How do you know if a therapist will be helpful?

May 20, 2008 1:58 PM

Finding a therapist: I'm sure I can find one. But how do I know whether the therapist I choose is any good?

Some details if you need them: I have dysthymia and generally shaky self-esteem, plus the last six months or so have been particularly stressful. Over the past few weeks especially, my moods have been more fragile than I think is healthy. I've been on antidepressants in the past and they've worked well; currently not on them, but I'm taking supplements instead.

I saw a therapist for a few months about four years ago. I didn't much like him – though I can't quite put my finger on why – and I didn't think he helped me. The experience made me skeptical of therapy in general.

I've been feeling kind of broken lately and I'm starting to reconsider therapy. However, given my past experience, I'm not quite convinced. I don't want to waste time and money on therapy if it won't be good for me, and although I have insurance, I still can't really afford to shop around for therapists.

I have a primary care physician whom I like, and I'm sure he could help me with a referral. Getting an appointment with someone doesn't strike me as a big deal. Knowing whether I'll benefit from seeing them, however, is another story. I have a feeling a lot of it is just whether we click, but I don't completely trust my judgment on that, and I'm not sure what else to look for.

What should I be looking for in a therapist, and how do I know if I've found the right one? How long should my trial period with them be, and how do I know when to give up? How can I tell whether therapy is helping me?

My throwaway address is [e-mail]. Thank you in advance for your help!

posted by anonymous to health (9 comments total)

I knew after the first meeting with my counselor that it would work. I felt comfortable talking to her and didn't feel judged. I felt better after my first meeting. She gave me good advice and helped me sort out my thoughts and feelings.
posted by radioamy at 2:17 PM on May 20

I usually run therapists through their paces by talking about every weird thing I know about myself during the first session and seeing how they handle it.

If they're cool, cool. If not, find another one.
posted by kalessin at 2:28 PM on May 20

First of all, you can 'interview' a few therapists on the phone. What are you looking for? Someone gentle? Someone straightforward? I had problems with a therapist who fell more on the analysis side of things and so was very distant, and eventually I just had to say it wasn't working. (She didn't take offense; I think she knew it as well as I did.)

Personally, I think that if a therapist gives homework, she or he is probably a step ahead. The next thing I look for is personality. Would I be friends with this person in real life? Seriously, there are some big hints that a person might not be for you. I once had a therapist who mostly worked with drug and alcohol addiction recovery. So she was always quoting that mantra about what you can and can't control. It drove me crazy, and I might have known it would from my first session with her.

Does gender matter to you? That would take down about half the therapists you'll be looking at. Next, research different kinds of therapy, from analysis to cognitive behavioral to straight talk therapy. Which do you think would work best for you, just based on gut instinct? Ask potential therapists what their style is.

A lot of therapists have rules, and if you can't live with them, you know those folks aren't for you. There are those who won't allow cancellations, for instance, and some who will do a 'three strikes, you're out' policy on cancellations. It's good for some, and not good for others. I once met a therapist who wouldn't take me on as a patient unless I was working at least twenty hours a week.

There are also time considerations. If you're looking for someone who is available on evenings or weekends, you're narrowing your pool somewhat.

If you can narrow this stuff down over the phone, you may have a better chance of finding someone you like faster. But you probably will have to shop around a bit, unless you can enumerate exactly what you're looking for and also tell us where you live, so we can recommend specific people. (I know a few great therapists in New York, for instance.)

Whatever you do, don't discount therapy because of one bad experience. There are as many kinds of therapists as there are personalities, which is what makes it necessary to shop around in some manner.

Good luck, and feel free to contact me via MefiMail if you want to follow up on anything.
posted by brina at 2:32 PM on May 20

I think finding a therapist is a bit like blind dating----if there's no chemistry up front you will know and you should probably keep looking. Of course you should ask about fees, style of treatment, qualifications, cancellation policy, and all that. You can google "what to ask a therapist" and get all kinds of variations of the basic questions you might want to ask. But a lot of it is just trusting your gut. Is s/he a kind, empathic person who seems to care about helping you? Does s/he listen to what you're really saying?

As far as how long you should go---keep that an open dialogue between you and your therapist. That should be something you cover in the first couple of meetings. Ask how long they want to see you (usually something like 6 visits) before you discuss where your treatment is headed. Don't feel embarassed to bring that up----if they make you feel bad about asking questions you're seeing the wrong person (or in internet speak: you're doing it wrong!)

I've also found reading various blogs about therapy to be helpful---in knowing what to expect to some degree. Shrink Rap is a good one. And Tony White. And Jung at Heart.
posted by hulahulagirl at 2:42 PM on May 20 [2 favorites]

This is written for therapists, but it would be worthwhile for you to read. This guy has it exactly write--a good therapeutic relationship is far more important than any particular style or technique. That's what you are looking for.
posted by Pater Aletheias at 3:36 PM on May 20

What everyone else said.

I recommend "If You Meet The Buddha On The Road, Kill Him" by Sheldon Kopp.
It's a good overview of what a therapist can and can't do for a patient. Remember that therapy is a two-way conversation (unlike the usual medical one-way doctor-patient relationship), and the more you can put into it (in terms of honesty, courage, thought) the more you'll get out of it. I had a therapist who could look at me for 10 minutes without a word, if I was silent. I've also had one who was more interactive. So, before you judge any therapist, try to review your own part of the discussion. Also, remember that most therapy takes time to work, and that you are likely to experience fluctuations in mood. Feeling anxious or depressed after a few sessions may not be a sign of a bad therapist, but of healing pains. Good luck!
posted by pantufla at 3:47 PM on May 20

Therapy works well, and the best predictor of how well and quickly it will work is the patient's relationship with her therapist.

I wrote a long response, using what I know about outcome research and what works in therapy, to a very similar question. I won't reprint it here, but please click through as it directly addresses how to get the most out of therapy, including how to choose a therapist. My email is in my profile if you have more specific questions.
posted by OmieWise at 4:07 PM on May 20 [1 favorite]

You are thinking about the right questions and it's a good thing you are considering talking to someone again.

Interview multiple (3-5+) therapists from a variety of sources (don't just take your PCP referral) and check out different approaches (psychodynamic, CBT, IFS, etc).

Look for basic compatibility, trust, emotional maturity and the capacity for a working psychologically-oriented relationship (among other qualities).

Don't stick around if you don't feel good about what is happening or the way the therapist is relating to you. A month or so should be enough to tell if the relationship is working. Don't feel it's your fault, just learn from the experience and move on.

Are you using health insurance? How many sessions will it cover? Can you self-finance your therapy (more choice, confidentiality, less restrictions).

What are your goals and needs? A good therapist could help you define your issues and help sort out your options for treatment/development.

What is "broken" defines what needs to be "repaired" and is your general measure of whether the therapy is working. Sometimes we need safe places to feel even more broken so we can find our healing in the midst of the pieces.

Empathy, understanding and the ability to challenge your preconceptions are good qualities in a therapist.


On preview: I forgot Omniwise already did this better.
posted by psyche7 at 4:13 PM on May 20

OmieWise covered a lot of very good and pertinent points in his linked reply.

The one thing I think is exceedingly important for a relationship between therapist and client is the compatibility of the theory to which the therapist subscribes and the way the client wants and needs the therapy to be conducted. If you, as a client, feel that Freud was a quack, then please don't spend hours of your life in therapy with someone that applies Freudian theory to your therapy sessions. All therapists will be able to identify themselves with a particular school of thought. Ask them to explain their approach to you, then do some research on the web and see if it will fit your goals, your approach and your communication style.
posted by kirstk at 7:17 PM on May 20