12 min read
I once had a therapist who nodded off during our session. Another unexpectedly died between our second and third appointment. Perhaps I should have taken his fondness for rolling his own cigarettes and smoking them during our session as a warning sign.
As someone who went on to become a clinical psychologist and have his life transformed by therapy, I’m here to say that, if you are feeling overwhelmed by your problems, therapy is definitely worth the effort.
-Dr. Jason Holland, Lifespark
After such misadventures, I suppose no one could have blamed me if I decided that my problems were simply too boring and ordinary or that I just wasn’t cut out for therapy.
But as someone who went on to become a clinical psychologist and have his life transformed by therapy, I’m here to say that, if you are feeling overwhelmed by your problems, therapy is definitely worth the effort.
However, encountering some bumps along the way is par for the course. If you are motivated to work with someone to find greater happiness and meaning in life, here are six simple tips on navigating through the process and finding a therapist that is right for you.
1. Identify therapists that have training and expertise related to the problems you’re having.
One of the first things you probably want to do is to generate an initial list of potential therapists. Psychology Today provides a searchable database of therapists in your area that is very good, or your insurance provider may be able to provide you with a list of eligible therapists.
You’ll probably notice that people who call themselves “therapists” have a diversity of backgrounds. Although research suggests that the type of training a therapist receives is generally not a strong indicator of their effectiveness, as a consumer there a few important things for you to know.
First, disciplines within the mental health field tend to focus on different problem areas, as briefly described below:
Clinical Psychologist – received a Ph.D. (more research-focused) or Psy.D. (more therapy-focused) in clinical psychology, which is generally concerned with the assessment and treatment of severe problems that meet criteria for a mental disorder (e.g., major depression, post-traumatic stress disorder, or bipolar disorder).
Counselor – received either a Ph.D. (sometimes referred to as a counseling psychologist) or Master’s degree in counseling psychology, which tends to concentrate more on basic problems of living, such as dealing with a break-up, finding a meaningful career, or adjusting to a new environment.
Social Worker – typically has a Master’s degree in social work which offers training in a variety of therapeutic skills, including providing individual/group therapy, connecting clients to relevant community resources, and advocating for clients.
Marriage and Family Therapist (MFT) – has a Master’s degree in marriage and family therapy, which as it sounds, focuses primarily on ameliorating family difficulties, such as marital distress, parenting problems, or destructive family communication patterns.
Psychiatrist – has an M.D. and received specialized training after medical school in prescribing medications for mental health problems. Some psychiatrists offer therapy but their practice is likely to focus primarily on prescribing medications.
Though there is certainly overlap in what each of these different types of therapists do, some may have more relevant training depending on the problems you’re facing.
So, if you’ve been, more or less, feeling fine but just went through a pretty major life adjustment, like losing your job, breaking-up with your spouse/partner, or moving to a new city, and just want someone to talk to about it, you might consider narrowing your list of potential therapists to counselors or counseling psychologists.
Likewise, if you feel like you’re dealing with something more serious and enduring, like a deep depression, paranoid thoughts, or severe anxiety that lasts for more than just a few days, you might focus your search on clinical psychologists, who are more likely to have received training in assessments and treatments for these kinds of problems.
2. Know that not all therapists are created equal.
Some therapists are quite simply better than others. When the effectiveness of different therapists has been compared, some are found to be consistently better than others at helping clients to feel better and achieve their goals.
So, how do you make sure you pick one of the good ones? It turns out that’s not as easy as it may sound. Simple indicators like years of clinical experience turn out to be fairly unreliable predictors of a therapist’s effectiveness.
What seems to be more important is the degree to which your therapist is able to form good relationships with clients. And some are just better at that than others.
The quality of the therapeutic alliance—the degree to which a client feels comfortable, understood, and supported—is one of the most reliable predictors of positive change in psychotherapy. In other words, if you can find a therapist that gives you a “good vibe” and works well with you, then chances are you’re going to be able to get somewhere in solving your problems.
3. Keep an open mind.
Though we may have preconceived notions about the people we are most likely to connect with, efforts to match people to a therapist that, on paper, would seem to be a “good fit” (e.g., based on demographic similarities) have largely failed.
Of course, if you have a strong preference for a therapist of a particular gender, sexual orientation, age group, or ethnicity, it is perfectly reasonable to factor that into your decision-making. It’s your therapy, and you’re the boss.
However, in my experience, I’ve found that people are often poor judges of who they are likely to hit it off with. I recall one male therapist I supervised that was assigned a client, who on the first session declared that she didn’t feel comfortable working with a man.
She was offered two options—to either wait until a female therapist at the clinic was available or give it a shot with the male therapist for a few sessions, with the understanding that she could still switch therapists if it didn’t seem to be working out for her.
Bravely, she decided to give the male therapist a shot and ultimately never requested a switch. In fact, by the end of her treatment, she talked about how it was therapeutic for her to be heard and understood by a man, which ran counter to her prior history and beliefs about what was possible for such relationships.
Bottom line—some therapists are better than others at forming good relationships with clients, but that can be hard to predict beforehand. That’s why I recommend giving the relationship a test drive before you commit to a long-term relationship.
