How can a client tell between "therapy is hard" and "therapy is bad"?

So a brief bit of my own experience first.

I think a lot of my problem in therapy was that the therapists were trying to break through defense mechanisms and get me to challenge unhelpful thought patterns and all that. Only, in retrospect, the therapists were exactly wrong. We're talking things like trying to challenge unhelpful behavior patterns that were keeping me from getting support from my family, when the truth was that my family was abusive and the things the therapists were trying to get me to challenge were the ones that were keeping me safe. Or with the recent ADHD diagnosis, therapists were constantly trying to get me to challenge the supposedly distorted and unhelpful idea that I might actually have something different about how my brain works. Turns out that was exactly the truth.

But then I'd talk about this and people will say things like, therapy is hard and you have to be open to new ways of thinking. Or that a therapist who just agrees with you all the time isn't helpful. And you shouldn't quit therapy just because you're uncomfortable or don't like what the therapist is saying, because if you do that you'll never be able to get better.

The trouble is these two events in therapy look exactly the same from the client perspective, so far as I can tell. And most stuff on keeping yourself safe in therapy seems to start from the assumption that you're already in a basically safe place and able to confidently tell the difference. When the fact that we don't understand or aren't sure is often what drives us to seek therapy in the first place.

Therapy is hard, to me seems like it’s challenging to open up to the therapist, express emotions, change behaviors you agree need changing... things like that.

Therapy is bad, to me also agrees with your feeling that the therapist is misjudging you and seeing it all wrong, not getting you no matter how you explain to them they are off base.

I experienced some of that myself. I would really reflect on if the therapist was seeing something in me I was blinded to, but I agree with you, I think they were just way off mark and didn’t want to see what I was telling them to be the case and respect my take on things.

That is really tough. It is hard to tell. And sometimes therapy isn't a safe place and the therapist is wrong. And sometimes clients (myself included) don't want to change patterns of behavior that aren't helpful simply because they are used to them. And it's hard to tell which is which. And then there is also "abusive or unethical therapist" and "bad fit for me" therapist, which are different too.

I think that is often why people post on this board...to ask "am I misunderstanding this or is the therapist?" Or "is this ethical?" Then you can get different points of view. I have also hired therapists just to ask questions about the first therapist. I've also found that sometimes if you email one of the therapists on psychology today and are upfront with them about what you want they will give you a free 20 minute phone consultation. Ultimately though you have to trust your own instincts because you are the one that will experience the consequences.

My instincts were numbed out so, yeah, I needed some help, some therapy(?) to un-numb them. And that was hard and painful but OK. But I was also numb to how therapists were using or engaging with me in the same people-pleasing ways I had learned in my family and did in my interactions in normal life -- but it's not like they helped me discover that and we talked about it. No, the therapists I had picked were those who liked my people-pleasing, ego-building ways -- it may well be that I unconsciously picked them for that. But if so it was unconscious so don't blame me on that part. Stuff I went into therapy with and, presumably, for.

When it all blew up -- and I didn't have close friendships or relationships in real life, so it wasn't a pattern I was familiar with in myself -- the therapists blamed me and I felt all the blame, and -- it was very unhelpful.

Based on several stories of seemingly successful, and seemingly unsuccessful, therapies it is seeming like it basically comes down to, can the therapist accept and deal with their part of the transference-countertransference tangle or can they not. Can they only get triggered, and deal with that in a number of possible unhealthy ways. The latter is bad therapy, and can be very harmful to clients. But the client frequently can't see that. I know I couldn't. My therapists probably couldn't either, but they were the one who were getting paid and who presumably were taught about this kind of mess and were supposed to know how to deal with it, only it looks like from what we have seen in this forum there are an awful lot of them who don't.

Have you checked out the list lilly2 posted on this thread

Pamphlet - In all clinics for Survivors of Unethical Therapy; what goes in it?

There might be some good clues in some of those articles, especially the "50 Warning Signs of Questionable Therapy and Counseling" vs. "50 Signs of Good Therapy". Also Goodtherapy.org says they screen the people who sign up with them, so maybe that's a help, IDK.

I have, but I don't really see anything that addresses what I had happen to me. It just doesn't even seem to be on the radar. I've read goodtherapy articles multiple times and not found anything useful - in fact some of the signs of "bad therapy" were actually things that I think were missing from therapy being able to be helpful to me. Like I needed way more focus on diagnosis prior to problem-solving and way more openness to the idea of actually blaming my family for some things.

I think part of the problem is so many of these lists are themselves only written with mood disorders in mind. ADHD, which is what I mentioned upthread, is not a mood disorder. And what might be good or helpful therapy for a mood disorder is going to be totally useless or even harmful for something like ADHD. It's also not really a transference-countertransference issue at all. It's just a matter of the therapist persistently trying to apply the fix for a superficially similar problem. Mood disorder treatment does not and will never make any significant improvement for a client with executive functioning issues. Similarly, no treatment at all is ever going to make significant progress for someone who's still being abused and isn't aware of it.

I think there's other categories too, honestly.

I don't feel like "unethical" quite describes my experience, at least not in the way it's usually meant. I don't like it because it has sort of a deliberate feel behind it, like the therapist knows they shouldn't be doing something and is doing it anyway. At the same time I think there was more going on than just "bad fit." I feel like "bad fit" implies just sort of a personal mismatch, and I definitely think there was more going on than that.

