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:
- You won't do the work. Psychotherapy involves finding a good therapist and buckling down. If you sort of, kind of want to do it but not really, if you back down every time you face an awkward moment in treatment, you're wasting your time. You've made fear your master. Here's more about willingness. A related value is "teachability": an open mind and the willingness to learn.
- You assume anybody who would have you as a patient must be a genius and a saint. Our culture still regards anyone who admits to an emotional problem as a childlike weakling. Many of my patients feel ashamed of not being able to just "snap out of it," and often their families reinforce their shame. So they may regard their therapist as a godlike oracle of answers to their problems. But it ain't so. Hold your head high and be skeptical. You're still going to have to do most of the work. Find somebody who will support and guide you through the process. Be sure they don't get weird when you express strong emotion.
- You pick a therapist who doesn't listen or makes you feel awful. Sometimes people stay with therapists who belittle them or make them feel like they're hideously screwed up. Such a psychotherapist can harm you. You need a safe space. Usually, you should leave your sessions with a bounce in your step, more confident than ever you can overcome your problems. (On the other hand, occasionally early in treatment as you get down to work, you begin by acknowledging the depth of your emotional distress. This can be quite painful at first. But you should feel that your therapist is on your side and fully supports your process.)
- Your therapist colludes with you to make you dependent upon him/her. When treatment works initially and then stalls, this is probably the most common reason. One rule of thumb is if your treatment has lasted for two years without meeting your needs or your changing at all, find another therapist. Sometimes, the therapist is the last one to realize that therapy isn't working. (On the other hand, many productive therapeutic relationships work well for five to ten years; certain problems just take a long time to resolve. Your call.)
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
Send feedback, comments, or discussion about this page.©2011, James Gagné, MD