Is your therapist the right fit for you?

Pop culture's portrayal of therapy can oftentimes be problematic. We reach out to mental health experts to understand what a healthy client-therapist relationship really looks like

In the popular Netflix series Sex Education, one of the leads is a successful sex therapist whose character, although endearing, is constructed on clichés and a breach of boundaries. Jean Milburn practises out of her home office decorated with dildos, has penned a chapter about her son’s sexual difficulties in her new book and frequently takes on clients she crosses paths with in her everyday life. What we’re shown is barely rooted in reality; in fact it’s far from it.

Pop culture today is filled with several misrepresentations of therapy, largely an attempt to entertain rather than educate. Moreover these portrayals aren’t problematic when consumed with this insight. However, if viewers take what they see at face value and are unable to separate fact from fiction, it can lead to one of two scenarios: (a) confusion when real life experiences don’t mirror what’s on screen, and (b) the inability to sound the alarm when faced with less-than-ideal circumstances that may have been glossed over in fiction. In order to better understand what a healthy client-therapist relationship really looks like, we reached out to mental health experts who helped us paint a more accurate picture of violations of boundaries and recognising red flags.

Setting boundaries

Boundaries are the building blocks of healthy personal and professional bonds and a client-therapist relationship is no exception. Let's take a minute to talk about another familiar fictional therapist–Dr Jehangir Khan in Dear Zindagi (2016). The eccentric character, played by Shah Rukh Khan, was critiqued for conducting sessions in unconventional settings, ranging from beaches to boats. “The movie gave the impression that therapists are cool if they take you to outdoor settings but in reality, most traditional therapists will not do outdoor therapy unless they are trained for it,” says mental health counsellor Binita Modi. Such locations, according to psychotherapist and research scholar Tamanna Edwards, may also come at the cost of the client’s confidentiality. “Meeting your client outdoors dilutes the therapeutic process. Many may not be comfortable with meeting their therapist outside, let alone having other people around them know they’re in therapy,” she says.

Another boundary violation occurs if the client confuses the therapist for a confidante who is available around the clock. “A therapist is commonly misrepresented as a best friend or agony aunt, which couldn’t be further from the essence of therapy. Unless there is an emergency, calling your therapist after working hours or dropping continuous texts will not aid your growth. The idea is to empower the client rather than build dependency,” says Edwards, highlighting that a client-therapist relationship shouldn’t be mistaken for a friendship and shouldn’t evolve into one either. In addition to this, it should not stem from an existing connection. “If you know the person directly and expect to see them in social settings, you shouldn’t work with them,” adds Modi.

There’s also the crucial, and often tricky, topic of physical contact. “While many may relate touch with a sense of comfort, it means different things for different people. Using it with clients who have a past history of trauma or abuse might be doing them more harm than good,” explains Edwards. However, there are some exceptions to this rule. “Somatic work and certain other forms of therapy might allow for some amount of physical touch but it’s done intentionally and has to be explained to the client. Also, consent needs to be taken beforehand,” says trauma-informed psychotherapist Suchismita Bose.

Physical contact is not the only boundary that isn't black and white. A therapist expressing emotion in front of a client is another grey area. “On one hand, this may make the client feel that it was too heavy for the therapist. On the other hand, some clients may see this as the therapist truly feeling for their situation. While the client-therapist relationship is professional, it is also very human, and it’s imperative to recognise that,” she says. An example of this, Edwards adds, is seen in Lori Gotllieb’s book Maybe You Should Talk To Someone (2019), where the author, who is also a therapist, decides it is appropriate to attend the funeral of a terminally ill client after much contemplation.

Recognising red flags

Once strong boundaries have been set, it’s also important to recognise red flags. Initially, my understanding of what could be considered unethical in therapy revolved around flakiness and forgetfulness. So when I found myself sitting across from a therapist who was cold, curt and confrontational, I was unable to identify the issue instantly. Today, after five years of therapy, I know one thing for sure–not every session will result in a revelation but if you leave feeling judged, it’s definitely not a good sign. “A therapist should not make you feel inferior or mock and reject your feelings. If you can’t express yourself openly or honestly because your therapist might judge or admonish you then that’s not helpful. Also, in the event that this occurs, you should be able to share feedback with your therapist and they should be receptive to it,” says Bose.

The goal of therapy is often to increase the client’s self-awareness, accountability and autonomy, which, according to Bose, can be obstructed if the therapist encourages pinning the blame on others or routinely offers unhelpful advice. “A therapist should not spend time telling you how to best fix or change things. There’s a problem if they tell you what to do and make decisions for you,” she says. Advice can also take the form of examples involving too much self-disclosure. “A therapist constantly saying “this happened to me too, what I did was…” is indicative of a not-so-great session,” says Edwards. While you don’t want a therapist who draws parallels between your experiences and theirs, what you do want is someone who is informed, open-minded and equipped with the relevant knowledge. “A therapist should have adequate training to cater to your needs. For example, if you’re from the LGBTQIA+ community and the therapist has a value clash, it’s a cause for concern. It’s also not okay if your therapist doesn’t agree with your sexual identity. Recently, a client came to me after terminating therapy with a psychotherapist who didn’t believe that the client was polyamorous and tried to convince her that her identity was an ‘issue’ to be resolved. The self-doubt from this rejection was an added painful layer on top of the previous traumatic events,” says Edwards.

No one-size-fits-all

“Clear boundaries and ethical practice are important in every therapeutic relationship but finding a therapist who is the right fit for you goes deeper than that,” says Anusha Manjani, psychotherapist and former lead counsellor at The Akanksha Foundation. Most major decisions in our lives are backed by a substantial amount of research, and trusting someone with your mental health should be no different. “It’s always helpful to do some research in terms of training, approach, fees, timings and so on, and seek referrals from someone who has visited the therapist before,” says Bose. Any lingering feelings of uncertainty can also be addressed through an initial call with the therapist.

“Most therapists will have a call with you to understand your concerns and explain their approach. For example, you might reach out to a therapist to work with sexual intimacy in your relationship and the therapist might tell you that it is not their area of expertise,” says Manjani. Other than an awareness of their expertise, it is also crucial to understand that different therapists may have mastered different methods and there’s no magic formula that works for everyone. “There is no one-therapist-suits-all model. You might have a therapist who works on thoughts and behaviours, and another who utilises bodywork within the session. It is important for you to see which school of thought suits you best,” says Edwards.

The key to persevering through this journey–which is often not quite as straightforward as we’d like it to be–is patience. “Building a deep, trusting relationship in therapy takes time and initial discomfort can be part of the process, so don’t be alarmed if you don’t feel instantly connected. Over a few sessions, you should be able to sense more comfort and trust in the relationship. It is also completely okay to change therapists. Sometimes clients change therapists even after a few years because the areas that you might want to work on might be better supported by another professional,” explains Manjani.

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