welcome to my scientifically informed insider look at mental health topics if you find this video to be interesting or helpful please like it and subscribe to my channel well this is dr. grande today's question is what are the signs of a bad therapist this was a question from a subscriber I've also seen this question many times before so I decided to format this video as six signs of a bad therapist or really six signs of a less-than-ideal counselor so I'm using the word counselor here not necessarily to refer to a particular professional identity but anybody who can deliver therapy so a professional counselor would be included in that but also a social worker psychologist Marriage and Family Therapist or some other similar profession I'm also talking here in terms of signs as a bad counselor in general not necessarily someone that's not a good match because sometimes the counselor can be very effective and good for most people but not effective for certain individuals so that's something to keep in mind I'm really looking again here in general terms it's also worth mentioning here that most counselors are good this video is focusing a lot of negative aspects specifically six negative aspects that might be seen in the world counseling but the vast majority of counselors do a good job under a lot of different circumstances the problem is that just a few counselors can do a lot of damage that's one of the reasons I decided to answer this question I think it is an important question now when I use the word bad here I'm not really referring to bad versus good but again less than ideal or not competent or less competent than preferred something like that now some of these signs are very bad indicators and others really have to think through and look at other circumstances before making a termination that somebody's less than ideal in their role as a counselor I also tried to make this list fairly objective there's a lot of subjectivity with this topic I searched this topic on the internet and you see all these different websites and videos that offer these really ambiguous lists they have items like you're not clicking your counselor that's not very easy to define or they'll use statements like to like t oo like too much empathy or too little empathy or too active or too passive really these terms have meaning but it's very hard to determine what level is too much so I tried to again make these more objective anchors that are a little easier to at least observe again though there is always some subjectivity when you come to an issue like this and a lot of variables need to be taken into consideration so the first sign of a less-than-ideal counselor I have is what I refer to as a story and I've heard the story many many times in my career and what the story means is when a client asked a counselor if they have a license which most clients probably wouldn't have to ask because they would know and it's not really a question that comes to mind readily because a lot of people don't understand licensure very well which is actually quite understandable so in this question is asked there are all kinds of potential stories that come out other than just yes or no in the explanation so they might say well it's complex you know I asked without a license say well it's complex well it's a long story or I almost have a license but my supervisor didn't sign the form because they disappeared in a hot-air balloon accident or they were selected to be an astronaut now they're on the way to Mars or some excuse as to why the normal course of events that would be licensure didn't leave the licensure in their instance now again if somebody just says no but I have an explanation no but I'm working on it no I don't have the money or something like that I can understand that but what I don't really like is when there's this whole complex story there's this whole story that's using the technical language of counseling like supervision and things like that where the client might not know what that means so they might think oh well their supervisor disappeared but that means they're still licensed they wouldn't really know now of course there are valid explanations if somebody's an intern they wouldn't have a license so that's just something somebody would tell you we we hope no I'm an intern therefore I don't have a license and one area I do see rickets a little complex is this associate or graduate license like the state of Delaware has a licensed associate counselor mental health so it's technically a license but they're not license to independently practice so the answer would be yes but there'd have to be an explanation it's an associate license I'm not fully licensed as an independent practicing professional but again oftentimes we hear the story instead we hear this whole complex set of sometimes really fantastical reasons as to what prevented the individual we're getting a license now I know in the counseling profession of course there's a lot of preparation there are a lot of things that can legitimately go wrong sometimes supervisors do disappear sometimes people don't have the money to pay for the license all kinds of things happen I'm just really talking about being up front and not weaving it into a complex story that potentially a client would not be prepared to understand at a technical level so the second sign of a less-than-ideal counselor would be when somebody has a doctorate not in a counseling related profession but again if you ask them about it they haven't Hall and kind of give you a big story so just to understand the ethical requirement if somebody has a master's degree and they get licensed that level they're a licensed professional whatever that is counselor or social worker whatever in order for them to refer themselves as a doctor that doctorate has to be in a counseling related or mental health treatment related field it can't be in something completely unrelated so for instance if somebody has a doctorate in biology or art history or something like that that's an interesting doctor either one of those is interesting but it's not enhancing clinical skill so therefore they really couldn't use that they couldn't say well I'm a doctor not in that context they could say I have a doctorate but it's not one related to counseling so I'm operating here at a master's level and that's fine but they can't call themselves a doctor it's actually of course an ethical violation and some degrees are right on the fence and these are debated like some PhDs or other types of doctorates like sociology I've heard people will debate that in both directions that's why I use the standard clinical skill being enhanced that's the standard I use so somebody's doctorate adds to