Do You Speak Therapist?

A list of common questions and phrases used in therapy – includes a free PDF printable version of this resource

Do You Speak Therapist?

Therapy Language

By Cassie Jewell, M.Ed., LPC, LSATP

Therapists have their own unique (and purposeful) language. We may use clinical jargon when talking to other clinicians, but when we’re with our clients (and most likely, with other significant people in our lives), we are focused and thoughtful.

Therapy is a tool for self-discovery; as therapists, it’s important to know how to effectively employ this tool. (For example, a hammer, while a useful tool, would not be effective if someone used the handle to pound a nail instead of the head.) What we say and how we say it is powerful: open-ended questions, reflections, clarifications, etc.

The following is a list of questions/phrases I find myself using in individual therapy and group sessions to explore, empathize, empower, and motivate change, including a few versions of the “miracle question” (a question used in therapy that asks the client to imagine what their life would look like if, miraculously, all of their problems disappeared and everything was perfect).

Click below to access a printable PDF version of this list.


For additional conversation starters and questions, see 161 Questions to Explore Values, Ideas, & Beliefs.


Therapy Language

1. How are you feeling?

2. How does/did that make you feel?

3. What would happen if you gave yourself permission to feel your emotions?

4. What was that experience like for you?

5. When did you first notice that…

6. When did you first recognize that…

7. What are your current internal experiences and reactions?

8. I’m noticing that…

9. What I’m hearing is…

10. It sounds like…

11. I wonder if…

12. It makes a lot of sense hearing it from your perspective… and, I wonder what would happen if…

13. May I share some feedback with you?

14. Are you open to a suggestion?

15. Would you like to hear a different perspective?

16. May I share my observations?

17. Would you like to know more about [mental health topic]?

18. Some research indicates that __________, but other studies have found that __________.

19. Tell more about that.

20. Tell me what that was like for you.

21. Will you say more about that?

22. Can you speak to…

23. I’m not sure I understand.

24. Help me to understand.

25. Correct me if I’m wrong, but…

26. What am I missing? Something doesn’t quite match up…

27. Is there anything else I need to know?

28. Did I hear you correctly when you said…

29. May I pause you for a minute?

30. Can we return to what you said earlier about…

31. It looks like you shut down when I said __________. Can we talk about it?

32. You seem distracted today. Do you want to talk about something else?

33. Do you want to take a break from this topic?

34. What do you think __________ would say if they were here in this room with us?

35. If it was __________ in this situation, what advice would you give them?

36. What does __________ look like to you?

37. What does __________ mean to you?

38. What message did you hear when they said…

39. How would your life be different if you didn’t have…

40. Was there anything you could have done differently?

41. It sounds like you were doing the best you could with what you had at the time.

42. Honestly, I’m not sure how I would have reacted if in your shoes.

43. You’re the expert on you.

44. I wish I had the answer to that.

45. That’s a really good question. What do you think?

46. On the one hand __________, but on the other…

47. You say __________, but your actions…

48. I’m concerned that…

49. I can only imagine how __________ that was for you.

50. Can we explore this more?

What Are the Characteristics of an Effective Clinical Supervisor?

“It was the bad supervisors who taught me what NOT to do.”
Are you an effective clinical supervisor? What is helpful… and unhelpful in supervision? Read about Reddit users’ experiences with clinical supervision, including the traits of “bad” supervisors.

By Cassie Jewell, M.Ed., LPC, LSATP

Shortly after being trained and approved as a clinical supervisor, I took on my first supervisee (whom I’ll call “DM”). I was confident in my abilities and knowledge as a counselor, but quickly learned it takes more than skill or expertise to provide effective supervision.

In one of my first sessions with DM, I inadvertently offended her (and thereby damaged our newly forming rapport). We were discussing personal and professional growth, which led to a “bucket list” discussion. I shared how I’d always wanted to do a police ride-along; DM immediately stated that as an African American woman, this was distasteful to her.

Unfortunately, I missed my cue and continued to talk about how exciting it would be. Meanwhile, she felt disrespected. In this instance, I got carried away with talking about myself and my interests, ignoring her feelings on the subject. I came across as ignorant, in the least, and at worst, culturally insensitive or uncaring.  

Another time, I suggested that DM (who held a doctorate degree in counseling) not refer to herself as “Dr. ____” when coordinating with outside agencies, as it often led to confusion. Once again, she felt upset and misunderstood.

She later explained that I failed to take into account all she had overcome to earn that degree. It was more than a title to her; it represented triumph in the face of adversity. Furthermore, it was a piece of her identity as a helper and as a role model to African American women.

Although well-intended, my suggestion was offensive on several levels. In hindsight, I could have explored how she viewed herself as a professional or simply asked why she called herself “Dr. ____” before commenting.  


Self-awareness is crucial for effective supervision and self-care is essential for coping with stress.   

