Imagine that you have reached a moment in life when you need to work out something painful and problematic. Your best friend is not getting it, and today the I Ching seems disturbingly vague. You want to feel more hopeful before the conversation ends. What would you google? Or who?
Therapy has lost a lot of its stigma; people no longer associate it exclusively with wierdos and psychotics. That’s good. Life can be trying, and sadness or humiliation can linger for a long time. I have friends who swear they don’t trust anyone who’s never had therapy. But savvy consumers of all sorts of things for the computer or the garden, feel baffled by the thought of finding the right therapist.
A piece appeared on NPR this morning called “Shop for a Psychotherapist to Avoid the Lemons”. It suggests that you begin by researching which forms of therapy are proven to work for your kind of problem, and demand them. Alan Kazdin, a Yale psychologist, recommends you interview a prospective therapist by asking whether she/he uses “evidence based treatment”.
Like most advice, it’s only semi-helpful. It’s true, for example, that Cognitive Behavioral Therapy is helpful with depression for a lot of people, and it’s an option worth asking about. But even “proven” techniques, in the hands of the wrong therapist, may not help you much. Besides, researching alternative therapies may be difficult, if you don’t know what to call the problem.
NPR featured an interview with a woman who found the right therapist; she found him the old fashioned way, by asking her friend, a social worker, for a personal recommendation. Her therapist, as it turns out, uses a psychodynamic approach, which includes a lot of fascinating work with unconscious motivation. Ironically, there’s relatively little formal evidence for or against the effectiveness of psychodynamic therapies, compared to behavioral ones. Most therapists use an eclectic mix of approaches; asking which ones they recommend, and why, are fair and useful questions.
The woman in the NPR story says she has been helped by her therapy, and that, too, is evidence. It’s helpful to have a well connected friend who knows your heart, to help you find someone who not only uses sound methods, but with whom you will resonate. Barring that, ask a potential therapist how she understands her role. Pay attention to the music, as well as the words. Notice your reaction. Are you intrigued, provoked, bored, intimidated?
The effectiveness of any therapy depends, in part, on intangible features. The counseling relationship itself, greatly influences the outcome of counseling, no matter what methods are used. Empathy is hard to quantify for research purposes, and so is insight; yet successful therapy of any type, requires both.
Kazdin is of course right in suggesting that you be a careful consumer. Odd omission: it’s a good idea to check a therapist’s licensure credentials. Therapists might be called Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), or Registered Psychologist. Hint: every therapist thinks his/her own credential is the best. Really.
By the way, how did you choose your cellphone? After reading the specs, perhaps you wanted to see how it felt, whether the way the features are organized made intuitive sense to you, whether it got on your nerves or made your heart sing. Therapy is a bit like that. It has to fit. There is no formula, no single right result. But when you find the right relationship, you will know it.