Choosing the Right Therapist
By Carol Ann Rowland, MSW, RSW, DCEP
The decision to consult with a therapist or other counselor is often made at a time of considerable emotional stress. In most cases, people delay seeking professional help until they feel they are at the limit of their ability to cope.
As a result, when they first begin looking, many find the decision-making process overwhelming.
Where do you begin? What should you look for? How do you know if you have chosen the “right” or “best” person?
Too often people simply pick a name out of a phone book, and begin working with someone without taking the time to learn more about the person they are entrusting with their healing process and mental health.
The best approach is to figure out what it is you are looking for, and interview potential therapists accordingly, to ensure that you are making an informed choice, before you have invested a great deal of time or money.
While many people feel uncomfortable with or intimidated by the idea of interviewing a therapist, this is unnecessary. In most other areas of life, we interview people before hiring them, and there is no reason to make an exception when the work to be done is personal therapy.
If anything, obtaining a good fit between therapist and client is even more crucial than in other professional relationships.
In many cases, therapists and counselors will provide an initial brief consultation by phone or in person, to help both of you to determine if the two of you will be a good match for each other.
Those who practice therapy or counseling may come from a variety of backgrounds. Clinical social workers, marriage and family therapists, clinical psychologists, and psychiatrists are all different types of trainings that those who provide therapy, may have.
It is ideal to consult with someone who has a strong professional background, and is accountable to a disciplinary college.
People often ask me which type of background is “best”. Through experience – both my own and that which clients have shared with me, I have come to believe that most cases the particular discipline the individual comes from is far less important than whom the individual is, and how he or she works in actual practice.
The one exception to this is if consultation is needed regarding medications. If you wish to seek an assessment regarding use of medications, in most cases this must be done by a psychiatrist.
Many psychiatrists, however, do not offer counseling and psychotherapy. This varies – some of them do. If you are seeking psychiatric assistance, it will be important to ask this question.
In many cases, those seeking both therapy and medication will consult with both a therapist and a psychiatrist.
Does the therapist have skills, knowledge, and experience in relation to your main areas of concern?
Many therapists will be able to identify what their main areas of expertise include.
No one can be an expert on all things, and it is possible that there is no “expert” regarding your issue, in your area. Or, that if there is, they do not otherwise feel like a good match for you.
If a potential therapist does not have prior experience dealing with the type of concern you have, are they willing to lean more about it?
You may also wish to ask what their beliefs are regarding why this type of concern is experienced, so that you can determine if their perspective fits comfortably with your own views.
Would you be more comfortable with a male or female counselor? Many people have a strong preference for one or the other, though many people feel comfortable with either option.
If someone has come highly recommended to you, and they are not of the gender you would normally prefer, it may still be a good idea to set up an interview with them to check this out. Sometimes a really good fit in terms of approach and personality, can easily override imagined concerns about gender.
Sometimes an option that can seem uncomfortable on paper, feels exactly right in person.
What fee is charged? Is it something you will need to pay entirely out of pocket, or is it partially or fully covered by insurance. When is payment due? What is the policy regarding sessions that are missed or cancelled with less than 24 hours notice?
In some areas, agencies exist that offer low cost or no cost counseling. The absence of a fee is usually not an indication of the quality of counselor you will receive.
It may, however, mean that certain parameters will be placed upon the work that can be done. For example, many agencies that offer low cost or no cost counseling will have a session limit that can vary anywhere from 3 sessions, to 28 sessions, with most falling within the 6-8 session range.
It is often difficult to determine at the start how much counseling you will want or require. Many people choose to simply come for 1-3 sessions and are quite satisfied with that. However, others may assume at the start that they will just do a few sessions, and then discover once they get into things that they would like to extend this much further.
Having to change counselors can be a difficult process to go through, so it is important to be aware from the beginning, any limits that exist regarding what can be provided.
How frequently can the therapist be available? Are evening or weekend sessions available? Are weekly sessions a possibility, or biweekly?
What is the therapist’s perspective on how often sessions should occur? Ideally a therapist will provide a balance between sessions being regular enough to develop a sense of connection and therapeutic relationship, together with an approach that fosters the client’s independence and self-reliance.
Is it okay to contact the therapist between sessions if needed? If so, is there a fee for this? During which hours is the therapist available to take calls?
How often does the therapist take vacations, and for how long? If you feel you want or need ongoing support for an extended time period, it may be important to know ahead of time if the therapist regularly travels, or goes on vacation for weeks at a time.
Is the therapist located conveniently for you? Sometimes it is worth traveling for therapy if you are seeking specialized skills or knowledge, or if there is a particularly good fit between you and the therapist.
How and where therapy is being done, has changed dramatically in recent years. Many therapists now offer therapy sessions by phone, or even online.
While some prefer having face to face contact with their therapist, others find that they really enjoy the convenience and flexibility of receiving therapy sessions from the privacy of their own home.
In some cases, working with a therapist by phone or online can make it easier to focus upon concerns, as fewer distractions are present.
Some people also find that it’s easier to make difficult disclosures over the phone than in person, thus enabling them to work on issues that they otherwise may have been too afraid or uncomfortable to face.
Are you aware of any particular approaches that you would like a therapist you are seeing, to be knowledgeable about?
Many people appreciate the speed, effectiveness, and gentleness that energy work or similar approaches can offer. Energy work can help therapy to be much more cost effective, as the work then proceeds much more quickly and with less emotional disruption than can occur with many other modalities. If this is important to you, you will want to ask the therapist if she or he has expertise in this area.
Other possible tools you may with to ask about could include EMDR, Narrative therapy, feminist therapy, trauma training, and so forth – whatever feels important to you.
If you are at a loss in knowing what approach is best for you, do not despair. One of the most important factors in a successful therapy relationship is feeling genuinely liked and cared about, by the therapist, and that is something that you will be able to measure for yourself, even in the absence of any more technical knowledge.
Feeling comfortable with the person you are seeing, and feeling understood by them, is often more important than what their professional background, tools or training, are.
While it is important to look at the overall picture and know the facts when making your selection, it is also important to keep in mind that it’s not the answer to any one of the questions above that necessarily should cross someone off your list.
Often even more important than any of the answers given in response to the questions asked a potential therapist, is how he or she responds to being questioned. A therapist should be approachable, and welcome any concerns that a client – or potential client – brings forth.
If a therapist you have chosen to interview shows evident discomfort with the idea of being questioned or interviewed, that in itself can be extremely valuable information to have, even if otherwise all of the answers that were most right for you, were given.
The best clients are empowered clients, and that empowerment begins with the very first phone call that is made to a potential therapist.