More recently, a different supervisee (whom I supervise both clinically and administratively) told me that I had been acting out of character by “harping” on her about completing various assignments. I checked myself and was able to recognize my high level of stress was indeed impacting our interactions.

Self-awareness is crucial for effective supervision and self-care is essential for coping with stress.   

Reversing roles, and looking back on supervisors I had in grad school and as a new counselor, I can recall what was beneficial and what wasn’t (or was annoying/upsetting/disturbing… even unethical).

What helped the most was direct feedback, along with specific suggestions for improvement. Constructive criticism, while unpleasant, made me a better clinician (and probably a better person). Feeling supported and having my doubts or fears normalized was also helpful.


The bad supervisors taught me what not to do.

On the flip side, unhelpful, “bad,” supervisors were the ones who rambled on about their clients, micromanaged, were punitive, or who never met for supervision. There was even one who called me a hurtful name; the comment came from a misunderstanding, but I took it to heart. It was inappropriate and unprofessional; I carried it for a long time. The bad supervisors taught me what not to do.  

This post was inspired by my desire to learn more about what makes supervision effective. I looked to Reddit for others’ experiences and opinions and asked what’s most (and least) helpful in clinical supervision.

Gr8minds is a master’s student and MFT trainee who wrote, “For myself, what I find most helpful is when my supervisor shares questions I may have not thought of about the client’s case. This really helps give a second pair of eyes and I can take those into the next session.”

Questions are as fundamental to supervision as they are to the counseling process. A question inspires contemplation and may lead to a new understanding. An effective supervisor asks thoughtful questions about the client, their upbringing, their beliefs, etc., providing the supervisee with valuable tools to use with their clients.

RomeRawr, a doctoral student, shared about a self-centered supervisor who used sessions to talk about their clients instead of promoting the supervisee’s growth. “What I’ve found least helpful is my supervisor complaining to me about clients. Not conferencing, or asking my opinion, but just complaining to unload.”

A supervisor who complains/vents about clients should not be in a supervisory role. It’s one thing to consult, but to complain shows a lack of empathy and professionalism. It makes me question why that person is even in the field.

To an extent, I can relate; I previously mentioned a “bad” supervisor who, while he didn’t complain, regularly discussed his difficult cases in group supervision. This is how it would go: Dr. BS (Bad Supervisor) would present a case and then seek our (the students’) opinions. He had the audacity to take notes.

When we were provided with (rare) opportunities to talk about our clients, he’d make comparisons to his private practice… and seek advice (un-cleverly disguised in the form of, “Well, what do you think you [I] should do?”)

While it can be helpful for a supervisor to share client stories, it should only be as a teaching tool (or to convey empathy). Similarly, a counselor should self-disclose for the client’s benefit, never their own.

grace_avalon, clinical counselor, holds a master’s degree and has been licensed in Minnesota for over a year. “I’ve had so many supervisors. The best ones worked me hard, required consultation with every DA (a word-for-word transcript of a counseling session)… [were] highly involved and observed me closely, tirelessly… and responded neutrally and understood my tears. We met privately, which was pivotal to growth.”


A supervisor can’t be a gatekeeper if they don’t know to close the gate.

An effective supervisor expresses empathy; they’re not reactive. An effective supervisor is also dedicated; they strive to help the supervisee by observing his/her interactions with clients and/or reviewing lengthy transcripts. A lazier supervisor might give advice/feedback based solely on the supervisee’s report, which is subjective. There’s a place for this in supervision, but it can’t be the only method of assessing a supervisee’s skill.

Reviewing recorded sessions or transcripts is time-consuming (and, not gonna lie, boring), but imperative for a counselor’s growth. (It should also be noted that a supervisor can’t be a gatekeeper if they don’t know to close the gate.)

_PINK-FREUD_ is a clinical psychology doctorate student (with an MA in clinical psychology) who provides therapy to children, adolescents, and families. “My most helpful supervisor taught me to examine how my history comes into the room with clients. For example, my very first client told me something painful about a learning disorder and I responded with humor. Basically achieved the polar opposite of attunement. The footage was cringeworthy af. She didn’t shame me about it (of course, I was shaming myself anyway), but just inquired as to why I did that I realized I’ve dealt with my own LD with humor and by “laughing it off,” which led me to automatically and inappropriately apply that same response to my client… That supervisor showed me to move past the shame of making mistakes and towards understanding why I made that mistake. She led me through that process of self-examination countless times, and it taught me to do it independently.”

Being aware, both self and of what the client/supervisee is experiencing, is a vital component of counseling and supervision. In fact, many of my early (and more recent) mistakes could have been avoided had I been more attuned.

