"Art Informed by Science"
Bare Bones Basics of Good Psychotherapy
This is not an exhaustive list, but rather basic guidelines for psychotherapy, including essential ethical elements for the therapist. This post was inspired by learning of a situation involving “therapy gone wrong” in all sorts of unethical ways. I have no words that capture how I feel about that.
This is not an exhaustive list, but rather basic guidelines for psychotherapy, including essential ethical elements for the therapist. This post was inspired by learning of a situation involving “therapy gone wrong” in all sorts of unethical ways. I have no words that capture how I feel about that.
When asked to describe psychotherapy, I have long responded with: “It is art informed by science”—with clear boundaries.
The best therapy isn’t mechanical but relational. For therapists, it involves taking what you learn and tailoring it to what is needed for each person in order to be most helpful. It requires compassion, creativity, adequate and ongoing training as well as your own self-work, self-care, and introspection.
Psychotherapy is personal. It is creative. It is humble. It is human. It is respectful.
It has clearly delineated boundaries and is focused on meeting each client where they are while partnering with them to help them heal and reach their goals. It is based on proven practices that may be amended and clinically attuned for each individual. It is confidential while adhering to all laws that govern this work.
There are many approaches and therapeutic techniques, and what works for one client may not work for another. This post is about the overarching therapeutic framework and ground rules, rather than specific techniques.
Good therapy has a few essential features (this is not an exhaustive list!)
Good therapy:
Is backed by science. Check to see if your provider has adequate or extensive training by accredited sources, and utilizes evidenced-based approaches and tools as their foundational approach. These may be adapted as needed.
Stays current with the evolving field of psychology and neuroscience. Oh, the advancements that I have seen over the last 20+ years! There have been remarkable updates in the field of psychology and neuroscience. I’d be remiss not to include this in my work.
Involves ongoing professional education for the therapist, which is often required to maintain their professional license. The field evolves, and so should our approaches.
Is more than “common-sense.” Rather, “good therapy” is based upon years of education, appropriate training and supervision, and ongoing consultation.
Is offered by qualified and experienced professionals. Check to see if your provider is licensed in your state; this is one way of verifying their training and professional standing. It will let you know if there have been previous ethical complaints or licensing violations. This is public information and can be incredibly helpful.
Has clear boundaries and therapeutic “guard rails” that serve the client’s well-being.
Routinely involves check-ins with each client as to how therapy is working—or not working—for them.
Solicits client input and goals. Incorporates this input into ongoing work.
Is bound by professional ethical guidelines as delineated by the provider’s license. I just can’t say this enough. Clients are trusting their provider with such important issues at what is likely a vulnerable time in their lives. As providers, we must honor these ethical guidelines—and more.
Is compassionate and respectful. Always.
Feels safe, warm, non-judgmental, and welcoming—without pressure.
Creates a trusted space for healing and understands that trust is based on actions over time. In other words, trust is gradually earned, not immediately expected.
Starts off with informed consent (APA guidelines: HERE) that outlines the parameters of therapy, background and expertise of the therapist, legal and licensing issues, limits of therapy, and more.
Is built upon a solid and trusted therapeutic alliance. Extensive research validates the importance of the therapeutic alliance or connection between client and therapist.
Features a working and healthy collaboration between therapist and client.
Fosters a sense of “felt safety” (defined below).
What is felt safety? What elements are critical in therapy to foster a sense of felt safety?
Briefly, according to Agents of Change, NIH, and others:
Felt safety encompasses physical, emotional, psychological, and social safety. All of these aspects are important in contributing to a sense of felt safety, especially in therapy.
Felt safety is a subjective experience of safety, based upon internal and external cues. This means that the client determines whether they feel safe-or not. The therapist’s job is to do their best to set the stage to facilitate safety, knowing that feeling safe is individualized, based upon many factors, and may take time.
Key aspects of safety include: predictability, control, and a sense of empowerment—in the therapy room, and beyond. Knowing what to expect and having input into how therapy unfolds is crucial.
More specifically, “felt safety is based on an individual’s perception of what is happening inside their body, around them in the environment, and between them and the people they are with.”
Many of the aspects noted above (confidentiality, compassion, non-judgment, patience, evolving trust, clear ethical boundaries, etc.) can help foster felt safety.
Felt safety is essential for learning, connecting, and healing.
I absolutely advocate that clients trust their “gut” or intuition (neuroception) as to whether a therapeutic approach —or provider—feels right and safe for their healing. Change course (or therapists), if necessary. Share your concerns with your therapist if you feel safe and able to do so. A “good” therapist will welcome your input. It is your therapy, after all.
A good therapist won’t take your input personally. They will welcome it.
It is an honor to work with clients. We owe them our best. Every single time.
Side note: All of this can be confusing these days as “trauma”, “therapy”, “therapeutic coaching”, “trauma-informed care”, counseling, etc., are in the mainstream culture, media, and society. All sorts of people indicate that they offer therapy, trauma-informed care, or trauma coaching. Some are excellent, accredited, and licensed by their state. Others are not. It’s a broad field, and my recommendation would be, to the best of your ability, check out the professional’s background first prior to enlisting their services. Check the licensing board, if there is one, to make sure that the provider is in good standing.
Harm can be done.
What do other professionals think?
“I think therapy should be a safe place, an anchor if you will, for exploration of your own wounds, for learning how to have the courage to help yourself, ask for help, and help others. It is a place for radical compassion and forgiveness which means it is also a place for deep trust.”—Dr. Elizabeth Bostock Empoweredwomanshealthmd
“...the most crucial factor in the success of counseling is the therapeutic relationship, also known as the therapeutic alliance. The way we build this is through attributes such as warmth, empathy, and trust.'‘— From What are therapists really like?, — Ordinary Therapist
“Good therapy” can be transformative and incredibly helpful in facilitating healing and growth.
I am truly honored to be any part—big or small—of someone’s healing journey.
Final point: there are many complex topics regarding ethical and professional care that are beyond the scope of this post. Perhaps, I can tackle them at a later time (e.g., when is it appropriate for therapists to share personal information? What types? For what purpose? Is it ever okay? When is it contraindicated? What are the ethical standards on this? Who is benefiting from this disclosure?) And so on.
I welcome your questions. I will honestly answer what I can, and tell you when I can’t.
It is an honor to work with clients. We owe them our best. Every single time.
Thoughts about this? Your voice matters.
I’m listening.
APA Ethical Guidelines on Psychotherapy
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Great article.
nicely written