CHOOSE THE RIGHT THERAPIST © 1999 Ellen Oler

I am frequently asked by potential clients to describe how I work. they are hoping to find some indication that will let them know if I am the right therapist for them

After 22 years as a therapist, some experience as a client and countless professional relatiohships with other therapists, I have some clear thoughts on how to choose your therapist. And an "educated consumer" of psychotherapy services, like anything else, is one who tends to take more responsibility for their own experience, I hope this will help you choose your therapist.

Following is a series of Frequently Asked Questions about how to choose your therapist and my responses to them. Keep in mind as you read them that my answers are coming from personal experience and are my own professional and personal opinion. I am not summarizing research studies, unless specifically stated. If you want to know more about any particular area, follow the links to get more in-depth information and/or ideas.

WHERE DO I START?

If your situation is an EMERGENCY immediately call your EAP, insurance company's 24 hour mental health phone number which is usually on your insurance card, call your local hospital emergency room, or 911. If it is not an emergency, continue reading.

Many people today have health insurance or are part of an HMO which provides counseling or therapy. In addition most people who are working or are covered by insurance through their workplace have access to an Employee Assistance Program (EAP). If you have either of these resources, start there. An EAP is especially helpful since the people who work with EAP's are there specifically to help you clarify exactly what your needs are and identify all resources that may be available to you, including, but not limited to therapists in your area, self-help or professionally run support groups, etc. Their job is to either help you resolve your problem themselves, usually within 1-6 visits or to refer you to the most appropriate resource to meet your needs. EAP services are generally free or available for a very low co-payment. An EAP professional can take much of the legwork and guesswork out of finding the resources you need. But, while every effort is made to match you with a therapist they think you will work well with, realistically it is still up to you follow the steps covered below in determining for yourself if the "fit" is right for you.

A word on insurance companies, HMO's and PPO's (Preferred Provider Organizations): While your choice of therapists is limitted to their list of participating providers, this does not have to mean that you have NO choice. You can still screen the therapists on their list using the guidelines covered on this Web page.

If you do not have insurance or an EAP, contact your local Mental Health Center or Family Service Agency, Professional organizations such as your local chapter of NASW (the National Association of Social Workers), APA (the American Psychological Association), your minister, priest, rabbi, etc. These professionals can often suggest other resources or a local self-help group that deals with the issues confronting you.

ONCE I HAVE SOME NAMES, HOW DO I FIND THE ONE WHO IS RIGHT FOR ME?

Before calling anyone, sit down and think about a few things. (NOTE: If your situation is an emergency, immediately call your EAP, insurance company's 24 hour mental health phone number which is usually on your insurance card, call your local hospital emergency room, or 911.) If it is not an emergency, answer these questions for yourself before calling anyone.

  • what hours are you available to meet with someone? (This may sound superficial as a first question, but I can't tell you how often I have come to the end of a discussion with a potential client about problems, my experience, style and approach, etc. only to find that I cannot accomodate their scheduling needs. That can be very frustrating and discouraging. So be clear about these needs up front.
  • what are your financial needs and resources? ie:
    • do you have insurance? if so who is the provider? what is your co-payment?
    • what can you afford if you will be paying out of pocket? When considering this, think about how much this is worth to you. You would probably spend $50-$100 an hour for a plumber, how much are you worth? Do not expect to spend less on a therapist in private practice and many charge more depending on their degree, geographic area and experience. However, the most expensive is not necessarily the best. There are many agencies, clinics or training institutes offering therapy on a sliding scale based on income. If you go this route, it does not mean you are getting an inferior service. There are many good providers in these settings and it is more important that you be realistic about what you can afford, rather than adding financial stress to your current list of problems, or ending your therapy before you are ready because of financial pressure.

  • what is the problem you need help with? While you will not necessarily go into the details of your problem on the phone, you need to be as clear as possible about what specialties your therapist should have. There are many problems that any well-trained, experienced therapist should be able to help with, but some really need particular expertise. And many therapists will say they can help you with any problem. I have heard many say they treat all ages, individuals, couples, families and groups and work with any problem. Be suspicious if you hear this. While they may have some familiarity with a wide range of problems, it is my experience and belief that we are all better at some things than at others and I would rather have someone tell me "I specilaize in XYZ, but I do not do ABC." If your problem has to do with any of the following, you should be especially concerned about special training and expertise:
    • substance abuse in yourself or a loved one
    • domestic violence
    • trauma, including experiences related to 9/11, have been a victim of violence or traumatic loss of a loved one, or sexual abuse
    • child or adolescent treatment
    • relationship issues [This is a particular concern of mine. Since I received training in Imago Relationship Therapy (LINK) - an approach to understanding and working on committed relationships - in 1990-92 and have specialized in treating couples since then, I am increasingly convinced the the issues that come up in the context of a relationship are unique. Many therapists believe that if they have training in family therapy and individual therapy these theories and therapeutic approaches can be applied to couples. I do not agree. And I have seen many couples who have seen other perfectly competent therapists before me and have not been helped, have even been hurt.

