying only on the client’s perspective
We all see experiences through a biased lens. Therapists need to understand that what they are hearing during a session is only the client’s point of view. Obtaining the perspective of another person can be a game changer. It may even cause you to alter how you assess and treat your client.
Solution: Ask for a release to speak to one of your client’s friends, family members, or partner. Ideally, this would be in a session with your client present but it can be done without your client if that is what they prefer. You just need to make sure that your client is okay with it and reassure them that any information you obtain will be shared with them. After all, you don’t want them to feel like you are keeping secrets. If the client won’t agree to you talking to someone in their lives, you can ask questions that might help you gather another perspective. For example, “How do other people in your life feel about your behavior?”
Therapist knows best
Sometimes, therapists are ineffective because they are more concerned with implementing their agenda than they are with listening to the client’s needs. At its worst, the therapist may project their issues onto the client and end up giving them advice that works for the therapist rather than the individual. The clinician must remember that their job is to help the client work out their problems, not just tell them what to do based on their own experiences.
Solution: Practice active listening, be flexible, and provide options. For example, let’s say a client does not do their homework consistently. Instead of trying to force it (because you are a CBT therapist and supposed to give homework), discuss why they are not doing it and come up with an acceptable solution.
Lack of boundaries
Loose boundaries have a myriad of consequences, none of them good. On the more obvious side, this may include having a personal (e.g., sexual) or business relationship with a client. Less overt is offering therapeutic services to a client’s friend or family member, or allowing a client to contact you regularly after work hours.
Solution: Set strong boundaries during the first session and review periodically as incidents arise. Most boundary problems can be prevented if you discuss them with the client at the beginning of therapy. Then, if another boundary issue comes up later, you can remind them of the boundary limits in session. One of the worst mistakes a therapist can make is to minimize boundary issues. This is not an area that gets better over time if you ignore it.
Fighting resistance
Sometimes, clients put up roadblocks to treatment. It might be no-showing for a session or not completing their homework. These examples of resistance jeopardize the progress of therapy and may sabotage it altogether. It is the client’s indirect way of saying, “I’m not sure I want to be doing this.” One of the worst mistakes a therapist can make is to fight resistance. For example, telling a client that they must complete the homework or you will terminate therapy. The last thing you want to do as a therapist is to end up arguing with a client who may not want to be there in the first place.
Solution: Roll with the resistance. Clients are not unruly children who need punishment. Yes, you want to set limits but your ultimate goal is to find a way to help. Resistance is a setup. It is your job to not take the bait. For instance, if a client is not showing up for sessions, don’t threaten them. Instead, use that to start a discussion about their attendance and what you can do to help them become more motivated.
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Not being present
Every therapist has heard a story about a colleague who fell asleep during a session. Although sleeping is a rare occurrence, being preoccupied happens much more frequently. Imagine what a client thinks when they see their therapist looking at their Apple Watch or staring into space during a session. Adding to the difficulty is that teletherapy has made these distractions much more likely. Admit it: How many times have you glanced at your phone beside you (but out of sight of the camera) while you were conducting therapy online?
Solution: Get enough sleep and prepare your environment. Feeling tired leads to zoning out and dozing off. Additionally, therapists need to create an office space free of distractions. This means keeping all electronics out of reach (and sight) during a session.
Lack of preparation
Therapists can see upwards of 40 clients a week. Unless they have a photographic memory, they aren’t going to remember the details of every person they treat. However, forgetting important people and events in the life of your client damages the trust and rapport you have worked hard to develop.
Solution: Take notes and review them before each session. If you don’t take notes during a session, it is crucial to take them right after so you don’t forget essential information. Take a few minutes before each session to review your notes and other documentation so you feel confident in discussing what is going on in your client’s life.
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Taking every client
Yes, therapy is a business. You want to see a lot of people so you can make more money. But, the truth is that you aren’t qualified to see every type of client. You may lack the expertise or the cultural competence to treat certain populations. Therapists have an ethical obligation to help their clients and you can’t do that if you don’t know what you are doing. For example, if you have no specialization or experience in treating the LGBTQ population, you may want to think twice.
Solution: If you are thinking to yourself, “I have no idea how to treat this issue or population”, just say no.
Therapists are human. They make mistakes. However, they can cause harm to their clients if they are irresponsible or careless. As such, therapists need to do their best to limit mistakes that can negatively impact the people they are trying to help.
Resources
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References
Aravind, V. K., Krishnaram, V. D., & Thasneem, Z. (2012). Boundary crossings and violations in clinical settings. Indian journal of psychological medicine, 34(1), 21–24. https://doi.org/10.4103/0253-7176.96151
Gallo, A.(2024, January 2). What is active listening? Harvard Business Review. https://hbr.org/2024/01/what-is-active-listening
Tait, A. (2021, July 17). ‘It was devastating’: what happens when therapy makes things worse? The Guardian. https://www.theguardian.com/lifeandstyle/2021/jul/17/it-was-devastating-what-happens-when-therapy-makes-things-worse
Watson, J.C. (2006, August 12). Addressing Client Resistance: Recognizing and Processing In-Session Occurrences. American Counseling Association. https://www.counseling.org/resources/library/vistas/vistas06_online-only/Watson.pdf
