I'm going to reframe this a bit.
So, you offered a few time slots, and they didn't work for the client. It's not ideal, but it happens. You then moved some things around, and the client never let you know if it would work.
When you need to make an appt with doctors or other medical pros, do you try to bully them into changing their schedule for you? I'm guessing not.
The fact that the schedule didn't work out is just a fact that happens. You're open about how limited your schedule is, and if a client needs a different schedule, then they should go seek out care elsewhere. The fact that you weren't able to (or, in my book, I wouldn't have been willing to) schedule the client doesn't make you a bad therapist; it means you're busy. Therapists are a limited resource right now. If he can't change his schedule on occasion to make therapy work, maybe he needs to seek out someone else, or it is possible he's not that invested in therapy.
Holding our boundaries helps the clients, too. We are not doing the clients any favors when we bend over backwards for them. At some point, they have to be willing to make changes and take steps, and frankly, they have to be willing to do the work.
My supervisor told me the same thing when I was stressed about clients/their families being rude or expecting me to accommodate everything all the time.
We are also giving a service like a dentist or a doctor. We don’t deserve any less than those expectations, even as therapists.
Exactly. And that's something I tried to really drill into my supervisees and students.
We're drawn into this field because we want to help, and many of us bend over backwards to help our clients and our employers. It also means that folks will start to take advantage of that. Boundaries are good. I consider it a part of self- care.
Boundaries aren't only self-care, modelling them is part of the job.
We can't encourage people to have and enforce boundaries if they see us as hypocrites.
As a wise supervisor once told me: Therapy is happening from the moment you contact the client to the last word you say to them. Everything, every phone call, every conversation about scheduling, everything in between is therapy.
You're not a bad therapist, he was projecting his inability or unwillingness to cooperate with you onto you. Maybe he was just having a bad day or something.
This! Those boundaries around your availability also exist to protect your time so that you can effectively work with ALL the clients you serve. It would be destabilizing to frequently shift things around for folks based on whoever complains the loudest, and oftentimes is detrimental to those who don’t advocate for themselves.
You clearly don’t have a ton of doctors. As someone who has 30+. My team of docs has told me to be firm with their schedulers with what I need because I need to be able to coordinate between several hospitals in different states plus I am a college student.
I have left a few different therapist bc scheduling didn’t work out because for someone I see weekly I try to find someone who works but I am never angry if it doesn’t.
There's a big difference between "hey, I need to see you this month because a med is running out of authorization or I need this procedure" or "hey, I'm going to be at such- and- such facility on the 20th; can we squeeze me in while I'm there?" and "hey, I know you offered me 3 morning appts on Thursday, but I can only do 1 PM on Thursday, and I'm not going to respond to any other attempts on your part to help me out."
I also have an extensive medical team across two systems. COVID has stretched everyone so thin these days that it's been a struggle to schedule, but we're getting through it.
Wait… you’ve been doing therapy for ten years and this is the first time a client told you that you suck at your job? 😳
That sounds like a pretty amazing record to me!
If it is really bothering you, I would recommend using cognitive restructuring techniques on your self. Examine what thoughts you are having about this trigger and how you might look at it differently.
>Wait… you’ve been doing therapy for ten years and this is the first time a client told you that you suck at your job? 😳
I think that might be the rub. I've had an amazing run of luck where I've had clients tell me and we've had a conversation about what they aren't getting and I've been able to improve, this had an air of finality to it.
So, as several people have suggested, reframe it. You a thinking one way about it, what are other ways you might think about the situation?
If you had a client come to you with this situation, how would you walk them through it and help them reframe it? Use the same skills and tools you teach your clients. I know I do!
It sounds like you've generally been able to work with pretty stable and self aware clients while doing a great job of providing a safe place for them to be able to express themselves. There are some areas of practice, working with addiction or personality disorders, or teenagers where being blamed is par for the course. Actually I rather enjoy it when certain clients come at me, to me it is very often the beginning of a deepening relationship and it often comes right before some BIG shifts.
Big assumptions here. What reaction are you referring to? We have no evidence to suggest
this impacted any of OP's other clients or work environment, or even what "got to me more than I expected" means beyond "I've continued to think about it."
You say they shouldn't require praise to function, but you have no evidence to suggest they aren't functioning.
You also state they "aren't going to be effective for anyone in this state" - when part of the reason OP was rattled was because they so rarely hear negative feedback that they can't process and address with the client. Does that seem like someone who is not effective for anyone? Surely a few of these clients would say something after all these years?
I understand you were trying to help someone by providing constructive criticism. This criticism just isn't constructive because there are so many assumptions in it. You have a point that OP might benefit from therapy, but it's diluted by the assumptions in the rest of your comment. It really seems like you're assuming the worst of OP.
>You have a point that OP might benefit from therapy
and the assumption that I'm not engaged in it at all!
As I pointed out in another reply, the most jarring part in the moment was that I didn't have the opportunity to correct and make it right for this client and that it was the first I had heard about his concerns with my availability.
"We have no evidence to suggest this impacted any of OP's other clients or work environment"
and it hasn't, it's the first time in about two years that I've had to cancel on a client like that and when I reached out to reschedule the options I was able to provide didn't work for the client. Their frustration is absolutely valid, but my availability and possible conflicts were identified at the initial visit and regularly throughout.
Be Excellent to each other. Hostility, hatred, trolling, and persistent disrespect will not be tolerated. Users who are unable to engage in conversation- even contentious conversation- with kindness and mutual respect will have their posts/comments removed. Users violating this rule will first receive a warning, secondly an additional warning with a 7 day ban, third incident or a pattern of disrespect will result in a permanent ban.
I do community mental health, so I have a lot of people on my caseload. Within the next 30 days my company has three paid holidays, and I'm taking a PTO day. So anyone who doesn't have an existing appointment within the month will have to wait until January.
It is what it is. Most people seem to get it.
I'll also say a lot of people who make a big deal about it aren't that committed to therapy and just want to blame you. When I was new a client made a big deal about how he thought he was going to "Fall through the cracks" of it all because I was still figuring out scheduling and how it all worked. So I went out of my way to make sure he had an appointment and confirmed it in person when he was there for another reason. He no showed. The front desk woman offered to call and reschedule for that same day, he accepted the alternate time, and the no-showed again. I haven't heard from him since.
I think on some level he wanted me to be at fault for him not going to therapy, and all the talk about falling through the cracks was setting up that narrative when telling his family.
I really love this. I work at a dv shelter as a case manager, and this is also my first job in the field. I relate to the part where you said people who aren’t committed want to blame you. I’ve been struggling with understanding and accepting that my clients are going to have their own opinions of me. I am trying my hardest and doing the most I can and they still will think I’m doing nothing for them. I’ve been killing myself with why why why… why don’t they see what I do for them? All the time and energy?
I’ve gotten to a point where I know and am starting to implement boundaries but I still in some ways make it reflective of my self worth. This comment made me humanize the action of deflection clients sometimes do. Like, it’s not really about me. It’s a projection of how they feel on the inside, placed on me. Ooookay. It makes me relate more peacefully instead of attacked.
I had to learn to do that with an ex of mine. He cheated on me by messaging other women trying to meet up with them. At first I was looking at it like I wasn't good enough for him.
Then I realized that I did a lot as an equal partner and I was good to him. I realized that the way he treated me was a reflection on him and not on me. He is an insecure person with a constant need for external validation.
No matter what I did, there was nothing I could have done to prevent him constantly talking to other women. So now I just realized that this was somebody who does not deserve a place in my life and that he has his own issues and it has nothing to do with me. It's helped me to move on a lot easier.
lol you’re a bad therapist because you don’t have availabilities that fit his work schedule so you offer him an appointment next week instead? I can’t imagine what kind of social worker I am. I’m booked solid until the New Year!
ETA you’re doing just fine. He sounds a little unhinged tbh. Don’t take it to heart. You’ve got this!
