What Makes a Good Therapist?

How to screen for a skillful child/teen therapist who is not captured by radical ideas

(scroll to the end for screening questions)

As a licensed therapist who has provided clinical supervision to therapy students for over 10 years and been in the field for longer, I’ve seen a significant decline in quality and skill level in child/teen therapists. Mental health training programs are more focused on social justice themes than giving their students the skills to help their future patients. Founder of Open Therapy Institute, Andrew Hartz, wrote this great article in The Federalist called Leftist Extremism is Turning Therapists and Counselors Against their Own Patients. He writes how identity politics, critical theories and other Marxist ideas have taken over the field and therapists are more interested in being activists, instead of helping their clients in need.

How do you know if the therapist your child is seeing isn’t competent and overtaken by harmful ideologies? As in many situations, it is very difficult to determine if a mental health 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. Therapists have different credentials, styles, use an array of therapeutic approaches and have a variety of 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 outcomes, 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 mean the person is effective. You also might find them nice, however nice doesn’t equate to good therapy.

Common traits of good therapists

Regardless of the approach, style etc., there are some commonalities that good child/teen therapists all exhibit:

Involves the parents and adults in treatment

One of the most important criteria for a good child/family 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, 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. In addition, without parental input, a therapist simply will not get all the needed information. For starters, if parents are not involved from the beginning of therapy, the therapist is not able to do a complete assessment, which is essential to developing appropriate goals and providing effective treatment. You should be having regular conversations with your child’s therapist, especially in the early phase of treatment. This includes teenagers. Read specific reasons why this is crucial here.

Does a thorough assessment and treatment plan. A good therapist will do a thorough assessment that will include you. The therapist will look at your child's behaviors, what they report, what you report, family history, 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 clues and getting a better understanding of the big picture so they can address issues. This includes a history of developmental milestones of your child, health issues, family dynamics, 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 a divorce, or so many other things. 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. Plus, in the process a good therapist is getting to know your strengths and weaknesses so she can learn how to best support your child and family. Read more about the importance of an assessment here.

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 and don’t be afraid to ask about them.

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 should investigate how this new identity is helping with their pain by bringing a superficial sense of belonging, or a sense of control after dealing with heavy trauma. A sudden new identity is likely not coming from internal sources and a therapist should tease that out. The role of a therapist is helping their clients gain insight, look under the surface and figure out what is truly best for their 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. (Although this is less common nowadays) 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. Good therapists also understand that many diagnoses are not permanent and are not meant to be. Even if someone has certain limits, it is never an excuse to stop trying. 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? The therapy renders useless if the therapist perpetuates a permanent victim perspective. Read more about how victim mentality can be damaging to mental health here.

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 quality 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. What does this mean? A good therapist with appropriate boundaries wants to build a strong therapeutic alliance, but is not trying to make friends with or ingratiate themselves to their clients’ lives. Some examples: They would not ordinarily give gifts or do favors for their clients. An exception to the gift rule may be on the last day of treatment. Another example is around phone and e-mail communication. 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 only. I would be cautious of a therapist who is comfortable texting and e-mailing regularly with patients outside of simple interactions like schedule changes.

A therapist knows their place and would not insert herself in the family. A solid therapist will recognize that you are the parent and are ultimately responsible for your child and not wedge herself in the middle. There may be circumstances they need to call in a report to child protective services, but a good therapist never wants to “rescue” your child, even when things are challenging. The therapist should never be eager to report you because of her overbearing (and inappropriate) feelings of responsibility.

Also, 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 strategically for teaching, but a client should never be helping a therapist with his/her problems and spending more time on them. Also, a good therapist is genuine with emotional expression, but it's not appropriate for them to be over-emotional in sessions, especially if it makes 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 and can explain them. 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. They should be open to different cultures and world-views.

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 we aren’t talking about destructive behaviors, 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. Therapists should accept and embrace their client's religious beliefs. For example, Christianity is often demonized by mainstream therapists. It is looked down upon, or even undermined in many therapy circles. It is the therapist’s role to help a client figure out what their own beliefs are without interference. Sometimes there is conflict in the family around these religious and cultural topics. A good therapist will help their patients sort that out and build family communication, not create a bigger wedge. 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. (I am not talking about dangerous or destructive behaviors and ideas)

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 climate change, politics, violence or illness, unless it is something specific to the individual’s prognosis. For example, too many therapists stoked fear during the COVID era and it is still happening in certain areas. 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 strengths and positive things so your child can manage fear, live with it and overcome it. Developing these capabilities will help create resiliency that the child can draw upon 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.

About your child’s privacy and you: You have a right to know what is happening in therapy with your child in 1:1 sessions. However, they appropriately will not tell you every single detail in order to establish a therapeutic trust with your child, especially with an older teen. Although, 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 any secrets that may have a safety repercussions. That rule also applies to other identifiable children, such as a friends or classmates and even other adults. 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 of physical harm in session, you should be the first to know.

