Finding a Good Therapist

A thoughtful approach to an important decision

by Tom Cloyd, MS, MA – Counselor / Psychotherapist – Cedar City and St. George, Utah (435)-272-3332 – email: tc (AT) tomcloyd (DOT) com (please read about content licensing)

SUMMARY

The key to finding a good therapist is YOU – what you know about yourself and what you do about it. While we cannot offer any “sure-fire” formula to solve this problem, there are some things you can do that will probably help significantly. One’s quality of life is the central concern, so it’s only sensible to proceed thoughtfully.

Preliminary Considerations

A good therapist is one who helps you get the changes you want in your life. It’s that simple. Finding that therapist may NOT be simple, however.

To help you solve this problem, we discuss here some of the difficulties you will face, and some of the ways people we know have found to work through these challenges.

The following challenges can make finding and engaging an effective therapist difficult. Each requires different approaches if they are to be well managed.

• The difficulty of the problem being taken up, as measured roughly by the number of previous, failed attempts to solve it; or by the seriousness of its impact in daily life; or by how early in one’s life the problem was evident – earlier onset often leads to harder problems. DEAL WITH THIS BY adjusting your expectations about how quickly you’ll get results in therapy, and to what degree, so as to make your expectations more realistic and reasonable. More difficult problems usually take longer to treat, and the outcomes may well be more moderate than with less difficult problems. To adjust your expectations intelligently may require consultation with an experienced expert.
• The presence of active compulsive behavior. This usually takes the form of habitual and uncontrollable use of alcohol, drugs (street or prescription), or any other substance (including food), or behavior, engagement in which significantly compromises important areas of life (family, friends, work, leisure, self-esteem). Some therapists will treat people who have simultaneous (“dual”) mental health and compulsive behavior problems; some won’t. Virtually all will require evidence of active, productive work to resolve the compulsivity, as such factors can make mental health treatment rather difficult. DEAL WITH THIS by entering into active treatment for the compulsive behavior, and by seeking out a therapist who is comfortable working with such dual problems.
• Financial resource limitations. Limited finances can result in limited access to treatment. In addition, many health promotion or health care payment organizations are more willing to pay for physical care or medications than they are for mental health care. DEAL WITH THIS by being prepared to advocate for active mental health treatment, when it’s needed, and by seeking out qualified therapists who employ a sliding fee scale.
• Other resource limitations. Lack of access to transportation, or to child care, or limited hours available for access to treatment – all of these can constrain one’s choices. DEAL WITH THIS by becoming clear about your priorities, and by asking for help and advice from professionals, case managers, family, friends, etc., about particular solutions to your individual problem.
• Geographical constraints. There is little question that health care of all sorts is more diverse and more available in urban than in rural areas, worldwide. Beyond this, urban areas differ significantly. Truly large urban areas will tend to offer almost all sorts of care, and the presence of one or more training resources (usually university-based) in a region will tend to increase the density and quality of care options. DEAL WITH THIS by assessing your geographical situation, and adopting realistic expectations from the beginning. Some individuals may have to plan long drives to get to treatment, and to plan on doing two treatment sessions in one day. Some may even want to stay in an area for a series of days, focusing on psychotherapy, until major progress is accomplished. Flexible thinking by both client and therapist will usually resolve these sorts of geographical problems.

Steps to Take to Find a Qualified Therapist

Assemble a list of possible therapists.

• Begin by deciding the kind of training and experience you want in your therapist. Decide also what you can afford, per session, and for the whole treatment period. Finally, think about the support costs you are willing to bear (transportation time and cost, total weekly time out of your schedule, and so on). Write all this down, so that you don’t have to rethink any of it.
• Locate therapists to consider, using referrals from other health care professionals who serve you, directories made available by professionals organization (printed and on the Internet), the telephone book, or friends. Know that many studies have failed to show much of a correlation between kind or level of degree and licensure and the outcomes of treatment, although one might expect that there could be such a relationship. Much more important is history of success in treating the problem of interest to you. At this stage, you should be open to many different sorts of providers, as long as they all offer psychotherapy.

Reduce the list of possible therapists, using the telephone.