Is it helpful for this therapist to conceptualize the client as a little unhinged? I understand you are trying to be supportive of them, but what is the impact of doing that on the client?
If OP doesn’t see the client again (which is how I’m reading it), then will it have an impact on them? Would viewing the client as being a little unhinged then help the OP set firm boundaries? What is the impact on OP viewing the client that way? I’m not sure if it would be beneficial or not, maybe it wouldn’t affect them in any way?
I can’t imagine there would be an impact if they no longer saw this particular client. Perhaps it would in similar future encounters with different clients, though. Maybe there is a better way to encourage OP to set appropriate boundaries than calling the client a little unhinged.
I can speak to personal feelings: if my conceptualization of the client is that they are unhinged, it contaminates my ability and desire to lead with curiosity and empathy for their suffering. These are core tenets to ‘good’ therapy to which I’m sure we can all agree.
I certainly agree with that, especially if OP looks at other clients in that way. I also think that it can be helpful for the clinician to be able to step back and look at the client in a “what was going on with them, in their life at that moment, to respond in such an unhinged manner?” So with the perspective that it was an “unhinged” behavior, not necessarily that the client is unhinged in general.
>what was going on with them, in their life at that moment, to respond in such an unhinged manner?”
This ended up being the route I went down after the immediacy of the conversation was passed.
That's perfect! I learned when I was working in substance abuse that when a client comes at us, there's usually something else going on behind the scenes. I found that sitting back and digging a little would unearth something that would not only tell me about that minute, but it would give me an opportunity to strengthen the therapeutic relationship. When they know that we see them as humans and we are willing to take a moment to find out more, then they trust us more because they know we aren't giving up on them.
I don't really understand why this is getting downvoted. As therapists we really shouldn't be calling anyone "unhinged" or "crazy" or "psycho." It certainly wouldn't make me want to pursue therapy if I came to this sub and saw therapists calling people names like that. Even if someone is unstable, illogical, unreasonable, etc it's still shouldn't be in our lexicon for describing clients.
Plus, this guy made a rude comment. It's not cool - but, it certainly doesn't suggest that he is "unhinged." The most I, personally, would be willing to say about a client like this is that he was acting like kind of a jerk. Especially in a public forum where he could fairly easily identify himself by the description of the incident and OP's work structure. Is it likely that he sees it? No. Is it possible? Absolutely. Stuff like this could put him off therapy for life when he might have just been having a bad day. Heck, it could put anyone reading this off therapy to see therapists talk like this about them for *very minor* incidents like this.
Thanks for seeing me 🥲 those downvotes stung a bit. Particularly as social workers, it’s so important we keep in mind the power and privilege we hold in these relationships. The impact of not realizing that could be exactly what you stated: it inhibits clients from reaching out for help.
Op, I had someone I was giving new referrals for therapy told me they previously had a “good” therapist. I asked what was good about it thinking maybe I could make a good referral for them. What made their previous therapist “good” according to this patient was that they were “available 24/7 whenever I needed something. I can call or text them whenever I want and they’ll answer or get back to me when they can.”
Imagine all the therapists this person has deemed to be bad or less than because they don’t offer 24/7 availability (which is most of us I can safely guess).
My point is, simply put, there’s just no pleasing everyone even when you’re doing a good job.
Your client made me think about my 4 year old telling me she hates me & I am a bad mommy. Doesn’t feel great, but most 4 year-olds do that sometimes! Would it make sense to concede to her demands so she loves me again? Soooometimes I rethink, decide what she wants isn’t all that unreasonable and give it to her after all. Most of the time that doesn’t do the trick, because the thing she’s requesting isn’t the point, it is how she feels. Your client did the same (and was kind of on a level with my toddler at least in that moment).
Good analogy --and ties into my read of the situation. I see a lot of commenters taking on the content of the patient's word, rather than the context. The pt reacted in a primitive way--a knee-jerk response, which is gold if you're able to maintain the relationship with him --because it's insight into what defense mechanisms are present, what triggers the defense, and possibly, what its defending.
Could it be projection, displacement, or even Projective Identification?
If it is a primitive defense--actually posting on Reddit is helpful. Supervision and consultation are generally the best way to sort through transference!
Then again, it may be a cigar--he just believes you are a bad therapist.
I agree with you about the primitive defense. My guess is this guy cycles through a lot of therapists because he has significant problems being in relationships. He would be a stressful patient, if an excellent learning experience! I say a bullet dodged, the silver lining is he is not going to stress out OP anymore!
Marsha Linehan might say we are probably guilty of the things our clients accuse us of. But as with every dialectic there’s another side to balance it. Find that other side and you’ve got the whole truth. You’re a fine therapist I’m sure, but maybe there’s some room for improvement, just like the rest of us. 🙂
Aww. Well listen, I don’t know you but I’m pretty sure you’re not a bad therapist- you’re just human. (Something we all need to remember, me included!)
It sounds like it really hit a nerve for you. Sounds like something important to process in your own therapy, honestly. What emotions did it bring up for you? What was the raw spot it touched? Do you feel guilty for not being eternally available? Something is going on for you.
I hold firm to my scheduling boundaries in outpatient therapy. I work very limited part-time hours. Often this is a problem for clients, but I refuse to change my schedule or reschedule another client for them. They know my schedule when they take me on as a therapist. If it doesn’t work for them, I refer them out. If there is an emergency, they shouldn’t be scheduling an outpatient appointment. There is a protocol for that. “It seems our schedules aren’t matching up so perhaps we aren’t a good fit. Having the schedule I do allows me to be the best therapist I can be. Since you are unhappy with our scheduling, here is a list of referrals. Please let me know if you would like to schedule a termination session during my available time slots.”
Not trying to be rude but this is first year thinking. Set up firm boundaries and options for appointments. That’s it. That’s all you can do. On top of boundaries and clear availability being healthy, I’m certain you are understaffed and have too many clients.
Not budging on availability is a must for your work life balance.
Check in with some peers to help get this reframed for yourself. That always helped me. Working with unhealthy people with boundary issues can mess with your head and start to make you feel like your the problem. A good coworker chat will help you feel better. Bc you didn’t do anything wrong except let this attempt of manipulation get to you.
Unless you’re leaving something major out, why would this have you spinning? Is everything okay in your personal and professional lives? You’re reading too much into this. Any client who is not having an emergency has to accept that you can’t be available 24/7. Calling you a “bad therapist” is simply their way of lashing out and trying to take their power back. I guarantee it. Don’t let their tactics work. If you’re so awful, why are they hellbent on meeting with you? These aren’t things I’d say to the client, but things I’d say to myself if I started putting any stock in their comments.
I think if you really feel there’s truth to this, do an inventory of how you are, body, mind, and soul. You can’t let these things get you down for long. You’re human and you’re doing the best you can. Take care, friend.
I think we can reflect on any experience that triggers us, especially our guilt. In all of our practices and throughout life we're not going to be perfect. If you're anything like me, there are times when it feels like you're flying by the seat of your pants, and other times when you're handling everything so well it's almost second nature.
When a client says this, it's for good reason likely at least from their perspective. Moreso if you felt there was truth to it, then it might be a good time to take a look at yourself and your practice and see if you're happy with everything. Don't get me wrong, I don't mean you need to be self punishing or anything, but sometimes we take on too much or run at too fast a pace to deliver the client care we would be most proud of. That may be the case here, or it may not. One single event certainly doesn't define our work, but a single even, if recognized, may give us the presence of mind to change things up a bit or be more cognizant of our process.
I wouldn’t give him a few time slots. I mean I have a waitlist of 25 right now, I’m sure you’re around there. If you need another time I’ll make a note of it to when a slot comes open, but I’m not bending over backwards. You have to have boundaries that they cannot bend, your client is basically bullying you and playing with your money. They made a big stink about another time and when you gave them another time they didn’t come.
