choosing a psychotherapist

Choosing and Assessing a Psychotherapist

Today there are so many different types of therapy available that the opportunities for healing and therapeutic support are greater than ever before, but finding the right therapist can be a confusing proposition.

Many people don’t know what psychotherapy is “supposed” to feel like and have no one but their therapists to educate them. In fact, the approaches to therapy and the types of experiences possible are about as diverse as are the different ways it is possible to be in relationship with another person. And, essentially this is what psychotherapy, especially individual therapy, is–it is a relationship, not just a consultation with an expert (as with your accountant or car mechanic).

As in any relationship, your therapist’s strengths, weaknesses, preferences, and life experiences are all going to enter into your therapeutic process on some level. What this means is that in choosing a therapist it is important to choose a whole person–not just the appropriate degree or agency.

As there is a personal “chemistry” component tof successful therapy, pick someone with whom you feel comfortable. The best therapist for your friend might not be the right one for you. Listen to your own instincts on this as you make an evaluation. Talk to several therapists before deciding on one.

Having one session with many different therapists is an expensive way to make a selection, so spend a little bit of time on the phone with each person you are considering. Keep these phone interviews brief–no one is going to want to give you lengthy, free-of-charge phone counseling.

Have several questions prepared regarding training, experience, and orientation, that will give you some information about each person as well as a feeling for how they relate and communicate.

Ask therapists for the name of books that will give more information about their philosophy and treatment approach. Even just perusing the cover and table of contents of a book is likely to give you some valuable information that wouldn’t be covered in a phone interview.

If you go to a counseling center, if at all possible, pick your own therapist rather than letting the agency assign you. Assignments are often made on the basis of who has an opening or is next up in the rotation rather than who would be the best person to work with your issues. Find out whatever information you can about each therapist from the agency receptionist regarding their approach, area of specialty, training, and years of experience, then call and talk to the ones that sound of interest to you.

Factors such as the gender, age, or race of your therapist are not necessarily crucial to successful therapy, but they can make a difference. A young woman fresh out of social work school would probably not be the most effective therapist for a middle aged man with a drug problem, but she might be the perfect mentor for a teenage girl with an eating disorder. A white therapist may not be sufficiently aware of the added pressures that minority races experience to adequately assist an African American client. A woman who has suffered abuse from men, or who has always had strong male figures in her life telling her what to do, would probably do best to seek a woman as her first therapist. At another time in her life, however, she might find great benefit from building a safe trusting relationship with a male therapist.

Men and women have very different styles of relating, communicating, and giving support. Sometimes being with the opposite gender can be a beneficial learning experience and other times can limit the depth of therapy. For example, males will often instinctively avoid addressing feelings of rage with a female therapist. A man might find it initially easier to open up with a female but ultimately may never delve into deeper core issues. Of course, the more skilled and experienced a therapist is, the more he or she is able to transcend external differences and assist a diverse range of people.

If you have strong feelings that a therapist may not be able to understand you because of differences in life experiences, trust that your instincts may be right. If you feel comfortable with a therapist in spite of differences, again trust your gut feelings.

After a few sessions with a therapist you can expect to feel the beginnings of rapport, trust, and a belief that something positive is happening. If you feel discounted, patronized, or misunderstood, talk to your therapist about this. Open communication will often set your relationship back on track. Over time it is natural for some feelings of distrust and misunderstanding to arise as this occurs in relationships of all sorts as they grow and deepen. Strong and persistent feelings of distrust that do not get resolved through talking them out can be a sign that you and your therapist are not a good match.

As therapy progresses, periodically assess whether or not it is working for you. Does therapy leave you feeling more aware of your wellness, your strengths, your progress, and the possibilities available to you? Or does it leave you feeling more aware of yourself as being irreparably damaged, weak, or limited? This can happen sometimes when therapists become overzealous in their efforts to identify and address pathology, inadvertently affirming these qualities rather than healing them.

The bottom line to keep asking yourself is whether or not therapy is helping you to feel better, to improve your life, your relationships, and your feelings about yourself. While therapy is not a quick fix, it is reasonable to expect results, even in the early stages. This may be simply a subtle feeling of renewed optimism, or a lift in self-esteem. It is important to keep in mind that therapy does not always feel good. When you are healing painful wounds and breaking through limits it is normal for there to be periods of fear, pain, and low-self esteem. Everything in your life will not right itself overnight with therapy, and your therapist will not “make” your life work. The work is primarily yours to do. But, if you have been in therapy for many months and have felt no shift at all or if you have been stuck on the same issues for years and your therapist says that you simply need more therapy, it is time to question the value of the therapy you are receiving. There may be something wrong with your therapy, not just with you. Your therapist will not necessarily be the one to tell you that your therapy is not working. This is an assessment that you must make yourself.

