Warning Signs Of Abuse In Therapy
Therapy is a form of mental health care that individuals undertake to find support, care, and guidance. Those experiencing symptoms of a mental health condition may be looking for insights on navigating their symptoms. They often trust that the professionals they turn to will provide ethical, supportive, and compassionate care.
If a mental health professional breaches that trust, it can compound negative feelings and cause further mental harm. While many therapists do not display abusive behavior, some use their position of power in a potentially damaging way.
What is abuse in a therapeutic setting?
The American Psychological Association (APA) outlines ethical guidelines for all therapists to practice. One of these guidelines is not to cause undue harm to a client. Abusive dynamics can cause harm and may be a reason for a therapist to lose their license to practice.
Abusive therapists can further traumatize individuals who may already be vulnerable. Abusive treatment may exacerbate symptoms of a mental illness like depression or post-traumatic stress disorder (PTSD) and erode the client's trust in the effectiveness of therapy. If you're concerned about the possibility of your therapist acting unethically, stop attending sessions and report them to their state board.
Warning signs of abuse in therapy
Therapist abuse may occur gradually, and it may be challenging to recognize if you have not seen another therapist before. The following are potential warning signs to be aware of if you feel your mental health provider is abusing the therapeutic relationship.
Shaming or blaming you
A therapist is often chosen as a source of support for individuals experiencing mental health concerns or life challenges, which can put them in a vulnerable state. If a therapist passes judgment or places blame on a client who turns to them for help, it may be a warning or one of the signs of a bad therapist, or an unhealthy dynamic. As a mental health specialist, a therapist must often be an empathetic, professional, and understanding provider for their clients. Judgment and shame may further harm a sensitive client.
Unhealthy behaviors from a therapist may build up and become more apparent over time. If you believe your therapist may be abusive, consider how you feel while working with them. Do you feel safe? Do you feel your therapist is someone you can trust and confide in, even when discussing uncomfortable topics? Do you feel heard? If one of your answers doesn't feel right, your provider may be acting in a potentially harmful manner.
Financial exploitation
Unhealthy therapists might use their position to benefit themselves financially to the detriment of their clients. Financial exploitation may happen in several ways, including overcharging their services, asking for payment for services not provided, or stealing financial information. If your therapist changes the terms of their payment structure or you notice that you're being charged more than you were previously, consider broaching the subject with them.
Talking about other clients
Revealing personally identifying information or sensitive topics about another client can violate declaration agreements. Therapists often have discreet agreements they must follow, which can be violated if they discuss other clients with you or anyone else.
Speaking about clients with others breaches the trust in a therapeutic relationship. If a therapist reveals other clients' profiles, you may wonder whether they're also divulging information about you. If you have a therapist who engages in this conduct, you can report their behavior to the proper authority, a licensing board, or another governing entity.
Sexual advances
Romantic advances or sexual attention are against the codes of conduct for mental health professionals, whether the interaction is consensual. For example, the ACA Code of Ethics prohibits sexual or romantic counselor-client relationships or interactions. Sexual harassment from therapists may be progressive. If your therapist seems to be increasingly interested in details of intimacy or other topics that are sexual in nature, it could be a warning sign.
The professional dynamic should remain intact for clients to have the best opportunity to heal, improve, and achieve the desired results from counseling. If your provider is overly inquisitive about your sexual history or fantasies, makes inappropriate physical contact, or suggests forms of treatment that include touching or intimacy, end the relationship and consider reporting them to the board.
If you are sexually or romantically interested in your therapist, it may benefit you to find a new provider. Being interested in your therapist may take away from your ability to connect on a professional level.
Adverse impacts after sessions
Many people seek therapy to overcome obstacles or manage mental health concerns. If you're noticing adverse impacts you hadn't experienced before therapy, such as anxious thoughts or feelings after sessions with your counselor, your therapist may not be practicing appropriately. If you experience negative feelings or find your symptoms worsen after a counseling session, consider how your therapist treated you in therapy.
Therapy can sometimes be challenging, and uncomfortable emotions and memories may be brought up. Differentiate these areas from your therapist and determine the underlying cause. Ask yourself if you feel upset because of a challenging topic discussed or because of your therapist's behavior. Taking note of what happens after your sessions with a therapist may help you understand and identify your feelings. However, if you don't feel safe and find yourself questioning your sessions often, it may be beneficial to find a new provider, even if your therapist isn't acting abusively or unethically.
