Getting a Therapist - a brief step-by-step

Sorting It Out

When you start your search, keep an open mind. A therapist does not need decades of experience — or a sheepskin from an ivy-league school — to be helpful.

It used to be that a psychiatrist was considered most qualified because he or she had more education, but that’s not true anymore. Some psychiatrists got their licenses 25 years ago and haven’t kept up. Many psychiatrists who are trained today just handle medications. You can have a primary care doctor do that — it’s not like psychiatrists are indispensable!

Credentials aren’t everything. Even people with great credentials aren’t necessarily great therapists. They may be smart, but that doesn’t mean they have good common sense.

Where to Start?

Collect Names. 

[NOTE: depending on where you live, you may need a doctor’s referral to see a therapist/counselor]

Don’t start with three names from your managed care company.

- Avrum Geurin Weiss, PhD, author of the book, Experiential Psychotherapy: A Symphony of Selves.

Very likely, you don’t have the company’s entire list of providers. “Insist on getting the whole provider list. Then ask friends and colleagues if they know a psychologist or psychiatrist who could make recommendations from that list.”

Weiss gets plenty of calls from people who say, “I have Aetna insurance. I know you’re not an Aetna provider, but can you look at my list?”

“They fax it to me, and I make recommendations. I do it all the time,” he says.

Other sources:

• Call a university psychiatry or psychology department and ask recommendations of people trained in that program. “At least that way you know they’re under scrutiny,” says Turner.
• If you’re moving to a new city, ask your current therapist for referrals, or have him check with colleagues.
• Call a large clinic; ask the receptionist for recommendations. “They know who specializes in what,” Baker tells WebMD. “They can match you up pretty well.”
• Check with friends and family.
• Check on Psychology Today’s therapy directory [Canada and the United States]
• Check at a local crisis center or women’s shelter for resources.

If you’re embarrassed about asking for help, get over it. Get past the stigma. The outcome’s too important.

Also, check with professional associations to learn about a therapist’s expertise — whether they provide psychotherapy, if they treat children, etc. The American Psychological Association and the American Psychiatric Association both provide such lists for people wanting to find a therapist.

The First Appointment

Ask questions: How long has the therapist been in practice? How many patients have had your problem? What were the results? Ask about policies, fees, payment. But don’t bargain hunt for mental health care.

You find a therapist in the same way you choose any health care professional. They must be professional, credentialed, and competent, with no lawsuits against them. And they must be an intuitive fit — you can’t underestimate the absolute value of feeling a good intuitive match with somebody. Also, if you ask them questions about themselves, and they get defensive, go somewhere else. 

If you and your therapist are not a good fit and do not “connect”, do not hesitate to find a new therapist and continue looking for new therapists until you find the right one. Any therapist worth their degree/certificates will understand.

Another important point: Has your therapist been in therapy? They have to have resolved their own issues, or they will steer you away from things they are not comfortable with. They may also bring their own issues into your therapy.

Ask yourself:

• Do I feel reasonably OK with this person? “Feeling totally comfortable isn’t the best criteria, because if you’re too comfortable, you’re just chit chatting, and that doesn’t help you,” says Baker.
• Is the therapist really listening to me? Is he or she asking enough questions? Especially in the first sessions, the therapist should be asking many questions, to become acquainted with you and the issues you are dealing with.
• Has the therapist asked what outcome you want from therapy — how you want your life to be? How will you know when you get there, if neither the patient nor the therapist has established a goal?
• Do you feel satisfied with the therapist’s resources? For example, do you have to find your own therapy group? Or is your therapist checking with colleagues about a group appropriate for you?
• Does what the therapist say make sense? Does it seem like bad advice? Does it help you or not?

Baker says patients don’t always like his suggestions — yet he knows from intuition and experience that its good advice.

Example: Your husband uses profanity constantly when talking to you; you want him to quit. Baker suggests that you mirror your husband’s behavior — you use profanity the next time he does — a technique he knows will work. “People are always resistant to that, they don’t want to ‘sink that low,’ but then they’re amazed at how well it works,” Baker says. “It’s not that you should take up bad habits, but that he stop his.”

Child/Adolescent Therapy

It’s tough finding a good child psychotherapist. Not many people have much experience working with adolescents. You can end up with a therapist trained to work with adults, but they work with adolescents because they have an adolescent or because they like working with adolescents.

