How to choose a Therapist or Doctor

win2It’s easy to find a therapist but perhaps more difficult to know if you’ve found one who is right for you. There are a number of questions you can ask that will help you to choose a counselor. This short article outlines 11 of these questions, in no particular order.

1. What does it feel like for you to sit with the therapist? Do you feel safe and comfortable? Is it easy to make small talk? Is the person down to earth and easy to relate to or does he or she feel cold and emotionally removed? Is the counselor “stuck in her head,” or overly emotional and empathic? Is the therapist a “know it all” or arrogant? Sure, for many of us, going to a therapist for the first time is a bit  provoking,  But, if a therapist doesn’t feel like a good fit for you, that’s okay; there’s absolutely no contract or rule requiring you to continue working with any counselor. However, it’s important to check to see if there’s a part of you avoiding therapy through a dislike or judgment of the therapist. If you find yourself reacting negatively to every therapist you see, then the issue could be yours and may warrant you sticking it out with a therapist in an effort to work through your fears of beginning therapy.

2. What’s the therapist’s general philosophy and approach to helping? Does your therapist approach human beings in a compassionate and optimistic way? Does he or she believe humans are born loving and lovable, or does the therapist believe people are genetically deficient? We believe that good therapists and counselors adhere to the elements of good therapy.

3. Can the therapist clearly define how he or she can help you to solve whatever issue or concern has brought you to therapy? Experienced therapistss explain how they can help, are able to give you a basic “road map,” to their approach, and can even give an indication of how you will know when therapy is finished.

4. Can your therapist accept feedback and admit mistakes? A healthy counselor is open to feedback and to learning that something he or she said hurt or offended you. Good therapists are willing to look at themselves, to check their feelings, and to honestly and openly admit mistakes.

5. Does the therapist encourage dependence or independence? Good therapy doesn’t solve your problems; it helps you to solve your own. Likewise, good therapy doesn’t soothe your overwhelming feelings; it helps you learn to soothe your own feelings. Like the old proverb, therapy is most powerful when it helps people to learn to fish for themselves rather than rely on another to feed them. If your counselor provides wisdom, answers, or emotional support without encouraging you to access your own resources, it is more likely you will become dependent on your therapist to help you feel better, rather than learning to depend on yourself.

6. Does the therapist have experience helping others with the particular issues for which you are seeking therapy? The more experience therapists have addressing a particular issue, concern, or problem area, the more expertise they have developed.

7. Does the counselor make guarantees or promises? It’s important for a therapist to provide hope but not absolute unconditional guarantees. If you have the will to change and put in the necessary time and energy, healing is possible. Most of our wounds and defenses are the result of what has happened to us and to those around us. Healing can happen quickly intherapy, but only after getting safely through the layers of protective gate keepers, which understandably can take a long time. So, although everyone is capable of healing, changes can take years to happen for some people; unfortunately, because time is limited, some may never achieve the level of healing they desire in this lifetime. In addition, people are not always at a time and place in their growth where they are ready to heal, and a given therapist may not be the right person to help them. Overall, there are numerous factors at play in the therapy process that may contribute to or interfere with healing; we are conscious of some of these factors, and others we are not aware of. And so, there are no guarantees without conditions.

8. Does your therapist adhere to ethical principles in regard to issues such as boundaries, dual relationships, and confidentiality? There are numerous ethical guidelines designed to keep counselors from harming clients. Most important, there is a guideline barring against dual relationships. When a therapist enters into a therapeutic relationship with a client, he or she should not have any other relationship with that person, such as teacher, friend, employer, or family member, although there are some exceptions to this rule in villages or very rural communities. The principle behind this guideline is really about whose needs are getting met. A therapist should be there to meet your counseling-related needs for empathy, understanding, support, guidance, unburdening, and healing. When a counselor gets his or her own needs (emotional or otherwise) met by the client, he has crossed a boundary, and the therapy process can be damaged or ruined. This is one of many ethical guidelines, and it’s important for a counselor to adhere to these. For more information on ethical standards, you can visit these links:

9. Is the counselor licensed? Licensure implies that a counselor has engaged in extensive postgraduate counseling experience which, depending on the state of licensure, may include up to 3,000 hours of required supervised experience. It also means the counselor has passed a licensing exam. There are many unlicensed therapists who have years of experience and do excellent work, but licensed counselors have (generally but not always) jumped through more hoops and have undergone more extensive supervision than unlicensed counselors.

