• The Madness Issue

    How to Find a Good Therapist

    The Madness Issue
    Terapist web

    How to Find a Good Therapist

    How do you find a person you can trust with your most tender and vulnerable thoughts? Here are seven things to consider.

    How does one choose a therapist? Perhaps a more accurate way of phrasing this question would be to ask, “How does one choose another human with whom to build one of the most significant relationships of one’s life, joining together in a process of skillfully and patiently mapping out the complexities, deep truths, and profound sufferings of their inner world – both conscious and unconscious.” It’s a mouthful, but it's likely closer to the truth. Even if you are choosing a therapist to help you with something that seems simple and separate from any kind of depth, it is connected. If you are going to therapy for it, meaning it is an issue you cannot think through on your own or change through sheer will power, there is a corresponding depth if you are willing to find it.

    As an example, perhaps you’re considering quitting smoking. Did you start smoking because you wanted an anxiety soothing activity to fit in or seem cool? That’s why many people start smoking and it points to unresolved attachment issues. Attachment issues form out of unattended fears in your relationships to caregivers around things like belonging, being special, and feeling safe in the relationship. Maybe you cried as an infant and your cries weren’t answered often enough? You might not think that’s a big deal, but babies are totally vulnerable. A cry that goes unanswered can slowly become a fear that you will not be safe, existence is called into question, and the only thing you have to connect to a real and concrete sense of yourself is a thumb to suck on. Now you’re a smoker.

    Uncovering your deeper truths is what therapy is all about. Not knowing how to find the right person to talk to can prevent many people from making changes in their life, despite wanting to. Consider the gravity of what you are trying to do: choosing a psychotherapist or any other kind of psyche healer is a serious and sometimes difficult task. Therapy is expensive, time consuming, and is a long process – you will benefit from making an educated choice. If the therapy is going to be powerful and effective, it will involve a level of emotional risk that puts you in a vulnerable position. Psychotherapists are no different from other people: there are trustworthy, skilled therapists and just as many who have found themselves in the wrong line of work. Like all people, therapists have psychic wounds with corresponding needs. It takes an incredible amount of skill and self-awareness to put your needs aside and hold space for someone else’s. When you bare your innermost tender and vulnerable parts to another human, you won’t want someone who is unconsciously seeking gratification through you. Your therapist might have a wounded-baby-turned-smoker inside too, but you want them to have the wherewithal to take enough care of the inner-baby, so that it isn’t psychically crying out for attention during your sessions.

    Here are seven things to consider before you make the choice:

    1. How do you typically make choices?

    Are you a person who just goes with whatever choice presents itself first? Or do you scour the internet and networks with friends, only to find that no one is ever going to be good enough? Take an inventory of this process for yourself, because that is likely the approach you’ll take in this task as well. If you always find that no one is the right fit, not finding someone right for you may actually be a part of the material you eventually work through in the therapy. Do an online search and ask people in your community or other health care providers. I advise calling at least three therapists and trying out two. Having options to compare will help you get a better sense of what you need. It may seem expensive to try out more than one therapist, but consider the disappointment of spending six months of energy and finances to realize it isn’t a good fit.  

    2. Why are you going to therapy?

    Therapists specialize in certain issues and I recommend finding a therapist who specializes in the issues you want to work on. Working with someone who has a specialty means they likely have extra training, get issue-specific consultation, and have worked with many people who struggle with similar issues as you. Take the time to write down a sentence – or better, make a list – about what you want to discuss and keep it with you for the first phone call. If you find a therapist who seems like a match in terms of personality, but not in terms of specialty, ask the therapist to refer you to a colleague who does specialize in helping people with your needs.

