REASONS A THERAPIST CAN’T WORK WITH YOU, EVEN WHEN IT’S A GOOD FIT
Part Two. Click to read Part One.
Everything else being equal, having met all fit categories (clinical, financial, scheduling, personality), including feeling that it’s a good fit both ways, sometimes a therapist still won’t be able to work with you. I know, it sucks, but it’s true. It can get especially tricky around ethics. There are some hard lines that cannot be crossed, and others that are more challenging to navigate. Ultimately, it’s the therapist’s call since it is their professional license on the line, their reputation, and their risk tolerance. Rest assured, most clinicians will wrestle with these situations at one point or another and hopefully, make a decision based on everyone’s best interest.
3 Reasons A Therapist Can’t Work With You
1) Conflict of Interest
Business Dual Relationship - If you do business with the therapist in any capacity, seeing them in therapy may pose a conflict of interest. It’s important for therapists to maintain a degree of neutrality and not know you in other relationships in order to help you from the most objective perspective. For example, if you deliver mail to them, work in their favorite grocery store, or sell them products, services, or software.
The degree to which this is problematic or ill advised may vary depending on location (rural vs. urban), availability of services, specialty/expertise, intensity of the relationship (how well you actually know the person), and frequency/intentionality of contact outside and between sessions.
Personal Dual Relationship - If you know the therapist on a personal level or through a personal connection, it is usually discouraged to see them for sessions. For example, your best friend currently meets with them, your brother used to see them, you are close colleagues/acquaintances, or you used to date (please don’t try to date or initiate physical contact with your therapist!)
Again, many of these may be dependent on multiple factors and are usually not clearcut (not dating your therapists/clients or having sex with them is absolutely clearcut. Don’t do it). Although most dual relationships are generally discouraged, they may not necessarily prohibit you from meeting with the therapist, as long as you are both upfront about the relationship, recognize the limitations, and weigh the benefits against the costs. Of course, other relevant ethical and legal standards must be considered in this determination. Therapists will often consult with trusted colleagues and/or supervisors to make the best decision for the circumstance (this is typically done without revealing any of your personal information to maintain confidentiality).
2) Personal Reasons
Therapists are people too. I know you know this, but it’s sometimes hard to remember, especially when you are struggling and thought you found the perfect fit therapist.
Therapists may be going through a tough time. They may have lost a loved one, they may be battling their own medical challenges, they may be extremely triggered by specific situations - trauma, crime, abuse, kids, animals, politics, disease, etc.
Whatever the reason is, they may not be able to work with you at this time, even if at some other point in time they might have. This is for the best. If they don’t believe they can help you - for whatever reason - then you will be better served by someone else, even if they don’t seem as good a fit given the other criteria.
You don’t want a therapist who will monopolize your session time, become inappropriately emotional, or express biases against you, even if unconsciously or unintentionally, as well meaning as they are. Hopefully they have the insight to recognize if this occurs for them or someone else points it out to them. They may give you the specific reason or just tell you it’s not a good fit, they’re not available, or give you referrals for someone else.
3) Licensing Regulations and Location
Most mental health providers can only offer therapy in the state that they are licensed in. In addition, a client usually needs to be in the state in which the therapist is licensed at the time that they are being treated (this may vary by state and new reciprocity laws). This is especially important given the growing use of teletherapy options.
For example, if you are located in New Jersey and commute to New York for work, you can meet with a New York therapist in their New York office. However, if you work from home in New Jersey and the therapist doesn’t have a New Jersey license or permit, they are not allowed to treat you.
This poses a huge limitation and burden on both therapists and clients. It is devastating to work with someone who is by all accounts a great fit only to find out you have to stop treatment because the client is moving and/or the therapist’s license has changed. Trust that it may be as heartbreaking for the therapist as it is for you and that they would often choose to continue working with you if it weren’t for these regulatory limitations.
Many therapists see clients in-office and by video. Try one or both options and see what works best for you. Reserve judgment until you’ve tried them as they each offer unique pros and cons. Once you decide, factor it into your search. A therapist can be a good fit by every other category, but if you want in-person and they don’t have an office, that’s an impasse.
Remember, if a therapist tells you it’s not a good fit, it does not mean it’s about you (though it is for your benefit). If you tell a therapist you want to keep looking, that’s well within your rights. They won’t be mad or upset with you and definitely shouldn’t tell you if they are (that’s a red flag and a sign to find someone else). They may feel disappointed if they’ve enjoyed working with you, thought they were helping, or think they can be a good fit, but that’s not a reason for you not to find someone YOU feel is a better fit. You can definitely talk to them about it and they may even be able to help you find someone else and support you while you look.
You deserve to find a therapist who will help you feel respected, understood, and empowered. You will gain awareness, learn to accept yourself, see things from a new perspective, improve your relationships, and build a toolbox full of strategies to get you through the most challenging as well as fun times. At least that’s what I strive for with my clients.
Something I was taught all throughout graduate school is that therapy is an art and a science. While it’s true certain things are done “by the book” in order to achieve specific outcomes, other things are flexible, depend on the situation/person/time, and may be totally unpredictable. Therapists are said to have “clinical judgment,” you might refer to a similar concept as “common sense,” and we may all sometimes rely on “intuition” or “gut feelings.” All of these contribute to “fit” in therapy.
Summary
There are four categories of “fit” in therapy and an additional surprise one. The four categories are: Clinical, financial, scheduling, and personality. The surprise category is the therapist’s perception of the fit. There are also ethical, legal, and personal considerations a therapist must take into account to determine if they can work with you. These are not signs of rejection or that something is wrong with you or the therapist, but that it is simply not a good fit. Fortunately, especially with advances in teletherapy, you have more options than ever to work with a great fitting therapist for you.
If you missed part one, click to read, What Is “Fit” In Therapy
Disclaimer: Nothing in this article should be construed as legal or ethical advice or evidence-based data. These are simply my views and opinions based on my personal and professional experience as a psychologist in NYC. I have my own unique perspective which may be very different from yours or your therapist’s. This is for informational purposes only.
If you’re a professional in New York or Florida and you struggle with stress, anxiety, or OCD, schedule your free 15-minute phone consultation with me to see if we’re a good fit for each other.