Aug 15 2009
How do you choose a therapist?
For many people the task of choosing the right therapist is a very perplexing one. The irony is that when you are in depths of despair is probably the worst time to try to choose the right one. You are stressed and not thinking rationally and you don’t really know the right questions to ask?
I remember when I was living in the country with my parents and in the depths of depression and , my sister came up from Sydney to help me find someone local to talk to.
I’m confused
My sister who is incredibly capable on the phone found the process so confusing and I was highly impaired in my ability to navigate my way through the maze.
Where do you start?
We searched Yellow Pages under counsellors and then began ringing people to try and understand the counsellor’s background and approach. As a novice it is an almost impossible task. How do you choose between the different therapeutic approaches? How do you know if they are properly qualified when anyone can put up a shingle saying they are a “Psychotherapist”? How do you know if they have a good bedside manner?
A friend of mine, Che McLeod started an Australian website called www.GoodTherapy.com.au for exactly this reason (there is also a similar website in the UK ( www.counselling-directory.org.uk ). I have asked her to describe the process she would go through if she was asked to guide a stranger in how to find the right therapist. These are her suggestions after many years of interacting with a variety of counsellors and those seeking their services.
Choosing a Therapist
Research has shown quite clearly that for the majority of people looking for a therapist, the rapport he or she feels is influenced more by compatibility of personality, than professional qualifications, experience, age or gender.
This is not to say that the latter qualities are unimportant, indeed they are!
However, most would agree that: if you experience a strong aversion to a particular therapist, it is highly unlikely that you will want to engage in a working relationship with this therapist.
Good Therapy Australia, a not-for-profit health promotion charity, has designed a therapist profile page and directory search facility that maximises the chance of a “good match” between therapist and client.
Their website – www.goodtherapy.com.au – includes information on the various approaches to therapy. Educating one’s self about the different orientations can be helpful because what appeals to one person will not necessarily appeal to everyone.
While some therapists work primarily with dialogue – the session is essentially a conversation – others, who have trained in complementary modalities such as Art Therapy, Gestalt, Psychodrama or HeartMath; may incorporate therapeutic processes that engage us in a number of different ways.
These processes, often experiential in nature, enable us to become more aware of the emotional/physical/mental blocks that keep us stuck.
Whether you are struggling with depression, anxiety, or self-destructive patterns, what you ultimately find helpful will depend on your openness to moving beyond your present situation, and the quality of connection you create with your therapist.
To explore what is meaningful for you, you may want to participate in Good Therapy’s online surveys: Looking for a Therapist; The Therapeutic Space; Questions for Therapists.
http://www.goodtherapy.com.au/flex/surveys/253/1
Also, an article that addresses some of the issues relevant to Choosing a Therapist:
http://www.goodtherapy.com.au/flex/choosing_a_therapist_title/101/1
END OF ARTICLE
I think this provides some excellent insight and advice. I would also suggest asking the following questions after the first visit:
- Did the therapist strive to fully understand your situation?
- Did they outline a plan you had confidence in?
- Did you trust them and feel positive about returning?
A good GP can be a fantastic guide to a good therapist as they regularly hear the feedback of patients who have been referred. Another source of psychologists that have a special interest in depression and anxiety and are in your area can be found at www.beyondblue.org.au
My recommendation is that if your therapist doesn’t tick all the above boxes after your first visit you should find another. This is much easier said than done when you are feeling very low which brings me back to my first point, that you should seek out a therapist before it gets to a crisis situation.
What has been your experience in finding a therapist? Do you have any suggestions? What do you like best about a therapist? What do you like least?
Please add your contribution by responding to this blog. Your responses are anonymous as you just need to enter your first name and email address (which won’t be published).Your suggestion could really help someone else.
Kind Regards
Graeme
hi Graeme
It is of the utmost importance for the sufferer of mental ill health to find the most suitable counsellor and or psychiatrist. Yes while we are in the depth of despair is the worst of time to have to contend with this search. In my case my GP thought only of the cost involved and referred me to a psychiatrist because that practice bulk billed. This was helpful in getting me onto a medication which would be of assistance to my state of mind, but it was not long before it became more and apparent that this person only saw the situation from a medical point of view. Yes I am total in favor of getting the medical side of things right and it was only that the medication which was prescribed was able to help me with the situation which I faced at that time.
