When to Fire Your Therapist
By: Art Nunymiss
Tags: Life Lessons, Mental Health, PTSD, Therapy, Self

Have you kissed any good frogs lately?

Photo by Nik Shuliahin on Unsplash

I would never make it as a Scientologist, because I am a true believer in therapy. I think counseling is something almost everyone could benefit from. For those of us with rougher personal histories it’s mandatory. PTSD is the №1 threat to my life. Aside from the suicidal tendencies, PTSD ravages my physical health.

According to The American Institute of Stress:

Researchers reported that the number and severity of PTSD symptoms were significantly associated with deaths due to coronary heart disease as well as non-fatal heart attacks.

Unfortunately I have to fire my new therapist.

One of the saddest things I hear people say: “I went to therapy. It didn’t help.” That always comes down to one of two things: either the patient really didn’t want to do the work, or the therapist failed in their role — which many of them do.

So I’m here with some pro tips I’ve picked up since beginning therapy in the late 1980s. You can learn from my mistakes, work smarter at your wellness, and get better results. Self-care is the gift that keeps on giving.

Therapy: The emotional gym

The last person who told me therapy didn’t help her, when pressed, said she had only gone to two sessions. People often have unrealistic expectations for how therapy should work, what kind of benefits they can expect.

The issues we address in therapy have usually built up over a lifetime. I’ve found that a good therapist helps people learn how to balance and navigate from the lives they have to the lives they want. The therapist helps people find the healthier, happier, more balanced version of themselves. That’s why I go.

Using the gym analogy, I’ve recently lost over 120 pounds. For many years my weight and mental health both seemed insurmountable, intertwined and completely demoralizing. However in hindsight it has only taken me a year to lose about 35 percent of my body weight. Because I was emotionally ready, like I had hit bottom, it has been much quicker to correct the problem than to create it — which took decades of imbalance.

When I started at the gym I was 350 pounds. It took a good six months before I saw any difference except on the scale. But there is no scale for your therapy progress except the happiness in your life. What works for me is to trust the process and keep doing tiny amounts of it constantly.

The imposition of an infrastructure — a sustainable, reality-based understanding of my physical needs and how to consistently approach them — was what I needed to lose weight all along.

And that’s what I want from a therapist, too: a competent person to provide healthy guardrails for my life. People like me almost never graduate high school. Anyone who was able to become a therapist by definition had a better life with significantly more social support than I did.

Really excellent therapists enable me to leverage their stable childhoods by relating to them. They show me how a person with undamaged self-respect and healthy attachment would respond, often indirectly. A strong therapist is an ultimate role model.

For me a therapist is like a professional parent.

Key word there is professional: they’re not your actual parent. But they’re trained to behave like a highly appropriate, high-functioning parent.

At least that’s how I think of it, since neither of my parents was appropriate. Therapists give me a model of what it could look like without all of my parents’ poop injected into my thought process, a healthier way to reframe my life than I could imagine. Therapists don’t share your history, and thus can create a wonderfully neutral space.

I learned what good parenting is supposed to look like in therapy. A psychologist was the first person to tell me it’s not appropriate for parents to lean on their children for emotional support. I was horrified at the suggestion that I should stop being my mom’s #1 emotional supporter. It took me years of therapy to get it in my bones, which I now do.

After discussing these ideas many times with many therapists over the years, here’s what I believe a good parent thinks:

1.The child’s needs always come first.

2. The child may not necessarily like what’s best for them, but I do it anyway.

3. I may not like what’s best for the child, but I do it anyway.

Like a doctor, lawyer, or teacher, a good parent is an advocate who runs interference while providing guidance. You can’t do that when you are emotionally dependent on the child. That imbalanced relationship requires clearly defined duties and priorities. There’s a fiduciary responsibility. It is unethical for a parent, doctor, lawyer, or teacher to place their own personal needs —such as sex or money — above the needs of their charge.

The fiduciary duty doesn’t mean therapists can or should be abused. But in the session, the patient’s personal feelings count and the therapist’s don’t. That’s the only way it can be.