_PINK-FREUD_  also shared, “Another good supervisor trait IMO is someone who does not guess why a mis-step was made. I’m currently working on interrupting my clients more instead of letting them ramble –something I think mainly stems from the very common newbie clinician fear of invalidating or injuring the client. That supervisor pointed out my mis-step, then spoke about my need to “be friends with clients,” which felt off to me. When I tried to express that, I was perceived as defensive about having poor boundaries. It really broke my trust with that supervisor. I felt that he had made blind judgments about my underlying motivations for responses without listening to my explanation. It made it difficult for me to go to him for help with tough cases as I was afraid of the conclusions he would jump to. ASK, don’t tell your students for their motivations. It builds trust that you seek to understand them and also teaches them how to do this independently.”

Similarly, it broke trust when one of my “bad” supervisors called me a name. She made an assumption based on a blind judgment.

Assumptions, sometimes true, but more than often not, have no place in supervision (or counseling). Going back to awareness, it’s important for a supervisor to recognize when they’re making assumptions.

alfredo094, an undergraduate student, shared that as a supervisee, “having [a supervisor] that knows me very well and listens to everything that happened to the session in detail is important.”

As counselors, we listen to what our clients say. By listening, we learn and are able to provide support and guidance. The same is true for supervisors. Listening and being fully present with the supervisee will help him/her to become a better counselor.

What are some of your experiences in supervision? Share in a comment!

What Counseling Has Taught Me (Part Two)

Learn to be more effective in your personal and professional life! This is the second installment of how counseling has led to a better understanding of people. Working with addiction and mental illness has gifted me with the capacity to better recognize why people do what they do, which in turn enhances how I relate to others.

By Cassie Jewell, M.Ed., LPC, LSATP

This is the second installment of how counseling has led me to a better understanding of people. (In Part One, I discussed calmness, silence, active listening, partial truths, and hidden agendas.)

Working with addiction and mental illness has gifted me with the capacity to better recognize why people do what they do, which in turn enhances how I relate to others. As a result, I’m more effective in my personal and professional life. I have a sense of peace and “okayness” in the world.

One thing I hadn’t previously considered was brought up by Quora user and mental health professional, G. Bernard (MA Counseling); he shared that counseling revealed the truth about change. “It has really reinforced that idea that people who want change will work harder to achieve it; those who are forced (legally, by parents, spouse etc.) probably won’t.” I agree with this 100%. People can’t be forced into change; and when they are, their efforts lack fortitude and it doesn’t last. Those who are internally motivated will fight for change, making it worthwhile and enduring.

Here are some additional truths and realizations that I gained through my counseling career.

What counseling has taught me (the second installment):

1. A new perspective

The DSM – Diagnostic and Statistical Manual (the “Bible” for mental health professionals) – uncovered a whole new world for me. Sure, I was familiar with mental illnesses like depression, PTSD, and anxiety before grad school. I took Abnormal Psych in college and even before that, I’d read books on schizophrenia, eating disorders, and other mental disorders. (Guess who did their middle school science project on schizophrenia? Me!) But my fleeting knowledge was laughable compared to what I found in the DSM; it provided me with information on every single diagnosable mental disorder. When I started working with clients, I was able to see how mental illness manifests in real life.

The more I learned (and saw), the more I was able to make sense of behaviors. Consequently, this led to me looking back on people I’ve encountered throughout the years. I realized how many of them had been struggling with a mental illness. (At the time, I probably just thought they were just a jerk, or acting inconsiderately.)

I also became more aware of the prevalence of severe mental illness and the way it presents in society. This led to increased tolerance and patience regarding behaviors I’d previous found annoying; I learned to recognize them for what they were.

Mental illness can easily be interpreted as something it’s not. By having an awareness, I’m more compassionate. Instead of judging, I observe. Someone who seems snobby may have social anxiety. That coworker who calls out sick every Monday may be struggling with addiction. A friend who never wants to go out anymore could be depressed.

Mental illness is everywhere if you know what to look for. I strive to give everyone the benefit of the doubt, which is better for my mental health.

2. Don’t give money to the homeless

I knew a client at a residential program with a talent for making clever signs. He’d use markers to write his message (“Will dance for food!”) on a piece of cardboard before grabbing his pail to hit the streets. He didn’t need the money; he received government benefits (funded by taxpayers). The money he earned panhandling funded his K2 habit or the occasional beer.

Many of the “homeless” people you meet are not homeless; they’re con men (or women) who make a profit on your sympathy. Most are either addicted to drugs/alcohol and/or severely mentally ill; they need treatment, not the crinkled dollar bill in your pocket. Giving your spare change isn’t helping that person. Instead, offer to buy a meal, give them a pair of socks, or hand them a bottle of water.

3. Telling someone what to do is not helpful

Giving advice rarely leads to lasting change.

There are a few different reasons why advice, no matter how well-meaning, isn’t helpful. Firstly, it doesn’t account for the person’s full experience or struggle; it could seem ignorant or insensitive. (For example, “Why don’t you just get a divorce?” is not helpful to a woman struggling with her husband’s infidelity; the problem is more complex than just getting a divorce. Children could be involved. Maybe she’s financially dependent on her husband. Maybe she’s still in love with him. Or maybe it’s against her religious beliefs.)