A final word on abuse in therapy
Abuse in therapy can affect an individual emotionally, psychologically, and physically. If you or someone you know is experiencing abuse from a counselor, know that help is available. You can terminate therapy at any time without letting the therapist know and report the professional to their state board so that your complaint is on the record. If the therapist has a pattern or specific proof is shown, they may lose their license.
Note, however, that many providers practice ethically and professionally. A therapist can provide you with comprehensive, empathetic support and guidance so that you can address mental health-related concerns and life challenges.
Healthy counseling options
If you have experienced a negative relationship with a therapist in the past, it may be scary to reach out to a new provider. However, many therapists offer healthy, ethical practices. Because having a sexual abuse counseling session with them helps you feel validated and comfortable expressing your emotions. If you're worried about your boundaries being crossed, you might feel safer re-entering therapy through a distant option like remote online therapy. Through this type of counseling, you can choose whether you partake in phone, video, or live chat sessions.
Online therapy can be a valuable tool, with studies suggesting that it can be as effective in treating various mental health conditions as face-to-face therapy. A study conducted by the University of Zurich found that online therapy can be more effective than in-person therapy in the medium and long term. Researchers found that participants continued to experience improvement far into treatment and several months post-treatment.
Specifically, three months post-treatment, 57% of online clients continued to experience a decline in their depression symptoms compared to just 42% of in-person therapy clients.
Online therapy may be effective if you feel you could benefit from working with a counselor.
Online therapy platforms like BetterHelp can match you with a professional therapist that best suits your needs. BetterHelp has a thorough vetting system for providers that includes cross-referencing credentials, interviews, and thorough criteria for acceptance. Understanding this, you may feel safer signing up to meet with a new provider.
Takeaway
An individual's ability to trust their mental health professional can be vital to the therapeutic process. If a therapist violates that trust, they may exacerbate symptoms of mental health conditions and erode the individual's confidence in mental healthcare. If you're ready to reach out to a new provider, consider contacting a therapist online or in person to gain further empathetic support. You're not alone, and professional treatment is available.
How do you know if your therapist is manipulative?
Manipulation by a therapist can be distressing and, in some cases, devastating for people who need safe and secure guidance from a professional for mental health issues. Here are a few signs that your therapist may be manipulating or gaslighting you:
- They try to shame or guilt you for your thoughts and feelings.
- Your therapist tries to blame you for counseling mistakes they've made.
- They try to control or dictate your behavior outside of therapy.
- They make you feel dependent on them for support or validation.
- Your therapist tries to instill doubt and confusion about your thoughts and feelings.
- They may try to manipulate or minimize your thoughts and feelings.
- Your therapist misdiagnoses you but refuses to listen if you have concerns about their diagnosis.
When should you stop seeing a therapist?
The decision to stop seeing your therapist isn't always straightforward. In many cases, the reasons might be positive, like if you feel you've made significant progress and accomplished your therapy goals. You might decide to stop seeing your therapist if you feel like you've learned how to manage symptoms and feel confident that you can cope with mental health challenges as they arise.
Sometimes, people decide to stop seeing their therapist for negative reasons. For example, if you feel as if your therapist minimizes or dismisses your thoughts and feelings. You may not feel comfortable discussing sensitive topics with them or feel like you never really bonded.
In other cases, there might be more serious reasons why you need to leave your therapist. For example, if your therapist crosses physical boundaries with you or engages in sexual abuse or physical abuse. You may also want to leave your therapist if they harass you, approach you for a relationship outside of therapy.
Similar ethical guidelines that protect individuals from therapist abuse apply in other areas where there may be similar relationships, like in cases of clergy abuse, for example.
What if a therapist can't help me?
If you have spent time and effort in therapy and still don't think it has helped you, there are some things you may need to consider:
- You may have unrealistic expectations for what therapy is and what it should do.
- You want a faster solution to an issue that might take longer to address.
- You may not be willing to make recommended behavioral or lifestyle changes that play a significant role in whether your therapy will be effective.
- You aren't revealing information that's relevant to progress because you are afraid your therapist may judge or reject you.
- Your treatment plan isn't appropriately tailored to your needs.
- You and your therapist haven't set realistic goals and milestones to measure your progress.
- You and your therapist aren't a good personality match.
- Your therapist isn't an effective therapist.
If you don't think your therapist can help you, you might try different therapists who use various treatment methods until you find a relationship that fits your needs.
When should a therapist drop a client?
A therapist may discontinue their relationship with a client if the client feels they no longer need treatment or is no longer benefitting from treatment, if the therapist feels they can no longer help the client, or if the therapist is unwilling to continue to provide care due to compromised objectivity or boundaries.
How can a therapist fire a client?
