Today I have the great pleasure of interviewing a hero of mine, the brilliant mind behind PsychCentral.com, the Internet’s largest and oldest mental health network … Dr. John Grohol. John is the CEO and founder of Psych Central and has been writing about mental health and psychology issues online since 1992. He lives with his wife and six cats north of Boston.
Question: In your very popular post “The 12 Most Annoying Bad Habits of Therapists,” you mention some red flags to watch out for. For folks who are currently shopping for the right shrink, how would you advise them? What are the three most important attributes of a good therapist, or what’s the most important factor for therapy to work?
Dr. Grohol: I think finding a good therapist to work with is a challenging prospect, even when you have a recommendation or two from a trusted friend or your doctor. Why is it so difficult to find a good therapist? Because the qualities that might be ideal for one person may not work as well for another. A therapist is more than a plumber for your mind; you can’t just pick one at random from the Yellow Pages. Well, you can, but you may not find the right one using that method.
And when I say “right one,” I’m really getting to the heart of the matter. No matter what qualities I may suggest a person look for in a good therapist, ideally a person should look at finding a new therapist as a test drive, a completely temporary arrangement that may or may not work out. Most people try going to a single therapist, find it incompatible with their needs, and never return for a second session (much less try again with a second therapist). The key is to find a therapist that seems to complement your needs and your personality. A therapist isn’t your friend, so you shouldn’t just be looking for someone you get along with or feel really comfortable with (although that might be an important quality to look for nonetheless).
A good therapist is positive and empathetic.
So I’d argue above and beyond everything else, no matter what, the most important factor for therapy to work is to find a therapist you can have a positive, empathetic relationship with. And the research confirms this advice — all types of psychotherapy work to some degree or another, so one of the key factors in the reason they work is because of the professional, positive relationship one has with one’s therapist.
1. A good therapist is professional, courteous, and respectful.
Beyond that single most important factor, there are secondary things to look for that are attributes of a good therapist. One is that a good therapist is always professional, courteous, and respectful. This means they show up on time for your appointment, explain how they work with you in a clear and direct manner (hopefully putting aside any psychobabble), and use legitimate, recognized psychotherapeutic techniques (such as cognitive behavioral techniques and such). They don’t try and hug you after the first appointment, they don’t show up late, and they don’t eat their lunch in front of you.
2. A good therapist recognizes her strengths and limitations.
Second, a good therapist recognizes their own strengths and limitations and tries to work with patients they know they’re likely to have the most success with. That means a good therapist is a discerning one. They don’t necessarily take every client that walks through their door, nor do they agree to work on problems they have no experience in dealing with. You’d think this is common sense, but I’ve known therapists who do both. Perhaps when you’re first starting off as a brand new therapist, you’re allowed a little leeway with these things. But if you’ve been practicing for 5 or 10 years, there’s no excuse for not being aware of your strengths and limitations, and what kind of clients one works best with. Good therapists know these.
3. A good therapist is genuine.
Third, a good therapist is genuine no matter what. I’m a big believer in the power of genuineness, that it’s one of those qualities impossible to fake. Someone who is genuine is likely to be a better listener and be interested in what you’re saying — and if they aren’t, they say as much. Call it the Albert Ellis approach, but with compassion and toned down 95%. A good therapist is *there* with their clients, and tries to be there with the emotional content of their words and experiences. They take all of that and reframe it and help a person look at it from different perspectives, with different thinking, and tries to help them undo years of poor learning.
You can see why it might be a little challenging to find a “good therapist.” You can rarely tell from one session alone, especially since you’re the one usually doing all the talking during the first session. But if I want to work on a problem and really change things about me, I’ll take the time necessary to find the right therapist to work with that can best help me. Even if it means going through 2 or 3 therapists before finding one that fits best with my needs.
Question: After I read your post, “When you disclose too much in therapy,” I decided that I still needed to do a lot of boundary work because I thought you could tell your therapist anything. Doesn’t the patient have the green light to spill her guts?
Dr. Grohol: Clients absolutely have the right to say as much or as little as they would like in psychotherapy. I was only trying to point out that we sometimes say too much — even in everyday conversations with our co-workers, boss, friends or family — that we wish we could take back. That happens in therapy too. We can cross a border we hadn’t quite meant to cross as soon as we did (or in some cases, at all). You can indeed tell your therapist anything, but if you do so, you have to be prepared to live with the consequences of that disclosure. Nothing wrong with it, only that sometimes we don’t mean to do so when we do.
This post bookended another post I had written about why would people lie to their therapists. I mean, you’re in therapy, ostensibly you’re paying some good amount of money to be there once a week (that might be better spent on clothes, chocolate, or video games), so why would you ever waste your time not being entirely honest or truthful with your therapist? And yet we all are because it’s a part of human nature to tell little white lies, or to gloss over something we’re not quite ready to talk about in therapy. And that’s okay too — it’s okay to withhold things from your therapist in session when you don’t feel like you’re ready to tackle a difficult subject.
One of the key points I’d like people to get is how extraordinarily strange the psychotherapy relationship is. And it’s okay for clients to feel awkward or unsure because of it. It’s the only relationship in your life where you’re paying a professional for guidance and to help you make changes in your life, and it can be deeply intimate one moment, and oddly at arm’s length the next. It’s an artificial relationship, not one that you’d find naturally occuring in the wild. Because of that, it can lead us to bad feelings when something goes on in that relationship that’s unexpected — like disclosing too much or lying. And my point is to recognize that it’s the nature of this odd intimate/professional relationship — not you — that’s to blame.
