The Minefield of Choosing the Right Therapist

When I was diagnosed with Complex PTSD five years ago following a breakdown and hospitalisation I was set on a road to recovery laden with potholes I could never have envisaged. It was for a start one step forwards, two steps back in everything I did. I would have one good day then weeks of flashbacks and dogged depression that just would not lift. The Clinic I was admitted to assigned me a Psychiatrist but as I went through stages of recovery it was obvious to be that we were not a good match ! He was the ‘five minute consultation type, that wrote the whole time you were there and never once looked at you’. We were not going to make any headway so I set about trying to find a suitable Psychiatrist that I could work with. Oh boy little did I know. They as a profession did not really like being evaluated by their patients for suitability. Some were down right recalcitrant about answering my questions of the modality of their treatment regimes. I think as patients we have every right to ask questions and should expect informed answers. After all we are paying the bills. Choosing the right kind of therapist is vital, bit it your Counsellor, Psychiatrist, Psychologist, Psychotherapist, Hypnotherapist or whatever form of therapy you feel is right for you or is recommended as suitable for your presentation.

Depending on the type of issues or concerns that are bringing you to therapy, you may need information to help you choose the type of therapist that will suit you best.

There are a number of therapists who have specialised in certain areas or types of therapy and may be better able to help you achieve your therapy goals. Location will be another point to take into account when seeking a therapist.  You may have to travel some distance to find a practitioner who can meet your specific needs.  Some counselling may be available via the internet, for example using Skype, although face-to-face counselling is viewed as the best way to develop a strong therapeutic relationship.

It is recommended that prospective clients choose a registered Counsellor,Psychotherapist and Psychiatrist.  Registered practitioners have to undertake ongoing professional development and to receive professional supervision for their counselling or psychotherapy work. This is all crucial to the care they provide you.

How will I know if a therapist is right for me?

This is a difficult question, but an important one nonetheless. For those who have the good fortune of finding a suitable therapist first time, this question may not even arise. For others however, it can be quite a different story. The search for the ‘right’ therapist is not unlike searching for the ‘right’ accountant, doctor, builder or hairdresser. Whether it be entrusting our finances, our health, our home or our hair to another person, few people would settle for just anyone.

However, many of us are seasoned procrastinators. We rarely seek anything unless we perceive or feel an immediate need for it. How many people do you know who can say that they have found a therapist but not yet engaged their services? As it happens, most people wait until they are suffering intense emotional pain or in the midst of a crisis – and need help right away. Such a time is probably not the best time to choose a therapist.

When discomfort is extreme, there is a great deal of pressure to find relief – and find it fast. These less than ideal circumstances can make it difficult to focus our thoughts and make sound judgements.

A typical scenario: After struggling for an extended period of time we finally ‘hit the wall’. Desperate, we make an appointment with the nearest and first available therapist. At the initial meeting we discover that the therapist operates on a wavelength that is not compatible with our own. We sink into despair and disappointment. Unaware of alternatives, some of us opt to persevere – albeit half heartedly. Or we might become disillusioned and give up on the idea of therapy altogether. Neither of these outcomes is satisfactory; there is little joy in settling for mediocrity and perhaps even less in allowing ourselves to become jaded.

Factors that influence the client-therapist relationship

There is no universal fail-proof formula for choosing a therapist, but this needn’t discourage us. Many choices in life require discernment and some deliberation. We identified ten factors that may impact on the therapist-client relationship. This list is by no means exhaustive, and is included here only to encourage you to reflect on your own experience.

1) Atmosphere. Therapists’ rooms vary a great deal. And, though we are not all equally sensitive to our surroundings, we are all affected; just differently. For example, some people may feel constricted in a small space; whereas others may find the same room cosy and preferable to a larger one. Brightly coloured walls may be intimidating to some and inviting to others. Some of us are comfortable sitting on the floor; others would rather sit on a chair. These sorts of things will contribute to overall impression. Still, it is the quality of presence engendered by the therapist that ultimately sets the scene.

2) Gender. Does it matter whether the therapist is male or female? Gender won’t be a critical consideration for everyone, but some of us will gravitate towards a particular gender. There are no rules here, just preferences.

