How do you choose a therapist?

by Lynn Fitz-Hugh, M.S.

Washington State Licensed LMHC Psychotherapist

Especially if you have never had therapy before, it is confusing to figure out among all the names in the phone book or cards on a bulletin board how to choose a therapist or from whom to get a referral.

Even if you do not choose me, here are some things that I think are important to take into account:

Training:

In the state of Washington, anyone with any level of education or experience can be registered as a therapist, or can advertise as a therapist. So you may prefer to see that your therapist has completed a master's level program in counseling which means that they will have two-and-a-half to three years training. (They also will have an "M.A.", "M.S." or "M.S.W." degree after their name.) This typically includes an internship, which means they had experience working with clients under supervision. You may also want to be sure that the person is state licensed. This means that they had to spend over 3,000 hours with clients under the direct supervision of someone with more experience. They have also passed a nationally recognized test.

There are 3 kinds of licensure in the State of Washington: LMHM (Licensed Mental Health Counselor), LMFC (Licensed Marriage and Family Counselor), or LSW (Licensed Social Worker). The difference between these three is essentially the kind of master's program they were in before they met the qualifications for licensure. There are, of course, other kinds of therapists, like a Psychiatrist or Psychologist, and in other states where licensing laws are different there may be other credentials as well. It really helps if you are going to tell personal things about yourself to another person that they have a theoretical and ethical way of thinking about you and that their work has been observed by others.

Experience:

Where have they practiced, for how long, and is their experience relevant to the issues you want to work on? While it may not be necessary to get someone who specializes in the issue you want to work on, it is helpful to know that the therapist has worked with this issue before and feels they have adequate training and experience to help with this issue.

Modality or way of working:

Trained therapists are taught different theoretical ways of working and techniques that go with that way of working. For example I draw upon Gestalt, object relations, and the thinking of Harvey Jackins (founder of Re-evaluation Counseling) to work with individuals. If a term the therapist uses to describe their work does not mean anything to you, ask them to describe it to you. For example: Object-Relations means that I look at how family of origin and developmental impacts have effected you. Gestalt is an approach which encourages people to be in touch with what they feel in the here and now and uses a variety of techniques to help people get in touch with their feelings. Re-evaluation Counseling also says that our early experience creates patterns that may hold us back and that "discharge" or a catharsis of feelings helps one move into the present in one's thinking and out of the pattern. E.M.D.R. (Eye Movement Desensitization and Reprocessing) is a highly researched process, created by Francine Shaperio, to help people process trauma. Highly effective with Post Tramatic Stress Syndrome (P.T.S.D.) and phobias. This method duplicates what we do in R.E.M. sleep (dream state) while we are awake and have our conscious attention on our traumatic memories or fears. This method is very effective at reducing fears, nightmares, flashbacks, anxiety and avoidance responses.

Most important: are you comfortable with this person?

Studies show that it is not the technique of the therapist or a type of modality that predicts success of therapy, but the chemistry between the therapist and the client. It is important, therefore, that on a gut level or intuitive level you feel comfortable with the therapist. Your first appointment may be just a time of seeing if the chemistry feels right between you and the potential therapist.