Have you been naughty or nice this year? Or have you simply been anxious or depressed? Now that Christmas is over and that Boxing Week has arrived, perhaps you are thinking about self-care once again after post-holidays fatigue. Whatever your reason is for shopping for a (new) therapist, it still does not negate the fact that it is a major decision. Too many resources on- and off-line will share with you general strategies on how to choose a mental-health professional and would advise you to consider factors such as credentials and qualifications, personality, gender, theoretical orientation, fees/costs, and even wardrobe – or so says one marriage and family therapist who blogged how if she ever sees her own therapist in anything but a suit and a tie she would fire him as she does not want him to be a “real person.”
Needless to say that everyone has different wishlists and standards for what constitutes a good “fit.” Well, I’m here to go beyond the surface-level criteria and to share tips based on what I have observed or heard from my senior peers/colleagues and my clients who have had previous therapy experiences. Who knows: perhaps one of the following may just be the little nudge or warning sign that finalizes your decision…
#1: Do they abide by their college/registering bodies’ ethical guidelines in conducting their practice?
Aside from abiding by the local laws, mental-health professionals are further guided by ethical codes in their practices. Although each organization may have their own ethical codes, the primary responsibilities will be comprised of more or less of the following (B1; CCPA, 2021):
Beneficence – Being proactive in promoting the best interests of clients
Fidelity – Honoring commitments to clients and maintaining integrity in counselling relationships
Nonmaleficence – Refraining from actions that risk harm and not willfully harming clients.
Autonomy – Respecting the rights of clients to agency and self-determination.
Justice – Respecting the dignity of all persons and honoring their right to just treatment.
Societal Interest – Upholding responsibility to act in the best interests of society.
All of these pillars of ethics are influenced by the practitioner’s own moral codes and cultural values. As the client, you may use your therapist from time to time as a sounding board at times to see if you two are a match in terms of your ethical and moral values. You are also encouraged to consider if they demonstrate ethical practice in their professional conduct: it can be as simple as the provision of a consent form to the more complex as evidence of upholding ethical principles in the face of challenges and sociopolitical pressure. Personally, I have been inadvertently “tested” quite a few times over the past few years. Most commonly would be clients asking for letters of advocacy for reasons I find unmerited. “I don’t like stress and cannot handle pressure,” one new client confessed while asking me to fill out an accommodation request for his LSAT. Amongst the red-flags observed that would make it unethical for me to support his request, he also admitted to “escaping” to Canada to avoid the gaokao and planned to do the same to go to the States if he fails the LSAT, which he had rescheduled previously at least 3 times already. I did not rebook him after that session and instead advised him to think over the decision to either work on confronting his avoidant behavioural pattern or to seek another practitioner who would comply with the request without question as I’d rather not make his money if he is unwilling to address his core issues. He did not return; I was only disappointed that another professional had given in to the temptation of easy money.
#2: Can they explain what they are doing with you?
“So, what did your previous therapist do with you?”
“Talk therapy.”
Too many times when I ask clients what they have done with their previous therapists I would receive this answer. I’m hopeful that my clients, both former and present, would be able to give more specific answers as “talk therapy” is an umbrella term that basically describes all psychotherapy/counselling formats. It is important for clients to understand the process by which their clinical progress is taking place. If you ask your therapist which therapeutic modality they are using with you or what their plan is for you, they should ideally have a ready answer to indicate that they are actively engaged in treatment planning and are involved in your work together – that is, unless you’re one of those clients who prefer to direct the session or are simply working on maintenance. In this case, please lead the way and tell me what you would like to work on in the session 🙂
#3: Do they establish and maintain boundaries with you?
There have been a few instances over the past couple of years since the start of the pandemic that I have had to reaffirm boundaries with clients and even terminate when the latter crosses them inappropriately. From a new client who showed up to the initial session drunk then tried to belittle my qualifications by attacking my “age” to a potential client who screamed “show me your face!” and accused me of being “insensitive” when I declined to meet in person without a mask. Boundaries are an important part of therapy as it defines the relationship parameters, sets mutual expectations, and establishes respect and emotional safety for both parties. Therapists with no boundaries or blurred sense of boundaries are at risk of misleading clients. Furthermore, their work may, at most, give a semblance of helpfulness without actual clinical progress. On the other hand, a rigid implementation of boundaries that is so uncompromising that it takes precedence over taking calculated risks to help can be deleterious as well (Lazarus, 1994). Incorporating beneficial boundary-crossing interventions, such as relevant self-disclosures and flexibility in scheduling for clients with certain limitations, can increase clinical effectiveness if done appropriately. While I do not wholeheartedly agree with some of Lazarus’ (1994) own examples of boundary-crossing, I do agree with his conclusion to practice flexibly and responsibly and to treat all cases with “compassion, benevolence, sensitivity, and caring” (p. 260). To do so, it all starts with proper boundaries.
