Q: I’ve never seen a therapist before, but I’ve decided to do it. I got some names, but how do I know if someone is the right therapist for me? Which kind of therapy has the highest success rate?
A: The most important thing to remember is that therapy happens in a relationship. It may be a professional relationship, but it’s still an intimate dialogue between two human beings. The factors that make it work are about the same as those that make any intimate relationship work—trust, mutual respect, a sense of safety, personal warmth, genuineness, and so on. One interesting study of the outcome of treatment found that the early reaction of a client to a therapist is highly predictive of the outcome. If you feel a “click” and sense that you’re talking to a person who respects you, and whom you can trust, then that’s a good sign that this person may be right for you. If you have an early negative reaction, you may ultimately get past it and be able to work together, but this is less likely than if the initial take is warm and positive. As in any intimate relationship, trust your intuition.
Many people, especially if they’re new to therapy, feel on the defensive, or even a little ashamed, in an initial meeting. They sometimes don’t ask important questions because they’re too focused on what the therapist thinks of them. It’s important to remember that what you’re doing is hiring a consultant to help you resolve important issues in your life, and that you have as much right to ask questions as the therapist does. You may want to know about his or her education, background and qualifications. You may want to know how much experience he or she has had in dealing the kinds of issues you want to discuss. You may also have some personal questions. Therapists differ in how much personal information they’re willing to share, and it might be important to get a good idea of the ground rules and boundaries of the relationship before you commit to it.
What kind of therapy is most effective? There are so many different schools of thought about how therapy should be done that it would be a full-time job to sort them all out. Professionals naturally tend to become partisans of their own approach, but there isn’t really very much evidence that decisively favors any one school over another. A Vanderbilt University study found that differences in theoretical orientations among therapists didn’t make much difference in their success rate. The study did find that some therapists were more effective than others, however. The ones who were more effective were those who provided clients with information, encouragement and opinions, made special efforts to facilitate discussions of problems, focused more on the here-and-now than on early childhood experiences, and encouraged the client to seek new social activities. Active involvement, rather than passive listening, appears to be more effective, regardless of the school of therapy to which the therapist belongs.
There are also some client factors involved in success in therapy too. One of the most important of these is patience. Unless you’re seeking therapy for a discrete behavior change, like quitting smoking, therapy can be a time-consuming and, at times, frustrating process. Change is typically incremental rather than dramatic. The “a-ha!” experience that instantly transforms a patient’s life usually only happens in movies. Clients who are impatient or intolerant of slow change seem to benefit less that those who can tolerate careful exploration and a series of small changes over a period of time.
Tom Moon is a psychotherapist in San Francisco. For more information, please visit tommoon.net
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