But a lot of problems are more subtle than theft or sexual abuse. Therapists are only human. It’s not always easy to see where interpersonal boundaries are or should be. Ultimately it’s your job as the patient to make sure you feel heard and respected, and if you don’t, kiss another frog.

Of course the relationship works both ways. I’ve never been fired by a therapist, but I know people who have. I don’t get close to anyone who confides that in me. I take it as a clinically educated red flag that this person has unsustainable issues. Therapists usually have to drum up their own work. They don’t just fire patients on a whim. If a doctor can’t work with them I probably can’t either.

My new therapist isn’t necessarily wrong. She’s just wrong for me.

I had a therapist that I really liked for the last couple of years, and my life improved immensely in that time. I moved out of my van and into an apartment with no help from anyone, which was Herculean. As I said, I’ve lost 120 pounds and counting. Neighbors who once ignored me now meet me in the parking lot for aerobics before dawn. People want to pay me to be their personal trainer. All of my problems are solving each other. My life got much better with her, and it felt so good.

So I was devastated when my therapist told me that she’d no longer be accepting insurance, any insurance, in 2020. She saw me on New Year’s Eve, twice that week. I know she hated to leave me without a new provider lined up. We both had to move on. Again, it’s a professional parent. I never lose sight of that. It doesn’t hurt me on a personal level, only the issue of kissing more frogs.

Importantly, though, it puts my entire therapeutic process back to Square 1. I’m heading into Month 6 without a new therapeutic relationship established despite my best efforts. For someone with my mental health issues this not sustainable. I’m keeping myself alive until I find a new doctor to help me survive. Unfortunately the last session with the latest provider, Kathy, was a deal-breaker.

Like having a baby, it’s never a convenient time to switch therapists.

I thought I was going to die when my second therapist, Raye, moved away.

I had fired the first-ever therapist after one visit. I told her that I was working with childhood sexual abuse, and I felt like forgiveness was a crucial part of my process. I needed to de-escalate emotionally. Forgiveness was so clear to me, like a lighthouse in my heart.

That initial therapist felt that for me to be thinking about forgiveness that early in the game was a cop-out, that I was letting people off the hook to avoid my anger. This was a complete misread of the situation and a foolish thing for her to say. She didn’t even explore what I meant by forgiveness.

My very first therapist didn’t have enough clinical experience to get that I first needed to forgive myself in order to truly believe I deserved therapy. I could not budge off that forgiveness vibe, nor should she have advised me to. I was so angry I couldn’t find any other safe way to approach it except with the goal of forgiving everyone unilaterally, because I can and that’s how I want to feel.

That first therapist was shocked and horrified when I told her I would need to switch providers because of the irreconcilable difference in strategy. The next person, Raye, was much more skilled. She saved my life.

THERAPY PRO TIP: When I fired that first therapist, she said that was fine but I’d have to come in for another session to discuss it. She said she needed to ensure that I wasn’t ditching her because she challenged me. I had already explained to her that we have irreconcilable differences in our goals. If anyone ever tells you you need another appointment to fire them, tell them no. The relationship is over when you say it is.

Not all therapists are created equal.

Like every other profession, therapists have their share of C students. Then there’s also the common thing of people simply not communicating well together. Some people don’t click. However it’s the therapist’s job to establish rapport with the patient, never the other way around.

I think my latest therapist, let’s call her Kathy, is both inexperienced and not especially skilled.

With the very first therapist I ever saw, our irreconcilable difference was, on the surface, how we understood the word “forgiveness.” But it was actually her inability to meet me where I was at. She expected me to get onto her page. And it’s the same thing with Kathy.

With Kathy I find myself in the session thinking I’m not doing it right, not meeting her expectations, that she’s not understanding me. I remember several times thinking, “Wow, she must think this is my first therapy session, Day 1 of my process.” I made another appointment with her for next week, because I wanted to make sure I’m not incorrect. I wanted to fire her several times during the session. But I felt like I needed to sleep on it to be sure it’s the right decision. Next time I will just pull the plug, even on a therapist.

