It started happening early. Mary had just begun attending a new therapist. At 31 she was grappling with some big, transformative life decisions, such as whether or not to have children, and she also had a recurring distressing false memory that would crop up when she was stressed.
She found a female therapist who she initially liked, enjoying her tone and calming presence. But then Mary’s therapist started to get some details about her life wrong, such as frequently asking about Mary’s brother – Mary doesn’t have a brother. In early sessions Mary forgave these small errors, assuming it was just teething problems.
But 18 months later, the therapist still can’t manage to remember basic facts, despite Mary discussing her life in therapy every week for 50 minutes. Mary’s therapist keeps asking about her nonexistent brother and referring to Mary’s “yoga” when Mary is in fact a Pilates instructor. She has also got big thematic issues wrong, which Mary finds particularly unnerving.
“A couple of times she brought up ‘when you want kids’. We have discussed many, many times that I’m probably not going to do that and actually might not be able. She has also mentioned relationship issues that I’ve never discussed with her – my relationship is probably one of the only things I don’t complain about.”
All these mistakes have eroded Mary’s sense of confidence and trust, and she is considering ending therapy. “It makes me think, you’re mixing me up with somebody else, and are you potentially discussing my issues with that person?” says Mary.
“If she can’t remember the basic details about me, what is the point? I just think, ‘Are you even listening to what I’m saying? And is this all just a waste of my money when you can’t even seem to remember details about my life?’ I don’t know if I’m getting much benefit from this. I do sometimes think if I had spent the past 18 months with someone else, would I have seen more progress?”
Despite the therapist’s blunders, Mary finds it difficult to correct her in the moment, and her therapist doesn’t offer regular check-ins to evaluate their progress together. Without these openings to address any concerns, the onus falls on Mary to bring them up; a prospect that Mary finds anxiety-inducing.
“I know I should be better at saying, ‘Look, you need to make more of an effort to remember details,’ but I’m just not that kind of person – I don’t like to complain about things – and if I did say anything, I’d probably worry about it all night then after. I know it’s silly but it’s like when you get a bad haircut or something: you say ‘I love it’, pay, then go home and cry afterwards.”
The idea of having a conflict with a therapist could feel particularly daunting to many Irish people, for whom therapy is still a relatively new concept.
[ How can a person know what kind of therapy they need?Opens in new window ]
After decades of a cultural omerta regarding trauma and mental health issues, suddenly therapy is everywhere. Celebrities now frequently speak about attending therapy as a form of mental self-care and development. Friends openly mention their therapy appointments while trying to schedule time together.
Instagram is full of therapists making slide shows about complex post-traumatic stress disorder and obsessive compulsive disorder. And while some people dating online are looking for a man in finance, 6ft 5in, blue eyes, other dating app users explicitly state that they’re looking for someone who is in or has been in long-term therapy. Doing therapy – also known as “doing the work” – is officially in.
But as more and more people turn to therapy for help, issues can arise between the client and therapist – and often, there seems to be little understanding about what kinds of issues are navigable with a therapist and how to do so. This lack of understanding can leave clients feeling disempowered and unsure, not only stalling their progress but exacerbating their mental health difficulties.
Siobhán is 37, and struggled with fertility for a long time before having her son via IVF. Wanting a second child, she and her partner went back to the fertility clinic that had helped with her son. Due to Siobhán’s age and health, there were strict protocols regarding IVF, which left Siobhán physically and emotionally exhausted; however she persevered through the difficult process again, only to receive devastating news.
“We had initially what we thought was a good outcome from our cycle of IVF, but unfortunately, we lost 13 embryos between day three and day five. I was just so devastated. We thought we were in a really good position. We thought we had loads of options and loads of hope, and it kind of felt like it was all taken away from us.”
Siobhán was shattered. The fertility clinic recommended counselling and had its own in-house counselling service, which Siobhán researched. When she saw their counsellor was registered with the Irish Fertility Counsellors Association (IFCA), she felt reassured. “I felt secure and like they must have a certain level of competence. But I was very much mistaken.”
