How to Choose a Therapist
“The meeting of two personalities is like the contact of two chemical substances: if there is any reaction both are transformed.” — C.G. Jung
Choosing a therapist can be overwhelming. You want help, perhaps urgently, and you have decided to entrust a stranger with your most private, personal concerns. Your work you with this therapist may have long reaching consequences for your mental health, relationships or life choices. And you are not currently at your best. You may be depressed, anxious or grieving, with resulting difficulties in concentration or decision making.
If you’re looking online, you will be faced with massive information to sort and digest… an alphabet soup of credentials and titles, photographs, seemingly endless websites, approaches and methods and wide variations in fees. In this article, I will try to simplify the process by suggesting questions I would consider if I were choosing a therapist for myself or a loved one.
Is the therapist licensed?
Colorado is one of the few remaining states that allow unlicensed therapists to practice legally. For a modest fee, almost anyone can become a “registered therapist” or “registered counselor” and begin treating patients. These counselors may appear attractive to potential clients because they generally charge very low fees.
While some of unlicensed therapists may be helpful and caring, many lack the graduate training and years of post-graduate clinical supervision necessary to competently address the range of problems that therapists are called on to address. Others are students who wish to begin practicing therapy while “working towards licensure.” It is difficult for the consumer to distinguish between a “registered therapist” and a “licensed therapist.” But the difference is important.
Unlicensed (registered) therapists and counselors have no minimum standards for education, clinical training or testing. They are not subject to oversight by professional boards and have no requirements for continuing education. Nor are they required to abide by the full ethical standards accepted by licensed professionals, which are designed to protect the client in matters such as boundaries, confidentiality and conflicts of interest.
Licensed therapists must complete a minimum of a 60 hour specialized masters degree, provide therapy for three years of close supervision of an experienced therapist, pass a rigorous national licensing exam, participate in ongoing education and abide by the ethical standards of their profession. These requirements are your assurance that the therapist meets established standards of competency and professionalism.
To find out whether a therapist is licensed in Colorado, and whether there have been complaints about him or her, visit colorado.gov (To check my license, please enter my full name, Kaitryn Wertz).
What about a life coach?
Similar to unlicensed therapists, coaches, “professional coaches,” “life coaches,” “relationship or dating coaches,” and so on, often provide counseling without clinical training, supervision or accountability. Anyone can declare him or herself to be a coach, as there is no state regulation of coaching as an occupation.
While some coaches have graduated from commercial training programs, usually by taking internet courses, this training is minimal compared to the level of graduate education and supervision needed to become a licensed therapist. Certainly there are coaches who provide helpful services to their clients, and therapists who fail to help, but the consumer choosing an unknown coach has fewer protections against incompetence and unethical practice than the person choosing a licensed therapist.
What is the difference between counseling, psychotherapy and psychoanalysis?
People are often confused by the differences among these types of therapy. All these forms of therapy are provided by licensed therapists, with variations in training and approach. I have training and experience in all three types of therapy.
- Counseling can be effective in addressing everyday life issues and is supportive in nature. Counseling may include the use of advice, problem-solving strategies, coping strategies such as meditation or relaxation techniques and learning new ways of viewing and understanding a problem. This may also be called solution-focused or brief therapy. I consider mindfulness-based therapy to fall within this category.
- Psychotherapy is an approach that often probes more deeply into the history and causes of a problem. In psychotherapy, specific symptoms such as depression, anxiety or obsessive behaviors are addressed. Common methods include cognitive-behavioral, psychodynamic and Dialectical Behavior Therapy (DBT).
- Psychoanalysis or analysis (these terms are interchangeable) is a longer-term process that provides time to heal, change and grow. The end result is that we get to know ourselves more fully and often develop a deeper acceptance of ourselves. While this approach may seem to run counter to the “quick-fix” mindset of today’s fast-paced world, taking time for this work can lead to a sense of satisfaction and meaning in uncovering unknown aspects of our personalities. Psychoanalysis and analysis have evolved respectively out of the work of Sigmund Freud and C.G. Jung. Psychoanalysts undergo several years of additional specialized training after becoming a licensed therapist or counselor.