This is by far the quickest, and least expensive, way to do this. Call each person on the list and find out more about them. Take careful notes, thank them, then call the next person on your list. Make no decisions until you’ve called all persons on the list. Inquire about their success with your sort of problem. Do not be misled by considerations of how likeable you think someone is – that is a rather useless quality. Focus on the question of their likelihood to be effective for you – on whether or not they seem serious, intelligent, experienced, attentive, committed, and eager to help.

Here’s a general checklist for your telephone calls to potential therapists:

• Credentials: What are their credentials? Do they have any specialized training relevant to your problem?
• Years in practice: Skill in most health care professions tends to rise to its highest levels after about a decade of practice. (Costs do as well, so don’t go after more skill than you really need.)
• Experience: For more difficult problems, it is probably best to look for a professional who has at least a couple of years of experience using your chosen mode of therapy (if you have a preference) with the sort of problem you’ll be bringing to them. Inquire also about the major focus of their practice. Some professionals profess expertise in a group of problem areas, while other specialize more narrowly.
• Success: Ask about the success they’ve had with problems such as yours. Look for an answer that sounds realistic, yet promising. It’s ideal if someone you know has had success with a particular therapist, you’ll do well still to ask the therapist about their success. Be wary of someone who reports poor results (although you should check to see if this might be due to the nature of the problem you’re bringing with them – some problems are particularly difficult). Be wary, too, of someone who reports overly good results. After talking with several professionals about this matter of expected success, you’ll be in a better position to evaluate the answer of any one person to whom you speak.
• Availability: Do they have immediate openings, or do they have a waiting list? Do they have openings on a day and at a time that works for you?
• Payment: What are their fees? What kinds of payment do they accept? Can you afford at least 12 sessions? (This is a very rough average length-of-treatment for a moderately serious problem.) Do they have a sliding fee scale (if you have limited income)? Do they take pro bono (no-fee) clients?
• Other costs: An otherwise perfect therapist may be unaffordable to you if costs of access, including time costs, exceed your resources, so note estimates of these costs as well, as you talk with each candidate.

Pick a therapist candidate.

Keep your notes on all the others, in case your pick doesn’t work out.) The main challenge at this point is to consider ALL the information you’ve gathered. People tend to throw away information just to make a problem simpler. Try not to do that. Pick what looks to you like a good bet, but know that your ability to really how good a choice you’ve made is still rather limited until you’ve worked with your “pick” for a while.

Engage the therapist and begin work.

This is, in many ways, the most critical part of the process. Remember
that your purpose is to get results. Work hard to be clear about the results
you want, and to communicate this to your therapists. Listen carefully to
their reactions, including any offers they make about modifying your goals.
They may well suggest goals you had not thought of, or suggest that you
modify your goals a bit. Active, thoughtful consultation at this point will
pay off later.

Track the progress you make in therapy

There can be many distractions in this work. You’re the customer and it’s your primary responsibility to see that you get results, so pay attention to what happens in your therapy! Work with your therapist to have goals that are as well defined as you can make them, then check back periodically to see is you’re getting closer to where you want to be.

• When results are obtained, seek to understand what produced them. This important information.
• If you’re not getting results, first of all talk over the matter with your therapist, and if things don’t change, find another therapist.
• Be realistic: some types of problems are simply very difficult. Every therapist – even the famous ones – have conspicuous failures. None of us are happy about this, but it’s a fact. Generally, if you want to get better, work hard, exercise your full intelligence in relation to your treatment, and have a skillful, knowledgeable therapist, you WILL get better. Statistically, we therapists, on average, get distinctly better results than do physicians. It is reasonable for you to expect to get a distinct improvement.

The Real Test

In mental health treatment, as with any other form of health care, the “proof of the pudding” really IS in the tasting. Physicians know, for example, that due to the “biochemical individuality” of each person they treat, treatment outcomes can only be predicted up to a certain level. Beyond that, factors we cannot (yet) control or even know determine treatment outcomes. It is the same in mental health treatment. Just make sure you do your part, with all the intelligence and energy you possess, both in choosing and in working with a therapist, and you then can know you have done all you could do. Usually, the results will be a real improvement in your situation.