An Educated Consumer is Our Best Customer - Choosing a Psychotherapist

Finding the best therapist for you and your needs

Posted Jan 22, 2010

An Educated Consumer is Our Best Customer - Choosing a Psychotherapist

This was the slogan of a well-known clothing store in the New York City area for many years. It seems to me that it's also the best possible way for anyone to approach psychotherapy. There are many different kinds of therapy available these days: cognitive behavioral therapy (cbt), dialectical behavioral therapy (dbt), psychoanalysis psychoanalytically oriented psychotherapy, coaching, body-mind therapy, Eye Movement Desensitization & Reprocessing (EMDR), and of course medication, to name only a few. There are also many modalities, including family therapy, group therapy, couples therapy and individual therapy. So it is crucial that a client go into therapy with at least some ideas about what she needs and what the different approaches have to offer.

Being a selective consumer of psychotherapy is not easy at the best of times, but it becomes almost impossible when we are in pain and looking desperately for help. Most of us go into therapy when our self-esteem is at a low point, making it hard to think logically about what we need - other than to feel better. If a therapist promises to help us, we can only gratefully accept what they offer; and if it doesn't work, then we have only ourselves to blame. Or so we think.

Many years ago, when I was training to be a psychoanalyst at the Psychoanlaytic Institute of the Postgraduate Center for Mental health in New York City, I, like all of my colleagues, went through a required 'training analysis.' My analyst, a psychologist named Dr. Martin Wagner, had been a cognitive psychologist before he became a psychoanalyst. I would never have thought to ask for someone with this background; yet it contributed an important component to my own therapy and to the therapist I became.

Martin often said that he believed that everyone comes into therapy with a theory about how therapy works. Part of an analyst's job, he thought, is to help each person put their personal theory into words. Once someone has found the language for the way she believes her therapist can help her, she has a crucial tool for knowing whether or not she is getting what she needs.

Most clients' ideas about how therapy will help them change as therapy progresses. But developing the tools and skills for talking about the needs that color and motivate one's behavior is a tremendous part of what therapy has to offer. It is not inappropriate to ask a potential therapist to explain how the process works. It is also not a sign of incompetence if a therapist cannot answer clearly or succinctly. Some clinicians will ask why you are asking. Try to answer honestly, and try not to think of this as a test you have to pass. But you also have a right to ask why the therapist is asking you that question. Her answer, or lack of one, will not only help you understand something about how she thinks, but it will also show you how she works.

If she explains briefly, and helps you put your own ideas into words, then that is most likely how she will work with you in therapy. If she seems interested in your thoughts, that is also a signal that she will be interested in your ideas, however unformed they may be, if you choose her as a therapist.

Two useful questions for a therapist using any technique are: why and how do they believe that will the therapy they are offering would be best for the concerns that you have presented to them? 

Heinz Kohut, who developed a psychoanalytic approach that he called Self Psychology, wrote that a client is "cured" when she can figure out what she needs, can communicate it to someone else in a way that makes it possible for the other person to respond, and can find someone who is willing and able to make that response. In the early stages of therapy, it seems to me that a crucial part of a therapist's job is to help a client begin to think about her needs, put them into words, and figure out how she can get those needs met -- whether or not it is with that particular therapist.

Each of us goes about working on these issues in our own ways. Finding a therapist is not about finding someone who is "the best" in their field, but finding someone who is the best fit for you and your needs. Your best friend's therapist may be perfect for him, and not right at all for you. In a first or second session, you will have at least a sense of whether or not you feel safe with a particular person. You do not have to like them! but you do have to feel that you can take a chance with them.

I encourage new clients to shop around. Only after checking out several different therapists, sometimes with several different styles and techniques, can you have a sense that you are ready to start with a particular person. You can always change your mind; but if you start with at least a sense that you have chosen someone who feels right to you, you will be off on the right foot.