6 Ways to Choose a Good Psycho-Therapist
By Michael Abruzzese, Ph.D.
© Copyright 2021 Vista Health Services, Inc.
Posted February 5, 2021
“You cannot become successful at something just by reading about it” – Charles Atlas
One of the silver linings to the black cloud of COVID19 is an increasing awareness of the importance of good health. Especially good Psychological health. In truth, there is no reason to split “health” into archaic and misleading terms such as ‘general health’ and ‘mental health,’ despite the media and medical education that has created a false dichotomy in the public’s mind for only the last 180 years or so. Even as the old term “mental health,” is still used by many educated people who should know better, consumers are now realizing after a year of COVID quarantines and home-bound self-protection from those reckless others in our communities that ‘behavioral health’ concerns are far more prevalent than the usual ‘medical health’ concerns that have consumed and driven the health care system in this country for generations. There is no differentiating between and among someone’s HEALTH.
We don’t talk about someone’s “Cardiovascular Health” or someone’s “Neurological Health” or “Podiatric Health,” but some people love to stigmatize Behavioral Health concerns and that restricts people’s access to getting the type of help needed to fight off Anxiety, Depression, Attention Deficit Hyperactivity Disorder (ADHD), Post Traumatic Stress Disorder (PTSD) and other very common health issues facing children, families and adults today. Before COVID, people tended to go to psychotherapists for two reasons and two reasons only – they are forced into it by others, such as the police, their boss under threat of being fired, their spouse under threat of divorce, the police or judicial system under threat of incarceration – or they have finally gotten fed up with feeling a certain way, such as always sad or anxious or engaged in bad habits, or from doing a certain behavior, such as gambling, failing tests, not understanding work or academic tasks, or job or relationship failures, and they want to change. These can be broadly understood to be CHOICE or DEMAND characteristics.
That is, you decide (choose) that you would probably benefit from going into therapy, or SOMEONE ELSE has determined that you would benefit from going into psycho-therapy and demands that you go. Those two categories have been brought front and center in people’s lives now that people, the media, the government and even physicians realize that psycho-therapy, that is, therapy utilizing sound psychological education and training, is helpful and necessary in these modern times. But how do you “know” that a “therapist” is any good? Well, how do you know that a pediatrician is any good? Or an internist? Or a surgeon or dentist? The truth is, you don’t, until after you’ve been treated by the Doc and only then you may realize you don’t like the doctor or think that the Doc is not very good. Most doctors, like most every other profession, are average. Same with therapists. And car mechanics. Unless you ask the right questions and know what to look for.
How do you know that a Clinical Psychologist is any good? Or any therapist, for that matter? Well, how do you know an internist is any good? The truth is, you don’t.
Not at first. You have to ask questions. It is usually WAY more important to have a good match between the therapist and patient for psychological therapy, for example, than having a good match between You and the Emergency Room Doc who treats you after an accident. Here is a primer of 6 things to watch for when choosing a good therapist and how to know you are in a good therapeutic situation. The first thing is to understand that not every “good” therapist will be a good therapist for you. Psychotherapy is a multi-faceted process and a key – but not the only – component of psychotherapy is the match between patient and clinician.
A technically proficient psychotherapist may just impress you the wrong way – his or her style of practicing psychotherapy may not fit with what you expect, or the type of procedures the therapist employs don’t agree with your life-viewpoint or you may not, in fact, be ready for therapy at all, even though you claim that you are! The second thing is to understand that “resistance to change” – that is, YOUR resistance to change – is often a component in any therapeutic interaction. You may believe that a particular psychotherapist is just not to your liking, when in reality, you are looking for any excuse to not start ANY psychotherapy at all! To find a good therapy match, sit down and write down – if you happen to really know – what you want to change and what problems you are having that make you want to seek out psychotherapy.
Then take that short – or long – list to a psychotherapist for an initial interview. Find out what techniques and procedures the psychotherapist would employ to help you and why. Next, Ask specifically what the therapist thinks that your “problem(s)” is/are. It’s very important to know that all good therapy starts with an accurate diagnosis. Surprisingly enough, many patients have told me that their previous therapists NEVER gave them a diagnosis or presented them with a treatment plan or rationale for treatment; The therapist just…started to do “talk therapy” with them! I’m still astonished when I hear that from people. If you are using insurance, your insurance is going to want to know why you are being treated and what they are paying for. This is, of course, your official “diagnosis.”
When you visit a physician, you may have a complaint about a sore throat, runny nose, back ache, chest pain or something else, but your physician doesn’t bill the insurance company for that: those complaints you present with are just symptoms. Symptoms are generally believed to be representative of a certain underlying condition or illness and it is that underlying condition or illness that your physician bills the insurance company. So too, with psychotherapy. You may come into the office complaining about fears or phobias or anxiety or helplessness or crying or sadness, but these complaints are only SYMPTOMS of an underlying condition. It is that underlying condition that your psychotherapist bills your insurance company. Sometimes, the underlying conditions are quite sensitive, such as sexual abuse trauma, bipolar disorder, psychotic depression or other condition.
