I’ve decided to write a blog post in the hope of helping people to find a psychotherapist that fits them and what they’re seeking in treatment. The question I get asked most by prospective patients is: how do I know which therapists are good and which aren’t? I, often, encourage patients to ask, and to continue to ask, these types of questions and to afford themselves the chance to explore a potential therapist’s assessment of their ailments, as well as her or his treatment recommendations. Too often, patients have complained that they weren’t able to find what they were searching for in treatment. Rather than feedback, they received reframing. Instead of collaboration, they had to guess at what their therapist was thinking by means of interpreting head gestures and silence. In writing this post, my intention is to outline several questions prospective patients can ask themselves and their therapists to help them assess whether or not that individual would be a good fit for them.
1. What do you think is maintaining my symptoms?
This question confers a wonderful opportunity for a clinician to propound her or his theoretical framework in terms of the patient’s clinical presentation (i.e. their symptoms). Because it’s difficult to answer questions about causes, as casual links are rarely evident, it’s more appropriate and fruitful to ask about symptom maintenance and the foundations of their present manifestations. This will help the therapist articulate her or his conceptualization (i.e. how she or he perceives it) of the ailment(s), and help the prospective patient gain a broader understanding of what’s contributing to their illness, helping them feel more confident in the effectiveness of treatment and in their role in it; the more they know, the better they feel about their ability to contribute.
2. How do you usually treat my symptoms?
This is another important question to ask, as it allows the prospective therapist to outline their treatment plan and ask their patient for their input. Setting a treatment plan is one of the most significant and often difficult aspects of therapy. I think it’s important for a therapist to present her or his plan as a rough draft, asking for their patient’s input in return. I tend to advise people to seek out collaborative therapists, rather than more passive ones, as evidence indicates that collaboration is one of the major driving forces toward the development of patient-confidence, skill-building, and the reduction of the need for treatment. Although a more active role may be advised for patients with more severe ailments, and for a short duration in the beginning, collaboration is desirable because it allows the patient to gradually sense their developing-ability to help themselves and to become their own therapist, which is one of the major points of treatment. Additionally, collaboration is best because, although an expert in the field of clinical psychology, no therapist IS EVER an expert on any one of their patients, which includes their experiences and their needs; only a patient can ever be an expert on her or himself.
3. How long will treatment last?
This is always a difficult question to answer. I tend to tell people that, on average, treatment lasts for about six months to one year, but that every person, and the treatment trajectory of each disorder, is different. What makes this question significant is that it allows an individual to ascertain their prospective therapist’s timeline for treatment, and to be able to ask themselves if it works for them. Sometimes, therapists tend to make therapy open-ended and keep their patients for years upon years without any expressed treatment goals; although unethical, this practice is more common than not. To make sure that the agreed upon goals are being worked on, it’s important to set periodical re-assessment periods for both the therapist and their patient to re-examine the efficacy of treatment and whether or not to set new treatment goals, provided that prior ones were completed. Additionally, periodic re-assessment is needed to help the patient map their progress, or lack thereof, and to help both parties assess how close they are to treatment termination, which again, is necessary.
4. What is the point of therapy? What do I get from it?
Although broad, this is a great question to ask, as patients are often unaware of the purpose of treatment. Earlier, I stated that a major purpose of treatment was to help an individual become their own therapist, which entails the utilization of skills in distressing instances when the presence of a therapist is no longer required. This question creates a great opportunity for the beginning of the collaborative process, prompting the patient to put forth any potential needs and desires she or he has for growth and change. Additionally, this is a great opportunity for the therapist to articulate the limitations of treatment, as well as their own, explaining the necessity of collaboration for treatment to progress, as motivation and effort is needed from the patient’s end for any significant change to occur. Although daunting, the beauty of the patient’s efforts is wrapped up in their increased confidence in their ability for growth and emotional maintenance: teaching is the easy part; but, applying that knowledge is the most difficult, which is why patients deserve the vast majority of the credit for their development in treatment.
5. How does she or he make me feel?
This is a question for oneself. The foundation of a good treatment is the therapist’s compassion, empathy, and respect for their patient. If a therapist makes you feel judged or belittled, as though she or he knows better, then it’s likely best to keep searching. For therapy to work, the office needs to present an individual with a sense of safety, both physical and emotional. If, during the initial session, you sensed that your prospective therapist was actively listening to your needs and your difficulties, that they conveyed a desire to help you, they were interested and wanted to hear your story, that they cared about your suffering and your sorrow, and that they respected you and valued your assessment of your needs and wishes for treatment, then you have likely found a great fit.
Finding the right therapist can be a challenging process, and I hope that these questions help you in your journey.