Can identify the appropriate level of care. If your child begins engaging in harmful risky behaviors, such as serious suicidal gestures or heavy substance abuse, an outpatient therapist can no longer 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/unfounded suicide threat towards parents, but not provide any safety measures. For example, “Would you rather have a dead daughter or a living son?” is not an appropriate question. If the suicidality were considered serious, then the child should placed in a higher level of care, which is not being recommended when that unprofessional question gets asked. This question is a manipulative emotional blackmail device and is very anti-therapeutic.

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 and not be afraid to. The client should be working to reach their goals together with the guidance and support of the therapist. Being a “safe space” doesn’t mean zero challenges.

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.

Screening questions:

1. 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.

2. How do you involve families in your work with youth? A child/teen therapist should involve you in the work. You should be a part of the intake process, the assessment and formulating treatment goals. The therapist should also be talking to you regularly about concerns, changes in the family and progress. NEVER EXPECT A THERAPIST TO “FIX” YOUR CHILD WITHOUT YOUR INVOLVEMENT.

3. How do you believe the internet and social media impacts children’s thoughts and behaviors? The therapist should be aware of how kids are learning ideas and behaviors online. They should know that many things they may say are parroted from influencers.

4. How do you incorporate religion into your clinical work? The therapist should be open to religion and see it as a strength. Therapist could be aware of conflicts around faith in the family or individually and be open to discussing it in sessions without imposing their own beliefs onto the client.

5. Do you believe in systemic oppression in the United States and how does that inform your clinical work? There is no systemic oppression in the US, and if the therapist believes there is, those ideas have no place in a therapy office since that concept takes away all personal agency, and is anti-therapeutic.

6. What is your confidentiality policy with children and parents? The therapists shouldn’t keep important secrets from parents, and they must disclose any safety concerns. They should be able to articulate this easily.

7. What do you think of gender affirming care for children? If you believe that sterilizing children is wrong, be sure your child’s therapist agrees with that sentiment.

8. What do you think about the concept “let the child lead”? If you think adults need to lead, be sure that is clear before you work with a therapist who feels children know themselves and know what is best.

9. What do you think about the current medicalization of children’s mental health issues? The therapist should be aware that the use of psychotropic drugs has risen and question whether all of these new prescriptions are appropriate.

10. What is one aspect of mainstream mental health care that you disagree with or question? You want a therapist who will think for themselves and not follow the dogma. They should be able to answer this question. This will show if they have critical thinking.

If the therapist is already working with your family, questions to stay involved:

1. 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.

2. 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.

3. 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, but more often is better. The therapist should be welcoming of your interest to be involved and not shutting you out. Child therapy is usually only 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.

Red Flags:

The following behaviors or actions should cause you to question whether a therapist is competent:

• Does not want to communicate or provide updates to parents.

• Talks to your child about a diagnosis before talking to you.

• Can not answer simple questions about treatment and your concerns.

• Immediately develops a course of therapy/treatment without understanding issues and can not articulate why.

• Gives diagnoses without being able to explain them.

• Makes threats if you do not follow their recommendations or use their prescribed language.

• Spends a lot of time talking about themselves and their personal life.

• Is overly emotional in sessions.

• Texts you or your child often between sessions, like a friend would, and not about professional matters (such as scheduling).

• Plays into victim mentality, such as “teaching” you about “systemic privilege”.

• Over-identifies with your child’s perspective and can’t balance it with yours.

• Only has one style or way of working and can not be flexible.

• Imposes unnecessary fear or anxiety onto you or your child.

• Is trying to divide you from your children, rather than build family connection. (Beware of a therapist with a “rescue fantasy”)

• Can't explain the laws and limits of confidentiality in your state.

• Makes empty suicide threats without imminent danger.

• Is very negative or hopeless about your circumstances.

• On the contrary, if the therapist never confronts any issues.

• Is over-emotional in sessions.

• Uses too much “psycho-babble” without explanations.

• Is overly focused on skin color, gender, and identity in general.

• Has ideologically driven symbols and language on their marketing or in their office. (Example: trans flags)

In summary, my best advice is to 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. Speak up. Don’t be afraid to ask direct questions. You are the expert on your own children and family. Therapy for your child renders almost useless without your involvement or input, so whatever happens, stay involved. Bad therapy is worse than no therapy.

Pamela Garfield-Jaeger is a licensed clinical social worker. 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. Since getting fired for not getting the COVID vaccine, she has dedicated herself to educate parents and embolden other mental health professionals to challenge the ideological capture of her profession.

For more detailed information on how to empower yourself as a parent and navigate the mental health field, see the Parents' Guide to Mental Health. Pamela is the author of A Practical Response to Gender Distress, a tool book for parents who do not want to affirm a false gender identity.

Therapists: earn three professional CEU’s while learning the truth about the gender industry here.

Now here! A cute rhyming children’s book about self-acceptance: Froggy Girl.