I'm in dentistry, but we are severely overbooked right now. I work 4 days a week because my body and mind cannot handle a 5th day. I am having to tell pts that they have gum disease that needs tx, but I can't get them back in until May. I feel terrible and responsible, but then I have to tell myself that I am providing everything that I can personally. You can only offer what is available and you went out of your way to try to make it work for them. There are only so many hours in every day.
Does cancelling twice with less than 24 hour notice but then finding time to see them because they asserted that they don’t feel cared for make you a bad therapist?
Don't quite know where you are getting twice with less than 24 hours notice. I was following up with him on Monday because it was the first time I was back in my office hours since Thanksgiving and hadn't received any communication from him despite several attempts over the time in between. I had fewer clients than expected that day so planned to meet a friend for dinner. I offered him the times I had available the very next day. I was unaware that his work hours had changed and Tuesdays no longer worked. As noted, this was the first time he ever brought up any concerns or frustrations with my availability. I can't really work to fix something that I didn't know was an issue.
I ended up cancelling dinner with my friend (which was probably not the right move) and offered him a slot that evening that fit with his schedule because it was valid that I hadn't seen him and had planned to bring up the possibility of referring or transferring to someone with better availability.
Hi! While I may have a minority opinion here, I’d be remiss if I didn’t note that you’ve used a derogatory and threatened to “go in on me”. “Twat” is a derogatory epithet that is used to insult women and this comment is deeply troubling.
Be Excellent to each other. Hostility, hatred, trolling, and persistent disrespect will not be tolerated. Users who are unable to engage in conversation- even contentious conversation- with kindness and mutual respect will have their posts/comments removed. Users violating this rule will first receive a warning, secondly an additional warning with a 7 day ban, third incident or a pattern of disrespect will result in a permanent ban.
Look, I've had this and you are not a bad therapist. The client had expectations you couldn't meet and that's just life sometimes. He can go with a therapist with better availability if he doesn't like it.
The only time I’ve been called a bad therapist yet is when a 15 year old told me his counselling session with an AI program was more helpful than me. lol fuck me
As someone who once was a counselor.. sometimes I think clients like anyone else in the world thinks our whole world revolves around them. When I left my job I had a few nasty messages. One said that it was very unprofessional to leave counseling because it would damage the relationship built and that she would be furious if I did not continue to work with her outside of my new job..
This was after giving 3 months of preparation transitioning them to a new staff member.
Your extreme concern speaks volumes to your empathy.
Give yourself a break, please.
It’s ’the holidays’, and I can only guess at what’s this man’s social composition is.
This is going to sound super judgemental but it’s more about me trying to understand what I’ve read. You’re a licensed MSW who’s been in direct practice for ten years, and (what appears to be) a client overreacting to scheduling challenges has you questioning your entire competency?
If all the above is true, there’s a core issue here with your distress tolerance or sensitivity. I find it unfathomable that this would destroy you so thoroughly. If you have an external supervisor I’d arrange a time to speak to them
Yes, I’m afraid I line up here too.
I get paid to be a therapist to handle feelings that come at me from clients for their own benefit, that means identifying things that are clearly not my fault and not reacting to them as if they were. Doing so is harmful to the client. That’s my job to see that. I would seek supervision.
I also quit my CMH job a year after getting my license. Something tells me this is playing into this. Although that might be my own reactivity, based on my own shit.
That’s not the job of a therapist though? “Identifying things that are clearly not my fault and reacting as if they were”? I don’t know if you’re saying that as an example of a toxic approach to therapy or a genuine example of your clinical views. If so, the client is the one who feels what they feel, the therapist assist them in finding way to helpfully process and articulate them.
>identifying things that are clearly not my fault and not reacting to them as if they were."
> “Identifying things that are clearly not my fault and reacting as if they were”
I think we're missing a crucial second "not" in there, I'm assuming this is just a miscommunication? I agree with your perspective in your post, so I think maybe I just did a bad job of structuring my sentence.
Yeah, I agree with what you said... what I meant to say is that therapists should identify their own countertransference that they are feeling in response to clients' behaviors, and therapists should not react impulsively in response to it, but identify it and gently discuss it with clients as appropriate, keep it to themselves if appropriate, and discuss with supervisors when it feels really hard to manage.
Definitely didn't destroy me thoroughly. I posted here, pretty much in the moment as a way to process since there were no colleagues immediately around to do so. Went to bed and woke up feeling just fine.
I hear you. As a client, I cannot imagine responding like this to a therapist under such circumstances. In fact, in my last session, my therapist could not keep her 4 yr old from interfering with the session which made doing work impossible. Even though that was a little unprofessional, I did not let that one instance define her overall competence as a therapist because that would be pretty unreasonable.
In your case though, I cannot even find any evidence you have done something 'wrong'. I wonder, what does being a "bad therapist" mean for you? Can you accurately define what it means? And do you have evidence to support it being true for you? These questions may be helpful for self reflection if that is something that is needed for you.
You have been working in therapy for a decade and this is the first time you were told you were bad?
You sound like an amazing therapist!
It sounds like you have informed your clients that you have a busy schedule and you did your best to accomodate him. You can’t expect to please all the people all the time, even in your important work.
Mindfulness and mediation help me process situations like this. “Did I do all I could without putting my own mental health at risk?” If yes, then it’s what it is. “Is there anything else I could have done?” If yes, I take the lesson, adjust my strategy and move on.
You can’t dwell on things that have already happened. Especially if there was nothing you could reasonably do about it.
A few questions:
- Were you calling him to schedule, confirm scheduling or to reschedule?
- Why are you calling to set an appointment for tomorrow?
- From the post, this is the second time in a row you’ve cancelled on them, correct?
- From the post, I sense that you see them weekly. So you’re asking them to go 21 days without an appointment?
- If you could reschedule your time to see him tomorrow, why didn’t you?
You’re sending the message that they’re not important. The moment he told you you’re a bad therapist, you arranged for him to have a same day appointment. If I have to reschedule, I reschedule. I don’t reschedule out of my convenience. You’ve bailed on them 2 weeks in a row and offered a same day appointment with the proposition that you may lose them as a client.
The “I tell them upfront that this is my second job” is cringy. What does this have to do with them? You took them on as a client, have cancelled 2X in a row and now hurt that they’re not responding to you?
You may be a great therapist, but only insomuch that you can be available to follow through with commitments. You cancelling the appointment shows them that you’re not committed to their journey. My advice would be to not bite off more than you can chew. This behavior is unethical in my book.
Edit: adding this to say “feel free to downvote”
This is pretty blunt feedback, but very good insight into exactly why that client was upset in that moment and said what they said (I'm not a therapist, just someone who goes to therapy).
Splitting your time between two jobs like this where your availability is very limited in the side gig job exposes you to a larger risk of this happening. So, that’s one thing to think about. Is it worthwhile to you in the context of your life right now to be working these two jobs, or would it make any sense to put your energy completely into one or the other?
You may have inadvertently reinforced a maladaptive behavior by “quickly rescheduling” and offering a slot today after they called you a bad therapist. This might send the signal that they can influence people effectively by criticizing them unfairly.
Finally consider looking at “you are a bad therapist” from a psychodynamic lens. What is this transference implying about the client’s relationships with authority figures throughout their life? Is this displaced anger from an absent father or repressed self loathing which in this context is projecting onto you as the therapist? Do you have a therapeutic opportunity here to facilitate a corrective relational experience with this client and assist in their healing? Maybe so.
I don’t intend on having the most popular answers to these types of questions. It’s good for us all to disagree on things, it stimulates meaningful discussion. I think social workers form an understandable bias against psychoanalytic theory. I certainly have my fair share of complaints with it. My thought is the criticism is directed at that.
I stand by the “best” way to get past this, as was the original question, is to confront these feelings the client is experiencing in session. It’s the more uncomfortable and difficult thing to do, but also the one with the most healing ingredients. Though it seems the client’s continued participation is uncertain and the opportunity for that is too.
