Friday, November 14, 2014

How to choose the right therapist

The small town in upstate New York where I live has over 100 licensed psychotherapists. We sometimes joke that there is one therapist here for every four people. All joking aside, however, it can be a real challenge to find the right therapist, particularly when your issues need specific expertise. Picking people at random from a list of practitioners can be very frustrating – and worse, it can lead to bad outcomes.

So how do you find the right therapist for you? Here are some thoughts from my end:

1) Start with expertise
Suppose you are dealing with PTSD. Or OCD. Or chronic illness. Or domestic violence. Most therapists can hum a few bars on any of these problems, but in my view, the difference between a specialist and a generalist can be huge. It is no different from trying to see a general practitioner when you really need a dermatologist.

There is a real risk in choosing a therapist at random from a directory: this person might say “yes” and start treating you, when you would have done much better with an expert. How do you find these experts? Drill down into their websites, search online to see what they talk and write about, and ask other health practitioners. Visit my website, for example, and you will discover that my specialties include marital counseling, treating anxiety disorders, and workplace interventions.

Another good test is to look for professional credentials or certification: for example, I am a clinical fellow of the American Association of Marriage and Family Therapy, a graduate of the International OCD Foundation's clinical training program, and the author of several books on workplace communications skills. You can also check websites of support organizations for specific issues, many of whom have therapist directories.

Finally, some issues usually demand the resources of a mental health agency or hospital. When someone is actively suicidal, suffers from severe or persistent mental illness, has behaviors that put others at risk, or needs a level of care that goes beyond a weekly psychotherapy session, private practitioners may lack the resources or expertise to manage these issues. Start with your local, county, or hospital mental health unit in situations like these, and get the help you need.

2) Chemistry matters
I am always delighted when a new client tells me that they are evaluating several therapists before choosing the best one. It tells me that this person is proactive about taking good care of him or herself. I strongly encourage this, and wish it happened more often. I personally do not care at all about whether I "win" or "lose" in these situations, as long as people are getting the right care.

When you don’t connect personally with an auto mechanic, they can still do a good job of fixing your car. Even a doctor with poor bedside manners may have strong clinical skills. But in psychotherapy, wellness pivots around a strong therapeutic alliance between you and the provider. This means you should trust your gut about how you feel personally about the therapist. At a minimum, he or she should make you feel heard, understood, and accepted as you share your issues.

Finally, this is a good litmus test for how secure the therapist is in his or her own practice. Run – don’t walk – from any therapist who gets upset about comparison shopping or tries too hard to “sell” you.

3) Look at the practicalities
Once you find one or more therapists who have the expertise AND the personal chemistry to help you, you can explore the specifics of how this therapist works:

• Does the therapist have evening or weekend hours?
• Does he or she accept your insurance coverage?
• Will the therapist call or see you off-hours in an emergency?
• Can you easily cancel a session when needed?
• Can a family member join you for a session?

Remember, the therapist is just a consultant, and you are the boss. Good luck, and be an educated consumer!