How and Why to Choose a Psychotherapist
An excerpt from the book: “Caveat Emptor, Let the Buyer Beware, A Consumers Guide to Mental Health Services” by Dr. Joseph Bono, PH.D, PC
There are so many myths and misconceptions about therapy that before we consider how to make a wise decision about entering therapy, we should dispel some of the irrational beliefs and practices that influence people at this critical time. It’s a sad truth that the majority of people considering therapy, or in need of therapy, never get the help they need because of a complex interaction of their own resistance, lack of resources, or lack of expertise and sensitivity on the part of the first therapist they meet. Many potential therapy patients are looking for an excuse to avoid therapy even while in the face of severe crisis and breakdown, especially when given the impression that therapy is hard work. Many people expect to have the therapy done to them in some magical way that doesn’t require too much effort on their part. They expect the therapist to have the answers that will somehow relieve them of their suffering. It’s not surprising people have these expectations. We’ve come to expect all doctors and health care professional to give us relief and make us feel better. People are naturally loath to talk about their personal problems and shortcomings, and would just as soon pretend they don’t exist. We all would prefer not to look at the worst in ourselves. So entering therapy is a dicey proposition. M. Scott Peck, M.D. provides great insight into the difficulty of entering therapy in his phenomenally successful bestseller The Road Less Traveled (1978, pp. 53-54).
No act is more unnatural, and hence more human, than the act of entering psychotherapy. For by this act, we deliberately lay ourselves open to the deepest challenge from another human being, and even pay the other for the service of scrutiny and discernment… Entering psychotherapy is an act of the greatest courage. The primary reason people do not undergo psychotherapy is not that they lack the money but that they lack the courage.
For many people, the prospect of consulting with a mental health professional comes up at a critical point in time and there’s a sense of urgency. Often something dire and unforeseen happens that generates high anxiety and apprehension and the person is distraught and suddenly in need of professional assistance. Unfortunately, finding a good therapist isn’t something you should rush into. Many people make an appointment with the first therapist they reach by phone, or with the fi rst therapist who returns their call. And their search for a therapist ends at that point, for better or worse. Some people are wary of mental health professionals and ask a few questions during the first phone contact, but many people are content to know if you’re accepting new patients and whether you accept their insurance. Many unsuspecting people place blind trust in the therapist because their insurance company gave them the name or because the name was in the phone book. I’ve found most people to be extremely naïve about the first interview with a potential therapist – so much so that they don’t realize they’re sizing him or her up as much as the therapist is making his or her own evaluation. Before you even step into the new therapist’s office and shake hands, you should notice everything there is to notice that could have bearing on his or her character, style, and success. Where is the office located? Is it in a professional setting? Is the parking situation suitable for you? Is the office barrier-free and wheelchair-accessible? What does the waiting room look like? Has it been straightened up lately? What’s hanging on the walls? Is the floor clean? Does the carpet need vacuuming? Is there anything to read if you have to wait? In general, therapists will have a professionally designed waiting room that will neither be overdone with décor nor overly ascetic and Spartan. Once you meet the therapist and are taken into the office, your first observation should concern the furniture and lighting. Do you have seating options? Is the office laid out so you must sit across the desk from the therapist, or is the furniture situated so there’s no barrier between you and him or her? Are there any windows? What’s on the walls? Is there a clock readily viewable? Is there an analytic couch? Are there bookcases? What about the desk – is it cluttered or does it seem to be the focal point of a busy professional? Are there any family pictures in view? Do the tables have any personal artifacts that say something about this person? Is the lighting too bright and antiseptic, or is it warm and gentle on the eyes? How comfortable do you feel in meeting this person? What does their appearance suggest? Does he or she appear to be well-groomed and in good physical health? Are they appropriately attired — over- or under-dressed? Is the scent of stale cigarette smoke in the air? So if you’re observant so far, you’ll realize already before talking with him or her you have a wealth of information to process that may or may not have bearing on your decision. Now that you’ve placed yourself in this new environment with this stranger, you’re ready to begin your story and explain why you made the appointment. If you’re like a lot of people, you’ll be fairly uncomfortable at this point. Notice whether any effort is needed or made to reassure you and place you at ease. And notice how you instinctively/intuitively feel when in this person’s presence. Your gut feeling may be the most important information you derive from this first visit – information that could make or break a decision to hire this therapist. How then does your new therapist handle the initial interview? Are you allowed to proceed in your own way and at your own pace? Or does he or she direct the interview with a list of questions? I’ve found most new patients don’t realize they have a right to know certain things about their therapist before they make a decision to commit to a course of therapy. Many new patients are taken by surprise when they’re given the opportunity to interview the therapist, and they’re at a loss when told to ask whatever questions they need to have answered before deciding on therapy. And yet when you practice psychotherapy with hundreds of patients over the years you realize that, for virtually all patients, the most important therapeutic issue boils down to whether they believe you can help them. And if they have that belief, then by virtue of the therapist’s authority, therapeutic progress obtains. People aren’t prepared for the kind of sensitivity a good therapist can demonstrate right from the beginning. It’s only fair, then, that the therapist let’s you know from the outset that he or she knows what he or she’s doing and what your ultimate struggle is, or will be, within the therapeutic context, even if you don’t. So there are a number of questions you should be prepared to ask when you make an appointment with a therapist. And before you decide to come back for another appointment these questions should be answered to your satisfaction.
