Finding A Therapist: What to Expect and How to Spot Red Flags
By Ryan Eberst | March 10, 2024
A recent article from WFAA outlines gross ethical violations by a therapist and TikTok personality. Texas regulators have since suspended his license. Unfortunately, this article is not addressing an isolated issue with one clinician, but speaks to a common experience of many mental health patients. (For example, a 2018 article from the Boston Globe suggests that 9-12% of psychologists admitted on anonymous surveys that they have had sexual contact with a patient).
Going to therapy is a deeply vulnerable experience. A patient places complete trust in their therapist, telling them their dreams, fantasies, hopes, goals, struggles, secrets, embarrassments, traumas – basically everything about them. It takes immense courage to enter into this kind of professional therapeutic relationship. Noting these stories and experiences can make it feel impossible to find a therapist.
But the search for a trustworthy therapist does not have to be a risky process of blind trial and error. Therapists are held to an ethical standard by their board, and further professional standards by their training, associations, and certifications. Knowing the ethical expectations for therapists can empower clients to enter therapy confidently, equipped with the knowledge of what to expect, how to identify possible red flags, and what to do about it.
Informed Consent
Mental health providers are required by law to obtain a signed informed consent from any person to whom they provide therapy. Informed consent includes a discussion of fees, scheduling, purpose, goals, techniques and risks of counseling, and how to file a complaint with the board. Everything in an informed consent is important, but related to the current topic, it is especially important to understand the nature of the therapy that will be provided.
Understanding the assumptions, methods, and techniques (what is professionally referred to as a theoretical orientation) the therapist uses can provide a roadmap to understanding ethical treatment. Potential patients should feel empowered to ask questions and obtain clarity about how the therapist works. If the therapist is hesitant to respond or is vague in their response, this could be a red flag. Patients are legally entitled to understand the treatment to which they are consenting. No therapist can predict the specifics of how a therapy process will go. However, they should be able to describe their presuppositions about how therapy works and how they will engage in the process.
Boundary Violations
The success of your therapy journey heavily relies on the therapeutic relationship you build with your therapist. This relationship thrives on clear professional boundaries. These boundaries ensure you feel safe, respected, and focused on your own growth during therapy.
What are these boundaries?
No personal relationships: This includes romantic or sexual involvement, friendships, or business partnerships between you and your therapist.
Financial boundaries: You and your therapist should have a clear agreement about fees. Avoid situations where your financial interests intertwine.
Limited social interaction: While encountering your therapist outside of sessions is possible, they should avoid initiating contact and keep interactions brief and professional.
Touch: A handshake is generally appropriate, but hugs or other forms of touch should only occur with your explicit consent and never be initiated by the therapist. If you feel uncomfortable with any touch, discuss it openly with your therapist.
Therapy-specific boundaries: Different therapy approaches have specific boundaries. These shouldn't contradict the general boundaries mentioned above. For example, a therapist using cognitive behavioral therapy (CBT) wouldn't delve deep into your personal life unless directly relevant to your concerns. However, a therapist using a different approach, like Freudian psychoanalysis, might explore deeper aspects like your childhood experiences or past relationships.
Remember:
Discuss boundaries with your therapist: If anything feels unclear or uncomfortable, open communication is key.
Be informed: Ask questions and understand the specific boundaries within your chosen therapy approach.
Trust your gut: If a behavior feels inappropriate, voice your concerns and don't hesitate to seek a different therapist.
When Therapists Talk About Themselves: Understanding Self-Disclosure
Therapists disclosing personal information can be confusing. While some therapists avoid it entirely, others see it as a tool for connection. Let's explore self-disclosure and how to navigate it in therapy.
Not all self-disclosure is equal:
Strict no-disclosure: Some therapists believe their personal lives are irrelevant and avoid self-disclosure altogether.
Targeted self-disclosure: This approach involves sharing relevant personal experiences to connect with the patient on a deeper level, like a therapist in recovery helping a patient struggling with addiction.
Therapeutic approaches using self-disclosure: Certain therapies, like transference-focused therapy, use the therapist's immediate reactions and thoughts in the session to explore the patient's experiences and relationships.
Practical disclosures: These are necessary to maintain professionalism and respect patient time, like informing them about upcoming absences due to personal circumstances.
Red flags to watch for:
Oversharing: Therapists should never share intimate details about their personal lives, struggles, or relationships.
Shifting focus: Self-disclosure should always benefit the patient, not create a situation where they feel responsible for comforting or caring for their therapist.
What to do if you feel uncomfortable:
Openly communicate: If the therapist's self-disclosure makes you feel uncomfortable, bring it up directly and express your concerns.
Seek a new therapist: If the therapist is dismissive or unwilling to address your concerns, it might be time to find a therapist who aligns better with your needs.
Keeping the Lines Clear: Communication in Therapy
Communication is vital in therapy, and knowing how your therapist handles communication outside of sessions can be helpful. Here's what to expect:
Setting expectations:
Your therapist should discuss communication boundaries and expectations at the start of therapy. This includes preferred methods (email, text, etc.) and response times.
Different approaches, different styles:
Some therapists prefer email for all communication, while others may be open to texting. Some may offer phone calls or video sessions, depending on your needs and their practice.
Therapists may also use communication strategically, like sending texts of encouragement during challenging times.
When therapy extends beyond sessions:
Some therapy approaches, like Dialectical Behavior Therapy (DBT), involve scheduled "coaching calls" between sessions to practice skills for daily life.
Respecting boundaries:
While communication styles vary, professional boundaries remain crucial. Communication should never be casual or overly friendly.
If the therapist's communication feels unprofessional, discuss it openly or consider finding a new therapist.
Conclusion
The list of red flags discussed is certainly not comprehensive; it only addresses some of the more common ones. If you feel like there are red flags with your therapist there are a few different ways to approach it:
Speak with your therapist about it – if you generally feel safe with your therapist and have had a working relationship with them, the first step is to talk with your therapist about your concerns. Therapists are trained and educated, but they are still human. It may be a simple misunderstanding, or a failed attempt at communicating care. It may be that discussing the red flags opens the work up to new or different direction that was needed but unknown. The presence of red flags does not necessarily mean that you need to find a new therapist. The important thing is that the therapist is able to engage in the discussion about your concerns without being defensive or dismissive.
Get a second opinion – general advice is to stick with one therapist and work through things. However, if you are concerned that your therapist is being unethical, consulting with another therapist may be a good option, especially if you’re not sure about bringing up your concerns with your therapist. If you know the specific approach your therapist takes, it is helpful to find someone to consult with that works from the same theory.
Find a different therapist – regardless of your concerns, if you feel unsafe with your therapist or do not feel like you can discuss your concerns with them, it may be best to find another therapist. A safe therapeutic relationship is essential to any therapy, regardless of the therapist’s approach. If you do not feel safe with your therapist, it’s probably time to move on.
Report – If your therapist has made clear boundary violations, then they should be reported to the board. If you have found a new therapist, and are unsure if your previous therapist should be reported, discuss it with your new therapist. They will know the code of ethics enough to help you discern whether or not they should be reported, and will make their own report if needed.
(The above guidelines discussed in this article are drawn from the Texas Behavioral Health Executive Council ethical code of conduct for licensed professional counselors. This has been selected for a few reasons: 1. In the State of Texas, there are more LPCs (22,709) than all other mental health licenses combined (LMFT – 2,979, LCSW – 8,799, Psychologists – 4,823). 2. While there are specific differences in the ethical guidelines for each license, there are more similarities than differences. 3. the author of the article holds an LPC).