Siobhán entered her counselling session hoping to feel heard, understood and comforted – but instead felt rushed, judged and blamed.
“It was two or three weeks after a failed IVF and, understandably I think, I was so upset. But I just had a really negative experience. They just kept asking me, what do I want out of this session? What do I want out of this session? I thought it would be fairly obvious what I wanted out of session – to feel supported; to feel listened to; for a sense of perspective; and mainly, to have my kind of feelings and my grief validated, because you’re in this weird space where you technically have not been pregnant and have not lost a baby, but all of our hopes and dreams were gone.”
Instead, Siobhán says the counsellor was callous, businesslike and dismissive. “I finished that consultation with this sense of ‘Sure, you haven’t actually lost anything. Just get on with your life. And if you need to do another cycle, off you go.’”
No follow-up sessions or referrals to another counsellor were offered, which compounded Siobhán’s feeling that she did not deserve support. She started “emotional eating, drinking too much, arguing more often in my relationship”, all of which she attributes to unprocessed grief.
“Looking back now I can see that consultation was so negative, it obstructed my grieving process. I didn’t feel I could grieve or I was entitled to grieve because of the experience with that therapist. It was just awful. I hadn’t taken any time off work or told anyone in work; I was desperately trying to hold everything together, and I needed time to fall apart. But I didn’t get any support or direction or anything from that consultation.”
Emma’s therapist never addressed the gaps in her knowledge, forcing Emma to spend her sessions explaining basic ideas instead of focusing on her own progress
Going to therapy is a huge exercise of trust; turning to someone from a place of vulnerability and need, and committing time and hard-earned money in the hope of receiving expert support and guidance.
When it goes well, the results can be life-changing and even life-saving – but as Siobhán discovered, when it goes badly, it can be detrimental to the client’s wellbeing. Or sometimes it can just be incredibly frustrating, leaving clients feeling like they are wasting their time, money and emotional energy striving to educate therapists who aren’t informed about the issues facing them.
Emma is 32 and from the southeast. After Covid, Emma was experiencing debilitating anxiety and found a therapist, but felt deeply frustrated when she found herself having to educate her therapist about basic issues around being a woman in society, and being a member of the LGBTQ+ community.
[ Why it is important to get the right therapist for youOpens in new window ]
“She would say she’s a feminist, I would say a very old-school feminist,” says Emma. “I feel like she wasn’t very informed about a lot of issues and hadn’t tried to educate herself or learn more. At one stage I mentioned something about biphobia, and she responded with, ‘What’s that?’ So, the wall goes up then.”
Emma’s therapist never addressed the gaps in her knowledge, forcing Emma to spend her sessions explaining basic ideas instead of focusing on her own progress.
“I just thought, why am I paying money to educate you? And if you’ve never put the effort in to understand this before and don’t seem to be following up and researching yourself even after I’ve explained, are you ever going to understand this or even believe that I’m experiencing biphobia?”
Stephen Vaughan is an accredited counsellor, supervisor and the co-founder of Mind and Body Works, which has a team of more than 200 counsellors, psychotherapists, psychologists and CBT therapists. Vaughan both trains and supervises psychotherapists, and is passionate about ensuring that psychotherapists keep pursuing training and education that help them support their clients.
“Sometimes a therapist may genuinely not have had experience around a particular issue that somebody is bringing in: being transparent about that is important. For instance, if it was something like biphobia or homophobia, hopefully most therapists would have some kind of understanding around that. But if they don’t, they need to be open with the client and say, ‘I’m sorry, I’m not familiar with that term.’
“Terminology can change quite rapidly, particularly when you get into the whole area of sexuality and relationships. Not every therapist may be up to speed – but they can certainly get up to speed pretty quickly, because this is relevant. And of course it would be frustrating if the client had to continuously explain things to them.