SCHEDULE AN IN-PERSON CONSULTATION:

Once you know what you are looking for, call a few of the people on your list. You will probably get an answering machine. Leave a clear message with your name (pronounce it clearly - spell it) your phone number (speak slowly and clearly) some good times to reach you, and who referred you. If you do not hear back within a day or, at the most 2, call again. Answering machines are fallible!

When you talk to the therapist tell her what you are looking for and ask if she would see you for a consultation. Be sure to ask if the consultation is free or not. Some therapists do provide a free initial consultation, most do not.

You should be able to get a feel for the therapist during this phone contact. If you feel uncomfortable or do not like the way he has responded to your questions, you may want to move on down the list. On the other hand, it does happen that you have a very different experience of the person when you are with him. The most important thing is that you get to an in-person consultation with anyone you are considering working with. It is only when you sit in the same room with someone that you can really tell how you feel about sharing your most personal stories, struggles and needs with him or her. While it is natural that it take some time to feel really comfortable with someone, I am convinced that you can tell in the first visit whether you feel safe with a particular therapist, whether you feel confident that he can help you. Trust your gut. And if for any reason you have concerns about working with someone, try discussing your concerns. See how the therapist responds. Therapy, after all, happens in the context of a relationship . If the therapist does not relate to you in a way that you feel you could trust, it may not be the right match. Even if the therapist came highly recommended, she may have been fantastic for your friend, but you just don't click. Trust your instincts. Studies show that the most important factor in the success of therapy is the quality of the relationship between therapist and client regardless of approach.

If you don't feel comfortable or are not sure and would like to look further before deciding, tell the therapist and do not schedule another appointment yet. If you do and later change your mind or want to look further, please be sure to let the therapist know right away. She will appreciate the concern for her time.

WHAT DO I DO DURING THE CONSULTATION?

Tell the therapist why you are seeking therapy at this time. He will probably ask you some questions to help him understand your situation. The questions will most likely focus on current symptoms or manifestations of your problem, precipitating events to your seeking help at this time, relevant personal and family history, current or past use of alcohol or drugs, and an assessment of risk of harm to yourself or others.

You should also feel free to ask questions. For example, once you have described your concerns and why you are seeking help, ask the therapist how she would proceed to work with you on these issues. By her answers you will be able to get at least an initial sense of her style and approach. If you want to know more, ask about training and theoretical orientation. And if you do not understand his answer, ask him to tell you what that means in terms of the way therapy would proceed.

If you are feeling comfortable at this point and think you might want to proceed with this therapist, you might want to discuss goals. What are your goals for this therapy? Would she agree based on what you have told her? Would he suggest other goals too? (NOTE: If you are covered by a managed care insurance plan your therapist will have to spell out the treatment goals and plan in order to have treatment authorized beyond the first few visits. Ask him to include you in the process of formulating the goals and evaluating progress as you move through the course of treatment. All of this comes under the heading of taking responsibility for your own experience and therapy is most effective when the client approaches it with this attitude. If the therapist is put off by this, be suspicious. And, if you have trouble being this assertive - for many people that is an issue for therapy - you can use the therapy process as an opportunity to practice being more assertive.)

WHAT ABOUT CONFIDENTIALITY?

Confidentiality is one of the most important aspects of therapy. It is one of the things that distinguishes therapy from other helpful relationships. The fact is that the issue of confidentiality used to be very simple and clear cut - the only time it could be compromised was in situations where a potential for harm existed -harm to you or someone else. While this is still the bottom line standard, the reality is that in the age of managed care and computers, it is more complicated than that.

While the insurance companies, managed care companies, HMO's, etc. promise confidentiality, the fact is that providers of treatment are required to document diagnoses, problems, treatment, medications, and anything else that might be relevant to determining "medical necessity" - the standad used to evaluate whether they should pay for continued treatment. The position of most of these companies is that if you are in therapy for "personal growth" and your symptoms do not indicate that the therapy is "medically necessary," go right ahead, more power to you, but they don't have to pay for it. And to make that determination, they ask the therapist to furnish them with the information listed above. Thus, your treatment is not truly confidential. Now, that does not mean that if your boss or your mother or your wife calls and asks if I am seeing you in therapy, that I would or even could answer the question. Any licensed therapist would not unless it was a case of imminent danger to you or someone else. And if she did, she could lose her license. So, therapy is still guided by the same principles of confidentiality as it always has been. If you are concerned about this, ask the therapist during your consultation how he handles confidentiality.

CHOOSE YOUR THERAPIST

I have covered all the main issues that I believe pertain to the process of choosing the right therapist for yourself. After going through the process described above, go ahead and choose who you would like to work with. And then give the therapy a chance to work for you. If after some period of time - be realistic about how long to give it - you are not comfortable with what is happening, talk to your therapist about it. And if after talking about it and trying to work it through you still find yourself to be uncomfortable or dissatisfied, have another consultation. No one should spend months or years in therapy with someone they don't like or who isn't helping them.

Therapy can and should be a positive, growth-enhancing experience. You should be able to say " I really like my therapist - I really feel she is helping me" even if it is sometimes uncomfortable. I hope this information will help guide you to the right therapist for YOU so that your experience of therapy will be a good one.

- Ellen Oler, LCSW


©1999-2008 Ellen Oler. No reproduction, retransmission or web distibution without prior written permission.