What are the red, yellow, and green flags in a therapist? And what are the signs of a good therapist? Emma sat down with her friend and fellow therapist, Kjrstin Walters, to talk about the difference between good and bad therapy. They discuss the subtle “yellow flags” in a therapist—small warning signs that something might be off—as well as the more obvious red flags, which may indicate your therapist is not just a poor fit but could be acting unethically. They also share what makes a good therapist. Read on to learn more about your own client-therapist relationship.
The Difference Between Good and Bad Therapy
Every good therapist upholds the professional and ethical standards required in their role. Knowing what signs to look for can help you protect your mental health and ensure you receive the care you deserve.
Small Signs Something Might Be Off
From the moment you start therapy, it’s important to be aware of “yellow flag” behaviors that might cause concern. Maybe your therapist seems distracted, or therapy feels stagnant, or therapy doesn’t feel safe. Another yellow flag could be persistent lateness or unprofessional behavior such as constantly checking text messages or talking about their own problems excessively. While occasional disclosures from your therapist might help build rapport or illustrate a relevant point, continuous self-disclosure that shifts the focus away from your well-being can diminish the therapeutic relationship. If these small warning signs go unaddressed, they could erode trust over time.
If you notice some of these concerning behaviors, especially severe breaches of ethics, it may be time to change therapists. A good therapist supports you in building a healthier, more resilient mindset—without adding to your distress. While it can feel daunting to leave a therapist—especially if you’ve built a rapport—remember that your emotional well-being is the priority. You can address your concerns directly or choose to move on without confrontation. And when you’re looking for a new therapist, be sure to check credentials, seek referrals from trusted sources, and use initial consultations to gauge fit.
Kjrstin Walters is a Licensed Marriage and Family Therapist who specializes in ADHD and neurodiversity. You can learn more about her work at www.FamilyFocusedADHD.com. Therapy in a Nutshell members also have access to weekly live calls with Kjrstin or Emma. Join us to learn more about ADHD and other mental health topics with Kjrstin, or be part of the Q&A or trauma processing conversations with me (Emma).
Trusting Your Gut and Protecting Your Mental Health
My hope is that our conversation helps you be more informed about both the subtle yellow flags and the more glaring red flags in therapy, which will help you better protect yourself and maintain a high standard of care.
Meet Kjrstin Walters
Emma: Hey everyone. So excited to be doing something fun and new today with my good friend, Kjrstin Walters. She’s also a licensed marriage and family therapist. We’ve been working together for 12 years.
Kjrstin: Yes
Emma: A long time. So good friends, coworkers, she’s an excellent therapist who also specializes in ADHD and neurodiversity, and especially helping parents and families build support systems around that.
So if you want to learn more about how to coach your kids through ADHD or build up family systems or get support around your own ADHD, you could check out her stuff, which is where?
Kjrstin: FamilyFocusedADHD.com
Emma: Cool. Okay. So yeah, check that out. And we are going to jump into talking about what are some yellow flags in therapy?
Kjrstin: And also red and green.
Emma: And also red and green. That’s right. Okay, let’s jump in. This is going to be fun.
Kjrstin: I’m excited.
[Emma and Kjrstin take turns drawing papers with therapy scenarios and categorize each as a red, yellow, or green flag.]
Emma: Alright. I’m going to grab one from the middle because that’ll make it more interesting.
Kjrstin: These are a surprise for me.
Emma: Oh yeah. Kjrstin hasn’t seen any of these, but I wrote them so I know what they say.
Ending therapy
Emma: Oh no! This one is one that was an actual comment from a person on the internet. They said, “I have no idea how to tell my therapist that I’m ready to be done with therapy after two years. I really value our relationship and I’ve learned so much.”
Kjrstin: Oh, so red flag, yellow flag or green flag?
Emma: Yeah.
Kjrstin: I think it’s probably a green. They’re connected. Yes, the therapist I think should be checking in and working to, okay, are we arriving at our goals and things like that. So maybe yellow, but I hate categories, so I would put it somewhere in the middle between yellow and green.
Emma: Okay. So I have a strong opinion on this one. This is why I saved this one.
Kjrstin: Okay, perfect.
Emma: Is because it actually drives me a little bit crazy when a therapist does not talk about the treatment goals with their client and check in. And I do think that’s the therapist’s job primarily
Kjrstin: Yes.
Emma: Is to say, “Hey, what are your outcomes that you want? And are we lining up what I’m doing with you to achieve those goals?” And so, it’s great that this person has a great relationship with their therapist and they feel like they’ve, done good work. So I can see why that would be
Kjrstin: Okay. Yeah.
Emma: But some therapists love working with slightly anxious clients for 20 years and never doing anything because it’s easy work. And that, I feel is malpractice.
Kjrstin: Yeah. And if we’re getting all of our relationship needs from our clients, that’s not great.
Emma: It’s like a super red flag.
Kjrstin: Yeah. Yeah.
Emma: Super red flag.
Kjrstin: Yeah.
Therapy that empowers you
Emma: All right. Onto the next. “They tell you that you are responsible for your life.”
Kjrstin: They tell, like you as a,the client is responsible for their own life.
Emma: Yeah, as I think about this one, I’ll let you ponder for a second while I think about this one, this could go either way. But I would consider this a green flag because in general I wouldn’t want the therapist telling me there’s nothing you can do about your life. You should probably feel bad for yourself and give up. Or the therapist telling me like, “Yeah, it’s everyone else’s fault.”
