How to Choose a Counselor or Therapist
May 14th, 2007 | Email this to your FriendsIt’s easy to find a counselor, but perhaps more difficult to know if you’ve found one who’s right for you. There are a number of questions you can ask which will help you to choose a counselor. This short article outlines 14 of these questions, in no particular order (Please note, the words “therapist” and “counselor” are used interchangeably). Thanks to the GoodTherapy.org members who contributed their ideas to this article! If there are other important questions to ask or things you’d like to add to this list, please post a comment below.
1. What does it feel like for you to sit with the therapist? Do you feel safe and comfortable? Is it easy to make small talk? Is the person down to earth and easy to relate to, or does he feel cold and emotional removed? Is the counselor “stuck in her head,” or overly emotional and empathic? Is the therapist a “know it all” or arrogant? Sure, for many of us going to a therapist for the first time is a bit anxiety provoking, and it’s important to tease out our own “stuff” from the actual counselor. But, if a counselor doesn’t feel like a good fit for you, that’s ok, there’s absolutely no contract or rule requiring you to continue working with any counselor. However, it’s important to check if there’s a part of you avoiding therapy by disliking or judging the therapist. If you find yourself reacting negatively to every counselor you see, then the issue could be yours and may warrant you sticking it out with a counselor in an effort to work through your fears of beginning therapy.
2. What’s the counselor’s general philosophy and approach to helping? Does your counselor approach human beings in a compassionate and optimistic way? Does she believe humans are born loving and loveable, or does she believe people are genetically deficient? We at GoodTherpy.org are biased and believe that good therapists and counselor’s adhere to the Elements of Good Therapy.
3. Can the counselor clearly define how they can help you to solve whatever issue or concern has brought you to therapy? An experienced counselor explains how she can help, is able to give you a basic “road map,” to her approach and can even give an indication of how you will know when therapy is finished.
4. Does the counselor seek regular peer consultation? An important professional activity for any wise counselor is regular consultation with peers or consultants. Consultation serves a number of purposes, such as, but not limited to, reviewing cases, receiving advice, getting unstuck, discovering one’s own blind spots, and noticing how one’s own “stuff” may be getting in the way. Consultation provides a counselor with a necessary reality check, a degree of objectivity, and feedback. Even the best therapists benefit from the help of others.
5. Can your counselor accept feedback and admit mistakes? A healthy counselor is open to feedback and to learning that something he said hurt or offended you. Good therapists are willing to look at themselves, to check their feelings, and to honestly and openly admit mistakes.
6. Does the counselor encourage dependence or independence? Good therapy doesn’t solve your problems; it helps you to solve your own. Likewise, good therapy doesn’t soothe your overwhelming feelings; it helps you to soothe your own. Like the old proverb, therapy is most powerful when it helps people to learn to fish for themselves rather than rely on another to feed them. If your counselor provides wisdom, answers, or emotional support without encouraging you to access your own resources, it is more likely you will become dependent on your therapist to help you feel better, rather than on yourself.
7. Has your counselor done his own therapy? One of the best ways to learn how to help someone to heal is to do your own therapy and to experience the healing process first hand. Thus, therapists who have been in their own therapy benefit from this as a learning experience and are probably better equipped to help because of it. Most good healers are wounded healers, those who in the process of healing their own wounds developed the know how to help others to heal theirs.
8. Does the therapist have experience helping others with the particular issues you are seeking therapy for? The more experience one has addressing a particular issue, concern, or problem area, the more expertise one has developed.
9. Does the counselor make guarantees or promises? It’s important for a therapist to provide hope, but not absolute unconditional guarantees. If you have the will to change and put in the necessary time and energy, healing is possible. Most of our wounds and defenses are the result of what has happened to us and to those around us. Healing can happen quickly in psychotherapy - but only after getting safely through the layers of protective gate keepers, which understandably can take a long time. So, although everyone is capable of healing, changes can take years to happen for some people and, unfortunately because time is limited, some may never achieve the level of healing they desire in this lifetime. Additionally, people are not always at a time and place in their growth in which they are ready to heal and you and I may not be the right therapist. Overall, there are numerous factors at play in the therapy process which may contribute to or interfere with healing, some we are conscious of, others we are not. And so, there are no guarantees without conditions. Here is more info on how “Sometimes We Can’t Help.”
