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A Shitty therapist: tell-tell signs

Updated: Jul 10

When a person is in mental or emotional distress, typically the person may have no energy or motivation to do anything. So, when this same person decides to seek a mental health professional for help, the process can be overwhelming and draining. There are several time-consuming steps before attending the first therapy session:

  • Locating a provider in their geographical location using a general directory or, if using insurance, taking a look at the in-network provider list on the insurer's website;

  • Selecting multiple providers to call; when calling, ask if their office is accepting new clients to determine if best to proceed;

  • Participating in a brief consult call or short meeting of less than 20 minutes to determine if the provider can assist with your condition/issue (**my recommendation);

  • Selecting the provider,

  • Scheduling the first session (i.e., intake session),

  • Completing the paperwork and signing the required consents before the first session;

  • If using insurance, call your insurance company to ask how much sessions will cost (specify whether outpatient, inpatient, in-office, or online); (**my recommendation) and

  • Attending the first session.

I recommend you ask a trusted family, friend, or another person to assist with these steps. But, you have to do most of the steps yourself due to knowing your symptoms and what you may be looking for in a provider.

I'm going to jump ahead to tell you what should not happen with a mental health provider:

If you DO NOT have an intake session, that's a red flag.
client and therapist sitting in chairs to face each other
client and therapist sitting in chairs to face each other

The first session at a mental health office or practice should be an intake session, which means the provider will not be going in-depth about your issue and providing therapy. The intake session is more like an interview, in which you will be asked about areas of your life in addition to mental and emotional health. The therapist or provider is gathering history about you and your family's mental health, medical history, drug, and substance use, childhood trauma and/or abuse, developmental history, possibly criminal or legal background. The provider will also ask about present drug or substance use and current medications. The provider will ask about your relationships, including intimate, family, friends, work colleagues, and peers if a student. The provider will ask about your lifestyle habits, including sleep, diet/nutrition, exercise, and stress management strategies. You will be asked to complete inventories to screen for symptoms and intensity; for example, common inventories are the PHQ-9 (screens for depression) and the GAD-7 (screens for generalized anxiety disorder). The provider will also ask about your initial treatment goals, which can be tweaked throughout your treatment.

If you DO NOT have treatment goals, that's a major red flag.

If you have been in treatment with a mental health provider for at least 6 sessions or longer, and are unaware of your treatment goals, that is a major red flag. Mental health providers are to openly discuss your treatment goals and progress towards goals with you. The treatment goals are SMART (specific, measurable, attainable, realistic, and timely) with target dates, and if using insurance, tied to your insurance coverage. If an insurance company audits a mental health provider, the insurance company looks for SMART treatment goals, a client/patient working actively toward the achievement of these goal(s), and whether the provider uses evidence-based interventions and therapeutic approaches. So, if your provider remains mum about treatment goals, I would assume your provider may not be using evidence-based interventions to appropriately treat your conditions or symptoms. The provider is money-hungry and wants to keep you coming back, and/or professional boundaries have been crossed, and roles are blurred (e.g., it seems like you're talking to a friend or family member). I encountered folks who have been in therapy for years (5+ years) and had no idea what their treatment goals were or what intervention/approaches the provider used to help them. Also, I encountered folks who were in treatment for years to show minimal progress or improvement in mental well-being or stability since starting therapy. Therefore, treatment goals are important to foster growth and positive change. If unknown, be direct and ask your therapist what are your treatment goal(s). Lastly, remember you can change them. The process is supposed to be collaborative with your therapist.

If you were abruptly discharged from a mental health office for a substantial high bill to be unaware of the growing bill.

Everyone who has a job expects to receive monetary compensation. The same goes for mental health providers. So, when there is trouble with a client's payment, someone within the office, if not the therapist, is aware or should be. If the office allows a client's bill to reach high amounts to then abruptly discharge, I consider that a red flag. In my opinion, it shows a lack of accountability on their end and a lack of compassion for the client if they were unaware of the growing bill. Now, it's different, if the office or therapist followed due diligence to inform the client about the growing tab, the client ignored the notices and still did not pay. Then that's the client's/patient's responsibility. The client should take accountability, pay the owed amount or establish a payment plan with the provider or office.

Another major red flag is if your therapist is a no-show, talk about themselves the entire session, or does other things during the session.

I heard horror stories of clients encountering disrespectful providers who simply do not care. I had someone disclose a provider put on fake eyelashes during their session. Another person revealed a psychiatrist did not show twice for scheduled appointments to cancel 15 minutes before each appointment. I heard of a therapist talking to a client about their shared love of music, bands and listening to the client's possible tracks for an album. I will give some benefit of the doubt to this therapist, maybe, there was a therapeutic value. I don't know. I heard of therapists spending sessions talking about their problems to their clients to make the sessions about themselves. None of these scenarios are healthy or appropriate. If there is a scenario when you're sharing music, poems, writing, etc., you and the therapist should have a conversation prior about the therapeutic purpose of this activity. What is the lesson or skill the provider is trying to teach you? You should be aware of it.

I will add more red flags as they come to me.



Hi, thanks for stopping by!

I am a clinical mental health counselor and an educator. I have been in private practice for almost a decade. During this time, I have encountered hundreds of individuals to listen to their narratives and to help them heal in some way. Additionally, I have my own story. I hope to weave takeaways and lessons learned over the years from these interactions and from my personal life into informative and thought- provoking posts. 

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