Kjrstin: Yeah.
Emma: If a therapist is gently and kindly being like, “Okay, if your relationships are bad, let’s see what you can do about it. This is your responsibility to improve your relationships.” I would call that a green flag.
Kjrstin: Yeah, I would too. The only caveat would be the tone in which the therapist delivered that message.
Emma: That’s right.
Kjrstin: But yeah, overall, yeah, we want clients to feel empowered. About their own lives.
Emma: Yeah. Because, yeah, and if they’re being a jerk about it, if they’re being like you’re, it’s all your fault. You’re just like, you need to fix everything. That’s not going to be helpful. You should be okay. Yeah. You want to grab one?
Inappropriate boundaries in therapy
Kjrstin: Yes. “They try to sleep with you.”
Emma: Oh gosh.
Kjrstin: If your therapist wants to have a sexual relationship with you, that is a red flag in every way shape possible.
Emma: Yep. Number one way for a therapist to lose their license. And also that relationship is not going to work out in the long run. This is bad.
Kjrstin: Yeah
Emma: Clear red flag. Easy one.
Kjrstin: Terrible.
Emma: Yep.
Kjrstin: I’m glad I got the easiest one.
Therapy feels stagnant
Emma: “You notice gradual improvements.”
Kjrstin: I guess it depends on how gradual are those improvements. I would say sometimes, especially in the beginning, it can either go, what, two ways. It can either be like drastic improvements really quickly or they are building like foundational improvements. And so those ones sometimes don’t, aren’t as obvious, but then the benefit and the reap of the reward is huge later. So I think it just depends on if it’s a month in, maybe not a red flag or a yellow flag, it’s probably fine. If it’s been six months…
Emma: You want to be seeing more improvements than that?
Kjrstin: Yeah.
Emma: Okay. I would put that as like a green flag, but we’ll put it right in the middle. I just think like, in therapy in general, it’s not going to magically get better, but you should be seeing some progress most of the time. That doesn’t mean therapy’s going to feel good all the time.
Kjrstin: Yeah. Yeah.
Emma: We’ll stick that in the middle.
Kjrstin: Yeah.
Emma: You pick one.
Breach of confidentiality
Kjrstin: “Discussing other clients with you.” If they are giving you any kind of information about the other clients, like their name, where they live, any of their protected health information, that is a 100% red flag. I do think that therapists can share stories or really non-identifying things that might help either validate the client, like you’re not the only person struggling with this. Or one, one time I had a client who came up with a solution for this. What do you think? Something generic I think is fine.
Emma: Yeah, yeah. And even in my YouTube channel, I sometimes talk about some of the clients I’ve had, but I make sure to not give any identifying information. And usually it’s a combination story where I’m not just talking about one person. But if they’re ever like, like you walk outta the office and or you walk into the office, you see someone else leaving and your therapist’s, oh yeah, that kid! Baba baba. And they talk about that other client. That’s like a big red flag. Ethical violation.
Kjrstin: Yeah.
Emma: You could lose your license for that.
Therapy doesn't feel safe
Kjrstin: “You just don’t feel safe with them.” I would say that this is yellow to red. Again, it depends on the timeframe. If it’s the first couple of sessions, you’re probably still establishing safety, especially if, I would say, if the client in general doesn’t feel safe with many people and that’s an issue.
Emma: Good point.
Kjrstin: Then I would say that’s maybe part of the therapeutic work. If they just creep you out and really you want to feel pretty safe and comfortable pretty quick. So I wouldn’t go beyond maybe two sessions with feeling uncomfortable. Now, therapy is a vulnerable experience, but that doesn’t mean you shouldn’t feel safe while working in a vulnerable way.
Emma: Yeah, I would agree. One of the interesting studies to come out, it shows that out of all the therapeutic, that’s okay, outta all the therapeutic interventions, there’s all these skills therapists can do. And they looked at the outcomes, they did this huge meta-analysis of outcomes and they made this amazing pie chart that shows like, what influences positive change in clients and 55% of that positive change really depends on the client and their situation, their biology, their family resources, what’s going on in their life. And then the other 45% kind of depends on what’s going on in therapy. And of that 45, 30% of that is the relationship with the therapist. And only five to 10% is really the interventions they’re doing. Those interventions do matter and those skills can add up in a big way, but the relationship is one of the most important things. So if after four or six weeks even, you just still just feel cringey or weird or really uncomfortable, then maybe it’s time to look for a different therapist.
Kjrstin: Yeah and if it’s like the first session and you just feel really creeped out.
Emma: Oh yeah!
Kjrstin: Just, it’s okay to say, “No thanks.”
Emma: Then I do think sometimes when you’re trying to shop for a therapist, which is reality, at least in the United States, you can try to get on the phone with them ahead of time and talk with them and get a vibe for them. Or even ask them for a 10-minute consult, because I think you can get a decent feel for someone in 10 minutes. And that’s something you can try because I know therapy can be really expensive and that can make it inaccessible.
Kjrstin: Definitely.
Mismatched therapy needs
Kjrstin: “They assume that the treatment you need is the treatment they specialize in.” Perfect. This is a good one for me. I specialize a lot in ADHD and so I have to be really careful to not get the medical school syndrome of diagnosing everyone with ADHD just because their symptoms may align, because most people’s struggles cross over to many categories of issues. And a good clinician is going to look much deeper than those surface complaints or really try to understand the root of the issue. Yeah, I would say that’s a red flag.
