Everything You Ever Wanted to Know About Selecting a Therapist

by Mark Sichel, LCSW

Part I: Everything You Ever Wanted to Know About Selecting a Therapist

Part II: Likeability, Intelligence, and Lifestyle

Part III: The Top Ten Reasons to Run From a Therapist

Part I
Over the course of two decades of clinical practice, my clients, friends and acquaintances have often asked me: How do I pick the right therapist for me? Having myself gone to three "bad" therapists earlier in my life before finding the right one for me, I have plenty to say on this subject.

First of all, don't even think about going to an unlicensed therapist for a serious emotional or interpersonal problem. When I'm called by a new patient and they ask me if I mind telling them my credentials, I always tell them that not only do I not mind, but I'm glad they asked. You have every right to ask any health care provider about their education, training, and licensure, and any provider who is not forthcoming with this information should be eliminated from the running at the outset.

There are, to my knowledge, four types of licensed practitioners available to people seeking psychotherapy. Clinical Social Workers, Psychologists, Psychiatrists and in some states such as California, Licensed Marital and Family Therapists. The usefulness of a practitioner who is licensed, and there are many who are not, is two fold:

1. Licensure is a guarantee that the practitioner has met minimal educational and
   experiential criteria necessary for the independent practice of psychotherapy. While some people feel that therapists are merely "nice" people who are paid to listen, there is in fact a science and art to the practice of psychotherapy. You don't want someone who is not firmly grounded in the tools and techniques that are covered in certified legitimate training programs.

2. Becoming licensed is hard work for providers, and we are very cognizant of the ethical and legal standards to which we must adhere to renew our licenses. In other words, a licensed practitioner will refrain, generally, from inappropriate treatment and behavior because of the threat of losing our licenses if we don't adhere to these standards.
   
   

Having said all of the above, let me add that there are other categories of helping professionals which are often appropriate for given problems. For example, I've had experiences working with patients when an ethical or moral issue has come to the surface for which the patient needs guidance. It is often helpful, in my experience, for clients to consult with a Pastoral Counselor who is ordained in their particular faith. Many issues in life are not psychological in nature, and in areas of ethics, morals, and values, it is often most helpful to consult with a Pastor of your own faith.

There are other instances in which seeing a licensed therapist may not be the most appropriate for a given individual. For example, anyone in the active stage of an addiction would be better served going to a Twelve-Step Program than seeing a therapist, especially in the early part of their recovery. If a person can do both therapy and Twelve step that's ideal for their recovery, but the point I'm making here is that therapy is not always the treatment of choice.
Back to Top

Part II: Likeability, Intelligence, and Lifestyle
Once you've established that a therapist is appropriately licensed, there are, in my opinion, three major factors you ought to take into consideration before working with that person:

LIKEABILITY The first is likeability. What do I mean by this? Simply that you are going to be spending a significant amount of time with your therapist, ranging from a period of weeks or months to years in some cases. There's never ANY reason to work with a therapist for whom you don't feel a basic liking. For that matter, you all should know you're entitled to feel this way about anyone whom you're "hiring" as a healthcare provider.

How do you know if you like a therapist? The same way you gauge whether you like or dislike any individual: basic chemistry. We usually have the ability to know within a short time whether or not we like a given individual. It is a grave error to tell yourself that it's okay to work with a therapist whom you don't like. It just doesn't work, and also, you've got to wonder if that therapist likes you. Usually when we dislike a given individual, they are not too wild about us either. The whole situation will not be conducive to constructive therapy unless you feel comfortable with the therapist you choose.

Likeability is a very subjective experience; many people, especially when they are in the throes of despondency or anxiety, have a hard time trusting their own gut reactions. I've often had clients come to me after one or more unsuccessful therapy experiences and as I've listened to them, it became clear that they didn't like their therapist. Whenever I have asked about this, I get a response reflective of the kind of self-doubt that people experience when they are in trouble. They second-guess themselves, and convince themselves that their not liking the therapist is their problem because they're "crazy". If you don't like your therapist, it is NOT because you're "crazy". Please, never ever continue to see a therapist whom you don't like.

