50 Signs of Good TherapyJanuary 10, 2012 • By Kelly P. Crossing, LPC, MEd, MS
As a companion piece to the 50 Warning Signs of Questionable Therapy article, it’s important to understand there are many signs of good therapy as well. After all, good therapy has been proven to help people from all walks of life, in thousands of different situations, and in countless ways.
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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.
© Copyright 2012 by Kelly P. Crossing, LPC, MEd, MS, therapist in Colleyville, TX. All Rights Reserved.
GiaJanuary 10th, 2012 at 3:44 PM
I want a counselor that I can really connect with, who I feel like understands the issues that I am grappling with and who can help me to come to some resolutions. I need a problem solver, or at least someone who I can trust to lead me in the right direction with solving the problems in my life that I face. I have never really thought about checking credentials, because I guess I think that it would take a whole lot of guts to blatantly lie and open a therapy practice without a license. I just want someone that can relate to me and the feelings that I am experiencing and who has some common sense advice for helping me to lead a richer and more fulfilling life.
BethJanuary 11th, 2012 at 11:42 PM
And I was expecting to see some technical mumbo jumbo here.Thank for putting this in layman’s words! Its a nice list and if you ask me the biggest sign of good therapy then I think it has to be that your therapist does not try to impose her ideas upon you and that she is patient with you.
Mary SFebruary 13th, 2012 at 9:14 PM
Numbers 1 – 32 mostly sound great. Numbers 33 – 50 sound too one-size-fits-all; they don’t take into account that people may come to therapy from different places. For example, looking at item 33: I was very hopeful for the future when I started therapy, although I certainly sought improvement in being calm and at ease. (Unfortunately, items 1 – 32 were not in place in my therapy experience, and I became less hopeful for the future, as well as less calm and at ease, in response to therapy.)
Some of the items 33 – 50 also sound as though they could be contradicting item 30, by setting an agenda based on the therapist’s values and belief systems, and disrespecting the client’s.
I do have one concern about the “positive regard” part of 29 as well, namely, it needs to take into account item 30 – specifically, the therapist’s idea of positive regard might in fact be based on the therapist’s values and belief system, and not be positive according to the client’s values and belief system.
LifesFebruary 22nd, 2012 at 8:00 AM
You missed one:
Clients should recognize that therapy doesn’t always feel like anything is progressing. Some work needs to go slower than what clients wish. ALSO therapy has ups and downs…basing “progess” ONLY on HOW I FEEL is NOT always accurate! I might reject an idea one week, only to realize weeks later that the idea IS valid! But if I look at just an isolated session– well, therapy is hard work and I want to quit a thousand times because of feeling “this isn’t working”– but it is working.
stefApril 29th, 2012 at 1:10 PM
As I expected, my T fits this list quite well. We have worked together a long time. But both of us maintain good boundaries.
MkhululiJuly 6th, 2012 at 5:48 AM
This is an amazing list, thank you for preparing me for my first session. At least I know what to expect….
margaretsJanuary 17th, 2013 at 7:31 PM
Perhaps some of the therapists here could check out the blog “Therapy is a con” and weigh in on the blogger’s experience. What went wrong with the therapy? What should have happened?
AnnieMarch 7th, 2013 at 4:22 AM
I disagree with this: “our counselor explains right up front how she can help you. She gives you concrete examples of what she will do, what you will need to do, and how you will know the therapy is progressing.”
How could my therapist possibly know, up front, how he could help me, or what he would do? He needed to wait for me to start disclosing and revealing myself. When I walked into his office the first time, I didn’t know half the things I was going to reveal, and neither did he. He needed to be patient and wait.