Other times, the condition is quite benign sounding, such as adjustment disorder, grief, mourning or similar condition. You may not mind if your insurance company knows that you have pneumonia, but you might have second thoughts about insurance company employees knowing that you have Bipolar Disorder or Post-Traumatic Stress Disorder or that you were abused by a family member. It is your choice as to whether or not you choose to use your insurance benefits for psychotherapy and state, professional and federal safeguards are in place to protect such sensitive psychotherapy diagnoses and clinical notes about treatment which are beyond the scope of this article to discuss. You also have the right to NOT use your insurance benefits and pay for your therapy out-of-pocket if you don’t want the insurance company to know about your diagnosis or treatment, but you can’t make that decision if you know what your diagnosis is. But at minimum, you should know exactly what your diagnosis is and, as explained next, what the treatment is going to be.
So the third thing to know is that ALL good therapy starts with an accurate diagnosis. Insist on a diagnostic work-up prior to starting therapy. Ask questions. “WHAT?” is a pretty good question to employ in your first meeting with the therapist, such as “WHAT do you think these symptoms mean? Then follow up with these other good choices: WHO, WHAT, HOW, WHEN, and WHERE. Such as “HOW did you arrive at that decision?” “WHAT is the recommended treatment to deal with that?” HOW long have you been employing that treatment method?” “HOW many patients have you seen who have had this problem?” “WHAT makes you think that you can be successful in employing that treatment?” “WHEN (or how often) should that treatment be applied?” “WHERE should the treatment take place?” (Treatment for a phobia, for example, or for a fear of flying, may be best handled out of the office and at a location where the fear or phobias is manifested, such as in an airplane or at your home, office or other location).
And also, “WHAT are your credentials, WHERE did you train, HOW long have you been practicing?” You get the idea: Ask appropriate questions about your doctor and treatment. NOTE: Most physicians will not like a patient who asks a lot of questions – you will have to “train” your physician to spend more than 5-6 minutes with you and convince them that your questions are helpful, not suspicious. Psychotherapists are much more open to questions that are other care givers. Any care-giver who is NOT open to your questions, or seems annoyed with them is signaling to you that he or she is probably NOT someone you’d want to work with. Go somewhere else.
When such things have happened, I’ve encouraged people to tell the Doctor about it and give him/her the chance to change. When the behavior didn’t change, people left the practice. And the practitioners knew why. What is the treatment plan that your psychotherapist is recommending and why did he/she determine that treatment would be best? Unfortunately, especially considering that classical psychotherapy puts such an emphasis on “talking,” psychotherapists have not historically put such a premium on discussing the various treatment options available for conditions and exactly what the “treatment” will entail.
Every psychotherapy visit should be in service of the treatment plan that was specifically devised for you as a treatment for your presenting condition. Every treatment plan should be designed basd on the appropriate diagnosis received based upon the symptoms presented by the patient to the psychotherapist at the time of the first few visits. The diagnosis is arrived at based upon a clinical diagnostic interview process which could take one or several sessions.
Determining the cause of the presenting problem(s) may involve psychological testing or even neuro-psychological testing. Make sure your psychotherapist does a thorough diagnostic work-up of your presenting problems to accurately determine your diagnosis, in order to accurately determine which treatment is best for that or those underlying psychological problems. Every subsequent office visit should largely focus on completing the work necessary to follow through on the treatment plan until it is finished. Imagine going for kidney dialysis and you get a back message instead. Wouldn’t you ask how that is helping your kidneys? Stay on therapeutic task.
Finally, if you live in a rural area without much choice of therapists, how do you make a good choice? Well, it’s true that every clinician starts out fresh, but every licensed clinical psychologist who is licensed must graduate with a professional degree and that typically includes a supervised internship wherein the student provides therapy to clients under the supervision of a licensed clinical professional. That’s the same way that physicians are trained. In teaching hospitals and clinics, the “doctor” you may be seeing is really a student who is finishing up his or her education in a supervised clinical internship or “rotation,” as medical turns at sampling different types of patient contacts are called. So you can ask what types of supervision your novice clinician has access to – who can s/he contact to ask questions and get guidance about how best to proceed in treating your issues.
Good clinicians always undertake continuing education every year to keep their skills sharp; many states mandate such continuing education for licensed professionals in fact. And sharp clinicians know when to ask for help and to seek supervision when treating novel or complex issues with which they have little experience.
Michael Abruzzese, Ph.D. is a clinical psychologist on Cape Cod and a former Clinical Instructor at Harvard Medical School. He is the author of Ten Lessons in Power Psychology; Psychology Tips and Techniques For People Who Would Never Visit a Psychologist’s Office. https://www.amazon.com/Lessons-Power-Psychology-Techniques-Pscychologists/dp/0991011708