I often get asked by family and friends “do you know someone?” Their hope is that I will have a colleague who will be a good fit to work with them in therapy. Over the years, I believe I have gotten better in making these “matches.” Partly this is a result of my “Yenta-Superpower-Skills”; as my professional network has expanded I know many more great therapists. But another critical part of my learning curve has come from personal experience. Several years ago, when I hit “re-set” on my life, I sought out therapy. From my own experience in seeking out a therapist, I gained a better understanding of the critical questions to ask and the information to seek when selecting a therapist.
Additionally, I now realize how the initial step of deciding to do therapy is critical to finding the right therapist. Since this first step is so important to making the right match, when I now make a referral I try to understand why a person is seeking therapy and what has led up to that point. If the answer isn’t obvious, I encourage my friends, family or clients to ask themselves and answer these important questions:
- What’s going on in your life/your family member’s or your child’s life that you want to change? For how long has that been going on?
- Do you/your family member/your child have a diagnosis or label? Do you agree with that diagnosis/label?
- How have the difficulties been impacting your life/your family member’s or your child’s life?
- Who would be involved in therapy?
Once people can articulate, in their own way, these therapy goals and what they’re hoping to gain, there are some boring but essential questions to ask about logistics. Moreover, individuals should have a good understanding of their mental health/behavioral health insurance benefits (including out-of-network benefits and limitations), their budget, their availability, and how far they are willing to travel. Important questions to ask the professionals are:
- What are your fees? Do you have a sliding scale option?
- Do you accept insurance?
- Where is your office located?
- How flexible is your availability?
- Are you available for case management, such as speaking to or going to a school for IEP meetings, working with service coordinators, and completing important paperwork?
- What is your communication policy and the best way to be in touch with you?
- How quickly do you return calls? And are you available for emergency?
While these details may seem unimportant, they can play a significant role in the delivery of your care. As a therapist, I put a lot of time into how I want to answer these questions. For instance, as I realized that my typical fees may be out of reach for some people and thus have therapy be less accessible, I worked hard to institute a fair and transparent sliding scale policy, as well as a commitment and plan to train and supervise other professionals in my area of expertise who would charge less. Also, as I transitioned from single woman to single Mommy, I recognized that my ability to return calls and communicate by email would be impacted. As a result, I put a lot of thought into a realistic communication policy and tried my hardest to educate current and potential patients of my new policies and limitations.
Equally important is understanding a professional’s training, expertise, and general approach to being a therapist. In asking this question, I think it’s key to focus on what a person actually does, not just their training. Important questions to ask:
- What are your privacy and confidentiality policies, and what are the limits? This is especially important for work with teens and young adults.
- How do you involve parents in work? Believe it or not this is important for families with children of all ages.
- What conditions do you treat and how many years have you been working with these patients? What percentage of your practice consists of work with people with this/these conditions? Additionally, which conditions do you NOT treat?
- After about a month, are you willing to articulate a diagnosis, treatment plan, and what our therapy goals are? Hint- if a therapist cannot do this, I encourage you to look for another therapist.
- How do you typically collaborate with other professionals, such as psychiatrists and speech therapists? Is this something standard you do or something you wait for the patient to request? Will you make referrals to other professionals if applicable?
- How will I know I am/my child/my family member getting better? How do you measure progress? While there are no guarantees in therapy, and while the answer may change as your therapist learns more about you, if a therapist has a difficult time answering these questions, I encourage you to look for another therapist.
- What are you views on medications? For certain conditions, medicine can play an important role. The key is to look for a therapist who is open-minded, collaborative, and questioning in this area.
- What are the techniques/specific skills for (fill-in-the-blank-for-specific-condition)? Can you provide an example of that? Is that a first-line treatment for this condition? Some therapists will say they “treat” a condition, but when pressed, it is difficult for them to articulate the important components of its treatment, know what is the first recommended treatment for that disorder and what research and evidence say about treatments for a condition. Just as you would want antibiotics for strep throat (a first line treatment with good scientific evidence to support that it works) and a doctor who knows the proper dosage and days to prescribe for the antibiotic to be most effective, you would want a therapist to be able to similarly do this for a mental health condition.
- How often is HW assigned planned? My recommendation is that out of session work is given almost every week and central to therapy. It is unrealistic to expect much change to happen from just 45 minutes a week. As I tell my patients, “I’m good, but I’m not that good.”
Last but not least, just like in a marriage, there are important intangibles in therapy. In fact, previous research indicates that the therapeutic alliance is one of the main factors in determining successful outcomes of psychotherapy. There should be a certain “chemistry” (or in therapist-speak, “rapport and alliance”) between therapist and patient. Experience does not always increase the odds of success in therapy. When talking to a therapist, ask as many questions as you want. Pay attention to how much time they give you, their style in answering these questions and their patience with you. And just like in marriage, it is totally appropriate to divorce a therapist; in fact terminating at any point is a patient’s right. If you are working with a therapist and you don’t feel like they are the right fit, it is appropriate to seek out someone else. Life is hard enough. Therapy is the one place where the therapy may be challenging, but you want understanding, empathy, expertise, a clear plan, and a good match.
Rebecca Sachs, PhD, is a New York City-based psychologist specializing in treatment of autism, OCD, and anxiety. For more information, visit www.cbtspectrum.com.
© 2018 AHA Association. Further reproduction of this article is prohibited without express written permission of AHA. This article was reprinted with permission and was originally published in the Fall 2018 issue of AHA Association’s On The Spectrum. For more information, visit www.ahany.org.