Friday, April 8, 2011

How to choose a therapist

The first thing to know about choosing a therapist is that you should like your therapist. A big part of what helps people in therapy is their relationship with the therapist. A relationship grows over time, but when you start therapy, you want to have a good feeling about the therapist and your ability to trust him or her. It is important to trust your gut here. If you have a bad feeling about someone, or a kind of neutral feeling for them, I would suggest you try someone else. I am not saying you should love and wholeheartedly trust your new therapist after one session, but you should have the gut sense that this a person, who in time, you will be able to trust to know the parts of yourself you keep hidden from most of the world.

To this end, I think it makes sense to view a first appointment with a therapist as a trial session. If this first session doesn’t feel right, then move on to another therapist. Sometimes it may take more than one session to make this decision. Now seeing a few therapists before you find the right one could cost you some time and money. Of course, you probably want to get down to business and feel better/work on yourself/grow but taking the time to find the right person is crucial. You are engaging in therapy to make some change in yourself. This is important business and in the long run it will be cheaper and quicker to find the right therapist rather than start therapy with someone only later to discover that you don't work well with this person.  

I want to repeat one point here: Trust Your Gut! If someone doesn't feel right to you, trust that. Choose wisely. Don’t settle. Not every therapist is right for every person. Keep going until you get the sense that you have found the right person.

A word about money:

Therapists have a stated rate, but most also work on a sliding scale. It is standard practice to ask therapists if they have a sliding scale. A therapist's rate is usually up for discussion, however, be prepared to talk to the therapist about your financial situation and the role that money plays in your life. The therapist will likely view the conversation about the fee as part of the therapy.    
If you don't have insurance, and the therapists in your community have sliding scales that you can't afford, you can likely find low-cost therapy through graduate schools or community-based organizations in your community. To find graduate schools use the search term "psychology graduate program" "mft program" and "msw program" and the area you live in (ie. “psychology graduate program san Francisco”). Visit program's websites and see if they have a low-cost clinic. Some community based programs to check out are Catholic Charities and Jewish Family Services (these organizations serve people of all faiths and/or no faith).

You need to be able to afford therapy. But don't just go to the lowest-cost therapist you can find. Find the person who is right for you. Therapists who charge more usually have more experience. This is a plus, but it doesn't mean a new therapist can't be helpful to you.

How to find a therapist

Like most things in life, one of the best ways to find a therapist is to talk to friends and family. Ask people who you know who are in therapy who they see and if they have benefited from the therapy. Another option is to ask friends who are in the mental health field for a recommendation. If neither of these options is available, the web is a good place to find a therapist as many therapists have websites. Check out the site and see if you like what the person has to say about how they work. Visit a bunch of different therapists' sites so you can compare. Again trust your gut.  

Qualifications and training

First, know that it is perfectly acceptable to ask about a therapist's training and their experience working with people who are struggling with what you are struggling with. However, most therapists are generalists. That means that they work with people with a range of problems and life circumstances. So it is usually not necessary to find someone who is a specialist in your problem area but you also want someone who has some experience with what you are dealing with.

There are hundreds, perhaps thousands of types of therapy and it is well beyond the purview of this article to talk about this variety. Research has shown that, in general, therapy works and also in general, that one type of therapy is not better than other types (there are exceptions for certain problems, however). Furthermore, most therapists don’t practice one type of therapy, but instead combine different elements in their work. I suggest you ask the prospective therapist about his approach to therapy and get a sense if this is a fit for you. If you are a very spiritual person, you may want a therapist that includes this element in her work. If you a very logic driven person, you may want a therapy that relies heavily on rationality (ie coginitve-behavioral therapy). Include trauma.

What do those letters after the therapist's name mean?

There are a bunch of different degrees that allow someone to obtain a license from the state that allows them to practice psychotherapy. I am providing this information because people can be confused by this subject, but having one degree versus another is not a way that I distinguish who is a good therapist and who is not. My recommendation is to make sure someone is licensed by the state to practice psychotherapy and then to forget about the letters after their name. That said, here is what those letters mean:

Psychologist (Phd, Psyd, Edd) - Psychologists have a doctoral level degree. Traditionally, to be a psychologist, you had to go to a Phd program and learn how to do research.  The Psyd degree came into existence in the 1970s due to demand for more clinically-focused training. The Edd degree is less common and denotes that the psychology program was housed in an educational department of a university.

Social worker (msw, lcsw) Social workers have a master's degree. Msw is the degree you get when you graduate and lcsw is the letters you put after your name after you are licensed by the state to practice. Social work training often focuses more on learning how community systems help people.

Marriage and family therapist (Mft) - MFts have a master's degree. Their training ensures that the person has experience treating adults, children, and families.

Psychiatrists (MD) - These days most psychiatrists prescribe psychiatric medicines, but some still practice therapy. Psychiatrists went to medical school where they learned to be general practitioners and then went on to specialize in psychiatry.

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