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.