1. What training, degree, and /or credential does your prospective therapist possess? As indicated in chapter 4, many people remain ignorant of the qualifications of the person they’re about to entrust. Related to this question is the question of why did this person choose to become a psychotherapist. Questioning the therapists occupational motivation is fair game in an initial
interview.
2. If the degree and license is not prominently displayed on the office wall, be prepared to ask where he or she received their training. I know of a limited-licensed psychologist who received a master’s degree in clinical psychology from a small training institute and she was never required to formally study personality theory. That’s like studying agricultural science without learning about fertilizer.
3. Ask how long the person has been in practice, especially if you’re a middle-aged or older person yourself. If you’re a young adult, this requirement isn’t as important. But it’s often difficult for mature people, especially if they’re accomplished themselves, to look up to a younger person as an authority figure in life, even if they do have a doctorate. My former mentor, the late Dr. John Brownfain, once explained to me that what makes for a good therapist is “broad sympathies through broad experience.” There is no substitute for seasoned clinical experience, no matter how well-read and erudite the young therapist may be. You need someone who can easily empathize with you because they’ve had enough life experience to know how difficult and painful life’s challenges can be. Theoretical empathy is not enough for the more mature and sophisticated patient.
4. A valid question people usually don’t think to ask is whether the therapist has had their own therapy. If you’re entrusting your intimate secrets with this person, you should know if they’ve had the courage themselves to go through with the process. Avoid psychologists and psychiatrists who have never had their own therapy or who refuse to answer this question. 5. Ask the therapist to explain his or her theoretical approach. At first glance, this may seem overly technical and abstract for the average person. But in reality, you have every right to know how this person goes about his or her business. You have a right to know what system or theory is being applied to you. And you have a right to know how the therapist conceptualizes therapeutic work. You’re simply asking how the therapy is supposed to work, and what can be expected as an outcome.
6. Ask the therapist if they’re married or ever been married, especially if you have marital issues yourself to address. If he or she is divorced, notice how that issue is handled. Remember this is about you, not the therapist, but you still have a right to know about this fundamental life issue in your therapist. If you’re gay or homosexual, you should ask if your therapist has any experience working with homosexuals, and whether they have an issue themselves about homosexuality.
7. Ask the therapist how long the therapy is likely to take. Be wary of therapists who promise quick fixes.
8. If you have substance abuse issues, ask the therapist for his or her opinion of drug use and abuse, looking to see if they have expert knowledge in that area. If you’re in recovery yourself, ask whether your therapist has an alcohol or drug problem and what they have or haven’t done about it. Many people in AA and NA insist that the only therapists worth seeing are those in recovery themselves.
9. Ask your therapist about psychotropic medication. Although psychologists don’t prescribe psychiatric medications, they should be more knowledgeable about their use than the average person, and should be able to engage you in an intelligent conversation about them. You may be in need of another opinion if you’re already getting drugs from a psychiatrist who feeds you the “company line.”
10. Get as clear an idea as possible what the cost of therapy will be. This is not always possible until after insurance companies have been contacted. In addition, ask whether your therapist does insurance billings. Now what about paperwork? You should know that an official file or record must be kept concerning your treatment. This protects both you and your therapist. You could be forced to legally prove you consulted with a psychologist in perhaps a custody dispute, and conversely, the psychologist may be legally forced to prove the same. Certain forms and consents must be obtained from new patients. And if you intend to use insurance coverage, you must sign an authorization permitting the therapist to file a claim with your insurance company. All health care professionals in the United States are also required to show you and have you sign a “HIPAA Notice of Privacy Practices” that explains how personal health information is managed.