Even considering that effective therapy takes many forms, I’m personally not reading this list as black and white. These features look like red flags if they arise repeatedly. Are there any of these points in particular that you believe can consistently fit with effective psychotherapy?
Thanks for your question. Yes, there are some that I resonate with but my point was not so much about the list specially, more a comment about do’s and dont’s in general that has become pervasive on social media and in modern day discourse. So it’s really wider than this post.
I completely understand why it’s done and I’m not even saying it’s ‘wrong’ but, as psychotherapists, we live in grey areas so even mentions of physical touch, which I lately agree with, cannot be taken as absolutes in my view as I have received a hug from certain clients inc retain moments where it feels right. Hope that makes sense
Yes. Some points are genuinely important, and I appreciate the intention. But a few items mix real ethical issues with practices that are actually adaptations for neurodivergent, traumatised, disabled, or culturally diverse clients. This can read as a bit ableist or culturally narrow, as if good therapy must follow one style. Warmth, soothing, or practical tools aren’t always red flags. For many clients they’re accessibility or cultural fit. My worry is that this is just not that simple
“Anything involving tapping on your body.” EMDR is out? Along with Hakomi (no handholding, God forbid). Looks like you have a very narrow view of psychotherapy modalities and dismiss them (and therapists using them)out of the box, no matter the the professionalism of the practioner and effectiveness of the treatment.
As a psychologist, I see how much confusion there is about what therapy should feel like. Many of these red flags show up when the therapist is trying to soothe their own anxiety or avoid their own countertransference, not actually engage the patient.
Real therapy requires emotional sturdiness, curiosity, and the willingness to tolerate discomfort, not rescuing, not platitudes, and definitely not a “therapist voice.”
I appreciate how clearly you laid this out. Clients deserve to know what competent treatment looks like.
Agreed, Nicole. The "therapist voice" is annoying, just as are the platitudes on placards and the other little emblematic doodads meant to 'virtue signal," if I might employ the term, just how 'calm' the therapist is. Showing up authentically, allowing one's personality to be seen rather than papering it over with genericisms, matters.
Why make a clickbait article ? To appeal to the younger kids these days ? My own analyst sometimes response to small talks from me and it was very helpful for me personally , of course we don’t go on and on … possibly helped creating the “holding environment “ or maybe it is about the “twinship transference “ from self psychology . What if free association has to come after some small talk and the small talk let people to feel safe to talk more freely … I felt that this list just added to the list of “ should “ for both parties beyond the necessary ethics and principles of psychoanalysis that is already being understood somewhat by analysts and people seeking analysis ..
Agreed and the same could be said of a therapist giving you advice on decisions. Some people need a little bit of that to trust and feel safe, and then the real work can proceed.
Some of my patients appreciate a little bit of chit-chat at the start of sessions. I've seen a variety of perspectives and I do what feels right. It's an anchoring of sorts, and might only last a minute or two. Especially over Telehealth, one might share a bit about the cat or dog that's popping into the frame, or comment on what the weather or environs are like where they sit.
As someone who is learning to be a better therapist, this list makes one feel as though it is impossible to achieve an average status. I’ve met 5 items on that list, myself. And struggle to see the problem with a few.
These are the ones I’m trying to see the harm in: 12, 39, 40 (EMDR?), 47, 48.
I’ll comment on the first item you mentioned (#12), “Peppers you with questions throughout therapy sessions.”
It’s the patient who is supposed to be doing the work. They need space to notice, reflect, organize their thoughts, find words, attend to things at the edge of awareness. If the therapist is peppering them with questions, none of this is happening.
Appreciate it. For context, I’m learning. I follow you for this reason. To learn. When I ask, I’m genuinely asking. Because I really don’t know. Or haven’t perfected it.
Some clients need more space... Others need more questions. Personally found it unbearable to be a teenager and have constant silence in my sessions. I was suffering and the therapists seemed to have no questions, interest, or care. It was highly damaging.
As a therapist, I've been told by clients that I ask good questions and theat the client finds it highly valuable. I use art therapy, which allows for additional space to notice, reflect, and attend to things at the end of awareness.
It seems like you think there is one form of therapy that is right for everyone at all times?
I'm clear as to avoiding peppering patients with questions in the normal course of therapy. Yet what of the 'intake interview' that is considered de rigueur in some settings? I've found myself vexed over whether or not to adopt the habitual practice of conducting a formalized intake.
Still waiting for JS to respond to you on the rest of your points. Sounds like JS sees EMDR therapists as personas non grata. So what therapy modality *does* meet with his positive regard?