A pediatrician can often make a referrals.

“I warn people about school counselors making referrals; they are overwhelmed and busy, don’t follow up to see if good work is happening.” - Weiss

Also, check with other parents. “I recommend that parents identify two or three therapists that they find acceptable, then let your kid pick from among them. That’s so they have a voice in this,” Weiss advises.

Eugenio Rothe, MD, professor of psychiatry at the University of Miami and director of the Child and Adolescent Psychiatry Clinic at Jackson Memorial Hospital, offered his insights.

Pediatricians and professional counselors should not be treating a child for attention deficit hyperactivity disorder (ADHD), he tells WebMD. “More than 75% of children with ADHD are treated by a pediatrician or primary care doctor. But studies show that 40% to 60% of those children have another psychiatric diagnosis. How can a pediatrician [or counselor] diagnose that?”

“Professional honesty is very important — referring patients to other professionals when you’re not trained to handle the problem,” says Rothe. “Many psychologists feel very threatened by psychiatrists, that they will lose the patient if they make a referral. But they’re doing a disservice by not getting patients get the help they need.”

Psychiatrists understand both the body and the brain, and that’s a critical difference, he explains. “Depression may begin with a situational problem in your life, but that event causes chemical changes in your brain. Once those chemical changes are established, you have a chemical imbalance. If you treat depression as something abstract, you won’t get to the fact that it’s a chemical imbalance that needs be treated.”

He retells one landmark court case: A man with what’s known as “agitated depression” wore out three pairs shoes from pacing for more than six months in a mental health facility. Talk therapy was not helping, so he signed himself out, went to a psychiatrist, got medications, and got completely better in six weeks.

“He sued the hospital, said he hadn’t received appropriate treatment, and he won,” says Rothe.

The lesson for therapists: You are making a patient suffer unnecessarily if you don’t treat the depression effectively — or if you don’t help them find a therapist who can.

Harsh Parenting in Relation to Child Emotion Regulation and Aggression

Previous emotion researchers have analysed the effect of affect communication in the family on the child’s social behaviour in and outside of the family. Their results suggest that children transfer negative emotional response strategies they have acquired from parental punitive emotions to other contexts, resulting in incompetent social behaviours.

Viewed from the emotion regulation literature, the findings from a study conducted by the national institute of health, provides additional empirical evidence supporting parental socialization of negative emotions and children’s transfer of emotional incompetence. From the perspective of harsh parenting research, our findings further clarify the paths through which harsh parenting channels its negative effects to children. Bridging these two corpuses of literature, the work from the national institution of health (NHI), provides a new perspective on harsh parenting.

In addition to the view of harsh parenting as a form of behaviour, harsh parenting can also be viewed as a form of affect communication. Its effect on children occurs both directly through behavioural and indirectly via emotion dysregulation. This perspective on harsh parenting is especially relevant when viewed within the widely adopted family systems and child emotional security systems approaches.

Conceptualized within these frameworks, the present findings suggest a broader implication—that underlying each behavioural perturbation is the undercurrent of emotional malfunctioning that may spill over into different marital, parental, and child systems. In terms of harsh parenting per se, this view is consistent with the common experience that when a parent hits or scolds a child, the parent communicates anger. The expression of anger, coldness, or hatred that accompanies the physical act of parental aggression could well be more detrimental than the act of aggression itself.

Several practical implications can be derived from the findings from the study conducted by the NHI, on the emotional channel by which harsh parenting affects children. On the basis of these findings, intervention efforts with high-risk children may be more effectively organized to focus, either directly or indirectly through work with parenting, on children’s emotion regulation.

 These findings also have implications for family policy and parenting practice. Traditionally, advocates for good parenting have aimed to change parents’ behaviour, for example, banning spanking. More work may be needed to deal with parents’ negative emotions such as controlling anger. Our findings also inform the public policy debate regarding the right of parents to hit their children. The argument in favour of that right rests largely on the assumption that a child who is hit mildly is not being harmed in a lasting manner.

The present findings suggest that parental harshness, even if it does not meet a criterion of physical maltreatment, may have an impact on a child’s ability to regulate emotion. This kind of impact may strengthen arguments against the use of even mild physical discipline especially when it is accompanied by negative emotions.