How to Find the Right Therapist

"How do I find the right therapist?" I am often asked this question and would like to preface my opinions by saying that they are just that – opinions. Therapists are as diverse as their clientele and I presume that all would have something to add to this discussion, or perhaps an entirely opposite perspective. If you are looking for a healing, caring, supportive, and emotionally challenging experience, this is my take.

The Basics

1. All therapists are different, but I would say that the primary characteristic of importance in your therapist is that he or she tries to make you feel comfortable and wants to be present with you.

2. Having said that, everyone will be nervous at the beginning of therapy, your therapist included if he or she is human, so give yourself a few weeks to settle in. If you feel inclined, talk to your therapist about feeling nervous and he or she should response empathically.

3. Therapy can be funny and light-hearted at times, but you should not feel the need to impress or entertain your therapist.

4. Therapy can be humorous, intellectual, and emotional, but remember that intellectualism and humor can be used to defend against difficult emotions. Therapists are in the business of emotions, so you may be challenged to access your own at times.

5. You should feel safe in therapy at all times and your therapist should be able to create that safety with you.

Soap box:

Many of the clients I see have discussed "settling" with their previous therapist(s).  He or she would listen most of the time, or was good enough is not an ideal therapeutic situation.  You have the right to the right fit for you.  If it isn't ideal, talk to your therapist about what is missing.  If he or she responds in a way that upsets you, say that you're upset.  If it gets to the point where you want to end the relationship because of this disconnect, talk about it.  A relationship with a therapist should enhance your ability to have relationships in the real world.  As a model of relationship, a therapist should encourage honesty, even when it is difficult, and should always have your interest first on the list of importance.

Step 1. Assess your needs.

What do you need and what do you want? You can have both needs and wants met in therapy with the right person. Read the following questions for guidance on your needs and wishes for therapy.

Are you going through a life transition like college, marriage, divorce, parenthood, or late adulthood?

Are you a member of an oppressed group? Is it important to you that your therapist is a part of this group or has special training around your difference?

Will it be difficult for you to speak to a stranger for the first time?

Have you had therapy experiences in the past that did NOT work? What was missing?

Are you depressed, anxious, sad, or do you have a dominating emotion that comes to mind?

Have you consulted a medical professional and if so, what does he or she recommend?

Do you just want to talk and have someone listen?

Do you want to explore your past or focus on the present? Or both?

Do you want to be challenged or supported unconditionally?

Do you want to talk about goals and be accountable to your therapist in attaining them?

Do you seek structure or freedom in therapy?

Are you more comfortable with a particular gender, and why? Would it be helpful to you to have a therapist representing the gender of comfort or perhaps to have a new experience with the gender you do not prefer?

Are you comfortable with a particular age group, and why? How would your experience be enhanced or compromised with different age groups?

What are you able to pay for therapy?

Step 2. Find a recommended therapist

Word of mouth is the most helpful way of finding a clinician but more and more, therapists are advertising and promoting themselves online. There are some websites that verify the credentials of the therapists who are advertising (psychologytoday.com, goodtherapy.org) so make sure that the therapists you read about have credentials.

Money is usually an uncomfortable topic for most people, but prospective therapists should be clear about charges when asked. Some therapists work on a “sliding scale” basis, meaning that they have different rates depending on financial need. If you are in need of financial assistance, think about what you are able to pay and ask the therapist if the rate would be acceptable.

Credentials:

LPC-i and LPC – These therapists are master’s level professional counselors who are seeking or have obtained a clinical licensure. You can expect to pay more to see an LPC than an LPC-Intern.

LMSW and LCSW – These therapists are master’s level social workers who are seeking or have obtained a clinical licensure. You can expect to pay more to see an LCSW than an LMSW.

Psy.D. or PhD. - Psychologists are doctorate level clinicians who perform therapy and also focus on psychological assessment or testing. Psy.D. is a newer degree plan focusing on clinical psychotherapy as well as research and testing. You can expect to pay more for a doctorate level clinician than an LPC or an LCSW.