No, you are quite mistaken. I see EMDR as a useful method, for some patients some of the time. But I would have serious doubts about someone who professionally identifies as an “EMDR therapist,” vs. a psychotherapist with training in EMDR. I hope you appreciate the difference. If not, this isn’t the forum for extended explanation.
As a clinical psychologist, I regard the integration of decolonisation theory, critical race theory, queer theory, and similar frameworks into psychotherapy as fundamentally unsound. For the following reasons: No credible evidence base Systematic reviews (e.g., Clinical Psychology Review, 2023) find zero high-quality RCTs showing these approaches outperform established evidence-based treatments. Efficacy claims remain anecdotal or ideological.Ideology trumps individual psychology -Distress is routinely attributed to systemic oppression (colonialism, whiteness, patriarchy) rather than biopsychosocial factors. Clients’ own agency, ambivalence, or alternative explanations are dismissed as “internalised oppression” or “false consciousness.” Risk of iatrogenic harm - These frameworks often increase victimhood cognition, external locus of control, intergroup resentment, and guilt—variables robustly linked to worse mental health outcomes. Violation of therapeutic neutrality -
Declaring “all therapy is political” and “neutrality is complicity” transforms the therapist into an activist who imposes a worldview, breaching ethical obligations to respect client autonomy and values.
Until ideologically driven approaches grounded in critical theories or decolonisation demonstrate superior outcomes in rigorous, replicable research, they function more as political re-education than evidence-based psychotherapy. Clinicians who prioritise ideology over science and client self-determination cease to practise psychology and begin practising activism.
How is oppression not a biopsychosocial factor? Seems like it's one of the core social factors...
As for studies
Ussher, J. M., Hunter, M., & Cariss, M. (2002). A woman-centred psychological intervention for premenstrual symptoms, drawing on cognitive-behavioural and narrative therapy. Clinical Psychology & Psychotherapy, 9(5), 319-331. https://doi.org/https://doi.org/10.1002/cpp.340
Oliveri, A., Muir, S., Mu, E., & Kulkarni, J. (2025). Advancing psychological interventions for premenstrual dysphoric disorder: A dialectical behaviour therapy–informed treatment model. Australian & New Zealand Journal of Psychiatry, 59(, 670-673. https://doi.org/10.1177/00048674251348370
38.a : may include joining the client in projection or advising the client to blame the mutually agreed upon bad object, often, of course, other human and non human caregivers like medical providers {I mean, are they even human?}, medications or substances.
#51. Refuses to discuss the red flags listed here.
This is very helpful but it may be worth considering whether some of these flaws would benefit from contextualization. What appears as a major flaw here may be benign in practice. Or not.
That’s lists for you!
This should be provided to all clients, new or old.
I wish I’d had this a year ago, it would have helped me identify a really toxic therapeutic relationship sooner. The good news is, my new therapist does exactly zero of these things. Thanks for posting this, I’m sure it will help some folks recognize behaviors that can be confusing for clients.
And what about just being a “good listener.” I heard a colleague call it “How ya doing therapy” it means following “common factors” to establish a positive relationship, but remaining disengaged when it comes to helping with the specific troubles the client brought. There’s too much of that going on besides the more flagrant issues raised by your list.
Honestly, I just gloss over this stuff now. I’ve been doing the work long enough to stop confusing lists with wisdom.
There’s a whole cottage industry of “experts” telling people what therapy shouldn’t be, but very few who understand what it actually takes to sit with another human being in real time.
The deeper work isn’t found in red flags or rules… it’s found in presence, attunement, and the courage to stay when things get uncomfortable.
So these lists come and go.
You’d think we should live in a perfect world by now since all we have to do is follow this list - but I in all seriousness am grateful to so many therapist - I’ve supported myself for 20 years from the clients who left and came over to the dark side- mindfulness coaching
Whilst I believe there is some merit to most of these,
I do think the list is symptomatic of a black and white, right or wrong culture that is currently being perpetuated by so many on social media.
In a profession that is rooted in nuance, this, ironically, may be itself something to be mindful of.
Maybe you missed the intro to the list?
No, I read it. My point still stands.
Even considering that effective therapy takes many forms, I’m personally not reading this list as black and white. These features look like red flags if they arise repeatedly. Are there any of these points in particular that you believe can consistently fit with effective psychotherapy?
Thanks for your question. Yes, there are some that I resonate with but my point was not so much about the list specially, more a comment about do’s and dont’s in general that has become pervasive on social media and in modern day discourse. So it’s really wider than this post.
