How to Find & Choose an Effective Therapist

Recently The Harvard Health Newsletter posted some interesting questions to ask while seeking out a psychotherapist. I will add a few more details and areas of inquiry in this post. Keep in mind that these questions and inquiries do not mean you will be happy and improve with a therapist you selected via these suggestions.  However, it will mean that you have completed a reasonable investigation as to the proper fit for you, the therapist, the therapy, and the area/s you seek help for.  Safety, comfort, and hope are important variables in outcomes. The key area related to positive outcomes are the quality of the therapeutic alliance, the actual skill of the therapist, the match among various variables (therapist style, interpersonal qualities, type of problem/s, and your personal/emotional preferences). So let us begin to review your search process.

1. Expertise is the key factor in successful outcomes. So questions about level and types of clinical training, specialty certifications, degree/s, length of clinical work experience, types of therapies offered, prior formal complaints or law suits, and word-of-mouth reputation and/or formal investigative search regarding clinical quality of the person you are
   considering. If the therapist becomes annoyed or impatient with you in this process, you may not want this person as your therapist. Therapy requires a great deal of personal honesty regarding your true (inner) self and your false (outer) self. Both are real!  If you feel you cannot open up deeply with the therapist, perhaps this is not the right person for you.
2. Expectations for good outcomes may involve questions about pros/cons regarding the type of therapy offered to you, how that therapy works concretely, and outcome expectations given your particular clinical needs.
3. The alliance quality is a very important variable in effective therapy.  Skilled therapist know how to use certain psychodynamic methods to form a strong and positive therapeutic alliance.  If after a few sessions you are not feeling the power and emotional comfort of that alliance, it is time to discuss this with the therapist. And although psychodynamics of the alliance are essential for success, psychodynamic therapy alone may not be the answer.
4. Does it work?  You will want the therapist’s opinion as to how long it may take before you experience some improvements.  As in medicine, this is not an exact science.  A very important variable is HOW the therapist will know you are improving.  Ask: How will you measure my progress? Likewise, you will want to discuss how you will know actual change is happening in the therapy.  Beware of therapist who make you feel very good in the session but over time there is no real improvement in your condition. Improvement must be measured and documented!
5. Cost is very important.  Be sure to ask about fees, co-pays, “no-show” billings, if the therapist takes your insurance (if you have insurance).  What happens if you do not have health insurance?  Make sure your insurance covers the treatment and the person providing the treatment. In today’s health care marketplace, where for-profit insurance companies exist, you need to be very clear on financial expectations and realities.
   Remember some medical and psychological providers refuse to accept medicaid and medicare.  They claim it fails to pay adequately.  Sometimes this is true, and sometimes the provider is simply too greedy.
6. Failed treatment is not as uncommon as people think, especially if your clinical condition involves the norm of co-occurring disorders (alcohol/drug AND other mental health issues) or if the condition is very serious in complexity (serious attachment problems, serious chemical dependency, serious trauma, serious co-occurring medical problems, etc.). If after two or three months of weekly session (more or less) you are not experiencing some positive changes, it is time to re-visit the choice of treatment and/or the therapist. Discuss your impressions with the therapist.
7. Medications may be needed to support improvement in your clinical condition/s. However, remember that effective medications may improve personal emotional experiences, but they cannot effectively deal with past patterns of behavior/habits (self-medication, anger, isolation, etc.) and skills deficits that may have resulted in the clinical condition you suffer from. So the best model is biopsychosocial-spiritual NOT purely biological.
8. Spirituality can be an important variable in your improvement and recovery .  If you are a spiritual person, ask if your therapist feel comfortable and skills enough to support you in this area.
9. Lastly, some therapist spend all of their time trying to fix a problem.  In the reality of clinical practice, exaggerated documentation requirements,  and low clinical payment rates this often makes sense. However, there are two ways to look at clinical problems: one way is to fix something that is not functioning well; another way is to improve the quantity and quality of positive life experience – even personal happiness. In the end, combinations of both approaches often work best. There are only 24 hours in a day; so reducing suffering and expanding joy may be part of the recovery picture.
10. I wish you great luck and good fortune in selecting your personal therapist.  This person may become one of the most significant people in your life. Select her/him very carefully!

By Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont

Author of Mindful Happiness  

New Edition of Mindful Happiness in Production…Coming soon!