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On choosing a psychotherapist (part 3 of 3)

In Part 1 of this series, we looked at the various licenses and certifications that psychotherapists hold and at some of the similarities and differences among them that are wise to consider when choosing a psychotherapist. In Part 2, we explored some of the best ways to find a psychotherapist. In this article, I will talk about some of the many approaches to psychotherapy and when it might be important to consider a therapist who practices from a specific theoretical orientation. I will also offer some ideas to keep in mind when choosing a therapist.


Different approaches

In addition to information regarding licensing and degrees, you may also see other words or letters following the therapist’s name or listed on their website. These words or letters usually indicate that the therapist utilizes a particular approach to therapy. When deciding to work with a therapist, you will want to decide whether their approach resonates with you. For example, some approaches, such as CBT (Cognitive Behavioral Therapy) or Solutions Focused Therapy can be very directive. Therapists who are directive may instruct you to do homework that will be discussed in the next session or suggest techniques designed to help you solve a specific problem. Other approaches, often called “client centered,” offer less direction. In a non-directive therapy session, the client takes the lead while the therapist provides reflection and understanding, leading to greater self-awareness and personal development. Most therapists are somewhere in the middle, utilizing their education, training, and experience to help you find your own path.

Some approaches to therapy offer certifications to document that the therapist has obtained special training in working with people who are dealing with specific issues such as addictions or eating disorders. Therapists may also train in therapeutic approaches such as Gottman Couples Training or Eye Movement Desensitization and Reprocessing (EMDR). The requirements for obtaining a certification can range from taking a few brief workshops to many years of advanced study. Other therapists take a more general approach to their professional development and opt to explore a wide range of approaches, depending on their interests and the populations they serve. Regardless of whether a therapist has sought specific training or not, all California-licensed therapists are required to obtain many hours of continuing education each year, including regular continuing education in the subject of law and ethics.

Should I look for someone who subscribes to a particular theory?

In some cases, seeing a therapist who uses a particular approach or theoretical perspective may be very helpful. For example, DBT (Dialectical Behavior Therapy) is an approach that was created to help people struggling with a diagnosis of borderline personality disorder. It makes sense for a person with this diagnosis to consider whether they should work with a therapist who uses this approach, even if they may ultimately decide to work with someone who uses a different approach. For most people, any number of approaches can be helpful.

One important consideration is whether you feel you would work best with a therapist who is or is not interactive. In other words, would you prefer to work with someone who primarily listens to you or would you rather work with someone who approaches therapy as a conversation? Often, the theoretical approach of the therapist may give you some idea about how interactive he or she may or may not be. For example, analysts tend to speak less and CBT therapists tend to speak more, with most therapists falling somewhere in between. Most therapists are happy to briefly talk about their approach in an initial phone conversation; however, there is no substitute to meeting someone in person to get a sense as to how she or he works.

Keep in mind that even the most interactive therapist may be reserved until she or he has a chance to hear your story or, conversely, a less interactive therapist may have many questions as he or she begins to work with you. As a result, it is helpful to use the first few sessions as a “trial period” to make sure you are comfortable with the therapist and his or her approach.

OK, so how do I choose someone?

If you are seeking help for a specific issue, you may decide to look for a therapist who has experience in working with that issue. It may seem strange to suggest that you may want to look for a therapist with specific experience, rather than recommend that you should. There are two reasons for this: first, the connection you feel with your therapist is almost always the most important factor to consider. While there are some exceptions to this rule, the research shows that a therapist with whom you feel comfortable will generally be the most helpful to you, regardless of his or her theoretical approach. The experience a therapist has working with your particular issue is important, but it may not be helpful to you if you do not feel comfortable with the person. Second, depending on the therapeutic approach of your therapist, the original problem that led you to therapy may take you in many unexpected directions. A good therapist can skillfully work with you regardless of which direction the path may lead—and will tell you if he or she does not feel qualified to help. In these situations, you will be offered referrals and assistance with finding the right person. While it can be discouraging to hear that a particular therapist is unable to help, it is also an opportunity to make sure that you are working with a therapist who will be right for you.

The bottom line

So whom do you call when you are looking for a therapist? For some situations and diagnoses, finding a therapist who has skills in working with your particular issue may be the most important consideration, especially if you are seeking help for a serious eating disorder, severe alcohol abuse, or domestic violence. If you are seeking help with something that is specific to a particular license, e.g., if you are interested in medications, the only practitioner who can prescribe them is a medical doctor. For most people, however, the biggest consideration should be the fit, not the license. If you don’t feel like the therapist sitting across from you is someone you can talk to, it is wise to keep looking.

Psychotherapy is part science and part art. The science comes from a variety of places, including studies that have been done using various psychotherapy techniques, and current research on the brain using imaging equipment that allow scientists to literally see the changes in neural pathways that are the result of psychotherapy. The art comes from the fact that each therapist and each person coming to therapy is unique and what happens when the two sit down together is also unique. Because of this, there is no precise formula for doing therapy or for finding the right therapist.

While all of this may feel overwhelming as you look for someone to work with, the process also holds the potential to find the person who can be most helpful to you. Take the time to narrow your list down to two or three people who sound like they might be a good fit, speak with them briefly on the phone, and then sit down with each of them and see how it feels. Once you have decided on the person with whom you would like to work, give yourself a few sessions to make sure you feel good about your decision. From there, the possibilities are endless.

Marla Cass

Marla Cass

Marla Cass, LMFT, is in private practice in downtown San Francisco where she works with individual adults and couples. Her interactive approach is informed by relational, neuropsychological, attachment, and depth perspectives. She is also a group supervisor, and leads groups for students and post-graduate interns who are in training to become psychotherapists.

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