Therapy Red Flags And How To Respond
Going on the search for an available mental health professional, that offers the type of therapy/intervention one needs, is already hard enough on its own. The wait lists are long, insurance sometimes refuses to give the okay for it and not every professional makes it easy to book an appointment with them in the first place.
So it takes quite a lot of patience and effort to actually make it to that first appointment with them and nothing is quite as frustrating, as then feeling as if, that professional is doing a horrible job at listening to you and potentially even invalidates you.
This experience is not limited to the first appointment either and while theres sometimes simply the issue, that the chemistry between professional and patient doesn't fit (which is neither their fault, nor yours), sometimes it is due to a professionals red flags and unprofessional behavior.
Those who are not as familiar with what makes a professional a good one and those who may not know their way around the field of psychology as a whole, find themselves at a loss for what to do and how to respond to such situations.
Are the things they are experiencing really red flags and unprofessional behavior? Is that something where you try to go for the open conversation, or is it a sign to look for a new professional? When is the professional the problem and when is it you? What is simply a personal style of conducting therapy and at which point is the professional harming the patient?
While I am not a professional myself, I did study special needs education at uni for two years and am at least sort of familiar with the etiquette and concepts surrounding treatment (which is still not the same as being a trained professional tho obviously) and I have also made my fair share of positive and negative therapy experiences in the position of the patient, so I have some thoughts on this, that I'd like to share.
Therapy is a very individual thing and thus will obviously look different depending on the person who is seeking treatment and the professional who is giving said treatment. Different conditions need different approaches and therapy types, different professionals will have their unique personality styles they bring to the situation and not every professional is licensed to conduct diagnostics, prescribe medication, or refer you for further treatment, so you'll have to search for which professional fits your personal needs.
If you're a very sensitive person, a professional who is immediately very blunt may not work well.
If you're looking to work on your behavior explicitly, a professional who is specialized in working trough & confronting traumatic memories, may not be the ideal fit.
If you're looking for a diagnostic, a professional who isn't licensed to do that, will not be able to help you.
Those are situations where the fit simply isn't right and where no "red flags" are present. You'll simply have to try the next one.
There are however a few "common" red flags for professionals, that go beyond such basics and where the "mistake" is more on the professionals side (tho this is just my personal opinion here and I can only talk about what I experienced, so its an incomplete list that you can add onto!):
1. They do not take diagnoses or suspected conditions seriously
If you go to a professional for the first time and during the intake you list off your previous professional diagnoses and the things those professionals have additionally suspected in you and the new professional goes and immediately disregards those, that is a red flag. Someone who barely knows you, is not able to judge whether previous professionals have made a mistake or not, whether what your symptoms were caused by was puberty/momentary circumstances or not, etc. If they have genuine concerns that you may have been misdiagnosed, after they've worked with you for a while, thats different! But disregarding the work of previous professionals immediately, simply because of their own bias, is a red flag.
2. Seeing medication as the devil you should never touch
A good professional keeps up to date on the research regarding the medication they are allowed to prescribe and only does prescribe them, if the benefits would outweigh the consequences and if they have educated the patient on the side effects of the meds! Its fine if professionals have some reservations regarding specific medication types, due to the available research, but if they try to tell their patients that all medication is bad, thats a red flag! Some patients need anti depressants, anti psychotics, anti anxiety meds, etc. in order to get into a mindset where they can actually participate in treatment and be so stabililized, that they can manage their daily life. Theres no shame in needing help from medication and any professional who tries to tell you the opposite in an inherent fashion, is not one you should trust!
3. If a professional talks about themselves more than you get to talk about yourself
Theres certain therapy types, that benefit from the professional bringing up some personal stories or examples, in order to get the patient thinking, or assess their reaction to a certain type of situation. Its especially helpful when assessing social skills, empathy and the like! But if a professional dominates the conversation with information, that genuinely has no relevance to the patient and doesn't really try to expand onto the patients answers, thats not a good professional. A 45 minute therapy session shouldn't consist of the therapist talking about the animals in her stable and her daughters problems of getting into her uni classes for 30 of them! You're there to talk about your problems and not to have a coffee date with your best friend.
4. When they refuse to diagnose no matter the circumstance
It is perfectly fine for a professional to be careful about putting a label on a patient, especially if they aren't sure whether its the right one and/or aren't a fan of the diagnostic system itself. Professionals get to have their opinions and those do get to influence the way they work! Not every problem actually needs a diagnosis and symptom based work is a thing! If the professional however inherently refuses to diagnose, no matter what they are confronted with, thats a red flag, since they no longer have the patients best interests at heart. Some patients need a diagnosis in order to have access to medication, accommodations, further treatment, care teams, etc. so if they meet criteria and would not be able to get better without those diagnosis blocked treatments, refusing a diagnosis is a red flag!
5. Trying to scare you away from transitioning
If you go to a new professional as a trans person and you've been happily living as your actual gender for some time and maybe already started transitioning (or you're very sure about wanting to do it), it is a red flag, if they try to scare you away from it, especially if they do not know you enough to have genuine concerns about whether or not your transition goals are simply due to identitity issues or trauma. Those situations exist and will need to be ruled out in order for you to receive a gender dysphoria diagnosis, but if you already have one and you're happy as your actual gender, trying to scare you into not transitioning further by showing you botched surgery cases, telling you horror stories, or telling you that your b*obs aren't big enough to need surgery anyway, is not professional behavior. Theres a line between genuine concern and being an ass about it.
