Blog post: How to choose a therapist
Therapy works! It can help you. The average person who has had therapy is better off than 80% of those who haven’t.
Most people do not know the truth about talk therapy.
This document will help you understand more about talk therapy. Information can help you make decisions about what's right for you.
The professional title of the therapist has not been shown to make any difference on client treatment outcomes. Talk therapies include "psychology", "psychotherapy", "counselling" etc, but they help in much the same way.
Find someone with relevant training. Find someone who gets you.
As long as they've been practising several years, that is good enough. Ignore the "I've been doing this 10, 20, 30 years" etc. After a certain point, experience doesn't improve therapist performance.
You want to ensure you have the best experience possible with a therapist.
What can you do?
You’ll need to trust yourself, rather than trusting a supposed expert. But don’t worry, I’m going to give you an arsenal so you can approach your therapist-finding-expedition with confidence.
My advice to anyone considering therapy
Arrange to talk to the therapist on the phone for around 10 minutes. The call will help you establish whether you feel like they get where you’re coming from. It will tell you whether they have empathy. You can ask questions about their expertise, qualifications, style, and fees. You could ask about their approach to working with the problem you’re facing.
Ensure they have completed a relevant training programme. A postgraduate qualification in a psychological discipline is a good idea. A credible training programme is another option.
There are around 400 approaches to talk therapy. There is little evidence that one therapy modality is better than another. What is important is that you feel that the therapist is competent and confident.
You should feel validated and understood. If you didn't get this, interview another therapist. Consider interviewing another therapist even if you did feel understood. Therapy is expensive and it's built on trust. Find someone who understands you and what you need. It can prevent running into problems down the track.
Therapists are human. They are subject to their issues just like any of us. They must have completed their own psychological healing work before they attempt to help you. Therapists' issues can come out to play in the therapy room. You want someone to help you. It's difficult to get help from someone who needs help themselves. Ask your therapist what they think about therapists having therapy. Pay close attention to their response. They should provide a humble and open reply.
Ask yourself these three questions: Is this person stable, wise, and skilled?
Sex and relationship therapy in New Zealand
It is not possible to train as a Sex and Relationship Therapist in New Zealand. International trainers occasionally fly over to New Zealand. Emotionally Focused Therapy (EFT) is one type of relationship therapy. How good an EFT therapist is will come down to the individual therapist. EFT is not a panacea for all couples. EFT will work for some couples, but not all.
Other therapists who want to become sex and relationship therapists go overseas to undertake their training. Ensure that your therapist has completed a training programme in sex and relationship therapy. A credible programme. Not read a few books or been on a weekend course or two.
There are hundreds of therapists in New Zealand who offer relationship therapy but who have no training in it.
Providing relationship therapy with no specialised training can harm both individuals and relationships. Relationship therapy is a specialist area.
Be sure for yourself: Is the training programme the therapist has undertaken reputable, credible, with a sound evidence base? Do your homework.
Do your homework on both the therapist and their training programme.
Choose a therapist who specialises in your problem. Therapists cannot be proficient at every single issue. Therapists cannot have success with every population group. For example, eating disorders, obsessive-compulsive disorder, and drug addiction are specialist areas. Sex and relationships are a specialist area.
The first session with a therapist
The phone call went well. You may have decided to have a session. Have a session with the therapist first before making your decision. You wouldn’t reveal everything to a stranger in a first meeting (unless it was an emergency). During the first session, the therapist should demonstrate that they're qualified and are a good listener. They should validate your experience, explain to you what you’ve described to them, and how they may be able to assist you. They should be sensitive and respectful to your needs and be open and non-defensive when you ask questions.
If the session makes you feel uncomfortable* you can politely leave. I have heard countless stories of people waiting until the end of a session before escaping. Don't wait! It's your time you're wasting, not theirs. It is always better to leave a session and have your confidence intact. It’s a good idea to leave the session with some faith remaining in talk therapies too; I have heard stories of folks not attempting therapy again for years after a bad experience.
The kind of thing you can say to exit: "I appreciate you making time today to meet me but this is not going as I had hoped. I don't feel we're the right fit, so I am going to head off now. I might get myself a coffee/tea and collect my thoughts. Thank you for your time."
