Good therapy is all about helping the client to feel better, to make healthy decisions and set healthy boundaries, to move from a place of poor emotional health to good emotional health, to make connections with others, and to replace sadness, anxiety, anger, and frustration with happiness, peace, and hopefulness for the future.
Because the “Warning Signs” article is so focused on the therapist and the behaviors he or she engages in—or doesn’t engage in—we wanted the “50 Signs of Good Therapy” to put the focus on the client, which is exactly where it belongs.
While the “50 Warning Signs of Questionable Therapy” is structured in a list format, these 50 signs of good therapy are structured along thematic lines.
- Training/credentials, experience, and professionalism
- Informed consent and other legal issues
- Communication and client focus
- Empathy and the therapeutic relationship
Below is a listing of the 50 signs of good therapy, placed in order by theme:
Training/Credentials, Experience, and Professionalism
Most states and other municipalities require that therapists or counselors meet specific education and training requirements. Though these vary from location to location, all therapists must be educated, trained, and must follow basic professional codes of ethics and guidelines. The foundation for good therapy exists when:
1. Your therapist is trained appropriately and meets all local and/or state guidelines for providing therapy.
2. Your counselor seems competent and experienced enough to help you with your issues and does not appear overwhelmed by them. While it is possible that you may see a counselor that does not have the training or experience to help you with your problems, he or she should always let you know if that is the case.
3. Your therapist explains the therapeutic process and how you can benefit from it, without guaranteeing your success or promising that “everything will be okay.” The bottom line is that no one can make such guarantees—neither the therapist, nor you.
4. Your counselor always maintains professional business practices by keeping the focus on you. She prepares ahead of time for your sessions by reviewing notes or action items from previous sessions, keeps your appointments, is generally on time, demonstrates that she is paying attention, and doesn’t answer the phone, check email, or become distracted during your sessions.
5. Your therapist provides a diagnosis if necessary, but remains steadfastly focused on helping you to manage any such diagnosis and get better. The diagnosis remains the backdrop for therapy, not the focus of it.
6. Your counselor understands and communicates to you that there are many effective approaches to therapy, and no one approach can meet the needs of every client. He or she models open-mindedness about other approaches to therapy.
7. Your counselor explains what psychotherapeutic technique he or she plans to use, welcomes and answers any questions you may have about a specific technique, and requests your comments for any technique that may be new or different for you.
8. Your counselor is active in the therapy community and regularly interacts with other professionals. It is this regular collaboration with other professionals that keeps your therapist current and able to provide the best therapy for you.
9. Your counselor provides insight and knowledge that you otherwise might not have seen. This insight clearly comes from experience and training.
10. Your therapist maintains a good balance between your thoughts and your feelings without neglecting or diminishing either one.
11. Your counselor always demonstrates a balanced and appropriate level of emotion during sessions. Because good counselors are empathic and genuinely care for their clients, sometimes they express emotion when learning about a client’s experience. For example, if the client has experienced the loss of a loved one, the counselor may show sadness. While some emotion is appropriate, an abundance of emotion is generally not okay. Good therapists maintain their focus on you and not their own emotions.
12. Your therapist helps you to work through highly vulnerable feelings or memories in a safe and therapeutic way that does not re-traumatize you. Because of your work together, he or she knows when it is safe to deal with these feelings or memories and when it is not. He or she neither pushes you to “go there,” nor prevents you from “going there.”
13. Your counselor has also experienced being in therapy. Many counselors choose this field because they’ve had positive therapy experiences themselves, and they want to do the same for others. For those who have not experienced therapy prior to entering a counselor education program, most curricula require counseling students to participate in therapy, even if briefly so. This allows therapists to understand therapy from the client’s perspective.
Informed Consent and Other Legal Issues
The term informed consent is common among therapists. It simply means that the client should be made aware of any and all benefits and risks of therapy or a particular treatment or technique so that he or she may make the best decision about proceeding with the therapy. Informed consent is often a legal requirement as well, and these next few signs of good therapy are specifically about informed consent and other legal issues. The foundation for good therapy exists when:
14. You receive a packet, commonly called intake forms or informed consent, to complete before or with your first appointment. This packet should explain how therapy with your counselor works, what your rights are as a client, the fee schedule, insurance information, privacy information, and more. Your therapist should also answer any questions about this packet to your full satisfaction.
