The first time I went to therapy, my parents chose a psychotherapist quickly (an easier decision than which mechanic to use). The way they found this nutter-butter-can-of-cashews: My first pediatrician didn't know what to do for my all-night, every night nightmares, and so he sent me to a therapist. He thought she was good because of her seemingly impressive pedigree. And let me let them tell you as they told everyone who asked: "She did therapy on the Prime Minister from Israel." Even at age 10, I found this bit of information troubling and logistically dubious, as we lived in a beachside suburb in Los Angeles and the Prime Minister from Israel lived in Israel.
Here are a few examples of her wacky behavior:
1. She ate cottage cheese with her mouth open during our sessions. I feel sure that her mouth full of curds gave me more nightmares.
2. She read her mail during our sessions. While I get that my 10-year-old chatter was not very stimulating, she was getting paid to listen to me and not to read what the latest edition of Readers Digest said about how to declutter your desk. Good God, do I wish I was making this stuff up.
3. I have since learned that she asked patients for rides to the airport. She never asked me for a ride, but I was only 10 and I didn't even own a bike.
I thought, as a public service of sorts, and because I am a therapist and I write about being in therapy, it might be a good thing if I shared some thoughts about picking a therapist—should you ever find yourself in need of one—as they can be harder to find than a good mechanic.
1. Ask friends and family
Ask friends who are in therapy if they like their therapist. If they do, find out what it is they like about them and ask your friends to ask their therapists for referral lists. I have never gotten a good referral that way, but I have given out some good referrals because friends have asked me if my therapist knew anyone for them.
If none of your friends are in therapy or if they tell you that they don't like their therapist and how they keep going just because they don't want to hurt the therapist's feelings, it's best to get a referral elsewhere. I have gotten most of my referrals by calling institutes (Jungian, Psychodynamic, Psychoanalytic) for therapists in my area. That said, you don't want a therapist who is convenient—you want a therapist who is good. Good and convenient do not often go hand in hand. I could have a therapist that is only five minutes from my house, but I believe Igor is worth the hour drive. And, I find the drive home to be an important time to process my feelings.
Many institutes have a service in which a clinic director will do an intake and determine what therapist in the community might be a good fit for you. That is a wonderful way to find a therapist if you don't have a referral source.
2. Shop online
While I have never found a therapist online, I do have an ad on Therapist Finder. And I do think (in the online age) it is likely to find a therapist on Psychology Today's Therapy Directory. When therapist shopping I would look for therapists who are not selling themselves but rather those telling you about their work and their philosophy of working with patients.
3. A picture tells a story
Take a look at therapists' pictures on Psychology Today's Therapist Directory. Red lights for me: Therapists who use glamour shots or whose portraits seem in any way seductive. I would also steer clear of therapists who use a photo of themselves partaking in a favorite hobby or recreational activity. If you have any doubts about a therapist based on photos, I would listen to your intuition. See if you can find someone who you could easily sit across from. I am not saying your therapist needs to look like a supermodel; you just want to look at the therapist without feeling any concern or apprehension. I would heed any intuition.
When choosing a therapist, almost all people have an instinctive idea on gender they would prefer to work with. For me, my default therapist choice is always male which, in fact, comes out of my relationship with my parents. I don't think there is a right or wrong when it comes to choosing which gender you prefer to work with. However, I think it can be clinically valuable to notice which gender you absolutely wouldn't want to work with. I would make note of that and let my therapist know about my strong feelings of "no way" when considering a certain gender for a therapist.
5. Theoretical orientation
This one is really tricky. There are many theoretical orientations and I certainly cannot explain them all in one single post. Here is what I can say in a huge and gross oversimplification:
- If you believe there is an unconscious motivation for your behavior, you might want to go to a psychodynamic therapist.
- If you want to change your thoughts and you think doing that will change your life, and you don't believe in an unconscious, then you might want a cognitive therapist.
- If you don't ever want to talk about mom and dad and you only want the here and now then maybe narrative, behavioral, or solution-oriented therapies are something to consider.
- If you want to work on your family and not just on you, then try a family-oriented systems therapist. Let me say again that was an enormous oversimplification.
If you still have no idea at all about what orientation you might want, I would then call the referrals you found and ask about orientation. If the therapist says, "I am an existentialist" and leaves it at that, then have her explain what that means and how you would experience that orientation. Keep calling until you find someone whose style resonates with you.
6. Call them
When you find a therapist to call, then call. It sounds easier than it is; I have had the numbers of therapists in my possession for weeks before I dared to call. Once on the phone, I had questions handy:
- Where did he go to school? The best schools don't necessarily make for the best therapists. When asking this, I am not looking for a certain answer. I just want to know for sure that it is an accredited school and not an online coaching certificate.
- What is her specialty? I tend to be wary of people who specialize in everything. One can't be all things to all people.
- Has he worked with people with your issues? On the phone, share a little about your presenting issue and see how the therapist responds.
- What is her training? If she says she is trained, find out if it was a one-day seminar in EMDR and, or, if she took a three-hour online course in psychoanalysis. If she calls herself an expert in a modality after such a short training I would likely hang up and move on to someone with a little more experience.
- Is he licensed? If he says that he is, I would still look up the license and make sure. There are people (people I know, people I went to school with) who don't have a license and they are practicing. And it makes me wackadoodledoo. I have too big of a Superego to ever trust someone who would work outside of the law. Once you are sure that he actually has a license, I would also look on the state licensing boards to see if there are any infractions against the license.
- Are they now, or have they ever been, in therapy? This is a big one. Do not, repeat, do not, get into therapy with someone who hasn't done her own work. Seeing a therapist who doesn't do her own therapy is like going to a priest who has no relationship with God. This is a big one for me. Unless one has done her own work, she is likely to have issues that create an increased chance of boundary issues, unmanaged counter-transference, and blind spots.
Before I set up the appointment, I would find out the fee and discuss sliding scale or insurance. If you like everything about the person, but the rate is more than you can manage, I would share this. If he can slide no lower, then I would ask for referrals. He might know someone who works like he does at a lower fee. That said, cheap is not always better.
If you don't have insurance and can't afford the fees: see an intern at a clinic. The great thing about working with interns is that you get two therapists for the price of one. You get the intern therapist you are working with and the supervisor who is supervising. Training institutes usually have interns on staff that are available at very low rates.
For years, I saw a Jungian analyst for the embarrassingly low fee of $25 a session. He saw me at that low rate because I couldn't afford more and because he was doing pro-bono work for the institute as a way of giving back.
Notice how you feel on the phone with the therapist. Nervous was how I usually felt on that first call. I rarely have had an immediate "yes" feeling when I talked to a therapist on the phone. I usually felt a little weird and awkward. You may feel differently. Just notice how you feel on the phone and after you have made the appointment. Also, if you are doing psychodynamic therapy, you might want to write down any dreams you have had once you have made the appointment.
On your first appointment, notice how you feel when you are in the room with your new therapist. Do you feel heard when you speak? Notice how you feel in that person's presence. Notice everything. You might not decide on the first session if the therapist is for you. It may take some time to determine if you have picked the right therapist. If you decide that it isn't a good match, then you don't need to go back. It is best to tell the therapist what it is you're looking for and why she isn't the best fit for you. The therapist might have some ideas for a referral that would work for you. And sometimes that desire to not go back is motivated by some more unconscious anxieties about being in therapy. Best to discuss those, too.
Also notice if there are any red flags, any ethical, boundary issues, or cottage cheese eating that starts to arise. If there are, it might be time to pick another therapist.
Copyright Tracey Cleantis 2011