People often want to fire a therapist who challenges them in an appropriate, even vital way.

Before I do the list of why to fire a therapist, the list of why not to is very short:

Don’t fire a therapist who tells you things you don’t want to hear, unless those things are abusive, or like the forgiveness thing, an irreconcilable difference. That’s why I didn’t fire Kathy mid-session. I need to make sure she didn’t have a valid point.

A good therapist must be able to put a boot up your ass if need be.

It goes back to the professionalism of the therapist. I need to work with someone whose clinical judgment I trust. I have to get that they’re my advocate, that they get me, that we’re understanding each other. If we’re not communicating in therapy something is bad wrong. Kathy has to go.

So here’s my quick list, reasons I’ve fired therapists:

Must-Fire ASAP №1: I’m not comfortable with this person or in this environment.

I once went to a session at the private office of a therapist who also worked for the county mental health department. He gave me the address, and I met him at a small office park near the county building.

When I pulled in on Saturday morning it was a little spooky, completely abandoned. It was four smaller buildings around a courtyard. As I was parking, a homeless guy came out from the courtyard and stood by the entry.

I sat in the van and smoked a bowl, hoping he’d wander off and I could go to my appointment. He didn’t look dangerous, just dirty and disheveled. I didn’t want to be panhandled or deal with him.

The guy didn’t leave after five minutes. I decided I could take him in a fight, and went to look for the office.

Even though he turned out to be the therapist, I did go into the office with him. I was amazed that he would show up in dirty sweatpants and a T-shirt, as though he had rolled out of bed, down Main Street, and through a mud puddle. In hindsight this simple lack of professionalism should have been an automatic deal-breaker.

His office was, of course, in the back of the building. We went in and sat down on opposing couches, in a room he clearly shared with other therapists. When he left the door open for the session I was glad he did. He gave me the creeps.

I sat inside his office looking at outer door and the base of the stairs. During the session a stranger walked into the middle of the room with us and asked us how to get to the architect’s office. I walked out behind him.

I shouldn’t have walked into that office, period. That guy skeeved me out, which is why I was glad he left the door open. If that’s the case, save time and trouble and just leave. You can’t do therapy with someone you don’t want to be alone with.

Never do a therapy session where your privacy isn’t guaranteed. Someone walked in on me with my last therapist and she looked like she wanted to gouge his eyes with a scissors. Even so she held her shit together and stayed in professional mode until my session was over, because I wanted to finish my thought. I hated losing her. When I get rich I’ll pay cash and go back to her, unless I kiss the lucky frog.

Must-Fire Moment №2: This visit is traumatic.

I once had a psychiatrist ask me a rapid-fire series of questions about my life, ticking boxes without considering either the questions or the answers.

A psychiatrist is not actually a therapist, but was a required part of my mental health assessment process. That appointment itself was incredibly traumatic, jumping from one painful aspect of my life to the next at a high rate of speed without regard for the questions’ impact on me.

That psychiatrist taught me to get up and walk out the door mid-session if need be. I almost did it with Kathy today. But because she’s an actual therapist I wanted to be sure I wasn’t reflexively rejecting constructive criticism, that she didn’t have an important point.

Take a tip from every Larry Nassar survivor:

“I hated it, but I didn’t know it was abuse.”

If you’re traumatized by the experience itself — unless it’s like a colonoscopy or a root canal, and you’ve been warned, and they’ve taken steps to minimize your stress level — something is wrong. I know psychiatry kind of sucks. But the first rule for doctors is “do no harm.” There’s a reasonable, empathetic way to do that process. That wasn’t it.

Must-Fire Moment №3: Can you hear me now?

I’ve been in therapy longer than many people have been in practice. So I have my own personal practice of therapy, over many years, with many different providers as described herein. I’ve got a certain style that may be challenging for the clinician, especially if their own game is not so strong.

