When the Therapist Dislikes the Patient

Posted on March 30th, 2011 by Dr. Blumenfield

What should psychotherapists do if they realize that they don’t like a particular patient who has come to them for help?

First of all, we should realize that it is a virtue that a therapist can recognize and acknowledge to themselves  negative feelings towards a particular patient. One can’t expect to like every person you meet and just having some negative feelings isn’t necessary a contraindication to working with someone. If the feelings are minor it should not interfere with the treatment and the therapist would keep these feelings in mind but proceed with the treatment. In fact as will be described, the awareness of such feelings may actually assist the therapist in carrying out effective therapy.

Therapists are usually trained to reflect on their own feelings as they work with a patient, particularly when they are aware of strong positive or negative feelings. In the case in question, where the therapist is becoming aware that he or she doesn’t like the patient, the self oriented question is “Why don’t I like this patient?” The answer may  be obvious, such as the patient is inconsiderate, self centered, prejudiced , anti my political or religious beliefs etc. One doesn’t necessarily dislike a person who meets such criteria and therapists in their self reflection need to include the contemplation of “What do I know about myself that might help me to understand these feelings?” It may be that the patient reminds you of a significant person in your life or certain situations which have occurred to you. One more additional self directed question should be “Can I work with my own feelings and try to help the patient or are these feelings too strong for me to objectively work with the patient? Also, am I just not inclined to work with the patient even if I understand why I feel this way?”

If the awareness of the dislike for the patient comes during the initial consultation and the therapist is not inclined to work with the patient,  it may be relatively easy to refer the patient to a a colleague. A therapist not uncommonly will refer a patient to another therapist after the initial consultation if a therapist with special expertise might be better suited to treat the patient or if the therapist and the patient’s schedules don’t mesh for setting up ongoing therapy. On occasion, the consulting therapist might feel, after an initial consultation, that the therapy should be by a person of another sex, background or age. While these situations are less common, it may happen. Therefore referring the patient to someone else whom you feel will work better with the patient after you have initially examined the patient is ethically proper. Our guideline is to do no harm to the patient and do everything in the patient’s best interest. Therefore it most likely would only be hurtful to the patient to explain that you don’t like the them and that is why you are making the referral, therefore you shouldn’t do that. This may put you in the position of having to tell a “white lie” by saying that your schedule doesn’t work or that you are sending them to another therapist whom you feel is better suited for them (although this may technically be the truth). The therapist has to make the decision whether to discuss the reason for the referral. If the reason was one which there was a good possibility that another therapist might have the same problem ( ie. The patient was a member of the Klu Klux Klan or was a psychopath etc,) it would be best to discuss this with the potential new therapist in order to find someone who could separate their own personal feelings and work with the patient. When the reasons were totally personal  (the patient reminded the therapist of someone or some personal situation ) such a discussion would not be necessary. In such case, a general reason or a scheduling problem could be given for the referral or you could share this information with the new therapist.

When the awareness of the dislike for the patient occurs during ongoing therapy, referring the patient to someone else becomes more complicated as interrupting the therapy would have to be weighed against the therapist concluding that they can’t help the patient due to their own feelings. Psychodynamically  trained therapist are usually trained to recognize and work with their own countertransference and this would be the preferred mode of operation. This approach not only facilitates insight into self but also has the opportunity to facilitate the ongoing therapy. The therapist should always have the option to seek the assistance through a consultation with a colleague, a clinical  supervisor or their own therapist and certainly if they themselves are in ongoing therapy – this situation should be closely examined. Therapists should be constantly monitoring their own feelings and the awareness of some negative feelings about the patient is not unusual.

In fact the experienced therapist knows the kind of issues which push their own buttons and an emotional reaction to the patient may be the first opportunity to identify some conflict within the patient that both the therapist and the patient may not have had a conscious awareness.

5 Responses to “When the Therapist Dislikes the Patient”

  1. Bryan says:

    I have this issue with my current therapist. Tries to push their religious beliefs on me in a dogmatic way. In my last two sessions I became uncomfortable because of it and when I tried to challenge their views and talk to them, they became authoritarian and telling me this is the way it is, religiously/doctrinal. Sad thing is they just showed they are the type of temperament and/or personality that I have a hard time dealing with. My decision is to switch therapist. Not sure if complaining is the best thing to do but how do you address this with a new therapist?

    • Do it exactly as you describe . Get another consultation and talk about your concerns. It sounds as if you tried talking with your current theapist about your concerns and it didn’t get you anywhere. Good luck


  2. Dianne Short says:

    I have seen a psychiatrist at the VA for medication management only. I have only seen him 3 times, but he has already told me twice that I am not his patient, I am the System’s patient. I have never been told that before by any health care provider at the VA and it makes me feel really bad. I believe he said this to me because he has dislike for me. Should I ask for another mental health provider? Thank-you

  3. Dena says:

    I’ve been seeing my therapist for 2 years. I’m concerned she is harboring negativity towards me because 3 months ago she recommended I take a 6 month break from therapy. She said I’m self-absorbed and she said I need to work on that by myself. My diagnosis however, is depression and GAD with chronic suicidal thoughts. She obviously didn’t feel I needed therapy for that any longer. She said if I felt that I could still benefit from therapy after 6 months, then I can call her back to reschedule. Other than that, there has been no further explanation and she has not returned any of my calls since. I don’t understand why she did this to me. I really want to resume therapy again with her, but I’m afraid.

    • We can’t understand what is going on in the mind of your therapist and if she is having ” countertransference” related to her own psychological issues. The best thing for you to do, in my opinion, would be to seek a second opinion from an experienced therapist on the value of you continuing your therapy Certainly, it seems like a good idea for you to be able discuss your feelings and reactions to your therapist.

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