Emma: Yeah.
Kjrstin: Yeah.
Emma: They might be skilled in that area and that’s okay. But I think a common thing might be a therapist who specializes in trauma is going to immediately assume that it’s a trauma issue. Or a therapist that specializes in ADHD will be more likely to assume it’s an ADHD issue. So you want to find a therapist who’s willing to listen and really explore what’s going on before they jump into assuming what’s the matter.
Therapist in teacher mode
Emma: “Sometimes they switch into teacher mode.”
Kjrstin: Oh yeah.
Emma: What do you think?
Kjrstin: I do that sometimes. I’ll be honest.
Emma: I do too. I do it all the time. I think it’s a green flag, but I wouldn’t want someone doing that the whole time.
Kjrstin: Yeah, exactly. It’s just balance. It’s like parenting, right? Like parenting can’t be teacher mode all the time. Otherwise kids just feel like you’re lecturing. And yeah, I think that there’s a lot about therapy that’s just education.
Emma: Yeah.
Kjrstin: So I think it’s okay.
Emma: Yeah. There’s three different sides of therapy. One is empathizing and connecting, trying to validate and understand. And then intervening often looks like, in session, pointing out what’s going on, exploring what’s going on, asking questions that probe and I consider that much more personalized. And then the teaching part, which is what I do on YouTube and the other parts I can’t really do on YouTube. It’s okay if your therapist maybe does that some of the time, but not all the time.
Kjrstin: Yeah.
Therapist advises to take supplements
Kjrstin: “They tell you to try a supplement.”
Emma: As in you should take vitamin D.
Kjrstin: Yes. I’ll put it in as a yellow. Okay. I’ll put it as a yellow. I do think there is some education. Anytime I, maybe I’ll say I have heard, this is good. Talk to your doctor.
Emma: Bing. Yes. That!
Kjrstin: I joke, I’m like, I’m not a doctor on the internet or anywhere. I went to school, not that kind of school.
Emma: Yep.
Kjrstin: But I have heard potentially this may be helpful in your struggles or whatever. Worth looking into. Talk to a doctor.
Emma: Yeah, and I would probably, if I were to, if I were to categorize that, I would probably put it into the red area. If they say, “Let me teach you that these supplements might be helpful, but you should talk with a doctor,” that’s totally okay.
But if as a therapist, I give someone medical advice or legal advice or financial advice, it’s actually an ethical violation. So what I try to do on my YouTube channel is I try to teach people about resources and then say, “Work with your doctor.” And if I ever don’t say that, I can get in trouble.
Kjrstin: Yeah.
Emma: Ethically, I could get a ding on my license or something like that.
Kjrstin: And if they say, “And I’m selling these,” that’s definitely a red flag.
Emma: Definitely a red flag. Yep.
Dual relationships in therapy
Kjrstin: “They friend you on social media.” This one’s hard. I get friend requests from clients.
Emma: Current clients?
Kjrstin: Uh huh.
Emma: Okay.
Kjrstin: And I decline because then I am violating HIPAA and health privacy laws and so I would say it’s a red flag.
Emma: I would agree. Yep. So this is an ethical violation. As therapists, we are not allowed to have dual relationships. So you can’t, unless there are circumstances, like if you live in a very small town and there’s only one therapist, you might happen to go to church with that person and they might be your therapist or something like that. But in general, as therapists, we can’t do therapy with our friends. We can’t do therapy with our neighbors or people we know in some other way. So we can’t be their therapist and their hairdresser. Unless, there’s really extenuating circumstances like you live in Alaska and there’s only 10 people in your village.
Kjrstin: Right. Yeah.
Emma: But otherwise, that’s an ethical violation. However, there is like a timeline for this. The sleep with you one, they’ve gotten rid of the timeline. You can never, as a therapist, you can never sleep with a previous client, ever.
Kjrstin: They did get rid of the timeline?
Emma: They got rid of it.
Kjrstin: Fantastic.
Emma: It used to be like five years or something.
Kjrstin: Yeah
Emma: Two years.
Kjrstin: Yeah.
Emma: You can’t sleep with your client for two years. They’ve gotten rid of that timeline.
Kjrstin: Fabulous. So dumb! So all therapists have to do ethical training for part of our license across the United States. I imagine in other countries as well. Every time we have to have the discussion, do not have sex with your clients, you’ll lose your license. It’s wrong. It’s ethically a nightmare.
Emma: Yeah.
Kjrstin: And yet it happens all the time.
Emma: It happens way more often than it should, at least.
Kjrstin: Yeah, yeah. Okay.
Emma: I don’t want people to be too scared of seeing a therapist.
Kjrstin: Yeah
Emma: But yeah, it just, it shouldn’t ever happen. But you can, I believe it’s two or five years now for other dual relationships. So let’s say you stop, like you work with a therapist, you’re great. You’re like, man, I wish they were my, I don’t know, rock climbing buddy. I don’t know, whatever. Or I want to create a business with this person. You have to wait at least two years after the end of therapy. And they can’t be your client anymore. And you have to wait, and then you can potentially have a different relationship with them. Not a sexual relationship though, ever.
Kjrstin: Yes.
Emma: But like a business relationship or a friend relationship, that’s acceptable. So I do have a couple clients from 12 years ago who friended me on Facebook, and I see their stuff sometimes. But they reached out, I did not.
