Therapeutic relationships are imperfect. Like all relationships, therapeutic relationships can contain disagreements, disconnects, or times when you just aren’t on the same page. Maybe you have limited choice of therapists because of location, finances, or other logistics. Maybe you’ve found a great fit, but your therapist just doesn’t understand an aspect of your story. Maybe you’ve been interested in trying something different for awhile, but you feel nervous about asking your therapist.
As a client, you have every right to ask for what you need. Generally speaking, your therapy is your therapy. Therapists may be trained to have an idea of what helps generally, but a good therapist will want to work with you to ensure therapy is working for you specifically. It can be hard to be honest about what you’re thinking, particularly if you’re nervous about how your therapist will respond. But being honest can help you and the therapist readjust, or it can help you better assess to see if this therapist is the best fit.
Let’s talk about ways to advocate for yourself in therapy.
1. Consider your safety and boundaries.
Before deciding how to self-advocate, it is important to decide if your goal is to preserve the therapeutic relationship or remove yourself from it. A good therapist will always respect your autonomy and will ensure you have a say in your treatment. It is important that you feel safe, and safe may mean different things to different people. You don’t have to keep trying to make a therapeutic relationship work if your therapist crosses your boundaries or doesn’t respect you.
To determine your safety and boundaries, ask yourself the following:
- Do I feel protected and secure, or am I worried about my therapist hurting me?
- Do I trust my therapist will address this situation in a way that respects my needs?
- Is this something fixable, or is this something that’s too impactful to fix with this person?
- Is this a single instance or a pattern of problems?
- Do I want to continue working with this therapist?
It is always okay to discontinue services or request to switch to a different therapist. Your safety comes first.
2. Voice your concerns.
Therapists often don’t know something is ineffective for a client until a client is open about their experience. Even with the best of therapeutic matches, there can be disagreements or miscommunication. Provided you feel safe enough to bring things up, successfully resolving the problem can strengthen the relationship and help the therapist make changes. As a client, you have every right to say, “no.” Some ways of starting a conversation include:
- Could we talk about something that I don’t think is working for me?
- I don’t feel comfortable with _______.
- When you said ______, it made me feel ______.
- Next time ______ happens, it would be more helpful if you ______.
3. Put the learning on the therapist.
Maybe a therapist misunderstood an aspect of your background or asked you to teach them about a specific community or concern. When you go to an expert for help, it is a potentially uncomfortable scenario to have those roles reversed, especially if you are the one paying to be there. It is not up to you to educate your therapist– they should be owning the work of ongoing professional and personal development. If you feel you need to redirect the learning back onto the therapist, some strategies include:
- I’m happy to tell you about my personal experience with ______, but I can’t speak for everyone with this experience.
- It’s important to me that my therapist has more knowledge about ______. Are you open to researching more about it so we can work better together?
4. Revisit your goals.
Any time you start therapy, your therapist should take some time to identify what your goals for therapy are. Most often, this means creating a formal treatment plan that may even include measurable outcomes to help you and the therapist track your progress. You usually have the right to review your treatment plan, whether you feel stuck in your progress, feel that you and your therapist aren’t on the same page, or just want to check-in.
- Can we take a look at my treatment plan together? I’m curious what progress I’ve made, and where we can go from here.
- I feel like a lot has changed since we first made my treatment plan. Can we readjust the goals so they’re more suited for what I need now?
- It feels like you and I may be looking at my goals differently. Can we take a moment to make sure we’re on the same page?
- I hear that you think _____ is important. But I really want to prioritize _____. How can we work together to make sure this treatment is working for me?
5. Ask for clarity.
Most therapeutic relationships rely on open communication and trust. If you don’t understand why a therapist would suggest a certain intervention, ask. Therapists may be using their training to identify an intervention that is a best fit at the moment, or a therapist may be suggesting something that would just be a bad fit. Check-in to better understand the therapist’s treatment rationale.
- I’m not familiar with ______. Can you tell me more about it and why you feel it is helpful at this moment?
- I’m concerned ______ doesn’t fit with my goals here. Can we talk about it first?
- I hear you saying that we can’t do ______. Can you help me understand exactly why?
6. Consider the power dynamic.
Sometimes clients feel like they don’t have power in the therapeutic relationship. It makes sense– therapists are professionals who can diagnose, refer, report, and determine treatment recommendations. You may have been required to attend therapy, or you may need your therapist to make a good recommendation to the court or a caseworker. Or, you may just feel like you don’t have a voice or a say in what your treatment looks like.
Unfortunately, the mental health care industry often prioritizes the voices of professionals over clients. This means that if you feel disempowered, you may be experiencing a very real and frustrating effect of the structure of mental health care.
However, even if a client feels stuck in a therapeutic relationship that isn’t working, there are some common strategies which may help empower clients. Consider if these feel like a fit for your situation:
- Talk with friends and family. Not only can this help validate and support your feelings, but bringing loved ones into the process can help leverage your power.
- Rally support through mental health organizations. Some organizations, like NAMI or MHA, work to educate and support clients in getting meaningful and effective care. Check out the national or state chapter of these organizations.
- If possible, talk with supervisors or human resources at your therapist’s practice. Not all therapists have direct supervisors or HR departments, but if your therapist does you have every right to reach out to their supervisor.
- Make reports to the state licensure board. If your therapist does not have a direct supervisor or HR department, and you have a major concern about your therapist, you can also file a complaint with that therapist’s licensing board. The board will investigate concerns and address issues with the therapist.
Therapy is an ongoing process that evolves and changes over time, which may lead to misunderstandings or conflict with a therapist. Advocating for yourself in those situations can be difficult and intimidating. Many times, a conflict in therapy is fixable and can strengthen the therapeutic relationship. However, sometimes finding the best fit means trying a few different therapists to see what works for you and what doesn’t. If you’ve had one bad experience, don’t let that stop you from trying again with someone different. With patience, you can find the right therapist to help you on the journey ahead.
Laura is a clinical mental health counselor in Cleveland, Ohio, who specializes in gender-issues, power dynamics, and advocacy. She is a doctoral candidate studying Counselor Education and Supervision and she researches power in counseling, the intersection between mental health and pop culture, and mental health access. Laura teaches and supervises counselors-in-training and she presents regionally and nationally on issues pertaining to counselor development.
This article is not a substitute for medical advice or professional counseling. While we at Take This want to provide you with resources, we do not recommend or endorse any particular site, treatment, therapy, or resource. We provide these links at our sole discretion but have not necessarily vetted or reviewed any particular resource. We assume no liability for the use of the information or resources on these sites and encourage you to use your own best judgment when reviewing these resources.
If you live in the US and you’re having suicidal thoughts, reach out to the Suicide & Crisis Lifeline or call/text 988. If you’re outside the US, you can find local crisis lines at Suicide.org. If you’re even debating whether you should call them, you should call them. The Suicide & Crisis Lifeline handles all psychological crises, not just suicide.