In my own search I went through a number of psychologists, psychiatrists, and social workers over many years, with little progress. Then, I found a social worker whose skills and therapeutic techniques transformed my life. Finding the professional that offered this rich opportunity for change was just plain luck. In fact, when we are seeking direction and healing we are usually in the worst possible state to make a wise selection. The issues that propel us to seek help (depression, anxiety, failed relationships, etc.) are so overwhelming that little energy and clarity are available for the challenging task of choosing a therapist.
Recently three friends asked me for assistance in selecting a mental health professional. After some consideration I suggested character qualities that are important and drafted a list of questions to ask potential therapists. Later they told me the evaluation criteria guided them to vary capable professionals, and they encouraged me to write an article.
An Action List
Here is an action list to assist you in selecting a therapist:
1. Ask people close to you about their therapy experience. Would they recommend their mental health professional?
2. Attend public offerings where therapists present their approaches and skills. Ask questions about their success with your symptom(s).
3. Read professional journals, such as Psychotherapy Networker, where therapists report their work and therapeutic processes. Most libraries have professional journals. Look for success with your issue(s) and contact the author for advice about finding a therapist in your geographic location.
4. Key your symptoms into the internet and run a search. Look for therapists and modalities with a proven track record with your issues.
5. Ask a therapist you respect for recommendations.
6. Review books and articles focused on your mental health issues. When the author reports positive results, contact him or her for advice to find help in your area.
7. Become knowledgeable about therapists' credentials. Disciplines vary in their requirements for clinical training and supervision. Many professionals are licensed after completion of academic degrees, supervision in clinical sites, passing professional testing, and committing to ethical practices. Others practicing as psychotherapists/counselors may have limited training and experience.
8. Ask for a free introductory session to interview the therapist. Many therapists are skilled at keeping the focus of discussion on the client's issues. This is very appropriate in therapy but the goal in the interview is to discover more about the therapist. At the onset I suggest the client state, "While I realize it will be necessary for me to tell you about the general nature of my concerns, I would like to use most of our time today asking questions to learn about your skills and training." Competent therapists will welcome this interview.
Questions for the therapist
1. "Have you worked with clients with similar issues as mine? What were the results? If successful, how long did the process take?"
2. "What modality(s) are you an expert in?" It is desirable for a therapist to be an expert in at least one therapeutic process.
3. "What are the sources of your clients?" I believe the more referred clients by present or past clients, the more positively it reflects on the therapist.
4. "What trainings have you attended in the last six months and what do you have planned for the future?" Enthusiastic, capable therapists love their work and seek to improve skills, interact with colleagues, and learn new techniques.
5. "What are your credentials and training? How much clinical experience have you had?" Clinical experience in a psychiatric hospital, mental health clinic, etc. is an asset.
6. "What motivated you to become a therapist?" Formerly wounded healers who have worked through their pathology bring the special gift of personal experience to therapy.
7. "Do you have a spiritual practice?" A spiritual grounding helps bring depth to therapy.
8. "Do you offer group therapy?" Groups offer a powerful therapeutic opportunity that is difficult to duplicate in
individual sessions. Groups are also usually less expensive then one-on-one meetings and are of greatest value in concert with individual sessions, where group experiences can be processed.
9. "What is your goal for clients, and your philosophy about therapy?" I believe the therapist should be focused to meet the client's goals, not his or her own expectations or agenda.
10. "Are you experienced and comfortable with deep emotional work?" Brain research is confirming that emotionally charged material is stored in the early brains—the visceral brain and limbic system. These are formed before the neocortex, the thinking brain. These early brains know no time, are very reactive, and frequently are the unconscious forces that direct our lives. Deep emotional work, accessing, processing and releasing early pain, is a critical and powerful form of healing for many clients.
11. "Are you supervised?" It is an advantage if a therapist is under supervision. Supervision offers an important second opinion and a healthy review of therapy progress.
12. "Are you trained in Eye Movement Desensitization and Reprocessing (EMDR), or energy therapies such as Emotional Freedom Techniques (EFT) and Thought Field Therapy (TFT)?" These modalities can be time efficient and frequently result in significant breakthroughs.
Be aware that therapists using insurance or HMOs may be pressured to refer you for medications before additional visits can be approved. Therapy sessions may be shortened to complete paperwork. Some therapists refuse to be burdened by the insurance industry, believing the most effective therapy is pay for service. Studies show the more clients pay for therapy out of pocket, the greater the progress. A smooth, polished, highly verbal therapist, well dressed, with a finely appointed office may not bring much to the therapeutic table. Another therapist may be less skilled in presentation but possess a strong capacity to heal. The initial impression of a therapist may be misleading. You cannot judge the book by the cover. You may have to invest time and money to assess a mental health professional. The best test of the therapist is whether you are moving towards the results you desire. Sometimes symptoms will be become more difficult as a necessary evolutionary process in improvement of conditions.
Qualities to look for
1. Healthy appearance. A sound body and mind go hand in hand.
2. Happiness, joy, enthusiasm, energy. These contribute to a strong, desirable role model.
3. Integrity. Does not cheat on insurance forms and will admit mistakes and inconsistencies. There are many clues as to one's integrity.
4. Attentive. A good listener who remembers what you said.
5. Open-hearted. You may feel this.
6. Trustworthy. You can rely on what he or she says or does. Does not promise the impossible.
7. Risk taker. Not afraid to confront you when it is in your best interest.
Unfortunately, the rate of burnout in therapists is high. The frustrations dealing with managed care companies and other stresses in the profession exhausts many therapists. One out of every five private practicing therapists leaves the field each year. Some signs of burnout are fatigue, boredom, tardiness, and over-sensitivity. You want someone who is energized, enthusiastic, and upbeat. I support the position that therapist contact should be limited to the therapeutic setting. The therapist is most effective where personal relationships do not cloud objectivity.
In a quiet place, consider your impressions of the therapist. Did you sense openness, a closed attitude, a warm heart, anxiety, competence, confidence, depth? Run through the list of your impressions. Close you eyes, quiet yourself, sense your heart, and ask your inner wisdom to help in your selection. Therapists are human and you do not have to find perfection to select one who is very capable. You have the right to expect progress in therapy. You should fire your therapist if you are not getting results. There are wonderful therapists available. Do not settle for less.
Norman D. Lowery is a Licensed Clinical Social Worker and psychotherapist practicing in Boulder, Colorado. He specializes in Men's issues, Bonding Psychotherapy groups for adults, and enjoys helping children and adolescents. Norman offers family therapy in the client's home.
This article appeared in the Fall 2001 IPA Newsletter.