15. Your counselor explains to you that therapy is always your choice. He or she should make you feel comfortable with the choice to discontinue therapy or to choose another therapist. Some people decide to leave therapy before the counselor thinks it is healthy to do so, and your therapist is obligated to express any concern if you opt to discontinue therapy before the therapy has been “completed.” However, this concern should not make you feel as if you don’t have the choice to leave.
16. Your counselor maintains your confidentiality at all times. While there are some occasions when it’s necessary for a counselor to break confidentiality, these are typically outlined very carefully in the state’s or other municipality’s legal and ethical guidelines for counselors. Though the guidelines vary depending on where you live, generally speaking, a counselor can divulge the contents of a therapy session or sessions if the client or another person appears to be in imminent danger, or if the court requires information for a legal proceeding. You may want to check your own local and state guidelines.
17. Your counselor maintains the confidentiality of other clients as well. While your counselor may tell you anecdotal stories of other people’s experiences with counseling if there is a therapeutic value to you, he or she should never reveal the identities of other clients or give you any information that would allow you to identify them.
18. Your therapist responds openly and honestly to any questions you may have about complaints filed with the licensing board. We recommend that you always check with the licensing board to make sure your therapist’s license is current and that there are no unresolved issues.
Communication and Client Focus
Effective communication and the relationship between you and your counselor are probably the most important and indicative factors in whether or not your therapy will be successful. While everyone has different communication styles, it is the counselor’s role to be clear throughout the counseling process. A key part of effective communication is the focus of the counselor—which should always be on you. The foundation for good therapy exists when:
19. Your counselor explains right up front how he or she can help you. He or she gives you concrete examples of what he or she will do, what you will need to do, and how you will know the therapy is progressing.
20. Your counselor regularly checks your progress against your goals and helps you to understand where you are and where you may still need to go.
21. You feel a connection with your counselor that shows he or she really believes in you and in the goals you have set for your life.
22. Conversations with your counselor seem natural and balanced. He or she neither talks too much nor too little. He or she uses terms and language you understand and explains any concepts that may be difficult or confusing.
23. Your counselor helps you to see your own role in your level of happiness and recognizes that, while some people in your life may influence you negatively, blame is a destructive force and cannot be part of healthy choices.
24. Your therapist balances the day-to-day needs of managing your symptoms using effective coping skills with the need to work through and resolve the underlying root causes of those symptoms. By focusing on both, he or she is better able to help you progress and move forward than by putting all therapeutic attention on one or the other.
25. Your counselor models the behavior he or she is trying to help you with. He or she is thoughtful with comments and responses, he or she is calm and speaks at a moderate volume, and he or she is not antagonistic or aggressive with you.
26. It is clear that your therapist’s sole purpose is to help you—without focusing on meeting his or her own needs, talking excessively about himself or herself, disclosing personal information that does not hold some therapeutic value for you, or enlisting your assistance with anything that is outside the purpose of helping you.
27. Your counselor recognizes that he or she may not have all of the answers or be able to help you in some circumstances. She freely acknowledges any mistakes, welcomes your honest feedback, and uses these as learning experiences in order to better help you and understand your needs in the future.
Empathy and the Therapeutic Relationship
Empathy, or being able to “put yourself in somebody else’s shoes,” is a hallmark of good therapy. And therapists are often naturally empathic, as this is one of the common reasons they choose to be therapists in the first place. Demonstrating empathy within the therapeutic setting helps the client to feel safe, to feel understood, and ultimately to feel like he or she can make progress.
Empathy is what helps build a relationship with your therapist. And your relationship with the therapist is key to the success of therapy itself. Without a strong relationship, the therapist has little chance of genuinely helping the client work through his or her difficulties, and the client has an equally low chance of progressing.