[ What does a lonely brain look like?Opens in new window ]
The onus is on the therapist to say, ‘Well, can I actually find out more about this without depending on my client to do that? Are there articles out there, books or training courses? Can I bring it into my supervision and find out more about this because I’m trying to understand my client, and it doesn’t help if my client has to bring me along in this way?’”
Emma has since found an LGBTQ-friendly therapist and feels like she’s making much more progress. While frustrated about her previous experience, she remains a cheerleader for therapy and has encouraged other people in her life to try therapy, stressing that it may take trying a few different practitioners before finding the right fit.
“For many people, particularly of my parent’s generation, mental health is really tough for them and it’s not as openly discussed as it is for my generation,” she says. “So the idea of even seeking therapy or talking about your mental health is super scary, let alone being confident enough to try it again after a not-great experience.”
“I have relatives who only buy their socks in Marks & Spencer, and I have to say to them, ‘This isn’t socks. You need to shop around for a therapist and find one that works for you.’ There are also so many different types of therapy that they may not be aware of. Just because one type doesn’t suit you doesn’t mean therapy’s off the cards altogether.”
She just didn’t seem to get it. It just felt like she was telling me I was the problem and over-reacting, instead of actually helping me
— Jenny, 29
Researching and trying different therapists is important, but a bad therapeutic experience can discourage clients from seeking out someone else. Jenny is 29 and booked in to see a couple’s counsellor with her partner. They had been together for over five years but were having repeated issues, one of which was due to a miscommunication that led to Jenny’s partner physically hurting her during sex.
“It was very traumatic for me,” says Jenny. “I knew he had accidentally hurt me, but it really scared me. I was still feeling scared of my partner, like there were nights where I was finding it difficult to fall asleep next to him. I knew that he didn’t hurt me on purpose, I needed to find a way to work through this and feel safe with him again.”
Jenny and her partner were hoping that their counsellor could give Jenny some ways to process what had happened, a framework for how to address it as a couple and exercises to re-establish a sense of trust and safety in the relationship. However, Jenny instead felt rushed and blamed by her therapist, who didn’t seem equipped to help the couple address this trauma and instead undermined Jenny’s experience.
“She just went ‘Yeah, you just need to accept that and move on, like, he’s not trying to hurt you. So why are you still scared?’ Because I am! Because that was really traumatic for me! But she just didn’t seem to get it. It just felt like she was telling me I was the problem and over-reacting, instead of actually helping me.”
Jenny describes the process as blaming and retraumatising. “After some of our sessions I couldn’t go into work the next day because I just hadn’t been able to sleep that night. I was so upset, and I was using my own individual therapy session to unpack what had happened in the couple’s counselling sessions.”
The counsellor also failed to give Jenny or her boyfriend any guidance on how to process their sessions together, and they both often left her office feeling emotionally hungover and unsure of how to act around each other for the week. Jenny got so stressed about the sessions that she and her boyfriend decided to leave. They’re still together and want to find a new couple’s counsellor, but need some time to recover first.
“It was just so difficult that I don’t want to try again right now,” says Jenny. “Further down the road I might, especially knowing that my own therapist is someone who is very good at therapy, and I’ve been with him for three years now. So I know there are great people like him out there, but just trying to find them is like a needle in a haystack.”
Jenny believes her counsellor wasn’t equipped to address trauma or guide the couple through their difficult experience, and Stephen Vaughan states that sometimes therapists need to be open about their limitations and refer their clients elsewhere.
“If it’s particularly complex trauma or the therapist just feels like ‘I’m way out of my depth’, or the client is hoping to work in a particular way and the therapist doesn’t really have training or experience around that, then it’s the therapist’s duty of care to say: ‘I may not be the therapist to really help you in the way that you’re seeking, and maybe I can suggest another therapist or other forms of therapy that I don’t have training in.’”
