A GUIDE FOR SEEKING PSYCHOTHERAPY OR COUNSELING

A GUIDE FOR SEEKING PSYCHOTHERAPY
OR COUNSELING (Part 1)

If you decide to seek counseling or therapy, achieving the results or outcome you desire is important. For this to occur, it is important to be an informed consumer. Part of being an informed consumer includes gathering information, educating yourself and having some skepticism about the service or product you are buying.

First, it is helpful to know whether the service you are seeking works.  Fifty years of research unequivocally demonstrates that psychotherapy/counseling work! Review and comparison of hundreds of research studies demonstrate that people who engage in treatment (i.e., psychotherapy and counseling) are better off than 80 percent of the people receiving no treatment for similar problems. So seeking a therapist can be exactly what you need to assist in making the changes you wish to make.

However, what works for one person may not work for another. Research has demonstrated that a good “fit” or “match” between therapist and client is the single most important factor in achieving a positive outcome in therapy. The question then becomes, “how do I find a therapist who is a good fit or match for me?”

Finding a Therapist - Narrowing the possibilities

There are various ways to identify prospective therapists who might fit your needs. If the process is new to you, think about how you typically narrow the possibilities and select other service providers and products. For example, consider how you select home repair contractors, physicians, and lawyers, how you decide what car or TV to buy, or how you determine potential colleges/schools and neighborhoods in which to live.

You might start by talking with friends, family members, or acquaintances who may have first hand experience or knowledge of therapists in your area. Your medical professional is likely to have the names of some therapists to recommend. Searching online (for example, “psychologist Williamsburg”) or in the yellow pages for local psychologists, counselors, social workers, and psychiatrists can provide a large list of potential therapists from which you can begin to narrow the possibilities. Additionally, some health insurers only cover certain therapists who are part of their network or panel of providers. If you have health insurance, call the insurance company to determine if there is a list of therapists they cover or recommend (a toll free number for your insurance company is usually on the back of your insurance card).

When gathering information about potential therapists from these sources, review information in the yellow page ads, Internet sites, or other sources that give you an idea about what services a therapist offers, specialty areas, philosophy of treatment, etc. If you have a specific concern, problem, or preference, look for therapists who advertise experience or specialization in that area. Make a list of potential therapists who seem like they may meet your needs.

An important consideration in selecting a therapist is determining whether the therapist is licensed. Therapists are licensed in the state where they practice, and clearly identify their license by profession in online or printed advertising, e.g., Licensed Clinical Psychologist, Licensed Clinical Social Worker, or Licensed Professional Counselor. Psychiatrists are also licensed to do therapy by the state in which they practice, although not all psychiatrists do therapy. A professional license indicates that a therapist has a required level of specialized education, training, experience, and awareness of ethical guidelines identified by that profession and the State Licensing Board. However, having a professional license does not guarantee therapeutic effectiveness any more than a driver’s license guarantees that all drivers are equally skilled.  There are sometimes other therapist designations that vary from state to state, e.g., Certified Substance Abuse Counselor or Marriage and Family Therapist. Further information about any licensed therapist is available on your State government websites related to health professions, e.g., Virginia Department of Health Professions. Some agencies or therapists also utilize graduate students who conduct psychotherapy and counseling under direct supervision of a licensed, experienced professional, and this is also an option to consider.

Different professions (e.g., Licensed Clinical Psychologist, Licensed Clinical Social Worker, Licensed Professional Counselor, or Psychiatrist) emphasize different areas of knowledge and training. For example, clinical psychologists have training in psychological evaluation and testing as well as counseling and psychotherapy. This does not mean that all clinical psychologists offer psychological evaluations as part of their practice – however, they should all be able to intelligently discuss and answer questions about psychological evaluations and testing.  If you are looking for a therapist, there are excellent therapists in all of the professions listed. Again, the key factor to a successful therapy experience is finding a licensed therapist who is a good match for you, including your needs, preferences, goals, and experience of what has helped and not helped in the past.

When you have a list of therapists who seem like they may offer what you want, the next step is to call prospective therapists for more information (see Part 2). 

A GUIDE FOR SEEKING PSYCHOTHERAPY
OR COUNSELING (Part 2)

Finding a Therapist - Selecting a therapist

When you call a prospective therapist, get the basic questions regarding fees, insurance, location, scheduling, and how soon you can be seen, out of the way with the receptionist or office manager if there is one. You can also ask to schedule a five minute phone call with the therapist or counselor to discuss your needs and interests, and determine whether it is likely to be a good “fit”. An unwillingness to give you five minutes to ensure a good fit should cause you to be skeptical about whether that therapist is right for you. Respect the therapist's time and keep the phone call to five minutes or less.  

