There are some clear, relatively straightforward reasons that might prompt you to consider whether you are seeing the right therapist. They sit within the ethical and professional frame of therapy:

• Sexual or romantic boundary violations
• Financial, emotional or personal exploitation
• Serious breaches of confidentiality outside legitimate safeguarding or legal limits
• Repeated humiliation, contempt, shaming or coercion
• Chronic unreliability or significant instability in the therapeutic boundaries
• Persistent failure to listen, particularly when the therapist cannot tolerate being corrected
• Self-disclosure which results in the patient having to reassure, care for or emotionally support the therapist
• Pressure to stay in therapy, demands for loyalty, discouraging a second opinion, or implying that wanting to leave proves that there is something psychologically wrong with the patient
• An inability on the therapist’s part to acknowledge mistakes or consider their own contribution when something has gone wrong between therapist and patient
• A prolonged absence of therapeutic movement where the concern has been raised openly but cannot itself be discussed or thought about

But simply feeling discomfort in therapy isn’t necessarily a bad thing.

Anger, disappointment, feeling misunderstood, dependency or fear of dependency, feeling exposed, being challenged, experiencing painful feelings more intensely, and even wanting to leave therapy are not automatically signs of bad therapy.
Such things can be productive discomfort. Something difficult has happened, but it can be spoken about and thought about with the therapist.
One of the aims of therapy is to create some space between a feeling and the reaction to that feeling. Rather than immediately acting on anger, fear, hurt or rejection, we try to become curious about what has been stirred up.

So if someone says, My therapist makes me uncomfortable, the next question might be Can you tell your therapist that?

If the answer is yes, and the discomfort can be explored together, there may be something therapeutically valuable taking place.

If the answer is no because the therapist becomes defensive, punitive, dismissive or insists that the patient’s experience is simply wrong, that is much more concerning.

Rupture and repair

The healthiest therapy is not therapy without ruptures. It is therapy in which ruptures can become thinkable.

Therapists inevitably misunderstand things. They may say something at the wrong moment, fail to appreciate the significance of something, or simply not understand part of the patient’s world.
That does not automatically mean the therapy has failed. Rupture is not necessarily evidence of bad therapy. The capacity for repair is one of the tests of good therapy.

The important questions are whether the patient can say: That hurt. You misunderstood me. Or even I’m thinking of leaving.

And whether the therapist can remain curious rather than defensive. A good therapist should be able to consider the possibility that the patient may be right.

When psychological theory becomes a problem

Concepts such as resistance, projection and transference can be extremely useful, but they should create more curiosity, never less.

For example, if a patient says, I don’t think this therapy is helping and I’m considering stopping, it is possible that fear, dependency or resistance is part of what is happening. But that should be the beginning of an enquiry, not the end of it.

The concept of resistance becomes dangerous if it is used to make the therapist impossible to challenge.

If every criticism of the therapy is interpreted as evidence of the patient’s pathology, the therapist has effectively created a position from which they can never be wrong.

Self-disclosure

A therapist occasionally saying something about themselves is not automatically inappropriate. A completely impersonal therapist can sometimes feel just as difficult.

The useful question is: Whose need is the disclosure serving?

Does knowing something about the therapist help the patient think or feel more freely?

Or does the patient increasingly find themselves listening to the therapist’s problems, reassuring them or looking after their feelings?

If the patient is having to care for the therapist, the relationship has begun to move away from its therapeutic purpose.

Feeling misunderstood

Misunderstanding by itself is not necessarily a reason to leave. In fact, misunderstandings are inevitable in any sufficiently important relationship. What matters is what happens next.

A therapist saying, in effect, I may have misunderstood you — help me understand is very different from a therapist saying, I know what you really mean better than you do.

Getting something wrong is human. Being unable to entertain the possibility that you may have got something wrong is much more concerning.

Feeling worse in therapy

Therapy can sometimes bring painful feelings closer to the surface, so a temporary increase in distress does not automatically mean that the therapy is harmful.

But Therapy makes you worse before it makes you better should never be used as a blanket justification. If someone’s wellbeing is deteriorating substantially or persistently, that deserves active clinical attention.

When therapy feels stuck

Therapeutic change is not linear, and some therapies — particularly longer-term psychodynamic psychotherapy or psychoanalysis — may unfold over several years. Periods of apparent stagnation are therefore not necessarily evidence that nothing is happening.

But the question What are we doing here now? should always be available for thought. If patient and therapist cannot discuss whether the treatment is still useful, that itself becomes concerning.

Changing therapist and ending therapy

Sometimes changing therapist is absolutely the right thing to do. Sometimes the form of therapy is no longer appropriate, or someone’s needs have changed.

But a therapeutic relationship is also a relationship, and endings matter. Rather than simply disappearing or immediately replacing one therapist with another, when circumstances allow, there can be value in making the ending conscious.
A good ending may involve looking back at:

• why the person originally came to therapy
• what has changed
• what remains unresolved
• what they have learnt about themselves
• and what it feels like to lose the regular relationship with the therapist.

The ending itself can become part of the therapeutic work. Feeling uncomfortable in therapy is not automatically a red flag. The red flag is when the discomfort cannot be questioned, discussed or thought about.