Red flags and therapists?
Have you ever attended therapy, either with the NHS or privately and was it a positive experience? Are you considering therapy? If you’ve never been to see a therapist/counsellor, perhaps you don’t know what to expect, or what to look out for in a therapist? Let me say, if you are thinking of therapy, you might want to read and consider some of the therapists and red flags listed below.
But first — this post came about after a friend (an Occupational Therapist) told me she’d had six sessions of counselling, which she accessed through her work’s Wellbeing programme. While she said there had been an improvement in her mood, she would never go to counselling again! She hated the therapist who allegedly looked bored, was too blunt, always late and talked about herself a lot of the time. “She looked like she should be in counselling,” moaned Hayley.
We talked about how many other people we knew that had had bad experiences with therapists, and all for various different reasons. I’ve seen 5 different therapists over the years, and although one was excellent and a few were good (ish), the final one was so awful, I didn’t go back after the second session. My first time was arranged via my GP, it lasted over three years and my therapist was fantastic. The other four times were accessed through my NHS Trust’s Wellbeing programme and the difference between these therapists and the first one was like night and day.
In the UK, most NHS Trusts provide workplace counselling as an employee support. The service is usually short term and provides an independent, specialist resource for staff – a free, confidential, workplace counselling service. Sounds great, doesn’t it?
However, during my chat with Hayley, we both thought, how do you tell if a counsellor is any good? Why was one better than the rest for me? In hindsight, I think the problem for me was that these independent therapists tend work on a freelance basis, and although they are all registered and approved by their various governing bodies, they are not vetted by the Trusts themselves.
Then Haley and I thought, what about all those people that have to pay to see a therapist? I’ve since looked online and seen that, in London, you can pay anything upwards of £70 and often way over £100. Although I believe that counselling is a great investment in yourself, if the therapist is ‘no good’, it’s a terrible waste of a lot of money. I’d hate for that to happen to you so I’m going to share some of the red flags you might come across. But first,
Before you go into therapy, you may want to ask your therapist about:
- their background and qualifications
- the type of therapy they practice. If they have a specialism, as some therapists specialise in working with particular issues like abuse and violence, addictions, LGBTQ, or survivor groups
- their experience of working with the problem you’re experiencing
- how long the therapy will last
- the benefits and any risks involved
- their confidentiality policy
- whether they have a waiting list and how long it will take to get an appointment
- if you have a disability and need reasonable adjustments to make the sessions easier for you to attend.
Let them know if you have any preferences i.e male or female therapist or someone who speaks your first language.
Therapists red flags
In no particular order, and though counsellors and therapist might offer different therapies, I’ll use the word therapist throughout and for ease I’ll say she or they, so, if she
- doesn’t talk you through what will happen during counselling, like which type of therapy i.e. CBT and a short explanation about the concept and how long it will last
- doesn’t provide you with information about your rights as a client i.e. fees, her policies, or confidentiality
- constantly misses, cancels, or shows up late to appointments
- looks down on you or treats you as inferior, subtly or not
- blames your partner, family, or your friends, or encourages you to blame them
- doesn’t have sufficient or specific training to help with your problem and/or she tries to treat problems outside the scope of her specialism
- can’t or doesn’t clearly define how she can help you solve whatever problem that brought you to therapy
- isn’t interested in the changes you want to make or your goals for therapy, and works from her own agenda
- speaks in the language (psychobabble) that confuses you
- discloses that she’s never done personal therapy work (maybe she’s only done group work)
- gives no explanation of how you will know when your therapy is complete
- focuses on diagnosing without also helping you to change
- doesn’t ask your permission to use various psychotherapeutic techniques outside of what you’ve discussed already
- makes promises like “you’ll be much more confident after this”, she won’t know this for sure
- tells you that only her approach i.e. CBT works and ridicules other approaches
- acts as though she has all the answers and spends time telling you how to fix things instead of working with you
- tries to make decisions for you, tells you what to do, or gives frequent unsolicited advice
- focuses on thoughts and cognition at the exclusion of feelings and somatic experience
- focuses on feelings and somatic experience at the exclusion of thoughts, cognition and cognitive processing
- hijacks your session to get her own emotional needs met, instead of focusing on you and your therapy
- talks too much about her own issues and/or self-discloses in a manner that doesn’t help you. Self-disclosure can be used if it’s to help the client
- seems too emotional or overwhelmed with your feelings or problems
- empathises too much
- focuses too soon on helping you appreciate or resolve the underlying causes of an issue when learning coping skills to manage your behaviours or impulses would benefit you more
- avoids exploring your emotional or vulnerable feelings or
- pushes you into really vulnerable feelings or memories too soon or against your wishes
- tries to befriend you
- tries to touch you in a way that makes you feel uncomfortable i.e. hugging without your consent or
- attempts to have a sexual or romantic relationship with you
- tries to enlist your help with something outside of your therapy i.e. you might be a hairdresser and she asks can she come to your salon
- is frequently confrontational with you
- doesn’t remember your name and doesn’t remember what you discussed or what your issues were from previous sessions
- ignores how important your spirituality, religion, faith, or culture is
- promotes her own religion, beliefs and tries to push it all onto you
- allows/encourages you to become dependent on her
- shows no empathy or compassion
- is judgmental or critical of your problems, behaviour, or lifestyle choices
- discloses your identifying information without authorisation or your consent
- talks about and tells you the identities other clients, famous or otherwise
- doesn’t accept feedback or admit mistakes
- talks too much or doesn’t talk at all, just sits nodding and staring at you — too much eye contact or none at all
- tries to keep you in therapy when you think it’s time to stop
What to do if you spot red flags
If any of these red flags come up during your first few sessions, you might need to re-evaluate your therapist and your relationship with her.
If you do see of these red flags, the first step would be to discuss your concerns with your therapist, telling her what’s bothering you. Say time-keeping is an issue for you. If she was only late once and had good reason, you could excuse that; she’s human too and sometimes things happen outside our control. However, if she was late for a second time, explain that it’s not acceptable, your time is valuable too, and you don’t appreciate other people being late. A good therapist will listen, understand your concerns, and make any necessary adjustments to their practice.
Most therapists have your well-being and best interests at heart, and they can make small mistakes too. However, some errors can prove more serious, such as touching you or trying to have a sexual relationship with you. If you’ve been in or are in a situation like this, you must report it to their practice manager and their governing body immediately.
Most people in therapy tend to know quite quickly whether the therapist is a good fit and whether or not they think they can work with them. But generally, I’d give it a maximum of three sessions, all being well before I decided if I needed to go elsewhere. However, too many red flags during the first and second sessions would make me hot tail it out the door.
“If you feel like something isn’t right in your first phone call or initial session, this may be a bad sign. Some discomfort is a normal part of therapy, just as seeing a personal trainer isn’t always comfortable, but if you feel uncomfortable to the point of dreading or avoiding sessions, you may want to keep looking.“Ryan Howes
There are lots of good therapists out there. Unfortunately, there are lots of charlatans too. They’ll keep taking your money, even when they should have discharged you weeks, months or even years ago. Yes, years! I’ve known a few patients who’d been in therapy for five years plus, and if you ask me, they were more confused and anxious or depressed than when they first started.
Over to you
Of course, there may be many more red flags that I don’t know about. Do you know of any that you’d like to share? What’s your experience of therapy/therapists? I’m looking forward to your comments and any questions you might have.
Related: Boundaries in therapy (1) Boundaries and warning signs of a bad therapist (2)