Kjrstin: Yeah. Good, good.
Therapy cost and frequency
Emma: “They pressure you to schedule more sessions than you feel you need, or you have no idea how much this will cost until the bill shows up.”
Kjrstin: There’s actually a law now around making sure you, I don’t remember how it’s working.
Emma: It’s like fair notice of billing or something like that.
Kjrstin: Yeah.
Emma: Basically, so you can afford them.
Kjrstin: Yeah. How much it’s going to cost. That’s for all medical and therapy falls into that category. So it should never put you in a position of financial hardship that you aren’t prepared for. So you should know what you’re going to have to pay, including if they are taking your insurance. How much is your portion? How much should the insurance company pay? Sometimes that’s difficult because insurers are–
Emma: Awful to work with.
Kjrstin: Yes. And they make it very difficult to know until they process the claim. [Therapists] don’t know exactly because there’s so many various plans. But you should have a decent idea and if your therapist is pressuring you to schedule more sessions than you feel is necessary, that also is not good at all. I do think having a realistic expectation of how often you meet in therapy, typically most people will meet weekly. There are some therapies that are more frequent and there are some therapies that are less frequent, but I would say averages weekly.
Emma: Yeah, and I think you have to understand, like most therapists are in this business because they care about people. They want to help people and they’re trying to do their very best. Most therapists do a good job and most therapists are going to try and work with you on this. Sometimes insurance stuff does happen where people will do eight therapy sessions and they’ll get billed at $150 a session and then their insurance will process it and decline it or something or they haven’t met their deductible or whatever, and then they’ll get this bill in the mail that’s $2,000 and it’s so sad. Okay.
Kjrstin: Yeah.
Emma: Insurance can make this more complicated, but also you have to understand that as therapists, we aren’t financially rewarded when our client finishes and succeeds and does really well. So a therapist who maybe is burned out or maybe not as ethical or feeling a little lazy would be happy to keep a client on longer and longer if they’re like an easy client to work with or whatever.
Kjrstin: Make them feel good as a therapist.
Emma: Yeah
Kjrstin: ‘I did a great job.’ Yeah, it’s not good.
Therapist disagrees with you
Kjrstin: Okay. “They don’t agree with you.” So your therapist does not agree with you. I think that’s a green flag.
Emma: I would agree.
Kjrstin: Yeah. Thank you. Thank you for agreeing with me. 😉
Emma: Yeah. If your therapist only agrees with you all the time, they’re just like, “Yeah, poor you. Must be your husband’s fault. Everything is bad.” Yeah, then maybe they aren’t challenging you to grow.
Therapy doesn't feel helpful
Kjrstin: Alright. “You feel better in session, but feel worse overall.” This one again, probably depends on the timeframe. But I would say probably a yellow to red flag.
Emma: Yeah. If you go to session and your therapist just makes you feel good and reassures you over and over again, “No, you’re a good person. No, you don’t need to worry. No, you’re good. You’re good.” And you feel like in therapy, “Oh yeah, everything’s okay.” And then you go home and you have zero skills or zero new techniques. Then that gets weird.
Kjrstin: Creates a dependency on therapy.
Emma: Yeah. So then you think, “I just need more therapy. I just need to call my therapist.”
Kjrstin: Yeah.
Emma: I would definitely yellow flag for me.
Kjrstin: Yeah.
Emma: It would be normal, in the beginning stages of therapy, if you don’t have the skills yet to solve your problems, things aren’t going to get better right away. And, I would say that’s normal. But if therapy makes you feel good, but you don’t learn anything, that is not good therapy.
Kjrstin: Yeah.
Therapist's realm of competence
Kjrstin: “They treat every disorder.” Now, if you get on most therapists websites–
Emma: Yeah, Psychology Today.
Kjrstin: Oh yeah. Because a lot of that has to do with search engine optimization and making sure, “Oh, I can work with that.” But really, you don’t have to specialize and be totally in a niche category, and treating every single thing.
Emma: And I see this—so this is another ethical rule—is that you treat within your realm of competence. And so if I had a client come to me and they were like, “Oh, I’m having sexual dysfunction.” I’d be like, “I’m sorry, that’s not in my realm of competence. Now, most therapists should be able to treat depression, anxiety, and PTSD, because those are so common. But when it comes to the other conditions, you might want to find someone who actually specializes or has certification in those areas.
Kjrstin: Definitely.
Therapist supports growth
Kjrstin: “You sometimes feel worse after a session.”
Emma: This is normal.
Kjrstin: Sometimes our emotions are just like our muscles and just like a workout, sometimes you walk away sore and in pain, hopefully not sharp pains.
Emma: Yeah.
Kjrstin: Therapy can be uncomfortable. We are often working toward looking at and resolving things that we’ve been avoiding or procrastinating, so I think we should feel uncomfortable. Maybe not every single time.
Emma: No. You don’t want, like in the long run, therapy shouldn’t make you feel worse. But in the short term, it’s pretty normal that it’s uncomfortable and painful sometimes.
Therapist's views on your religion
Kjrstin: Okay. “They encourage you to leave your religion.” That’s a tricky one.
Emma: Yeah
Kjrstin: That’s a tricky one. I think it probably depends on what your motivation is, but really your religious preferences should come from you. And a therapist is a great sounding board as you’re thinking through things, but ultimately you should be making that decision that should not come from your therapist. So I would say yellow to red—orange.