I have to fire Kathy for a few reasons:

I felt judged. I was stunned when Kathy stopped me mid-sentence and accused me of ranting. This is how I’ve worked successfully with other therapists for years. But I gave her the benefit of the doubt. Then she didn’t have anything other than her belief that I was much angrier than I was. Annoying AF. Not good. I feel like it’s rude for a therapist to stop me short and say I’m ranting, especially if that’s all she has to say. I felt like I’m not able to be emotional with her. I can’t express myself freely with Kathy, game over. I felt belittled. Kathy asked me what I got out of that, and I told her how I work through my process, talking. I listed the reasons it’s important for me. Even so she described it as “venting” and told me that wasn’t therapeutic. My last few therapists — and the circumstances of my life , described above— would beg to differ.

Given a do-over I would ask her to rate my anger level on a 1 to 10. I would’ve put it at about 2–3. She seemed to think I was much angrier, even when I flipped it on demand. Again it’s her job to get on my page, not the other way around.

Must-fire ASAP: therapist who tells me how I feel. Especially when they’re incorrect.

PRO TIP: Next time I notice feeling bad about myself during a therapy session — not processing that self-blame but experiencing it anew — I will drop the therapist like she’s hot, THEN sleep on it and decide if I’ve made a mistake and want another appointment. Because that one rule, about not firing them for challenging you when you need to be challenged, is really crucial.

3. Kathy doesn’t understand the therapeutic relationship well enough. While we were discussing rape trolls on Medium and how I deal with them, Kathy said she didn’t think I was being an effective advocate because she could tell I was angry. I was shocked that she assumed I would speak to everyone the same way I do in therapy. Not everybody has a fiduciary relationship with my feelings, right? Especially rape trolls, eh? Super basic. She also assumed that the rape troll was conversing with me the same way people do with her in her office. Also obviously wrong. Those are two entirely different communications. If Kathy thinks everybody is at the same level of conversation in therapy as they are all the time, she’s very low-functioning.

4. It’s not the patient’s job to establish rapport or run the session. Kathy and I met on a video chat due to the lockdown, I brought up the awkward last session. I wanted to see if she had some point that I missed, and clearly she felt the same way. This is your red flag moment, folks. I shouldn’t be the one trying to make this work.

Kathy said, “If you were in my office I would’ve shut you right down.” First of all it’s very scoldy, fuck that. I’m sure I wasn’t inappropriate. I’ve never had a therapist suggest that I was before. That tone, especially after she used the offensive word “ranting,” was a good time to end the call. Other therapists have successfully set boundaries with me. Not often, but it can happen. There was a gentle, effective way to redirect me, but Kathy couldn’t find it.

It’s important to understand the therapeutic relationship, the sacred space that is created. That video conference was her virtual office. If she maintains lower professional standards because of the lockdown, because the patient is not physically present, then videoconferencing is unethical for her to participate in. To say, “If you were in my office…” implies that what we’re doing here is somehow now official, not what she actually does. If she wanted to “shut me down” and didn’t know how, and I also didn’t know what she wanted from me, then we have nothing to discuss. She’s simply unqualified.

PRO TIP: Don’t let anyone do you any special favors, things they wouldn’t normally allow but we’ll keep it between us. That’s a grooming technique.

At the end of that session Kathy showed me a printout that said, “You are not your thoughts,” which is not a deep or new thought, and also had nothing to do with anything we discussed. Kathy failed to demonstrate either insight or empathy, and she got fired.

So that’s my short list of reasons to look for a new provider. Fortunately there are more options than ever before. I found Kathy through an online service that has all kinds of virtual doctors. Like a dating site, I can pull up profiles, request appointments, and see how it goes.

On the one hand I see that I will need to be more cautious next time, taking the time to make the provider prove themselves before thinking I can continue working on my issues. Just like with dating, I shouldn’t have jumped right into bed with Kathy right away. When I got to know her I didn’t like her.

On the bright side, I can take my time and shop around, and find the perfect partner for my best life. And I know that I will.