Monday, March 29, 2010

...what to consider when seeking a therapist...

Here are some things to consider when you are looking for a psychotherapist:

*  Seek out a therapist that comes with references from someone you respect.

*  Attend to how you are treated by secretaries or the therapist themself when you call for your appointment - notice your immediate response to how they deal with you.  How respectful, professional, courteous are they?  The therapist should be willing to answer some logistical questions during the first phone call.  They will not have time to listen to all your issues or hear your history - that needs to be saved for the session.

*  Prepare a set of questions that you have for the therapist about their orientation, experience, goals for your therapy,  fees, receipts, cancellation policy, etc to ask at your first appointment.

*  I would only want to work with a therapist who apart from their training, has done their own course of therapy.  If they have not done their own psychological healing work, they could unconsciously steer you away from subjects or feelings which would bring up their unresolved issues.  How can someone take you on a 'journey' where they have never been?  Some psychology programs at both the under-graduate level and the graduate level neglect to make personal therapy a requirement of the program.  Thus it is quite possible to have a psychologist that has not really done their own personal psychological work.


  To my mind, it is an entirely appropriate question to ask - "Apart from your schooling, studies and training, have you done your own psychological work in a course of therapy?"  Some may hem and haw around this question, if they have not.  If you get the feeling they have not, seek out another therapist.

*  attend to your comfort level in their consultation room ... are the chairs comfortable, are you fairly close to the therapist or stuck across the room, is the consultation room sound proof ...


*  are you comfortable with their body language ... does the therapist seem comfortable in their own skin?


*  as much as you may want advice, a good therapist should be there to facilitate you finding your own answers.  Certain suggestions on how to deal with anxiety and stress will be helpful - certain educational moments happen at different points to help you understand your own process - but just notice if your therapy sessions become more problem-solving or advice-giving sessions.  If that is the case, it is not truly therapy.  Lazy therapists will fall into the trap of always giving advice.



Consider asking some of the following questions:


* Has the therapist worked with anyone else with the same issues as you?


* Is the therapist comfortable working with any dreams you bring to the session?  I like a therapist familiar with Jung's perspectives for dreamwork.


* How long have they been working in the field? 


* What is their policy about cancellations? 


* How long do they think you will need therapy?


* Are they able to do both short term and long term therapy?  Which do they think you will require?


* How will you both know when the therapy is completed? 


* Do they issue receipts and/or deal with third party payers (insurance companies)? 


* If you are dealing with relationship issues, would they be comfortable meeting and working with you and your partner for a couple of sessions?


* Are they planning a sabbatical or lengthy vacation in the near future after your therapy gets started?  (You do not want to just get comfortable disclosing with your therapist and then have them disappear for a month or two.)


* Do they work at the time of day most convenient for you?

* Remember that in the first couple of sessions YOU should be assessing whether this is the person you want to work with.  If not, be honest and let them know that you do not think 'the fit' is right and that you prefer to keep looking.  A good therapist should be entirely comfortable with your choice.


Things you can do to maximize your therapeutic experience:


Work on being as honest and forthcoming as possible.  To fudge on the facts or withhold information is not fair to yourself or the therapist.  You are not there to protect an image - you are there to work on the truth of your life, anxieties and behaviours.  A good therapist is not judging your revelations, but using them as pieces to solve the unique puzzle that is you - (as much as that is possible!).  Honest disclosure is a fundamental key to progress.


Don't wait until near the end of a session to disclose important developments, feelings, issues - if possible.  Of course, it happens that something important may only occur to you at the end of a session.  But you have 50 minutes to 1 hour to work - maximize the time available to you by bringing up the important issues early in the session - if you are already aware of them.


*  If issues or problems arise with the therapist's way of working or dealing with you don't be shy to address them.  You are paying for the time and have every right to seek clarification and get your needs met.  You are not there to impress, be polite or have a lovely social conversation.  Deal with what is, as it arises.  You will save yourself a lot of frustration, time and money by so doing.


*  Begin to keep a dream journal and bring up your dreams in therapy.  Hopefully you will have a therapist who does not provide his/her interpretation, but asks the questions that will help YOU interpret YOUR dream.  While there are common or universal dream symbols, the symbols your mind uses may be uniquely yours and ones only you can decipher.  (One good thing to recall, is that generally everything and everyone  in the dream represent something your psyche is trying to tell you about you.  As with everything, there are always exceptions.)

*  While sometimes it is appropriate to come prepared with things you want to talk about ... most of the time I would advise just allowing yourself to talk freely about whatever is most pressing for you.  Sometimes preparing subject matter in advance is a way of avoiding dealing with what needs to bubble up.

*  Take time to reflect on the content of your session - after it is over.  This is how you maximize learning and understanding.

*  While you may find yourself resisting or defending against things your therapist says or suggests, be willing to give the thoughts some consideration.  Good therapy is dependent on your ability to reflect on and truly understand the observations or interpretations made by the therapist.

*  Now and then ask yourself - "am I using what I am learning in therapy to effect change in my life?"  Fundamentally, therapy should be about change - about eliminating ineffective life patterns - about assuming more responsibility for your life - about growing up.  The only way to improve how you feel or to improve your life situation is to make the changes required.  Only you can do that.  The therapist can accompany you to 'the edge', but it is up to you to jump to the new shore.

* Depending on your therapist's orientation/style/education you may be asked to do more than talk.  Be willing to role play, visualize, learn stress reduction techniques, learn thought stopping techniques, learn about recovery from trauma, learn about the grieving process, etc.  You can learn many valuable life skills IF you are willing to try something new right in the consultation room.