    3. Do you have any parts of your identity that are the target of oppression by mainstream society?

    Western psychology has a long, tragic history of upholding oppression by pathologizing aspects of identity – meaning it defines ways of being as illnesses. We live in a larger cultural context that points a pathologizing finger at the victims and survivors of abuse and oppression, and rarely at the people causing harm, or the culture that cultivates it. There is no You Had An Abusive Parent Disorder, You Are Surviving Racism Disorder, or You Are Finding Reasonable Solutions to an Insane World Disorder. On a psychic level, oppression is partly the act of asking a group of people to shoulder feelings – intolerable, disowned, rejected feelings – for another group of people. For example, white people collectively struggle to adequately feel rage, vulnerability, and shame and project it outward onto people of color. Most therapists are white. If you’re a person of color, would you want a therapist who may unconsciously see you as a person to hold disowned feelings for white people? If you are white, would you want a therapist who unconsciously colludes in your struggle to adequately feel rage, vulnerability, and shame and thus project it outward? You may decide you want a therapist who shares some aspects of your identity and that is OK.

    You can ask a therapist about their sexual orientation, their ethnicity, their class background, et cetera. Some therapists will not answer these questions, which is fine, but you can still ask. It may not be about the actual answer, but more about the way that they engage with your question. You can also tell them in the first phone call, “I am X, Y, and Z, what kind of experience do you have working with people like me?” You can even be so bold as to say, “I am scared about being misunderstood or pathologized by you.” Listen to how the person responds to these questions and most importantly – listen to how you react to their statements. No one is perfect, and part of the therapy relationship is being able to work through conflict and uncomfortable dynamics. You may also specifically want to work with someone who is different than you, as part of your healing process. Whether you are working across more or less difference, you want to find someone who can have integrity in relationship to you. Many therapists are radical and do intrapersonal work around these kinds of issues to better serve their clientele.

    4. What modality would you like to practice with your therapist?

    There are several different kinds of therapy, but across all modalities there is one single most common determining factor for success: the quality of the relationship. I recommend that you research different modalities through conversations with your community and online, but ultimately you are seeking to build a relationship with someone. There are several kinds of therapy that use a “short term” model. This is a model of therapy spawned from capitalism. It is popular with the business side of healthcare, such as insurance companies, as well as agencies that are working with limited resources. It is useful for what it is, but if you have the means to see someone on a longer timeline, I highly recommend you take that route. Incidentally, there are low fee clinics where you can see someone longer term in most major US cities.

    5. What can you afford to pay?

    Therapy is not something where the cheapest version is the same as the expensive one. Long-term therapy work is an investment that costs a lot of money. It is important to know what you can pay and for how long. It is a total disappointment to quit therapy before you're ready, because you can’t afford it anymore. If need be, see a less expensive therapist that you can see for longer. If you have a loved one offering to pay for therapy, but you have a tenuous relationship around money with them, consider rejecting the offer and choosing something you alone can afford. If your insurance covers ten sessions a year, it might seem affordable, but find out what it would cost if you decide you want to stay on and pay out of pocket. Oftentimes to get therapy covered by insurance you need a diagnosis. That is something that will go down on your permanent health record and may have effects down the road. Paying out of pocket offers more confidentiality. You will also want to consider how often you are going to therapy. It can be tempting to go every other week to save money. My recommendation is to go every week, because two weeks is a long time to maintain a connection to someone wherein the relationship itself is a big part of the healing.

    6. Make a list of what you want to ask when you are on the phone.

    • Ask about fee, location, and scheduling.
    • Ask about their specialties.
    • Tell them what you need help with.
    • If you have any accessibility needs, ask about those. Is the office up several stairs, for example?
    • Consider asking: What does a therapy session with you look like?
    • If you are sensitive to space and environment, ask what the office is like. Is there a window, are there toys, what is the lighting like?

    7. Listen to your gut.

    This is the most important part of making this choice. Somewhere in you is this amazing wisdom that tells you what is right for you. If you are a person who has been socialized or raised to not feel yourself, to dismiss your own opinion, to ignore dangers or threats to your safety, this will be more difficult to know or trust, as you have probably had to ignore and hide your wisdom and self-knowing for a very long time. What do you feel inside yourself when you know something is right and when you know something is wrong? Listen to that. Somewhere in those first moments there will be an answer for you – some kind of sign that this is someone with whom you can build a very special relationship.  

    Good luck! For further inquiries or advice, please hit me up on my Tumblr, where I answer questions about counseling, politics, sex, and love.

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