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Choosing A Therapist
Whether
deciding to do shorter term counseling or embarking on an open ended
term of therapy, only rarely will a person have the names of even a few
therapists that they have confidence in. There are many
possible factors to consider when choosing a therapist including
individual chemistry with a particular therapist, their location, cost,
specialty, the type of therapeutic approach they take, the attitude and
policies about confidentiality. Below, you can take a quick
look at some of these factors and consider a few suggestions.
The basic conclusion reached here: While it is
possible to increase your chances of success with some preliminary
research, you simply can't know if a therapist is a good fit for you
until after a session or two at the earliest.
What
is most important: Style of therapy or Specialization?
First,
let's consider an important distinction about the term,
"specialization". Unlike certain branches of medicine like
orthopedics that enforce highly standardized treatment protocols,
specialization in types of "mental health" problems (e.g, anorexia,
depression or anxiety) tells us very little about the how that person
works with their clients. But that's not necessarily bad. In
fact, some research indicates that the rapport between the client and
therapist is much more important than almost any factor including the
therapist's specialty. More critical than their
"specialization" is a therapist's theoretical approach and counseling
style. The mere fact that they specialize in a particular
problem simply tells us that they've had a certain amount of education,
continuing education credits, and experience with that type of problem.
However, in the field of psychotherapy there are literally
hundreds of different educational programs and theoretical approaches
to resolving those problems. As outlined below, three
therapists advertising the same specialty may treat a particular
client's condition in wildly divergent ways.
The
following examples don't do justice to the strengths of the different
methods discussed. They are offered here
only to illustrate the viewpoint that understanding the style
of therapeutic intervention utilized by a therapist is more valuable
information than whether they "specialize" in a particular problem.
Imagine a client seeking help for depression and considering
three different therapists all specializing in depression.
Using a rigorous traditional "psychoanalytic" approach, a
therapist seeks to stimulate the client to gain insight by asking
questions and listening quietly. The theory is, that
eventually, as the relationship matures, clients reenact the same
dynamics with the therapist as they had with their parents; but now,
with the therapist, there's a chance to end old, unconscious patterns
causing the problem. Psychoanalytic therapists
specializing in depression will likely have much more in
common with psychoanalysts treating completely different problems than
with a gestalt or cognitive therapists treating depression.
"Cognitive-behavioral"
therapy works on the premise that depression stems from
faulty thought patterns. Here's a simple example.
If something goes wrong for a depressed person, they may say
"it's always this way". "Always" is a
type of word called a universal quantifier. It portrays our
experience as fixed and in this case, very negatively. The
cognitive therapist may challenge the use of "always" by asking the
client if "always" is really accurate or if there have been exceptions.
The client is then urged to stop using universal quantifiers
because, at least in some small way, that reinforces their depression.
Of course, there are dozens of other thought patterns to be
addressed.
Various
family therapies, group therapies, psychodrama, and Ericksonian therapy
among a number of other methods aim to create more directly what some
call a "corrective emotional" experience. For example,
if a woman links her depression to difficulty asserting
herself or saying no to others, a Gestalt group therapist might ask
everyone in the group to ask the client for something. She is
given the task of telling them no. If she agrees to try this
experiment, she's practicing saying no but if she refuses to play
along, she's also getting the direct experience of saying no (to the
therapist's suggestion). Either way she may have, at least, a
mini corrective emotional experience. That seems ridiculously
artificial in this brief explanation, but such experiences emerge quite
naturally in therapy and can be very effective. Once again,
the point here is simply to notice that in these brief examples the
"specialization in depression" told us much less about what the actual
therapy experience is like than understanding a little about the style
of therapy.
Though
their differences are highlighted here, in practice most schools of
therapy aren't at all mutually exclusive. Despite their
claims to be unique and exclusive, a careful examination of therapy
reveals that at times each method actually relies on similar techniques
at any given moment in therapy.
The
Importance of Asking Questions
Even with
a suggestion from a friend or a referral from another professional, the
success of therapy depends on a number of intangibles. Many
people find that identifying a therapist who will work them effectively
isn't a simple straightforward process. I recommend calling
and talking on the phone first with several people. Of
course, it may be wise to ask prospective therapists questions about
their style, how they might work with your type of concerns, and about
their fees and availability. But the most valuable result
from this approach is the opportunity to get a sense for the rapport
you might have with each therapist. After that it is matter
of picking someone and meeting with them. One study concluded
that the best indicator of the ultimate success of therapy is the
rapport between the client and therapist at the end of the second
session.
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