If you have been in therapy at some point in your life, you, dear reader, may have some good suggestions you might like to share in your comments that will help others.  The suggestions I have made here are by no means a comprehensive list (just typing as I think), so anything you can add will be considered, appreciated and probably commented on by me.



14 comments:

  1. Some really good points! Ones I have used myself and have found a wonderful therapist that suits my needs. I find speaking freely when I get there is best...that way I am dealing with issues that are pressing on me at the moment.
    Hugs
    SueAnn

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  2. Bonnie I was away for a few days and have read all the posts I missed. I was interested in the way you envision therapy. I vaguely remember going to a therapist years and years ago. I had gone to my doctor because I kept scratching my arms. He thought there was nothing wrong with me and sent me to a therapist I did not know. After about ½ hour of consultation she told me I should divorce my husband that my scratching my arms was showing I was trying to get rid of the relationship. I was very surprised because I was happily married. I left and went on to a dermatologist. I was growing 150 rose bushes at the time and my problem was an allergy to the pest control I used. Once I stopped using the product my arm scratching stopped immediately. That was my only time with a therapist. I think that to try to help people with their emotions, real or imagined must be quite difficult. You have a ton of patience I am sure. How can you not take home their problems with you, sometime?

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  3. some great thoughts here on what to consider...

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  4. Some very sensible questions and observations Bonnie. I'm sure they'll prove very helpful.

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  5. Excellent post, Bonnie! Your posts are always so filled with extraordinary insight and pragmatism, too! I'm sure you are an exceptional therapist! ~Janine XO

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  6. Such fine advice here. I would have never thought to ask a therapist if he/she had done their own course of therapy. It's a logical question. It would just never have occurred to me. So now I wonder, have any potential patients asked that of you?

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  7. Vagabonde: Oh my ... what a sorry tale of a therapist. Very cavalier of her/him to tell you to take such a life-altering step after 1/2 hour!
    Thank goodness you knew to listen to your own intuition and seek more medical help. Glad you found and eliminated the real problem - and the therapist!!

    As a beginning therapist, one can take on the client's distress or problems -- however, if you do supervisions with more experienced therapists, you soon learn how to keep the boundaries between their issues and your own life.

    Again, the key is having done your own psychological work - then you are much less likely to be 'tweaked' by a client's issues.

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  8. Brian: Thank you.

    Barry: Thank you.

    Janine: Thank you.

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  9. Hilary: Good question - as I think back, it seems the only ones I recall asking me that are therapists who consulted with me as clients.

    Unfortunately, when most people come to therapy they are so caught up in their problems they often neglect to ask enough questions of the therapist. Thus this post.

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  10. I think sometimes, we are a bit confused as to the role of a therapist versus a counselor and we don't know what to expect at all. Psychotherapy sounds so ominous sometimes. I think you are helping promote the field and dispelling the myths and mysteries about what happens. Could you provide some example of the nature of problems or questions people bring to you? What is a typical course of treatment in number of sessions? Does it depend on the topics being addressed?

    Thanks for the enlightenment!

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  11. Hi Bonnie,
    Like some others here, I would not have thought of asking about the personal therapy aspect. Excellent point!
    I never felt really comfortable with the one-sidedness of the therapist-client relationship and felt that I should show my (genuine) interest in her. Your explanation of the importance of that relieves me, and if there is ever a next time, I won't feel so self-centered for it being 'all about me'. ;)

    Very interesting stuff, and LOTS of it. Thank you.

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  12. Vicky: Yes, the duration certainly depends on the issue the client is dealing with - but also what is discovered in the course of therapy - as often the presenting issue is not really the core issue at all.

    Presenting issues are diverse - but often are something like:
    * depression
    * pervasive anxiety - panic attacks
    * need for anger management
    * relationship problems - e.g. affairs, resentment, wanting a relationship and being unable, it seems, to have one ....
    * developmental stages - e.g. middle age, old age, fertility problems, difficulties with teens, difficulties with elders, etc. etc.
    * obsessive/compulsive disorders - hoarding, thought patterns, repetitive actions, etc.
    * unresolved issues from the past - e.g. suicide of a parent or sibling or close friend
    * major losses and disappointments e.g. bankruptcy, illness of a child or loved one, etc.

    Duration depends on the depth of the problem. If it is simply the presenting problem often a couple of months is adequate. If there is unresolved grief and depression - longer. If there are existential issues (meaning, mortality, responsibility, etc) that arise beneath the presenting issue therapy can go on for a year or more.

    The funds available also determine the length of the therapy - and so if I know in advance that funds are limited, I will 'triage' the issues as I become aware of them - deciding which can be put on hold and which must be dealt with.

    A lot of therapy is helping the person assume a more adult perspective and stance toward life, leaving behind there child-like sense of specialness, entitlement and sometimes victimhood. Life seems much more managable from the adult point of view than from being caught avoiding responsibility and expecting special favors and magic.

    I could go on..... perphaps the answers to this question could constitute a good post!

    Thanks Vicky - I hope I addressed most of your questions.

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  13. Deborah: Yes, the one-sideness serves a purpose. If you know little about the therapist, you will project some of your issues onto them and then the work can really be done in the 'here and now' on what is happening between the two of you. Eventually the client will see that they have been unconsciously 'seeing' the therapist as a substitute parental figure and the work being done on the current relationship ends up healing unresolved issues from the family or origin relationship.

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