Emma: That’s what I’d say too. I think it’s clear that some forms of religion and some forms of religious practice for some people can harm their mental health. Like even some people have a really rigid approach, a really anxious approach, like practicing religion in certain ways might make them feel significantly worse. However, a therapist should never tell you what you should do with big life choices, and they probably shouldn’t even push you in a certain direction.
Kjrstin: Okay.
Emma: And I think one of the things that worries me is often therapists do tend to be less religious than the population, and therapists tend to be more left leaning politically than the population in general. And so I think I have heard a lot of stories of people who have left their religion because their therapists coached them to do that. And I would say the therapist should be there as a guide and a support as people make their decisions. And I understand why many people do choose to leave their religion, but the therapist shouldn’t be telling you what to do. They should be helping you make your own decisions based on the kind of life you really value.
Kjrstin: I’ve also had clients come to me saying that the last therapist that they went to was reading from religious text.
Emma: Oh yeah, that’s another.
Kjrstin: And they didn’t want that.
Emma: Yeah.
Kjrstin: They were maybe questioning things. And so that therapist was maybe pushing more of the religious agenda than the client wanted. Really, again, red flag.
Emma: Yep. So when it comes to religion, you and your therapist should have a reasonable conversation about what you do and don’t want them to talk about.
Kjrstin: Yes.
Therapy gives hope
Kjrstin: “When you’re working with them, you feel hope that things can get better.” Green. Green. Hope is wonderful.
Emma: Yeah.
Kjrstin: I can feel hopeful and I would hope that my clients feel hopeful about things, even if they’re going to be a challenge. Hope comes often when we have a good plan and we have strategies, tools, and processes to implement to help. And a good clinician is going to lay that out for you as a buffet of this is what we can do and maybe this is where we should go. And if you feel hope, that’s fantastic.
Emma: I would agree.
Your therapist cares about you
Emma: All right, my turn. “You feel like they care about you.” It’s a green flag. How about you?
Kjrstin: Yeah.
Emma: Is that creepy?
Kjrstin: No.
Emma: You should feel like they actually care about you.
Kjrstin: Yeah, I think they should. If they don’t, that would be red if they didn’t.
Kjrstin: “You trust that they will remain confidential.” Also green.
Emma: You should feel that way.
Kjrstin: That’s good.
A therapist you can trust
Emma: “You feel like therapy isn’t working, so you tell them.” Green.
Kjrstin: Yeah.
Emma: Have those conversations with your therapist.
Kjrstin: Definitely. Yeah. And that you feel like you can have that conversation, that is great.
Emma: Yeah.
Your therapist understands your culture
Kjrstin: “They have no understanding of your culture, whether that’s racial, ethnic, or religious.” I would say yellow to red. I’m going to put it in yellow. I think there’s sometimes limitations if you have some sort of a cultural difference and there are not clinicians in your area that you can see that are going to have that understanding, but your therapist recognizes that there is a cultural difference and is open to learning and understanding and growing. I think that actually is better. If they say, “Oh, it doesn’t matter. You’re a person.” That puts them in the red category for me.
Emma: If you tell them, “I’m dealing with racial discrimination,” and they say, “That’s not a thing!” They’re really dismissive or they’re like, “Oh, why would you wear a hijab? Like, why would you ever do that? That’s silly.” That’s obviously oppression and they aren’t really listening to what you believe or what your experience has been.
Kjrstin: I think for the LGBTQI community there are lots of therapists that are allies. They may not be part of the community from the sense of their gender or sexual preferences. And yet they can be fantastic therapists for people of that culture and that community. And so it really depends, I think, a lot on the intention and the willingness to learn of the clinician. But I do think, if there’s a racial or any kind of cultural thing, and the clinician has a really solid understanding, it’s going to help.
Emma: Definitely. And I think I, as a clinician, have made mistakes culturally and understanding and empathizing with racial issues and things like that. I’ve made mistakes in the past. I try to stay curious. I try to learn when I know better, I try to do better. But it shouldn’t be the client’s job to educate their therapist. So if the therapist doesn’t really understand anything about it, they should go read a couple books and take some training, in addition to saying, “What’s your experience with this?” And listen to your experience. But should it be [the client’s] job to say, “Let me give you the history of oppression for my people”? That’s just not [the client’s] job and you shouldn’t have to pay to teach [your therapist].
Kjrstin: Yeah. It is the therapist’s job to ask questions of the client so that they can understand because each person is an individual.
Emma: Yes.
Kjrstin: So we do need to understand each person’s experience. And that is education. And our culture is a big part of that and we also, as clinicians, we need to go learn stuff.
Emma: Yes. It’s our job.
Crying in session
Emma: Ah, “You cry in session or you feel exhausted afterwards.” Thoughts?
Kjrstin: It’s a good thing. I hate crying.
Emma: I’m really good at crying.
Kjrstin: That’s true. You are really good at crying. I hate crying. And it took me a while, actually, as a therapist to feel comfortable—. I felt like I was causing my clients to cry. And I was like, I hate that. I just don’t like the physical sensation, my neck, like chokey. But it’s a good thing. It’s a good thing. So that’s coming from me as a non-crier: it’s okay to cry.
Emma: It’s okay to cry. All right. I would say, green flag.
Kjrstin: Yeah.
Working on Accommodating vs. Avoiding
Kjrstin: “They tell you that you need to avoid things because of your diagnosis.” What do you think of that one?
