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How to Pick a Therapist

It can be difficult to decide if and when psychotherapy would be helpful. There are many different ways people make this decision. A general guideline that I offer is what might be called the “interference rule.” That is, if a problem is significantly interfering with your ability to live your life the way you’d like, then psychotherapy may be helpful.

Another question follows. Once you have decided to seek help, how should you go about finding a therapist?

There are a few factors to consider in making this decision. One factor to consider is finding a therapist with competence or expertise in the issues you want to work on. While it is impossible to have an exhaustive list of issues that prompt people to seek therapy, here I will discuss a few common issues and how to find a qualified therapist for each.

  • For issues to do with a romantic relationship, it is helpful to see a therapist qualified to do couples therapy. Even if you’re not interested in couples therapy at the beginning, it’s useful to have this option available.
  • For issues relating to a very difficult experience such as a car accident, an assault, a rape, the attacks of 9/11/01, or other life-threatening experiences, it is helpful to find a therapist qualified to use cognitive-behavioral therapy (CBT). CBT that includes something called “exposure” has been shown in clinical research trials to be effective for these types of difficulties.
  • For depression, there are several types of psychotherapy that have been shown to be helpful. Three of the best known are interpersonal therapy (IPT), CBT, and behavioral activation.  Click here to for a nationwide listing of qualified therapists competent in one of these areas.
  • For issues relating to overuse of alcohol or drugs, I recommend finding a therapist with a specialty in substance abuse issues, particularly one who has significant experience treating addiction. It is not necessary to find a therapist with a personal history of addiction, although some people find this helpful.
  • For issues relating to eating – including anorexia, binge eating, etc. – I would recommend contacting an eating disorder treatment center, even if it’s not local to you. The reason for this is that larger centers such as the Renfrew Centers can refer you to a local provider with relevant expertise.
  • For panic attacks, anxiety attacks, chronic anxiety, or phobias, it is important to find a CBT therapist. One effective way to do this is to visit the provider listing at the website for the Association for Behavioral and Cognitive Therapies, which permits searches by locality.
  • For difficulties stemming from perfectionism, obsessions, compulsively repeated behaviors, “germophobia” or contamination fears, it is important to seek out a therapist with training in Exposure and Response Prevention, a type of CBT. The website for the International Obsessive Compulsive Foundation is a good resource for this and has a nationwide therapist directory.

Another factor has to do with the training of the therapist. (For more information on this, see the accompanying FAQ page.) Many therapist listings will turn up results that include all kinds of professionals, including Psy.D.s, L.M.H.C.s, Ph.D.s, L.C.S.W.s, M.D.s, and several others. There are no hard and fast rules about which of these types of professionals make the most effective therapists. However, there are important differences in the training of each.

  • Social workers (LMSWs, LCSWs) have completed at two years of graduate training to attain their degree. LCSWs, specifically, have also completed at least 3 years of clinical training after getting their MSW degree; this is not a requirement however for LMSWs.
  • M.D.’s (psychiatrists, typically) are the only group of professionals trained to prescribe medication. Sometimes medication is necessary, sometimes it isn’t. Psychiatrists have typically completed four years of medical school and, typically, a 3-4 year residency in psychiatry. Some psychiatrists only provide medication management with periodic meetings that can vary in frequency from monthly to semiannually or less frequently; some psychiatrists also provide weekly therapy (although this may be less common).
  • LMHCs (licensed mental health counselors), LCATs (licensed creative art therapists), and MFTs (marriage and family therapists) have typically completed a 1.5 to 2 year masters degree in counseling.Psy.D.s and Ph.D.s (psychologists) typically complete doctoral training of 5-7 years, and in NY state must complete one additional year of training before becoming licensed.
  • Psychologists (Ph.D.’s or Psy.D.’s), in this author’s opinion, are the most likely to have extensive training in specialized therapy for a given problem or disorder.

Another factor to consider in picking a therapist is the “match” between you and the therapist. Research on psychotherapy has consistently shown that the better your relationship with your therapist — the more you feel you two are on the same page — the more effective the therapy will be. It is important that you feel your therapist understands what you want to get from therapy and that the two of you agree on how to accomplish that. If you leave your first therapy session with serious concerns about your compatibility, consider trying out another therapist. While this represents an additional commitment of time and money, it may be well worth your while.

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