INTELLIGENCE The second major area of importance when assessing a therapist is whether or not you think they are as intelligent or more intelligent than you are. Never continue to see a therapist whom you feel is not sufficiently intelligent. If you have any sense that the therapist is perhaps competent, but not that "with it," you should look further. Again, I've had clients say to me, "I didn't think that therapist was all that smart, but I figured he was licensed and knew what he was doing anyway." There is never any point in second-guessing yourself about a therapist's basic intelligence. You also need to remember: Our unconscious minds are very tricky and crafty; part of therapy is learning to not let us outwit ourselves by a lack of consciousness. Although no one has a way to assess this, you need to feel that you can't outsmart this therapist. If you feel that you can, your treatment is doomed to failure.

LIFESTYLE The third criterion that is crucial for you to explore is your therapist's basic lifestyle. A therapist learns a great deal from living through life's ups and downs. If you are someone who embraces a variety of experiences in life, you may very well be uncomfortable with a therapist who is a staunch academic and who spends most of their free time in intellectual pursuits. If you're looking for a therapist to help you to manage a marriage, you might not get the kind of help you need from an unmarried person. If you need help managing your children, a therapist who is also a parent may best understand your feelings.

There are no clear cut guidelines about how to pick a therapist whose lifestyle is consistent with your own, or who can at least value and appreciate your lifestyle. There is no hard and fast rule on issues such as ethnicity, race, lifestyle, or sexual orientation. There are "straight" therapists who work well with "gay" clients, African American therapists who would be compatible with White clients, or Jewish therapists who work well with Catholic clients, for example. Again, finding a comfort level with a therapist's lifestyle is a subjective experience, but the bottom line is that you must experience the therapist as being able to be supportive of YOUR lifestyle, and knowledgeable enough, in an experiential way, to help you find the kind of solutions you seek.
Back to Top

Part III: The Top Ten Reasons to Run From a Therapist

1. Sexual relations of any kind are inappropriate, unethical and unacceptable between a psychotherapist and patient.This includes any kind of kissing, fondling, or lovemaking. The goal of therapy is often to help the client become more comfortable with intimacy and less fearful of physical contact with others. It is highly appropriate to talk about sex and sexual feelings, and it is even appropriate at times for a patient to talk about their sexual feelings toward the therapist. It is never helpful, however, to act on any of these feelings in the treatment situation, and any therapist who tells you it will be is either a charlatan, a fraud, or an exploitative sexual predator who should be reported to his or her professional association.

2. Any other form of exploitation of a patient is inappropriate.Remember: You are paying for a therapist's help; it is never appropriate for a therapist to ask for your help.

3. While a therapist may use examples from his or her life to help you feel better about something, you should never become a therapist's confidante.You don't want to hear about intimate details of the therapist's life, their marriage, children, sex life, parental problems, or anything smacking of an inappropriate use of the time for which you are paying.

4. There have been actual instances of a therapist requiring patients to cut off ties with their families of origins, spouse, children or other important people in their lives. This is never acceptable, and should never be a condition to which a patient agrees.

5. Your beliefs, religious or political, should never be questioned, or construed as signs or symptoms of psychopathology. Beliefs and values are just that; they are never synonymous with emotional illness.

6. You should run for the hills if your therapist falls asleep on you. I have heard this happen to clients with the excuse that it is the patient's resistance that is causing the therapist to fall asleep. This is never the case; if the therapist is sleeping, he or she is not doing their job and should be "fired."

7. A client or patient should not be kept chronically waiting for their scheduled appointment. Emergencies are inevitable and every therapist runs late once in a while, but you shouldn't have to chronically wait for a late, disorganized, or confused therapist who can't be respectful of your time.

8. If you feel you are being treated with contempt, disdain or disgust in relation to any of your questions about the therapist, you should look for the nearest exit.

9. If you feel that your therapist is taking a stand directly contradictory to your value system, you are fully entitled to walk out. For example, a couple recently came to me for marital problems because their former couples' therapist told them that the husband's having had an affair was "no big deal, and more common than they could imagine."

10. Sometimes people in therapy have insights, which lead them to feel worse than when they came into a session. If, however, you chronically feel worse after your therapy session, and you're not making progress in meeting your goals, you have every right to at least go for a second opinion, or begin to see someone with a very different orientation and technique.

    Okay...so there are eleven reasons, not ten. But here's the last one, and it's just as important as the rest.

11. No therapy is magic. Any therapist who promises a quick and easy "cure" is trying to sell you a bill of goods. This is not to say that a patient can't possibly feel better after just one session, but overall, most problems take some time in developing, and more often than not, take some time to resolve.
    

Back to Top