The American Psychological Association's Ethical Principles of Psychologists and Code of Conduct states that a client/therapist relationship should be ended "when the client isn't benefitting from treatment, isn't likely to benefit from it, or is likely to be harmed from it."
In some cases, this may be because the therapist doesn't possess the skills or competence to treat the patient adequately. In others, the therapist may be unable to maintain objectivity in the patient/client relationship.
Under these circumstances, the therapist has an ethical duty to initiate pre-termination counseling and refer the patient to another mental health professional before discontinuing treatment. However, the therapist has the right to immediately terminate treatment in cases where the therapist is threatened or endangered by the patient or another person with whom the patient has a relationship.
How do therapists feel about termination?
How a therapist feels when their patient terminates treatment may depend on the reason for termination. If the patient feels confident in their ability to cope with mental challenges outside of therapy and they no longer think they need treatment, there may be mixed emotions on behalf of the therapist.
On the one hand, they might be happy for the patient and satisfied with the progress they've made. Still, on the other, they might feel disappointed in ending a relationship in which they're likely invested emotionally.
If a client abruptly terminates therapy without explanation or warning, the therapist might feel confused, insecure, or inadequate— particularly if they thought treatment was progressing well.
In other cases, a therapist might feel relief if the treatment is terminated because the patient expressed animosity, dislike, or dissatisfaction with the therapist and the therapeutic process.
How do you tell your therapist they hurt you?
If your therapist has hurt you or made you angry, there are options for how you might approach communicating with them.
It might be challenging, but communicating your feelings directly is sometimes the most effective way to resolve such issues. Some therapists may prefer the direct approach so they can respond to your hurt or anger in an appropriate, productive way, and you can both move forward in your progress.
Softening the approach may help to acknowledge that what you have to say might be difficult. Letting your therapist know you're nervous or struggling with how to approach the topic might make it easier to get to the matter.
Similarly, you might talk your concern about telling them how you feel. Are you worried they'll be upset or won't understand why you feel that way? If so, voicing your concerns might pave the way for feeling more at ease.
If your feelings make you feel reluctant to return to therapy, you may consider telling your therapist through a text, email, or letter that things came up in your last session that are making you question whether you should return. Ask them if you can speak about it in your next session and approach the topic then.
How do you quit a therapist?
Separating from your therapist may seem awkward and difficult to approach, but there are ways you can verbalize your reasons confidently. Here are some suggestions for what to say:
- "I don't feel as if we are compatible in this relationship, and I think I would be better off looking around for another therapist at this time."
- "I wanted to give it a chance, but I'm not confident that this is working."
- "I appreciate your collaboration so far, but I feel as if we might not be on a productive path."
Is it okay for a therapist to hug a client?
Typically, it isn't appropriate for a therapist to initiate a hug with a client. However, if you ask for a hug, it's acceptable. If you feel uncomfortable about the idea and your therapist offers to hug you, you should feel fully confident in saying no thank you. A therapist should always respect their client's physical boundaries.
What are therapist red flags?
Finding a therapist with whom you feel comfortable and secure is the bedrock for successful treatment. When patients enter a therapeutic relationship with someone who makes them feel uncomfortable or insecure, it can have a severe impact on treatment success but may also further compromise the patient's mental health.
It isn't always easy to tell when a therapist is ineffective or even harmful. In some cases, abuse occurs, but the therapist can manipulate their client such that they don't recognize it. But there are some red flags to look for if something feels "off":
- Boundary violations
Therapists who initiate nonconsensual physical touch or ask inappropriate questions about a topic that has nothing to do with your treatment cross the lines of professionalism. You should never be asked to share to your therapist sexual or other intimate information unless it's relevant to your treatment.
Additionally, it might be a red flag if they ask specific questions about where you live, work, or socialize that aren't relevant to your treatment, especially if they show up in those places unexpectedly.
- Excessive or inappropriate self-share
While it can be helpful in some situations, if a therapist talks about themselves excessively during your sessions, it may be an indicator that they're unprofessional. It's also a red flag if your therapist shares personal information with you that seems inappropriate or makes you uncomfortable.
- Licensure violations
It is a severe violation for any therapist to practice without a license or to lie about their licensure unless they're in training and working under a supervisor's license in a clinical setting.
- Communication problems
If your therapist cannot communicate with you adequately beyond an occasional misunderstanding or explanation of a complex topic, it might be a red flag that they aren't the right one for you. For example, if you try to explain something to your therapist and they don't understand what you're saying, but your friends and loved ones do. Or if your therapist continuously speaks in academic, technical jargon even though you don't understand the terms.
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