Advice also robs a person of the ability to solve their own problem. We need to learn to find solutions in life in order to grow and to be effective. If someone is always told what to do, they’re not going to learn to function independently.

Lastly, if advice is taken, and it works, the credit goes to the advice giver, not the taker. The results are less meaningful. Alternatively, if advice is taken and it doesn’t work, it becomes the advice giver’s fault. Advice deprives a person of being able to take full ownership of their actions.

If you own your decision and fail, the blame falls on you (helping you to grow as a person) or if you succeed, the triumph is yours alone. Either way, you’re better off finding your own solutions; this allows you to feel capable and you’ll become better at solving problems in the future.

4. The value of transparency and honesty

People like to know what’s happening and what to expect. I get better reactions from clients when I explain why I’m doing or saying what I am. I’m honest, and when I can’t be (or believe it would be inappropriate to do so), I tell clients exactly that. For example, if a client asks about my religion, I’d let them know I don’t feel comfortable sharing personal aspects of my life.

Personally, I prefer the company of others who are straightforward. I don’t like having to guess if someone is upset with me. I don’t like it when someone is nice to my face, but gossips when I’m not around. Those types of games are played by people who are insecure or who are attempting to manipulate you. Life is complicated enough. With me, you’ll know if your fly is down, and if you ask for my opinion, you’ll get it. (There’s much to be said for tact though!) Gentle truths are worth more than flattery. 

5. You can’t demand respect

It’s something that’s earned through words and actions, not freely given. Forced respect is not true respect; it’s fear or deception. And while I believe in treating everyone with respect, I don’t truly respect someone until I know what kind of person they are.

Furthermore, I’ve learned that if someone chooses to disrespect me, it’s not a threat. Respect is powerful, but disrespect? Feeble and pathetic. If someone is disrespectful, it won’t harm you or make you less of a person (unless you give it that control).

Throughout my career, I’ve been disrespected on many, many occasions by clients who don’t want to be in treatment (and even by colleagues with differing opinions). But my sense of self-worth is not dependent on how others treat me. As a result, disrespect from angry clients (or rude salespersons or drivers who cut me off, etc.) doesn’t faze me.

In sum, being a counselor is life-changing. I imagine many professions are to a degree, but I can’t picture any other job leading to such a deep understanding of humanity. Entering the mental health field is like having horrible vision and then finally getting glasses (except it happens over the course of years). I have an enhanced awareness of who I am along with an unforeseen sense of serenity. 

Every single client who’s shared a piece of their story has contributed to my awareness (and to my own personal growth), and I owe them each a gratitude. I’m more cautious in life, yes, but I’m also more compassionate. Instead of having high expectations, I have high hopes. I don’t attempt to control things I have no control over; and I don’t get angry over the decisions, views, or actions of others. Instead, I channel my energy into something more productive; I’m passionate and I’m an advocate. My beauty pageant answer to the stereotypical question is not “world peace”; it’s for everyone to have a deeper understanding of each other.

What insights have you gained from your chosen career? Please share in a comment!

What Counseling Has Taught Me (Part One)

Counseling is generous in that it’s supplied me with the tools needed for not only professional growth, but personal success, emotional well-being, personal development, and effective communication. It’s also taught me about various aspects of human nature, from the brightest to the murkiest.

By Cassie Jewell, M.Ed., LPC, LSATP

In grad school, I learned theories and techniques of counseling. I learned basic and advanced counseling skills; I practiced various interventions and methods. My professors taught developmental theories and multicultural competence. I took classes in career counseling, family counseling, and couples counseling; I studied research and ethics.

And when I accepted a substance abuse counselor position at a drug and alcohol treatment center… I had no clue what I was doing… or how to be a counselor. I went into my first year as a clinician with self-doubt and uncertainty.

Negative thoughts consumed me. I questioned myself and wondered if I was in the right field.

“Do I have what it takes to be an effective counselor?” 

“Should I have pursued a career in research instead?” 

“Should I have pursued anything instead?” 

“Am I capable of helping others?” 

Furthermore, social anxiety crippled my ability to relate to clients; being genuine was difficult. I couldn’t stop comparing myself to other “seasoned” clinicians, which only made things worse.

Gradually, my doubts and fears subsided; I felt more comfortable in my role. I accepted and settled into my new identity as a professional counselor; it was a good fit. I stopped trying to “fix” or control clients.

Anxiety no longer dictated my actions; I found a way to take ownership of my mistakes and accomplishments. Moreover, I learned to be okay with making mistakes. I accepted that I would never have all the answers. I let go of irrational beliefs that had previously plagued me. I thrived.

Today, I can reflect on my journey and on the positive changes I’ve made throughout the years. My chosen career is generous in that it’s supplied me with the tools needed for not only professional growth, but personal growth — success, emotional well-being, personal development, and effective communication.

