Choosing a therapist

How to choose a therapist or counselor

Therapy is an investment in our inner wellbeing. Like any investment, we want it to be successful, to give us what we hope for and improve our lives.

 

Here are some guidelines that I hope will empower you to maximize the benefits of your venture into therapy. 


 

When you decide to see a therapist, it’s really important to choose someone who is not only good at what they do, but GOOD FOR YOU. It is vital that you do not invest your emotional energy and share your intimate personal problems with someone who is not a good match, not effective, or even detrimental to your wellbeing.

 

A bad therapy experience often leaves us worse off than before—not only have we not met our healing goals, but we are often traumatized by the encounter.

 

It’s also important that you know your rights as a client. We go to a therapist for her experience, knowledge and help, but those factors can also tempt us to give up some of our personal power.

 

I hope that the following points will support not just your choice of a therapist, but your continuing empowerment in the therapy relationship. 
I’ve been both a therapist and a client, and have personal experience of the successes and failures of therapy from both perspectives. I’ve written with all of this in mind.

 

How to consciously choose your therapist

You should consider not just going with the first therapist you contact or hear about.

 

Consider getting several names to choose from. Ask for referrals from your doctor/pastor/priest etc, or go online and scan listing services and web sites. Or go to the Yellow Pages and look under headings such as Mental Health, Therapists, Psychologists, or Psychotherapists. 
Choose 3 or 4 people to follow up. Start by interviewing them for 10-20 minutes by phone or Skype. Let them know that you are talking to several therapists so that you can choose one who’s right for you. An ethical therapist will have no problem with this. If it’s still not clear who to choose, then you may need to do a session or two with one or more therapists for more information, and make a decision after that.

 

Remember that as the client, you are ultimately in charge. You are spending your money to employ a therapist for the specialised service that she can provide. You are free to work with the person you choose and leave at any time.

 

Most important—you need to feel safe

 

The most important criterion for therapy is that you feel safe with your therapist. I cannot emphasise this enough. 
Your therapist needs to be someone you feel comfortable with, someone you really can trust. The more you can share with her, the more successful therapy will be. If you feel that there are things you cannot of should not say, it will limit the change that can happen.

 

You should feel that she respects and cares about you unconditionally, never rejecting or judging anything you say or do. You need to feel that she is genuinely interested in you as an individual, and that every part of you is accepted with compassion and understanding. Even though you will have goals for change, you need to feel that you can show up just as you are now, warts and all, and be treated with kindness. Change can only happen when we start with exactly where we are.

 

If in the first few sessions it seems as though your therapist is judgmental, not sensitive to you, lacking in kindness or giving you unwanted advice, then you should consider making another choice.

 


What difference does the therapist’s experience make?

 

Like most professionals, therapists generally get better with time. Those who have been in practice for 10 years or more are usually more effective than those with less experience. You will probably also have a better outcome if you look for someone who is experienced in the particular issue that you have. 
In your initial interview, you should ask the therapist how long she has been in practice, and how many people she has worked with whose problem is similar to yours. It’s fine to ask direct questions and expect direct answers. Remember that it’s your care that’s at stake, and you are getting to know the therapist just as much as she is getting to know you.

 


What kind of credentials should I look for?

 

Research has shown that the personal qualities of a therapist are more important than the particular academic credentials that she holds.

 

More qualifications do not necessarily make for a better therapist. That said, you probably want to look for someone whose formal title is Social Worker, Psychologist, Psychotherapist or Counselor.

 

Note that those with the title of Counselor generally have much lower academic qualifications – diplomas or trainings rather than degrees – and may not have completed a several-year supervised internship. However, long experience can definitely compensate for lesser qualifications.

 

Also note that psychiatrists generally do not do therapy, but prescribe medications for various mental ills. If it’s talk therapy you want, do not go to a psychiatrist.

 

You should generally look for a professional who is licensed by a government licensing board. Licensing boards require strict codes of legal and ethical conduct, and those who break those codes can be denied a license to practice. You should ask your therapist whether they are currently licensed and in good standing with their licensing board. This information is usually available online, and you should check it for yourself. No ethical professional should mind being asked about their licensing status and their educational or professional background.

 

What kind of therapy techniques or methods are best?

There are many different forms of therapy, and unless you’re in the field, it can be difficult to know what each entails and what issues it’s best at addressing. You can usually find some information on a particular method by searching the Internet, and also from a therapist who uses it. Some methods have been particularly designed to address certain problems, although many are more general.

 

The most important factor is that the therapist is competent in the method she does use. You should check that she has undertaken extensive training in her primary technique, and has practiced it for at least a couple of years. 
However, the personal qualities of the therapist are ultimately more important than the particular technique or method that she uses. What seems to heal us is not so much the particular method as the quality of the relationship.

 

What should I expect at my first appointment?

 

The therapist will usually spend at least part of the first appointment asking questions about you and your background. She will generally ask you what brings you to therapy, what you hope to get out of it, and what the history of your issue or problem is. 
An ethical therapist uses this information not just to get to know you, but also to assess her own professional competence to work with you. If she feels that she is not the best person to treat you, she will tell you so, and give you at least one suitable alternative referral.

