ABOUT PSYCHOTHERAPY

Any form of psychotherapy must be guided by one overarching purpose: to help you, the patient, achieve that which you are seeking. Treatment must alleviate pain and suffering and it must result in greater self-realization and inner strength. Accordingly, therapy must be a constructive experience, and as work proceeds, there should be advances in your sense of well-being. Inevitably, as part of the process, there will be a reliving of childhood traumas and other painful episodes, but on the whole there should be an upward trend characterized by hope and greater self-esteem. Your capacity for intimacy in human relations and your enjoyment of life should increase, concomitant with a decrease in suffering and pain. Clearly, a therapeutic process in which such changes are conspicuously absent is cause for concern.

Analytic therapy obviously must deal with your past developmental history, but in doing so the therapist must seek to forge a link between the present and the past in order to help you understand the present in terms of the past. Nevertheless, it is essential that the focus of any therapy rest in the present and that it help you deal with contemporary conflicts and difficulties. It may be stated categorically that any therapy worthy of the name must effect changes on (1) your sense of well-being and (2) the quality of your interpersonal relationships—experienced as more harmonious and satisfying. Reconstructions of the past may, and often do, play a part in such results, but they can never be a substitute.

Therapy will fail if the therapist becomes an impersonal technician whose primary recourse is to the technical literature, who treats his or her craft as a “business,” or whose objective is to ferret out “pathology.” The ideal of analytic psychotherapy is the superimposition of a special, significant human relationship upon an earlier significant relationship for the purpose of modifying certain maladaptive and self-destructive thoughts, feelings, and actions. The new relationship can have a therapeutic effect to the extent that it meets important psychic needs and to the extent that it produces corrections in one’s cognitive structure.

What often complicates the therapeutic task so immensely is one’s pervasive unawareness of precisely those mental/emotional structures that are having the most profound impact on his or her experience and behavior. It is this tendency for self-deception that disguises and hides from oneself and others that which is most important to know clearly. Essentially, a good therapist must be able to recognize and support your positive qualities and strengths, particularly during turbulent periods. The therapist’s acceptance cannot be feigned, pretended, or hidden by a stance of “therapeutic neutrality.” Either it is present or it isn’t—and you will feel the difference.

An essential prerequisite for meaningful psychotherapy is the sense of collaboration, partnership, and alliance. No technical discussion can drive home the point more glaringly that therapy is doomed unless the therapist succeeds in enlisting you as an ally in a joint endeavor. Unless you can develop sufficient trust in the benign qualities of the therapist as a reliable helper, there is little chance that you will collaborate in the arduous task of permitting yourself and the therapist access to the source of your difficulties. The paradox is that while we are eager to find out what is so troubling, we are equally committed to the proposition of opposing change. Therapeutic work therefore entails, to an important degree, the erosion of those barriers by which you may be perpetuating your patterns of thinking, feeling, and acting. There is a well-recognized reciprocal relationship between the growth of trust and weakening of defenses—those same defenses that have been so protective and so critical to your very survival for so long. This conundrum challenges us to begin to trust once again and reestablish a profound, meaningful and healthy sense of connectedness with our world and those in it.

Choosing a Psychotherapist

Choosing a Psychotherapist

Deal-Breakers: The Three Most Critical Questions

Choosing the right psychotherapist can be one big challenge. I’m not at all uncomfortable stating that there are far too many bad psychotherapists out there—very likely the majority of those now in practice. So, how do you find the one that is right for you? Where do you look? Who do you look for? What do you look for? How do you know what’s right for you? These are all very good questions, and deserve good answers. I’ve come up with what I believe are the three most crucial questions for you, the client, to ask any potential psychotherapist, but before I get to those important three questions, hear are some basics…

First: Take this seriously. You have made a decision to undertake your own personal psychotherapy—often at great expense. You’re the one paying for the service, and you deserve to get what you are paying for (see: About Psychotherapy). Your investment in psychotherapeutic treatment is important, it’s your life, and that’s serious.