their clinical skill then that makes a much better case to use the term doctor than if it didn't add to the clinical skill so again what a degree like sociology you really have to look very carefully at that degree and say was there actual clinical skill added to the skills that were learned before or were there new skills added that are related to the profession the third sign of a less than ideal counselor would be when a counselor introduces the idea of being a friend during the time when therapy is occurring like during the time when somebody is a counselors client or suggests that it's a possibility for the future like hey after this therapy is over we'll be good friends no that's not something that's acceptable and we could look at romance as being even worse if somebody suggests a romantic or sexual relationship that's not only a violation of ethics that's illegal in most places as well now the friend question of course is more complex when you talk about post termination so when counseling is over can a counselor be friends with a client that's a real murky area I would say in general that should be avoided now it's arguably as complex but certainly more debated is can a romantic or sexual relationship occur after the termination of therapy I say no I say there should be a lifetime prohibition I don't really see any good coming out of making that okay at some level the codes of ethics generally disagree with me on this so with counseling with the American counseling Association there's a five year limit but again it's the counselors responsibility to make sure that no harm will occur even after the five years well the national board certified counselors is a two-year limit so I understand why they do this instead of making a lifetime ban but my concern is that counselors may think about those time limits and that may change the dynamic of the relationship they may try to therapy early or they may make plans even if it's two or five years out so I just think the potential benefit meaning allowing some of the allowing a couple to be together that wants to be together when it's many years later does not outweigh the risk during therapy that's my logic for it but again this is really debated I wouldn't say it's extremely frequently debated but it is something that comes up once in a while it's really the way they look at it is really comparing the duty to protect the client with respecting the client's autonomy meaning 5 10 15 years later the client may want a romantic relationship and in theory a counselor wouldn't want to interfere with that autonomy of course the counselor would have to be willing to get involved in relationship and would have to be no harm but that's the logic that we see applied and I just say it's simpler and I think more supported by evidence to say there's a lifetime prohibition but either way if a counselor introduces the idea of friendship or mass I think of that is a very bad indicator so moving on to the fourth sign of a less than ideal counselor this has to do with incorrect diagnosing and again this is a little more objective than a lot of the items we see on these various lists now one thing that's important remember here is that I realize that everything a diagnostic impression isn't going to be a technical correct diagnosis meaning it's okay to add supporting information so if you see a diagnostic impression and there's a disorder and then there's an explanation of that disorder or some of the symptoms with that disorder that's okay for example if you see major depressive disorder and then there's an explanation that says the client is unhappy pretty much every day that's not necessarily technically excellent language for diagnostic impression but I'm generally okay with something like that because it's describing why the criteria might have been met for major depressive disorder but what I'm talking about here is really much different I'm talking about a few different things so one is making up a diagnosed and I've seen this so many times I've lost count I've seen examples like angry person disorder again there's nothing like that out there that's not a real disorder talkative personality disorder some people are certainly talkative but it's not a personality disorder super sad disorder I guess this is as opposed to just regular sad disorder again none of those are actual disorders I have also seen disorders that seem to be borrowed from trends like the trend we see with the popularity of the construct of narcissism like gas fighting disorder again that's not real or a narcissistic abuse disorder now narcissistic abuse happens but there's no disorder there's no narcissistic abuse disorder we also see other terms that are based on trends like high functioning depression that's not a technical disorder it really refers to a mild presentation of some sort of depressive disorder so making up diagnosis that's one problem another thing I see and fortunately I haven't seen this too often but does happen is what I call weaponizing a diagnosis to me this is really one of the worst diagnostic practices and completely unethical but again it is seen sometimes so we see this once in a while on substance use treatment we also see it in the treatment of other disorders as well and what I mean here by weaponizing a diagnosis is when a clinician gives a diagnosis because they know there's a stigma associated with that disorder in a sense to punish the client for having whatever symptoms the counselor doesn't approve of so again highly unethical I've seen this done with antisocial personality disorder where when somebody comes in with a substance use disorder like using heroin for example they're automatically assigned antisocial personality disorder those disorders have nothing to do with one other so if they did in fact qualify for opioid use disorder that would have nothing to do with antisocial personality order yes there's high comorbidity between those two disorders but the criteria still have to be met weaponizing a diagnosis is okay I've seen this done as well with borderline personality and I've seen it with substance use disorders where the substance use disorders are piled on when somebody doesn't meet the criteria I call this stacking substance use disorders so somebody comes in and they say that they've used heroin and after talking to them it seems clear they would meet the criteria for opioid use disorder but then they mentioned that they also have used alcohol in the past marijuana and cocaine so instead of just really looking at those uses and determining whether the criteria for the disorder is met the clinicians simply stacks one the diagnosis so stimulant use disorder for the cocaine alcohol use disorder for the