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9 comments
Dr. Grohol offers some good advice here on personal fit which is tremendously important. Unfortunately, most people won’t be able to take this advice because they won’t know how to “look for” a therapist to begin with. Before they ever get to the point where they’re considering “fit,” they have a hundred questions about cost, setting, kinds of therapy, etc.
I’d like to recommend a little book called “How to Find a Good Therapist.” It’s short, cheap ($6 on Amazon), and walks you through the process step-by-step.
Yes, I wrote it. That notwithstanding, it really is the best and most current reference available for choosing a therapist.
What is your last name so I can find your book?
This post is nice and theoretically on the mark, but, as someone practicing psychiatry in several different venues of mental health, less clinicians in the field value and encourage therapy these days as the pervasive mantra of “biochemical imbalance” has skewed even seasoned providers.
So, technically Dr Grohol is correct on most of his philosophies and perspectives, but it would be nice to read a post from someone who practices psychotherapy in community mental health, or an established private practice seeing more than 28 hours a week. A little candor and directness would probably reveal less is respected and sought.
Hell, I hope I am wrong!
Skillsnotpills
Hi Ben,
After seeing several therapists and not really clicking and not undestanding I needed to click with them, I finally found the near perfect therapist. Or should I say, she found me. She was assigned to me in hospital and after several sessions I followed her into private practice. I knew I’d found someone special because I clicked with her the minute I set eyes on her. Transference at first sight, I called it.
I’m just checking out your book on Amazon.
I find the relationship fascinating. I would use the word ‘unique’ rather than ‘strange’. Artificial would imply ingenuous. I just don’t view it that way. It is different from what we’re accustomed to and we can’t act in ways that we would in our relationships outside of the room, but it’s very real and felt. It’s both restrained and intimate at the same time.
I thinking finding a good therapist means finding one that can relate to your difficulties without suffering from them. I’m sure there are different dynamics in each client-therapist dyad. I was fortunate enough to find a therapist that worked very well for me. He was both caring and genuine. He had in himself exactly what I needed so we matched quite well. It was a healing relationship for me and not one I’ll ever forget.
I really appreciated this post, but I especially liked the piece about a good therapist knowing her limitations and not taking every client who walks through the door. I think that one of the best things supervisors can do for their therapists-in-training is to model appropriate consultation when dealing with clients and issues that are outside of your area of expertise. I think that when supervisors don’t model this, and instead, act as though they are able to manage every clinical issue and cultural difference, it sets up early therapists to believe they can do the same. It is a disservice to therapists in training, but ultimately, it’s worse for the clients who may not know better.
I made up this “phone interview” to do before I meet w/a therapist as I saw one about 5 times when she told me she didn’t believe in psych meds as they “blunt your emotions.” Here I am w/a dx of bipolar 1 & on meds & the meds have helped me so much. Before meds I couldn’t even participate in therapy as I just cried all the time. My emotions need to be “blunted” for me to get any benefit from therapy as I had been in therapy off & on for about 30 yrs. w/it not helping much.
So I felt like I had wasted a lot of my time (& money) when I disagreed w/the basic premise of medication. My pdoc couldn’t believe the therapist would announce that opinion to me, either.
But I did have a relapse despite being medication compliant due to my sleeping getting way off track & spending mos. in hypo mania before an overdose. Phone interview below:
Thank you for returning my call. I’ve made some notes to hopefully keep this as brief as possible. I’d like to give you a short synopsis of my situation & ask you a few questions about your methodology before I schedule an intake & give you the opportunity to decline to work with me, as well.
I’ve seen some therapists that have opinions or methods that I don’t agree with so I would like to avoid doing an intake appt. if we don’t share some important ideas about treatment.
I was dxed w/bipolar 1 about 8 years ago. I’m 53 & was misdiagnosed w/unipolar depression for many years. I’ve had several suicide attempts with my first at the age of 15. About a year and a half ago I ODed, but it wasn’t really a suicide attempt but trying to get rid of the intense emotional pain I was feeling. I ended up in the ER & my meds provider has strongly rec’d therapy. I had a chaotic childhood due to my mother having bipolar & committing suicide & having an alcoholic father.
Do you have much experience working w/clients who have been dxed w/bipolar?
What method of therapy would you use for a person like me?
What is your opinion of psychiatric drugs?
Eventually, I’d like to bring my husband into the therapy sessions for us to work on our relationship & communication & understanding of my illness. Do you have training in marital therapy & would you be willing to see me alone until I feel comfortable adding my husband to the sessions?
What are your credentials?
How long do you allow for the initial intake & what is the cost?
How long is a typical appt. & what is the cost?
From what I understand my insurance co. will require a treatment plan after my first visit to authorize 5 more visits. Then another treatment plan will need to be filled out by you to get authorization for more sessions after every 6 sessions.
Is this a process you are familiar with & would be willing to do?
I HAVE found a wonderful therapist. She is the same therapist who leads the DBT group I attend.
agreed with Dr. John Grohol that its difficult to find a therapist as the need differ from one patient to other. but the whole psychology lies at this point that no law can be applied to all humans. so therapist also know this, and respond to every single patient with different techniques and that’s called mastery.
Nowadays it is not very difficult how to find a therapist. A professional who works very well with one individual may not be a good choice for another person. It is important to find a good fit between you and your therapist.