My mother died, we were over five hours drive away so unable to get to her before life had ended. We spent a week away from home with very limited money but we managed. As does happen at those times in families there were some unpleasant moments with siblings. Then the viewing and the funeral I do not quite know how I coped. But I did with the support of my husband and the medication I was now on enabled me to survive. I returned home and at the next appointment with my psychiatrist when asked how I was, responded with F@@K terrible. Then revealed the circumstance of the previous weeks, the response from my therapist was that I had not prepared as they had for the death of my mother.. Then my therapist told me in detail what that person had done prior to and when faced with their father’s death. Then proceeded to tell me I needed to get a divorce and move on with the rest of my life. I at that time was turning 60 years old and my mum had passed away at the age of 96 years. After that appointment I never returned to that psychiatrist but continued with medication and for quite a while had good mental health. But as depression does it returned again with even more debilitating degrees you see with my new GP’s knowledge I had tried to get off medication and it worked for a while but down I came. I was then referred by this doctor on the basis of who my doctor felt was the best therapist for me. By the time I got to see the psychiatrist I was a mess partly because of financial problem. Thank God this psychiatrist although not their usual practice realized that the financial situation was one of the stressor which had propelled me into my present situations. Cost was not going to be an issue as this psychiatrist was able to find a way of bulk billing. It was also arrange for me to see a psychologist who worked with my psychiatrist. This psychologist at first left me somewhat cold but the psychiatrist encouraged me to continue to see the psychologist. I found that the best part of the psychologist was that I could talk on for the time about whatever was on my mind without judgment or for that matter too much directing me, just hearing where I was at in I think a Rogerian context. This together with a different combination of medication has now got me to a place with my mental health where I have more good days than bad days. The bad days are manageable because I know the way back out of the pit of despair. I was able to see the psychologist with no cost to myself. Do not get into some self help groups because well meaning but untrained people can be very dangerous to our mental health.
My advice is to seek till you find what will work for you. Do not accept second best. You do know the way back from “the brink” as we all do. Do not get caught up with what others tell you what works for them, and feel you have failed because it did not work for you. There is Hope just hang in and on..Life can and will be beautiful once again.
Keep on keeping on Graeme
regards Chris
Hi Graeme,
I can’t thank you enough for this post. Its unvbelievably timely for us as my partner has just recently decided not to go back to his psychiatrist. And for pretty much the same reason as Chris stopped seeing her first psych.
My partner has been studying a degree in social science at uni for the past few years. He became a fulltime student on Austudy a few years back, a situation which caused its own range of issues for him to deal with not the least of which was his feeling like a parasite because he wasn’t “earning” his living.
More recently tho he has realized that social science was not the right choice for him and decided to quit it after some 4 years study. As someone who has been in the same situation AND who works at a university I can tell you this happens *often* course descriptions being the ambiguities they are. But of course he saw this a just another failure until I made him realize that it happens so regularly. Once he internalized that idea he was happier than I’ve seen him in about a year. It was like a huge weight had been lifted off his shoulders. He began to explore his options and plan what he now wanted to do with his life from that point onwards…and it was really good to see… It was at this point that he went to his regular monthly appointment with his shrink.
Now appointment days are never good. My gorgeous man is very introverted and shy and having to bare the deepest parts of his soul to someone who is essentially a stranger is very difficult for him. He will respond if asked a direct question but will rarely offer unsolicited information about his feelings. So I usually expect these days to be difficult.
But this particular day was worse than usual which I was surpised by given his state at the time. It turned out that upon being told that he’d dropped his uni course the shrink decided, without asking how he felt about it at the time or how he’d felt since, that he was obviously not responding to his meds and that he needed to be on lithium with the posibility of electro shock therapy as well.
Needless to say my partner was devastated by this. He has always hated the zombie feeling some of his meds give him and he expected lithium to be all that and more. And to compound the situation the shrink even told him he was going to blood test him at the next appointment to make sure he was taking the it!
So he made the decision not to go back and we are now on the search for a new therapist, one who he can trust and feel comfortable with and who doesn’t just automatically reach for the prescription pad just because life’s thrown my partner a curve ball.
As my partner’s GP believes he should go back to see his current shrink we’ve begun by asking a close friend who has ties to the medical industry and who also has family who are in similar situations. However, the link to the Good Therapy site will really come in handy and I want to thank you and your colleague for making it available. I’m also going to pass it on to others I know of who will find it invaluable.