10. Does your counselor adhere to ethical principles such as boundaries, dual relationships, and confidentiality? There are numerous ethical guidelines designed to keep counselors from harming clients. Most important, there is a guideline against dual relationships. When a therapist enters into a therapeutic relationship with you, he or she should not have any other relationship with you, such as teacher, friend, employer, or family member; though there are some exceptions to this rule in village or very rural communities. The principal behind this guideline is really about who’s needs are getting met. A therapist should be there to meet your counseling related needs for empathy, understanding, support, guidance, unburdening, and healing. When a counselor gets his or her own needs met (emotional or otherwise) by the client, he has crossed a boundary and the therapy process can be damaged or ruined. This is one of many ethical guidelines and it’s important for a counselor to adhere to these. For more information on Ethical Standards you can visit these links:
11. Is the counselor licensed? Licensure ensures that a counselor has engaged in extensive post graduate counseling experience which, depending on the state of licensure, may include up to 3000 hours of required supervised experience. It also means the counselor has passed a licensing exam. There are many unlicensed therapists who have years of experience and do excellent work, but licensed counselors have, in general, though not always, jumped through more hoops and have undergone more extensive supervision than unlicensed counselors.
12. Does the counselor have a graduate degree? There are numerous people who call themselves “counselors” or “therapists” because they have taken a weekend seminar or have learned a certain therapeutic approach. But without a graduate degree in counseling, psychology, social work, marriage and family therapy, or another related field of study, such a person lacks the education, training, and skills to provide safe psychotherapy & counseling. It is highly recommended to only work with counselors and therapists who have graduate training. People without graduate level education in a mental health may lack the necessary skills and know-how to properly diagnose and treat issues; and there is a great danger in misdiagnosing and mistreating. Psychology is an enormous field and human beings are multifaceted and complex. It takes years of education and training to effectively help people. Without the proper training there is enormous risk of causing harm.
13. Does the counselor have post-graduate training? Many new counselors fresh out of graduate school have had excellent book learning but lack enough actual counseling experience to claim expertise and feel totally confident. Post graduate training in a particular approach to psychotherapy is often the next step in a new counselor’s career and is helpful in getting a new counselor to the next level in which they have more confidence and know-how.
14. Have any complaints been filed with the board? If so, what are the complaints and have they been satisfactorily resolved? To see if a counselor has a record or is under investigation, you can check with your state licensing board, usually under the state dept of health or occupational licensing.
May 17th, 2007 at 11:05 am
What a great resource for everyone. You provide a good service
May 27th, 2007 at 8:27 am
As an eating disorders and addictions expert, I recommend looking for a therapist who specializes in your problem area. For example, not all therapists are skilled at couples or family therapy and you want to put yourself into the hands of the person with the most expertise and experience. Regarding eating disorders and addictions, I would only suggest going to someone who has substantial skill in these areas; a generic therapist won’t do. In many geographic areas, the general populace is fortunate that they can choose from a wide variety of gifted and talented therapists in numerous specialty areas.
May 27th, 2007 at 8:52 am
I like the premise of what you have here. I think the order of the questions might want to be rethought as you describe the licensing process in the 1st question, including all the requirements (post-licensure experience, exams, etc.) and then discuss in the 4th and 5th questions the same information (do they have post-licensure experience? Do they have an advanced degree?). The information becomes redundant in this manner.
I like the question on guaranteeing results and how you explain it to your clients. This is VERY important for clients to understand!
May 27th, 2007 at 10:12 am
Thank you for your succinct and clear list of ways to choose a counselor. I have a few suggestions in response to your request for feedback.
Based on the meta-research done at The Institute for the Study of Therapeutic Change (ISTC) http://www.talkingcure.com by Barry Duncan and Scott Miller, the most important and easily controlled for element of therapeutic change is the feeling of trust and understanding between the client and the counselor. These “alliance factors” account for about 60% of the general therapeutic change. Based on this research I would recommend moving the following statement, “9. What does it feel like for you to sit with the therapist?” up to number one in your list. One thing I would add to this paragraph is that therapy should show some change within the first 3 sessions (same research set). If clients are not seeing change or experiencing some relief within that 3 session window, they may need to seek a different therapist.
The second most important factor in therapeutic change, according to this meta-research, is allegiance factors. This is the understanding that the client’s beliefs about change and healing are matched by the counselor’s practice and beliefs. Based on that knowledge, I would recommend moving the following statement, “5. What’s the counselor’s general philosophy and approach to helping?” to number two on your list and changing the paragraph to include information about how the philosophy and approach matches client expectations.