Kim SkillingJuly 16th, 2013 at 11:12 AM
While I agree that Education and credencials are important for growth and everyones safety today, we do seem to need more of those pieces of paper, I do feel we are loosing the importance of life experience and the more natural elements needed to build that relationship with people and for them to begin to express themselves and to grow. The relationship is the most important but we hear more and more about how we as counsellor’s need to know more about diognosis and medication. All knowledge is helpful but don’t lets loose sight. I have 20yrs training from the UK and now live in Vancouver Canada where counselling isn’t yet regulated, there appears to be cross over with counselling and Psychology where I am used to them being very separate area’s. Over the years I have seen many clients where I may not have had the knowledge for there perticular issue but i have their experience of it and that’s what matters as well as.
Kim SkillingJuly 16th, 2013 at 11:17 AM
Sorry My grammers not the best, thats why I have a degree and not a Masters, nothing to do with counselling eh just spelling, another story:)
Berita Hari IniNovember 1st, 2013 at 1:20 AM
It is obvious that Your therapist is trained appropriately and meets all local and/or state guidelines for providing therapy.
colette erckNovember 15th, 2013 at 4:00 AM
I had a bad therapist for a year. She called me fat and lazy. She told me to get a paying job so I would have more money. She said I should switch volunteer jobs to A volunteer job in a nearby city that I could not easily access to with public transportation. When I explained that to her she told me to have my case manager drive me there and back. Um, a casemanager is not a taxi service. Finally after a year of seeing her she said I had made no progress. I started to cry. I said I would find a new therapist. Thank God I did. I love my new therapist. She helps me so much.
Jessica PorongJanuary 14th, 2014 at 3:17 PM
What if you’ve got racial/cultural wounds that need healing but can’t/fear/don’t want to really discriminate against the therapist of an opposite race/culture but reluctant of any chances of healing/change because of the fear/pain of underlining indifference? How could you proceed with believing they could possibly be indifferent to your circumstances? All I want to do is feel free to be me and live!
AspenJanuary 19th, 2014 at 12:43 AM
I like this post and I think it will be helpful for clients to recognize whether their therapy is productive or not. Although, I have to say some of these points are problematic, such as #23 and #36.
“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.”
I understand that we control what we linger on so actively blaming and thinking about someone or something that is no longer happening is destructive. Although, if the client is currently and actively being harmed by other people that is when 23 is destructive because it derails from the real problem and individualizes the problem on the client instead. Part of therapy is teaching how to cope with other people harmful behavior and how to cope how it is affecting the client emotionally, mentally, physically, sexually, etc. It is not simply holding the client accountable for feeling happy or sad.
“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.”
I have to disagree with this too. I understand the power of forgiveness and acceptance but that is finally accepting something has happened at a time and place and accepting you cannot change that but only move on. It is not rationalizing or normalizing an aggressor and his or her certain behavior. It can be helpful in most situations, but sometimes there are NO rational reasons, some people are just willingly malicious and there are things that are not light enough to sweep as a mistake. To make a client view their victimization as a “mistake” while humanizing their malignant aggressor undermines the gravity of the action and the client’s feelings. It will make the client think there is something wrong with themself instead and put them at risk of being pathologized for not following such logic.
Chris60September 1st, 2014 at 7:45 PM
Thanks for the list to help clients find good care. It is hard to make changes to build a better safer life after enduring years of abuse, and clients have a load of symptoms and patterns to learn and overcome. The idea of building on a person’s strengths instead of focussing on their weaknesses is a great place to begin. Ironically, abuse can be a learning curve where survivors emerge with great strengths as they work on themselves and their reactions to other people. Sometimes the very thing we need to tap into is the thing we dread, and for many survivors they overlook their anger and fear appearing unacceptable or not nice, instead of listening to that tight knot in their gut that says to speak up and act to protect themselves and what they love. Trust and forgiveness are rich qualities that may be exploited by those who are habitual perpetrators. Sometimes it is not only appropriate, but also highly effective, to voice out loud that enough is enough to earn the respect of those who violate others or trounce on people’s feelings. Good therapists teach you to make wise choices and to be your own therapist. Trust your gut and listen to that little voice of warning when you start to feel uncomfortable about the way that others treat you. Most of use crave security and acceptance but find to hard to navigate how to achieve such a state. Find a point of calm and peace inside, and you are better at creating harmony outside as well. Good therapy should help you to arrive at such a point instead of remaining mired in distress caused by the actions of other people. The balance between over-analysing the past and living in the present should start to shift toward creating future goals and changes to improve your level of functioning and make your life more rewarding. The therapist may gently nudge you, but only you can make that shift.