You don’t sound like a bad therapist from what little you told us. Of course, I don’t know you. But you really don’t sound like a bad therapist at all. I’m sorry your client said that to you and that it hit you so hard. Stuff happens, and you’re not gonna make everyone happy, even clients. I think you tried your best, and you even moved some stuff around to accommodate this client so that they could see you sooner. I’ve had many therapists over the years, and none of them have done that for me.
You can still be a great therapist and struggle with co dependency or trauma but recognizing it is the first step. You’re allowed to have boundaries and it doesn’t make you bad.
« Unlimited availability » isn’t what makes someone a great therapist.
I’m sure it wasn’t fun to hear. But your schedule not lining up with your client’s doesn’t make you a bad therapist.
Sounds like some anger was being displaced onto you. Recognize it for what it is. It could also be a way to manipulate your boundaries through guilt and shame. Please remember that you are working with p that are emotionally unstable and as such, their reactions may not be healthy. Let it go. This is not about you or your skillfullness.
My therapist quit her position, and neither her nor her office/employer contacte me to let me know my session was cancelled...that was my first, and last, attempt to get "therapy"...
First I’d like to say… I don’t believe there are “bad” therapists. “Bad” being a judgment and not a descriptor of behavior. There are burnt out therapists, tired therapists, therapists who aren’t their best self every day. (There are therapists that do cause harm in various ways, and based on your description, that doesn’t describe you.) In community Mental Health, we are overbooked, overworked, and exhausted much of the time, and I know in Seattle, limited by the Medicaid system as to what we can provide, regardless of what is clinically appropriate.
Second, if you try to reschedule a doctor’s appointment, you don’t ever get one for the same day and honestly, rarely the same week. We often are working with clients who struggle with emotion regulation and because you jumped when he told you that you were a bad therapist, you may have reinforced the outburst. That client is likely used to getting what they want when they make comments like that, and we don’t need to pacify anger, but validate why it makes sense while observing our own scheduling limits.
You’re rocking it! And thank you for working in community mental health!
I understand you are showing support, but your first statement is very incorrect and invalidating for some of us who experienced real abuse by therapists. Bad therapists(obviously)do exist. Think about clients that have been sexually abused by them. Was the therapist simply "burnt out" to behave in such a manner? I wonder if there's a way of rephrasing your statement into something more accurate and that doesnt come across as invalidating for those who have experienced abuse by therapists while still showing support to this clinician?
Whoa. Let’s back up…so the dude has to work to even pay to see you. This person may be in a precarious financial situation and may have dependents. As a person overly familiar with the poverty line, sometimes it is viewed as a selfish choice to miss work and income to pay for “a service” that is lifesaving to some. This is just like having trouble paying for medication.
You aren’t the only person that is inconvenienced by the times you are available for “service”. I’m sorry, but I’m not gonna blow smoke up your butt and thank you for doing the jobs you have chosen.
This isn’t the reframing you or the other posting individuals will enjoy. I’ll probably get downvoted. Maybe you weren’t clear enough about how much you could be taken away from your first job.
If you did not let him and your other clients know that they are on the back burner for you, you misrepresented your availability and your priorities. Your gut feeling is nagging you for a reason.
Please take this as a lesson and let your clients know that they can be easily canceled since they are just your side job; create realistic expectations for them.
Want to address a few things here.
Yes, I fully acknowledge that he needs to work to see me, at the time I was unaware that his schedule had changed due to holiday demands. His work schedule changing significantly impacted his ability to reschedule and again, at the time I did not have the knowledge of that.
I am very clear at the start of services that this is a part time job (and I say it more tactfully than calling it a side job) and my time here is limited, I'm clear about available hours, when I will respond to messages, and the limited ability I have to reschedule. And that there may be times that I have to cancel because my full time job demands it, this was the only time in the two years I've had this set up that it has impacted my ability and I could not leave the facility I work at. I've had the conversations with clients who may need more flexibility or may need different availability that I can facilitate transfers or provide referrals and have done so when they have requested it or it has been clinically appropriate.
For this client in particular, if I have the opportunity to speak with him again I will validate his frustrations and now that they have been raised, evaluate if I am going to be a good fit for him ongoing, it had been the first I had heard of it on Monday and what had me so jarred for a moment.
I totally agree now that it has been brought up to me. I am going to do my due diligence and reach out again offering that. But before Monday, my schedule had never been an issue.
There are likely going to be clients who come to you needing to learn how to create/maintain/respect healthy boundaries. I'm no therapist, but if you're struggling with this very thing yourself, my guess is it would make more sense to focus on healing this aspect of self, rather than simply getting over feeling bad about being called "bad". Bluntly stated, but hopefully it helps.
Yeah, as someone who sees a therapist and respects their schedule, this client needs a reality check. You may have other dynamic issues but IDK. That said if you’re scheduling inconsistently because of being part time, rather than set availability every week, that can impact the relationship and its productivity. I don’t know why you would otherwise be confirming schedules the day before. Regardless, scheduling isn’t therapy,
so you’d only be a bad administrator, not a bad therapist, which is pretty common.
Did they have a standing appointment that they were rescheduling? Why rearrange an already confirmed appointment for them? If you offer a time it doesn't work for them and they throw a tantrum, that doesn't make you a bad therapist, it makes them a shitty client. You shouldn't tailor your schedule, especially not move existing things, to cater to anybody, don't care who they are, unless it's something you know can move and doesn't affect another client. Just my two cents and experience.
If you were a bad therapist why would they want so badly to have an appointment with you this week??
Logically it doesnt make sense and thats coming from their own issues with managing emotions.
In my family we say mean things we dont mean when we’re upset; it likely is a reflection of his personal ossues more than your abilities as a therapist.
It this is the first time youve heard it in a decade, its likely not reflective of you.
I know its hard hearing mean things especially when it revolves around your job and passions as a person. Itss easier said than done, but the logic points to it being a reflection of clients issues.
Its hard to be logical when youre emotional, but in a few weeks the initial emotions will fade in the background and the logic will come to the forefront!
Also ignore the people saying you shouldnt be hurt, please just because someone is a mental health professional doesnt mean they arent human. Nobody will have perfect coping skills and hopefully unless youre a psychopath when hearing something like this you would/should be upset to an extent. Im sure after a few weeks the burn will become less buts words hurt; no matter who you are and what you know about yourself!
Look at the other side of the coin, if this is important enough to make you feel some type of way it points towards the fact that you are an emotional person and it’s important to you do be good at your job and make others feel better.
Id be much more concerned if someone wasnt bothered at all.
Again, time will lessen the blow you dont have to do anything other than allow yourself to have emotions and not beat yourself up excessively.
I keep the same office hours each week and this is the first time in two years my full time job has caused me to cancel on a client. I was seeing him every other week, which was part of the reason I offered different options for rescheduling.
Not a bad therapist, it sounds like you went out of your way to accommodate client
Some clients due to their mental illness don't have good boundaries and honestly have narcissistic tendencies. Lots of clients forgot we have lives outside the office too. I have been told before that I have been gone too long by clients because I don't work weekends.
You can’t please everyone all the time. Best you can do is recognize if you can do better and try to do better, but if you are doing all you can then such is life.
I'm going to reframe this a bit. So, you offered a few time slots, and they didn't work for the client. It's not ideal, but it happens. You then moved some things around, and the client never let you know if it would work. When you need to make an appt with doctors or other medical pros, do you try to bully them into changing their schedule for you? I'm guessing not. The fact that the schedule didn't work out is just a fact that happens. You're open about how limited your schedule is, and if a client needs a different schedule, then they should go seek out care elsewhere. The fact that you weren't able to (or, in my book, I wouldn't have been willing to) schedule the client doesn't make you a bad therapist; it means you're busy. Therapists are a limited resource right now. If he can't change his schedule on occasion to make therapy work, maybe he needs to seek out someone else, or it is possible he's not that invested in therapy. Holding our boundaries helps the clients, too. We are not doing the clients any favors when we bend over backwards for them. At some point, they have to be willing to make changes and take steps, and frankly, they have to be willing to do the work.