I’ve learned a lot the past ten years. This post explores the discoveries I’ve made and how I apply that knowledge to my life. But before delving into what I’ve learned, here’s what a few other clinicians have said on the topic:

Nancy Lee, MA, LPCC, Psychotherapist in Aurora, CO

“Being a counselor has shown me that it’s possible to live on the edge of what I know and don’t know. In a single moment, I can feel strong and confident, yet small and humble. Counseling isn’t about fixing problems. It’s about believing in my client’s capacity to connect with their own solutions, insight, and growth.”

Robert Martin, M.Ed Early Childhood Education & Counseling, Francis Marion University

“There is no learning … if there is not a relationship… The foundation of counseling and teaching is [the] relationship. There must be a connection. The student must know that you care about them personally and it is ok to make a mistake … Consequences and corrections can be given, but always directed at the behavior [and] never the person … That you are only talking about their behavior when you correct them … and not them. They must feel that you respect them … and if you make a mistake say, “I’m so sorry. I made a mistake.” … [Always respect] their differences, their hopes and weakness, their failures, their dreams, their divinity. There is nothing more important than this…”

Bridget Cameron, Artist, Depth Psychologist, Stress Counselor (1992-present)

“To accept people as they are, to be non-judgmental, to be directed by compassion, and to know how to be impartial so that I am fair-minded with all people and do not project any of myself into my client’s history and am non-attached to the outcome.”

In comparison, while I’ve learned much about compassion, connecting, and being okay with being wrong, I’ve also learned how to use counseling to be effective, both personally and professionally… and I’ve learned to be more guarded due to the darker aspects of human nature.

Here’s my list of small wisdoms, or, what counseling has taught me (the first installment):

1. How to remain calm

Emotion regulation was difficult for me as an adolescent and young adult. My emotions ruled me – lorded over me, even! Then, as a counselor, I observed emotion disregulation in clients. I realized how truly counterproductive (and ridiculous-looking) it can be.

I made a choice to stop engaging in negativity, with both self and with others. Feeding into an argument solves nothing, but the effort leaves you emotionally and physically drained. Luckily, my personal transition from chaos to calm was painless. By the time I learned how to remain calm, I was in my mid-20s; the intensity of my emotions had already naturally subsided. Today, calmness is my natural state.

2. Comfortable silence

In grad school, I learned to use silence as a counseling technique. Instead of filling up every minute of a session with reflections, open-ended questions, and paraphrases, we were encouraged to use “comfortable silence.”

Silence allows the client time to process and/or collect their thoughts. To me, it always felt horribly awkward (remember, social anxiety!) and wrong. I wanted to rush on to the next topic or to ask a question or… anything.

I’m not sure when it finally stopped feeling awkward. I just knew that one day I was sitting in silence with a client and it felt natural. Today, I use silence in my professional and personal life all the time. It feels nice to sit quietly and not feel pressured to talk.

3. Active listening

Counseling taught me to really listen. I learned to quiet my internal dialogue to hear and comprehend what’s being said. Instead of thinking about how I’m going to respond, I give my full attention to the speaker. I’m aware of body language and other nonverbals. Counseling has strengthened my communication skills.

4. Partial truths

Counseling taught me that people don’t always say what they mean. They often tell partial truths. There are many reasons for this: Fear of being judged, not fully trusting the therapist, feeling embarrassed, etc.

For example, a client who isn’t ready to change their drinking probably wouldn’t tell me they drink three bottles of wine every night. Instead, they’d offer a partial truth. “I usually drink a glass of wine with dinner, but that’s it.”

Partial truths are not lies; they allow for a certain measure of comfort. (A lot of people feel uncomfortable with lying because they were taught it was wrong, or possibly because they view themselves as honest – and honest people don’t lie.) Partial truths, on the other hand, don’t feel wrong (or less wrong, at least). Plus, they’re safe. A person can be partially truthful and still protect their secrets.

When I realized how common partial truths are, I changed the way I listened to clients… and to everyone. Instead of taking things at face value, I listen to what is being said while recognizing that much more is not being said.

5. Hidden agendas

I also discovered that there are plenty of people out there who seek counseling with hidden agendas. For example, a man sees a therapist, stating he wants to learn anger management techniques. What he doesn’t reveal is that he’s abusive to his wife. He recently lost control in an argument and pushed her down the stairs. She gave him an ultimatum: Therapy or divorce. He doesn’t believe he needs counseling, but he’ll do it to save his marriage. And he doesn’t tell his therapist this (of course). Why would he? It’s none of her business.

Both partial truths and hidden agendas happen outside of therapy (and for similar reasons). Words paint a very limited piece of the entire picture. People often show only what they want others to see while keeping their true motives hidden.

Because of counseling, I have a better awareness and understanding of why hidden agendas (and partial truths) exist. It’s not cynicism, but a form of acceptance. I recognize that half truths and hidden agendas serve a purpose. While I may never understand their purpose, I’m okay with it.

