Challenges and red flags in therapy

Although therapy is a powerful tool for improving mental health and well-being, the process itself can present challenges at times. You may question if you’re working with the right therapist, whether their approach is working for you, and if you’re making the progress you want to make. While it’s normal to have these questions even in the best of therapeutic relationships, sometimes, concerns come up because something truly is amiss. In rare circumstances, clients may experience inappropriate or upsetting behavior from therapists that should be considered red flags. Read on to learn about common challenges in therapy and how to address them.

What should I do if it feels like therapy isn’t working?

If you feel like therapy isn’t working, it’s important to tell your therapist. Their ultimate goal is to help you. Part of a strong therapeutic relationship is feeling like you can voice any and all concerns. By telling your therapist how you’re feeling, they can work with you to adjust the treatment plan or their approach.

This could look like trying a different psychotherapy modality, blending different types of therapy together, or teaching you coping skills and strategies you haven’t used before. However, it’s important to remember that it takes time for therapy to work — and sometimes, things feel worse before they start to feel better. Though you should notice small signs of progress early on, if you aren’t feeling any improvement over several weeks, consider bringing this up with your therapist.

What if I have nothing to talk about in therapy anymore?

There are many reasons you might feel like you’ve run out of things to talk about in therapy, including

• Your therapist isn’t the right match for you
• Your goals have changed
• You aren’t making progress
• You’ve made enough progress and got what you need out of therapy

If this happens, be honest: Let your therapist know that you don’t have anything to discuss in your sessions, and are wondering how to proceed. They can help brainstorm for other opportunities for growth or discuss new goals you can work towards. Alternatively, if it seems like you’ve met your therapy goals, you and your therapist might discuss whether to reduce the frequency of your sessions, or end therapy altogether.

What if my therapist doesn’t listen to me?

Feeling unheard in therapy is very frustrating. This can happen for a couple of reasons. If you feel like this is an issue of your therapist dominating the session, spending more time talking rather than listening to you, you can talk to them about their style and what isn’t working.

A professional therapist should be open to your feedback and take your concerns seriously. They can then adjust their style to sit back and let you speak more freely. However, if your therapist consistently interrupts you, doesn’t acknowledge your input, becomes defensive when you give feedback, or disregards your opinions, these are signs that it may be time to look for a new therapist.

What do I do if my therapist is unprofessional?

A therapist might be unprofessional in the sense that they’re insensitive, judgmental, pushy, or unreliable in maintaining sessions. A more serious type of unprofessionalism includes unethical behavior such as attempting to cross client-therapist boundaries, disclosing too much about their personal life, making inappropriate remarks, violating confidentiality, or having a dual relationship with a client.

If you experience any of this, you can first try to discuss your concerns with your therapist. But you’re also well within your rights to end therapy and find a new therapist. If your therapist is unethical, you have the right to report them to your state’s licensing board so they can take the necessary steps to ensure this doesn’t happen to other clients.

What if my therapist breaks my confidentiality?

Your therapist should go over confidentiality in your first session together. Therapists cannot legally violate the Health Insurance Portability and Accountability Act (HIPAA) and share information about you with a family member, partner, employer, or anyone else. They also can’t write or post about you (online or otherwise) or approach you and speak to you in public.

However, there are a few scenarios where a mental health professional has to break confidentiality for safety purposes, known as “duty to warn.” The specifics vary state by state, but generally, therapists are legally required to report if you are an imminent threat to yourself (such as if you have a plan to attempt suicide) or others (such as if you have specifically stated you will endanger another person).

They may also have to report child or elder abuse or neglect. If they break confidentiality outside of duty to warn, consider reporting them to your state’s licensing board and finding a new therapist.

What should I do if my therapist makes me feel unsafe or uncomfortable?

Sometimes, therapy can include uncomfortable conversations or emotions. But even if therapy doesn’t always feel good, it should feel safe and helpful.

If your mental health provider is doing or saying things that make you feel unsafe or uncomfortable, or violating your boundaries, consider speaking up. A good therapist will take your feelings extremely seriously. If not, or if your therapist responds inappropriately to your concerns, you should feel free to stop seeing that therapist immediately.

In this case, it’s ideal to find a new therapist who can help you work through what you just experienced, as well as your original mental health concerns and goals that brought you to therapy. Additionally, you have the right to file a complaint and report them to your state’s licensing board.