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A skeptic's guide to finding a good psychotherapist

I frequently recommend to my patients that they undergo psychotherapy to support them through an emotional crisis. Many also embrace therapy as a means to enhance personal growth. A good psychotherapist is a godsend. How in the world do you find one?

What not to do

Sometimes the best way to express skepticism is one of Parkinson's Laws. My favorite is what I've known as Pohl's Law: "Ninety percent of everything is crap." (This saying was named after Frederick Pohl, the science fiction writer, but it's more accurately called Sturgeon's Law).

The first corollary of Pohl's Law is, "Ninety percent of the people who do anything are incompetent." The percentage of incompetence is not really that high, but sometimes it's close. It's a piece of cake to find a psychotherapist who is a lousy match for you. The trick is tracking down the therapist who can help.

Sometimes in my personal life I learn best from my mistakes. In medicine, I try to learn from the mistakes of others. Here are some of the mistakes you can make in trying to set up an effective psychotherapeutic situation:

How to proceed

Find out about what the process of psychotherapy entails

The discussion of emotional healing on this web site is intended to give you a good understanding of how to proceed. Sometimes you'll get good results in less formal settings, such as a group of people your same age and gender who meet at a church weekly for several years. This works better when you're not in crisis.

Learn about the different types of psychotherapy

One common approach is dynamic psychotherapy. Here, you talk about your problems and explore how the present represents unresolved holdovers from the past. It works best when you have a history of emotional difficulties and need to get to the bottom of things.

Many counselors and psychologists focus on the present and help you work through your feelings, assess what you're up against, and find practical solutions. This approach may be best when the problem is temporary and short term.

Marriage and family therapy works with two spouses or a whole family all at once. This can be extremely powerful, since you bring together people who have presented problems for each other and make them into allies. It's hard to do well.

Cognitive behavioral therapy ("CBT") is performed by specially trained psychologists who do no other kind of treatment. (I know of several psychologists who say they do CBT but are in fact not well trained in this technique. Instead, they are "eclectic": they mix in a variety of approaches depending on the situation.) Here, you ignore the past completely and focus on what happens when you become upset. What are your thoughts ("cognitions"), and how do your automatic thoughts get you in trouble? (The informal way of saying this is, "How do your thoughts drive you crazy?") CBT teaches a skill of analyzing and logging what you're thinking and then learning to stop the sorts of thoughts that make you upset and dysfunctional. A large body of scientific evidence shows it to be highly effective at resolving depression and anxiety.

Interview a number of therapists

Use the suggestions on this page to find someone compatible with you and your situation. If possible, take your time to find the best person.

Get to work

In addition to the therapy itself, use journals and spiritual approaches to enhance your progress.


Last updated Fri, Jun 19, 2015

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©2011, James Gagné, MD