I think it's a competence issue, really. In my case, I'd say that a lot of therapists simply aren't equipped to spot anything other than depression or anxiety. And I think it ought to be a basic expectation of a therapist that they are able to determine when something is outside of their competence and refer appropriately - even if that referral is to someone who can do a more complete evaluation. What often actually happens is therapists are only looking for mood disorders so the client ends up diagnosed with one no matter what, especially since they can be vague enough to cover a lot of other issues. And this is going to cause problems if the client isn't correctly diagnosed.

I'm sorry, I don't think my first reply was very help so let me see if I can relate it more to your specific experience.

What I've learned, specifically, in the last few months on this forum is that when therapists and clients can stick through the misperceptions that happen on both sides, including in the case of the therapist a misdiagnosis, then something better in terms of understanding or relationship or perceptions -- or some things else IDK -- can happen. Yes, the client needs to stick through it and accept challenges to our way of looking and doing -- it's hard. BUT the therapist does, too. When they can't, then . . .it can end up badly for the client.

Unfortunately I, too, couldn't recognize when it was a therapist-problem, in part because of issues I went into therapy, I believe. The last therapist did eventually recognize that she had a problem, apparently, but still couldn't deal with it, so she bailed. That has been bad for me, and I have not chosen to look for more long-term or relationship-oriented therapy to "help" with that. Some people have, in what seems similar situations, with results they feel to be good.

So, from that, therapy is "hard" when you're challenging stuff inside yourself that may be unhelpful or painful. It's "bad" when -- I don't know exactly how to describe it -- the therapist is screwed up and gives you screwed up ideas and advice and neither client nor therapist can see that.

Often you can't tell, in advance.

I agree that many therapists are not equipped to handle diagnoses beyond the usual suspects of depression, anxiety, etc. Many do not have the clinical background to deal with ADHD, bipolar disorder, schizophrenia, and other specific diagnoses that come with very particular issues that require some detailed knowledge of specific treatments, some of the medical in nature.

It is important to have a psychiatrist who IS knowledgeable in working with these specific diagnoses, who can differentiate comorbid diagnoses symptoms from each other, and who can sort out which diagnosis is at play at a given time and how to deal with it and how they interplay.

It's complicated, and I do believe that kind of complexity is beyond many therapists' knowledge and training.

As someone who was dealing with several comorbid diagnoses, having a therapist with the broader and more clinical background to sort through those complexities was a must.

Yes, therapy IS hard, but is made harder when the therapist is not really equipped to deal with that level of complexity. If the therapist is unable to work with that complexity, then the therapy can also be bad due to the lack of skill and knowledge of the therapist.

Therapists should know when they are in over their head; unfortunately, many either are clueless or refuse to admit they really aren't able to work with a client. Or, they tell the client that they need a different therapist/level of care, and the client refuses to take that professional advise.

I have had a lot of T’s like the ones you describe and current T cried when he heard my experiences.
Current T is VERY gentle bringing up things I may not be aware of or things I might not be comfortable with about myself yet. If I balk he lets it go, regrounds me and works on finding out why I balked... he knows there is always a reason. Right now the two I am balking on are “I am” statements and “balanced life”. For the “I am” statements he would gently bring up that we need to write those when I was calm and feeling most connected to him. Two weeks ago I walked in with one “I am” statement and he beamed... IMO that is supporting me through something that is hard for me. We have also found that a specific tone of voice of his triggers me and will get me to balk at anything he says.

I think a lot of the problem for me - what's the difference between a therapist bringing up something that you're not aware of or not comfortable with, and a therapist just bringing up something that's plain old wrong? My issue was therapists were doing the second while thinking they're doing the first. So exploring why I'm balking or not comfortable isn't going to help unless the therapist is open to the idea that they are just not on the right track.

So one example: I remember a lot of talk about why I was avoiding doing mood charts and whatnot. Why I wasn't comfortable and what I might be avoiding and so forth. The problem is just that "keep track of this piece of paper and remember to fill it out" isn't something I could to do, no matter what the paper is about. And no matter how gently the therapist approaches the subject, it's going to be damaging to be pushing the assumption that I really could if I just fixed the emotional block.

I think...

Hard = resonates with me, but too afraid to face it right now.

Bad = not it at all, and therapist is insulting me, misjudging me, infantilizing me, brainwashing me, controlling me, punishing me, putting words in my mouth, accusing me, disbelieving me, unfairly judging me, attacking me, hindering me, undermining me, and/or misdiagnosing me (therefore mistreating me with wrong treatments).

BOTH bad and hard = it resonates with me but...

..the treatment is not working or is disseminated incorrectly

..the treatment is not working because the therapist is abusive, unethical, negligent

..the treatment is working, but the therapist is abusive, unethical, negligent (e.g., I am doing the work without proper feedback; I am doing the work, but the therapist says I am not working fast enough or that I am doing it wrong, and the therapist does not help me to do it right; therapist is impatient)

..the treatment is working, but the therapist exploited me afterward

..the treatment is or is not working, and the therapist is not competent or trained in treating the other mental conditions that interact with this current condition that we are working on (i.e., comorbid disorders that may require concurrent treatments, adapted treatments, and/or alternative treatments)

..the treatment is or is not working, and the therapist does not understand cultural issues

...there are many other scenarios that could probably fall in here...

Even if I am balking at something my T respects that I have a reason to balk and that either he is wrong or we need to do more work before I am ready for what he brought up. Having a humble T is a big benefit.

A humble T... I haven't found one

Therapy is hard - feeling challenged but supported and heard.

Therapy is bad, the therapist is misjudging, pushing wrong assumptions, attacking, refusing to listen.