Professional Help: Choosing a Therapist, Expectation, Procedures

Additional Information for Chapter 4, page 58

One of the better on-line sources of information on this topic is found at Psych Central, particularly an article written by John M. Grohol, Psy.D. This is the link:

What follows is a list of items you should consider in choosing a therapist. Some of these are included in Dr. Grohol’s article, others extend beyond it. Dr. Grohol, of course provides far more detail.

  1. Acknowledge that choosing a therapist is not an easy task. There are therapists (this statement applies to professionals in any field) who are not very good, others are simply inexperienced, and others adhere to a philosophical perspective that may not fit your situation well. In light of that consider the following:
  2. Choose a therapist with whom you are comfortable and who adheres to a similar spiritual or philosophical perspective, OR, (probably just as good) is able to appreciate your perspective and counsel within that context. For instance, if you are Christian, it would be helpful to counsel either with a Christian therapist or with a therapist who understands (and is not antagonistic to) your Christian perspective.
  3. Choose a therapist who is experienced. At least 10 years of practice is desirable. Also they need to be experienced in the type of difficulty you are experiencing. Feeling sorry for the new therapists? Let them “practice” on people who aren’t doing their homework like you are right now. If you know others who have used a particular therapist, ask their opinion. If not, it is entirely appropriate to ask direct questions during a first session:
    • How long have you been in practice?
    • Are you licensed in this state/province?
    • Have you worked with people who experience difficulties similar to mine?
    • What kind of success have you had?
    • At which university did you earn your degree?
    • Do you think that your expertise is a good fit for my needs?

    Don’t be afraid to ask. It is your life and this person’s services will cost.

  4. Choose a therapist with strong credentials: A Ph.D. or a Psy.D. from an accredited university is desirable. Ask directly which university they received their degree from. If you have heard of the university (e.g., Harvard, UCLA, Michigan, Stanford) chances are good that your therapist has a strong degree from a good school. If you have not heard of it, jot down the name and check it out on the web at home—particularly noting whether the university is accredited. If he or she mentions attending an “on-line” school, run screaming the opposite direction. You are guaranteed a sub-standard degree. It is impossible to get adequate training in therapy on-line. A masters level degree (M.S., M.Sc., M.S.W., C.S.W.) is adequate in some instances. For masters-level therapists, how long the therapist has been practicing and references are better indicators of quality than the degree itself. The pastor of your church probably has no counseling credentials whatsoever. But, some do, and they may provide a reasonable alternative, and cost much less.
  5. Is your therapist registered and licensed to practice in your state or province?
  6. Consider the cost: Depending on which country state/province you are in, insurance coverage may vary substantially. In general therapy costs money. If you do your due diligence, you are likely to end up spending substantially less than if you don’t. Also consider that some therapists charge on a sliding scale based on the income of the client.
  7. What should you expect on a first session? Generally the first session is devoted orientation and information gathering. You will likely fill out some forms. You may take some assessment tests. The therapist will probably ask a lot of questions related to the problem(s) you are experiencing and things that led up to this problem. The function of the first hour is to determine whether further sessions should occur. The therapist should be asking him or herself, “Do I have the expertise to assist this person with their issues or should I refer to someone who is a better fit?” The question you should be asking is “Is this someone I am comfortable working with; does his orientation and experience suggest a good fit with my needs; do I think I would benefit?” One thing for certain: the first session will be very different from sessions that follow.
  8. How about theoretical orientation? This is a topic far too large to cover in here, however I mention three broad perspectives (and which type of issues they best address) to provide initial guidance.
    • Psychoanalytic therapy: This is essentially the therapy used by Freud. Some adaptations have occurred in recent years. The focus is on airing and externalizing damaging material from the past. Essentially it is designed to exorcise your personal “demons”. People who would benefit most from this type of therapy are those whose past severe trauma (usually repressed) has resulted in an intolerable present life.
    • Cognitive therapies or which Albert Ellis’ Rational Emotive Therapy is the most famous: The focus here is to correct irrational patterns of thought and provide you with activities to pull you out of your difficulties. The therapist will initially ask many questions to gain a perspective. Then, when you are ready, the two of you will work together to determine a valid perspective and set treatment goals. The therapist is likely to be confrontative at times and challenge you to think straight and do the necessary steps. People who would benefit most are those who seek clarity in a complex set of circumstances. They also seek action steps to lead them most surely out of their difficulties and lay the foundation for future success.
    • Humanistic therapy, most popularized by Carl Rogers. This style of therapy is warm, nurturing, non-confrontative and (initially) non-directive. The central tenets are those of unconditional positive regard, providing a safe environment, and allowing the client to come up with their own answers. Humanistic therapies are just as concerned about positive results as other therapies but proceed at a slower tempo. This form of therapy also considers the “real self” and the “ideal self”. In therapy you uncover the real self (stripping away misconceptions). In therapy you explore the ideal self—where you wish, ideally, to be in the future. And in therapy you determine a set of steps to take you from the former to the latter. This mode of therapy is best suited for people who are shattered, fragile, feel unloved, require nurturing, and want to move at a slower pace. Humanistic therapies are poorly suited for those who want to get in and work hammer and tongs to get things done.
    • Eclectic: Dr. Grohol points out quite accurately that the majority of therapist draw from several theoretical perspectives and attempt to match the therapy to the client. But don’t kid yourself, most therapists also have one theoretical perspective that they most enjoy and are most skilled at. So ask directly: “is your theoretical perspective something that is best fitted for my needs?” Such a question will almost always yield a thoughtful, honest answer.
  9. How long? The question is, of course, impossible to answer at a general level. For Elizabeth and myself (with a totally proactive perspective), one session is typically plenty. We go to a therapist when we have initial questions about an appropriate response and a session or two is often more than enough. Otherwise, the duration of therapy is associated with the severity of problem you are facing. If you are essentially a sound person who has experienced a shattering blow, fewer sessions will be required than if you have a long history of chronic problems. Problems that are deep seated, for instance a person who has history of angry outbursts, will take longer than issues with a shorter “etiology”. By the way, etiology is a good word meaning “past factors that contributed to a present situation.” Ask your therapist; he will provide a reasonable estimate of the number of sessions required.

You may have other questions. Please contact us at “Ask the Expert” on this website. Not only will we provide an answer, but, if appropriate, we may anonymously include that information in this prescript making it more useful for others.

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