10. Does the counselor have a graduate degree? There are numerous people who call themselves “counselors” or “therapists” because they have taken a weekend seminar or have learned a certain therapeutic approach. But without a graduate degree in counseling, psychology, social work, marriage and family therapy, or another related field of study, such a person lacks the education, training, and skills to provide safe psychotherapy and counseling. It is highly recommended to only work with counselors and therapists who have graduate training. People without graduate-level education in a mental health field may lack the necessary skills and know-how to properly diagnose and treat issues, and there is a great danger in misdiagnosing and mistreating. Psychology is an enormous field, and human beings are multifaceted and complex. It takes years of education and training to effectively help people. Without the proper training, there is great risk of causing harm.

11. Have any complaints been filed with the board? If so, what are the complaints, and have they been satisfactorily resolved? To see if a counselor has a record or is under investigation, you can check with your state licensing board, usually under the state department of health or occupational licensing.

Remember that your therapist is someone you have hired. It’s important to bear in mind that some problems will take longer to resolve than others, so treatment duration can vary considerably. But if you notice absolutely no change in your problem after the first couple of months, hire a different therapist.

 

After all, nobody wants to put their intensely personal emotional problems into the hands of an inexperienced, ineffective, or useless practitioner. The below guidelines will offer suggestions you may want to follow in choosing your next therapist.

 What should I look for first in a therapist?

First and foremost, you must find a therapist you feel comfortable with. Therapy is not an easy process and your therapist is not there to be your friend. Having said that, however, you can certainly choose a therapist whom you feel respects your individuality, opinions, and self. You must be able to trust your therapist 100% and if you cannot and feel like you have to lie to your therapist or withhold important information, you are not going to get any real help. You must also feel, in some respects and at some point in therapy, that actually going to your therapist is helping you. If you do not feel relief from your emotional problems, you may not be getting the best treatment available. Look for these types of warning signs as reasons to think about choosing another therapist if you are already in therapy, or signs to look out for during your initial few sessions with a new therapist.

Second, you should seek out therapists who have been practicing in the field for at least a few years, longer when possible. Research doesn’t show much difference between the quality of therapy outcomes based upon a clinician’s degree or training, but it does show that the longer a clinician has been practicing, usually the better client outcomes. This means that experienced therapists will be more likely to help you. Seek out a therapist with specific experience with your issue — you don’t want to be any therapist’s first time client for the problem you’re grappling with! Ask point-blank questions about the therapist’s experience in your first session with them. Don’t be shy! After all, it’s all about you and your care here. You’re interviewing the therapist as much as they are interviewing you. Take the opportunity to ask about the therapist’s experience with your issue. For instance, questions such as:

  • “How long have you been in practice?”
  • “Have you seen a lot of clients with similar concerns to my own?”
  • When was the last time you treated someone with a problem similar to mine?”

are all appropriate to ask your therapist in the first session. Listen to the answers and make your decision about whether this therapist will help you or not accordingly.

What difference does the therapist’s degree make?

I’m often asked, “Well, what’s the difference between the various academic degrees?”, or, “What do all those letters stand for after a person’s name?” And of course, these questions are posed because you, as an individual and a consumer who has choices in this broad field, can make the best and most informed choice when choosing a mental health provider. My rule of thumb in this has always been to go with what you can afford. You are not going to be helping anybody if you put yourself into deep financial debt while trying to get out of deep emotional pain. If you have insurance, most companies will pay at least some minimal mental health benefits. You will find out how minimal those benefits might be when you go to access them. (This leads me to an important sideline which I must write more about some day — Demanding better mental health benefits from your insurance company in America.) Generally, most insurance plans today will only cover about 12 to 18 sessions of outpatient mental health care. That’s enough to cover most problems that might come up and if you’re in the hands of a competent professional, you are likely to be able to experience some solutions to your problems.

Getting back to the degree question, however, we are still without a real clear answer. Here’s a formula you might find helpful . . . Go with the most skilled professional you can afford, starting at the top with psychologists. Psychologists are like the General Practitioners of mental health. They have a unique educational background grounded in research and science which helps to ensure that the techniques they utilize are the most effective and beneficial to you. Psychologists, like any other mental health practitioner, can refer you to a psychiatrist, a medical doctor specializing in prescribing psychotropic medications, if their professional assessment warrants it.