Will let you know how our search goes…
Regards
Gai
Hi Chris and Gai,
Thank you for your responses. I think you both clearly confirm how important it is that good rapport and trust exists between mental health professionals and their clients.
One of ths things that frustrates me immensely is that many professional only see things from their perspective - See my previous post “What’s wrong with evidence based treatments”. Whilst you can never generalise, the majority of psychiatrists see medication as the first line of attack for recovery.
I really believe that the key to recovery is having a holistic approach which includes exercise, support of family and friends, psychological counselling, fulfilling work, meditation/relaxation, nutrition and medication (for some people). I determined this list by asking those with depression what helped them most with their recovery. I have just finished recording a 4 CD and Workbook program called “Beating Depression Together” which is for those with depression and their caregiver. It will be available in September.
Having gone through 20 ECT treatments myself, I would only advise people to pursue this strategy if they tried everything else. Although it is approached with rigour these days, with the aid of muscle relaxant and anaesthetic, there are just to many downsides such as short term memory loss. Having said that, some people have found it very helpful when all else has failed and they are SEVERELY impaired.
Kind Regards
Graeme
Hello Graeme,
The scariest thing I found about finding a suitable therapist was that there are so many I was aware that not every therapist would be the right one for me. In the end I was recommended a therapist from the nurses at the hospital that I was an impatient in, and ran with that. Fortunately this has been successful for me. Although I’m still there after two years, and at times I feel I’m getting nowhere and want to give up I still go. I do pretty much everything that he suggests, (except I am resisting going to hospital, just for now) and have found some very reliveng benefits. I believe that my therapist has a plan for me now, most of that was my fault it was very hard to discuss how I was actually feeling. Now that I am we are working out a plan together (so now I’m not alone with this!). It has taken me time, but now I do trust him as he didn’t blanch or seemed disturbed by what was bothering me. This can also keep people away, as everyone would understand discussing these problems can be one of the hardest things you could ever do.
If I can advise anyone about a therapist it’s that there is plenty of information out there - on the net, ask around discreetly (through a trusted friend) even ask your GP! And I think you have to keep trying, even though a theapist has not worked for you (I have had five). When you find the right one for you and things start to work the little reliefs are very good. The only downside I guess, is finding the right one and time always seems to run out for me, just when I am ready to talk more. I now go in organised, try not to rush myself before the appointment and write down some cues of what I would like to discuss. I guess also one of the hardest things, is to do what they suggest (ie medication, cognitive behaviour therapy) as some of it can be very uncomfortable iniatially.
I wish everyone who reads this good luck and care
Kind Regards
Leisa
Hi Graeme and others
I don’t often check this link even tho’ I receive your regular emails; however, I am pleased I did so on this occasion. I contributed to a segment earlier this year, in which I mentioned that I have been a previous long-term sufferer of depression, as well as a counsellor/therapist, and myself in long-term therapy. The latter has facilitated life-changing growth and recovery which has enabled me to enter university as a mature age student and to graduate, thus leading to a new career path in which not only am I now able to offer to others that which I experienced myself, but the journey could not have been possible without the guidance and support of a trusted (in my case) psychotherapist. It has been costly - not available to all, I admit - but of inestimable value. I myself am only qualified to call myself a ‘counsellor’, but depending on the type of training and therapy to which one is exposed, can provide long-term therapy to those wishing to embark upon a similar journey.
I realise that clients generally come to therapy in a ‘crisis’ situation. Psychologists are usually those consulted at these times, often recommended by one’s GP because of available rebates, but they are not always available nor trained for long-term therapy (counsellors and psychotherapists come into their own here). These recommendations can be - but are not always - a reliable source from which to begin. I would offer a warning though - psychological intervention may suffice in the short term, but will not bring about long term healing, recovery and growth. I support all the avenues to which Graeme refers; a ‘holistic’ approach.
Referrals by word of mouth seem to me to be the preferred method of locating a helpful therapist who will be there for the long haul. It is imperative to check the therapist’s qualifications, and that they belong to a professional assocation - don’t hesitate to ask. Then, enquire about the methods they employ - and if you are up to it, check out what this means for you, on the Web. For instance, my therapist uses ’self-psychology’, so consequently I incorporate much of what I experience with her, in the way I work, and it evidently works for my clients.