A number of the warning signs refer to a “dual relationship,” which is quite simply one where the client knows the counselor in another context or setting besides the counseling environment. This secondary relationship can cause confusion for the client, which is why it’s typically an ethical issue. Good therapists maintain a productive and professional relationship with you at all times. While the relationship with your therapist can seem quite close—after all you are sharing your most private thoughts, sometimes over long periods of time—therapists are trained to manage this closeness and not cross the ethical line of becoming friends or romantic partners. The foundation for good therapy exists when:
28. Your counselor maintains a professional relationship with you at all times. His or her demeanor could be friendly, but she never depicts your relationship as a friendship.
29. Your therapist treats you as a “whole person,” an equal who is not defined by your issues, and does not make negative judgments about you. You feel genuine care and concern from your therapist. One of the hallmarks of good therapy is known as unconditional positive regard. This is an idea that is taught in counseling programs across the country; it maintains that the therapist should see clients in a positive light regardless of any behavior, lifestyle, or other issues.
30. Your therapist is respectful of your values and belief systems and does not exhibit an agenda founded on his or her own values or belief systems. He or she is sensitive to your culture and religion and uses aspects of these as part of your therapy, when appropriate. If he or she lacks knowledge about your beliefs, he or she asks questions in a respectful way to gain better insight.
31. Your therapist knows you well enough to understand any physical boundary issues you may have and does not “move into your space” or touch you without asking if it’s okay with you.
32. Your counselor empathizes with you at an appropriate level, such as a natural or fitting response or level of emotion to your life’s experiences, and not one that is either overdone or exaggerated, or flat and almost nonexistent.
Finally, your progress in therapy is the ultimate indicator of whether or not you are receiving good therapy. After all, regardless of how competent or skilled your therapist may be, you getting better is what really counts. Before we get into the final list, it is important to note that just because someone is not making progress doesn’t mean the therapist is bad or incompetent. Therapy by its very nature is highly subjective and influenced by the varying needs, readiness, and styles of both the client and the therapist. Sometimes a client may not be ready for therapy and sometimes the therapist and the client are not a good fit.
With regard to the changes listed below, it should be mentioned that they don’t usually happen all at once; instead, they often happen gradually and in different sequences. The foundation for good therapy exists when:
33. You feel better! You notice that you are happier, calmer, at ease more often, and more hopeful about the future.
34. You are resolving your own issues and not looking to your therapist or anyone else to fix things for you. A good therapist guides you to your own best solutions. They are not “rescuers” who are there to save you from the issues you are facing. Instead they help you achieve insight into your own thoughts, feelings, and experiences so that you can make the right choices for yourself and move toward a healthier emotional state.
35. You handle life’s ups and downs more easily and with more control over your emotions. You see the difficult times as part of life and are less likely to become overwhelmed by them.
36. You are more forgiving and accepting. You are seeing those around you, including those who may have hurt you, as humans who may have simply made mistakes just as you have.
37. You are more connected to yourself and your own emotions, to those around you, and to life in general. You look forward to living your life and not just moving through it.
38. You are beginning to see things differently. Your perspective on life and everything around you is changing, and you see solutions where you may have seen problems in the past.
39. You are making different choices and looking at your own needs more often. You recognize that you have choices you didn’t used to think you had.
40. You smile or laugh more; your whole demeanor is more positive and future-focused.
41. Other people are noticing differences in you, and they are beginning to react to you in different and more positive ways.
42. You are getting along better with the other people in your life—from your friends and family members, to your coworkers, to strangers you come across on a day-to-day basis.
43. You have more hope for a brighter future for yourself and for your loved ones.
44. You have some sort of plan or goal for what you want your life to be, and you’re working towards that goal.
45. You are setting healthy boundaries with the people in your life and actually building stronger relationships because of it.
46. You notice that you’re feeling better outside of the therapeutic setting and not just while you’re talking to your therapist.
47. You feel safe both emotionally and physically.
48. You feel important, competent, and significant in the lives of those around you. You know you have value to them and to yourself.
49. You feel stronger and better able to express your own needs and desires. You don’t feel victimized by the actions of others.
50. You are making your own healthier choices for your behavior, for your thoughts, and for your feelings.
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