This awareness fosters caution; I’ll never be caught off guard.

There’s more to tell, but for the sake of keeping this post to a reasonable length, I’ll save my remaining insights for the second installment of this post (in which I’ll discuss giving money to the homeless and demanding respect, among other “lessons” from counseling).

What Are the Characteristics of an Effective Therapist?

Are you in therapy or have you sought counseling in the past? Are you currently practicing as a therapist or counselor? This article explores what makes a therapist effective (or not).

By Cassie Jewell, M.Ed., LPC

Image by Tumisu from Pixabay

For readers less familiar with counseling as a profession, I’ll briefly review the mission, values, and ethics established by the American Counseling Association (ACA) to guide professional counselors. The ACA’s mission is “to enhance the quality of life in society by promoting the development of professional counselors, advancing the counseling profession, and using the profession and practice of counseling to promote respect for human dignity and diversity.”

 Professional values include the following:

  1. enhancing human development throughout the life span
  2. honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts
  3. promoting social justice
  4. safeguarding the integrity of the counselor–client relationship
  5. practicing in a competent and ethical manner

Ethics include autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity.

The ACA outlines professional values and ethics, but for the purpose of this article, I wanted to learn about current perceptions and views. Also, how do counselors exemplify the code in their practices? Using social media (Reddit and Quora) as a survey tool, I reached out to mental health professionals and therapy participants; I also browsed through older threads and posts on the topic.

I read about traits (like active listening and compassion) that are important to both therapy participants and clinicians. Additionally, I learned about negative experiences, which was disheartening. So what makes a good (or bad) clinician?

An effective therapist is someone who…

  • Actively listens
  • Is kind and compassionate
  • Practices honesty
  • Is transparent
  • Puts a lot of thought into what they say
  • Educates their clients (coping skills, symptoms, stress management, etc.)
  • Conveys warmth
  • Reflects and validates feelings
  • Understands human behavior and mental disorders
  • Is non-judgmental
  • Sets and adheres to healthy boundaries
  • Is genuine (and genuinely cares for their clients)
  • Has a wide range of techniques and a variety of tools
  • Is humble (and gives advice sparingly)
  • Creates a safe place for healing
  • Is knowledgeable (evidence-based practices, current research, etc.) and intelligent
  • Possesses emotional intelligence
  • Is respectful
  • Experiences and conveys empathy
  • Has a sense of humor
  • Is curious
  • Has patience
  • Is trustworthy
  • Recognizes and values other perspectives

Interestingly, a few responders took into account a therapist’s personal values and views (not just how they conduct themselves in a session). As a counselor, this resonated. For example, a therapist can’t be genuine if they’re empathetic with their clients, but rude or nasty otherwise. Being a counselor means fully embracing the code of conduct. Consider how it would feel to discover your therapist treats restaurant staff poorly or gets hammered and then drives. It would likely leave a bad taste in your mouth. A good clinician is a role-model. Furthermore, it’s important for a counselor to be emotionally stable and self-aware, which is something I’ll explore shortly.

Some personal values/traits for effectiveness include…

  • Resilience
  • Optimism
  • Faith in humanity
  • Courage
  • Self-acceptance
  • Holding others and self accountable
  • Self-awareness
  • Seeking to improve self and grow, both personally and professionally
  • Self-esteem and acceptance
  • Practicing self-care

Regarding professional development, it was noted by Lazar_Milgram (Reddit user) that a counselor must commit to “relearning,” meaning re-reading text books, literature, and research to prevent it from fading. As humans, we forget things. We need to go back to the original source of knowledge now and again. It’s not enough to go to grad school; a counselor must commit to a lifelong education. Along those lines, Lazara_Milgram reported that an effective counselor re-visits his/her failures. If we were unable to help a client for one reason or another, it’s worth it to review their file and our records, consult, and then learn from our mistakes.

On self-awareness, Reddit user Valirony, a marriage and family therapist, shared it’s important for a therapist to be aware of “[his/her] own existing issues and [be] either well-processed on those fronts and/or very capable of compartmentalizing the baggage that is less well-processed.”

To expand on this, consider the experience of emotional anguish. An empathetic person who has experienced a personal tragedy may consequently feel a desire to ease suffering in others. Naturally, they’re drawn to the counseling profession; but if their wounds haven’t healed, they lack the capacity to help their clients.

Sadly, some counselors enter the profession seeking to “fix” others as an attempt to compensate for being unable to face their own issues. In contrast, an effective therapist recognizes his/her limitations as a counselor, especially in the face of personal tragedy. They recognize when it’s their own “stuff” (and not the client) triggering a reaction. They leave the past where it belongs and carry little to no emotional baggage. This allows them to be fully present and engaged.

