When Your Adult Child Breaks Your Heart

Coping with mental illness, substance abuse, and the problems that tear families apart

Is Your Therapist the Right One?

Ten Signs of Healthy Therapy

As of 2011, there were about half a million practicing mental health therapists in the United States. A master's degree is the minimum level of training a therapist needs to begin practicing, and though this means therapists have lots of education, it also means that anyone willing to put in the work can enter the field. The best therapists don't keep their clients for life; instead, they help spur real change in their clients, then allow them to move on. Not all therapists are equally skilled at this practice, though, and every therapy client should critically evaluate whether a particular therapist or therapeutic approach is right for them.

Clear Boundaries

Although a therapist should listen and care, a therapist is not a paid friend, and is certainly not a romantic partner. Your therapist should establish clear boundaries for both of you. A therapist who calls you regularly or intrudes on your personal life dos not have good boundaries, and your therapist should never flirt with you or express romantic feelings. Likewise, your therapist should also limit your behavior. Good therapists clearly explain what is and is not acceptable. For example, your therapist should let you know how frequently you can call, whether it's ok to be friends on social media, and what times of day he or she accepts phone calls.

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The clearest boundary a therapist should have is over confidentiality. Good therapists make their privacy policies clear from the outset, and are at great pains to protect the confidentiality of their clients. Your therapist should not reveal information to you about other clients by using the client's name or describing the client, though your therapist might tell you she's treated people with similar problems in the past. Your therapist also must not report on your therapy session to third parties – including your spouse or your parents – without your explicit, written consent.

Confronting Problematic Thinking and Behavior

Your therapist should make you feel comfortable, but not so comfortable that problematic behaviors and thoughts continue unchecked. Your therapist's ultimate role is not to agree with everything you think or do; instead, your therapist must point out problematic thought patterns. Some therapists do this in an indirect way, by asking you questions that encourage you to gain an awareness of ways your own behavior affects your life. Other therapists are more direct. If your therapist never takes either approach, though, it's probably time to find someone else.

A Defined Treatment Plan

Your mental health isn't that different from your physical health. You'd never go to a cardiologist who didn't offer you a clear treatment plan, and you certainly wouldn't keep going back if your symptoms got worse. Therapy is the same. Your therapist shouldn't keep secrets or behave like your treatment plan is a surprise. Instead, she should discuss treatment options at your first session, then continue checking in with you for the duration of your time together. If something's not working, you should feel comfortable telling your therapist, and your therapist should be sufficiently skilled to make adjustments that improve your outcome.

Use of Scientifically Validated Methodologies

Therapy isn't just time you spend talking about your feelings. While there are many different ways to approach treatment, your therapist should only use methods that are widely accepted and scientifically validated. Treatments such as primal scream therapy and uncovering repressed memories are generally frowned upon, while approaches such as cognitive-behavioral therapy and dialectical behavior therapy are widely accepted. Ask your therapist about her methods, then research them. If something seems off, ask your therapist to stick only to scientific approaches. And if your therapist veers too far into approaches that seem kooky or unproductive, move on to someone else.

Unconditional Positive Regard

Unconditional positive regard is an attitude of acceptance and non-judgment, and all therapists should embrace this approach. Your therapist doesn't have to approve of all of your choices, but should not make you feel like you are deficient, weak, or stupid because of the decisions you make. If your therapist talks down to you or behaves in an aggressive or preachy manner, you're not getting the treatment you need.

Acceptance of Value Differences

Our values form the core of who we are. No matter what you believe regarding religion or politics, your therapist should not try to change your core values. Therapists who push political or religious agendas, or who persist in asking you to engage in practices you disagree with – such as going to church, filling a specific gender role, or behaving according to a predetermined value system – aren't giving quality treatment. They're proselytizing. Your therapist should embrace your values, and the best therapist is often one who shares your basic worldview.

Collaboration with Other Experts

Therapy isn't always enough to help you get better. You might need psychoactive medications or help with health conditions. Good therapists recommend that you seek additional treatment when necessary, and will collaborate with your other medical professionals. A therapist who discourages you from seeking a second opinion, who tells you medication doesn't work, or who believes that home remedies can cure every medical problem doesn't have your best interests in mind.

Embracing Your Relationships

Your relationships with the people who love you are critical to the success of therapy. If you're in an abusive or otherwise dangerous relationship, your therapist should talk to you about it. But good therapists never tell you to cut people off or end relationships; indeed, doing so can signal that your therapist is trying to foster an unhealthy sense of dependence.

Your therapist shouldn't stop with encouraging you to develop healthy relationships, though. The best therapists welcome the people you love into the therapeutic process. An outside perspective can provide your therapist with much-needed information, and many therapists ask you to invite your spouse, best friend, or another significant other – but only if you feel comfortable doing so. No therapist should ever violate your confidentiality or force you to share information with a third party when you don't want to.

The Right Training

It's not enough to be nice or to know the right treatment protocols. Your therapist needs the right educational background and a license in the state in which he or she practices. Ask about your therapist's training and license, then double-check her status with your state's licensing board. A therapist who practices without a license is a dangerous confidante.

Even if your therapist has the right training, though, he should only practice in his areas of competence and training. A psychologist who normally specializes in ADHD and who has no experience treating couples is not typically a good fit for marriage counseling. The best therapists refer their clients elsewhere when they encounter a challenge they're not equipped to handle.

Willingness to Accept Criticism

Therapy exists to help you through life's challenges, not to make your therapist feel good about herself. Every therapist should be prepared to deal with disagreements, and should be willing to tell you when they feel that a disagreement is due to short-sightedness or bias on your part. But even the best therapists make mistakes. For example, your therapist might assume you believe something because of your religion or nationality, or might forget something important you told her. Good therapists are prepared to accept criticism and to adjust their behavior accordingly. If your therapist treats fair and constructive criticism as a sign of mental illness, get away from this therapist immediately.

Therapy is an imperfect process that two or more imperfect people embark on together. You should, however, be able to trust your therapist and must feel comfortable sharing the most vulnerable parts of yourself. If your current therapist isn't working for you, there are plenty of other therapists out there. Take some time to do your research, and listen to your gut. With a little luck, careful planning, and a willingness to try something different, therapy can and will work.

References:

Grohol, J. M., Psy.D. (n.d.). Mental health professionals: U.S. statistics. Retrieved from http://psychcentral.com/lib/mental-health-professionals-us-statis...

Mental health counselors and marriage and family therapists. (n.d.). Retrieved from http://www.bls.gov/ooh/community-and-social-service/mental-health...

Wampold, B. E. (n.d.). Qualities and actions of effective therapists [PDF]. American Psychological Association.

 

Joel Young, M.D., who teaches psychiatry at Wayne State University, is the Medical Director of the Rochester Center for Behavioral Medicine, near Detroit.

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