Starting a relationship with a therapist is very personal and can be nerve-racking for many. It’s hard to know who’s going to be a good fit without taking the time to meet a few. There are many posts out there that offer tips on how to find a good therapist. However, each time someone releases a “how to” for choosing a good therapist, it always seems key points are overlooked. There are many schools of theoretical approaches in the therapy world, and it’s important to remember that the therapist you choose is practicing from her/his theoretical perspective — there isn’t one universal form of therapy. Here are some suggestions that, in my experience both as a therapist and as a patient, will help narrow the search to locate a therapist who will hopefully be effective for you.
1) Post-Graduate Training. It amazes me how many therapists there are in private practice who have little to no training beyond their masters programs and clinical licensing hours. Most masters programs do not give someone the tools to be a psychotherapist; and while clinical hours gives experience and supervision, it doesn’t necessarily provide the grounding, or study in a theoretical school of psychotherapy. When I graduated from NYU’s school of social work, I remember believing I was ready to be a therapist — because I knew how to actively listen to someone, validate them, and empathize with them. And then, while working towards my clinical licensing hours, I soon learned how naive I was. I began to realize I didn’t know how to truly intervene, help change life-long maladaptive patterns, or understand the ways in which to listen to certain types of patterns (emotionally, relationally, etc.), and more importantly, respond to them in ways that would foster insight and change. All of these skills I learned in post-graduate study that focuses on being an effective therapist — rather than only a supportive listener.
If you’re just looking for a supportive ear, then it’s possible that any therapist with a chair and a couch would work for you. But if you’re looking to go deeper with self-understanding, self-reflection, and looking to change negative life patterns, then make sure to ask the therapist about their post-graduate training up front. A solid training will involve minimally a year-long program (I completed a 4-year post-graduate program in contemporary and comprehensive psychotherapy for adults, and work from an integrative approach), or in some cases, consistent workshops over a period of time (such as Gottman, Imago, EMDR, etc.). Be wary of therapists who only describe short workshops or brief seminars as the totality of their post-graduate training if it does not fall into a base approach.
2) Be wary of the “yes” therapist. People often focus on finding therapists who are nice, warm, and caring. I also agree that these are basic essentials. However, be wary of the therapist who simply “yes’s” everything you do or say. Validation is nice and does tend to feel good…however, the collusion of a therapist with their clients when negative patterns are repeating (in life or in the room), just for the sake of making a client feel good, is generally not helpful, and can perpetuate exactly what the client is there to work on changing (it’s also a sign that therapist is afraid to not be liked by you, and has an impact on how they approach and respond to you). Warmth, support, and care are necessary, but a good therapist won’t be afraid to constructively challenge you at times.
3) There is an opportunity with every (trained) therapist. The reason I re-emphasize “trained” is because people who aren’t well-trained will have a harder time working constructively when negativity enters the room between you and the therapist. Some therapists may be really good at their jobs, and still activate you (I’ll spare you the theories behind this). Many untrained therapists will say maybe this is the time to find a another therapist if you’re not always feeling warm and good in therapy. Or, people may believe that being angry at your therapist at times means it’s time to leave. On the contrary, when there is emotional activation in the room, it often means deeply-rooted enactments are surfacing that can be central in the areas where improvement is desired. There are times where therapy won’t feel good, and may be difficult. But even if your therapist is frustrating you, or activating you in a negative way, there is an opportunity to work through something significant from our personal life histories. If your therapist is upsetting you all of the time, then, yes, probably a good time to try someone else, but keep in mind in your search that negative feelings in therapy can actually lead to some of the most progress (as long as you bring them up to the therapist).
4) The Basics — Care, Warmth, Support, Openness. Tacking on to #3 above, there should always at least be a base of care, warmth, support, and openness. The reason I don’t include “trust” here is many people come in already having difficulty with trust. Trust takes time and shouldn’t be immediately expected. But at the least, even when there is anger or frustration in the room, a person should have a sense of care and support from their therapist as a whole. (And if it doesn’t feel this is happening enough, to bring it up with the therapist before ending the treatment). You should at least feel your therapist has your back (or early on, at least has the potential for trust).
5) Therapist’s Self-Awareness. The importance of a therapist having undergone their own therapeutic process can’t be overstated. Knowing one’s self is essential when working to help others know themselves, especially in dynamic work, where the dynamics in the room are part of the work (yes, there are actually many therapists out there who haven’t been in therapy themselves). I know that I function much better as a therapist when I continue to be in my own therapy because it keeps me attuned to my own emotions and dynamics, which plays a role in how I interact, dynamically, in the room with clients. It’s hard to help someone else emotionally if we don’t have a grip on our own emotional states and dynamics.
6) Therapist’s Supervision. I think supervision is essential, even for the most seasoned therapist. Supervision isn’t about how much you know or how qualified you are. In this field, supervision is about checking yourself within the context of your work. Being a therapist is an emotional job, and any therapist who tries to tell you the work doesn’t have an emotional impact on themselves shouldn’t be a therapist (or they’re lying to you or to themselves…which is a problem, either way). The process of supervision helps therapists manage the emotions and dynamics of treatment, and work through subjective blocks, in the service of improving their perspective and, therefore, their ability to treat you. A therapist who is in supervision doesn’t mean they’re still new and not qualified, it means they have an interest in tracking themselves within the context of their work to better help you. As a patient, I always feel better knowing there’s someone keeping my therapist in check. It is okay to ask the therapist you meet if they are in a process of professional supervision.
There are other things that can be included here: obviously a therapist who has appropriate boundaries (poor boundaries include therapists who talk too much about themselves, make sexual advances, look for a friendship or relationship with you beyond the treatment, or starts/ends sessions consistently late, or who who eat, check their phones during sessions, and other points can be included here).
While I feel the above points are basic essentials, there are many people who are well-trained, compassionate, warm and caring therapists, who are devoted to their work. Many have their own self-awareness and continue their education to work to be a better therapist. But it’s also all too easy to end up in the office with someone who meets few, to none of the above. Having been in this field for a while (and having been a patient for even longer), there is a noticeable improvement in the quality of therapy when the therapists meet the points above.
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