From students and colleagues alike, I often hear statements to the effect that “There are a lot of bad therapists out there.” As I understand it, “bad” in this context has a variety of meanings, ranging from simply ineffective to downright unethical. At either end of that spectrum, though, the next question is usually the same: How do they stay licensed?
Let’s start at the ineffectiveness end. No therapy is 100% effective, so providing therapy that doesn’t work with some clients is normal. I’ve had my share of cases that did not go as well as I would have hoped. A therapist is only violating professional standards if they make false claims to clients about the likelihood of success with a particular treatment. Of course, it could be argued that a therapist is behaving unethically if they are far less effective in their work than the average therapist, but there is no reasonable way for a licensing board to gather that kind of information. So they attempt to ensure effectiveness by proxy, through such requirements as ongoing continuing education.
For therapists who are unethical in their practices, it may take years before unethical practitioners are investigated and their licenses disciplined. And even then, only the most egregious acts — like sexual relationships with clients, insurance fraud, or repeated and knowing violations of confidentiality — will actually result in a license being revoked. Reasons for this include that (1) licensing boards rarely can act in the absence of a complaint coming directly from an impacted client, and even clients who have suffered great harm are reluctant to complain; (2) because effective psychotherapy is so dependent on the protection of privacy between client and therapist, investigations are lengthy and costly, and may fail to find a pattern of therapist behavior even when it does exist; and (3) standards of the profession, including ethical standards and disciplinary guidelines, are predominantly set by members of the profession.
So what is a mental health consumer to do? Three things:
1, Caveat emptor. Licensure ensures that a therapist met minimal state standards for independent practice — it is by no means a guarantee of effectiveness or up-to-date knowledge. Clients should ask lots of questions of prospective therapists, and if you do not feel fully comfortable with the person you are seeing, find someone else.
2, Demand accountability for effectiveness. The first session should focus on setting clear goals for therapy. From that point forward, you and the therapist share responsibility for getting there. It is not in your interest to continue spending time and money on methods that are not making a difference. Therapy does not always work quickly, but this is why it is so important to set clear and achievable goals, including some early-stage goals: You will have a quick yardstick of your ability to succeed with this therapist.
3, If you have been the victim of an unethical therapist, file a complaint. It is not especially unusual for colleagues to have a sense that a particular therapist is violating the law or professional standards, but licensing boards cannot investigate a feeling. They need to hear directly from someone who has suffered because of the unethical therapist’s actions. For a variety of (understandable) reasons, many clients who have been victimized in this way never do make a report.