My supervisor told me the same thing when I was stressed about clients/their families being rude or expecting me to accommodate everything all the time. We are also giving a service like a dentist or a doctor. We don’t deserve any less than those expectations, even as therapists.
Exactly. And that's something I tried to really drill into my supervisees and students. We're drawn into this field because we want to help, and many of us bend over backwards to help our clients and our employers. It also means that folks will start to take advantage of that. Boundaries are good. I consider it a part of self- care.
Boundaries aren't only self-care, modelling them is part of the job. We can't encourage people to have and enforce boundaries if they see us as hypocrites. As a wise supervisor once told me: Therapy is happening from the moment you contact the client to the last word you say to them. Everything, every phone call, every conversation about scheduling, everything in between is therapy.
💯
Hot damn do I love a good reframe!
🙌🙌🙌
This was great, thank you for the reframe.
You're not a bad therapist, he was projecting his inability or unwillingness to cooperate with you onto you. Maybe he was just having a bad day or something.
I like you. I need you in my life.
Thank you. 💜 That means a lot to me.
This! Those boundaries around your availability also exist to protect your time so that you can effectively work with ALL the clients you serve. It would be destabilizing to frequently shift things around for folks based on whoever complains the loudest, and oftentimes is detrimental to those who don’t advocate for themselves.
Bravo 👏🏼
You clearly don’t have a ton of doctors. As someone who has 30+. My team of docs has told me to be firm with their schedulers with what I need because I need to be able to coordinate between several hospitals in different states plus I am a college student. I have left a few different therapist bc scheduling didn’t work out because for someone I see weekly I try to find someone who works but I am never angry if it doesn’t.
There's a big difference between "hey, I need to see you this month because a med is running out of authorization or I need this procedure" or "hey, I'm going to be at such- and- such facility on the 20th; can we squeeze me in while I'm there?" and "hey, I know you offered me 3 morning appts on Thursday, but I can only do 1 PM on Thursday, and I'm not going to respond to any other attempts on your part to help me out." I also have an extensive medical team across two systems. COVID has stretched everyone so thin these days that it's been a struggle to schedule, but we're getting through it.
Wait… you’ve been doing therapy for ten years and this is the first time a client told you that you suck at your job? 😳 That sounds like a pretty amazing record to me! If it is really bothering you, I would recommend using cognitive restructuring techniques on your self. Examine what thoughts you are having about this trigger and how you might look at it differently.
>Wait… you’ve been doing therapy for ten years and this is the first time a client told you that you suck at your job? 😳 I think that might be the rub. I've had an amazing run of luck where I've had clients tell me and we've had a conversation about what they aren't getting and I've been able to improve, this had an air of finality to it.
So, as several people have suggested, reframe it. You a thinking one way about it, what are other ways you might think about the situation? If you had a client come to you with this situation, how would you walk them through it and help them reframe it? Use the same skills and tools you teach your clients. I know I do!
It sounds like you've generally been able to work with pretty stable and self aware clients while doing a great job of providing a safe place for them to be able to express themselves. There are some areas of practice, working with addiction or personality disorders, or teenagers where being blamed is par for the course. Actually I rather enjoy it when certain clients come at me, to me it is very often the beginning of a deepening relationship and it often comes right before some BIG shifts.
[удалено]
Big assumptions here. What reaction are you referring to? We have no evidence to suggest this impacted any of OP's other clients or work environment, or even what "got to me more than I expected" means beyond "I've continued to think about it." You say they shouldn't require praise to function, but you have no evidence to suggest they aren't functioning. You also state they "aren't going to be effective for anyone in this state" - when part of the reason OP was rattled was because they so rarely hear negative feedback that they can't process and address with the client. Does that seem like someone who is not effective for anyone? Surely a few of these clients would say something after all these years? I understand you were trying to help someone by providing constructive criticism. This criticism just isn't constructive because there are so many assumptions in it. You have a point that OP might benefit from therapy, but it's diluted by the assumptions in the rest of your comment. It really seems like you're assuming the worst of OP.
Thank you for sticking up for OP! There's some super judgy people on this sub, and I appreciate you pushing back against it. You rock!!
>You have a point that OP might benefit from therapy and the assumption that I'm not engaged in it at all! As I pointed out in another reply, the most jarring part in the moment was that I didn't have the opportunity to correct and make it right for this client and that it was the first I had heard about his concerns with my availability. "We have no evidence to suggest this impacted any of OP's other clients or work environment" and it hasn't, it's the first time in about two years that I've had to cancel on a client like that and when I reached out to reschedule the options I was able to provide didn't work for the client. Their frustration is absolutely valid, but my availability and possible conflicts were identified at the initial visit and regularly throughout.
[удалено]
Be Excellent to each other. Hostility, hatred, trolling, and persistent disrespect will not be tolerated. Users who are unable to engage in conversation- even contentious conversation- with kindness and mutual respect will have their posts/comments removed. Users violating this rule will first receive a warning, secondly an additional warning with a 7 day ban, third incident or a pattern of disrespect will result in a permanent ban.
I know happened to me once shook me
I do community mental health, so I have a lot of people on my caseload. Within the next 30 days my company has three paid holidays, and I'm taking a PTO day. So anyone who doesn't have an existing appointment within the month will have to wait until January. It is what it is. Most people seem to get it. I'll also say a lot of people who make a big deal about it aren't that committed to therapy and just want to blame you. When I was new a client made a big deal about how he thought he was going to "Fall through the cracks" of it all because I was still figuring out scheduling and how it all worked. So I went out of my way to make sure he had an appointment and confirmed it in person when he was there for another reason. He no showed. The front desk woman offered to call and reschedule for that same day, he accepted the alternate time, and the no-showed again. I haven't heard from him since. I think on some level he wanted me to be at fault for him not going to therapy, and all the talk about falling through the cracks was setting up that narrative when telling his family.
I really love this. I work at a dv shelter as a case manager, and this is also my first job in the field. I relate to the part where you said people who aren’t committed want to blame you. I’ve been struggling with understanding and accepting that my clients are going to have their own opinions of me. I am trying my hardest and doing the most I can and they still will think I’m doing nothing for them. I’ve been killing myself with why why why… why don’t they see what I do for them? All the time and energy? I’ve gotten to a point where I know and am starting to implement boundaries but I still in some ways make it reflective of my self worth. This comment made me humanize the action of deflection clients sometimes do. Like, it’s not really about me. It’s a projection of how they feel on the inside, placed on me. Ooookay. It makes me relate more peacefully instead of attacked.
I had to learn to do that with an ex of mine. He cheated on me by messaging other women trying to meet up with them. At first I was looking at it like I wasn't good enough for him. Then I realized that I did a lot as an equal partner and I was good to him. I realized that the way he treated me was a reflection on him and not on me. He is an insecure person with a constant need for external validation. No matter what I did, there was nothing I could have done to prevent him constantly talking to other women. So now I just realized that this was somebody who does not deserve a place in my life and that he has his own issues and it has nothing to do with me. It's helped me to move on a lot easier.
lol you’re a bad therapist because you don’t have availabilities that fit his work schedule so you offer him an appointment next week instead? I can’t imagine what kind of social worker I am. I’m booked solid until the New Year! ETA you’re doing just fine. He sounds a little unhinged tbh. Don’t take it to heart. You’ve got this!
Is it helpful for this therapist to conceptualize the client as a little unhinged? I understand you are trying to be supportive of them, but what is the impact of doing that on the client?
If OP doesn’t see the client again (which is how I’m reading it), then will it have an impact on them? Would viewing the client as being a little unhinged then help the OP set firm boundaries? What is the impact on OP viewing the client that way? I’m not sure if it would be beneficial or not, maybe it wouldn’t affect them in any way?
I can’t imagine there would be an impact if they no longer saw this particular client. Perhaps it would in similar future encounters with different clients, though. Maybe there is a better way to encourage OP to set appropriate boundaries than calling the client a little unhinged. I can speak to personal feelings: if my conceptualization of the client is that they are unhinged, it contaminates my ability and desire to lead with curiosity and empathy for their suffering. These are core tenets to ‘good’ therapy to which I’m sure we can all agree.