#4: Do they apologize when they make mistakes?
To err is only human. Understandably, we therapists, too, are mere mortals and can make mistakes. However, as mental-health professionals, we should not be so prideful as to withhold apologies when due. Personally, I recognize that there are instances when I can come across as harsh in tone. I recall two incidents in my first two years in which clients thought I was overly “critical.” In both instances, the clients were brave/honest enough to tell me so that I can apologize and, fortunately, they also acknowledged that I had good intentions in trying to help them recognize their maladaptive behavioural patterns despite my less-than-ideal executions. I hope that I am cognizant in the fact that not every client will be comfortable in doing that, so I try my best to encourage them to be forthcoming by providing opportunities to share feedbacks or to negate me by starting with statements such as, “you can correct me if I am wrong,” before I offer my thoughts. In the same line of thought, it is important to recognize that studying psychology does not make us therapists “psychics.” Therefore, my belief is that the onus of open communication is shared between the client and the therapist. Of course, if the therapist did do the client wrong, it is only right to make amends by first starting with a humble apology without the conditional “yes, but.” If a therapist can demonstrate humility by apologizing when the situation calls for it, then it is a good indicator that this professional is on your side.
#5: Do they risk your aversion by challenging and calling you out appropriately?
Our experiences, training, and credentials qualify us to make general observations of human behaviours, not individual judgements of personality defects or vices when our goal is to help and support the client. However, being “nonjudgmental” and providing clients with “unconditional positive regard” is not equivalent to us demonstrating an absence of moral standards and personal biases/thoughts that make us sycophants in sessions. It is our duty to act in our client’s best interests. Sometimes, upholding beneficence and nonmaleficence could mean we have to prioritize one ethical pillar over the other and risk incurring the client’s wrath. This summer, I had a client who wanted to use up his student insurance before it expires at the end of August. As such, he tried to rush through learning the ERP to treat his OCD. His motivation, despite being fuelled by finances, made him an eager client that I could imagine would make other professionals very happy. Yet, the implications and the severity of his symptoms made me reconsider rushing his progress, despite his vehement protests. He was driven to work on only the symptoms that cause him distress but made no attempt to address the behaviours that negatively affect his family. It did not sit well with me when he made seemingly-callous comments such as, “ha, of course it’s hell for my mom when I do this [symptoms flareups] but who cares?” I also came to suspect that the “friends” he mentioned were actually his aunt and relatives and not his peers. After making more assessments so as to avoid making unfounded assumptions, I challenged this client with the observations and shared my concerns of his behaviours. It was a painful conversation. I remember feeling sad the entire time as I discussed my worries that his attempt to rush through treatment could be detrimental and that his socialization patterns could jeopardize his future career search and relationship developments. He was agreeable to my observations and understood the interpersonal consequences should he continue to dismiss others’ feelings. Unfortunately, he remained adamant that as long as he can manage his symptoms to a tolerable level, it does not matter whether or not he ever gets a job, how others are impacted, nor how his family continues to “suffer.” My example is perhaps a mild version compared to other incidents in which therapeutic relationships can be injured, such as when we have to forfeit the client’s autonomy by breaking confidentiality in known situations of intentional harm to self or others. As difficult as it is, sometimes the best therapist for you is one who is not afraid to disagree with you and to act in your best interest even if it means taking the risk of harming the therapeutic alliance.
Before leaving you to your Boxing-Week shopping, one last word:
It is essential for new clients to know that the process of finding someone to work with can be daunting at first, but know that you deserve a professional who is equally as invested in your journey as you. Remember that you have the right to ask questions and to seek a complimentary short session – or, in my case, an “inquiry call” – to help your assessment of fit. Here is wishing you all having a lovely rest of the holiday season and finding that special someone whom you feel comfortable with to share and support your growth in the year 2022 🙂
References
Canadian Counselling and Psychotherapy Association. (2021). CCPA standards of practice for counsellors.(6th ed.). Ottawa: Author. Retrieved from https://www.ccpa-accp.ca/wp-content/uploads/2021/10/CCPA-Standards-of-Practice-ENG-Sept-29-Web-file.pdf
Lazarus, A. A. (1994). How certain boundaries and ethics diminish therapeutic effectiveness. Ethics and Behavior, 4, 253–261.
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