 

She should also discuss her fees and fee arrangements with you. If you need any special payment conditions, this is the time to bring it up. At the end of this discussion you should both be clear about the per session fee, when it is due, and what cancellation fees apply. Most therapists require payment at each session and a fee for sessions cancelled with less than 24 hours notice. 
The therapist may also do a short therapy session with you so that you can get a sense of how she works. 
At the end of this session, she will usually ask you if you want to schedule another appointment.

 

Unless you feel very sure that this is the right person for you, it is generally a good idea to tell her that you will think about it for a few days, and call her back. Then, do just that.

 

What if I am not comfortable with my therapist, or not making progress towards my goals?

 

At any point in therapy, if you start to feel persistently uncomfortable with your therapist, or notice that you are not making progress towards meeting your goals, then you have the right to end the therapy. An ethical therapist will always welcome you telling her why you want to leave, and accept what you say without making you wrong in any way. It’s always possible that after talking it through, the problem will be resolved. Sometimes the block to therapy is revealed, and this can be very useful. However, you are not under any obligation to talk about your reasons for leaving if you don’t feel safe to do so.

 

How long will therapy take?

 

It’s not really possible to answer this question. It depends a great deal on what you want to achieve, and how quickly your changes happen. People can stay in therapy for 10 sessions or 10 years. The most important thing is to have a sense of what your goals are so that you will know if therapy is meeting them. A good therapist will regularly check in with you about this, and as she gets to know you, she should be able to give you some sense of how much longer may be needed to meet your goals.

 

What if my therapist acts unethically?

 

There are four main areas where a therapist may be tempted to cross the legal and ethical boundaries of her profession.

 

These are the areas of emotional abuse, sex, confidentiality and extra-therapy relationships. While unethical behaviour is thankfully rare, when it does happen it can be very damaging for clients, which is why I have included it here.

 

Emotional abuse

 

A therapist should unconditionally respect, support and work with all of your feelings, no matter what they are.  NO EXCEPTIONS. You should consider leaving immediately if you find your therapist is doing ANY of the following and not taking responsibility for and apologizing for her actions: denying your feelings, making your feelings wrong, criticizing your feelings, telling you that you are overreacting or too sensitive, distorting your reality then insisting that her version is the truth and there’s something wrong with you that you can’t remember correctly, swinging unpredictably between warm and cold behavior, blaming you for her own feelings or difficulties, telling you that you are crazy, making you doubt your own sanity, giving you an unwarranted mental illness diagnosis, putting you down and judging you, or making you feel small, weak or inferior. If you stay you will feel worse and worse about yourself while being less and less able to leave, and you may become quite traumatized. These are all the actions of a classic abuser, whose actions are directed towards weakening you with criticism and denial of your reality. This is often paired with telling you that they are the only one who cares about you, or that you are too broken for anyone else. The abuser then has you in their power – weak, dependent and totally controlled. When you are in that position of powerlessness, no healing is possible.

 

Sex

 

A therapist should NEVER offer or suggest a sexual relationship with you, or make sexual remarks or suggestions. Sex is not part of any valid psychotherapy. It is never, ever appropriate, no matter what a therapist may say. When it does happen, it is a great betrayal of trust, and often quite traumatising for the client.

 

Confidentiality

 

A therapist should never tell a third party anything about your therapy without your clear and detailed consent, usually in writing. This includes not just the content of your therapy, but even the fact that you are working with her.

 

Other relationships

 

It’s best if a therapist has only a therapist-client relationship with you. Any additional relationship can complicate and impair the therapy relationship, even if it seems harmless at the time. She should not also be working with close friends or family members (although this is sometimes unavoidable when you live in a small community). She should never engage in a social relationship, friendship, or business relationship with you. This includes things like bartering for services or accidentally meeting you at a party. She should not propose that you meet at her house or yours, unless she has a separate home office or you are disabled in some way. An ethical therapist who happens to run across you outside the therapy room will simply smile and move on. She is not being unfriendly – she is protecting your confidentiality.

 

Your choices

 

If your therapist acts unethically, the first things you should do is start taking detailed notes of time, place and incident, whether or not you have decided what to do about the situation. 
You have several choices. You can just leave therapy. You can talk it over with the therapist and ask that it not happen again. You can report her to her licensing board. 
Deciding to report can be difficult, as you will have to make a full statement about a difficult interaction, boards often move slowly and often consist of therapists themselves. However, if your therapist has harassed you sexually, reporting her may protect future clients. If you decide to go ahead, it is very important to get some solid support, preferably from a new therapist who believes and will substantiate your story.

How do I end therapy when I feel I’ve met my goals?

 

When you feel that you have met your goals, or that you have made as much progress as you can with this particular therapist, you can decide to end the therapy. All you need to do is let her know. A good therapist will help you look at your reasons for leaving, and help you clarify that this is the best decision. Then she will usually suggest a further 1-3 sessions to make sure that you feel complete when you leave. An ethical therapist may sometimes give some valid reasons for staying longer, but will never attack your decision or force you to stay. If that happens, you can either bring this up with the therapist, or if that does not seem possible, you should consider just leaving.

 

It’s my deep wish that your therapy adventure, whether with me or someone else, brings you growth, healing and the better life that you seek.