john grohol.jpg
Today I have the great pleasure of interviewing a hero of mine, the brilliant mind behind, the Internet’s largest and oldest mental health network … Dr. John Grohol. John is the CEO and founder of Psych Central and has been writing about mental health and psychology issues online since 1992. He lives with his wife and six cats north of Boston. 

I wanted to interview him about therapy, since many of his blog posts deal with the relationship between therapist and patient, and I don’t think anyone else writes about it as candidly and intelligently as John. 

Question: In your very popular post “The 12 Most Annoying Bad Habits of Therapists,” you mention some red flags to watch out for. For folks who are currently shopping for the right shrink, how would you advise them? What are the three most important attributes of a good therapist, or what’s the most important factor for therapy to work?

Dr. Grohol: I think finding a good therapist to work with is a challenging prospect, even when you have a recommendation or two from a trusted friend or your doctor. Why is it so difficult to find a good therapist? Because the qualities that might be ideal for one person may not work as well for another. A therapist is more than a plumber for your mind; you can’t just pick one at random from the Yellow Pages. Well, you can, but you may not find the right one using that method.

And when I say “right one,” I’m really getting to the heart of the matter. No matter what qualities I may suggest a person look for in a good therapist, ideally a person should look at finding a new therapist as a test drive, a completely temporary arrangement that may or may not work out. Most people try going to a single therapist, find it incompatible with their needs, and never return for a second session (much less try again with a second therapist). The key is to find a therapist that seems to complement your needs and your personality. A therapist isn’t your friend, so you shouldn’t just be looking for someone you get along with or feel really comfortable with (although that might be an important quality to look for nonetheless).

A good therapist is positive and empathetic.

So I’d argue above and beyond everything else, no matter what, the most important factor for therapy to work is to find a therapist you can have a positive, empathetic relationship with. And the research confirms this advice — all types of psychotherapy work to some degree or another, so one of the key factors in the reason they work is because of the professional, positive relationship one has with one’s therapist.

1. A good therapist is professional, courteous, and respectful.

Beyond that single most important factor, there are secondary things to look for that are attributes of a good therapist. One is that a good therapist is always professional, courteous, and respectful. This means they show up on time for your appointment, explain how they work with you in a clear and direct manner (hopefully putting aside any psychobabble), and use legitimate, recognized psychotherapeutic techniques (such as cognitive behavioral techniques and such). They don’t try and hug you after the first appointment, they don’t show up late, and they don’t eat their lunch in front of you.

2. A good therapist recognizes her strengths and limitations.

Second, a good therapist recognizes their own strengths and limitations and tries to work with patients they know they’re likely to have the most success with. That means a good therapist is a discerning one. They don’t necessarily take every client that walks through their door, nor do they agree to work on problems they have no experience in dealing with. You’d think this is common sense, but I’ve known therapists who do both. Perhaps when you’re first starting off as a brand new therapist, you’re allowed a little leeway with these things. But if you’ve been practicing for 5 or 10 years, there’s no excuse for not being aware of your strengths and limitations, and what kind of clients one works best with. Good therapists know these.

3. A good therapist is genuine.

Third, a good therapist is genuine no matter what. I’m a big believer in the power of genuineness, that it’s one of those qualities impossible to fake. Someone who is genuine is likely to be a better listener and be interested in what you’re saying — and if they aren’t, they say as much. Call it the Albert Ellis approach, but with compassion and toned down 95%. A good therapist is *there* with their clients, and tries to be there with the emotional content of their words and experiences. They take all of that and reframe it and help a person look at it from different perspectives, with different thinking, and tries to help them undo years of poor learning.

You can see why it might be a little challenging to find a “good therapist.” You can rarely tell from one session alone, especially since you’re the one usually doing all the talking during the first session. But if I want to work on a problem and really change things about me, I’ll take the time necessary to find the right therapist to work with that can best help me. Even if it means going through 2 or 3 therapists before finding one that fits best with my needs.

Question: After I read your post, “When you disclose too much in therapy,” I decided that I still needed to do a lot of boundary work because I thought you could tell your therapist anything. Doesn’t the patient have the green light to spill her guts?

Dr. Grohol: Clients absolutely have the right to say as much or as little as they would like in psychotherapy. I was only trying to point out that we sometimes say too much — even in everyday conversations with our co-workers, boss, friends or family — that we wish we could take back. That happens in therapy too. We can cross a border we hadn’t quite meant to cross as soon as we did (or in some cases, at all). You can indeed tell your therapist anything, but if you do so, you have to be prepared to live with the consequences of that disclosure. Nothing wrong with it, only that sometimes we don’t mean to do so when we do.

This post bookended another post I had written about why would people lie to their therapists. I mean, you’re in therapy, ostensibly you’re paying some good amount of money to be there once a week (that might be better spent on clothes, chocolate, or video games), so why would you ever waste your time not being entirely honest or truthful with your therapist? And yet we all are because it’s a part of human nature to tell little white lies, or to gloss over something we’re not quite ready to talk about in therapy. And that’s okay too — it’s okay to withhold things from your therapist in session when you don’t feel like you’re ready to tackle a difficult subject.

One of the key points I’d like people to get is how extraordinarily strange the psychotherapy relationship is. And it’s okay for clients to feel awkward or unsure because of it. It’s the only relationship in your life where you’re paying a professional for guidance and to help you make changes in your life, and it can be deeply intimate one moment, and oddly at arm’s length the next. It’s an artificial relationship, not one that you’d find naturally occuring in the wild. Because of that, it can lead us to bad feelings when something goes on in that relationship that’s unexpected — like disclosing too much or lying. And my point is to recognize that it’s the nature of this odd intimate/professional relationship — not you — that’s to blame.

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