April 22, 2019

Finding a Mental Health Therapist

It is only when you exercise your right to choose that you can also exercise your right to change.” Dr. Shad Helmstetter

This week, with input from the internationally known psychologist Barry Duncan, I describe how to choose a psychotherapist.

There are lots of us out there; how can you know who best for you? Underlying the opinion of this blog is research of the last 50 years. Research is clear — therapy is helpful. We know that people who get therapy are better off than 80% of those that do not. Therapy is helpful in dealing with depression, anxiety, variable mood, trauma, attention concerns. It is also helpful for pain and physical problems that are exacerbated secondary to struggle to recover from stress. Working with a therapist that fits with you is the key. Also know there is great variability in clinician effectiveness.

Many therapists now have a website offering you the advantage of learning a bit about the person before contacting. Many will also offer, at no charge, time to get acquainted. Following are guidelines for that time.

First, trust your gut. If you find a therapist that you do not like, try another. Getting along reasonably and communicating well with your therapist is a key to success. Similarly, if you sense the therapist does not like you, move on. You need to know the counselor you work with is on your side. You can, of course, discuss your concerns before leaving but do not do this session after session. It is important to note that the number one predictor of success in therapy is client rating of relationship with the therapist early in contacts.

Second, you and your therapist should have agreement on goals. If that is not the case, work with someone else. If the therapist’s approach to your problem does not make sense to you, talk with him about trying a different approach. There are nearly 400 different approaches and he should know more than one or two. If he does not shift approach, find someone else to work with.

Third, research is clear that hope must be a part of the relationship. If no hope, what is the purpose? If a therapist treats you or your situation as ingrained or hopeless, look around and find another.

Fourth, look for change early in your sessions. You should notice positive change in 3-6 sessions. If not discuss with your therapist and if no change persists find someone else. It was just a match that did not work — no reflection on you or on the therapist. Keep trying for improvement. It is fair to expect positive results sooner rather than later.

Therapist effectiveness is also widely different. The most effective mental health professionals show significant gain with 70% of their clients. The least effective show gain with only 20%; this difference is dramatic. It is fair to ask about success rate. Even working with the most successful therapists there can be a mismatch for you. While change can still happen by using a different approach, often a change in therapist is indicated.

Whoever you work with, you should expect and notice positive change. Remember you are the boss. You get to choose and your being actively involved in the process is vitally important. Pick someone with a good track record.

And if you wonder: Over the last 6 years, 67% of (800 or so) clients that I have seen more than 1x, have surpassed the 50 percentile of change based on national norms.

Bill