I completely understand why it’s done and I’m not even saying it’s ‘wrong’ but, as psychotherapists, we live in grey areas so even mentions of physical touch, which I lately agree with, cannot be taken as absolutes in my view as I have received a hug from certain clients inc retain moments where it feels right. Hope that makes sense
Yes. Some points are genuinely important, and I appreciate the intention. But a few items mix real ethical issues with practices that are actually adaptations for neurodivergent, traumatised, disabled, or culturally diverse clients. This can read as a bit ableist or culturally narrow, as if good therapy must follow one style. Warmth, soothing, or practical tools aren’t always red flags. For many clients they’re accessibility or cultural fit. My worry is that this is just not that simple
“Anything involving tapping on your body.” EMDR is out? Along with Hakomi (no handholding, God forbid). Looks like you have a very narrow view of psychotherapy modalities and dismiss them (and therapists using them)out of the box, no matter the the professionalism of the practioner and effectiveness of the treatment.
Someone had to blow the whistle on the tapping and the rubber bracelet snapping!
I’d love to read about your green flags.
Try this post
https://jonathanshedler.substack.com/p/how-to-choose-a-psychotherapist
Let’s collaborate?
As a psychologist, I see how much confusion there is about what therapy should feel like. Many of these red flags show up when the therapist is trying to soothe their own anxiety or avoid their own countertransference, not actually engage the patient.
Real therapy requires emotional sturdiness, curiosity, and the willingness to tolerate discomfort, not rescuing, not platitudes, and definitely not a “therapist voice.”
I appreciate how clearly you laid this out. Clients deserve to know what competent treatment looks like.
🙏 Thank you
Agreed, Nicole. The "therapist voice" is annoying, just as are the platitudes on placards and the other little emblematic doodads meant to 'virtue signal," if I might employ the term, just how 'calm' the therapist is. Showing up authentically, allowing one's personality to be seen rather than papering it over with genericisms, matters.
Excellent and thought-provoking list. I'd love to see you expand on some of the points in a follow-up post.
Why make a clickbait article ? To appeal to the younger kids these days ? My own analyst sometimes response to small talks from me and it was very helpful for me personally , of course we don’t go on and on … possibly helped creating the “holding environment “ or maybe it is about the “twinship transference “ from self psychology . What if free association has to come after some small talk and the small talk let people to feel safe to talk more freely … I felt that this list just added to the list of “ should “ for both parties beyond the necessary ethics and principles of psychoanalysis that is already being understood somewhat by analysts and people seeking analysis ..
Agreed and the same could be said of a therapist giving you advice on decisions. Some people need a little bit of that to trust and feel safe, and then the real work can proceed.
Some of my patients appreciate a little bit of chit-chat at the start of sessions. I've seen a variety of perspectives and I do what feels right. It's an anchoring of sorts, and might only last a minute or two. Especially over Telehealth, one might share a bit about the cat or dog that's popping into the frame, or comment on what the weather or environs are like where they sit.
I’m not sure anyone could ace this list.
As someone who is learning to be a better therapist, this list makes one feel as though it is impossible to achieve an average status. I’ve met 5 items on that list, myself. And struggle to see the problem with a few.
These are the ones I’m trying to see the harm in: 12, 39, 40 (EMDR?), 47, 48.
I’ll comment on the first item you mentioned (#12), “Peppers you with questions throughout therapy sessions.”
It’s the patient who is supposed to be doing the work. They need space to notice, reflect, organize their thoughts, find words, attend to things at the edge of awareness. If the therapist is peppering them with questions, none of this is happening.
I’ll leave the rest to you.
Appreciate it. For context, I’m learning. I follow you for this reason. To learn. When I ask, I’m genuinely asking. Because I really don’t know. Or haven’t perfected it.
Some clients need more space... Others need more questions. Personally found it unbearable to be a teenager and have constant silence in my sessions. I was suffering and the therapists seemed to have no questions, interest, or care. It was highly damaging.
As a therapist, I've been told by clients that I ask good questions and theat the client finds it highly valuable. I use art therapy, which allows for additional space to notice, reflect, and attend to things at the end of awareness.
It seems like you think there is one form of therapy that is right for everyone at all times?
Thank you for clarifying this. As a new therapist, I find this helpful.
I'm clear as to avoiding peppering patients with questions in the normal course of therapy. Yet what of the 'intake interview' that is considered de rigueur in some settings? I've found myself vexed over whether or not to adopt the habitual practice of conducting a formalized intake.
My analyst aces this list. I'm very lucky.
Still waiting for JS to respond to you on the rest of your points. Sounds like JS sees EMDR therapists as personas non grata. So what therapy modality *does* meet with his positive regard?
