I would like to add my perspective–as a patient and professional in the mental healthcare military-industrial complex–of behaviors to avoid in a therapist.
Not all therapists are good
However, before I share that list, I would like to warm you up to the idea that most therapists are unexceptional. This is evident on multiple levels with the most obvious being that by definition most people cannot be exceptional.
There is also the human phenomenon that in the long-run ‘you do not rise to the level of your goals. You fall to the level of your systems.’ and many therapists are in a bad system. They either work in a private practice with no oversight, a group practice with inadequate resources to implement robust standards, or a mega-corporation where there are exacting standards, however, the standards are focused on profitability first and patients second.
An often overlooked factor influencing the quality of therapists is the arduous process to become one. Forms of therapy have existed since the dawn of mankind, but the modern license-based system values mass production and standardization at the expense of brilliance and originality. Such a system raises the floor by providing effective, standardized training to those who need it, but there are inarguably therapists and patients harmed by such a system.
Ask yourself: what type of person is willing to undergo 7+ years of training and incurs hundreds of thousands of dollars of debt to learn something that is largely intuitive and requires no technical training? You do not need a license to help people. Exceptional people know they can make an impact now and will often find a more effective way to do so (such as becoming a writer, blogger, influencer, founding a startup, etc.)
Even if someone exceptional does decide to endure the lengthy certification process, what do you think such a process does to a person? Repetition of evidence-based one-size-fits-all thinking can beat even the best into conformity.
Behaviors to avoid in a therapist:
Anyways, without further pontification, here is my list of behaviors to avoid in a therapist:
- Never establishes goals: it’s financially good for your therapist if you stay in care forever, but that’s not good for you. The goal of therapy is to someday get well enough to no longer need it (at least for a while). There is unappreciated risk of staying in therapy too long and cultivating an unhelpful degree of ego-centrism and a victim mentality–if you have to find something to talk about each week indefinitely, you will increasingly make mountains out of a molehills.
- No systematic tracking of progress: self-reported assessments (written or verbal) have significant shortcomings, but they serve an important purpose:
- Periodic assessments help a provider evaluate and discuss with a patient whether the current treatment is working or whether new methods should be tried.
- An assessment also encourages the patient to think about their symptoms in a different light. Seeing progress over time helps some patients and sometimes the questions themselves inspire new avenues of discourse.
- No take home exercises: some people are naturally good at some things, but no one gets better without practice. 1 session per week is usually not enough to make significant, reliable improvement. A good provider will print out exercises to do at home, a great provider will tailor those exercises to your interests (e.g. read The Little Prince to see one potential solution to nihilism)
- Ignores the subconscious: cognitive behavioral therapy (CBT) is helpful for many people, but it has a major blind spot. There is often a disconnect between conscious awareness and unconscious behavior. It can be invaluable when a provider is able to point out subtle behaviors that betray your words (e.g. your first clenched when you said that, your eyes drifted to the floor there)
Conclusion
Don’t settle for a bad therapist. Search for someone exceptional, a system that has high standards, or a friend that has a way with these things.
Whatever you do, please don’t stop trying and please don’t stop looking for help if you need it.