Valirony (Reddit user) also discussed constructive criticism. It’s essential for the effective therapist to remain open to constructive feedback in order to grow. Valirony explained, “I see a lot of defensiveness in some of my colleagues during consultation; I’m no saint and I feel defensive here and there, but I always take a look at that defensiveness for whatever it is in me that I need to change.” Defensiveness is a clue that something’s not right. On constructive feedback, Reddit user Lazar_Milgram suggested, “Embrace criticism – every criticism is a 50/50 package of perceptual information about you. 50% tells something about you and 50% tells something about client.” Providing it’s thoughtful and well-presented, criticism can inspire insight or provide a new way of looking at something.

Ann Veilleux, a private-practice psychotherapist and Quora user, identified emotional intelligence as a trait for effectiveness. “Intelligence comes to mind first, emotional intelligence certainly, a curiosity and interest in people [as] more [than] machines or plants.” Emotional intelligence is innate; it can’t be developed the way a skill can. Furthermore, a good clinician is curious, but their interest is attached to the well-being of their clients. Veilleux pointed out that an effective therapist must possess interest and ability – not one or the other – in order to sustain the level of investment therapy demands. It’s the “interest and ability to have intimate relationships with many people at the same time and not to tire of that.”

The Therapeutic Relationship

With regard to the client-counselor dynamic, an effective therapist recognizes that the relationship is central to the therapeutic process; it’s the key to healing and growth. A client must trust the counselor before they feel safe enough to share their pain or humiliation or guilt. Traits like warmth, humor, and transparency foster an honest and caring relationship. Counseling skills are important, but can only go so far without a trusting relationship.

To promote a supportive relationship, Reddit user RedYNWA suggested that counselors practice empathy without being overly emotional. RedYNWA described how they felt when their therapist cried in session. “I believe my topic brought up something personal for her. The minute she cried. I stopped talking, and changed the topic. I felt she was unable to hold my topic, and I felt a responsibility to ease her distress. It changed our relationship, I felt like the therapist, and it restricted my ability to divulge deep emotions. It was unintentional on her side. However, it destroyed the therapeutic relationship.”

In the above situation, a counselor’s emotional reactivity upset the balance of the therapeutic relationship. Unintentionally, the therapist sent a strong message. The message was that she was too fragile to hear her client’s pain. If the therapist can’t be strong, how can the client? A counselor who breaks that easily can’t be a source of unwavering support. It’s the client’s job to cry; the therapist’s job is to remain calm, to maintain a safe environment, and to instill hope.

I am acquainted with therapists (colleagues and former peers) who occasionally cry in sessions. Sometimes, it’s an instinctive reaction to hearing the horrors clients have gone through; the discrimination, the trauma, the abuse, and worse. There was a time I cried while facilitating a group, but it wasn’t related to anything being said. That morning, I had learned a former client died by suicide. He shot himself in the head. He was only 22. I felt vulnerable and self-conscious about crying in front of my clients. Later, my supervisor helped me to understand that crying can make a therapist seem more human and authentic, which has the potential to strengthen the counseling relationship while conveying empathy.

Some clients will feel closer to a therapist who cries; others will feel uncomfortable. There’s no right or wrong. Quora user Philippe Gross, Assistant Professor of Psychology at University of Hawaii, pointed out that even with all the right qualities, a therapist will not be a good fit with every client. When this happens, Gross stated that “an effective therapist should be able to recognize this soon and refer the client to a more appropriate therapist.”

One Reddit user and professional counselor, ForeverJung, touched on the importance of not getting caught up in their clients’ pain to the point it becomes their own (also known as vicarious trauma). It’s having “the ability to care deeply and then shut it off,” which can be difficult, especially for new counselors. ForeverJung also shared that an effective counselor must be able to listen, while at the same time “synthesizing data,” and then provide a constructive response that the client will be able to make sense of.

Redddit user blueybluel shared about a therapist they described as absolutely wonderful. “She was incredibly empathetic and patient with me, almost to a fault I felt like sometimes. But it really helped me a lot with my self-hatred, self sabotage and suicidal thoughts because for the first time ever, I was regularly associating with a person who was so soft with me. She genuinely thought I was a great person just the way I was, and that I didn’t have to accomplish and be perfect all the time just to have worth and to deserve to live.”

Similarly, Gatopajama (Reddit user) described positive interactions with their current therapist, who shares their odd sense of humor. “[My therapist] is serious when the topic calls for it, but usually a session with her feels very comfortable and laid back, like having coffee with a girlfriend. She also shares a little bit about herself sometimes (not in an inappropriate or TMI way) — it makes me feel like I’m talking to a real person and not a human psychology textbook. Plus, she’s got a gigantic bowl of moonsand in her office. Sometimes I plop that thing on my lap and play with it the whole hour to keep my hands busy if I’m trying to talk about something difficult.”

What are the traits or characteristics of an ineffective therapist?

