Giving Your Therapist Negative Feedback

Source: Burlingham/Adobe Stock

Eliciting and receiving feedback from clients is an essential part of cognitive behavior therapy (CBT). We therapists aren’t mind-readers, and, because we’re only human, sometimes we make mistakes. And when we do, we want to know, so we can make changes and improve therapy.

Some clients have no problem telling us when we have said or done something that rubs them the wrong way or when we’ve misunderstood them. But others have certain beliefs and thoughts that can get in the way.

Thoughts That Get in the Way of Giving Feedback

Some clients may think, “My therapist will get mad at me if I give them negative feedback,” or “My therapist is the expert—I should defer to them, even if I feel they got something wrong.” These types of automatic thoughts can prevent clients from speaking up when their therapist has made a mistake. That’s why CBT therapists carefully monitor how clients are feeling during the session.

When we infer that clients have experienced a negative shift in their mood, we often pause the session and say, “You’re looking a little distressed [or a little more distressed]. What was just going through your mind?” Sometimes clients are having a negative perception of us or of the process of treatment.

Whenever we get negative feedback, we say something like, “It’s good you told me that.” And it is good. If we’ve misunderstood something they said, we want to apologize and correct our understanding. If clients have accurately perceived us as inattentive or too controlling, we want to apologize for that, too, and talk about how we can prevent that from happening in the future. If the process of therapy bothers clients, we may need to change what we’re doing. So, honest feedback is important in keeping us on track.

Inaccurate Thoughts About the Therapist

Sometimes, though, a client’s negative feedback may be related to an inaccurate thought about the therapist—for example, “You probably think I’m making too much of this situation,” or “You don’t care about me.” Even though the client’s interpretation may not be accurate, it’s still helpful for us to know. Again, we positively reinforce clients for their feedback. Then we generally ask clients to elaborate, and we may ask them if it’s OK for us to figure out together the degree to which their perception is accurate.

Often, the inaccurate thoughts clients have about their therapists reflect patterns of thinking that may exist outside of therapy as well. A client who thinks her therapist doesn’t care about her may also think that friends or family members don’t care about her. Examining the evidence for and against this thought in the context of the therapy relationship may teach her strategies she can use to determine if others care about her.

Asking for Feedback

Although we try to pick up negative shifts in emotion during the session, sometimes we miss the signs that this has happened. That’s why we ask for feedback at the end of every session. At the beginning of treatment, we discuss why providing feedback—both positive and negative—is so important.

At the end of the first few sessions, we might ask: “What did you think about the session today? Was there anything that bothered you or anything you thought I got wrong? Is there anything you want to do differently at our next session?” After a few sessions, when we believe that clients feel free to give us negative feedback, we might just ask the first question. And if we believe clients might not be forthcoming, we might ask a specific question like, “How much did it bother you when I was encouraging you to talk to your family member?”

Not all kinds of psychotherapy espouse direct elicitation of feedback. But, in CBT, we’ve seen how it helps to build a good, trusting relationship with clients, which leads to better outcomes.