Thoughts on How to Choose a Therapist
But how do I choose a therapist, Dr. Erman?
That is the hardest professional question I encounter outside my practice, and my answer below takes several paragraphs. But if you are reading this you are about to make a very important decision, so my advice is that you read this short essay to the end.
Having a therapist recommended to you is a good place to start, but even this is tricky. Suppose you are facing knee surgery and are considering a particular knee surgeon. His operating room success rate will be widely known in the hospital, physical therapists and patients may talk freely about whether he is innovative or up-to-date, how aggressive he is in pursuing after-care, how he relates to his patients. Psychotherapy, by contrast, is completely confidential and most patients do not even want anyone to know they are in psychotherapy. Reliable information will be much harder to come by. So consider the source: the best recommendations come from people you trust who either themselves were actually in treatment with the therapist or else are themselves practitioners in the psychotherapy field, (and the key phrase in this sentence is “people you trust.”)
What if you are on your own, without a recommendation: what do you look for? This above all: someone you can relate to. Research in the area of psychotherapy is difficult to do and often inconclusive but one strong finding consistently emerges: patients who find psychotherapy helpful say the most important part of therapy is the relationship with the therapist. First and foremost you want to find someone you feel understands you and you feel comfortable with, a warm person, easy to talk to and whom you feel is actively engaged with you. The relationship alone is not enough, but in therapy it is the river on which everything else flows, and without this deep connection everything else, even insights or wisdom, will seem empty words.
But therapy, real therapy, is not cheerleading; it can be an intensely emotional process. This may include moments when the therapist has blunt or difficult comments for you. There is also a chance that you may feel hurt by or angry at your therapist, misunderstood or worse, feel slighted or demeaned in therapy. You want a relationship strong enough for this or anything to be open for discussion and resolution.
Finding someone you are comfortable talking to—isn’t that just buying a friend, Dr. Erman? That’s what my skeptical dad (mother/aunt/best friend…) says.
No, your therapist should be a highly trained individual whose comments are not clichés or pep talks but thoughtfully timed and nuanced interventions. Clinical psychologists, (my degree) for example, are in school from 5 to 7 years, take many courses in personality, therapy, take supervised practica in therapies, have at least a year of supervised internship before graduating and at least two years further supervised work post-graduation. Your therapist may have taken further advanced training. Feel free to ask about his or her training.
You want a therapist who is capable of offering you insight. By insight I mean an understanding of how our own particular way of experiencing others and ourself has been shaped by our life experiences generally and especially by our family of origin. Many of these shaping experiences have deep, dim roots, extending back to childhood, often back to a time when we lacked language to encode our experiences. We come to therapy knowing some of these shaping experiences but many remain present outside awareness, existing instead in patterns of actions or in feeling states we have in the present, in our current life.
In therapy we might discover, for example, how we distance our self from certain emotions or how we repeat self-defeating relationships; a good therapist should both help us discover the patterns and see their earlier meaning or function. For example, we might see that a pattern developed to protect our self from say an explosive parent or, to pick the extreme counter example, a withdrawn parent but this pattern, once protective, now only robs us of potential happiness or satisfaction. Real insight only emerges as a hard-won, deeply emotional achievement in the context of deeply engaged therapeutic relationship.
You also want a therapist who can offer wisdom, whose therapeutic presence emerges from a deep understanding of him or her self. I have a particular meaning of wisdom in mind. If insight is about understanding how the world shaped us, wisdom is the opposite, understanding how we shaped our psychic world, how we used our particular childhood including its tragedies and travails for our own internal purposes, perhaps using family difficulties to avoid certain developmentally frightening tasks involving aggression, say or assertiveness or sex or love. Since we are the actors here, and not just the victims, this process is even more painful than insight.
Wisdom is the result of this process and usually results in a painfully achieved humility, forgiveness and acceptance. Therapists with wisdom usually (though not necessarily) have themselves completed a difficult therapy process, meaning their commitment to the therapy process has deep emotional roots, with the chance that they may be able to bring you too through a process of achieving wisdom. Of all the attributes I suggest you seek in a therapist, this attribute, wisdom, is the hardest to even judge whether or not it is present. You may find the shadow of wisdom, as it were, in your sense that your therapist's strengths arise not only from what is “naturally” there, intelligence, perhaps or warmth, but also involved their own internal struggle, perhaps in their own therapy, perhaps elsewhere, to understand their own limitations and attempt to get past them.
You want a therapist who is comfortable with uncertainty and ambiguity, who is capable of stepping outside his usual patterns of therapeutic understanding if that is what it takes to understand you. Perhaps humility also captures this important characteristic, an acceptance that deep knowledge of therapy and people may still need to bow to the uncertainties and mysteries of a particular life.
Good therapists are fluid in their thinking; they ought to be able to move quickly in their mind between the serious and the light-hearted so they can be earnest without being stuffy and engaged without being over-bearing. This same flexibility of mind will often show up as an appreciation of the absurd, the humorous and the ironic, though these may not show up in a therapy where it may not be appropriate.
Your therapist should be actively engaged in the professional life of therapists, meeting with colleagues on a regular formal or informal basis and remaining a member of one or several professional organizations with Codes of Ethics or similar standards.