Emma: I have strong opinions on this.
Kjrstin: I bet you do. What’s your strong opinion?
Emma: I have strong opinions on a lot of things. So Jessica McCabe actually made a short the other day. She’s the How to ADHD girl.
Kjrstin: One of my faves.
Emma: Yeah. Excellent [YouTube] channel. She made a short recently that says, “What’s the difference between if you have ADHD, using ADHD as a way to avoid things and get out of things versus getting accommodations?” And she said, “If you’re short and you need to reach something in a high cabinet, then saying, ‘I can’t reach that’ is an avoidance form and saying, ‘Give me a minute, it’s going to take me a little longer because I have to grab a stool,’ that’s an accommodation that’s helpful. It helps you accomplish the task instead of avoiding the task. So in general, I feel like accommodation should not help people avoid tasks. They should help people gain the skills to face and resolve tasks. And there are some things that in general you can avoid certain jobs that aren’t your strength, right? Like you don’t have to do everything. But in general, I feel pretty uncomfortable when [a therapist] says, “Oh, you have anxiety. You should avoid that because that fuels anxiety. Oh, you have ADHD, so you can’t do something. Instead, let’s explore whether it’s in line with your values to learn the skills to do that, or if you want to put your energy somewhere else.
Kjrstin: Yeah. I think there’s a few–I actually learned from you, light therapy is not great for people that have a bipolar diagnosis.
Emma: Oh, that’s correct. That’s a good point.
Kjrstin: It could trigger a manic episode. I didn’t know that. And so now when I’m recommending light therapy, I will mention that, but that’s not, “Oh, you person that is depressed, you should never watch TV again because it’ll make you never leave your bed.” I don’t know, stuff like that. Overall, we want to be facing and challenging and coming up with tools.
Emma: Yeah. I think it becomes problematic when people are like, “Oh, you should avoid this person. You should avoid this problem. You shouldn’t do school. You should tell people to stop talking.” Like when people get involved in these anxious avoidance patterns.
Kjrstin: And as a person that works with people with ADHD, I work very hard to help educate around accommodations because legally, people with ADHD qualify for accommodations in academic and workplace settings.
Emma: Yeah.
Kjrstin: And also while I’m educating the school, I’m also educating that the person that needs that accommodation has to advocate for themself. So it requires work on both sides. It’s not a, “Just gimme this thing.”
Emma: For sure. Whose turn is it?
Kjrstin: I don’t know.
Emma: Alright, go for it.
Therapist qualifications
Kjrstin: Alright. “They aren’t certified in EMDR, but they’re using it.”
Emma: You’re certified in EMDR.
Kjrstin: I’m not certified.
Emma: Oh, you’re not?
Kjrstin: I’m trained.
Emma: You’re trained. I’m neither.
Kjrstin: Yeah, so I think this is a very much, there’s a marketing component to this, which I say this. My husband’s a digital marketer, so I understand marketing, but also there are many categories of certifications or trainings that you can get in specialties in therapy, and you do not have to be certified in all of them to use them as a technique.
Emma: So let give an example. I’ve taken multiple courses that give you a certified clinical anxiety training, like badge and certified clinical trauma therapist badge. And you can put that badge on your website if you’ve taken those trainings. I’ve probably done six trainings where I’ve gotten certified as a clinical trauma professional. But then, I would have to pay them $90 a year to maintain that little badge on my website. So I consider myself a qualified trauma professional, but I don’t pay them for the little badge on my website.
Kjrstin: Now, I will say, so I specifically clarify, I’m trained in EMDR. EMDR requires level one training and then some supervision, and then level two training and some supervision. I did both trainings, and I did the supervision. But to get certified, you have to do two years of supervised practice…
Emma: Oh, wow.
Kjrstin: …And pay the fees and take some more courses. And for me, at the time, it wasn’t reasonable. Actually I got trained and then we moved out of the country, and so that would’ve been just that much more complicated. Although, I did do all my supervision while I was in Costa Rica.
Emma: Really? Yeah.
Kjrstin: Anyway, I’m trained so I can use it, but I can’t say that I’m certified. And so somebody that is certified is going to have more education and they have to maintain continuing education credits to maintain that certification. I don’t have that. So my EMDR isn’t maybe the most up to date. Now, I can also get continuing education credits in EMDR, so I could do that. So it’s a little fuzzy.
Emma: It’s a little bit of a gray area. So yellow, right?
Kjrstin: Yes
Emma: Yellow flag. I feel like in general, like for example, an anxiety training certification, there’s so many skills when it comes to anxiety and it’s such a broad topic, and no one’s in charge of that form of therapy or anything that having a certification in that area is not so important. But when people are doing techniques that are a little bit more, how do I say this? If they’re doing brain spotting, if they’re doing art therapy, if they’re doing EMDR, which have the potential to really rewire your brain, or, I mean there’s all these different types of therapy, they get a little bit more advanced, you probably want to look for someone who is trained and certified, usually.
Kjrstin: Yeah. They’re more likely to stay current on how to be a good practitioner of that.
Emma: Do you maintain any certifications?
Kjrstin: My license?
Emma: Yeah. We keep our license, we do 40 hours of continuing education every two years. We make sure and follow the ethical guidelines. We practice a certain amount. So every good therapist should have a current license. You can look up their license in your state. You can see if they have any dings on their license. Any, what are those called?
