When people take a leap of faith and seek out a psychotherapist, it’s important that they choose a professional with the best skills and ethics to help them — and not just therapists with credentials that look impressive.
A Colorado State University professor who specializes in ethics in counseling has advice for choosing a therapist who will help clients meet goals. Sharon Anderson, a professor in the School of Education, suggests interviewing potential therapists and using a red flag, green flag system to determine a good fit.
When visiting with a potential therapist for the first time, Anderson suggests asking a mix of questions about business, the process and the therapist. Questions should cover appointments and fees, insurance coverage, the therapist’s training and credentials, and the therapist’s thoughts about ethics and his or her own personal beliefs and values.
Suggested questions include:
– How often do we meet and how long are the sessions? What if I need to cancel? How much are sessions, and will session fees change? Do you provide sessions over the phone or internet?
– How much and what kind of information will my insurance company get from you? How much influence does my insurance company have over my therapy?
– What kind of training, education, degrees and licensing do you have? How experienced are you with my issue, and how long have you been helping people with my type of problem?
– Based on what I’ve told you, what therapeutic approach do you think is best for me? Do you think your training and experience are a good match for me? What does research say about my concern and your approach? How long before I make progress, and how will I know I no longer need therapy?
– What professional ethics codes do you follow? What are your policies on relationships outside of therapy? What are your basic values that guide your work and life? Do you work from a religious or spiritual framework?
When working with a psychotherapist, a client would want to continue to keep his or her eyes open and watch for red or green flags. Anderson suggests watching for specific behaviors. Green flags are indicators that a therapist adheres to good ethical guidelines, respects the client and the therapeutic process, is professional and exercises good judgment. Red flags are warning signs that the psychotherapist may not be taking their professional responsibilities seriously and may lapse into poor judgment or unethical behavior. A therapist who displays red-flag behavior doesn’t necessarily need to be “fired” right then and there, but the client should watch for more red flags and understand that the lapses in judgment and ethics may become more serious as time passes.
Green-flag behaviors are:
– Amicable advice: The therapist talks about alternatives the client could consider and focuses on finding the best therapy for the client rather than promoting only their own services.
– Informative: Shares useful information about therapy and answers the client’s questions in understanding language and context.
– Clear consent: Explicitly seeks consent to treat the client and revisits the client’s consent at different points during therapy, such as when the client’s goals change.
– Sets good goals: Within the first few sessions, the client and therapist agree on goals for the client that are realistic and helpful. The therapist periodically assesses progress toward goals and makes adjustments if needed.
– Boundaries: Lets clients know about his or her professional boundaries and upholds them, even when the client pleads for an exception.
Red-flag behaviors are:
– Being everybody’s everything: The therapist conveys directly or indirectly that he or she can handle every problem because of superior skills. This shows a simplistic attitude toward complex human emotion and behavior.
– Defensive: The therapist uses his or her rank when challenged by the client instead of addressing the client’s concerns, setting a tone of “I’m the therapist here, don’t ask me that question.”
– Lax: Shows sloppiness by forgetting appointments, not having the right forms available and not keeping adequate records. These are all red flags that may show the therapist isn’t taking care of his or her business.
– Making exceptions: The therapist makes exceptions to his or her usual policies, which may create confusion about professional boundaries. This is especially true if the therapist announces that he or she is making an exception.
Sharing secrets: When a therapist asks a client to be secretive about certain activities in therapy, it’s a serious red flag indicating a compromise in ethics and professionalism that may lead to possible harm to a client.
Compromising confidentiality: If a therapist shares something private about you — or with you about another client — beware. Therapists also should maintain confidentiality by keeping file folders, correspondence or other paperwork with their client’s names out of view of anyone who may come into their office.
Inappropriate intimacy: When a therapist takes action to, or suggests, blurring boundaries between a professional and personal relationship, the client’s best interests are not at the forefront.
This advice also is provided in the book, “Ethics for Psychotherapists and Counselors: A Proactive Approach,” by Anderson and Mitch Handelsman.