No, you are quite mistaken. I see EMDR as a useful method, for some patients some of the time. But I would have serious doubts about someone who professionally identifies as an “EMDR therapist,” vs. a psychotherapist with training in EMDR. I hope you appreciate the difference. If not, this isn’t the forum for extended explanation.
Except you wrote "Anything involving tapping on your body." not "uses a tool, like tapping, exclusively"
Thanks for the response. I can understand that perspective.
Uses the word decolonisation in any description of therapy / formulation or intervention…😳
That may be a subset of #16
IMO, that word is a red flag in every context — not just therapy.
How come? I'm gathering insights for a piece of writing on this topic, so being nosey...
As a clinical psychologist, I regard the integration of decolonisation theory, critical race theory, queer theory, and similar frameworks into psychotherapy as fundamentally unsound. For the following reasons: No credible evidence base Systematic reviews (e.g., Clinical Psychology Review, 2023) find zero high-quality RCTs showing these approaches outperform established evidence-based treatments. Efficacy claims remain anecdotal or ideological.Ideology trumps individual psychology -Distress is routinely attributed to systemic oppression (colonialism, whiteness, patriarchy) rather than biopsychosocial factors. Clients’ own agency, ambivalence, or alternative explanations are dismissed as “internalised oppression” or “false consciousness.” Risk of iatrogenic harm - These frameworks often increase victimhood cognition, external locus of control, intergroup resentment, and guilt—variables robustly linked to worse mental health outcomes. Violation of therapeutic neutrality -
Declaring “all therapy is political” and “neutrality is complicity” transforms the therapist into an activist who imposes a worldview, breaching ethical obligations to respect client autonomy and values.
Until ideologically driven approaches grounded in critical theories or decolonisation demonstrate superior outcomes in rigorous, replicable research, they function more as political re-education than evidence-based psychotherapy. Clinicians who prioritise ideology over science and client self-determination cease to practise psychology and begin practising activism.
How is oppression not a biopsychosocial factor? Seems like it's one of the core social factors...
As for studies
Ussher, J. M., Hunter, M., & Cariss, M. (2002). A woman-centred psychological intervention for premenstrual symptoms, drawing on cognitive-behavioural and narrative therapy. Clinical Psychology & Psychotherapy, 9(5), 319-331. https://doi.org/https://doi.org/10.1002/cpp.340
Oliveri, A., Muir, S., Mu, E., & Kulkarni, J. (2025). Advancing psychological interventions for premenstrual dysphoric disorder: A dialectical behaviour therapy–informed treatment model. Australian & New Zealand Journal of Psychiatry, 59(, 670-673. https://doi.org/10.1177/00048674251348370
Thanks so much for the thorough reply, much appreciated!
Have I got a practice for you…..
https://www.transitionalcharacters.com
oh dear..
38.a : may include joining the client in projection or advising the client to blame the mutually agreed upon bad object, often, of course, other human and non human caregivers like medical providers {I mean, are they even human?}, medications or substances.
#51. Refuses to discuss the red flags listed here.
This is very helpful but it may be worth considering whether some of these flaws would benefit from contextualization. What appears as a major flaw here may be benign in practice. Or not.
That’s lists for you!
This should be provided to all clients, new or old.
Joined Substack specifically to read and share this post and of course, was not disappointed. Thank you, sir!
🙏
Feeling fortunate with past therapists.
I wish I’d had this a year ago, it would have helped me identify a really toxic therapeutic relationship sooner. The good news is, my new therapist does exactly zero of these things. Thanks for posting this, I’m sure it will help some folks recognize behaviors that can be confusing for clients.
🙏
And what about just being a “good listener.” I heard a colleague call it “How ya doing therapy” it means following “common factors” to establish a positive relationship, but remaining disengaged when it comes to helping with the specific troubles the client brought. There’s too much of that going on besides the more flagrant issues raised by your list.
How about “you’re special/unique/different, so the usual rules don’t apply”?
That was a get out of jail for a dozen of those red flags. . .
Honestly, I just gloss over this stuff now. I’ve been doing the work long enough to stop confusing lists with wisdom.
There’s a whole cottage industry of “experts” telling people what therapy shouldn’t be, but very few who understand what it actually takes to sit with another human being in real time.
The deeper work isn’t found in red flags or rules… it’s found in presence, attunement, and the courage to stay when things get uncomfortable.
So these lists come and go.
You’d think we should live in a perfect world by now since all we have to do is follow this list - but I in all seriousness am grateful to so many therapist - I’ve supported myself for 20 years from the clients who left and came over to the dark side- mindfulness coaching
Thanks for this.
Thanks for taking the time to read my thoughts