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Key points
- Red flags in therapy include violations of confidentiality, boundaries, and licensure, among others.
- Therapy can be ineffective when the therapist is unable to communicate or lacks the training to treat a patient’s specific problem.
- Patients can raise concerns with their therapist directly. If the problem can’t be resolved, the patient should find a new therapist.
Therapy is a delicate process. The ability to share one’s thoughts, feelings, and past experiences requires a strong foundation of trust. Research bears this out; the relationship between the therapist and patient is a key component of successful treatment. Therefore, it’s critical to find a therapist with whom you feel comfortable and secure—and to realize when something feels off.
The vast majority of therapists are smart and competent professionals who care deeply for the well-being of each and every patient. But a small contingent—as is the case in any field—may not provide professional, effective treatment. Some red flags are egregious, such as violations of boundaries, confidentiality, and licensure. Others may be less flagrant but nevertheless important, such as excessive self-disclosure or ineffective communication skills.
Here are the signs of a harmful or ineffective therapist, and what to do if you encounter them.
8 Red Flags to Watch Out For
1. Boundary Violations
Initiating any nonconsensual touch breaches a patient’s boundaries, and patients should leave any such therapist immediately. Another form of boundary violation includes asking too much about an unrelated topic. For example, if a patient came to therapy for a fear of heights, but the therapist repeatedly asks intrusive questions about their sex life, that would cross the line. The same goes if a therapist asks specific questions about where a patient lives or tries to run into the patient outside of therapy.
“Stepping over the line of professionalism is a red flag,” says psychologist Ryan Howes, Ph.D. “You can talk about it with the therapist at first, but if you don’t get a satisfying answer, get out.”
2. Violations of Confidentiality
Confidentiality is an integral component of therapy; therapists must keep a client’s information private unless given permission to share it with another party. If a therapist shares information about you with a family member without your consent, or if they share detailed information about another client with you, it’s time to find a new therapist. (Patients could also explore reporting this violation to a licensing board.)
3. Violations of Licensure
All psychologists should be licensed to practice therapy, which ensures that the person has some degree of training. Lying about being licensed or practicing without a license would be a clear red flag. (An exception to this rule would be trainees in a clinic, who may be working under a supervisor’s license.)
4. Excessive Self-Disclosure
Self-disclosure refers to a therapist sharing personal information about themselves with a patient. Perspectives on self-disclosure have evolved over time; far from the “blank slate” approach historically taken by psychoanalysts, many therapists today believe that sharing some personal details, in a thoughtful manner, can foster the connection.
Self-disclosure only becomes a problem when it is done excessively, to the point where the session centers around the therapist, or when the therapist reveals personal information that makes the patient uncomfortable. “Self-disclosure has to be a tool,” says psychologist Elinor Greenberg, Ph.D. “It should carefully be targeted for the patient’s benefit.”
5. Ineffective Communication
Another red flag is being unable to adequately communicate. This doesn’t refer to an occasional misunderstanding or the need for both the patient and therapist to sometimes explain concepts differently. Instead, this involves a pattern of ineffective communication skills—for example, a therapist who only uses complex, technical terms so the patients can’t understand their assessment, or a therapist who can’t grasp what the patient is relating to them after multiple attempts.
A helpful litmus test is explaining the problem to family or friends. If they are able to grasp the situation, but the therapist can’t, that’s an important sign. “If you’re starting to feel exhausted, like you've gone down the same road a few times, that would be a red flag for me,” Howes says. Again, it’s worth raising these questions with your therapist. But if the problem doesn’t change, it’s probably time to leave.
6. Lack of Appropriate Training
Many therapists have experience working with multiple treatment modalities. But some may not have the training or ability to treat your particular problem. “A therapist may have generalized knowledge and you have a specialized problem. Or they could be a specialist and you didn’t know.” Greenberg says. “You’ll know they’re puzzled because they’re not asking the right questions, you’re not making progress, and you feel misunderstood.”
7. Unfair Judgments
A good therapist will still need to ask follow-up questions to clarify and understand your experience. But if a therapist explicitly passes judgment on you and your choices, or makes you feel embarrassed or ashamed, this is a red flag.
8. False or Specific Promises
Therapists should be able to explain how they will treat you and the timeframe for your treatment. However, they should not make promises or guarantees, such as “In 10 sessions, you’ll be cured.” People are different, and making blanket statements for all patients isn’t an ethical approach.
The Importance of Communication
With the exception of egregious violations, it’s often worth raising your concerns with your therapist. Try not to assume the therapist’s intentions, Greenberg says. They may not realize how their actions came across and are capable of changing their approach.
Still, it’s natural to feel nervous about raising uncomfortable topics or critiques. But mental health professionals are trained to discuss the therapeutic process, so it may be easier than you think.
How to Voice Your Concerns
Some therapists will periodically check in with their client, Howes says, which can open the door for you to begin the discussion. If that doesn’t happen, introduce your question toward the beginning of the session, so that you have time to discuss it thoroughly.
In terms of the language to use, you can begin the conversation by saying something along the lines of “I wanted to talk about how therapy is going for me.” Then state your concern directly and use “I” language to do so. For example: “I feel like we spend a lot of time discussing you and your experiences” or “I’ve noticed that I’ve explained the same situation a few times, but we still don’t seem to understand it the same way.”
“That takes courage, but it’s time well spent,” Howes says. “If you’re getting your haircut, and the barber is cutting it wrong, you’d want to tell them. In therapy it’s hard and it feels like there’s a power differential, but a mature therapist should take that in stride and want to hear that feedback.”
Green Flags that You’re on the Right Track
Stumbling onto odious red flags in therapy is relatively rare. It’s important to remember that finding the right therapist takes time and effort. In that spirit, be on the lookout for “green flags” as well, signs that you’re on the right path.
One green flag is feeling comfortable enough to begin opening up and sharing your experiences. Almost all new relationships come with some anxiety at the beginning, but feeling a sense of understanding, empathy, and acceptance is a green flag, Howes says. Another is feeling hopeful after a session—feeling optimistic that with time, change is possible.
To find a therapist, visit the Psychology Today Therapy Directory.
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