Tips for Getting Good Therapy
I have been seeing patients for over 17 years, and in that time, I have heard many horror stories about people’s psychotherapy experiences. While it would be presumptuous of me to claim to know what happened in someone else’s consulting room, much less to blame either the therapist or the patient, these painful narratives have prompted me to think about the ways in which you can help steer yourself toward a positive therapeutic experience, whether it is with me or someone else. Remember: it’s your therapy, and you can help make it what you want it to be.
When first looking for a therapist
1. Experience the therapist first hand. Many therapists will give you a free evaluation session (I do.) Try seeing how it feels to sit with that person. Do you feel comfortable? Is there a sense of connection? How well does the therapist listen? Does he/she understand your emotional suffering? Do you leave with a sense that the therapist can help you?
2. Pay attention to the kinds of questions the therapist asks. Hopefully, they will be ones you haven’t been asked before, so that they open up previously unexplored areas of your emotional life. You can’t get someplace new by walking down the same old roads you have a thousand times before.
3. Do not believe promises of success. Therapists are forbidden from guaranteeing results, but many practitioners reassure patients that things will get better, or that their “skillful approach” and “environment of safety” will almost assuredly bring results. Unfortunately, however, there is no way a therapist can know this with any degree of certainty, and truly trustable claims are often leavened with a sizable dose of humility.
4. Unless you have gotten a very strong recommendation from someone who has seen the therapist in person, talk to more than one therapist. Your therapist needs to be a good fit for you, and only you can determine how good that fit feels. Think about it. Would you test drive one and only one car? Some people do, because the fit feels so right, but most of us try out more than one.
5. Check out the therapist’s experience. How long has this person been in practice? What kind of people does he/she mostly work with? Individuals? Adults? Children? Couples? Families? And what kind of work does he/she mostly do? Talk therapy? Medication management? Body work? Hypnotherapy? Make sure the therapist can give you what you’re looking for.
(Note: In my case, I have been seeing patients for 15 years, and I have been licensed for 10. I primarily see adult individuals. I also teach and supervise other therapists. You can go to my “About Me” page if you’d like to know more.)
6. Pay attention to the therapist’s areas of expertise and specialization. If (s)he has a list of 20 or 30 items, it’s a fair bet that none is a true specialization. That’s not to say that the therapist has no experience at all in these areas, only that everything can’t be an area of intense specialization. So find someone who truly specializes in what is bothering you.
(Note: My specialties are depression, anxiety disorders, personality disorders, relational issues, and men’s issues.)
7. Don’t put too much stock in reviews on Wellness, Health Grades, Yelp, or any other review service. Unlike other doctors, who can ask patients for testimonials, psychotherapists are bound by laws of confidentiality and cannot legally seek testimonials or reviews from present or former patients; as such, they are far less likely than other doctors to have patient reviews, either good or bad. In fact, many psychotherapists have no reviews at all.
8. If concerned, find out if the therapist has any official complaints or licensing violations. Some therapists have violations, even repeated violations, but that information will certainly not be published on their websites, where they advertise themselves as “safe” and “effective.” To help you get the facts, the state of California has set up a website: www.breeze.ca.gov. Go to the site and click the button for “License Verification.” Enter the therapist’s name. You will see his/her current license status, and if you scroll down to the bottom of the page, you can find any current or past violations and complaints.
9. Make sure the fee and schedule arrangements work for you. Psychotherapy tends to be a lengthy process, so you need to make sure you can afford to stay in it and not feel either cash-strapped or resentful. If money is tight, you might want to find a lower fee alternative. There are therapists at every price level here in Los Angeles. On the other hand, experienced, highly trained doctors do tend to be expensive, and if you have the funds, they are probably worth the increased cost.
10. Check to see if your insurance will cover any of the costs. If you have an HMO or an EPO, you can only use “approved” (in-network) providers. If you look on your insurance company’s website, you will find that company’s approved providers. If you have a PPO or a POS, on the other hand, you can use any provider you want (although you will generally pay more for out-of-network providers.) The obvious question would be: why pay more for an out-of-network provider? The answer is that these people tend to be the more experienced, better trained, and more in demand. In fact, many therapists, when they get enough clients, leave the insurance companies (because those companies pay less than the therapist could make otherwise.) That’s not to say that in-network providers are bad. Only that, as a rule, the more experienced people are not on insurance panels.
Once You Are in Treatment
11. Assess the process as it moves along, rather than by immediate results. Be wary about feeling better right away. Most people feel a bit worse before they begin to feel better, in response to the fact that therapy tends to put you in touch with thoughts and feelings from which you may have been protecting yourself. That is not to say that you shouldn’t feel a sense of relief that you have found someone who can truly connect to your emotional experience, or that you shouldn’t feel hope that therapy will help you. However, if you find all your pain magically disappearing in a short period of time, it’s likely something important is being overlooked.
12. Observe the interaction between you and your therapist over time. Does the connection strengthen? Does trust grow? Do you find yourself becoming more open and vulnerable, or are you shutting down? While there are plenty of moments of pulling away (it’s a natural part of the therapeutic process) the general movement should ultimately be towards greater expressive freedom and expansion of your emotional horizons.
13. Make sure you can talk about everything you want. There are NO topics that should be off-limits. EVER*. This includes both money and sex. Answers like “We don’t talk about that here” are signs you are with a person who is either very frightened or not well trained. Especially important are your reactions to your therapist. Make sure that person can hear whatever you are feeling about him/her and has the courage to be open to your criticisms and comments.
(Note: certain topics, such as child abuse or active suicidal intention, may trigger mandatory action on the therapist’s part. However, that is still not a reason not to discuss them.)
14. Ask yourself if your therapist is being open and forthright with you about what is happening in your therapy and why. Remember, you’re the consumer. It’s your therapy, and you have the right to have processes and procedures explained clearly, thoroughly, and without impatience or condescension. That’s not to say that the therapist will, or even should, answer every question you ask. He/she has the right to withhold personal information, and he may also choose, in the service of your therapy, to explore your feelings before answering. If something is really bothering you, however, you may very well need to have an open, frank discussion where answers are required.
15. Ask yourself if your therapist is really listening to you. This concern pertains not just to the feelings about the events in your life, but also to your concerns in the therapeutic process itself. If you you’re your therapist about something that bothers you in treatment, does he/she pay attention and take up your concern, or does he/she ignore, dismiss, or treat your issue lightly. Your feelings, not only in therapy, but about therapy, are serious matters and should be treated as such. Always.
16. Become Proactive. Ask yourself if you’re doing what you need to do as well. Keep in mind the fact that psychotherapy resembles a physical fitness model as much or more than it does a traditional medical model. That is, it is less about coming in with a disease and getting a pill and more about doing the work over time, like lifting emotional weights, so to speak. So the more you do it (longer, more frequently) the better off you’ll be, generally speaking. Again, it’s like going to the gym. You can’t come in once every other week and expect to get real results.
17. Give your therapist feedback. Express what you like and don’t like to ensure that your therapy is specifically tailored to your needs. Research has shown that treatments adjusted according to ongoing feedback have greater success than those in which feedback is not a part.
(Note: I incorporate regular feedback into the treatment itself as part of our ongoing therapeutic dialogue, and I am interested in all your feelings about our work together, including, perhaps especially, the negative ones.)
18. If you have any questions your therapist can’t answer, or if you are experiencing issues with the therapy that don’t seem to be getting resolved, get a consultation with another therapist. You can do this on your own, and you can also ask your therapist to go with you. There are no rules preventing you from doing this. The bottom line is this: it’s your therapy, and you want it to work. Don’t settle for anything less!
Dr. Michael Pariser