Research also supports a much stronger statement than number 11 about accepting feedback. Effective therapists do more than accept feedback offered by clients. They actively solicit criticism about what is working and not working in counseling through end of session commentary, written questionnaires and follow-up surveys. Good therapy requires an ongoing conversation between counselor and client about what is helpful and what is not useful.
My other suggestion is not yet supported by research but based on a personal bias. I think that the following question, “6. Can the counselor clearly define how they can help you to solve whatever issue or concern has brought you to therapy?” should also be moved up on the list. A good counselor should be able to explain the assessment process they use to determine what is not working. They should be able to clearly define what skills or changes are necessary and how they will explore those skills. They should also be able to describe how both parties will know when therapy is complete. If you cannot help people understand how they are becoming healthier, you will not be able to tell if you are actually helping them.
Thank you for the work you are doing to promote functional and effective counseling.
Jennyfer Raden
http://www.healthycouples.org
May 27th, 2007 at 10:51 am
In the UK at present it is not possible or needed to register. I am a member of the American Board of Hypnotherapy which for me in the UK is all that is required.
All of the other so called professional associations in this country are nothing but businesses and therefore are not any more a reliable indicator than my qualification.
Where does this leave me in registation with yourselves.
Roger Macdivitt
May 28th, 2007 at 6:35 am
A note to say that in the UK there is no licensure or requirement that a psychotherapist holds a graduate degree. Instead there are accreditation organisations UKCP, BACP or BCP which require a level of experience and proficiency, including a number of hours in therapy, training, continuing professional development etc. These organisations are responsible for standards, codes of ethics, complaints and so forth.
Therefore, in the UK it is useful to know whether a therapist or counsellor is accredited and who with.
May 28th, 2007 at 8:39 pm
Thanks to everyone who commented with feedback and suggestions on the 15 guidelines: Jennifyer, Jodi, & Karen I will put some time into ordering the guidelines by importance and adding some of the information that was shared via blog and backchannel. Roger, Claire, and others with similar comments, I want you to know that we adjusted our licensure questions to include room for those counselors who are accredited and certified. To view the changes or to adjust your licensure status log back into your profile here: http://www.goodtherapy.org/edit-counseling-practice-ad.html
May 31st, 2007 at 3:05 pm
[…] on Psychotherapy, Healing, & the “People are Proficient” Movement « How to Choose a Counselor or Therapist Call to action from the Consumer Reports Consumers Union of the US […]
June 26th, 2007 at 1:12 pm
From the time I was a student in psychiatric social work in the 70’s, I understood instinctively that when we “label” something, name it, it “exists”. I’ve shunned the “pathologizing” capability of psychiatric labels. With the assumed “power” given therapists/doctors by our suggestible clients/patients, identifying someone with (or as) a disease becomes their identity all too often. Only a strong, self-knowing soul could escape the pitfalls of that kind of diagnosing: I’ve never operated that way, and today, even try to avoid “calling someone” “codependent,” etc. We must find “labels” that lead our wards to their True, gifted Selves, that empower them- and ourselves, in the process. The labels often serve only to keep people in therapy -eh?
July 7th, 2007 at 1:48 pm
[…] Fourth, we make efforts on our site and in our blog to inform consumers about the difference between licensed and unlicensed therapists and how to choose a “good” therapist. We encourage consumers to check the credentials of any therapist or counselor they see. For example, see here: http://www.goodtherapy.org/custom/blog/?p=29 […]
July 21st, 2007 at 10:18 am
After 30+ years of experience as a licensed psychologist I know degrees and licenses mean nothing–zip. Nope, give me an emotionally safe person instead! A loving person, who is open hearted is the only one who can help anyone else. Got to heal yourself before you can help anyone else.
Professionals are not up to speed most of the time in the “Open Heart” department, but the ones that are–are great! Visit my web site, drjeanette.com for an article on “How to Pick the Perfect Practitioner for You” to make sure you do not get guilt tripped into staying with unhealthy therapists. There are some voice, non verbal and emotional ways to check them out.
July 21st, 2007 at 1:53 pm
I would emphasize that dual relationships include having sexual or romantic relationships with a client. This unfortunately still happens and when it does the patient may feel “special” but is really being exploited, and the therapy ends.
