Successful therapy with an intern?

April 5, 2012 2:08 PM

Tell me your stories (or tips) about successful therapy with an intern or other person-in-training as your therapist.

Super low-cost therapy is my only option right now. I've explored low-cost options and pretty much all of them utilize interns--therapists who have completed their degree but are still getting practice seeing clients under the supervision of someone else.

This leaves me uneasy. I've had mixed results from therapy in the past, and I'm hesitant about spending the money even for low-cost therapy because of my current financial situation. I suspect I would really benefit from good therapy, but I'm not feeling confident that I will find that with an intern. (Especially because I'm someone with a personal and family history of stubborn and chronic mental health stuff, rather than someone going through a random rough patch where I need a cheerleader or shoulder to cry on.) Last year I paid $50 for a first appointment with someone who admitted to me that she had only been seeing clients for 5 weeks (and remarked to me how her clients often are great at coming up with their own solutions and insights), and that was just hard to stomach. If I were just looking for someone to listen to my problems so I can blow off steam, that might work, but I'm looking for more counseling, direction, and some implementation of CBT techniques. (I've done a course of CBT and while I don't want to do another structured course of just CBT, I like that modality.)

TL;DR What has been your experience with therapy with an intern therapist? How can I feel better about going forward with this? Any particular suggestions in the Bay Area, especially East Bay? I'd like to stick to the $25/session range and would prefer something other than psychodynamic therapy. It seems like a lot of the schools around here churn out MFT interns who do mostly psychodynamic therapy, which doesn't seem like a good fit.

posted by needs more cowbell to health & fitness (8 answers total)

I have a close family member who has a severe PTSD variant and she has been seeing a great therapist for a few months--this therapist has helped my family member leave the house and go for walks, has been looking for activities to become involved in, even job and volunteering opportunities. I'm a master's-level therapist myself and was a little surprised to find out that my family member's therapist (a psychiatric nurse student) is just completing her bachelor's. Clearly a case of goodness of fit and just plain old empathy and support as the most important vectors in therapy there. When I was a trainee (still in school), I was able to help a lot of people, and also wasn't able to help some. As an MFT Intern getting my hours, I was able to help a lot of people, and also not able to helP some. I have seen therapists who have practiced for many years who do exactly the same--because the level of helped-ness someone feels isn't always about theoretical education or even years of experience. It's about being stood alongside of and heard, and then experimenting to find out how to improve whatever can be improved.

So something I'd consider in your position is that if you go into this with the preconceived idea that an intern isn't going to be able to help you, then you'll be most likely to prove yourself right. It's clear that you hope to find help through this experience, so keep a couple things in mind: 1) the best state of mind is to keep an open mind, and 2) if you hate whatever therapist you're assigned, you always always always have the right to ask for another one (there may be a wait list if the clinic staff is overloaded, but you have control over deciding not to continue with a therapist you don't feel you click with, even in county-funded programs).
posted by so_gracefully at 2:41 PM on April 5, 2012 [1 favorite]

As people here frequently point out - it's more about a good fit than it is about anything else. While you and I were looking for different things from therapy (I hated CBT and was looking for a more psychodynamic approach) I had fabulous luck with an intern, staying with her through the establishment of her own practice and onto several years later, despite the ballooning price (when she eventually told me she thought I was done - and she was right! Awesome!). Even at the intern stage, they've had a tremendous amount of training and will have some patient experience.

So don't be shy about trying to get a good fit for yourself. But my intern PsyD fit me a Million times better than the long-established therapist my doctor started me with.
posted by ldthomps at 2:43 PM on April 5, 2012

I don't want to thread-sit, just to say: I'm open to an intern, and I realize that to some extent it's what you make of it and much of it is about fit between you and the therapist.

I'm just stumbling a bit after my last experience. Anecdotes of other people's success stories, specifically with interns and specifically in situations where they needed more than someone to talk to, would be helpful where my own internal logic has not been helpful. I know your experience won't necessarily be my experience, but I believe that will help me be more open and motivated in seeking therapy and the right intern therapist.
posted by needs more cowbell at 3:00 PM on April 5, 2012

I had a therapist who was in training (not sure whether he was an intern, but he was a PhD student, and I was among his first three clients ever). He was the most helpful therapist I've ever had, and I'd had several therapists before him and have had several others since. In part, I think the fact that he hadn't been doing this for years made him more open to working with me in idiosyncratic ways, which I needed. Also, I liked that he was learning the newest techniques rather than relying on possibly out-of-date research about what works. For example, we used CBT techniques before CBT became as popular as it currently is, because he was reading the cutting-edge research that suggested it might be effective for people like me. Finally, and I think this was the most important thing, he was just a good match for me, temperament-wise. He knew when I needed to be pushed and when I needed to be supported, he made suggestions and gave advice that really resonated with me, and I really felt like he cared about me and wanted me to succeed. So yes, my experience was that a student can be an excellent therapist, but as with any other health care provider, the most important thing is finding someone you, personally, trust to give you the care you need.
posted by decathecting at 3:06 PM on April 5, 2012 [1 favorite]

How about data, although it's unpublished at the moment, so you'll have to take my anecdote for it:

A friend of mine runs the psychotherapy training program at a major community psychiatry program run by a major university and hospital in a large city close to Washington DC. For the past 10 years he has been collecting outcome data on the patients seen by the students there. The cases run the gamut, but could reasonably be called quite complex in many cases.

The interns have been highly effective at providing positive outcomes to the patients under their care. Close to 90% of the patients get better, and this is based on patient report, not therapist interpretation. Further, 98% are highly satisfied with their treatment. The measurements are taken at every session, used consistently, and easily demonstrate statistical significance for the positive outcomes generated by student therapists. The data have been successfully used to argue that the hospital should be reimbursed for patients seen by students. It is in the process of being published.
posted by OmieWise at 4:13 PM on April 5, 2012 [2 favorites]

Just did a round with an intern who was supervised, and I went in skeptical. Decided that one thing on the therapy agenda was whether this was going to be a good fit, and that after the first session I'd decide whether it had merit at all, and that if it did we would continue for 6 weeks and then evaluate, figuring that this would be a good point and there would be nothing to lose on this. I put this on the table openly at the beginning, and she agreed. All went well.
posted by kch at 8:47 PM on April 5, 2012

I have had a good experience with interns/people newly licensed. My current therapist is fairly new and she's actually LCSW (social worker) - I was dubious but it is indeed all about the fit. Part of what I like about her is that this is a second career for her - the feeling that she was out in the business world for years (she has an MBA) made me feel more comfortable with her too.
posted by pointystick at 10:37 AM on April 6, 2012

I am super-broke, so other than brief stint in college seeing someone at my school's counseling center, I have only gone to see interns at a counseling training center. It's been awesome! I have really bad anxiety and I have learned a lot of coping skills and I feel like I've grown a lot. I was on SSRI's for a long time but had a lot of side effects (and I can't stand my psychiatrist, but that's another story) so I made the decision to transition off of them a few months ago, and I couldn't have done it without my counselor's guidance.

As with any counselor/therapist (new or experienced), you have to find a good fit, and there are going to be some that suck. My first counselor at this place was pretty crappy and I kinda just stopped going. Then I got a call from a different counselor there who convinced me to come back and it was a great experience.

The downside to the place I go (and I guess all training centers) is that you only get to see them for a finite amount of time - a semester or two. However I see this as a positive, because you get to see things from different angles and learn different skills. Other than the first lady, I have liked the other 4 counselors a lot.
posted by radioamy at 3:43 PM on April 6, 2012