Looking for a good fit, and profiting from your interactions with a therapist PLUS some warning signs
Congratulations On Your Courage
Although getting involved in therapy is more common than ever, it still takes courage to recognize you have a need for outside help. Keep in mind that the majority of people who seek out counselling are “normal” and just need some help in tweaking their lives. Your decision to try therapy is the first proud step.
Finding the right therapist for yourself is a challenge that can intimidate the best of us. This card is here to help you through it.
Comfort vs. Discomfort
Before we start, here’s an absolutely crucial issue. You need to be comfortable with the methods, style and techniques of your therapist (to be). That doesn’t mean you will never be uncomfortable in the therapy process. Psychological growth almost always involves discomfort, and sometimes doing things you would rather not.
Try to distinguish between discomfort coming from progress and discomfort coming from a “poor match” between you and the therapist. Make sure you don’t “cop out” just when things get challenging. The toughest parts of therapy often result in the greatest gains, so be willing to stick with it.
What’s Important In A Therapy Relationship
- You are able to develop a sense of trust with the therapist, so that you can continue through the difficult parts of therapy.
- You have a reasonable comfort level with the style, approach and personality of the therapist.
- You feel able to be open and honest with your therapist.
If any of these are missing you need to find someone that suits you better.
Where To Start
You think you might benefit from some help. You don’t know exactly what you need. Where do you start? The first task is to find therapists that “might fit”.
- Talk to close family members and friends for their recommendations. Here‘s a little secret. You‘ll be surprised how many of your friends and family members have seen a therapist without your ever knowing. So don‘t feel embarrassed asking.
- Each state or province usually has a licensing board for psychologists and/or psychiatrists. Other associations in your area may keep a directory that outlines the specializations of therapists. Can be excellent starting points that allow you to start the hunt and remain anonymous.
- Approach your family doctor. If you can explain the nature of your desire for help, that may help him/her offer suggestions.
- Talk to a local clergyman. Many have excellent resources available.
- ¨ Check your phone book for community mental health centers, or even crisis lines. Even if you aren’t in crisis, these organizations have excellent resources available. Also check out if your company has an employee assistance program (EAP). They may be able to refer.
Then What?
Let’s say you have a list of possibilities. Your next step may be to arrange an initial consultation with some of the professionals on your list. Before we talk about what to look for and what to ask in that initial contact, here are a few important points.
- Therapy is a very personal thing. What may have worked for your friend may not work at all for you. So the key is to evaluate the “fit” between the therapist and your own needs and wants. Without that fit, you’ll be disappointed and disillusioned.
- The responsibility for determining if there is a good fit should be shared by you and the prospective therapist. Sometimes if you are under stress, your first reaction will be to refuse that responsibility, and rely on the therapist to decide for you. For therapy to work, you’re going to need to take responsibility, so it’s time to start now.
Things To Find Out
The following maps out information you should collect at the first meeting (recommended) or by phone. You may want to speak to several “prospects” before making a decision. Consider asking:
- Are you licensed and by whom? (licensing means they once met the standards for their profession — e.g. for psychologist, etc. Not all therapists need be licensed, and being licensed doesn‘t mean the person is good). Also, ask about any other qualifications and certifications.
- What is your experience/training/background dealing with situations similar to mine? (You want someone who has worked with people in your situation).
- What would we actually do during our sessions?
- How long do you usually work with people who have issues like mine? (for many problems a preference for short-term therapy is better).
- ¨ Are you available on short notice in emergency situations (might be a concern for you, may not).
- What are your fees? (and other nuts and bolts questions like possible insurance coverage, cancellation fees).
- What are your beliefs about how therapy should work? What do you do during sessions and what do you expect from a client during and between sessions?
- How often would I be coming? (and are you flexible with scheduling, e.g. night appointments, weekends).
- What do they think is usually the cause of most people’s problems? (this question allows you to determine if you and the therapist might be on the same wavelength about how people work).
Your First Meeting Reactions:
As important as the information you collect is your reaction to how the therapist interacts with you. So here’s what to consider:
- Did you feel listened to?
- Did the therapist ask what seemed to be good relevant questions, and show a sincere interest in getting to know you?
- Good communicator? Did s/he talk to you in a way that’s easy to understand but not condescending?