I would always urge people to consider carefully who they work with, and to have a very open conversation about what they’re looking for
— John O’Connor, Irish Council for Psychotherapy board member
Other interviewees expressed a wide range of negative therapy experiences, including having therapists comment on their body and weight; having therapists frequently cancel sessions without warning, preventing any progress; and having therapists insist they continue with stagnant, unhelpful therapy, leaving clients feeling like they were just being used as a cash cow.
A repeated problem is not knowing whether they can raise issues with their therapist and not feeling confident enough to do so. Stephen Vaughan believes that clients need to be aware that they can and should always raise issues with their therapist.
“It’s not your job to mind or protect your therapist,” says Vaughan. “Clients should know they have the power to say, ‘There’s something going on, I was feeling frustrated the last couple of times’ or ‘I’m not sure if we’re drifting here.’ You can bring these feelings and concerns in.”
Vaughan also highlights that sometimes therapy will feel uncomfortable or challenging and embracing some of that discomfort can be vital in order to gain insight and understanding – but feeling challenged is different from feeling neglected, disrespected or harmed by a therapist.
John O’Connor is on the board of the Irish Council for Psychotherapy, and says there are three big issues that can require an official complaint: breaches in confidentiality, inappropriate boundaries, and offering forms of treatment that the therapist does not have adequate training in.
On the last point, O’Connor stresses the importance of clients researching what training their therapist has. At the moment, the words “therapist”, “counsellor” and “psychotherapist” are not protected terms in Ireland, an issue that Coru, the regulator for health and social care professionals, is seeking to address.
“There can be a loose usage of the word ‘therapy’,” says O’Connor, “which means many different things. A person could have done a weekend of work and could offer themselves as a ‘therapist’ with some level of apparent legitimacy.”
O’Connor stresses the importance of checking what a therapist’s training and credentials are, and to also note what membership body the therapist works under, for example the APPI (Association for Psychoanalysis and Psychotherapy in Ireland), or the IACP (Irish Association for Counselling and Psychotherapy.) This information should be readily available on the therapist’s website and is the first point of contact if a complaint needs to be lodged.
“I would always urge people to consider carefully who they work with, and to have a very open conversation about what they’re looking for; about the psychotherapist’s training and experience; and if there is a meeting point between what you’re looking for and what this person can offer. It’s important to think that it’s a relationship, so you’ve got to think, ‘Is this somebody I can work with?’
“But also remember that as a relationship, there are two people and two sides of it. So I think equipping oneself for going into therapy and being ready to have a conversation about it, and being ready to bring questions are all important. One of the big things about psychotherapy is that it’s a space in which we can learn to communicate very difficult things, and so it’s very important to bring the difficult stuff in and know that you can do so.”
Some names have been changed to protect anonymity
The right therapy: different approaches
With many different types of therapy to choose from, it can be hard to know where to start. Here are just a few different types of therapy that can be helpful for different issues:
Cognitive behavioural therapy (CBT): Focuses on identifying and changing negative thought patterns and behaviours. It’s widely used for anxiety, depression and other mental health conditions.
Psychodynamic therapy: Emphasises understanding unconscious thoughts and childhood experiences.
Humanistic therapy: Centres on individual potential and self-growth and is based on the idea that everyone can develop self-awareness and personal growth.
Behavioural therapy: Concentrates on modifying harmful behaviours through conditioning techniques. Often used for phobias and addictions.
Dialectical behaviour therapy (DBT): A type of CBT that focuses on emotion regulation and interpersonal effectiveness. Can be particularly helpful for people who feel emotions very intensely, including people with borderline personality disorder or a history of suicidal thoughts.
Somatic therapy: Often used to address PTSD and other mental and emotional health challenges through focusing on the connection between mind and body. Can incorporate body-oriented modalities such as breathwork, movement, meditation and dance.
Family therapy: Involves family members in the therapeutic process to improve communication and resolve conflicts within the family system.
Mindfulness-based therapy: Incorporates mindfulness practices to help individuals focus on the present moment and reduce stress.