I would also suggest that a client can be comfortable with a therapist but such comfort can mean tha the client is not being challenged to change ways of thinking or being in the world. There must be a level of comfort, including the comfort that comes from being understood, but it there is no strain, there is probably no gain. For example, I have seen plenty of people with OCD who have been comfortable seeing counselors but they have received “talk therapy” or “relaxation therapy” and have had to continue suffering for months or years when what they really needed was exposure therapy. Exposure therapy makes the person somewhat more anxious in the beginning but the patient who can tolerate the titrated anxiety gets better, often quickly. So my point is an obvious one: comfort is not enough.
July 22nd, 2007 at 11:15 am
As a therapist in private practice since 1990, I would add a word of caution regarding the assumption that counselors who have jumped the licensure and supervision hoops may thereby be better at helping clients achieve emotional balance.
These hoops are designed to identify and treat psychopathologies of serious mental illness. They are nearly oblivious to the dissatisfactions of normal clients dealing with the everyday stresses of life, and generally are not useful to therapists in helping clients find deeper meaning, satisfaction, personal growth, and wholeness.
In my opinion, more important than licensure are the factors of:
~graduate and post graduate training
~continued education including a consultive relationship with peers
~successful experience working with others with the same issue ~whether the therapist has done their own therapy, and continues to address their own personal issues with a therapist of their own.
Most important, as research shows, is the rapport established between client and counselor. If you can’t feel comfortable with your therapist, it’s unlikely you will be able to open up and examine your issues to the degree necessary for healing and change.
Dr Deah Curry PhD
Holistic Counselor
Therapeutic Coach
August 1st, 2007 at 1:54 pm
I always suggest that clients perform a telephone interview with at least 5 counselors. The counselor they pick should represent the person that is the best employee.
August 2nd, 2007 at 4:03 pm
Begin by doing a little personal research. Decide why your are seeking counseling at this time, what you main issues or concerns are, what type of therapist might be best for you (style of therapy, male or female, location, etc.). Ask people you know and trust for referrals. Google the words: psychotherapy, one or two words that describe your issue, problem or concern, and the city or state where you live. Do a serious review of the credentials, philosophy and background of each of the therapists that seem to fit your requirements. Send an email to those that interest you. Wait for an email response and then call the one therapist that you feel is appropriate for you. if the therapist you have chosen does not respond to your email or fails to return your phone call, check out another therapist.
Keep seeking until you have a satisfying conversation on the telephone with a therapist that answers your most pertinent questions and “feels” right.
August 19th, 2007 at 3:27 pm
Good article! How about finding out what the therapist’s values are? I often reccomend that people interview therapists to see what there values are and their world view.
Often time’s people go to therapy because they are in intense emotional pain and need assistance in dealing with this. Very seldom are psychotherapists asked about their “world view” and their values, even though this will impact the therapy process. Psychotherapists are people and have biases. The way traditional therapy is set up is with an ‘expert” who has an unequal power relationship with the client. Therapists who are aware of this power relationship can hold their bias in check or continue to work on it. A good therapist will be up front with their biases and ask the client for consultation.
Psychotherapists have a world view. Do they (psychotherapists) see clients as enriching their lives? Does the psychotherapist believe their clients are experts in knowing themselves and what they need? Does the psychotherapist ask the client mid point during the session if they are going in the correct direction of the therapeutic process? Does the psychotherapist see the client as having problems that are external from the person or do they believe that the client “owns their problem”? What does the therapist believe their role in psychotherapy is? What are the psychotherapist’s views on people who are marginalized by normative society? Does the therapist actively try to correct social injustice with marginalized people—how do they respond in the therapy room?
Clients need to interview their therapists to learn more and of course to see if their views are compatible. Therapy sessions work more effectively when open mutuality exists. This allows the therapist and client to acknowledge their human vulnerability, make mistakes and those errors can be understood and repaired.
September 13th, 2007 at 9:29 am
It’s one thing to study all the theoretical approaches to effective social work, it’s quite something else to know the nature of the beast by personal experience. Since we can’t all be poor or homeless or or homeless military veteran, for instance, we need to read the chronicles of those who have successfully navigated this difficult terrain. One such resource I’ve found and recommend is: “Down Town: True Tales of Trial and Triumph on the Mean Streets” by the NASNA 2003 Award winning author Robert E. Lipscomb of St. Louis. http://www.eaglesviewpress.com Read this, thank me later. Peace.
December 30th, 2007 at 3:32 pm
I think people obtaining help though therapy is important. Your therapy blog is very informative. I would love to add a link from my therapy site to your therapy site.