Next in line are licensed clinical social workers. They most often have some specialized training in psychotherapy and helping clients in very similar ways to most psychologists. Master’s level counselors follow, with a little less training and supervision than most clinical social work degree programs.

You should likely avoid seeking help from a psychiatrist only, for almost all mental disorders. Emotional stress can be relieved temporarily through medications (and may be an important adjunct to psychotherapy), but they generally are not used as a “cure.” Most people I know want to solve their problems, not put them on hold only for as long as they are taking a medication.

 What if I can’t afford a psychologist?

If you cannot afford a psychologist, clinical social workers are the next best thing. They have less initial training and experience than psychologists, but after a dozen years in the field or so, this becomes a less noticeable and important difference. They are much more prevalent in giving psychotherapy as the managed care field has grown in recent years in America.

Should be noted here, research so far has not shown any real or significant differences between how well patients feel after therapy given by these various practitioners.

So how does one even choose a therapist to begin with, regardless of their degree?

The answer to this question depends on that tricky insurance question again. Some HMOs and other insurance companies are setup so that you must first consult with their GP and get a referral from that person, before you can see a therapist (either within their system or outside of it). Consult your health benefits handbook for the procedure for this, or contact your HMO directly and ask.

Otherwise, the procedure is bit more difficult, since there is no easy way to choose any professional in any field (e.g.- dentist, opthamologist, etc.). In many larger suburban or metropolitan areas in the United States, there are referral agencies set up to handle this problem. In smaller communities, this might be handled by a local professional association or the mental health advocacy association. The answer to this question is likely to be found in the Yellow Pages of your local telephone book under one of the following headings, “Mental health,” “Therapists,” “Psychologists,” or “Psychotherapists.”

What are the minimum qualifications I should look for?

Look for a therapist who is licensed (or registered) in the state or territory in which he or she practices in. Psychologists, for instance, likely will have to have a valid license before they can call themselves “psychologists”. For clinical social workers, they will generally have an “L” in front of their degree (e.g.- L.C.S.W.). Some states may not license clinical social workers, or do not require they display licensure in this format. Ask the therapist is you are unsure. No professional or ethical therapist should mind being asked about their educational or professional backgrounds. If a therapist has a degree, it will almost always follow their names in the advertisement (and may be required by law). You should likely stay away from individuals who don’t have at least a Master’s degree (e.g.- M.S., M.S.W., C.S.W., M.A.). Avoid “counselors” who have little or no formal training, or titles that are not easily recognizable. For instance, in New York state, you need nothing more than a high school diploma to become a “Certified Addictions Counselor.” While this sounds pretty impressive, it is misleading since the training required to receive this title is minimal.

And as a large-scale survey of Consumer Reportsreaders showed in 1995, people in therapy generally rated psychologists, clinical social workers, and psychiatrists about as equally effective. Marriage counselors were rated significantly worse, according to patient improvement skills. You’ll likely be better off if you follow the above criteria.

Okay, so I’ve made the plunge and set up my first appointment with a therapist. What should I expect now?

You will likely be told a little about financial information you should bring with you on your first appointment over the phone. Bring it and expect to fill out a few forms (especially if you’ll be going to a community mental health center or other government-involved agency for therapy). The first session, sometimes called an Intake Evaluation, usually is very unlike what you can expect of all of your following sessions. During it, you will be asked to explain what brings you into therapy (e.g.- What’s wrong at this point in your life?), what kind of symptoms you might be experiencing (e.g.- can’t sleep, always thinking about some things, feel hopeless, etc.), and your family and general history. The depth of this history-taking will vary according to therapist and the therapist’s theoretical orientation. It will likely include questions on your childhood, education, social relationships and friends, romantic relationships, current living situation and housing, and vocation or career. When this history is completed, and the clinician has a beginning understanding of you and what goes to make up the important things in your life, as well as your current difficulties, he or she should ask you if you have any questions for them. If you do, please feel free to ask them (and ask them even if the clinician forgets to offer this). This would be a good time to ask a few questions about the clinician’s theoretical orientation, training, and background, especially in treating your specific type of problem. As mentioned previously, professional and ethical therapists should have no problems in answering such questions. If your clinician does, that might be your first warning about that person’s ability to help you with your problems.

 You’ve mentioned “theoretical orientation” in the above paragraph. What is that and what concerns should I have about it?

