How to Choose a Therapist or Counselor
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How to Choose a Therapist or Counselor

Image for fertility issues article Randy was elated after completing her doctorate in literature but she soon fell into a slump of confusion and indecision. A summer spent teaching freshmen had confirmed her suspicion that she was not cut out for the traditional academic path. But her real passion—writing fiction—looked to be financially insecure. Feeling the need for some objective advice, Randy turned to a therapist and began to work through her professional dilemma.

"I went to a therapist because I felt I needed another perspective. Whenever I tried to think through my problems on my own, I just seemed to hit a wall."

Perhaps you have a chronic or difficult problem, or maybe you feel depressed or sad. Before you jump into therapy, there are important issues that you need to consider. For example, "How do I choose a therapist?" "How much will it cost and how long will it take?" "What kinds of therapies are there and how do they differ?" " What should I expect at my first session?"

Trust and Comfort Are Critical Elements

Your therapist is a counselor—not your friend. But it's important that you choose someone that respects your opinion, your input, and your individuality. Susan James, PhD, a clinical psychologist at the University of Chicago, says that one of the most important things to consider when entering a therapeutic relationship is whether the values of the therapist match your values.

"Are you being encouraged to behave in ways that make you feel comfortable or uncomfortable? Is your therapist able to talk with you about all of the important dimensions of your life such as religious beliefs and lifestyle?" Mismatches, Dr. James says, can occur when the client and therapist have different value systems or when there are misunderstandings about the level of conversational intimacy. Engaging the right therapist—someone with whom you are comfortable and trust—is important in ensuring that you get the best treatment possible.

Where to Find a Therapist

Look for recommendations from your doctor or other healthcare providers, professional organizations, or friends. Health care professionals can also separate your physical problems from emotional ones. Laura M. went for a physical checkup when her anxiety over moving to a new city and the birth of her second child made her irritable and chronically fatigued.

Her primary care physician could find no physical difficulties, and instead recommended that she talk with someone about her concerns.

"Although I didn't know my primary care physician well," Laura says, "he had an excellent grasp of my problems and talked about it in a way that made sense to me. The therapist he recommended also seemed to understand my issues and was able to help me without putting me on any sort of medication."

The Length and Cost of Treatment

Therapy can be costly, with an hour-long session (really only 50 minutes) ranging from $80 to $140 or more. This will be based in part on the reputation and educational background of the therapist, his or her institutional affiliation, and geographic location. Traditional fee-for-service insurance plans usually pay 80% of the bill when you visit a medical doctor, but only cover 50% of the fee for outpatient therapy. Most plans also "cap" therapist's fees at well below the average and put limits on the number of outpatient visits. Your therapist will usually ask you at the first session how you intend to pay for his or her services, so it's smart to check with your insurance provider to know exactly how much of your treatment will be covered.

The length of therapy can vary widely depending on your particular issues and your background. Treatment for mild or situational problems can be relatively short and might be accomplished in as few as five or six sessions. Some therapists use even shorter courses of therapy for certain kinds of problems. Chronic problems and long-term difficulties, however, may require a year or more before you feel that progress is being made. One way to monitor your progress is to formalize (in writing) a set of treatment goals. This ensures that both you and your therapist are working on the same issues and helps you assess the benefits for yourself.

When it comes time to end therapy, your therapist may encourage you to discuss your decision, but a good therapist should always respect your judgment about when it's time to go it on your own. Although the cost of therapy can affect the way you approach the process and what therapist you choose, the length of treatment should be based on more important factors.

Consider the Various Therapeutic Options

Laura was happy with her experience in therapy and felt she gained a great deal, but her growth also allowed her to reflect on the process.

"If I wasn't so frantic when I started, I might have looked more carefully at the therapeutic technique my therapist used," she explained.

It's difficult to make choices when you're in a state of near-panic. But most of us have a sense of when things are starting to spiral out of control. That's the time to consider the different approaches that various therapists take to healing. There are a number of different theories at the foundation of clinical practice. These theories help a clinician think about your problems and how to treat them.

Therapies are generally divided into the following approaches:

  • Behavioral Therapy —This type of therapy looks to replace harmful behaviors with useful ones. It is often used in coordination with cognitive therapy, which is aimed at helping people recognize and alter distorted ways of thinking.
  • Humanistic and Experiential Therapies —These therapies are based on the theory that people are growing and self-actualizing. Experiential therapists use emotionally-charged, experience-based techniques to effect change, while humanistic therapists concentrate on creating a safe place for the patient.
  • Psychoanalytic and Psychodynamic Therapies —These therapies explore unconscious conflicts and defense mechanisms that hinder adult behavior.
  • Family Therapy or Family Systems Therapy —This type of therapy is concerned with looking at the dynamics of relationships within the family unit.
  • Marriage and Family Therapy —There are certain patterns of behavior, conflicts, or dynamics that are characteristic to specific families or couples. These patterns will be addressed in therapy and worked on through the therapeutic process and its goals. The most important factor is the “set of relationships” that couples or family members are part of.

There are also different categories of mental health professionals:

  • Psychiatrists —physicians who have completed a residency in psychiatry and are the only mental health professionals licensed to prescribe medications
  • Psychoanalysts —therapists with a professional degree in psychiatry, psychology, or social work, plus extensive supervised training
  • Psychologists (PhD, DPsy, DEd)—licensed professionals who have typically completed a clinical internship
  • Certified or licensed social workers —therapists who have a master's degree and two years of supervised, postgraduate experience

Marriage and family therapists may have a master's or doctorate degree as well as supervised experience in the field. Note that while psychoanalysts are usually only trained in psychoanalysis, psychologists and social workers usually have training in several of the therapies discussed above.

What to Expect at Your First Appointment

Your first session, sometimes called an intake evaluation, will be unlike subsequent sessions. This is a time for your therapist to get to know you—what is important to you and what particular problems or difficulties have brought you into therapy. You will be asked about your family history and childhood, education, friends and social relationships, career, romantic relationships, and current living situation. The depth of this personal history will vary depending on your therapist and his or her particular theoretical orientation. Once the therapist has developed some understanding of you, he or she will ask if you have any questions. This is the time to raise questions you have about the therapist's training and theoretical orientation and experience with treating problems similar to your own.

Be aware that subsequent sessions may be complex. Facing what appears to be a singular issue can often veer off into many other directions. You may need to delve into areas of your life that you hadn't anticipated exploring. Once she began seeing a therapist, Randy discovered that the process was more difficult than she thought.

"I went in thinking that I wanted to deal with my work and career issues, but along the way many other questions emerged. We talked through feelings about my family, my concerns with authority, my relationship with my fiancé, and my desire to have children. I didn't have a clue about the scope of the things I would need to cover."

What if I Don't Like My Therapist?

You do yourself a disservice by staying with a therapist that you don't like. If you feel that your therapist isn't listening to you, or is downplaying your problems, or has a value system that differs from your own, don't hesitate to talk about it. A responsible therapist has an obligation to either work it out to your satisfaction or to refer you to someone else. Use the same consumer-wise techniques you apply to consumer goods when you "purchase" your therapy. Make sure you get what you need from the best person available.

RESOURCES:

American Association for Marriage and Family Therapy
http://www.aamft.org

American Counseling Association
http://www.counseling.org

American Psychiatric Association
http://www.psych.org

American Psychological Association
http://www.apa.org

National Association of Social Workers
http://www.naswdc.org

CANADIAN RESOURCES:

Canadian Psychiatric Association
http://www.cpa-apc.org

Canadian Psychological Association
http://www.cpa.ca/cpasite/home.asp



Last reviewed October 2007 by Theodor B. Rais MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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