4. If your therapist has a website, see what you can learn from it.
Before you set up an initial appointment and go on a test drive, see if the therapists you are considering have websites. Most do these days, and the information they provide there can be important in narrowing down your search.
Where is his or her office and how likely are you to actually make a trip there on a regular basis? Does he or she specialize in any specific populations (e.g., child, older adult, transgender, or Spanish-speaking clients) or particular problems (e.g., grief, phobias, or substance abuse) that you believe would be relevant to your problems and unique circumstances?
Beyond this basic information, therapists will also often talk about their theoretical orientation. That’s basically a fancy term for talking about a therapist’s beliefs about what gives rise to mental health problems and what therapeutic techniques he or she believes are most helpful.
It may come as a surprise, but this is a point of fierce debate among mental health professionals. Although none of the major theoretical orientations in psychotherapy have been shown to be consistently better than the others, you may get a sense for a therapist’s style and approach by understanding a little bit about their theoretical orientation.
Here’s what you need to know:
Behavioral: Therapies of this orientation are based on basic behavioral principles (e.g., reinforcement) and also tend to be fairly structured and time-limited.
*Other terms used may include ABA therapy, prolonged exposure, or habit reversal training.
Cognitive: Cognitive therapies focus on identifying and changing negative/unhelpful thought patterns, usually in a structured and time-limited context.
*Other terms used may include cognitive-behavioral or rational-emotive behavior therapy
Humanistic: These therapies tend to focus on emotions and existential concerns (e.g., finding meaning in life), often in the context of a longer-term and non-directive therapy.
*Other terms used may include existential, emotion-focused, client-centered, or gestalt therapy.
Psychodynamic: Psychodynamic therapists tend to view relationships (both past and present) as being most important and much of therapy may focus on identifying how long-standing relational patterns (e.g., fear of intimacy) affect current relationships. Psychodynamic therapies have the reputation of involving many sessions. However, briefer forms of treatment based on this model have been developed.
*Other terms used may include object-relations, self-psychology, psychoanalytic, or interpersonal psychotherapy.
Next Generation Behavioral Therapies: In the last two decades, several behavioral therapies have been developed that incorporate aspects of other treatment approaches. For example, Motivational Interviewing combines cognitive-behavioral principles with aspects of client-centered therapy (a humanistic therapy).
*Other next generation behavioral therapies include dialectical behavior therapy and acceptance and commitment therapy
If a potential therapist talks about his or her theoretical orientation, you may then want to think about how that might fit with your personality and unique needs as a client.
For example, are you looking to go to therapy for a short period of time to get help with a specific problem (e.g., fear of needles)? If so, a behavioral or cognitive approach may be a good fit.
Conversely, if your problems are more diffuse and you want to have the space to process them in a relatively unstructured and non-directive way, then a humanistic or psychodynamic therapy may better suit your needs.
5. Go on a trial run before committing to a long-term relationship.
Once you’ve narrowed your list down to a handful of potential therapists, schedule an initial appointment with the one that you feel most positive about based on the information you’ve gathered thus far.
Write down any questions you might have beforehand that will help you decide if this is going to be a good match.
For example, clients might consider asking:
- What is your approach to therapy and how might it be different from other therapists?
- Do you specialize in any particular types of problems?
- What should I expect in a typical session?
- Given the problems I’ve described to you, to what extent do you believe the therapy you offer is going to be helpful for me?
- If I ever feel like there is some problem in the therapy or our relationship, how should I approach that with you?
- How will we know when therapy is no longer needed?
In this first session, pay attention to how you feel interacting with your therapist. Does it feel comfortable and natural? Do you feel heard and understood? Or, do you find yourself feeling nervous, filtering your words, omitting details, or holding back questions?
Some nervousness in a first session is certainly normal, but I find that after about three sessions, you should have a pretty good sense for whether or not the therapy is going to work for you. If you’ve talked with your therapist about it and are still feeling uncomfortable, it may be time to try a new therapist.
6. No matter what, don’t get discouraged!
If your first experience with therapy was less than ideal, you may be tempted to conclude that it must just not be for you. As someone who has been there too, I say don’t despair and keep trying, even if you hit some bumps at first.
Trying could mean initiating an honest discussion about your concerns with your therapist and trying to work it out. But sometimes it can also just be a bad match. And when that happens, I believe it’s worth at least trying it out with someone else before deciding that therapy just isn’t your thing.
Therapists have very different interpersonal styles and ideas and what is and isn’t helpful, and it could take a couple of tries before you find someone that is a good fit for you. If you find yourself in this boat, use those past experiences to help you find a therapist that better suits your needs.
Ask yourself, what did you learn about what you like or don’t like in therapy? What do you think you are most needing that was lacking before? And how can you best communicate these preferences and needs to your next therapist?
The Bottom Line:
Navigating through the mental health care system can be a frustrating and confusing experience. However, if you keep the six tips I’ve outlined in mind (summarized below), I believe you are in a much better position to find a therapist that can help you to achieve your goals and live a happier or more meaningful life.
- Find a therapist that has training and expertise related to the problems you’re having.
- Know that not all therapists are created equal.
- Keep an open mind.
- If your therapist has a website, see what you can learn from it.
- Go on a trial run before committing to a long-term relationship.
- No matter what, don’t get discouraged!
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