While some traits (such as having a gigantic bowl of moonsand!) positively impact the counseling process, others contribute to nonproductive (or even harmful) therapy. When I elicited feedback on effectiveness, I learned about some horribly ineffective and disturbing practices.

An incompetent clinician lacks self-awareness and insight in addition to the required knowledge and skill. They may have entered the field for all the wrong reasons. They’re rigid and closed to new ways of thinking. Most importantly, they don’t listen to their clients. Ssdgmok, a Reddit user, described a bad clinician as “someone who talks about themselves each session, poor listening and ‘giving advice.’” Contrary to popular belief, a counselor’s role is not to advise the client. A therapist is more like a collaborative partner who leads the client to their own insights while providing the tools for change.

To give a personal example of a therapist who talked too much (although not about herself) and didn’t listen, I’ll use myself – but in the role of the client, not the clinician. I was in my late teens and it was one of my first experiences seeing a counselor (a middle-aged woman). The therapist had apparently just finished a session with a young woman who had attempted suicide. And the therapist proceeded to tell me all about it. Meanwhile, I was bursting with pain and self-doubt; and the therapist continued to talk about the client who had just left her office. She went on and on about how she couldn’t believe “that little girl” swallowed an entire bottle of Tylenol. It was like she didn’t hear a word I said, and I left feeling even worse. (Luckily, that experience didn’t poison my view of the profession or dissuade me from entering the field a decade later.)

A Reddit user shared about expressing thoughts of suicide to their therapist

Jwaggin
“Therapist: Are you suicidal
Me: Yea…
Therapist: You hate your mom?
Me: uhhh no
Therapist:Well if you kill yourself your mom would be very hurt
Me: uhhh ok (thanks for the guilt)”

If this happened, it’s clear that the therapist lacked not only empathy, but a basic understanding of mental illness. An effective therapist never shames or “guilts” a client. The client is already in pain (which is what brought them to therapy in the first place). Also, when a client says they’re suicidal, it’s the therapist’s responsibility to explore this with the client while ensuring the client’s safety. An effective therapist helps the client to identify what (if anything) would prevent them from killing themselves; the clinician won’t admonish the client for their hopelessness. To do so would be demeaning, with a disregard to human dignity.

Reddit user blueybluel shared, “When I told [the therapist] all my struggles, she seemed empathetic, but then got on this weird shtick of telling me to do homework of writing down things I like about myself, in an aggressive, demanding, pull yourself up by your bootstraps kind of way, and said, “Can you do that for me? By next week?” I canceled the next appointment and never saw her again.”

There’s no room for aggression in this profession. A good therapist is gentle; they don’t give orders. Instead, they explore, listen, and ask questions. It’s a respectful partnership between client and counselor.

After tragically losing their infant son, a Reddit user sought therapy 

wonder-maker
“I explained my situation about having lost my infant son in a tragic household accident. She asked me to wait a moment, got up, walked to the front desk, came back with a sticky note from the receptionist and told me to come back and see a different therapist at a later date, then refused to make eye contact with me.
The next therapist said to my face ‘Boohoo, your kid died, get over it.'”

In the above example, the first therapist was a woman in her early 40s and the second was a male in his 60s. I’m disturbed by what happened to wonder-maker (Reddit user); and I’m horrified that these “helpers” are out there providing counseling services. The female therapist’s reaction could be explained by lack of experience or skill; alternatively, hearing about the accident could have triggered her (which is why self-awareness is so important). However, there is no excuse or explanation for what the male clinician said. You don’t have to be a therapist to feel empathy or compassion (but you do have to be a jerk to tell a grieving parent to “get over” the loss of a child).

Final Thoughts

In summary, there are many things that positively impact a counselor’s effectiveness, while opposite traits are related to incompetent practice. An effective counselor is an active listener, expresses empathy and compassion, and is genuine and transparent. They promote healing and self-exploration. The therapeutic relationship is also important. An effective clinician creates a safe environment for building trust while providing support. Additionally, to be effective, a therapist must commit to a lifelong pursuit of knowledge to learn new techniques and evidence-based practices, to understand how scientific developments will change the counseling profession, and to keep up-to-date on relevant research.

In contrast, a therapist who is uncaring, uninterested, and who doesn’t listen will never be effective. A counselor who constantly advises their clients or who shames their clients is incompetent and unethical. Furthermore, the absence of emotional intelligence greatly impacts a clinician’s counseling abilities.

Regarding personal values and lifestyle choices, there’s a gray area. Can a therapist who gossips or who abuses sleeping pills provide effective services? What about a marriage counselor who cheats on his wife? While a few therapy participants and mental health professionals emphasized the importance of a therapist’s personal integrity, most responders viewed effectiveness in the context of therapy alone.

Lastly, therapy participants who reported unproductive or even damaging experiences received services from therapists who did not adhere to the ACA code. Conversely, positive and effective experiences were related to ACA values.

Were there any surprises in this post? Were any important traits not mentioned? Please provide feedback in the comments section!