6. Throwing around medical terms without being clear about why they are using them
If your professional mentions medical terms for symptoms and/or disorders, or compares your behavior to that of people who have a certain condition, without being clear about whether this is what you have, something they suspect or something that reminds them of you, that is a red flag. A good professional either openly communicates what which term means and why they're using it, or they avoid using them until they are ready to let you know thats the diagnosis you have! If you've been seeing them for a while and if, after you tell them about an experience of yours, they randomly say "yeah thats common for people with ADHD, so no surprises there" without ever having been clear about whether thats something they suspect in you, or whether they are simply comparing your experience to that of an ADHDer, thus leaving you confused and wondering, thats not a good professional. Diagnoses and medical terms have a huge impact and need to be used responsibly and clearly.
7. Immediately declaring puberty as the reason for your behavior
If you tell your professional about an experience of yours (whether you clarify it happened in your teenage years or not) and they immediately respond with "thats just puberty, its normal", without asking follow up questions about whether you're still experiencing that symptom, for how long you have experienced it, how frequently it pops up, etc. thats not a good professional. It not only invalidates how important this experience may be to the patient, but also shows that the professional is incapable of assessing current risks and that they will miss any impact this symptom still has on the patient. Those are also the professionals who will not believe that teenagers can have valid struggles with emotional dysregulation, conduct, impulsivity or psychosis, that go beyond what is common for teenagers and may need intervention.
8. Going back on their word
This sort of ties into previously mentioned points, but if your professional tells you they'll never precribe something or diagnose you, if they tell you they believe you were at fault/it was just puberty, etc. and they later go back on their word and/or it becomes clear, they've stated that, in order for you to think they're not looking into it, just for them to secretly assess you all this time...thats a red flag. If you're conducting therapy in a way that starts with invalidating your patients experiences/needs just to later say "sike!" because you wanted to assess them unaware of it, you will only make them resent and distrust you and you will cause them to refuse to admit to faults/mistakes/experiences, thus skewing the assessment. Its fine to say "I don't know if I can see that yet, but we'll see" or "lets return to that at a later point", but lying to the patient and invalidating them to assess them behind their back really isn't a good strategy.
As already mentioned, therapy is a really individual process and will not always look like having successfull, or good sessions. There will be setbacks, there will be frustration and there will be moments where you will not understand why your professional has done/said something, or you may feel invalidated/not seen. Sometimes it takes a few more sessions to realize, that your professional was actually right about something and you were just not ready to hear it yet. It is a psychs job to challenge your habits and beliefs about yourself and others to get you to look inward and learn how to recognize stuff and help yourself.
That being said, if a professional is outright rude, tries to scare you away from stuff, tries to invalidate you/deny things without knowing you, refuses to openly explain their choices/sentences to you, misuses terms, doesnt bother looking into your file and so on, it may be a good idea to either just leave that professional, or attempt an open conversation where you discuss how you do not find their approach helpful and determine whether thats due to the professionals errors, your own errors, or a lacking chemistry.
Its important to remember: You are there for your own benefit. That is your therapy session and you have a right to declare what you would like to do/discuss. Your psych can direct the sessions if you struggle doing so, they can open the conversation with a story/question and they can suggest topics, but in the end it should be okay if you say "no I'd like to talk about x today" or "I struggle with y, can we discuss strategies" or whatever else. Hell, if you'd use that therapy session to infodump about oven mitts, that should be okay, because you decide how you use the therapy contingent that you have (granted it might be better to actually discuss problems you're having, but I hope you get my point).
Therefore: If your professional does something that you dislike, they make you feel invalidated, or you realize that the therapy type/approach doesn't suit you, you are allowed to speak up and you are allowed to stand up and walk out. You're doing this for yourself and no one else, so YOU need to be happy with it.
That being said, breaking off therapy or walking out isn't actually always needed! Sometimes psychs just forget that not every approach works for everyone, sometimes they are limited in their own way of thinking, or they try to solve problems with approaches that feel natural to them but alien to their client.
Sometimes they are used to having to be gentle and careful with statements, when a client actually prefers straightforwardness, or the other way around.
So you can do what you (technically) should do in everyday interactions: Have a conversation, see if they're able/willing to adjust what they do and if not, you can run for the hills and look for a new professional! Theres absolutely no shame in that and sometimes it takes a few attempts to find the right one! You don't need to accept discrimination and invalidation, you are allowed to look for a better fit!
Other possible reasons to look for a different psych:
• they voice beliefs that you do not agree with
• they do not adhere to client confidentiality
• they refuse to/can't see you as often as you'd need it
• they do not show an interest in acknowledging that theres conditions beyond anxiety and depression
• they try to blame you for things that were not your responsibility
• they share too much of their private lifes with you
• they disregard your wishes in any way thats a dealbreaker for you
• they immediately label your difficulties as not being compliant
• they do not believe in comorbidities, or complex cases
• they refuse stuff out of principle/without giving an explanation
• they do not follow up on providing papers, tests, referrals, etc.
• they consistently are too late for appointments/cut the time short/dont show up at all
• etc.
