Michael Bader: How do you find a good therapist?
January 25, 2016
How do you find a good psychotherapist?
How do you know if he or she is right for you?
It's often not obvious.
Therapists have different orientations and/or theoretical backgrounds.
They have different degrees and licenses.
And, dwarfing all of these differences, there is the simple fact that the chemistry between two people can vary widely.
First, let's get the issue of degrees and licenses out of the way.
Most of the psychotherapists in private practice today belong to one of the following professions:
Psychiatrists (they completed medical school and a residency, have an M.D. after their name, and can prescribe medication);
Psychologists (they have a Ph.D in psychology and, in addition to psychotherapy, are the ones who usually administer psychological tests);
Social workers (graduates of master's-level programs in social work — the MSW — and later become licensed to do psychotherapy (thus are referred to as licensed clinical social workers, or LCSWs);
Marriage and Family Therapists, or MFTs (graduates of master's-level psychology programs specializing in "relationship issues").
There are other practitioners, including various types of counselors or coaches, who can and do hang out their shingle, but the M.D., Ph.D., L.C.S.W, and M.F.T. are the most common professional designations and subject to the most stringent licensing regulations.
Here's the bottom line: all of these "professions" can and do offer psychotherapy and the degree after their names is usually unrelated to their level of competence.
Unless you are specifically seeking medications or a battery of cognitive tests, it isn't wise to choose a therapist on the basis of his or her degree.
While psychiatrists have had formal medical training and are the only ones who can prescribe drugs, any of these practitioners might well have a great deal of knowledge about the brain and its relationship to behavior.
While Ph.D psychologists are usually the ones who administer intelligence and personality tests, other practitioners might have a great deal of knowledge about cognition, learning and are able to diagnose patients with great accuracy. And all of these professionals generally deal with relationship issues and the effect of social and cultural factors on mental health and illness.
Each profession likes to claim some special expertise, but in my experience, these distinctions are usually overshadowed by commonalities.
So, forget the degree and the letters after a name.
Make an appointment to talk with someone whom you've heard is good (word of mouth is a good way of getting started).
See how you feel about the person, during and after the session.
Do you feel understood?
Does the therapist seem like someone you could trust?
You might not know for sure, but try to be reflective and honest about your gut feeling.
I think that, generally, people should trust their instincts.
Can you express yourself freely?
Afterward, do you feel better?
It might be that you aren't happy after the first session — after all, Rome wasn't built in a day — but do you feel optimistic about getting help from this person?
Do you feel freer or more hopeful when you leave than you did when you began?
If you do, then continue with that person.
If you feel bad — not understood, shut-down, and/or even worse about yourself — then don't second-guess yourself.
Don¹t go back.
If you feel something in between — uncertain about whether the therapist "gets it" — then consider going back to that person for one more session and explain in detail exactly how you felt about the first session.
See how the therapist responds.
A good therapist will welcome your honesty and be curious about your doubts.
He or she will not be defensive in any way.
In fact, a therapist's ability to show empathy about a patient's complaints or doubts is often a good marker of his or her ability to help you.
If the therapist is defensive, or in any way insinuates that your doubts are primarily your problem, I would recommend not continuing.
Later in a therapy, it might be that you could benefit from looking at your resistances to getting therapeutic help, but not in the beginning.
Ultimately, the therapist that is right for you has to be a good "fit," able to non-defensively seek to understand and empathize with what ails you.
The proof is whether you feel these things, whether you feel helped — not the degrees after someone's name.
Michael Bader is a psychologist in private practice in Grass Valley. He can be contacted at firstname.lastname@example.org.
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