What Makes a Good Therapist
This is from my Parents' Guide to Mental Health: www.thetruthfultherapist.org
How do you know if the therapist your child is seeing is competent? As in many situations, it is very hard to determine if a professional you are working with is a good one. It’s much easier to tell when a repairman or mechanic doesn’t do a good job. You may be unsure about a therapist you are working with for many reasons. Different therapists have different credentials, styles, use different therapeutic approaches and have different personalities, none of which make them good or bad. While the only real indication of how good a therapist is for your child lies in the results you and your child sees, the following criteria and observations may give you a better understanding of what to look for in a therapist and what may be some red flags:
*It is important to note that just because your child likes the therapist, it does not necessarily make the person effective.
Regardless of the level, approach, style etc. there are some commonalities that good therapists all exhibit.
Considerations:
I believe that one of the most important criteria for a good therapist is one who makes an effort to involve you, the parent, and other important adults involved in your child's life. Collaboration is essential in good mental health treatment for youth. If a therapist does not involve you, they will only get one side of the story or over identify with your child and not understand and evaluate multiple perspectives preventing a well-rounded approach. A therapist who does not include the parents in the treatment plan is more likely to impose their own values and cultural beliefs on your child, rather than working collaboratively. If you are not involved at the beginning of therapy, the therapist is not able to do a complete assessment, which is essential to determining the overall situation, developing appropriate goals and providing effective treatment.
Does a thorough assessment and treatment plan. A good therapist will do a thorough assessment that will include you and your family history. The therapist will look at your child's behaviors, what they report, what you report and what other collaborative contacts report-such as doctors, teachers, or previous therapists- (with your consent) to get a comprehensive idea of what the issues your child is facing. A good therapist is like a good detective, looking for behaviors, clues and getting a better understanding of the big picture so they can address issues. This includes considering health issues, family dynamics, genetics (e.g.: history of mental health in the family), past trauma, cultural issues, communication issues, academic issues, social issues, recent life changes such as a move, or so many other things when developing a diagnosis and treatment plan. As the parent advocating for your child, you should ask the therapist what their impressions are and what they believe to be the best treatment plan for your child and family and have a thorough collaborative discussion.
Develops, sets, and communicates clear treatment goals. The goal of therapy is to help patients understand and/or manage issues that are creating problems, it is not to create long-term “professional” patients. There should always be checkpoints and goals. A good therapist works collaboratively with you and your child to create these treatment goals and measure progress against them. You should be able to discuss them freely. The length and frequency of treatment will vary depending on the situation, but regardless, the intention should never be forever therapy. There should be visible and accepted goal posts.
Addresses underlying issues with compassion. This is the reason a thorough assessment and treatment plan is so important. Good therapists don't simply affirm a child's worldview and take things for face value but explore what may be causing distress. For example, if a teen has past sexual trauma, and suddenly is requesting a gender change, the issues around trauma and self-worth should be addressed before “congratulating” the child for “being brave” with their new identity without further exploration. A therapist could investigate whether this new identity is helping with their pain by bringing a sense of belonging or a sense of control that is being craved after dealing with heavy trauma. It may not be coming from internal sources and a therapist should help tease that out. The role of a therapist is helping their clients gain insight and figure out what is truly best for their own lives, both in the short term and in the long term.
Can simultaneously can show compassion, while promoting personal responsibility. There are some people that need more compassion in their lives and some that need more limits and direct messaging. Most people need a mixture of both. However, some therapists can fall into the trap of being enabling and aligning with “victim mentality” or conversely, becoming too confrontational, in a way that messages can not be received. A therapist should know that having a mental health issue or being a part of any identified group does not make anyone a victim and it should never limit someone in their potential, and the group should not be the focus. Even if someone has certain limits, it is never an excuse to stop trying to reach life goals. Every individual has their own challenges. However, if a therapist doesn't help a patient reach past those limits, how are their clients supposed to thrive?
Can see greatness in all their clients. It is sometimes challenging for a therapist to see the greatness in their clients and hope for the future if client is really struggling. However, a great therapist will work through that struggle and keep hope alive, even during the darkest times. A therapist should be a great champion for their clients, no matter what the circumstances are.
Has appropriate boundaries. A good therapist wants to build a strong therapeutic alliance but is not trying to make friends with or ingratiate themselves to their clients. Some examples: They would not ordinarily give gifts or do favors for their clients. An exception may be on the last day of treatment. Most therapists usually have a separate business phone line and not accept calls at all times. Some specific therapists keep themselves on-call with high-risk clients, but this is for safety and clinical reasons. A solid therapist will recognize that you are the parent and are ultimately responsible for your child. There may be circumstances they need to call in a report to child protective services, but a good therapist does not want to “rescue” your child, even when things are challenging. CPS should never be called based on differences in ideology or religion. A therapist should be personable and open but should not share so much personal information that it gets in the way of your child's therapy. Self-disclosure may be used to form a connection and used for teaching, but a client should never be helping a therapist with his/her problems. Also, a good therapist is genuine, but it's not appropriate for them to be over-emotional in sessions, especially if it makes anyone in your family uncomfortable.
Can adapt their style to your child and family's needs. A better therapist knows many therapeutic approaches, not just one or two. Ask them what their theoretical framework is. Ask them what type of therapies they have training in. They should be able to articulate that clearly and convey how they expect it to help your child. They should be able to adapt to your child's development level and type of concern if they are a good fit. They should be open to different cultures and world-views. (See my introduction therapy to learn about different ways therapists’ work.)
