I hate lousy therapist stories. Just like accountants hate lousy accountant stories. An accountant can mess with someone’s finances, perhaps their financial future. But a psychotherapist can mess with someone’s well-being, their self-confidence, and their ability to trust.

I’ve heard stories of therapists who fall asleep during sessions. Or a therapist who said to a client who disagreed with them, “It’s not all about you, you know.” Wrong. A foundational principal of psychotherapy is that it IS all about the client. While it is a relationship, it is not reciprocal, and it is the therapist’s job to make sure it stays that way.

Therapist self-disclosure is included in the Code of Ethics of every discipline. Done well, it can be empowering for the client and enhance trust in the relationship. But whatever is shared must always be for the benefit of the client. The therapist must make sure that whatever lesson or healing he is trying to impart cannot be done another way not involving self-disclosure.

The most blatant malpractice involves the therapist having a business or sexual relationship with a client, or in any way benefiting personally from the clinical relationship. I have had clients who are techno-wizards, where I’ve had no doubt they would have enjoyed sharing their expertise with me. I’ve never pursued this, however, as this sort of thing is always a slippery slope to boundary violations.

Bartering is actually ethical, but I have never been comfortable with that either. I heard of a therapist who allowed a client to clean her house in return for therapy. This sort of thing only serves to cement a hierarchy of roles that is inimical to effective psychotherapy. I have always chosen to offer my services pro bono rather than engage in bartering.

Therapists need to make a living like everyone else. But psychotherapy is analogous to health care in general, whereby if profit is the prime motivator, quality of care will suffer. Another given is that a therapist must never, ever violate confidentiality.

Then there are the therapists who don’t rise to the level of malpractice, but are nevertheless incompetent. Therapists who over-diagnose, and who relate to their clients as diagnoses rather than as people. There are no scans or blood tests for psychiatric diagnoses, so therapists must proceed cautiously.

There are therapists who claim they can treat anyone, rather than training in a specialty and sticking to what they really know. The type of incompetence I hear most often concerns therapists who still know little or nothing about trauma. It is trauma, not serotonin, that causes the most emotional suffering.

There are therapists who are overly rigid concerning their schedule, and will cut someone off in the middle of a sentence rather than extend a session. There are therapists who eat or take calls during sessions. There are therapists who fail to help their clients set personal and familial goals for their treatment.

Meta-analyses of therapy effectiveness always point to the quality of the relationship, and feedback. Relationship and feedback go hand in hand. I encourage clients to provide feedback, offer them a feedback form, and regularly ask how they’re feeling about our process and if there is anything they would like to change.