Episode 055: How to Pick a Good Therapist
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
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Article Authors: David Puder, MD, Victoria Burghart, Valerie Pooudomsak
There are no conflicts of interest for this episode.
Why Is Finding A Good Therapist Important?
Some form of therapy, in combination with pharmacologic therapy, is often the most effective treatment for mental health disorders. Let’s use depression treatment as an example: according to the National Center for Health Statistics, approximately 12.7% of people over age 12 had taken antidepressants for various disorders, including depression, within the last month (NCHS Data Brief No. 283, 2017). Studies comparing antidepressants and therapy have shown they are similarly effective; some researchers conducting these studies have made sure they compare medication to therapists with experience, who also meet best practice standards. A good example of this can be found in this 2005 study conducted by DeRubeis et al.
Working with a good therapist often requires fewer sessions than other therapists to see improvement; in contrast, working with a therapist you don’t connect with, or with inadequate training, may require an extended number of sessions (Okiishi et al. 2003). People that see effective therapists are more likely to recover or partially recover, whereas those that work with a “bad” therapist are more likely to see no change or an increase in symptoms (Okiishi et al. 2006).
How Will I Know If I’ve Found A Good Therapist?
Fortunately, Len Jennings and Thomas Skovholt, both clinical educators and licensed practicing psychologists, had the same question: What are the characteristics of an expert therapist?
To answer this question, they asked therapists in their community to nominate those whom they felt were “master therapists,” those with considerable expertise and high rates of client success. After extensively interviewing 10 of these “master therapists,” they found that the therapists’ beliefs about what traits are essential in a good therapist fell into three categories:
Cognitive characteristics
Emotional characteristics
Relational characteristics (Jennings and Skovholt 1999). (an article I highly recommend reading!)
Cognitive characteristics of good therapists
The definition of the word “cognitive” is relating to or involving conscious intellectual activity, including thinking, reading, and remembering. These characteristics relate to how the therapist approaches their work from a logical or clinical perspective.
Good therapists have a hunger and thirst for learning. They actively seek out new information, therapeutic techniques, and opportunities to discuss their work with other therapists. They embrace the idea that “the more you know, the more aware you are of how much you don’t know,” and are never quite satisfied with their current mental resource bank.
Good therapists grow through their rich life experiences, through their own mentors and therapists, and can utilize their experience in the service of others. They have a variety of rich and sometimes difficult experiences through which openness and a learning mindset utilize as ways to grow. Experience as a therapist is not enough. The master therapist must be open to feedback, growth, and process life’s events to be of help to others.
Good therapists value and thrive in the complexity and ambiguity of the human condition. They don’t settle for a simple, yet incomplete, answer. Instead, they drive into the fray without fear of difficult issues with multiple causes and multifaceted solutions. They are drawn towards ambiguity and complexity and continually open to learn and discover.
Emotional characteristics of good therapists
In this context, “emotional” refers to how the therapist navigates their own emotions in work settings. These characteristics describe how they modulate their internal emotional experience.
Emotional receptivity (open to feedback, self-aware, reflective, and non-defensive) is an important indicator of a good therapist. These therapists are acutely aware of their own emotions and reflect on them. They approach any feedback, especially negative feedback, with a non-defensive attitude and openness that validates their client’s feelings and concerns. Their own therapy and supervision gives them continued increased insight into their own experience and the experiences of others.
Expert therapists know how their own emotions impact their work and how they relate to their clients. They spend time taking care of their own emotional health. Most meet or have met with their own therapist on a regular basis; they’ve put in their own work. Their home life and work life are congruent with each other (they are not two different people). They know it is important to maintain their own emotional health, and do so through exercise, therapy, mentorship, and spirituality.
Relational characteristics of good therapists
The relational characteristics describe how the therapist interacts with their client, perceives and interprets their client’s emotions, and responds to them. These characteristics describe how the therapist connects with others.
Good Therapists have strong social skills and excel in interpersonal communication. They have the ability to relate to others and create a safe environment for their clients. They have a clear and genuine interest in people. If you ever go to a therapist that seems uninterested or bored, either they are interested and just don’t outwardly appear to be so, or you’re seeing the wrong therapist.
The strong relational skills and warm, caring environment created by excellent therapists is often related to their personal background. Many are from families where they developed listening and observational skills and were in a position to care for others (they were the family therapist from a young age). Others are sensitive and compassionate because of their own experiences and personal wounds.
Good therapists focus on forming a strong therapeutic alliance and believe that the partnership between client and therapist is the source of change. They believe in their client’s ability to make changes and will to do even when it’s hard. These therapists use their relational skills to challenge their clients and keep them moving forward while providing them with a safe and supportive environment. They develop their situational judgement and use it to time their interventions. Master Therapists are not afraid of experiencing or witnessing strong emotions or being present during intense and difficult moments.
A Few More Things To Keep In Mind…
Sometimes you get what you pay for. Sometimes, good therapists can charge cash, and because of their reputation, they remain capable of living off what would seem like a higher feel than one might expect. A busy city attracts more therapists who do cash pay. In Santa Monica for example (where I went to the NCP for 2 years), the fee was anywhere from 150-250 for a psychotherapist per hour, and 350-600 per hour for a psychiatrist. Rates vary depending on location. I often tell patients to look at who is contracted with their insurance first. We look at the list, and consider which would be the best fit. If they have financial means, I often encourage them to see the best therapist possible. It still surprises me that many people will pay 30k for a detox center for 1 month (or a car), but not 30k over the course of 2-3 years seeing an excellent psychotherapist. The amount of benefit that 1 year of therapy will often lead to a strong ripple effect for the rest of your life.
Do other mental health professionals recommend them? Ask around. Mental health professionals form their own community. They work with others and are often aware of professional reputations. If your psychiatrist has been practicing in the area for a while, ask them for recommendations. If you have been seeing a therapist that you like as part of an intensive outpatient program or a community-based program, ask if they take on clients outside the program. If they don’t take on clients, ask if they know of any good therapists in the community.
Don’t be afraid to try going to a new therapist if you don’t “mesh” well with the one you’re seeing. If you’ve been to a therapist for several sessions and you don’t feel connected or uneasy with that therapist, don’t be afraid to look for a different one. However, I recommend talking to your current therapist first about concerns you have and seeing how they respond. If they are open and learn from it, that can be very connecting. Be up front with them about your feelings of being disconnected or uneasy and see what happens. Once your therapist is aware of your concerns they can take steps to make you feel more connected or comfortable. (**Within reason of course, therapy is NOT supposed to be a comfortable experience. If you feel relaxed the whole time, it’s time to reevaluate whether or not you’re getting anything done during therapy sessions.)
Be prepared to work hard. Once you find a good therapist they are going to push you out of your comfort zone. They’re in it for the long haul to work with you through the issues that you’ve been avoiding. Remember, we avoid things that make us hurt for a reason, but sometimes the best way out is through.
Conclusion:
Finding the right therapist can be difficult and challenging. I hope that from reading and listening to this episode you can find the right fit for you. I also highly recommend reading Len Jennings and Thomas Skovholt’s article found in the resource library: here.