alcohol and cannabis use disorder for the marijuana so they just stack on the disorders almost like saying well if this person uses one substance they must use several Smith's got a pile on the diagnosis really a terrible practice and a very good indicator that you're working with a less-than-ideal counselor I also see similar activities with weaponizing but with disorders that are made up like drug seeking personality sorter there's no such thing as that or taking psychosocial stressors and making those into a disorder like outstanding warrant disorder so somebody might write something like this client may have trouble meeting appointments because they have outstanding warrant disorder they have an outstanding warrant it's not a disorder that doesn't even make any sense but we see things like that another indicator in the same problem area of diagnosing is when somebody describes a diagnosis fairly well without ever mentioning the diagnosis that makes me suspicious that they don't know the diagnosis exists for example if somebody gives a primary diagnosis and then they go on to write that the client tends to eat substances that aren't foods why wouldn't they mention pica why wouldn't they say something like rule out pica now just because somebody does that they wouldn't necessarily meet that criteria you still have to look at the criteria sorter but it seems odd not to mention a disorder that lines up so closely with the description and the last area of diagnosing I'll mention here is when the diagnosis is confused now this happens to everybody the DSM has a lot of disorders so this isn't necessarily a clear sign of a less-than-ideal counselor but some of these make me worry a little bit for example I've seen in terms of what's been put down as a diagnosis improvised explosive disorder that's confusing improvised explosive device with intermittent explosive disorder I've also seen intermittent wiper disorder which makes no sense to me the only thing I can think of that would happen here is that somebody type in the word intermittent and perhaps the software suggested the word wiper because I don't know what that would mean otherwise I've seen examples like pre traumatic stress disorder it's actually of course post-traumatic stress disorder I've seen ones that are more understandable like major anxiety disorder that doesn't exist but major depressive disorder does exist so I can appreciate that one and the other thing I see is putting the specifier first so like major depressive disorder MDD saying modern MDD now I'm actually okay with this I don't think this is a major mistake technically of course it should come after it should be MD D comma moderate but what bothers me is when the specifiers aren't real so the disorder is real but the specifier is not like subtle MD D or terrible PTSD you can call a disorder subtle and I guess you could also call a disorder terrible it's not something that's really a technical term we would use but you certainly wouldn't put it as part of the diagnosis it would be in the descriptive information to support the diagnosis so moving one to the fifth sign of a less-than-ideal counselor this is what I call the one-hit wonder and this is where an individual has a dogmatic loyalty and over loyalty to one treatment modality so what I mean here is one particular theory of counseling like psychodynamic gestalt reality therapy cognitive behavioral therapy existential therapy one of the treatment modalities we see us sometimes more with certain modalities and other modalities for example I see it quite a bit with psychodynamic and I see it with motivational interviewing as well even though that really isn't a comprehensive theory of counseling but either way again this isn't over loyalty so it's okay to have one modality and be committed to it it's okay to be a psychodynamic therapist and really believe that the psychodynamic explanation makes sense for a lot of clients what I don't think is a good sign or what I think is a bad sign more to the point is when all other theories are then automatically dismissed there's no recognition that any of the theory could be valid because there's a dogmatic loyalty to one particular modality and oftentimes what you find out when you talk to the counselor is it's the first node allottee they really liked so they learned about a few modalities they found one and they committed to it and they never bothered looking at another modality so again I call this the one-hit-wonder one modality wonder of one Theory wonder something like that any of those would be consistent with what I'm trying to get at so with the sixth sign of a less-than-ideal counselor this is built around using the term more of an art than a science I appreciate that not all counseling is scientific there's also a philosophical component what we would call an artistic component is there as well so yes it's not pure science but this is an overuse of the term more of an art than a science or more art than science and when you usually see this term used in a less-than-ideal counselor situation is when you ask a question about a treatment goal or how does the treatment really work has the modality work it seems to me to be a way to dodge not understanding the science behind the modality and just to chalk it all up to art it's really to me like saying you don't know the answer to the question so I find that as a fairly distinct problem I've seen that quite a few times where counsellors can't really explain the science of counseling and instead of saying that instead of saying you know I really haven't read a lot on that topic so I'm not sure of the science behind it but I'll go ahead and check it out they just move immediately to saying it's an art and not a science so those are my six signs of a less than ideal therapist and again is just my opinion and you have to consider all the variables when looking at any of these signs it's not so simple as to say if somebody has one of the signs they're automatically a less than ideal counselor or a bad counselor or I think that as with most everything in counseling there is a complexity to it but we try to find objective ways to determine competence and some of these I think are fairly clear some are more subjective so you have to look at each one in context now I only covered six signs of a less-than-ideal counselor I would certainly appreciate if you'd add a comment if you know of another sign of a less-than-ideal counselor or you want to expand on one of the signs that I provided perhaps I missed something didn't provide enough information I would really look forward to seeing your comments on that as always I hope you found this video to be interesting or helpful thanks for watching