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Is My Therapist A Good Fit For Me?

A lot has been written about “Choosing a therapist.” When I google this topic, the same themes emerge repeatedly. There are those who advocate for a specific type of therapist (e.g., psychologist v. counselor). Some assert that it is important to choose a therapist who specializes in your area of concern. For still others, a specific type of therapy is the most important consideration when seeking assistance.

In his book, “The Great Psychotherapy Debate” Bruce Wampold demonstrates with an exhaustive look at years of research that NONE of the above, by themselves, guarantees that a given therapist will be helpful to you.

None of them.

Stop and think about that for a moment.

This means that a psychologist with a Ph. D. may be less effective than a minimally trained peer counselor! The Emotion Focused Therapist has no advantage over those who practice Cognitive Behavior Therapy. The therapist just graduating from his or her training program may have less experience than a seasoned clinician, but they have been found to be just as effective at helping people. Wampold strongly backs these claims with over 30 years of research.

Despite the above, there is strong scientific evidence that psychotherapy is just as effective as many common medical procedures. Scott Miller and colleagues have conducted research and written many articles demonstrating this. People struggling with anxiety, depression, eating disorders, substance abuse, and marital problems have been demonstrably helped by psychotherapists of all stripes. In fact, research shows that about 80% of those who receive psychotherapy are much better off than their untreated counterparts. The average psychotherapist helps people achieve greater life satisfaction, improve coping, better their relationships, and reduce anxiety and depression. These results are often achieved without medication.

For about three years now, I have been using Feedback Informed Treatment [FIT] to track how my clients respond to therapy with me. FIT is an ingenious method developed by Miller and Duncan to quickly evaluate client wellbeing at the start of each therapy session. Further, FIT is used at the end of each session to allow the client and therapist to discuss how the session went.

Combined, these measures enable the therapist to identify clients who are not responding favorably to what is happening in session. This allows the therapist and client to brainstorm additional strategies, consider medications, or maybe involve other people in the session to improve outcomes. With time, the client and therapist may discover that they simply are not a good fit. This frees the client to seek a therapist who might be able to better help them.

Another benefit of using a system to track outcomes is that clients can see their progress from session to session. Successful clients (and there are many!) and their therapists can talk about what is working and what isn’t. This discussion often leads to more ideas about how the client can improve their wellbeing.

In the United States, relatively few therapists track their outcomes. As a consumer of psychotherapy, you can take steps to determine if you are benefiting from therapy. After each session, ask yourself these four simple questions:

1. Did the therapist respect me, listen to me, and understand me?

2. Did we talk about the things that I wanted to talk about in the session?

3. Does what we did in the session make sense to me?

4. Was today’s session right for me or was there something missing?

Let’s look at each of these areas in a little more detail.

First, think about your last therapy session. When it was over, did you get the impression that your counselor understood your concerns? Did they seem interested in your concerns, or did they disregard something you thought was important? Did they seem distracted? A therapist's first mission is to understand your problem, and, what you hope happens with it. A skilled therapist will be curious about you and will ask questions to learn how to best help you. If your values are not “mainstream” does your therapist’s body language communicate disapproval of how you live or conduct your life? Or did they accept you for who you are without judgement?

Second, did the therapist ask what you wanted to discuss in the session? There are some subjects that automatically need to be addressed when they arise. Suicidal statements and credible threats against others are among those topics that get prioritized when they emerge. Aside from that, though, does your therapist work with you to address your pressing concerns? Or are they interested in imposing their own agenda on you? Perhaps you would like to talk about how your children are driving you crazy, but your therapist keeps redirecting the conversation to your goal to stop smoking. Both are excellent topics for therapy. In good therapy, though, you get to decide which is most important to discuss today.

Thirdly, keep in mind that we therapists vary significantly in how we view client problems. No two therapists practice alike even when they belong to the same school of thought. It is important that whatever happens in the therapy room makes sense to you. Despite what we are shown on some TV programs, there really is nothing mysterious about therapy. Therapy, simply put, is one human being helping another solve problems. These problems can be emotional, relational, work-related, or just about any other problem you can imagine. If you cannot see how your therapist’s approach is helping you solve what brought you to therapy in the first place, point this out to them and ask how they intend to help you “Get there.”

Finally, now that the session is over, how do you feel about it? Is the therapist a “good fit for you?” Even if you discussed difficult material and you are feeling drained, was the session helpful? Does it “feel” like you are making progress managing unhealthy negative emotions? Do you have a sense of hope for the future? Or did the hour seem like a waste of time (and possibly money)? Again, point this out to your therapist. A competent therapist will not take these kinds of comments personally. If your therapist becomes defensive when you assert what you want, it may be time to start searching for a replacement.

After all: It’s your therapy session. Not the therapist’s.

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