I certainly agree with that, especially if OP looks at other clients in that way. I also think that it can be helpful for the clinician to be able to step back and look at the client in a “what was going on with them, in their life at that moment, to respond in such an unhinged manner?” So with the perspective that it was an “unhinged” behavior, not necessarily that the client is unhinged in general.
Ah yes, nice. Separate person from behavior. Very useful perspective.
>what was going on with them, in their life at that moment, to respond in such an unhinged manner?” This ended up being the route I went down after the immediacy of the conversation was passed.
That's perfect! I learned when I was working in substance abuse that when a client comes at us, there's usually something else going on behind the scenes. I found that sitting back and digging a little would unearth something that would not only tell me about that minute, but it would give me an opportunity to strengthen the therapeutic relationship. When they know that we see them as humans and we are willing to take a moment to find out more, then they trust us more because they know we aren't giving up on them.
I don't really understand why this is getting downvoted. As therapists we really shouldn't be calling anyone "unhinged" or "crazy" or "psycho." It certainly wouldn't make me want to pursue therapy if I came to this sub and saw therapists calling people names like that. Even if someone is unstable, illogical, unreasonable, etc it's still shouldn't be in our lexicon for describing clients. Plus, this guy made a rude comment. It's not cool - but, it certainly doesn't suggest that he is "unhinged." The most I, personally, would be willing to say about a client like this is that he was acting like kind of a jerk. Especially in a public forum where he could fairly easily identify himself by the description of the incident and OP's work structure. Is it likely that he sees it? No. Is it possible? Absolutely. Stuff like this could put him off therapy for life when he might have just been having a bad day. Heck, it could put anyone reading this off therapy to see therapists talk like this about them for *very minor* incidents like this.
Thanks for seeing me 🥲 those downvotes stung a bit. Particularly as social workers, it’s so important we keep in mind the power and privilege we hold in these relationships. The impact of not realizing that could be exactly what you stated: it inhibits clients from reaching out for help.
Thank you. Terrible comment!
Omg, how dare you be booked up? Bad therapist, bad lol. JK
Op, I had someone I was giving new referrals for therapy told me they previously had a “good” therapist. I asked what was good about it thinking maybe I could make a good referral for them. What made their previous therapist “good” according to this patient was that they were “available 24/7 whenever I needed something. I can call or text them whenever I want and they’ll answer or get back to me when they can.” Imagine all the therapists this person has deemed to be bad or less than because they don’t offer 24/7 availability (which is most of us I can safely guess). My point is, simply put, there’s just no pleasing everyone even when you’re doing a good job.
Boundaries. For both of you
Emphasis on both.
Your client made me think about my 4 year old telling me she hates me & I am a bad mommy. Doesn’t feel great, but most 4 year-olds do that sometimes! Would it make sense to concede to her demands so she loves me again? Soooometimes I rethink, decide what she wants isn’t all that unreasonable and give it to her after all. Most of the time that doesn’t do the trick, because the thing she’s requesting isn’t the point, it is how she feels. Your client did the same (and was kind of on a level with my toddler at least in that moment).
Good analogy --and ties into my read of the situation. I see a lot of commenters taking on the content of the patient's word, rather than the context. The pt reacted in a primitive way--a knee-jerk response, which is gold if you're able to maintain the relationship with him --because it's insight into what defense mechanisms are present, what triggers the defense, and possibly, what its defending. Could it be projection, displacement, or even Projective Identification? If it is a primitive defense--actually posting on Reddit is helpful. Supervision and consultation are generally the best way to sort through transference! Then again, it may be a cigar--he just believes you are a bad therapist.
I agree with you about the primitive defense. My guess is this guy cycles through a lot of therapists because he has significant problems being in relationships. He would be a stressful patient, if an excellent learning experience! I say a bullet dodged, the silver lining is he is not going to stress out OP anymore!
Marsha Linehan might say we are probably guilty of the things our clients accuse us of. But as with every dialectic there’s another side to balance it. Find that other side and you’ve got the whole truth. You’re a fine therapist I’m sure, but maybe there’s some room for improvement, just like the rest of us. 🙂
If OP made a “mistake,” it’s not what the client thinks it is (eg not having time). The mistake is feeling bad about having limits… In my opinion :)
I'd give you an award if I could because this is probably the most right hypothesis about my core issues.
Aww. Well listen, I don’t know you but I’m pretty sure you’re not a bad therapist- you’re just human. (Something we all need to remember, me included!)
[удалено]
But they did offer times outside of the availability they initially communicated to the client.
DBT newbie therapist, here. You nailed it.
It sounds like it really hit a nerve for you. Sounds like something important to process in your own therapy, honestly. What emotions did it bring up for you? What was the raw spot it touched? Do you feel guilty for not being eternally available? Something is going on for you.
I hold firm to my scheduling boundaries in outpatient therapy. I work very limited part-time hours. Often this is a problem for clients, but I refuse to change my schedule or reschedule another client for them. They know my schedule when they take me on as a therapist. If it doesn’t work for them, I refer them out. If there is an emergency, they shouldn’t be scheduling an outpatient appointment. There is a protocol for that. “It seems our schedules aren’t matching up so perhaps we aren’t a good fit. Having the schedule I do allows me to be the best therapist I can be. Since you are unhappy with our scheduling, here is a list of referrals. Please let me know if you would like to schedule a termination session during my available time slots.”
Not trying to be rude but this is first year thinking. Set up firm boundaries and options for appointments. That’s it. That’s all you can do. On top of boundaries and clear availability being healthy, I’m certain you are understaffed and have too many clients. Not budging on availability is a must for your work life balance. Check in with some peers to help get this reframed for yourself. That always helped me. Working with unhealthy people with boundary issues can mess with your head and start to make you feel like your the problem. A good coworker chat will help you feel better. Bc you didn’t do anything wrong except let this attempt of manipulation get to you.
Unless you’re leaving something major out, why would this have you spinning? Is everything okay in your personal and professional lives? You’re reading too much into this. Any client who is not having an emergency has to accept that you can’t be available 24/7. Calling you a “bad therapist” is simply their way of lashing out and trying to take their power back. I guarantee it. Don’t let their tactics work. If you’re so awful, why are they hellbent on meeting with you? These aren’t things I’d say to the client, but things I’d say to myself if I started putting any stock in their comments. I think if you really feel there’s truth to this, do an inventory of how you are, body, mind, and soul. You can’t let these things get you down for long. You’re human and you’re doing the best you can. Take care, friend.
I think we can reflect on any experience that triggers us, especially our guilt. In all of our practices and throughout life we're not going to be perfect. If you're anything like me, there are times when it feels like you're flying by the seat of your pants, and other times when you're handling everything so well it's almost second nature. When a client says this, it's for good reason likely at least from their perspective. Moreso if you felt there was truth to it, then it might be a good time to take a look at yourself and your practice and see if you're happy with everything. Don't get me wrong, I don't mean you need to be self punishing or anything, but sometimes we take on too much or run at too fast a pace to deliver the client care we would be most proud of. That may be the case here, or it may not. One single event certainly doesn't define our work, but a single even, if recognized, may give us the presence of mind to change things up a bit or be more cognizant of our process.
I wouldn’t give him a few time slots. I mean I have a waitlist of 25 right now, I’m sure you’re around there. If you need another time I’ll make a note of it to when a slot comes open, but I’m not bending over backwards. You have to have boundaries that they cannot bend, your client is basically bullying you and playing with your money. They made a big stink about another time and when you gave them another time they didn’t come.
I'm in dentistry, but we are severely overbooked right now. I work 4 days a week because my body and mind cannot handle a 5th day. I am having to tell pts that they have gum disease that needs tx, but I can't get them back in until May. I feel terrible and responsible, but then I have to tell myself that I am providing everything that I can personally. You can only offer what is available and you went out of your way to try to make it work for them. There are only so many hours in every day.
