How to Choose a Therapist
How to Choose a Therapist
Choosing the right therapist is a complex and extremely important matter, involving
questions with licensing, training, degree, and, of course, personal comfort. Please find
these issues discussed below for your assistance.
Licensing: It is usually best to choose a therapist who is licensed by the regulatory board
in your state. Licensing typically ensures that a therapist has obtained a graduate degree
and one or more years of post-licensure training and supervision. It also gives recourse to
the regulatory board should a question of poor treatment or ethical misconduct arise.
Most licensed therapists are competent and ethical; however, it is good to know
beforehand common forms of ethical misconduct that are sometimes encountered by
those seeking mental health services. First and foremost, it is unethical for a clinician to
engage in a sexual relationship with a client. It is also unethical to form a “dual
relationship” in which the therapist is also the client’s friend, customer, salesperson, or
other outside associate. Some therapists treat problems without getting proper training to
do so. This is highly unethical. Please see the Training section below for examples of
problems requiring specialized training. For a more extensive discussion of ethical
misconduct, please see the ethics code of the American Psychological Association,
http://www.apa.org/ethics/.
Training: Many problems for which people seek counseling do not require specialized
training over and above that provided by graduate school, supervision, and post-licensure
study and experience. However, I have listed a few disorders below which appear to be
best addressed by therapists with specialized training. This is not a complete list, so
please do some additional reading to see if your particular problem has been studied in
clinical trials. You may also feel free to email me with questions of this sort: If I have
some knowledge that may be helpful, I will be happy to share it with you. Please note
that the discussion below addresses psychological approaches only. There is substantial
evidence that medication is also effective for these difficulties. Sometimes the
combination of medication with the therapies below is necessary to achieve the most
effective result. A competent therapist will discuss medication options with you and may
well offer to refer you to a psychiatric practitioner for consultation.
a) Panic Disorder: Typically, people suffering from this problem have panic attacks,
sometimes occurring out of the blue, which make them feel terrified that a catastrophic
event is about to occur. The disorder may or may not be accompanied by avoidance of
panic-prone situations.
Clinical research to date has indicated that the best psychological treatment for this
problem involves gradual exposure to panic symptoms and situations combined with a
great deal of therapeutic support and information. Therapists most likely to have training
in such approaches are those specializing in the behavioral or cognitive therapies. A
national directory of such therapists may be found at the following website:
http://www.aabt.org/.
b) Obsessive-Compulsive Disorder: Typically, people with obsessive-compulsive
disorder (OCD) suffer from obsessive thoughts and excessive, superstitious behavior
such as cleaning, counting, or checking. Although treatment of OCD may need to involve
many interventions, a necessary component of psychological care is called “exposure
with response prevention.” Research has shown that psychological care without exposure
and response prevention is less likely to be effective.
A good resource to find a qualified therapist for OCD is the Obsessive-Compulsive
Foundation, http://www.ocfoundation.org/. Make sure any therapist you interview,
whether referred from the Obsessive-Compulsive Foundation or elsewhere, has
specialized training with exposure and response prevention.
c) Attention-Deficit Disorder: A behavioral approach to this problem which also includes
the family and school, and which includes medication consultation, seems to provide the
best outcomes for this problem. A national directory of behavior therapists may be found
at the following website: http://www.aabt.org/.
d) Oppositional-Defiant Disorder: This problem occurs when children do not obey
appropriate parental requests. Treatment should begin as early in the child’s life as
possible.
Research ongoing for decades at the Oregon Family Social Learning Center has identified
many factors that contribute to this problem, a predominant one being the loss of a parent
from the household. There are also many treatment factors to be addressed, the most
important of which is the application of consistent, appropriate consequences for
oppositional behavior.
Therapists from many theoretical persuasions are competent to treat this problem;
however, when interviewing a clinician it is important to ensure that he or she is aware of
the importance of consequences as indicated above. A national directory of behavior
therapists, who may be more likely to know about the research at the Oregon Family
Social Learning Center, may be found at the following website: http://www.aabt.org/.
Degree Status: Psychotherapists may have a variety of degrees after their names. Ph.D.,
Psy.D., Th.D., and Ed.D. refer to clinicians who have obtained doctoral degrees. If they
have subsequently passed state licensing exams, they are able to practice as clinical
psychologists. Psychologists typically attend graduate school for 3-5 years and then
complete a year of internship training at an accredited institution such as a medical
school. Another year of supervised experience is typically required before the clinician
can sit for the licensing exam.
Clinicians with degrees such as MSW, MA, and MS –and licensure status such as LCSW
(licensed clinical social worker), LPC (licensed professional counselor), or LMFT
(licensed marriage and family therapist) –have earned a Masters degree, typically by
attending a graduate school for 2-3 years. An internship, and another year or two of
training and supervision, may also be required before the clinician can sit for the state
licensing exam.
Despite the fact that psychologists receive more training and experience before receiving
their doctoral degrees, I am unaware of research demonstrating that they consistently
achieve better outcomes in studies on psychotherapy. All things being equal, a
psychologist may be the best pick; however, there are many exceptional therapists in
practice who are licensed at the Masters level and who provide excellent care.
Personal Comfort: Of all the factors above, with the possible exception of specialized
training for certain disorders, personal comfort may be the most vital to getting a good
result from therapy. Clinical research has repeatedly demonstrated that relationship
factors - such as a therapist’s empathy and warmth–cause much of the positive change
observed from therapy.
In general, it is best to find a licensed therapist who –along with a good reputation in the
community and adequate experience –is someone you like and trust. Although
psychotherapy is a business, it is also - and primarily - a service, a unique partnership
between client and clinician in which personal information is shared with the promise
that it will be utilized in strict confidence and primarily for the client’s benefit.
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