Second: Interviewing several therapists is a good idea. You trust others all the time with important life affairs. Lawyers, accountants, real estate brokers—in life we have to trust other people’s expertise. What could be more important than interviewing a professional with whom you are not trusting with your mortgage, or your taxes, or your matrimonial settlements—but with your past, present, and future life?

 Third: Think about what feels natural. Would a female therapist feel more natural then a male therapist? Does he or she resonate a feeling of comfort and warmth? Do you get a sense of empathy and safety? Most of all: Does it seem like a good fit? These are all very good questions to ask yourself. Why? Because research has shown that one of the most universal factors in successful therapy is the therapeutic alliance. This includes the bond between therapist and client, consensus on the goals of treatment, and agreement about the work that will be undertaken to achieve these goals. Since trust is such a crucial component to successful therapy, begin by trusting what feels organic to you.

 Fourth: How does the therapist specialize? As I’m sure you’re already aware, there are many, many modalities or styles of psychotherapy. In the broadest sense, there are two main approaches to psychotherapy: Psychodynamic Therapy (including analysis), and Cognitive/Behavioral Therapy. Simply said, one (the Psychodynamic) works from the inside out; and the other, Cognitive/Behavioral (C/B), works from the outside in. Never hesitate to ask your therapist about his or her background if you have any question whatsoever. Specializations become more and more refined from there, either by areas, e.g., family or couples work, addictions, traumas, children, etc., or in diagnosis, e.g., depression, anxiety, ADD (Attention Deficit Disorder). Your needs must be a factor in any decision regarding a therapist’s specialization.

The three most critical questions

Now for the three most critical questions to ask any and every potential psychotherapist you are interviewing. It is my firm conviction that any competent, well-meaning therapist will have positive responses to all three questions. A therapist with even one negative response shows an egregious disregard for sound therapeutic principles, and it is a glaring harbinger of an inferior therapeutic experience.

In other words: it’s an instant deal-breaker.

#1. Are you in, or have you ever been, in your own psychotherapy? Quite simply: no therapist can take you where they have not been themselves. You are entering into a process of personal exploration and growth. You will be diligently working to face your innermost demons and resolve your deepest conflicts—that path is arduous. It is simply not possible for a therapist to effectively help you achieve a higher quality of life by sitting on the sidelines, portending to know how to guide you through this process, and never having challenged themselves in the same way. Research has found that therapists who have never been in their own psychotherapy have much more trouble separating their personal issues from their clients, get embroiled in counter-transferential conflict with their clients, and have more difficulty setting clear, appropriate boundaries. For me, a “no” response to this question would end the conversation cold—and, with any luck, it will for you, too.

#2. Are you in supervision? In the field of psychotherapy, unlike most every other profession, supervision is an ongoing process—even if you’ve been in private practice for 30 years. Why? No therapist can undergo all the traumas and stressors, or experience all the types of problems that their clients present without comprehending what their own triggers are, how they are being triggered, and how to not let them intrude in the clinical relationship. This takes competent, ongoing supervision. Without it, your session can easily become sidetracked or worse: it can become about the therapist, and then who’s looking out for you? Is that where you want your hard-earned money to go?

 #3. Do you have post-graduate or post-doctoral training? This is likely to be the most debated—but when your quality of life is at stake—and it is—this one’s non-negotiable. Don’t be fooled. Whether you eventually see a psychiatrist (M.D.), a clinical psychologist (Ph.D., Psy.D), a clinical social worker* (LCSW, CSW, MSW, etc.), or any other licensed mental heath professional, make sure they have some kind of post-graduate training or education from a credible therapeutic institution. Why? Understand that formal, academic university education is just that: academic. Each field of practice develops certain strengths or areas. Psychiatry today specializes in medications, Clinical Psychology emphasizes psychological testing and research, and Social Work covers a wide a range of areas (i.e., casework, client advocacy, community organization, etc.), to fully give the social worker enough clinical experience.

Why is post-graduate education so important? For many reasons, that include practical experience, specialization, and the fact that most post-graduate institutes require that their residents be in their own psychotherapy (often two to three times a week). Keep in mind; no university requires this of their students.

Insist on post-graduate training or walk, and I’d be walking with you.