Kjrstin: Investigations.
Client focus
Kjrstin: [Next prompt.] “They talk about themselves a lot.” I just read that through [the back of the paper]. I feel really good.
Emma: I’m impressed.
Kjrstin: Yeah. I’m going to talk about myself and my backwards reading skills right now. Generally, I would say this is a yellow flag.
Emma: Yes, you don’t go to therapy to hear about your therapist and all the cool things they did to fix their life. You should be the highlight of the session.
Kjrstin: Yeah.
Therapy progress plateau
Emma: “They’re nice. You like to talk with them, but all you do is tell them your problems and they empathize and you just do that over and over.”
Kjrstin: I would put it in the yellow as well. I have had clients [for whom] that is what they’re looking for. And somebody gave me the metaphor that sometimes we are the garbage can that people come in to puke into and then they feel relieved and that is good. But I think my preference is I would love to work myself out of a job. I would love to have clients gaining skills and we are working very specifically on a treatment plan that’s moving them forward.
Emma: Like how to not throw up so often, like maybe wash your hands more. Something like that.
Kjrstin: Yeah, yeah. Great metaphor. Yes.
"Just get over it"
Emma: [Next.] “They tell you to just get over it.”
Kjrstin: Oh yeah, that’s just red.
Emma: Okay.
Kjrstin: Yeah.
Emma: If that’s their only skill—“You shouldn’t feel that way”—it’s not helpful.
Kjrstin: There’s a Bob Newhart–-
Emma: Oh yeah. I’ll pop that in there.
Therapist explains your treatment
Kjrstin: “They explain to you the reasoning behind the treatments they are using.” Sometimes you have to do cart before the horse and sometimes the horse before the cart. But yes, you should understand why they are choosing or suggesting [your particular treatment].
Emma: Or if you don’t care why, they could at least say, “Hey, if you want to learn why I’m doing this, you could read this book. Or you could educate yourself here if you don’t want to use your therapy time for that.”
Trauma-informed therapist
Emma: “They label everything as trauma and they keep asking you to explore the past.”
Kjrstin: Oh…yeah. I don’t like that one.
Emma: I don’t either. Ooh, this is red…yellow…I’m going to put it in red.
Kjrstin: Yes, I agree.
Emma: In my opinion, trauma work, if you like, trauma is an important part of mental health. It’s obviously very impactful. However, focusing on the past doesn’t heal trauma. It’s bad therapy.
Kjrstin: Yes, you can’t change the past. We can change what it means to us. We can change how we respond to it now, how we define it now, and how we cope and or move forward after having experienced something traumatic. We don’t have to dive into all of the specifics, especially over and over again.
Emma: That’s right. But that is an old way of therapy. That is the way they used to do CBT exposure therapy for trauma all the time, and it was literally like, just we’re going to talk about this until you get tired of talking about this and your nervous system stops reacting, which didn’t work that good.
Kjrstin: No. I will say at first, I was a little reactive of the therapist labeling something as a trauma that maybe isn’t, but actually I feel like I have had to label things as trauma for clients that didn’t realize it. And so I do think there is a little bit of a clinician coming in and saying, that’s a trauma response or what you just described sounds very much like a traumatic experience, but I’m still going to explore and understand and let the client put the label on it. But typically, we don’t want to spend our time there.
Dual relationships in therapy
Kjrstin: Speaking of time, let’s keep going. “They offer you a job.” Red flag, dual relationship.
Setting therapy goals
Emma: “They ask questions like, what’s most important to you to work on this session?”
Kjrstin: Green, that is great.
Emma: Yep. There’s this little survey [that is part of the Feedback-Informed Treatment system] that therapists can give. It’s like a five-question survey, and [it shows that if therapists] ask that question ahead of time, it makes treatment outcomes much better.
Kjrstin: Sometimes it’s expensive to use [the licensing for the survey], so if your therapist isn’t using that, it might be because they just can’t get that survey. But [the therapist] can always ask [the question].
Emma: Therapists get nickel and dimed by everything. All the certifications, the training, simple practice, like the licensing.
Kjrstin: And then if you take insurance
Emma: If taking insurance, it gets really expensive for us.
Helping you see your blind spots
Kjrstin: “They make you uncomfortable when they point out things you didn’t notice about yourself.” I would say most of the time that’s a good thing.
Emma: I would agree. Therapy should be…you’re getting a second opinion, and it might feel uncomfortable.
Therapist labels non-clients
Emma: Ooh, I’m excited about this one. “They tell you that your mother is a narcissist. And they haven’t met your mother.”
Kjrstin: I will say I’ve had a lot of clients tell me that they feel like their mother or father is a narcissist
Emma: Or their partner or their buddy or their boss.
Kjrstin: Yes. And where I work with people with ADHD, I actually am usually trying to debunk that a little bit because the ADHD people sometimes get misclassified as narcissistic.
Emma: Oh, that’s a good point, because they sometimes don’t pay attention to other people’s cues and emphasize that well.
Kjrstin: Yeah.
Emma: So this, in my mind, this is a red flag.
Kjrstin: Yes.
Emma: It’s a complete red flag because it is unethical for a therapist to diagnose anyone they have not personally assessed in person. If a therapist tells you that your mother’s a narcissist or spouse that they haven’t met, they’re harming you. And I know what the internet does. It tells you that everyone’s a narcissist, but it’s just not the most helpful approach.
