I am often asked how to go about finding a psychotherapist, so I sat down last month to write a piece on the matter only to find that I'd been scooped by Daniela Tempesta in an excellent post detailing five important considerations to keep in mind. Although I enthusiastically agree with each and every word she wrote, I am proposing five critical guidelines to bear in mind in addition to those advocated by Ms. Tempesta.
Beginning with a recap of her five suggestions, first, it is essential to ask people who have your best interests at heart for names -- family, friends, physicians, teachers, and the like. Second, find someone who has experience and talent in working with your particular problems. Grief, anxiety, depression, relationship problems, occupational unhappiness, couples work, adolescent turmoil, panic attacks, substance problems -- few psychotherapists have training, experience, and expertise in all areas. Third, explore the Internet for any information that may be available, especially if the individual has put up a website. But be careful. Although the Internet can be useful in acquiring factual information about training, experience, and approach, web information alone is far from sufficient -- unless, of course the information is decisively negative. Fourth -- and most important, in my view -- interview the therapist to gather impressions of style and personal chemistry. Be sure to have a list of questions to ask: How do you work? What is your training and experience? What is your personal background? Fifth, trust the "relationship over the resume." Gold-plated academic credentials or a list of publications very often do not coincide with clinical talent. I would go further to say that if you do not have a strong positive feeling after a single session, you probably should keep looking. A single inspiring and hopeful session does not guarantee a successful psychotherapy, but without it, move on.
Building on Ms. Tempesta's observations, I urge the following considerations to be kept in mind:
1. Cost. Understand that private psychotherapy is often expensive, but that there is a wide range of fees based upon degree, experience, how well established and successful the psychotherapist is, and whether they are willing to discount their fee. Training clinics in university settings can be a very good, affordable option. More expensive often does not mean better. Conversely, a very low fee can indeed be a warning sign. People with questionable legitimacy can throw up a shingle as a coach, counselor, or substance abuse expert. Regarding insurance coverage, be very certain to read the fine print because the headline numbers are almost always misleading. What is the cap on a "usual and customary" fee? Is there an annual limit to number of sessions? What is the discrepancy between "in-network" vs. "out-of-network" reimbursement? Although this can be awkward, I discuss affordability in the first phone contact because nothing is worse than a person sitting down, telling her story, making a great connection in the first session, only to learn that the fee is beyond her reach. Wrenching for everyone. If the therapist does not bring this up before your initial meeting, you must.
2. Gender. Does the sex of the therapist matter? In a post by Dr. Michael Blumenfield, the author discusses this question in terms of capacity for empathy. I concur with his conclusion that matching gender in no way is required for an empathic connection to be achieved. My observation touches on another aspect of gender. To illustrate, I recently spoke with a woman who thought she should see a male therapist because she'd always been comfortable with men while feeling decidedly uncomfortable with women. She also had the name of a woman whom I know to be a superb psychotherapist. I suggested to her that I'd welcome the opportunity to work with her, but that she might consider seeing a woman. In addition to finding whatever help she was seeking, if she felt sufficiently comfortable with her after an initial session, she might then be able to sort out her discomfort regarding women with a woman, thereby potentially having a new and positive experience via the therapeutic relationship that could be replicated in her life. Two birds, one stone.
3. Boundaries. If someone is looking for psychodynamic, insight-oriented psychotherapy, although it is a terrific idea to get names from trusted sources, it is preferable not to see the same therapist as a close friend or family member. When seeking insight into a repetitive pattern or some other serious issue, it is optimal for the relationship to be fresh and free of potential conflicts of interest to ensure the essential atmosphere of privacy and sanctuary. Such conditions may be less relevant when seeking coaching or behavior modification.
4. Boldness. Although it is critical to feel a sense of sanctuary and support in the therapeutic relationship, much more is needed for insight and self-awareness to be achieved. It's not just about warm and fuzzy hand-holding if one is to get the most out of the experience. Akin to the idea of tough love, the art of psychotherapy entails the ability when necessary to lead someone to look at themselves and their potential role in longstanding repetitive patterns, but to do so in a sensitive, non-confrontational manner in which the person does not lose confidence that the therapist has his or her best interests at heart. Boldness is not recklessness. When this goes well, the atmosphere of sanctuary and support is enhanced, not threatened. When therapeutic boldness is lacking, the risk is reinforcing a sense of victimization by a cruel world against which one is helpless and has no control or choice. It is a relatively rare therapist who has the talent to push someone beyond what might be comfortable to explore in themselves, but this is a quality to look for.
5. The first step is the hardest step. The notion of acknowledging the need for professional help and calling a perfect stranger regarding matters that are deeply personal is a very hard thing to do. This does not make all that go away, but be well aware that the first phone call for virtually everyone is daunting. Similarly, a disappointing initial meeting can be very discouraging. Remember, assessing chemistry was the objective in the first place. I urge you to keep trying. When psychotherapy goes well, new possibilities open up and life fundamentally changes.