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CHOOSING A THERAPIST: HOW TO FIND THE HELP YOU NEED

By Lynn Yarbrough Naugle, BCSW, BCD
STEPFAMILIES, Winter 1994

When people call my office seeking help it is usually a crisis situation. I think I know why people wait until then to reach out to professionals. First of all, there is a misperception that you have to really be in over your head before entering counseling. Secondly, there is not a lot of information about how to choose a therapist. In a crisis we are less likely to be thoughtful in our choices. Choosing the best therapist for you is what I'd like to address in this column. I also want to emphasize that I believe that pre-crisis counseling is a good preventive medicine."

Deciding upon a therapist is a serious consideration. It is an investment in time, money and trust. If the choice is a good one, the pay off is great. I encourage each person to take his/her time and interview possible candidates. This is one of the reasons I encourage people to seek out a competent counselor before a crisis occurs. A counselor that is right for one person may or may not be a good fit for someone else. However, asking friends who have had a good experience with a therapist is an excellent place to start. Your pediatrician or family doctor can also be helpful in directing you towards skilled, experienced and reputable mental health practitioners in your area. Also the Stepfamily Association has compiled a list of clinicians from a variety of disciplines who have interest and experience in treating issues that are common in stepfamilies.

Once you have a list of possible candidates, the next step is to interview your potential therapist. Here are some areas you might want to consider exploring.

1) Credentials are important. Credentials mean that whatever the discipline - psychiatrist, psychologist, social worker, psychiatric nurse, licensed counselor, pastoral counselor or others - there is a minimal standard of training and experience that has been met. However, keep in mind that a therapist with the greatest number of credentials may not have the most wisdom. So there are other things to consider. Reputation is important. Ask friends, clergy, other professionals what they know about this person's skills and standing in his/her own profession.

2) Experience in a particular field is another appropriate area to explore. Does he/she have interest and experience in working with people in stepfamily situations? This is an obvious advantage and one of the reasons SAA is asking professionals from across the country to submit their applications for a directory. As you see, there is a fair amount of work that can and should go into selecting a counselor. Even if you feel that you are in a crisis and your family might disintegrate before your eyes, hold off making a final decision until you explore the available options. Most therapists will give you a brief, ten or fifteen minute telephone interview allowing you to ask the most obvious questions. Some counselors will even have an initial session at no charge to determine if the fit seems right both to you and to him/her. Even if there's a fee for the initial session, (and usually there is), it's well worth the money to get the right person.

3) Speaking of money, the fee is frequently a topic that seems difficult for people to discuss. The counselor should seem willing, comfortable and direct about discussing the fee that is charged and how it is to be paid. Sometimes payment is requested at each session. Other counselors will bill monthly. Some file insurance and accept what insurance pays, while others ask the client to pay the difference. Some counselors work on a sliding scale depending on the client's income. If certain times of day are impossible for you to make an appointment, ask about the hours he or she has available that best suit you and your family's needs.

4) If a therapist is competent and caring he/she will also be cautious, never promising things that can't be delivered. If you ask a question that the therapist couldn't possibly answer, such as predicting the outcome of your difficulty, trust the one who admits that they don't know. That therapist is being realistic and honest. Many times the ones who imply that they have all the answers are the ones with the least experience and expertise. However, a competent therapist can probably give you his/her opinion on the gravity of your situation without predicting the outcome. You also might want to contract for a certain number of sessions then reevaluate where you are. That seems agreeable for most therapists and clients.

After all this interviewing, compare the way you and your spouse felt with each counselor. With whom did you feel the greatest connection, ease and trust? That feeling is the best indicator of all. Remember that good counseling is not always a comfortable process. There are times you might feel misunderstood or unheard. If this occurs be sure to talk it out with the therapist. A good therapist will not respond defensively but will be eager to work with you in trying to understand the difficulty. If you continue to feel misunderstood or not respected after bringing this up with him/her, perhaps this isn't a good match and you need to look elsewhere.

Good therapy is much like a healthy family. There will be disagreements among family members but disagreements can be resolved so that nobody consistently feels they are on the losing end. In fact, a good therapeutic relationship will encourage the working out of the difficulties between the therapist and client as a model for how conflicts can be resolved outside the therapist's office. That ability is one of the indicators that you're accomplishing something in counseling. There are some people or families who never seem to be able to find just the right counselor. If you've tried several different counselors but continue to find fault with all of them, that might mean you are feeling ambivalent about counseling in general. In other words, there will never be the perfect counselor, just like there isn't a perfect mate or perfect family. In fact, if each of us is honest about our feelings toward counseling, the truth would be that we all approach therapy with both a desire to know and a fear of what we will find out about ourselves.

I believe this to be universally true. I've never known anyone, including myself, that wasn't hesitant about looking closely at those things that we would rather keep hidden. Therefore, don't let ambivalence or momentary discomfort derail your counseling. All in all, the search for the right counselor for you and your family can be an educational one. You not only have the right to make an educated choice, you have a responsibility. Good luck on your journey. Good therapy is well worth the energy it takes to find.

* Lynn Yarbrough Naugle is a clinical social worker in private practice in New Orleans, Louisiana, and a Board member of Stepfamily Association of America (when this was published.)

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