Searching For A Therapist by Renu K. Aldrich www.ASCAsupport.org October 28, 2011 The following should not be considered professional advice. Please consult with mental health professionals for personal recommendations. The search for a therapist does not end with deciding which type you prefer. Each mental health professional is unique and brings a particular set of training and experiences to bear. As a very personal encounter, the connection between a client and therapist is often cited as the reason therapy works regardless of the approach or modality used.

When meeting with a potential therapist, consider the following:

Would you feel more comfortable with a man or a woman? Would race, religion or language play a role for you? While most of us strive to be open-minded, therapy is about your needs and wants so be honest with yourself. Would the therapist's sexual orientation make a difference to you? Would you prefer a private setting within a home or would an office with a secretary and others around feel safer? Is age a factor? Would you take seriously someone younger than you or be uncomfortable with someone much older than you? Do you prefer a recurring appointment or would scheduling appointments week by week be acceptable? Some therapists feel that a recurring appointment is part of the safety in the relationship while others believe it fosters dependence. The important aspect is what you feel you need as you get into the relationship. Education and types of therapists vary (see sidebar). Do you want someone to have a particular license, level of education, or specialty?

Where to look

After reviewing the many different kinds of professionals offering psychotherapy, pick several to interview. There are several excellent web sites that list therapists, their licensure and specialties. Even if you are reviewing a therapist who has been referred to you by someone you trust or your health insurance company, it is a good idea to Google the person to investigate whether he or she would be a safe partner with which to enter into such a powerful and intimate relationship. You may even decide to ask their licensure board if a complaint has ever been made against them.

Making contact

After finding several therapist candidates, call or e-mail them to ask for a consultation. While many offer brief phone discussions to set up the first appointment, some will agree to an in-person consultation depending on their schedules and practice guidelines. You may not be able to gauge how safe or comfortable you feel until you meet in person, but don't be surprised to have an immediate reaction, positive or negative, with the initial contact via e-mail or telephone. Remember that you are a consumer and will be in a vulnerable position with this person. If it doesn't feel right from the beginning, move on to the next person on your list.

During an ideal first visit, i.e. one in which you are not in crisis, feel free to ask a range of questions designed to help you assess whether you can launch a trial period working with the professional. These questions should include the basics regarding fee structure and treatment approaches. The therapist may provide you with a sheet to sign regarding informed consent, which states the benefits and disadvantages of therapy, limits to confidentiality as governed by law and ethical guidelines, and any other relevant details about what you are agreeing to by entering into the relationship. Many professionals go through these topics verbally over the first few months rather than overwhelm you in the beginning. Either way, informed consent is an ongoing dialogue regarding the therapeutic relationship.

Sample questions for the therapist

Review the following questions as a guide toward getting the information you need to begin working with a therapist. Allow yourself time to hear the person's response, and feel free to ask questions throughout the process. It is never too late to question your therapist about any aspect of therapy throughout your work together.

What is your approach to therapy? How would you describe your personal philosophy and style of interacting with clients? How do you work? What would we be doing in our sessions together? Would we be meeting weekly? Do you generally provide short-term or long-term therapy? Is what we talk about confidential? What is your fee structure? (If you are indigent or a student, ask if he or she has a sliding scale fee.) What are the risks, benefits and alternatives to treatment with you? After giving you a brief description of my issues and needs as I see them, do you think you can help me? Why? What areas are you comfortable working with? Have you had clients with (trauma, childhood abuse, dissociation, etc.) before? How did you handle their treatment, and what was the outcome? Do you put emphasis on diagnosis? Tell me about your professional history. In addition to your licensing institution, do you have other relevant training? How many clients do you currently have? Are you a survivor yourself? Are you in personal therapy? How will you handle the affects of hearing about my trauma? Do you have a supervisor? What will you discuss about me with this person? How would you handle emergencies between visits? Do you have availability during weekends, nights and holidays if a crisis arises? Is there ever a time another therapist would be on call for you? What modes of communication are acceptable to you (i.e. office phone, mobile, texting, e-mailing)? What is your policy regarding touch? Will we be developing treatment goals together? Do you work with a psychiatrist or hospital? Do you have recurring appointments? Do you only meet clients within an office or do you also have a home office? How and when would you evaluate whether our work together is helping me? Do you plan to record our sessions?

Consider the following personal reflections

After meeting with potential candidates, take a moment to ask yourself these questions:

Were they full of energy or laid back? Did they want to delve right into what your problem is and get you moving or do they want the chance to get to know you first? Did they respond patiently to your questions and allow you the time to gather your thoughts or did they hurry you along? Was their body posture and sound of their voice soothing or grating? Did they seem qualified? Do they have the training, skills and licensure to adequately meet your needs? (Unfortunately, not all professionals will admit that they do not have competency to help you.) Did they make you feel accepted or judged, or were they neutral? Did they feel right to you (despite any fear or anxiety regarding beginning this process)? Does their approach resonate with you and where you are on the healing journey? Do you have concerns? Can you bring them up with a friend, current counselor or in a follow-up with the potential therapist? What does your gut say about them?

Endings

Terminating a relationship with a therapist can be as difficult as ending a romantic attachment. For some trauma survivors, it is the first truly intimate relationship they have ever had. Many benefit from the re-parenting and reparative attachment found with a therapist. When the relationship has run its course, you may be ready to handle life on your own or want to work with another type of healer. As you grow and change, your needs will as well.

Some therapists believe that it is the clients who must broach termination because their doing so could feel like abandonment while others mention it the first day of therapy in order to not foster co-dependence. Regardless of the professional's age or experience level, there exists a power imbalance in the nature of the relationship, and he or she has the responsibility to assess whether treatment is continuing to benefit you and whether a referral should be made due to their competency or conflicts. Many therapists will check in with their clients from time to time to evaluate if therapy is working and goals are being met. Whether the client or therapist brings up the possibility of ending, it should be a collaborative process.

Termination is much like the initiation of the relationship and could take some time to occur. Often, this will begin with a slow decrease in the number and frequency of sessions as a check on your readiness to leave therapy. If you have felt comfortable with the therapist, it is best to leave the door open for a return if needed down the road even if you are working with someone new. If you have decided to seek work with a new therapist, ask your current therapist for help in locating someone who can better benefit you where you are today and/ or for help transitioning to the new professional.

Therapists are human, and while they are hopefully trained to handle the ups and downs of life and their professional work, they may not take our leaving therapy well. If they have not resolved their own personal issues or derive their identity from their job, they may take it hard if you are going to work with someone new. Or a therapist may tell you it's time to move on before you are ready and you feel cast adrift. It is important to remember that these cases do happen on occasion and is evidence of the therapists' issues interfering with your care and not your fault. If you do not feel comfortable with discussing these feelings with your therapist, work through this with someone who can meet you where you presently reside on the healing path.

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