Choosing a Therapist
By Byron Kehler, M.S.
Selecting a therapist is an important decision and should be done with great care, thought, and evaluation. We often first seek a counselor in times of desperation, which can cloud our judgment. Slow down. The relationship is often long-term, certainly influential, and even intimate in regard to the type of personal information revealed. Such a decision is best made by taking into account a variety of factors ranging from practical (finances, schedule, availability) to personal (faith, style, philosophy). Recognizing the counselor as your employee hired to lead you from one psychological place to another is valuable in planning the selection and interview process. You are the best expert in what will be most helpful to you in a guide or consultant for your own personal journey. Below are some criteria and questions, that you may find helpful, as you consider hiring such a guide.
1. QUALIFICATIONS: Counselors vary in their education and academic disciplines. Psychiatrists, psychologists, psychotherapists and social workers offer different skills and specialties. Although credentials alone will not tell you who are best for you, they do insure particular types and levels of training. Often the best endorsement may be from someone you already know involved in their own recovery work and making progress. Remember, all personality styles may not “click,” so look for someone with whom you feel comfortable.
2. TRAINING: Few formal educational programs provide much information or training regarding sexual abuse recovery. Therapists must therefore take advantage of workshops, seminars, and specialized training opportunities. What specialized training in this area have they received? Does their library reflect personal study around recovery issues? Do they recognize authors you may be familiar with or can they easily identify authors that they can recommend? Are they familiar with recovery terminology and concepts? Do they regularly up-date their training in this area?
3. EXPERIENCE: Experience may be one of the best assurances of competence. How much actual experience do they have concerning recovery issues? What percentage of their client caseload involves recovery issues? Have they taken clients, successfully, from beginning to end of the recovery journey? Are they known by colleagues and recognized in the community as knowledgeable regarding recovery issues? Do they exhibit comfort and confidence in their familiarity with recovery issues?
4. SAFETY: Personal and emotional safety is a prime ingredient in effective therapy. What do you notice that they did to foster your safety? Were they sensitive to your needs both spoken and unspoken? How do they describe safety and the role it plays in recovery work? Does their office environment suggest safety in terms of comfort, seating arrangement, scheduling, professionalism, access, convenience and privacy.
5. PHILOSOPHY: What is their philosophy of therapy and treatment? How do they see their role in the process; can they describe or articulate it? What therapeutic tools will they utilize in your recovery journey? How important are memories to recovery? How might they promote remembering? What might you work on in the absence of clear memories? How do they understand people get healthy from these types of hurts?
6. BOUNDARIES: The relationship between client and therapist is a protected one. Sexual abuse violates the most fundamental of boundaries; therefore, the need for clear therapeutic boundaries to foster safety is essential. Is the therapist clear regarding the importance of boundaries to safety? Do they explain therapy practices, limits, guidelines, expectations, emergencies, phone access, finances, and other practical matters? Do they have a policy on touch? Are they cautious with information? Do they seem sensitive to issues of confidentiality relating to self-disclosure, material concerning others, and your own information? Do they utilize a formal contract or agreement outlining therapy guidelines? Do they ascribe to a particular professional code of ethics? Will they furnish it upon request? The therapy relationship is a professional one and should not include socializing, bartering, blurring of roles, or conflicts of interest. Although guidelines differ among therapists regarding aftercare, a helpful rule is, if you began as therapist and client, your relationship should remain such.
7. CHARACTER: Qualities that survivors commonly identify as helpful to them during their recovery process include: courtesy, respect, honesty, clarity, consistency, predictability, and acceptance. Are they non-judgmental? Do they possess a gentle strength to push you when needed? Is disclosure heard with acceptance, belief, sensitivity, and compassion? Do they place responsibility where it belongs, with the offenders?
8. ACTIVE – RESPONSIVE: Do you feel as though the therapist really hears you? Do they respond directly to your questions and concerns? Do they appear attentive, or easily distracted, during the course of the session? Do they only reflect what they hear, or are they actively engaged with you in discovery of meaning, insight, and awareness?
9. DIRECTIVE: Do they seem confident of their ability to help with these issues? Can they describe the recovery journey clearly? Can they identify a variety of recovery issues that you might expect to be addressed along the way? Do they expect you to introduce relevant issues or are they prepared to offer guidance? Can they outline a general treatment plan with you? Is power shared throughout the process? Do they remain focused or do you often find yourself off on tangents or distractions? Do they take notes during or after session indicating the importance of what you say and to keep track of progress as it is made? Is there continuity from session to session with a minimum of review? Do they focus on events of the week or probe into connections with your past and abuse experiences? Are they able to estimate within reason the duration of therapy based upon what is initially presented?
10. NON-INTRUSIVE STYLE: Are they sensitive to your need for pacing and shared control? Do they respect your timing? Do they demand, require, dictate; or rather suggest, invite, and recommend? Do they encourage the formation of your own views & beliefs, or limit your options and potential resources? Do they encourage you to question, evaluate, even challenge themselves and others?
11. FAITH: How does the therapist’s own faith impact their therapeutic approach, philosophy, and practice? Are they comfortable discussing faith related issues? What is their policy on prayer during session were you to desire it? How would they describe their belief system? Are they involved in a local congregational life? Are they recognized or identified as a Christian therapist with the community? How important is the issue of faith to you?
12. PERSONAL HEALTH: Do they appear healthy and balanced? Does their lifestyle reflect balance, stability, self-understanding, and adequate personal recovery? Are they relatively free from pronounced insecurities, fears, control issues, and defensiveness? Do they limit their own self-disclosure, and focus on your needs rather than there own. Remember, a therapist can only take you to where they have arrived themselves.
13. RESOURCEFUL: Time in session can be maximized by a therapist skilled in the use of resources outside sessions. Do they assign homework between sessions? Do they show a genuine interest in accomplished homework tasks? Can you expect reading periodically when helpful? Will they utilize journaling, art expressions, letter writing, genograms, timelines, handouts and other such tools? Are they familiar with hospitalization procedures were those to become necessary? Do they have a basic understanding of medications should that need present? How do they make determinations regarding hospitalizations and medications? Do they encourage the use of support people and therapy groups? Are they aware of available groups they can refer you to?
14. INSURANCE: Do you have insurance? What type of provider will it cover? What requirements do they have for provider eligibility? What is the limit of coverage? Will it adequately provide for the time needed for recovery? Does it cover the cost of group therapy?
SUMMARY: Start with the phone and friends. Often you can get some of your general questions answered over the phone in a few minutes at no cost, to help identify those you may actually want to meet. When interviewing them in person, identify why you are there (shopping for a therapist) and ask your questions. You can take notes if you like to later reflect on their answers. Don’t be afraid to meet with more than one therapist to compare. If they are uncomfortable with your process of selection and evaluation, then keep looking. Don’t get frustrated if some counselors are busy and difficult to get in to see. If they are busy, there probably is a good reason. They may be worth waiting for. Above all, trust your intuition. Don’t expect to immediately trust your therapist or the therapy process. That takes time. Keep asking questions and evaluating progress.