blogathon: choosing a therapist

canadian mental health association
this is an entry for my participation in the 2008 blogathon, a 24-hour marathon of blogging. please support the cause and donate – however much, however little – to the canadian mental health association (vancouver/burnaby branch). to donate, email me, use this URL: you should be able to get there by clicking the link;if not, just copy and paste the link into your browser. it will take you to the appropriate location at canada helps. thank you!

there are many different approaches to psychotherapy and effective practitioners come from a wide diversity of backgrounds.

if you are looking for a therapist or are thinking about changing therapists, knowledge of some basic facts and key questions can simplify matters. this article is meant to assist you to decide which therapy and therapist are likely to work best for you and your situation.

what we know about therapy

  1. research shows that psychotherapy works overall, and why it works. the basic facts are:
  2. psychotherapy is significantly more effective than a placebo treatment, and its effects are generally lasting. however, there is a wide variation in individual results and improvement cannot always be guaranteed.
  3. the effectiveness of therapists varies considerably, regardless of their professional background or specialty.
  4. the therapist needs to enthusiastically believe that their therapy will help you.
  5. good therapy gives you a sense of hope and expectation of change for the better.
  6. good therapy helps you develop practical ways forward.
  7. it is very important for your success that you feel you have a good working relationship with the therapist, that you feel comfortable with the therapist as a person, as we as with her/his methods.
  8. success depends greatly on your active participation in therapy and your openness and readiness to change.
  9. it is helpful to have some idea of tangible goals and how you might like to use therapy to achieve them.
  10. good therapy is sensitive to your viewpoint and adapts its methods to your individual circumstances rather than imposing the “right” way of a particular approach.
  11. good therapy helps to utilize and develop your own abilities and resources.
  12. compared to points 1-11, which specific therapeutic models and techniques are used play a small role in the effectiveness of therapy. no one type of therapy has been shown to be consistently superior to others.
  13. therapeutic models and techniques are helpful in structuring therapy when they fit your views of the situation and of how it might be helped.
  14. psychotherapy is not like a medical procedure: success does not depend on diagnosis of the problem or adherence to a prescribed treatment.
  15. psychotherapy is at least as effective as medication for most common psychological problems, has fewer side effects, and makes you less prone to relapse.
  16. the eventual outcome is very likely to be successful if you perceive some improvement within the first few sessions. the longer therapy goes on without any progress, the less the likelihood of eventual success.
  17. valid methods exist to assess your perceptions of the way therapy is conducted and its effectiveness. these can provide valuable feedback to improve the therapy.

what to ask your therapist

the following are key questions when you first contact a prospective therapist. in addition to enquiring about practical details (times, duration, location, cost and so on), you can ask them these questions.

  • what is your philosophy of therapy?
  • how do you think change happens?
  • how important will my contribution to therapy be?
  • will we collaborate on deciding what we do?
  • how and when will we assess progress?
  • how many sessions do you average per client?
  • how easy will it be to end therapy or spread out sessions as i progress?
  • what do you think of medical diagnoses and drug treatments?
  • can i seek other means of help at the same time?

once you have answers to these questions,

  • compare the answers you receive with your own views and the research findings.
  • find a therapist that is a good fit with them.
  • remember that successful therapy builds on your abilities and resources, and depends much less on the therapist’s theoretical views or assessment of the problem.

in fact, just thinking about some of these questions yourself can already move you forward in your healing process.

when to move on

how you feel about the working relationship with the therapist, as well as anticipating any, even the smallest, improvement are very important to success. you may want to consider finding or requesting another therapist if:

  • you do not like or trust your therapist.
  • you think that your therapist does not like you, understand you, or is insensitive to your point of view.
  • you think that the therapist’s agenda is different from yours.
  • you think that your therapist is pessimistic about helping you.
  • the therapist discounts other sources of help which you have found beneficial.
  • you feel uncomfortable with the therapist’s theories or techniques.
  • you are not getting sufficient opportunities to provide feedback and influence the course of therapy.
  • the therapist sticks to their approach regardless of your opinions or suggestions.
  • you do not feel any benefit within a handful of sessions, even after talking to your therapist about discomfort or lack of progress.
  • you have doubts about medication and it is recommended early on by your therapist. consider more than just medical and drug companies’ information. ask for specific information and explanations regarding the use of medication, and make sure you understand them. know about the limitations, probable side effects and likely duration of medication even if you believe it is the right choice for you.

(this is an adaptation of a tip sheet by the talking cure in scotland inspired by the work of one of my therapeutic “heroes”, scott miller.)

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