Questions to ask yourself (write it on a note and take it to the session with you). Does this person make me feel a) safe b) validated c) like I can be myself, or could be myself, in time.
*A note on comfort. Therapy is not always an emotionally comfortable experience. But here's the difference: Normal discomfort should be caused by your feelings about yourself. Discomfort shouldn't be caused by the therapist.
What to talk about in your first session
Especially anxious about talking to a therapist? Have something personal that's bothering you? Feel too nervous to bring up in the first session? This is normal. Choose a neutral problem to discuss with the therapist in the first session if that feels safer. A neutral problem could be a minor issue you’re having with a colleague. It could be a problem that a friend has. This gives you a chance to see how the therapist responds. Another good trick is the advice trick. Ask for some advice on something. A therapist should give good (wise) advice. Having selected a neutral topic, you have not spilled your beans. Spilling the beans is the only way forward with therapy. However, you need to spill the beans with the right person. You will be mortified if you spill your beans and it's met with judgment, embarrassment, or a deliberate attempt to change the topic of conversation.
Warning signs to watch out for
A therapist should be happy to chat to you for around 10 minutes on the phone if you want to touch base with them and ask them any questions. Beyond a few minutes, they have the right to direct you to making an appointment if you’d like to talk further.
Not providing you with a written or verbal contract (this outlines your rights, privacy and confidentiality etc).
Not providing you with the opportunity to ask questions or dismissing your questions. This may be subtle or overt.
Instructing you to do something without any explanation. The therapist should explain its relevance to your circumstances. They should also explain the scientific evidence. This may include a technique, model, or activity. You always have the right to pass. You don’t have to do anything that makes you feel uncomfortable.
Not being open to changing their treatment if their initial approach does not help you make changes.
Making you feel like you have to commit to working with them or commit to attending therapy long term. Some people make major gains in 5-8 sessions. Some people make gains in 6 months. Your therapist has no way of being absolutely certain.
Suggesting you read the Bible or other religious or other spiritual text. This includes spiritual books or materials they wrote themselves. The exception to this, of course, is if that’s exactly what you’ve sought them out for and the therapist openly advertises this fact.
Suggest you join a group that they're personally affiliated with (i.e. a church or social group).
Looks sleepy, distracted, or elsewhere during the session. Clock-watching, yawning, looking out the window, replying to messages on their phone, or not turning their phone on silent. These are not good signs.
A therapist should demonstrate good boundaries. They should not talk about themselves/their life unless it is of direct benefit to the client.
Doesn’t ask you questions. A good therapist wants to know your situation. A good therapist wants to know what matters to you. They want to know what you need and what you value. This indicates genuine interest and respect.
Doesn't have a plan. In therapy, you need to have an idea of where you're headed.
Whilst undertaking couple therapy, the therapist refuses to meet with you by yourself. This means the therapist practices old-school therapy. This approach can harm your relationship and you.
Only offers hour-long sessions for couple therapy.
You're not making progress, and they cannot tell you why.
They become defensive when you raise a concern regarding therapy with them. Or they become dismissive.
The therapist's office
The space the therapist provides you for your appointment should be physically safe and private. They should ask about your accessibility needs. Their office should be clean, warm, and comfortable. The room should be quiet and well ventilated. They should never sit between you and the door. They should check that the physical distance between you is comfortable for you. The environment should make you feel physically and psychologically safe and comfortable.
Continuous Quality Improvement & Feedback Informed Treatment [FIT]
Feedback-informed treatment is the Airbnb of therapy - but better.
With Airbnb, you provide feedback to your host after your stay. This enables the host to remedy things for future guests. It also gives accommodation some credibility.
In my practice, my clients tailor their therapy or coaching experience. At the end of appointments, my clients review me. Just like you would review your Airbnb accommodation. These methods make my client’s next session even better. The client designs their sessions. The approach is tailored to suit their needs and expectations. We track progress to see if what we are doing is helping. If we aren't making progress, we can then pivot.
Feedback ensures therapy is nimble. Feedback ensures therapy is responsive. Feedback measures for every session saves you time. It saves you money. It can save you regret.
I provide feedback-informed treatment to individuals, couples, and organisations.