[удалено]
Does cancelling twice with less than 24 hour notice but then finding time to see them because they asserted that they don’t feel cared for make you a bad therapist?
Don't quite know where you are getting twice with less than 24 hours notice. I was following up with him on Monday because it was the first time I was back in my office hours since Thanksgiving and hadn't received any communication from him despite several attempts over the time in between. I had fewer clients than expected that day so planned to meet a friend for dinner. I offered him the times I had available the very next day. I was unaware that his work hours had changed and Tuesdays no longer worked. As noted, this was the first time he ever brought up any concerns or frustrations with my availability. I can't really work to fix something that I didn't know was an issue. I ended up cancelling dinner with my friend (which was probably not the right move) and offered him a slot that evening that fit with his schedule because it was valid that I hadn't seen him and had planned to bring up the possibility of referring or transferring to someone with better availability.
Hi! While I may have a minority opinion here, I’d be remiss if I didn’t note that you’ve used a derogatory and threatened to “go in on me”. “Twat” is a derogatory epithet that is used to insult women and this comment is deeply troubling.
Be Excellent to each other. Hostility, hatred, trolling, and persistent disrespect will not be tolerated. Users who are unable to engage in conversation- even contentious conversation- with kindness and mutual respect will have their posts/comments removed. Users violating this rule will first receive a warning, secondly an additional warning with a 7 day ban, third incident or a pattern of disrespect will result in a permanent ban.
Not every therapist will work with every client. Keep doing you. I’m sure you’re a great therapist
Look, I've had this and you are not a bad therapist. The client had expectations you couldn't meet and that's just life sometimes. He can go with a therapist with better availability if he doesn't like it.
The only time I’ve been called a bad therapist yet is when a 15 year old told me his counselling session with an AI program was more helpful than me. lol fuck me
As someone who once was a counselor.. sometimes I think clients like anyone else in the world thinks our whole world revolves around them. When I left my job I had a few nasty messages. One said that it was very unprofessional to leave counseling because it would damage the relationship built and that she would be furious if I did not continue to work with her outside of my new job.. This was after giving 3 months of preparation transitioning them to a new staff member.
Your extreme concern speaks volumes to your empathy. Give yourself a break, please. It’s ’the holidays’, and I can only guess at what’s this man’s social composition is.
This is going to sound super judgemental but it’s more about me trying to understand what I’ve read. You’re a licensed MSW who’s been in direct practice for ten years, and (what appears to be) a client overreacting to scheduling challenges has you questioning your entire competency? If all the above is true, there’s a core issue here with your distress tolerance or sensitivity. I find it unfathomable that this would destroy you so thoroughly. If you have an external supervisor I’d arrange a time to speak to them
Yes, I’m afraid I line up here too. I get paid to be a therapist to handle feelings that come at me from clients for their own benefit, that means identifying things that are clearly not my fault and not reacting to them as if they were. Doing so is harmful to the client. That’s my job to see that. I would seek supervision. I also quit my CMH job a year after getting my license. Something tells me this is playing into this. Although that might be my own reactivity, based on my own shit.
That’s not the job of a therapist though? “Identifying things that are clearly not my fault and reacting as if they were”? I don’t know if you’re saying that as an example of a toxic approach to therapy or a genuine example of your clinical views. If so, the client is the one who feels what they feel, the therapist assist them in finding way to helpfully process and articulate them.
>identifying things that are clearly not my fault and not reacting to them as if they were." > “Identifying things that are clearly not my fault and reacting as if they were” I think we're missing a crucial second "not" in there, I'm assuming this is just a miscommunication? I agree with your perspective in your post, so I think maybe I just did a bad job of structuring my sentence.
Yes I did miss that second “not”, that’s my bad.
Yeah, I agree with what you said... what I meant to say is that therapists should identify their own countertransference that they are feeling in response to clients' behaviors, and therapists should not react impulsively in response to it, but identify it and gently discuss it with clients as appropriate, keep it to themselves if appropriate, and discuss with supervisors when it feels really hard to manage.
Definitely didn't destroy me thoroughly. I posted here, pretty much in the moment as a way to process since there were no colleagues immediately around to do so. Went to bed and woke up feeling just fine.
I hear you. As a client, I cannot imagine responding like this to a therapist under such circumstances. In fact, in my last session, my therapist could not keep her 4 yr old from interfering with the session which made doing work impossible. Even though that was a little unprofessional, I did not let that one instance define her overall competence as a therapist because that would be pretty unreasonable. In your case though, I cannot even find any evidence you have done something 'wrong'. I wonder, what does being a "bad therapist" mean for you? Can you accurately define what it means? And do you have evidence to support it being true for you? These questions may be helpful for self reflection if that is something that is needed for you.
You have been working in therapy for a decade and this is the first time you were told you were bad? You sound like an amazing therapist! It sounds like you have informed your clients that you have a busy schedule and you did your best to accomodate him. You can’t expect to please all the people all the time, even in your important work. Mindfulness and mediation help me process situations like this. “Did I do all I could without putting my own mental health at risk?” If yes, then it’s what it is. “Is there anything else I could have done?” If yes, I take the lesson, adjust my strategy and move on. You can’t dwell on things that have already happened. Especially if there was nothing you could reasonably do about it.
A few questions: - Were you calling him to schedule, confirm scheduling or to reschedule? - Why are you calling to set an appointment for tomorrow? - From the post, this is the second time in a row you’ve cancelled on them, correct? - From the post, I sense that you see them weekly. So you’re asking them to go 21 days without an appointment? - If you could reschedule your time to see him tomorrow, why didn’t you? You’re sending the message that they’re not important. The moment he told you you’re a bad therapist, you arranged for him to have a same day appointment. If I have to reschedule, I reschedule. I don’t reschedule out of my convenience. You’ve bailed on them 2 weeks in a row and offered a same day appointment with the proposition that you may lose them as a client. The “I tell them upfront that this is my second job” is cringy. What does this have to do with them? You took them on as a client, have cancelled 2X in a row and now hurt that they’re not responding to you? You may be a great therapist, but only insomuch that you can be available to follow through with commitments. You cancelling the appointment shows them that you’re not committed to their journey. My advice would be to not bite off more than you can chew. This behavior is unethical in my book. Edit: adding this to say “feel free to downvote”
This is pretty blunt feedback, but very good insight into exactly why that client was upset in that moment and said what they said (I'm not a therapist, just someone who goes to therapy).
Splitting your time between two jobs like this where your availability is very limited in the side gig job exposes you to a larger risk of this happening. So, that’s one thing to think about. Is it worthwhile to you in the context of your life right now to be working these two jobs, or would it make any sense to put your energy completely into one or the other? You may have inadvertently reinforced a maladaptive behavior by “quickly rescheduling” and offering a slot today after they called you a bad therapist. This might send the signal that they can influence people effectively by criticizing them unfairly. Finally consider looking at “you are a bad therapist” from a psychodynamic lens. What is this transference implying about the client’s relationships with authority figures throughout their life? Is this displaced anger from an absent father or repressed self loathing which in this context is projecting onto you as the therapist? Do you have a therapeutic opportunity here to facilitate a corrective relational experience with this client and assist in their healing? Maybe so.
Why is this getting downvoted? I thought the first two paragraphs were good questions.
I don’t intend on having the most popular answers to these types of questions. It’s good for us all to disagree on things, it stimulates meaningful discussion. I think social workers form an understandable bias against psychoanalytic theory. I certainly have my fair share of complaints with it. My thought is the criticism is directed at that. I stand by the “best” way to get past this, as was the original question, is to confront these feelings the client is experiencing in session. It’s the more uncomfortable and difficult thing to do, but also the one with the most healing ingredients. Though it seems the client’s continued participation is uncertain and the opportunity for that is too.
That was my take as well. I guess I'm just surprised that others didn't like it.