Psychiatrists have their place - but I agree with Graeme’s comments entirely. Surprisingly, very few psychiatrists are trained adequatley to be ‘therapists’ - medication following a ‘label’ is their main tool; active listening and empathy often absent! So - your own judgement about your ‘best fit’ with the therapist, is definitely the best solution.
It can be particularly helpful to find a counsellor/therapist who is registered with PACFA (pacfa.org.au) the Psychotherapists and Counsellors’ Federation of Australia - the main umbrella organisation for other subsidiary organisations, because their membership requirements are rigorous.
Kind regards
Jan.
Hi Graeme
Mark Pearson in his book The Healing Journey is on the right track with this quote on the first page….
Quote J. Krishnamurti from Letters to the School Vol 2 (1984)
“We are concerned are we not, with the exploration of our inward nature which is complex..
This investigation is really self education..Not to change, what is, but to understand what is.
What, is, is far more important than what should be..
The understanding of what we actually are is far more essential than to transcend what we are;”
We need to know who we are – what makes us tick – before we can ever think of how to change.
That is the journey which we are embarking on and we need the support of a Psychologist - Psychiatrist or Therapist who will aid us in discovering the way to live our Journey..
There are many part to the journey - yes we need the best for our individual circumstances not one that see us as a diagnosis but a human being who is not able to live the journey. I agree that it is a holistic approach. Which cover thing such as healthy eating - exercise both for the body and the mind - laughter and Play, having fun is a must. Getting involved with others one baby step at a time..
But yes we humans are very conplex… indeed.. the best therapist is often our self after we have gain the support and determination we need to live our individual journey.
regards Chris
not quite sure where this all came from I was just reading what others had said and felt compelled to write.. I think helping others really does help ourselves.. thanks Graeme
Hi Graeme,
I would just add to this that a person really needs to see a registered psychologist, lists of whom are available on the APS website.
http://www.psychology.org.au/. They spend 6 years of university based training, and for good reason. There are many ‘counsellors’ out there, with varying levels of qualifications. The Australian government is currently working on the National Health scheme, where psychologists will be registered nationally (rather than the current state registration).
This scheme is also implementing safeguards for the public on mental health issues, to ensure that any mental health professional is appropriately qualified.
My second recommendation, after seeing a registered psychologist, is if you don’t ‘click’ on the first visit, then it’s probably best to try another. Personalities differ, so it’s very important that you find a psychologist that you like, feel you can be open with, and who you feel really listens to you.
I guess I can’t stress my opinion that a person needs to see someone qualified (psychologist/psychiatrist). The recent article on a possible link between attending a ’self-help’ course and clients’ deaths is an example.
http://www.news.com.au/story/0,27574,25954030-2,00.html
All the best
Lisa
Hi Graham,
I read this article with interest as I WAS seeing a therapist, here are my answers to the questions outlined in your blog :
1. Did the therapist strive to fully understand your situation?
- I didn’t think he really tried to, I say that because I came away after the session unsatisfied with no resolution to solve some problems. I felt that all he did was get me to repeat what I’ve been saying to close friends. He gave me no indicators to show that something could be corrected or I need to fix this or that.
2. Did they outline a plan you had confidence in?
- Nothing, no plans, nothing to refer to or read about. I felt like his plan was to get me to open up and think that would help me. I felt unsatisfied coming away from a session without getting some kind of advice.
3. Did you trust them and feel positive about returning?
- I trusted that he was qualified (he’s a qualified Psychologist) but after 2 sessions I felt like I hadn’t gained anything out of them so I’m not sure about returning.
Before this experience I never thought about seeing a therapist or counsellor because I thought this would happen. I think the first consultation should be free, at least it gives people an idea of what to expect and how well their therapist can connect with them. If it looks like they can only relate to you in the business sense then find another person. Going around to find the right person will be a costly affair and you may end up feeling a lot worst than the first time you sought help.
So what can be gained from my experiences?
- Speak to close friends, associates from church or family members you can talk to.
- Get some recommended books, this time its the therapist doing the talking and motivating and you refer to it again and again.
- Exercise helps, I’ve always been doing this, it won’t solve the problem but will at least keep your mind off it, if you can overcome the small goals during exercise this will give you added confidence to overcome other little things and if you let that build up then that might give you enough strength to deal with the bigger problems.