How to Choose a Therapist

The therapy relationship is an intimate one. I am sensitive to the importance of finding a therapist who is both competent and caring for the therapy to work out. As in any intimate relationship, chemistry is essential. You may not feel completely comfortable in the first session since trust takes time. Figure out whether you’re the kind of person who can get an immediate sense of “fit,” or one who needs time and space to assess the situation. If you have several therapists from which to choose, it may become easier to sort out the anxiety, trust, and possible discomfort of the situation from what belongs to the therapist, what belongs to you, and what belongs uniquely to the situation. Pay attention to how you feel and trust your feelings.

In looking for a therapist, start by asking people you know who believe they are in “good” therapy to get names for you from their therapists. Ask any of your health care providers for a referral. Look on the Internet. Check out state or national associations, e.g. www.masspsych.org, www.emdria.org, www.istss.org etc.

When you interview a therapist, ask any or all of the questions below. These questions can be asked by telephone, although some people prefer to ask them in person. You are entitled to know the following:
• Academic degree; type of license to practice.
• Years of experience providing psychotherapy.
• Internships or special training.
• Therapeutic approach and/or methods used.
• Use of supervision/consultation.
• Statement regarding confiidentiality.
• If a complaint has ever been filed against the therapist.
• Are there openings on a day and time that fit your schedule?
• What is the fee, billing or payment policy. Policy for cancellation or “no
show” appointments. Option for insurance coverage, in or out of
network.
• Is there a charge for telephone consultation or calls between sessions?
• Emergency procedures.
• Does the therapist refer for medication consultation, traditional and/or
non-traditional practitioners?

Once you are in therapy, ask yourself:

• Am I intimidated by this therapist?
• Does s/he listen to me?
• Do I feel I can disagree with him/her?
• Can s/he admit if s/he is wrong about something?
• How does s/he handle crisis and conflict?
• Is this therapist comfortable with my feelings and the content of what I
have to say?
• Does this therapist help me understand his/her approach?  If the
therapist uses an eclectic approach with a variety of methods, does
s/he include me in choosing the right one for me?

Saying what is on your mind and speaking up for your rights are not always easy to do in psychotherapy (or in life). Nevertheless, try to be assertive to get what you need. Therapists are real human beings and can get caught up in their own issues. Worse, they might project them onto their patient. Or your issues may trigger the therapist’s unresolved areas. Other indications of a therapist’s unresolved issues: If s/he strongly wants you to do anything that feels uncomfortable or wrong to you, don’t do it! If s/he begins to disclose more personal information that you are interested in or comfortable hearing, say so! And, there is no circumstance in which a therapist can engage in sexual conduct of any kind with a patient in therapy. Each discipline (e.g. Psychology, Psychiatry, Social Work, Mental Health Counselor) has its own ethical standards about what is termed “dual relationships” during or after a therapeutic relationship.
Remember, the therapist is your employee: you have hired and are paying for his/her expertise and time.

Problems/Solutions in the therapy experience:

• If you believe the therapist is incompetent or less experienced than
“advertised.”
• If you believe the therapist has a philosophical direction that does not
feel right or helpful.
• If you feel that the therapist is not respectful of your boundaries, or you
just feel generally uncomfortable in the relationship.
• If the therapist is often late for sessions, takes telephone calls on a
regular basis, forgets appointments, or falls asleep during a session.

Tell the therapist what does not feel okay or helpful. Tell the therapist what you need in the therapy, and what is okay and helpful. If you cannot resolve some or all of these issues, yet you basically like the therapist and feel you are getting something out of the therapy, you can ask for a consultation to the therapy. This might mean that you will choose together another therapist as a consultant with whom you will meet, individually and/or jointly, and get feedback individually and/or jointly about the therapy. If consultation doesn’t work, you can terminate the therapy. You are the consumer. You can fire your therapist. The decision to end therapy, other than for the previous reasons, is best handled as a joint decision-making process.

In my experience, a good therapist is an authentic person who helps you meet your goals for therapy and make the changes you want in your life.