Consider whether or not the focus of your therapy is working for you. Does therapy focus so much on the past that it is not helping you to deal with the present? While it is important to deal with aspects of your past that are preventing your growth, delving into the past ceases to be helpful when it becomes a distraction from your life and healing in the present. Do you find that you understand everything there is to know about why you are the way you are but still don’t know how to make your life better? This tells you that a new approach is in order.

Too much emphasis on insight and understanding your emotions can become an avoidance of actually feeling your emotions. On the other hand, too much emphasis on catharsis can leave you in an emotional whirlwind without a context to give perspective and meaning to strong emotions. Some therapists are able to combine insight (that is, talk therapy) and more experiential approaches (such as Gestalt therapy, Inner Dialogue work, art, music, or movement therapies, guided imagery, body work, breath work, to name a few) in a balance that is right for you. Other therapists are more comfortable working primarily in one realm or the other.

If you and your therapist lean toward an imbalance in the same direction (as in too much talk or too much emoting) then you may feel comfortable in therapy but you might not see the results you want. While it is important to feel a basic level of comfort and trust with your therapist, the therapy itself isn’t necessarily meant to be comfortable. The purpose of therapy is to take us beyond our limits into new and more fulfilling ways of being. Venturing into the unknown is seldom comfortable.

If you have spent years with the same therapist and therapy has fallen into a routine, you may benefit from taking occasional breaks from therapy. The most productive therapy usually has an element of risk to it. When therapy becomes too predictable and comfortable then possibly your therapist has become more of a companion to you than a healer. This isn’t necessarily a bad thing–it simply means it’s time for therapy to end, or take a new direction, or for your relationship to take a new form.

It may be possible to have lunch with your therapist from time to time instead of paying an expert’s consultant fee to talk. While both of you may have resistance to ending for a variety of reasons, taking the leap to end therapy at the appropriate time can be as important to your healing as the step to begin therapy. If you wish to continue doing therapeutic work, consider choosing a different therapist. This is not a betrayal or rejection of your previous therapist. Different people will have different things to teach you.

If your objective is to improve your relationship with a lover or spouse, couples counseling is usually a better way to go about this than individual counseling. Individual therapy can even be counter productive for the reason that two people talking about problems with a mate who is not present always has the potential of creating a wedge in that relationship. This can happen even in a therapist-client relationship where there are the best of intentions. The therapist hears only one side of the story and may inadvertently “side” with his or her client at the expense of the relationship. When you go for counseling as a couple, however, the therapist is clearly there as an equal ally to both of you and is focused on the health of the relationship, not just the health of one individual. Because of this dynamic it is also advisable to seek out a neutral therapist for couples work rather than going to the individual therapist of one member of the couple.

Working with two or more people is a very different process than individual therapy, requiring different skills. An effective individual therapist may not be effective with a couple or family and it may feel like much harder work to a therapist who is more accustomed to individual counseling. It is also more likely to be of a shorter duration than individual therapy, which makes it less lucrative for the therapist. Faced with the choice between a treatment plan that is difficult and less lucrative or one that is more comfortable and profitable, some therapists may be inclined to cut short couples work or refer you both to individual sessions.

The same is true in regard to family therapy where the identified problem is the child. Some therapists are more comfortable working with a child individually rather than the family together but this is not usually the most effective form of treatment for a child. It is well known to family therapists that children with behavior problems are actually working hard to preserve their families. In creating a disturbance, they force their parents to become allies in dealing with the problem so that, at least temporarily, parents are relieved of having to deal with crises in their relationship and in their own lives. Many parents would prefer to send their child to therapy than to confront their own struggles and relationship problems, yet this approach to treatment often allows the underlying problems to go unaddressed, making it ultimately ineffective.

When you are seeking a therapist to work with your relationship or your family, check first to be sure that he or she has had training and experience in this area. And, if for any reason, in family or individual therapy, you feel that your therapist is developing a treatment plan that does not fit your needs, do not be afraid to insist upon the type of therapy you want. Ultimately, as with any form of health care, to achieve the greatest benefit, you must follow your own counsel as well as your therapist’s.

Lynn Woodland

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