Saturday, November 8, 2014

Choosing a Therapist


Choosing a therapist is a significant decision that requires careful thought.  Often, we are not quite sure why we are entering therapy. We know that something is not working and have decided to make a change. Many of us have heard from friends or family members that therapy has been helpful to them.  Yet, in looking for a therapist we find that there are many different approaches and models to psychotherapy.  How do you decide whom to call?

One approach is to locate a therapist who practices according to a particular psychotherapy model or school of thought.  For example, some therapists practice cognitive behavioral therapy or dialectical behavior therapy, others practice psychodynamic psychotherapy or psychoanalysis, and still others use an eclectic model that incorporates multiple approaches.

Most research into the effectiveness of psychotherapy models points to the conclusion that, in general, one type of therapy is not necessarily more effective than another.  Most often, it is the qualities of the therapeutic relationship, as well as the client’s level of motivation and readiness to change, that lead to positive outcomes.  For some problems there are certain psychotherapies that have developed a stronger evidence base.  In general, though, therapy works.  

My perspective on choosing a type of psychotherapy is that clients should evaluate the approach that best fits their style and that they can believe in.  Some people are naturally more interested in exploring the connection between their past and present, and are willing to commit to a longer-term treatment.  Others are more interested in leaving every session with specific skills and techniques to take home and apply to their daily lives.  Yet others want to strengthen the mind-body connection and focus on memories stored in the body.  One of these is not necessarily better than the other, and even the strongest evidence-based treatment is not likely to work if it does not make sense to you and does not have your buy-in.

That said, there are some psychotherapy models that have very strong evidence bases for particular problems. This should not be ignored.  If you are struggling with a mental health disorder such as major depressive disorder, post traumatic stress disorder, or obsessive compulsive disorder, for example, you are likely to want (and you deserve) to receive the type of treatment that is most likely to help.  People can and do recover from mental health disorders, and recovery can be nothing short of life-changing.  

Cognitive behavioral therapies have been proven time and again to help with these problems.  Similarly, people with borderline personality disorder experience significant difficulties with regulating emotions and maintaining interpersonal relationships, often to the point of harming themselves and/or attempting suicide.  Dialectical behavior therapy has a very strong record of helping people with these difficulties to create a life worth living through creating positive emotional experiences, reducing vulnerability to negative emotions, and living in a more mindful way.  Psychodynamic psychotherapy may be just as effective for many of these problems. It simply has not been studied as much, so we don’t yet know all we can about what specific elements of the therapy create the outcomes we want to see.

Of course, choosing a type of therapy is only part of the process of choosing a therapist.  Even therapists who practice “scientific,” evidence-based treatments according to a manual bring to the therapy room their own human qualities.  You bring your own human qualities as well. After all, you are far more than any “diagnosis” or “disorder” can capture.  The fit between you and your therapist is important, as the therapeutic relationship will be crucial to any potential benefit you would like to achieve in therapy.

Word of mouth recommendations are one way to get a sense of a therapist’s style.  We tend to have friends who are a lot like us.  (This is why acquaintances and extended community are so important if we are to learn new things and grow as people.)  Someone who has been able to help people close to you may be a good fit for you as well.  Of course, consider how you will feel about "sharing" a therapist with people you know. You may also get a sense from a therapist’s website or online profile.  Eventually, you will pick up the phone and call someone who seems like they could be a good fit.  You can ask some questions during an initial phone call and decide if you would like to schedule an appointment.

Meeting with a therapist for the initial evaluation does not obligate you to continue working with that therapist. You may need to meet with a few people before you feel comfortable.  Notice how you feel during the first meeting.

Cost is also a factor to consider.  Therapy is a significant commitment not only of time and energy; it is also a financial commitment.  Make sure you understand your therapist’s fee structure and any insurance benefits you may be using.  If you have concerns about the cost, discuss these with the therapist.

The attention you give to choosing a therapist is likely to pay off as you begin the challenging and rewarding work of being in therapy.

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