Kjrstin: The only thing is maybe sometimes your therapist may validate your experience and so they’re not outwardly disagreeing and say, “I cannot ethically say the word narcissist as a label, blah, blah, blah, blah. We don’t want to detract from your therapy session.”
Emma: Yeah.
Kjrstin: But also, you don’t want to be an armchair quarterback.
Emma: You don’t want to be diagnosing people that you’re not in the game with.
Kjrstin: Yes.
Emma: But if you are being abused, your therapist might be like, “Hey, here’s the signs of abuse. Do any of these line up for you? Here’s the signs that you probably need really firm boundaries with this person. Let’s work on your boundaries. And let’s work on your half of this relationship to build it, to make it healthier.” And I think it’s common that therapists tell people they need better boundaries or they need to improve these relationships by being more assertive. But it’s harmful when people label people who aren’t there.
Therapist remembers your details
Kjrstin: “They don’t remember key details about your life or past sessions.” I think it’s still okay. Well…key details. Okay, that’s probably not.
Emma: Yeah, if it’s really important.
Kjrstin: Most therapists are keeping notes. I actually write notes in the session because I have a poor memory and so I want to be able to flip back really quickly. And most of our note taking systems these days are electronic, and so it’s hard to just flip through without having a laptop in front of me and things like that. So I like being able to flip back, “Hey a couple weeks ago we talked about this and this.” But sometimes I’m going to forget the little details. But I’m working on taking notes so that I don’t forget the key details essentially.
Emma: Yeah, me too. Usually when I take notes in a session, I’m not like, “This person is crazy,” right? I’m not writing that. I’m writing, “The name of this person’s sister is…” because I’m not going to remember. I’m not going to remember the names of all my clients and people, but I will remember, “Oh yeah, this person had a traumatic experience,” or, “This person was abused.” I’m going to remember the key details, and that shows that I’m paying attention. But I’m probably not going to remember the tiny ones.
Coping skills vs. healing in therapy
Kjrstin: “They teach coping skills.” Pretty sure this is why Emma started this whole channel was to teach skills in therapy because you were irritated, right?
Emma: Yeah.
Kjrstin: Therapists weren’t teaching enough skills
Emma: Yeah. I do hate the word coping. I don’t like the word coping skills, so I would personally put that in yellow as I don’t like coping skills. I like resolving and solving and adapting skills personally. But same idea. Teaching skills is green. Teaching you just to cope over and over again is not going to get you too far.
Kjrstin: Good point.
Emma: I’m nit picky about certain things. I get rigid about certain things.
Kjrstin: But it’s also your motivation for a lot of things.
Emma: That’s true.
Person-centered therapy
Kjrstin: Alright. “They actually believe healing is possible, but they don’t claim to be the healer.”
Emma: Yeah, I like that.
Kjrstin: Yes, because actually the person that is doing the healing is the client.
Emma: Yeah. The client, and I believe in a Higher Power too. But the client is the one who does the work and gets the honor.
Kjrstin: Yes.
Therapy effectiveness
Emma: “Therapy is challenging.” Green flag. Therapy shouldn’t just be comfortable. It should be hard.
Kjrstin: Yeah. If it’s comfortable all the time, that’s yellow or red.
Emma: But not too hard. It shouldn’t be painful, like you hate it and dread it and you feel worse all the time.
Kjrstin: [Next prompt.] “You leave sessions knowing that you need to change something.” Also, a green flag.
Insensitive comments from therapist
Emma: “Your therapist makes inappropriate comments about your appearance or jokes that are insensitive.”
Kjrstin: Oh. If it’s a pattern of that, red. If it’s a one-time thing, yellow.
Emma: Sometimes I joke around with my clients about things that would normally be completely inappropriate because I’m helping them use humor as an adaptive way.
Kjrstin: Oh, totally. I do that so much. Yes.
Emma: But if I’m like, “Ha, you don’t have an eating disorder; you’re too fat for that,” okay, no! Inappropriate!
Kjrstin: Anything at the expense of the client? No.
Therapist encourages reflection
Kjrstin: “They encourage you to address painful things that you’ve been avoiding.” Mostly green.
Emma: Yeah.
Kjrstin: As long as you have skills in place and they’ve worked with you on that, then we should, it should be challenging and addressing things that you’ve been avoiding.
Emma: Roger that.
Finding the right therapist
Emma: Okay. We hope that helps people figure out if their therapist is doing a good job, if you need to change things up a little bit, or even just have a conversation with your therapist. I think therapists are really open. Usually they should be, but the majority of therapists are really good at having conversations like, “Oh hey, this isn’t working for me. What can we do to make it better?” From a client’s perspective, that’s really scary to bring up. But if you can, it’ll make your therapy better.
Kjrstin: Definitely.
Emma: Any last thoughts?
Kjrstin: When I first started working as a therapist, I was really embarrassed to tell people I was a therapist because I’d heard so many nightmare stories about bad therapy sessions. I feel like that’s improved quite a bit. And I always tell clients or people that are asking for recommendations to shop around. Like Emma said, do a consultation call. It’s okay if you want to check out the therapist’s social media. You don’t have to be their friend, but you could look them up.
Emma: You could look them up. They can’t look you up, though.
Kjrstin: Yeah. I guess that’s true. Yeah. I hadn’t thought about that. I wouldn’t anyway.
Emma: I wouldn’t either. Okay. Thank you all for being here. Hope that’s helpful, and take care.
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