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Here is the beginning of a post I just put up on Medium.  You can read the full article here.

“Reading Harriet Brown’s critique of my profession felt like someone was pouring salt on a wound I didn’t know I had. I recently went into private practice as a therapist, leaving behind the world of research in clinical psychology with mixed emotions of elation (no more bosses!) and grief (goodbye dear research). It’s been a tough transition and Ms. Brown’s epic failure to understand the challenges faced by therapists is both hurtful to me and harmful to those who might take her critiques at face value.

Ms. Brown is concerned that patients are not getting the therapy they need largely because we therapists choose to disregard science and instead like to think of therapy as an art. Now I wholeheartedly agree that not all therapists are competent (some astonishingly so). But this common critique of my profession is filled with misunderstandings, errors, and straw men that lead the people away from a deeper understanding of the complexities that exist in the development and delivery of evidence-based mental-health care. Let’s take a critical look at some reasons why patients often do not receive therapy based solely on what the science says to do…..”

I am often asked a question by friends and family that is hard to answer:  “How can I find a good therapist?”  I wish the answer to this question was as easy as sending folks to a website, but the truth is that it can be tricky to find the right therapist for you.  There are many important things to consider when looking for a therapist.  Most importantly, you need to consider:

  • Degree
  • Specialized training (this is unrelated to the degree)
  • Are they a good fit for you?

Unfortunately, you also need to be VERY careful to avoid people offering therapy who are not actually trained as therapists.  They are well meaning.  There are MANY of them.  They can do things that can cause serious harm.

Let’s talk about each of these areas in more detail.

Degree

Therapists can have many different types of degrees.   In North Carolina, your therapist should have one or more of the degrees listed below (please let me know if I missed one):

  • LCSW (Licensed Clinical Social Worker)
  • LMFT (Licensed Marriage and Family Therapist)
  • LPC (Licensed Professional Counselor)
  • MD (specifically, a psychiatrist)
  • PhD (in psychology or counseling), that’s me!
  • PsyD (somewhat similar to a PhD, this is also a type of doctorate level psychologist)

Your therapist should clearly state that they are CURRENTLY LICENSED by a board. Licensure boards were established to protect you, the consumer of mental health services. It is important that your therapist is licensed for several reasons.  First, it is illegal to practice therapy without being licensed.  Second, a board makes sure that your therapist has up to date and adequate training in skills and ethical standards.  Third, a board handles all potential complaints of ethical violations.  A fancy, schmancy degree is not enough – make sure they are licensed!

RED FLAGS:  There are a LOT of people out there offering therapeutic services when they in fact do not have adequate training.  At its worst, conducting therapy without having adequate training is not just ineffective.  These individuals can actually cause new harm on top of not helping you with your symptoms.  Often times these harmful services are offered by well meaning, empathic caring people who just do not understand the theoretical underpinnings of sound therapeutic practice, and they do not know how to monitor the safety and well-being of the people they see.

I have seen a disturbing number of unlicensed people offering therapeutic services in my community.  Many of them have very nice looking websites where they say kind and caring things and offer many kinds of services.  Many of these well meaning people say things on their websites like, “I offer an alternative to ineffective traditional therapy….”  Plainly stated, this is bogus.  There is a tremendous range of approaches that can be taken by a therapist.  If someone is stating that they offer an alternative because “traditional” therapy isn’t useful then they are merely showing that they are not educated about what therapy actually is.  To be a wee bit blunt, I spent nine years being trained at the graduate or post-graduate level to learn clinical psychology and become competent at conducting therapy.  There is just no way around not having adequate training, no matter how well meaning someone may be.

Bottom line:  Look for the degree, then look for the license.  If you cannot find both then they should not be offering therapy.  Do not be afraid to ask if you aren’t sure.

Areas of Specialization

Boards can certify that a person can work as a therapist, but they aren’t very useful in helping you determine if a therapist is going to be trained specifically in the areas that you may need.  GENERALLY speaking, if you are seeking a therapist for issues like depression, anxiety, and life adjustment issues then many therapists will be able to meet your needs.  Many other issues require extensive training and supervision specifically in that area.  For example, you will want a therapist who has specialized experienced if you are seeking help for issues related to eating disorders, substance abuse, trauma, issues related to identifying as LGBTQI, relationship therapy, bi-polar disorder, schizophrenia, sexual abuse, child abuse, parenting issues, and intellectual disabilities.

RED FLAGS:  Beware of therapists who say they specialize in a long list of complicated issues.  The more issues they say they treat, the less well trained they likely are in any one issue.  A good therapist should be able to say what s/he doesn’t treat as much as what s/he does treat.

Do not be afraid to ask!  Ask a potential therapist if they have dealt with issues that are similar to yours.  Ask how long they have been working with such issues.  Ask what percentage of people they see have issues similar to yours.  You may even ask to speak to a former or current patient.  It is your right to make an informed decision.

Is this therapist a good fit for you?

Finally, if you have made sure that a potential therapist is adequately trained then it just comes down to a good fit between you and the therapist.  Just like you don’t want to date everyone you meet (hopefully!), you shouldn’t expect that every well trained therapist is the therapist for you.  Part of this important decision comes down to trusting your intuition.  That can be tricky, as many people seek therapy precisely because they have trouble trusting their intuition.  Here are some points that can help guide your thinking.

  1. A good therapist has many of the same qualities that you would want in a good friend.  You should feel comfortable with your therapist, respect them, and feel that you are able to build a safe relationship with them.
  1. A good therapist, like a good friend, is not a bossy know-it-all.  Your therapist should work with you, collaboratively.  You should feel like your voice is being heard in session.  Therapists are humans and can misunderstand patients.  In fact, sometimes part of therapy is learning how to feel safe speaking authentically with your therapist.  But when you are misunderstood you should feel comfortable correcting your therapists’ thinking.  Your therapist knows how to do therapy.  You know you.  It takes a combination of each of these areas of expertise to effective create change for you.
  1. A good therapist empowers you.  The goal of therapy is not for the therapist to solve your problems.  The goal is to help you eventually feel strong enough to find and solve your own problems.
  1. Related to the above point, a good therapist tells you what the heck they are doing.  You should know (or be able to ask) what technique is being used at any given time and why that particular technique is being used.  You should never feel like something is being done TO you.  If you don’t know what is happening, a good therapist encourages you to ask questions about what they are doing.  And good gracious – this point is especially true if they are doing anything like hypnotherapy, EMDR, or any kind of computer program that “retrains” your brain.  Your therapist should still be able to explain the theory of why such a technique works and is the right thing to try with you.
  1. A good therapist encourages you to share your feelings, even the difficult ones.  S/he should create an environment where you feel safe bringing up even the most difficult and uncomfortable thoughts and feelings.
  1. A good therapist treats YOU, not your diagnosis.  Your therapist should be able to tailor treatment to your specific values, needs, and goals.  If your therapist is trying to change your values to fit theirs (e.g., on issues like religion, sexual preference, etc), then let them know you aren’t seeking advice on how to change these parts of who you are.  If they don’t respect these wishes, be sure to close the door gently on your way out.

There are many good therapists out there, but not all therapists in the specialization you need are going to be the right match for you.  Just because a friend recommends a therapist does not mean the therapist will be the right fit for you.  It is totally and completely appropriate for you to talk with a therapist on the phone and ask whatever you wish before setting up a first appointment.  It is also just fine to meet a few times and then decide if might be better to keep looking.  This is an important decision and no one knows better than you what is going to be a good fit for you.