If you are looking for a counselor,1 allow me to first commend you for seeking help. Many people do not. Many suffer in silence, and some take their own lives. Statistically, women are far more likely than men to reach out for help.2 3 This may partly explain why the male suicide rate is almost four times higher than the female rate.4 Whatever your circumstances, be proud for taking a first step toward positive change.
What follows is a list of issues to contemplate when selecting a counselor to work with. Taking the time to consider each one will not only help you choose a suitable counselor, but may also save you time and money.
Expectations
Architects design houses, not homes; homes are what people create, or fail to create, out of houses. Similarly, psychotherapists provide conversations, not cures; “cures” (of souls, now called “successful psychotherapies”) are what clients who engage in such conversations create, or fail to create, out of their contacts with their psychotherapists.
– Thomas Szasz5
In order to manage your expectations going into therapy, it’s important to understand what therapy is, and what it is not. Defining psychotherapy is a big topic (worthy of its own article) and there are disagreements among professionals regarding the therapist’s precise role. For our purposes, the definition provided by psychiatrist, Thomas Szasz (quoted above), should suffice. Embedded in Szasz’s comments are two key points; (1) therapists do not provide ‘cures’, and (2) therapy is a collaborative process. The relationship between client and therapist is, thus, very different to that of doctor and patient.
Unlike a medical patient who is simply expected to adhere to his doctor’s prescription, a therapy client must play a much more active role (both in and out of the therapy room) in her change process. It is via collaboration with their therapists that clients attain their goals, not by simply following doctor’s orders. In other words, if you are expecting a therapist to cure all of life’s ills or enable you to be forever free of unhappiness, you are almost certain to come away from therapy feeling dissatisfied. Competent counselors are not in the business of saying “Do X and you will feel better.” They do not presume to know how you should live. They can, however, provide a venue for conversation and exploration of your presented problems and concerns: in essence, they are a guide. So to reiterate, be willing to play an active role in your change process rather than expecting your therapist to have all the answers.
Goals
What we can measure, we can improve. Knowing what you want out of therapy – or at least having an idea – will not only help you to select a suitable therapist, it will help the therapist you eventually choose, help you. Furthermore, having a specific issue you would like to address will enable you to filter out therapists who do not specialise in your particular problem.
For example, if you are a parent in constant conflict with your infant, a therapist who specialises in individual psychodynamic therapy may not be the best fit. It may be better to find a therapist who specialises in parental issues and/or child behaviour problems (although, there is a caveat to be aware of when considering the theoretical orientation of a therapist, discussed in the next section). Of course, a good therapist will be able to help you identify what you would like to change and discuss ways of measuring your progress, but it is still a good idea to start thinking about how to do this, yourself, as you prepare for your first session.
The Client-Therapist Relationship
A therapist can be viewed as a kind of authority figure, and in some sense this is true. Therapists are granted access to their clients’ inner lives and have a special skillset designed to help resolve psychological issues. Having said this, it’s important to remember that a therapist is simply an individual providing a service. In many ways, therapists are no different to lawyers or accountants. They offer a service which you, the client, are hiring them to provide. Therefore, instead of viewing a therapist as your superior, simply view him as a service provider and yourself as a customer – a customer who is free to take her business elsewhere if dissatisfied with the service being provided. Framing the client-therapist relationship in this way should help to keep your needs at the forefront, rather than your therapist’s – therapists exist to serve you!
The quality of the relationship you forge with your counselor is the best predictor of outcome in therapy. Developing a good relationship with your therapist is more conducive to positive outcomes than her particular theoretical orientation.6 So although, as was mentioned above, it’s probably a good idea to choose a therapist with specific knowledge and experience related to your issue(s), you are unlikely to benefit from your therapist’s specialised skills if you do not feel comfortable sharing your inner life with him.
The critical question is this: Do you feel that your therapist is curious to find out who you are and what you, not some generic “PTSD patient,” need? Are you just a list of symptoms on some diagnostic questionnaire, or does your therapist take the time to find out why you do what you do and think what you think? Therapy is a collaborative process—a mutual exploration of your self.
– Bessel van der Kolk7
Questions to Ask
All therapists have aspects of their lives which they are unwilling to disclose to clients (e.g. their religious beliefs) – and others for which it would be unethical for them do so even if they wanted to (e.g. their personal struggles). However, as a client, it’s perfectly reasonable to ask about a therapist’s education and training. Some therapists may also be willing to disclose other personal information (if asked) such as their marital status and whether or not they have children.
Other questions you may wish to ask a counselor:
- Do you have experience helping clients with problems similar to my own?
- Have you ever seen a therapist, yourself?
- What do you think the role of a therapist should be?
