The basics!

I was recently asked to respond to the following three questions, as part of a guide for new patients seeking – or considering – psychotherapy.

1) What should a patient look for in a therapist?
2) What mistake do most patients make with their therapist/therapy (Do they quit too soon? Expect something other than what is offered in treatment? Etc.).
3) What is one myth in regards to therapy or treatment that you would like to bust?

Two of the three mistakes I’d like to address in question 2 involve choosing a therapist so let’s answer questions 1 and 2 at the same time.  The process of choosing a clinician is often derailed by two errors.  First don’t go in thinking you know what’s wrong with you.  Perhaps one out of 10 patients who come to me claiming they have OCD actually has this disorder.  The same applies to those who come to see me thinking they have a sexual problem, attention deficit, bipolar disorder.  “School phobia” turns out to be separation anxiety; “attention deficit” in a child is revealed to be an interpersonal problem, something going on at home that may involve family conflict, maybe just bad diet; “depression” may be rage, “anger problems” may mask anxiety or reflect justifiable outrage.  And so on.  (You can read much more about this at the main website page on the pages “Why Go“and “Why Go -II“.)

Much better is to go in – or make that first telephone call – and talk about your symptoms.  Report simply what happens to you, e.g. you get angry, obsessive, violent, indecisive, overly fearful, argumentative, phobic, preoccupied, sour.  Ask your prospective therapist if he or she has dealt with those problems – not with this or that diagnosis/disorder.  Find a well-trained, experienced clinician and let him or her determine what is wrong with you.  That’s one of the things you’re paying for.

Second, since you may not know what’s wrong, don’t assume you know what kind of treatment you need.  In fact, research has repeatedly shown that the type of treatment in psychotherapy – the approach – is not what determines successful outcome.  Success or failure of psychotherapy is determined by other variables, most important of which appears to be the experience of the therapist, and the quality of the relationship between therapist and patient.

That brings us to question #1, how to pick a therapist?  Again, first find one with a broad range of experience; you can look at “Credentials” in to see what kind of therapists there are and what training each type has.  Then in your telephone (or email) contact look for one who has dealt not with the diagnosis you think applies to you but rather with the symptoms – i.e. behaviors, thoughts, and feelings – that lead you to seek treatment.  Second and most important:  Find one who says things that “click” for you.  Now of course that may not happen in the first session, but by the third or so you should be having some sense that the conversations are interesting, not repetitive, that you are heading into new territory.  You should begin to feel that the therapist has a point of view you had not considered, that he or she asks questions and raises issues that are intriguing, even unsettling.  (The only exception here is if you are someone who is very experienced in treatment.  A therapist may take a little longer to surprise you if you’ve been at it for a long time and especially with many different clinicians.)

This brings us to the third error people commonly make in treatment:  Leaving just when things become exciting and productive.  This is also an answer to question #3 regarding myths of psychotherapy.  Psychotherapy is not a massage.  There is a place in treatment for support, reassurance, and encouragement, but if that’s all you receiving you probably won’t get anywhere.  An exception is working with children who may need almost exclusively warm fuzzies, at least for a while.  But even with them – and especially with adolescents – productive treatment will sometimes be uncomfortable.

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