M.D. or D.O. - Psychiatrists are medical doctors who are primarily focused on psychobiological assessment and medication management for patients. Some psychiatrists are trained in psychotherapeutic techniques but most have little training in psychotherapy. You can expect to pay the most for a psychiatrist since he or she has a medical license and can prescribe medication.

Unfortunately, when assessing therapists one can rarely tell which will be a fit on paper. You may be able to read a bio on the therapist that may help you get a feel for his or her personality and theoretical leanings, but having a conversation is the best way to assess goodness of fit.

Use the questions from Step 1 to guide you in expressing your needs and ask about their training, specialties, and areas of practice. Despite the traditional hierarchy, you may find your needs anywhere in this ranking of therapists.

Step 3: Get to know the therapist

In order to assess fit, one has to “talk the talk” in some ways to understand how a therapist operates. Read up on types of therapies and you may find that one resonates with you.

Psych Central's article on Psychotherapy - check out the types of therapy on the left index

Ask questions and expect to get your needs met!  This principle is basic to living a life with healthy self-esteem and self-care.

As always, take care.

Therapy Demystified: It's All in the Relationship

In the presence of darkness, we break, we wound, and we crumble inside; in the presence of kindness, openness, and love we heal with one another. When asked what my "style" of therapy is, I spout an eclectic mixture of therapies like "psychodynamic, supportive, and relational psychotherapy," but I truly believe that the most important element that can lead to healing in a therapeutic relationship is the connection between the therapist and client.  This is not a typical connection, because it is not reciprocal; it is only intended to serve the client's interest. But it can be even more powerful in healing broken hearts and wounded souls because of the commitment of the therapist to the client.

Many esteemed researchers have come to the same conclusion through different avenues.  Scholars like John Bowlby, Alan Schore, Daniel Siegel, and Robert Karen would liken this connection in therapy to healing wounds from lost or ruptured attachments in childhood and adulthood.  There is neurological research proving that being in connection with another person can actually create new neurocircuitry, or pathways, in the brain in order to form new attachments to others (Schore, 2003). The authors of Relational-Cultural theory discuss connection as a "growth fostering relationship" leading to a fuller, happier life, as opposed to disconnection as "empathic failures" and missed opportunities (Jordan, Kaplan, Miller, Stiver, & Surrey, 1991; Jordan, 1997; Miller & Stiver, 1997).  The arrival at this conclusion, that people heal in relationship with one another, is empirically undeniable.

But what does this look like in the therapy room?  Many will experience it as discomfort at first because it feels unusual to have someone in front of you who needs nothing from you and is there to openly explore your psyche.  I hope to alleviate some of that discomfort for those of you who are reading because therapists are humans too and we are both engaged in the process of relationship building the moment you walk in the door.

The experience "in the chair" can be enlightening for some in that it brings up feelings that are universal throughout the person's life.  For example, a person comes to therapy with severe social anxiety.  He tells the therapist this piece of information and the therapist responds by saying, "what a brave move you have made coming here since you are so scared to leave the house."  The client may feel discomfort, vulnerability, and like he is being seen and heard, feelings he is uncomfortable with in the outside world and in the therapy room.  The question is, what do you do with those feelings?  Is the therapy room safe enough to explore those feelings of discomfort?

It is the therapist's job to make sure there is as much safety as possible for the client.  In order for there to be safety, the client must understand that the therapist will be non-judgmental and genuinely caring.  She must also know that the things she says are confidential and will be kept safe with the therapist.  The client must also know that the therapist is taking care of herself and will continue to do so throughout the relationship.  For example, the client must know that his therapist will show up on time, will hold to their agreements, will have taken care of her own needs so that she is present, follows her code of ethics in order to maintain a practice, and is working in the best interest of the client.

This is not to suggest that the skills therapists learn from other empirical research is useless.  There is skill involved in exploration and presence while witnessing such important work.  However, we heal through one another and it should be known that if you are experiencing emotions like discomfort, tension, frustration, resentment, happiness, or any other feeling, especially toward the therapist, they should be welcomed in the therapy room.  They are incredibly helpful keys to unlocking closed doors in our minds and discovering how we behave in the outside world.  They can also lead to healing old wounds and finding new ways to open one's heart to others.