Theoretical orientation describes what theories the clinician subscribes to in thinking about a person’s problems and how best to treat them. Most clinicians nowadays subscribe to what is called an “eclectic” orientation. This means that, in general, they try to tailor their treatment approach to your own way of relating and the problems you present with. Other popular approaches to treatment are “cognitive-behavioral,” “behavioral,” and “psychodynamic.”

Okay, so now I’ve begun therapy and feel comfortable with the therapist I’ve chosen. How long should this take and what should I expect the course of therapy to be like?

While this might seem like an easy question, it is the most difficult to answer since individuals vary widely with their own backgrounds, severity of the problem, and other factors. For mild problems, treatment should be relatively brief or short-term and will likely end within 12-18 sessions. For more severe problems (especially chronic or long-term difficulties), it’s going to take longer. Some therapy can even last up to a year or more. The choice is always yours, however, when you want to end therapy. If you feel you’ve benefited as much as you’d like, you can tell the therapist and end therapy accordingly. A good therapist will respect your decision (questioning it a little to look at the reasoning behind it and make sure it is sound) and will seek to end the process with another session or two, to wrap things up and summarize progress made on treatment goals. An unethical or unprofessional therapist will attack your decision and seek to keep you in therapy. Be firm with this kind of therapist and leave whether the therapist wants you to or not. After all, unfortunately, not all therapists act appropriately in all respects in this field.

 You’ve mentioned “treatment goals” in the above paragraph. What is that and what if my therapist doesn’t use them?

I feel strongly that all therapists should use treatment goals, but there is no one standard in the field. Naturally, if you come into therapy with particular problems or difficulties in your life, you would like to have them solved (or at least begin working on them). Treatment goals, especially ones that are formalized and written down, ensure that both you and your therapist are on the same “track” and working on the same problems. Also, by occasionally reviewing said goals, you can chart your progress (or lack thereof) in therapy and work with your therapist to change therapy if need be. But, as mentioned, this is an individual therapist decision; if you’d like to have some goals set up, you can always ask your therapist to help you do so. I would certainly recommend it.

Sometimes, however, treatment goals don’t need to be formalized and written down. For instance, in couples therapy, the goal is generally understood at the onset — to help improve communication and improve the relationship. In such cases, it is usually not necessary to write specific goals down to work on every week. But if you feel more comfortable being concrete about your goals in therapy, let your therapist know. Most therapists (but not all) will comply with such a request. (Some therapists are simply “anti-treatment goals” and don’t believe in them. This doesn’t automatically make them a bad therapist, but it is something to be aware of.)

 What if I suspect that my therapist has acted or conducted him or herself in an unprofessional or unethical manner?

It is best, but not always easiest, to report such violations to your state’s licensing board as well as that therapist’s professional association (American Psychological Association for psychologists; American Medical Association for psychiatrists; ). It is not always easy to follow through on these charges, however, because these professions are generally “self-policed.” This means that it is up to the profession (e.g.- the licensing board or professional association) to investigate the charges and followup on them. This is a slow process.

If you therapist has done something harmfully wrong to you during therapy (e.g.- made sexual advances on you, which is never appropriate in any profession), it really should be reported, or else the therapist may continue to harm others after you. Inappropriate behavior which violates your trust, including engaging in a sexual relationship with you or violating your confidentiality without your expressed written consent, should also always be reported.

Remember, always keep in mind the most important key to having a good therapy experience . . . Find a therapist you feel comfortable with talking to and feel he or she is helping you work through your problems. Therapy isn’t meant to be easy, so if it is, that might be a sign that your therapist or you are not working hard enough. Don’t be afraid to stand up for yourself on this important issue and change therapists as often as need be until you find the right fit.

 

Tips

  • What a Therapist Can Do
    • Can be an understanding and supportive listener.
    • Can help you develop your ability to cope with life’s difficulties.
    • Can help you develop some of your life-skills: more effective communication, better problem-solving, better impulse-control, etc.
    • Can help you look at your problems in different ways and with a different perspective.
    • Can help you gain more insight into your behaviors and emotions.
    • May be able to help you make changes in how you function and feel. (This may require a lot of hard work on your part, though!)
    • Can offer advice on how to find services which s/he isn’t able to provide.
  • What a Therapist Cannot Do
    • Cannot remove hurt feelings and unhappy events.
    • Cannot change other people in your life, and cannot tell you how to change them, either.
    • Cannot create instantaneous change in you. change requires hard and dedicated work.