Does the therapist make guarantees or promises?
While effective therapists need to inspire hope, they cannot ethically promise success or guarantee results. If you are willing to take responsibility, make changes and spend the necessary time and energy, therapy is very likely to be beneficial. But while everyone is capable of growing and healing, sometimes change takes more time or effort than people are willing or able to invest. In addition, people are not always ready to face certain issues, or a particular therapist may not be able to help them. For all these reasons, therapists cannot ethically promise results. I would advise against seeing any therapist who offers a guarantee of results.
How important is the therapist’s theoretical orientation and method?
There are numerous theoretical approaches and methods, too many to describe in a single article. I believe it is helpful for therapists to be trained in more than a single method of theory. When therapists are too identified with one specific “brand” of therapy, they may have preconceived ideas of how to treat you.
At the other end of the spectrum are those therapists who advertise expertise in virtually every method. It takes time, training and commitment to develop expertise in anything—someone who claims to have studied a long list of methods may have dabbled in many approaches without developing skill in any. In selecting a therapist for myself, I’d want to be satisfied that the therapist had sufficient knowledge of varied approaches to respond to my unique needs, while having gone deeply enough in a few methods to have become highly skilled.
Despite all the many theories and methods of therapy, study after study confirms that the most important factor is the quality of the relationship, the fit between therapist and client, which is referred to as the therapeutic alliance. In short, when clients have a positive experience of the therapeutic relationship, they also tend to report a beneficial outcome to the therapy. This result cuts across methods that differ greatly, such as cognitive-behavioral and psychodynamic approaches, and suggests that, in actual practice, the most effective therapists may actually work more similarly than our differing theories suggest.
What is a good therapeutic alliance?
A good therapeutic alliance is more than simply liking each other or experiencing the therapist as warm and supportive. Of course, a warm, supportive connection is necessary. But for the therapeutic relationship to be effective, you also need confidence that you and your therapist can work effectively together to accomplish your purpose. This kind of trust takes time to develop and it requires mutual agreement about the purpose of your therapy and the methods that will be used.
Effective therapists begin to establish this kind of trust during the first meeting, by communicating that they are interested in you and in understanding what is troubling you. Therapists do this in many ways, for instance by being attentive, by asking relevant questions, by making eye contact, by demonstrating that they’re listening and by remembering what you’ve said. They also build the relationship by communicating sincere empathy for your situation and painful feelings, not just in words but in sincere facial expression and attitude.
How do you know if you and your therapist have the potential to create a good therapeutic alliance? Ask yourself if you feel comfortable talking to the therapist, if you are able to talk freely and if the therapist communicates an understanding of your problem. The therapist will not have all the answers, but he or she does need to be able to express an understanding of the issue that is bringing you to therapy and a caring commitment to helping you resolve it.
Some questions to ask during your initial phone call or appointment
When people call me to discuss therapy, they usually focus on the practical questions such as cost, insurance and the convenience of my location and hours. Here are some other questions, that are less frequently asked, that may help you decide if the therapist is likely to be a good fit for your needs
- Have you had much experience with my type of problem? Are you comfortable addressing this issue?
The more experience therapists have addressing a particular issue, the greater their ability to help you with it. - How long have you been in practice?
Experience is not the only factor in whether someone is a good therapist, but it definitely helps. It usually takes about eight to ten years for therapists to become fully seasoned in their profession. - What are your credentials, licensure and training?
In particular, if a therapist is advertising skill in a specific approach or method that is of interest to you, it’s important to know whether they attended a weekend workshop or trained in that method for many years. - Do you participate in ongoing peer supervision?
The best therapists continue to hone their skills by getting confidential consultation from other therapists. - Have you been in therapy? For how long?
It is essential for the therapist to have adequate understanding of his or her own issues and problems. It also gives an appreciation of the client’s experience. I would not recommend working with a therapist who has not participated in his or her own therapy for a substantial period of time.
To go deeper, here’s an excellent article about how to tell if your therapist is helping you.