Bob G.September 13th, 2014 at 3:19 AM
I have successfully completed psychotherapy, first with a good New York psychiatrist 1959-63, and then extending it with self-analysis of my dreams 1966-67 and journaling 1972. I reached psychological maturity in 1972, and I have not worked at psychological growth since then. This is all documented in my 2 books RE-EDUCATING MYSELF 1985 and THE MENTAL ENVIRONMENT 2007. I am reading your piece because I am trying to learn what people in the field know about psychotherapy.
I would move #13 up to #1. The primary qualification for a therapist is that they have resolved their own childhood traumatic experiences and moved up to psychological maturity themselves. That was the main quality in my New York psychiatrist.
#34 is important: The client has all the data in his/her mind, conscious or subconscious, and the client has to solve the problem. The therapist is only a GUIDE, and can key on things like defenses to know where the problem areas are and keep the client focused on them. I am not sure that people in the field know this. There is too much emphasis on the therapist’s role in solving the problem, and not enough on the client’s role as an active problem-solver.
I like some of the signs of psychological development you list down towards the end of the list. I am working on my third book, trying to argue that people should reach psychological maturity before they venture into spiritual pursuits like meditation and yoga, and I am trying to articulate the kinds of changes or developments that one can experience from psychological maturity. Your list is a help.
Thanks for giving me the opportunity to share my views.
Bonnie S.October 2nd, 2014 at 2:24 PM
I love this as well as your article about red flags. As a therapist, it is good to read and to confirm my goals toward being as healthy and effective as possible. It would be great for all of my colleagues to read these articles!
DominoNovember 6th, 2014 at 12:04 AM
I like this article too. What I am wondering is though, how could a therapist actually understand you? I mean, yeah, said therapist may have a bit of history about you but with out personal experience, how would he/she know what you are going through?
Alex U.December 30th, 2014 at 6:46 PM
Great article! I think that good therapy with the right therapist can be life-changing! I just wrote about the benefits of therapy on my blog.
ConneMarch 28th, 2015 at 7:27 PM
I have read this list 3 times. I think it is far from realistic. No one therapist can do most of those on the list. Problem I had was when a therapist couldn’t even do 7- 10 things on the list. I brought in a serious problem and two defferent therapists showed little emotion. Some don’t think they should care. They acted as if they had no idea what to say.I really don’t think you should expect them to care.
Please tell me if you disagree and why.
Smithf108April 6th, 2015 at 11:15 AM
I really enjoy the blog post. Great.
June 23rd, 2015 at
Conne, I am so sorry to hear you have not had positive experiences with therapists. I am sorry you have not experienced them to care for you. Don’t give up on finding the right therapist for you. I encourage you to interview several more therapists, bring up your concerns as to why past therapist didn’t work out for you, and see how they respond to that. If they respond in a way that doesn’t feel good to you, they might not be the right therapist. If they respond in a way that feels like they heard what you were say, understood how that doesn’t feel safe, and lets you know how that may be different in their way of counseling, then give them a shot. I always think if you can go in for 3 sessions, then make the decision if they are right for you. Don’t hesitate to “interview” the therapist, just like you would anyone else. The connection needs to feel safe so you can trust them with the tender things you want to work on. There will be a therapist out there who you can feel like they care for you.
ElizabethJune 30th, 2015 at 5:36 PM
@Conne: this is very realistic if your therapist is a good fit. I saw several people for brief periods and felt as you do but when I finally found a good match it set my life on fire (in a good way). Yes, no one is perfect, but she has been able to do about 90% of this for me. If you haven’t found s good fit yet, keep looking.
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