Does not impose his/her personal views onto their clients. It's the therapist's job to work with the individual and family on that families beliefs (within reason of course). They should not try to convince a client of their own opinions and views. For example, if a client is a vegetarian, a therapist shouldn't tell then they should eat meat because it's delicious. If a client likes a certain genre of music, a therapist can share a similar interest, but should not cast a negative judgment on a client's taste in music which can really put a wrench in the therapeutic alliance. It isn't important what the therapist does or doesn't like, it's important for the client to figure out what he enjoys without shame. The same goes with religion. If a therapist is good, their personal religious beliefs are irrelevant. Therapists should accept and embrace their client's beliefs, whatever they are. It is the therapist’s role to help a client figure out what their own beliefs are without judgment and interference. This concept can be applied to most topics. A therapist doesn't need to agree with their client to be effective, they need to be open, accepting and keep their contrary opinions to themselves.
Does not reinforce or create fear. With children exposed to so many concerning topics, legitimate or not, children need some protection from fear. In therapy, they should not be discussing anxiety-inducing topics such as how the world may end due to environmental issues, violence, illness, or others unless specific to their diagnosis and treatment. A therapist should help a child become more grounded and learn ways to manage anxiety not add to it. Your child's therapist should be focusing on the child's strengths and positive things in their life so they can manage fear, live with it and overcome it. Developing these capabilities will help create resiliency that the child can draw on in the future.
Understands confidentiality and its limits. A therapist should respect you and your family's privacy. They will need a signed release of information to speak with your family doctor or your child's teachers. They should never put anything about you or your child on social media without your permission. You have a right to know what is happening in therapy with your child, however, they appropriately will not want to tell you about every detail in order to establish a therapeutic trust with your child. Confidentiality must be broken when there is a safety concern and that should be explained carefully to you and your child up front. Your therapist can not keep secrets that may have a safety repercussion. That rule applies to other identifiable children, such as a friends or classmates. For example, if your child is worried about a friend's safety, the therapist has an obligation to call that child's parents or call the police, depending on the level of risk. If your child shows any imminent risk in session, you should be the first to know and develop a safety plan with the therapist.
(a safety plan is a one- or two-page document done with a client who is at risk of engaging in dangerous behaviors to give them resources to prevent dangerous urges. It usually includes important phone numbers, coping skills, helpful mantras, or other ideas tailored to the client that can help prevent self-harm)
Can identify the appropriate level of care. If your child is engaging in risky behaviors, such as suicidal gestures or heavy substance abuse, an individual therapist in private practice usually does not provide an appropriate level of care. A good therapist will know when they need to refer your child to a more comprehensive program. A bad therapist will use an empty suicide threat as a weapon without any safety measures.
Expects their client to work hard. Being a client in therapy isn't easy and involves doing a lot of hard personal work. An inexperienced therapist may not expect as much from their client, they may not challenge their client, or may even be working harder than their client. A therapist must be able to encourage their patients to do the appropriate work. The client should be working to reach their goals together with the guidance and support of the therapist.
Welcomes open communication and can handle conflict in a professional manner. You should feel safe to bring up concerns and issues. A therapist should be open to feedback and invite open communication. If a therapist cannot receive appropriate feedback well or becomes defensive or demeaning it is a significant problem. If this is the case, I recommend finding a new therapist immediately.
Questions to ask:
What is your style of working with your clients? The therapist should be able to give you a thorough answer and it should involve types of interventions, techniques and theoretical frameworks. Note: affirmation is not a therapy technique.
How do you conceptualize my child’s behavior? The therapist should be able to discuss some of the underlying issues, and explain their hypothesis on why your child is struggling. For example, trauma, grief, family communication issues, genetic disposition, autism, online influences, etc.
What is the diagnosis? The therapist should be able to tell you a diagnosis, or at least describe what symtoms and issues they believe they are treating. Its OK if they can’t name a diagnosis, but they should be able to articulate whats being treated.
What is the treatment plan? You should ask for a copy of a written treatment plan for your reference. It should be a few pages that includes specific treatment goals. You should be a part of building this treatment plan.
Throughout the therapy, ask how they believe your child is progressing and what the possible barriers are. Offer to work collaboratively so your child can reach goals. You can do this at least once a month or more often. The therapist should be welcoming of your interest to be involved and not shutting you out. Child therapy is most effective when the therapist consults with the parent regularly and keeps the parent involved in the process. If they do not want you involved, that is a major red flag. Below is a longer list of red flags:
Red Flags:
Based on the considerations above, there are some behaviors that create a ‘red flag’. The following behaviors or actions should cause you to question whether a given therapist is the right fit for your situation.
Does not want to communicate or provide updates to the parents.
Immediately develops a course of therapy/treatment without understanding issues.
Makes threats if you do not follow their recommendations.
Spends a lot of time talking about themselves and their personal life
Plays into victim mentality.
Seems to have a "savior complex".
Only has one style or way of working.
Imposes unnecessary fear or anxiety onto your child.
Is trying to divide you from your children
Can't explain the laws and limits of confidentiality in your state.
Is over-emotional in session.
Doesn't have hope for your family.
***Remember to trust your instincts. If something seems off, don’t dismiss it just because you are facing an “expert”. Be confident in your judgment. You are the expert on your own children and family.
Pamela Garfield-Jaeger is a licensed clinical social worker in California. She completed her MSW in 1999 from New York University. She has a variety of experience in schools, group homes, hospitals and community-based organizations as a clinician and supervisor. Since getting fired for not getting the C*VID vaccine, she has dedicated herself to educate/empower parents and embolden other mental health professionals to challenge the ideological capture of her profession. She provides consultations for parents and has written a parents’ guide to mental health: www.thetruthfultherapist.org.
NEW BOOK COMING SOON:
What is the difference between therapy and counseling? If one defines truth according to scripture:
Proverbs 1:5 KJV — A wise [man] will hear, and will increase learning; and a man of understanding shall attain unto wise counsels:
"Therapy" is not a biblical word. Not sure how it differs from counseling