I will never forget a lecture that I heard in 1973 (which says a lot since there is so much that I don’t remember). The speaker was the late David Rosenhan, Professor Emeritus, in his popular undergraduate class in Abnormal Psychology at Stanford. Each year, at the end of the term, he gave a lecture about choosing the right therapist. His advice was wise and as relevant today as it was forty years ago.
“Choosing the right therapist,” Rosenhan insisted (and I quote loosely), “should be like buying a pair of shoes. You would never buy shoes without trying them on, seeing how they fit, picking the brand that meets your current needs, fits your lifestyle, and is affordable. Even then, if you make your purchase, take them home and find they pinch you in the wrong places, you would not say to yourself, ‘I need a new foot, something must be wrong with me!’ now would you? No, you would take back the shoes and seek out a new pair.” So it should go, he sagely advised, with choosing the right therapist.
As I mentioned in my last blog, far too many people fail to seek help or wait much too long before seeking professional guidance. There are numerous explanations for this reluctance, and unfortunately, many negative myths also surround the therapeutic process. In the forty years since the Rosenhan lecture, I’ve heard them all many times.Myth #1: If you need therapy, you must really be sick or messed up. Myth #2: If you need therapy, it means the problems are your fault. Myth #3: All therapy does is blame your current problems on the past. Myth #4: All therapists are the same and most therapy goes on for years.
A big part of the problem is the lack of education about psychotherapy compared with constant advertising about the potential advantages of psychotropic drugs. In a world bent on instant answers and quick fixes, more and more people are choosing to pop a pill rather than seek out counseling.
Although decades of research show that psychotherapy is highly effective, money talks. Pharmaceutical companies today spend billions of dollars touting the effectiveness of designer drugs. According to Pew Research, in 2012, more than $24 billion was spent marketing drugs to physicians and over $3 billion on advertising to consumers.
Although Consumer Reports concluded in 1995 that psychotherapy of various types was effective for around 80% of those surveyed, they found in a follow-up survey in 2003, that 68% of the respondents seeking help for mental health issues received drugs compared to 40% in 1994. This trend persists in spite of the fact that consumers complained of more side effects than they had bargained for–40% complaining about adverse sexual side effects and 20% about weight gain.
People have better outcomes when they are more active and involved in choosing a therapist. Rather than just taking a referral from your insurance company or employer, ask friends or family members for names. If you know someone who has been helped by counseling, find out who they saw and what was helpful.
Most therapists will respond to questions you have about how they work in either a preliminary phone call or in the first office visit. Find out if the therapist has experience in the kind of problem you have. Ask about average length and cost of treatment.
Make an appointment for one visit without committing to ongoing treatment. Don’t feel pressured to make a second appointment. If the therapist you see is not comfortable with the fact that you are going to interview several therapists before choosing, that should be a red flag. It is often helpful to bring a family member or friend with you to the first visit.
Some therapists only treat individuals, not couples or families. If you are single and your problems do not involve any family members, that approach may work for you. On the other hand, many problems surface in the context of our intimate relationships. Those problems are generally helped more effectively and efficiently by involving the couple or the family.
Family involvement in therapy does not imply blame of anyone. We believe that although people are trying to do “what’s best”, they can get inadvertently stuck in patterns of interaction that lead to the development of symptoms in one or more family members. Our strategy is to elicit the family’s strengths and resources and to unleash hidden potentials that are somehow blocked.
The involvement of whole families in the treatment process serves to expedite change because each family member can contribute his or her unique perspective and understanding of the problem. The family often holds resources and influence essential to the treatment process of its members.
Therapists differ, both in their philosophy of treatment and in how active or passive they are in the treatment process. Some spend much of the time listening, providing empathy and support, and helping you discover for yourself what changes you want to make. Others are more active–offering specific skills, suggesting new behaviors, giving homework assignments, or teaching communication or conflict resolution skills.
Think about what you want from therapy and find a therapist whose model of treatment fits the bill. This difference is more important than whether the therapist is a psychiatrist, a psychologist, a social worker or a marriage and family therapist. More relevant is the therapist’s expertise and record of success.
Clients who share the same goals as the therapist and apply what they are learning in treatment to their everyday lives report more positive outcomes. Therapy involves hard work. If you want to get more physically fit, it is necessary not only to learn how to use the equipment at the gym but to actually work out three or four times per week. So it is with counseling. Change comes from practicing new behaviors, not just talking about what isn’t working. Find a therapist who holds you accountable.
Not every therapist is the right one for every client–remember the shoe metaphor–there has to be a good fit. And you, the consumer, are the one who knows what is best for you.
Some people only feel safe if they work with someone of a particular gender, or culture, or sexual orientation, or age or race. Honor your needs and preferences. Don’t judge yourself if you want red shoes. Since therapy will probably involve pushing past your comfort zone, you are more likely to do so if you feel connected to your therapist and believe that he or she has the experience and knowledge to help you.
The best time to seek help in therapy is before small problems become bigger ones. People often underestimate the seriousness of their situation and wait until crises occur. We don’t usually wait to get sick to go the doctor–we get annual physicals. If you have a question or discomfort about how you or someone else in your family is doing, go for a check-up with a reputable psychotherapist. It will not only shorten your treatment time but it may prevent future troubles.
Remember the wise words of Professor Rosenhan, don’t give up hope if the shoe doesn’t fit. There’s lots of therapists out there. Find the right one for you. If the shoes doesn’t fit, don’t blame your feet. Move on.
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Last reviewed: 3 Feb 2014