- Do you accept insurance payments?
- Are your fees negotiable?
Cost
The financial cost of therapy can be off-putting to some. A therapist charging a high fee does not necessarily mean he is superior to one with a lower rate. Likewise, a ‘cheap’ therapist is not necessarily a bad therapist. If you come across a therapist who looks right for you but fear that you will be unable to afford his hourly fee, it may still be worth getting in touch because some therapists offer discounted rates to clients with a limited budget.
Working with interns is another option for those of modest means.8 But that’s not their only advantage, as marriage and family therapist Tracey Cleantis, points out:
If you don’t have insurance and can’t afford the fees: see an intern at a clinic. The great thing about working with interns is that you get two therapists for the price of one. You get the intern therapist you are working with and the supervisor who is supervising. Training institutes usually have interns on staff that are available at very low rates.9
Regardless of the amount you decide to spend on therapy, remember that therapy is an investment; an investment in your future self. The return you hope to make on your investment will depend on the goals you set going in.
Red Flags
Several years ago when I was in search of my own therapist, I emailed several with some details about the issues I wanted to tackle and what I was hoping to get out of therapy. Some of the responses I received were great. I could tell that these therapists had taken the time to think about what I had written and respond accordingly. The other therapists’ responses, however, were not so great. Rather than a personal reply to my initial email, I instead received a breakdown of therapy fees and available time-slots. Suffice it to say that sending a vulnerable email only to receive a cookie-cutter response did not elicit a positive gut-feeling in me. Thus, I disregarded these therapists and (after some more emails) selected one from the subset of those who had actually taken the time to talk to me, not an anonymous potential client.
In sum, regardless of how experienced or accomplished a therapist is, if she is unwilling to spend the time to address you and your specific needs, this is a major red flag that would lead me to look elsewhere for a suitable therapist. This does not mean that you should expect therapists to begin conducting therapy over the phone or via email (another red flag), the purpose of the above illustration is simply to emphasise the importance of feeling heard by a therapist, right from the get-go.
Other red flags to watch out for:
- Therapists who do not take the time to discuss, and have clients sign, a confidentiality agreement before commencing therapy
- Therapists with sexually suggestive or otherwise unprofessional photographs
- Therapists who share their personal struggles with clients
- Therapists who medicalise client experiences/behaviours
- Therapists who do not welcome feedback or avoid answering legitimate questions
One More Thing
Seeking guidance from a counselor/therapist does not make you sick, ill, or crazy. It doesn’t make you stupid or weak, either. On the contrary, it shows that you are willing to better yourself; that you are open to hearing another person’s perspectives on your life and its challenges; and that rather than being perfect, you are a work in progress.
Key Takeaways
- Have realistic expectations
- Set achievable goals (with measurable results)
- Therapists do not provide ‘cures’
- Counseling is a collaborative process
- You (the client) are the customer and your therapist’s job is to serve you
- A good client-therapist relationship is the best predictor of success
- Don’t be afraid to ask questions
- Counseling is an investment in your future self
- Reflect on how you feel when interacting with a therapist
Other Helpful Articles From Around the Web
How to choose a psychologist – American Psychological Association
How to find the best therapist for you – Psychology Today
How to choose a therapist and other questions about psychotherapy – Psych Central
Choosing a psychotherapist – UK Council for Psychotherapy
Footnotes
- For the purposes of this article, ‘counselor/counseling’ and ‘psychotherapist/psychotherapy’ are used interchangeably.
- Diamond, J. (2013, November 11). Women seek help, men die: new findings on depression and suicide will save millions of lives. Retrieved February 03, 2019, from https://goodmenproject.com/featured-content/kt-women-seek-help-men-die-new-findings-on-depression-and-suicide-will-save-millions-of-lives/
- Doward, J. (2016, November 5). Men much less likely to seek mental health help than women. Retrieved February 3, 2019, from The Guardian: https://www.theguardian.com/society/2016/nov/05/men-less-likely-to-get-help–mental-health
- Farrell, W., & Gray, J. (2018). The boy crisis: Why our boys are struggling and what we can do about it. Dallas: BenBella.
- Szasz, T. (1976). Heresies. Garden City, New York: Anchor.
- Duncan, B. (2010). On becoming a better therapist. Psychotherapy in Australia, 16(4), 42-51.
- van der Kolk, B. A. (2014). The body keeps the score: brain, mind, and body in the healing of trauma. New York: Viking.
- Full disclosure: The author of this article is an intern.
- Cleantis, T. (2011, February 16). How to find the best therapist for you. Retrieved January 7, 2019, from Psychology Today: https://www.psychologytoday.com/us/blog/freudian-sip/201102/how-find-the-best-therapist-you