If you speak with a therapist on the phone, it is likely that the therapist will ask you about the problem or concern that prompted you to consider therapy. This is a legitimate question to help him or her answer your questions, but you do not need to go into detail on the phone. Remember, the goal of this phone call is to get an idea about whether this therapist will be a good fit for you.  Briefly describe the concern, problem, or goal you would like to address in therapy.  Don’t worry about trying to diagnose, offer your interpretation of the problem, or provide a detailed history. Describe what prompted you to consider therapy at this time and/or what you would like to change.

You can also ask some of the following questions or others you think relevant.

Do you have experience working with people who have concerns and goals similar to mine? If so, have you had success with them?

What therapeutic approaches do you use?

How many sessions do you average per client?

Do you monitor progress and outcomes? Tell me about it.

What do you do if a particular therapeutic approach is not helping?

When talking with a prospective therapist listen for answers that reflect an emphasis on a good therapeutic relationship and the importance of your participation. Listen for an emphasis on client resources, strengths, and capabilities; these will be the basis on which solutions and positive changes will be built. Listen for answers that reflect a therapist’s flexibility in adapting or changing treatment approaches based on whether you are experiencing improvement or not. Compare the therapist’s answers with your own views of how change occurs. If the therapist identifies with a particular therapeutic approach, philosophy, or orientation, consider whether it is consistent with your theory of change. If it is different but you still think it has some merit, try it out. Your input and participation in therapy is essential in getting the results you want.

Over the past fifteen years there has been an increased emphasis on what are called “evidence based treatments”. These are specific therapy approaches for specific problems or disorders; they are called “evidence –based” because they typically have at least two research studies supporting their effectiveness for the treatment of the specific problem or disorder. Consequently, these therapeutic approaches or treatments have sometimes been recommended as the treatment of choice for particular problems or disorders. However, just as medications effective with certain disorders are not effective for everyone with that disorder, the use of specific evidence based treatments is recognized as just one factor associated with positive therapy outcomes.

In an August, 2005 policy statement, the American Psychological Association (APA) adopted a less rigid perspective which incorporates decades of therapy outcome research regarding effective therapy practice. This APA statement emphasizes that therapy services which “have a high probability of achieving the goals of treatment” involve integration of the best available research [e.g., evidence based treatments] with the therapist’s clinical expertise and the client’s characteristics, preferences, and response to treatment. The APA further indicates that “ongoing monitoring of patient progress and adjustment of treatment as needed are essential…" (American Psychological Association Statement: Policy Statement on Evidence-Based Practice in Psychology - August, 2005). You should be skeptical if you encounter a therapist who emphasizes one approach to therapy with little flexibility or willingness to consider other approaches. Research demonstrates that the most effective therapists adapt their approach to their client, and whether the client is experiencing and reporting improvement or not. The most effective therapists do not try to force the client to fit their approach, or persist in using an approach that is not helping.

If you decide on a therapist who seems like a good match, schedule an appointment and give it a try. If you meet with the therapist and feel comfortable with their style, approach, and genuine interest in you, keep working with them. If you meet with a therapist and do not feel it is a good match, talk with the therapist about your concerns and what might be more helpful to you. If the therapist does not seem receptive to your questions and feedback, consider a different therapist. Finally, not all problems are most effectively addressed with a therapist, or by therapy alone. Some problems can be better addressed through other means, or by services in addition to therapy, e.g., support groups, case management services, or medication. Therapists who are willing to consider alternative options or “wraparound” services are more likely to be effective because they are likely to be more focused on what is right for you. 

Finally, keep in mind that research on therapy outcomes indicate that when therapy is successful, positive changes begin to occur early in the therapy process, e.g., the first 4-5 sessions. This has been found to be true whether the therapy is short-term or long-term. Everyone is different, but if you are not beginning to experience significant change by about the 4^th or 5^th session, discuss this with your therapist. Ask for his or her ideas about what is occurring, and whether a different approach or different therapist might be useful.  Remember, you are paying the therapist to work with you, and your input and participation in the process is essential.

Randy Walton, Ph.D. is a Licensed Clinical Psychologist with over 25 years of experience. He works full-time at Colonial Behavioral Health as Lead Clinician, and conducts a part-time private practice (www.williamsburgpsychologist.com) in Williamsburg, Virginia. Professional interests include elements of effective psychotherapy and using client feedback to help guide treatment.