How do you know if a counsellor is a good fit?
October 30, 2013 10:30 PM   Subscribe

How do you know if a counsellor is a good fit?

I was just fired by my previous clinical psychologist for not being a good therapeutic fit - she said that she was worried she was doing more harm than good, and ethically she couldn't keep seeing me if she was causing me more upset and distress than she was helping.

As I look for a new counsellor, what are the green flags and red flags?

I'm looking for someone to help me cope more gracefully with chronic pain and having a chronic physical illness. I don't have Anxiety or Depression.
posted by Year of meteors to Health & Fitness (8 answers total) 1 user marked this as a favorite
You have a session with them and see if you like them.
posted by Talez at 10:32 PM on October 30, 2013 [1 favorite]

When you talk to your counselor, do you feel better at the end of the session? Does your counselor make you reconsider beliefs that you had before? Is your brain churning through things that you and your counselor discussed in session?

Those are good signs.

Chronic pain and chronic illness are specialized issues. If you can find someone who specifically lists those issues as specialties, that might help.
posted by jaguar at 11:22 PM on October 30, 2013 [2 favorites]

2nding Talez...sometimes it's just experimentation until you find the right fit.

Also: I'd ask to do an interview with the practitioner, see what his/her style is and his/her expectations. Do they match yours? What do you want from him/her?

In my experience, good counsellors are not in the business of giving advice, but helping you to re-frame and elucidate your own experiences and perceptions. This may involve some boundary-pushing and questioning, but you should both be comfortable with the treatment modalities, progress, and outcomes. You are the driver, the counsellor is sort of your GPS, if you will.
posted by stillmoving at 11:24 PM on October 30, 2013

You weren't fired! Your doctor told you that she didn't have the right skillset to help you, and advised you to seek medical support from someone with the right expertise.

As far as finding a counselor who is a good fit: A lot of it is trial and error. It sounds like you really need someone who has worked with folks in your situation in the past, so ask (on the phone) if they have experience with helping their clients develop external + internal coping skills for living in constant physical pain, or if they have any recommendations for someone with that experience. Let them know you've already worked with one therapist and it didn't work out because they didn't have any first-hand client experiences, so you're explicitly searching for someone with that background.
posted by samthemander at 11:43 PM on October 30, 2013 [2 favorites]

How did you find your last therapist, and in what way was she distressing you? A clinical psychologist is different from a counsellor, who is different from a psychotherapist, who is different from a psychoanalyst. It might be worth you doing a bit of research into what approach you feel would be best suited to you and your goals. This might be a good resource to start with.

As others have said its also about finding the right person for you. It's a close, intimate relationship and its in the relationship itself that a lot of the work really happens. To be truly accepted and valued by another person is therapeutic in itself. Like any close relationship it's about the connection and chemistry between you, that "fit" that is hard to define. Don't be afraid to have a couple of sessions with different therapists to see who you feel happiest with, and don't be afraid to bring into the room any discomfort you are feeling. Good luck.
posted by billiebee at 3:18 AM on October 31, 2013 [1 favorite]

I used my insurance website to narrow the field using several criteria.

1. Specialized skills
2. Gender (this mattered to me, may not to you)
3. Age range (estimated based on college grad year)
4. Location

This gave me a manageable set to work from. I got very, very lucky first try but part of that was filtering out what I didn't want right up front.

Your list will probably be different from mine but if you don't have a list then everybody "qualifies" and that will make finding the right one harder.
posted by trinity8-director at 3:54 PM on October 31, 2013

It can be hard to know what good chemistry is like if you haven't experienced it but I would look at
1. do they seem to "get" what it is like to be in your position? do you feel understood?
2. do they feel like they are on your side? that they care about helping? that they will be Ok if you mess up?
3. do you feel more hopeful? does it feel plausible this person will be able to help you get better?
4. does it help? Sometime people know right away but sometimes the first session or two can be awkward but you are getting to know each other and doing the paperwork/history thing. In my experience by the third session, you will have feel for their personality and you will also have had enough time that there should be some small glimmers of helpfulness.
posted by metahawk at 4:05 PM on October 31, 2013

I think if possible you should get some additional feedback from your last therapist about what failed given that she is the one that identified the problem and put some analysis into what worked out of this round for you and what didn't, if anything, from your point of view. Were you surprised when your therapist withdrew? Or were you aware it was not going well?

In addition to the above answers, which are good, I would add you should look for a fit with:

1) Personality - someone that makes you feel comfortable. If after the first meeting a therapist makes you feel ill at ease, which happens, it's not you - it's the dynamic.

2) Communication style - do you understand each other? When s/he says things to you, do they make sense to you or do you think that maybe it will click later? When s/he recites what you are telling them or summarizes the content you are giving, do they get it right or are you having to do a lot of correcting? It should go back and forth both ways in a clear way.
posted by skermunkil at 5:40 PM on October 31, 2013

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