- Did you get the impression that the therapist had very rigid pre-conceived notions about your particular problem? (that’s not a good thing).
- Is this person someone you feel will be able to challenge you when necessary, and be firm when needed, but not overbearing.
- Can you see yourself learning to trust the person?
Is It Going Well?
It’s impossible to guarantee that a particular therapist will be able to help you without entering into the process. Since it’s your life, you need to take some responsibility for making some evaluations of how it’s going, once the therapeutic process has begun. Some tips for evaluating:
- As we said before, the fact that you are sometimes uncomfortable with the therapy shouldn’t be enough to tell you that it’s not working. Improving mental health can involve discomfort. However, if the discomfort is constant (each visit), and doesn’t diminish, it’s very important to discuss that discomfort with the therapist. That way both of you can work together to decide whether something different would be a better fit.
- You should have a sense that the therapist isn’t letting you manipulate him or her and is gently guiding you to explore areas of importance. Some therapists are too easy, some too hard.
- Over time you should have a sense of progress. This may take some time, but after 8–10 sessions, you should feel you are “getting somewhere”, even if your problem hasn’t yet been “solved”.
- It helps to have a set of goals worked out with the therapist along with an approximate time line to achieve them. If the therapist doesn’t suggest this you might bring it up, since it will help you evaluate progress.
- Don’t expect instant solutions, either. Look for “getting there”.
- Remember that therapy is a two way street, and that you have a responsibility to work in good faith, even when it’s very very hard. Some people end up jumping from therapist to therapist, always blaming the counselor for lack of success. Before deciding a therapist isn’t very good, look to yourself.
Watch For These Symptoms
It’s a shock to some people to find out that there are really great therapists, really poor ones, and there are some that can be downright damaging. It’s important that you know some of the things that serve as warning flags that the therapist or the therapy is not productive and will not be. Here are some things that should not happen during therapy.
- While the therapist may encourage you to try something new or participate in an exercise you might feel silly doing, the therapist should never browbeat you or intimidate you into doing something you don’t want to do. There are a lot of strange therapy techniques out there, and some may be unacceptable to you. Your objections should be heard and respected. If not, look elsewhere.
- Because therapists are in positions of power and trust, they should not be expanding the relationships beyond the therapy context. Socializing, sexual advances, and so on are completely inappropriate.
- Touching sometimes occurs in therapy — basically innocent reassurances, that kind of thing. At any time you should be able to tell the therapist when you do not want this kind of contact and have your wishes heeded.
- Some therapists see themselves as experts, some as equal partners, and may see their roles differently from each other. What’s important is that your views, feelings and opinions are not rejected out of hand, and that they are listened to and acknowledged. Again, when you find yourself feeling pressured, it’s important to tell the therapist. If you get an unsatisfactory response to your feelings, it’s time to move on.
If you notice these warning signs, you have two options. One is to terminate the therapeutic relationship without any further discussion. For example, if a therapist makes a sexual advance, that’s a very serious breach of ethics, and you may simply not want any further contact.
Your other option is to bring up the subject, and see whether you get a response that puts your concerns at rest. Sometimes, things can be misconstrued or misunderstood. Broaching the subject may allow clarifying misunderstanding. What is best depends on the situation. Remember that you are entitled to protect yourself from misconduct by mental health professionals.
It’s Really Not Working
You feel you’ve tried your best, fulfilled your responsibilities, but it’s just not working out for you. Now what? Consider these ideas:
- Therapy is for YOU. If it’s not working, then not only can you move on but you should move on.
- Don’t worry about the feelings of the therapist. Good therapists know they can’t help everyone.
- Provided the therapist hasn’t acted unethically, it’s always a good idea to discuss the end of therapy before just not coming anymore. You may learn more about yourself.
- If you discuss the “not working” with the therapist, one good outcome is that s/he might be able to suggest someone who might be of more help, and refer you to another therapist who would be a better fit.
- However, you are under no obligation to tell the therapist why you are stopping. The reason you would discuss it is that you might benefit by doing so.
- If the therapist tries to intimidate, frighten our otherwise convince you to keep coming against your best judgement, it’s time to leave.
Disclaimer: The material in this help card is intended as general comment and not advice on your specific situation. Since choosing a therapist is a very personal thing, it’s not possible to give you a guaranteed process that will always work.