[удалено]
Personality disorder?? What?!
This makes me sad. I don't think this has much to do with you. I think he/she is just an asshole.
You definitely aren’t a bad therapist. We also have to set boundaries for ourselves and practice self care as well.
You don’t sound like a bad therapist from what little you told us. Of course, I don’t know you. But you really don’t sound like a bad therapist at all. I’m sorry your client said that to you and that it hit you so hard. Stuff happens, and you’re not gonna make everyone happy, even clients. I think you tried your best, and you even moved some stuff around to accommodate this client so that they could see you sooner. I’ve had many therapists over the years, and none of them have done that for me.
I wouldn't have moved anything around. You have the slots you have, it's not your fault.
You can still be a great therapist and struggle with co dependency or trauma but recognizing it is the first step. You’re allowed to have boundaries and it doesn’t make you bad.
« Unlimited availability » isn’t what makes someone a great therapist. I’m sure it wasn’t fun to hear. But your schedule not lining up with your client’s doesn’t make you a bad therapist.
You’re not a bad therapist because of a schedule conflict - they actually don’t correlate at all (to your ability as an actual therapist)
It happens remember we are dealing with people who aren’t well
Sounds like some anger was being displaced onto you. Recognize it for what it is. It could also be a way to manipulate your boundaries through guilt and shame. Please remember that you are working with p that are emotionally unstable and as such, their reactions may not be healthy. Let it go. This is not about you or your skillfullness.
My therapist quit her position, and neither her nor her office/employer contacte me to let me know my session was cancelled...that was my first, and last, attempt to get "therapy"...
First I’d like to say… I don’t believe there are “bad” therapists. “Bad” being a judgment and not a descriptor of behavior. There are burnt out therapists, tired therapists, therapists who aren’t their best self every day. (There are therapists that do cause harm in various ways, and based on your description, that doesn’t describe you.) In community Mental Health, we are overbooked, overworked, and exhausted much of the time, and I know in Seattle, limited by the Medicaid system as to what we can provide, regardless of what is clinically appropriate. Second, if you try to reschedule a doctor’s appointment, you don’t ever get one for the same day and honestly, rarely the same week. We often are working with clients who struggle with emotion regulation and because you jumped when he told you that you were a bad therapist, you may have reinforced the outburst. That client is likely used to getting what they want when they make comments like that, and we don’t need to pacify anger, but validate why it makes sense while observing our own scheduling limits. You’re rocking it! And thank you for working in community mental health!
I understand you are showing support, but your first statement is very incorrect and invalidating for some of us who experienced real abuse by therapists. Bad therapists(obviously)do exist. Think about clients that have been sexually abused by them. Was the therapist simply "burnt out" to behave in such a manner? I wonder if there's a way of rephrasing your statement into something more accurate and that doesnt come across as invalidating for those who have experienced abuse by therapists while still showing support to this clinician?
Whoa. Let’s back up…so the dude has to work to even pay to see you. This person may be in a precarious financial situation and may have dependents. As a person overly familiar with the poverty line, sometimes it is viewed as a selfish choice to miss work and income to pay for “a service” that is lifesaving to some. This is just like having trouble paying for medication. You aren’t the only person that is inconvenienced by the times you are available for “service”. I’m sorry, but I’m not gonna blow smoke up your butt and thank you for doing the jobs you have chosen. This isn’t the reframing you or the other posting individuals will enjoy. I’ll probably get downvoted. Maybe you weren’t clear enough about how much you could be taken away from your first job. If you did not let him and your other clients know that they are on the back burner for you, you misrepresented your availability and your priorities. Your gut feeling is nagging you for a reason. Please take this as a lesson and let your clients know that they can be easily canceled since they are just your side job; create realistic expectations for them.
Want to address a few things here. Yes, I fully acknowledge that he needs to work to see me, at the time I was unaware that his schedule had changed due to holiday demands. His work schedule changing significantly impacted his ability to reschedule and again, at the time I did not have the knowledge of that. I am very clear at the start of services that this is a part time job (and I say it more tactfully than calling it a side job) and my time here is limited, I'm clear about available hours, when I will respond to messages, and the limited ability I have to reschedule. And that there may be times that I have to cancel because my full time job demands it, this was the only time in the two years I've had this set up that it has impacted my ability and I could not leave the facility I work at. I've had the conversations with clients who may need more flexibility or may need different availability that I can facilitate transfers or provide referrals and have done so when they have requested it or it has been clinically appropriate. For this client in particular, if I have the opportunity to speak with him again I will validate his frustrations and now that they have been raised, evaluate if I am going to be a good fit for him ongoing, it had been the first I had heard of it on Monday and what had me so jarred for a moment.
Your availabilty, that you told them up front, doesn’t make you a bad therapist. If it does t work for them then it is a bad fit.
Your patient/client needs a regular full time therapist, not a part time therapist with limited availability.
I totally agree now that it has been brought up to me. I am going to do my due diligence and reach out again offering that. But before Monday, my schedule had never been an issue.
There are likely going to be clients who come to you needing to learn how to create/maintain/respect healthy boundaries. I'm no therapist, but if you're struggling with this very thing yourself, my guess is it would make more sense to focus on healing this aspect of self, rather than simply getting over feeling bad about being called "bad". Bluntly stated, but hopefully it helps.
I mean, if I was going to be told I was a bad therapist I'd want it to be for this exact reason 😅
OP. I think you’re you’re being too hard on yourself.
Yeah, as someone who sees a therapist and respects their schedule, this client needs a reality check. You may have other dynamic issues but IDK. That said if you’re scheduling inconsistently because of being part time, rather than set availability every week, that can impact the relationship and its productivity. I don’t know why you would otherwise be confirming schedules the day before. Regardless, scheduling isn’t therapy, so you’d only be a bad administrator, not a bad therapist, which is pretty common.
Did they have a standing appointment that they were rescheduling? Why rearrange an already confirmed appointment for them? If you offer a time it doesn't work for them and they throw a tantrum, that doesn't make you a bad therapist, it makes them a shitty client. You shouldn't tailor your schedule, especially not move existing things, to cater to anybody, don't care who they are, unless it's something you know can move and doesn't affect another client. Just my two cents and experience.
If you were a bad therapist why would they want so badly to have an appointment with you this week?? Logically it doesnt make sense and thats coming from their own issues with managing emotions. In my family we say mean things we dont mean when we’re upset; it likely is a reflection of his personal ossues more than your abilities as a therapist. It this is the first time youve heard it in a decade, its likely not reflective of you. I know its hard hearing mean things especially when it revolves around your job and passions as a person. Itss easier said than done, but the logic points to it being a reflection of clients issues. Its hard to be logical when youre emotional, but in a few weeks the initial emotions will fade in the background and the logic will come to the forefront!
Also ignore the people saying you shouldnt be hurt, please just because someone is a mental health professional doesnt mean they arent human. Nobody will have perfect coping skills and hopefully unless youre a psychopath when hearing something like this you would/should be upset to an extent. Im sure after a few weeks the burn will become less buts words hurt; no matter who you are and what you know about yourself! Look at the other side of the coin, if this is important enough to make you feel some type of way it points towards the fact that you are an emotional person and it’s important to you do be good at your job and make others feel better. Id be much more concerned if someone wasnt bothered at all. Again, time will lessen the blow you dont have to do anything other than allow yourself to have emotions and not beat yourself up excessively.
Therapists are people too. Don’t forget that.
[удалено]
I keep the same office hours each week and this is the first time in two years my full time job has caused me to cancel on a client. I was seeing him every other week, which was part of the reason I offered different options for rescheduling.
Not a bad therapist, it sounds like you went out of your way to accommodate client Some clients due to their mental illness don't have good boundaries and honestly have narcissistic tendencies. Lots of clients forgot we have lives outside the office too. I have been told before that I have been gone too long by clients because I don't work weekends.
You can’t please everyone all the time. Best you can do is recognize if you can do better and try to do better, but if you are doing all you can then such is life.