Picture Bernard McDowell
Bernard McDowell, lcsw
Psychotherapy & Couples Counseling    
2700 SE 26th Avenue Suite D, Portland, OR  97202
503-234-9904

 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.