3) Age. Though birthdates are part of the therapeutic equation, they need not play a big role in relationship dynamic. Some people may be apprehensive about a therapist who is several years younger or older, others may be delighted by an age difference.

4) Cultural background. Persons from vastly different cultural contexts may encounter some difficulty understanding each other, even if diversity is warmly embraced.

Although I try to be universal in thought, I am European by instinct and inclination. -Albert Einstein

On the other hand, some people believe it is possible for us to simultaneously acknowledge and transcend our cultural heritage.

5) Philosophical orientation. No two people share exactly the same views and values, we are each one unique. This truth doesn’t seem to prevent us from carrying around the belief that others are or should be just like us. Many of our assumptions operate underground; this lack of awareness makes it difficult to see our biases ‘at work’. Do you want your therapist to be a kindred spirit? In what way might this impact on your expectations around how therapy should proceed?

6) Personal attitude. Recent research indicates that personality has a significant sway on how we evaluate therapy. If we don’t like the person we perceive a therapist to be, there is little chance we will want to engage this person on a meaningful level; especially if the aversion is particularly strong. This response may be tempered however, by a belief that the therapist can help. Does the therapist instill a genuine sense of hope?

7) Physical appearance, manner and voice. Whether we want to acknowledge it or not, the judgements we make about another person are influenced by how we perceive his or her appearance, body language, and voice quality. When you are greeted by your therapist in person for the first time, do you find yourself being drawn forward or wanting to pull back? As we get to know someone, it is not uncommon for our perceptions to change. Someone who appears quite ordinary in the beginning may become beautiful in our eyes once we’ve spent time in their company. Of course, this can happen the other way round.

Distance tests the endurance of a horse; time reveals a man’s character.

8) Therapeutic approach. There are so many schools of thought now; the myriad possibilities can be daunting. Still, most of us find that certain modalities and methods appeal more than others. Depending on whether we are motivated by strong feelings, a hankering to make sense of our experience, or swayed by the pragmatism of what works, we tend to lean towards a particular style. This may change from time to time; what appealed to us before may not be what we want now. There has been much research and even more written on the processes of learning. However, insights and shifts often occur when we least expect them, and in ways that defy explanation. The Types of Therapy reference page on this site provides a summary of 50 contemporary approaches in counselling and psychotherapy.

9) Academic accomplishment. A practitioner’s level of education may figure very highly for some and not at all for others. While a therapist’s university degrees and specialised training are important professional prerequisites, they offer no guarantees as to personal competence or compatibility.

10) Availability. Practical matters, like location, finding a time that is mutually convenient, and negotiating an acceptable fee may seem relatively minor concerns, but proximity, flexibility and/or affordability can turn out to be major deterrents.

‘Good therapy’ as a concept is meaningful because sometimes, therapy is not so good. Exactly how each person determines where on the good – not so good continuum a moment in therapy falls continues to baffle even the keenest of minds. This doesn’t mean we should dismiss our yearning to understand. After all, it is this very quest that imbues life with wonder and magic, from one moment to the next.

Asked about the difference between a well-made work and a masterpiece, Nadia Boulanger (a French composer, conductor, and teacher who taught many of the leading composers and musicians of the 20th century) replied,

“I can tell whether a piece is well-made or not, and I believe that there are conditions without which masterpieces cannot be achieved, but I also believe that what defines a masterpiece cannot be pinned down. I won’t say that the criterion for a masterpiece does not exist, but I don’t know what it is.”

My own personal experience was I found an excellent Psychiatrist who manages my medications and Clinic admissions in times of crisis. He referred me to a genius of a Psychotherapist who I see twice a week who practices EMDR. (Eye Movement Desensitisation and Reprocessing). Click on the link to read more on this fascinating and revolutionary therapeutic practice. I am still struggling with self-harm and suicidality but am in a much better place than I was five years ago. My family is coping with living with my Complex PTSD better and I am functioning on a day to day basis more efficiently. Returning to work yet is not an option due to the flashbacks and the need for supervision. Keep looking for good Therapists they are out there.

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