Tips for Clients, from Therapists

What should a patient look for in a therapist?

Research indicates that the most important criterion for a successful outcome in therapy is to find a therapist who is a good match for you. While the therapist’s age, gender, credentials, experience and fees may be factors in your decision, if you don’t feel comfortable, safe and supported, I recommend that you keep looking. A good therapist should be willing to answer your questions and explain how they might help you.

What is one mistake most patients make with their therapist/therapy?

I think some people stay too long with a therapist who is not a good fit. Always trust your instincts! If you’re not comfortable or you are not making progress, you should discuss your concerns or terminate therapy. Be your own advocate and participate in the treatment process. You have the right to terminate treatment at any time, with no obligation except to pay for services rendered. If you have been to therapy and had a negative experience, then you did not find the right person for you. Try again!

What is one myth about therapy or treatment that you would like to bust?

I have to bust more than one myth…

Myth number 1: Therapy is a waste of time and money, and you never really get better.
Reach out for professional help long before things become so difficult., because the longer you wait, the bigger the problem. There are many choices beyond traditional therapy, where people go for “analysis” for years. You might be surprised how much better you feel with a renewed sense of hope, new coping skills and an action plan to help you move forward quickly.

My motto is “Don’t Spend More Time In Therapy Discussing Your Childhood Than It Took To Live It.”

Shellee Moore, MFT

Myth number 2: You lie on the couch, and you do all the talking.
Therapeutic treatment can take many different forms and environments, including office sessions, phone sessions, home visits or walk and talk sessions outdoors. Many therapists do talk and offer feedback, resources, recommendations and encourage a collaborative process. Again, this is about finding the right therapist and the right treatment approach for you.

Myth number 3: There must be something really wrong with me if I need therapy.
I personally do not subscribe to the “medical model,” and therefore the people I see are my clients, not my patients. I do not think that every mental health issue is a disease or a disorder. For example, clients often reach out for help with parenting, divorce, relationship issues, grief, or life transitions. My approach emphasizes mental health and well being and considers some difficulties and challenges a normal part of life.

Myth number 4: Medication is the quick fix for my problem.
Obviously, medication is indicated in some circumstances. However, therapy may help you get to the root of the problem, while medication helps you manage the problem without resolving the core issues. My analogy is that you may have a beautiful garden overcome with weeds. You can mow down the weeds, but they will keep growing back until you pull them out by their roots.

Myth number 5: Therapy can fix your child.
Typically therapy cannot help your child without your participation in the process. Ideally, you want to work collaboratively with your child’s therapist to learn new skills and techniques to try at home and school to resolve problems.

What should a patient look for in a therapist?

The short answer is to find someone who is credentialed, honest, has the expertise, therapeutic fit, availability, close proximity and fits into a client’s budget. Through social media, clients today have the ability to search and explore various options to find a therapist. Nonetheless, it remains important for the prospective client to reach out to the therapist by phone or in person to ensure that both parties feel comfortable working together. Of course recommendations from other professionals, friends or clergy might help guide an individual seeking counseling. Any sincere therapist should be willing to share some time on the phone to answer questions and start to develop rapport, which is critical to the counseling relationship.

What is one mistake most patients make with their therapist/therapy?

It is very important that clients underline what the problems are, how long they have been occurring and have some understanding about the way the therapy process works. Therapy is a special relationship, which only grows in trust and comfort over time. During this process the client will often bring their issues with them to the session and these issues will often “play out” during the therapy. Sometimes a client may decide to discontinue treatment prematurely without discussing this with the therapist. Often this occurs at a time when issues are coming to the surface and painful feelings are experienced. This would be a wonderful opportunity for self exploration and healing to begin. Many clients are terrified of change of any kind and often “quit before the miracle happens”.

What is one myth about therapy or treatment that you would like to bust?

There are endless myths that are incorrect. Probably the most common myth is that therapy goes on forever and is ineffective. Short term approaches such as Cognitive Behavioral Therapy, Motivational Interviewing and Solution Focused Therapies are more active and address specific solutions to current life challenges.

What should a patient look for in a therapist?

Finding a therapist you want to work with is very personal. Research shows us that the type of therapy used does not predict success in therapy as much as the connection between the therapist and the client. I recommend that client’s who are looking for a therapist meet with them to see what it feels like to work together. It is also good to have some clear parameters for yourself. Do you need a therapist who is familiar with a specific issue, culture, or lifestyle? Is the therapist’s gender important to you? Are you looking for a therapist who practices a specific kind of therapy? When you meet with the potential therapist, how do you feel while you’re talking with them? What about afterwards? Some people prefer to meet several therapists before they settle on the one that feels the best.

One mistake most patients make with their therapist/therapy?

Most people come to therapy because they want something to change. Change is often uncomfortable, and sometimes hard. It is not unusual for therapy to be upsetting or to feel like it’s not working. I suggest that my client’s commit to coming for three months before they decide not to return. It usually take at least this long to start to see concrete changes in your life. I frequently check in with my client’s about what has felt most helpful and which areas they would like to focus on more. Healing through therapy is a process that requires a commitment. I’ve found that it often is more successful for people who come in ready to take a risk and give it a try. Sometimes people just aren’t ready yet, and that’s ok too. I like to ask new client’s, “How do you feel about being in therapy?”

What is one myth about therapy or treatment that you would like to bust?

There is not one right way to do therapy.

Many client’s have expressed to me that they’re concerned they’re not doing it right or they don’t know what to talk about. That’s why you’re here, to get help figuring out how to do things differently. What is successful therapy to you might look really different for you than it does for someone else. I like to think of therapy as a safe and non-judgmental space where you get to try out being the most authentic you; where you get to figure out what feels right and what doesn’t. It gets to be the one place you don’t need to be “good”, instead you just get to be.

What should a patient look for in a therapist?

Find a therapist who exhibits compassion, enthusiasm and creativity. There should be a sense the counselor has your best interest at heart, is sincerely interested in the process, and creatively tailors the therapy to your individual needs. Also important to avoid one who is slovenly, or appears less mentally stable than you.

One mistake most patients make with their therapist/therapy?

They are hesitant to move on when not seeing results or uncomfortable with the therapist, and remain mired in an untenable situation.

What is one myth about therapy or treatment that you would like to bust?

I believe targeting root causes of trauma for exhaustive examination is misguided. When you visit a medical doctor they focus on curing the ailment, not endlessly ruminating over the cause. Many therapists reverse the process, rummaging through the past and never getting around to actual healing.

What should a patient look for in a therapist?

The credentials of mental health professionals can be confusing. Be sure to do your research and get some understanding of the main types of mental health providers, their basic training, and areas of expertise. Three important credentials to understand are: Psychologist, Psychiatrist, and the various Master’s level mental health professionals.

Psychologist: A psychologist will have a “PhD” or “PsyD” after their name. Psychologists have the highest level of training in psychology and providing therapy. They hold a doctorate in psychology, and typically have between 6-8 years of graduate study. Graduate study must include at least two years and an average of 4000 hours of supervised clinical training working under the supervision of a licensed psychologist (though this can vary by state).

Psychologists must be licensed by the state in which they practice, and licensing guidelines are typically very strict. Most states have websites on which you can easily check to make sure a psychologist is licensed. A simple Google search of the name of the state and phrase “professional license verification” will usually quickly bring you to the appropriate site. Always check credentials and make sure your provider is licensed.

Psychiatrist: A psychiatrist will have an “MD” after their name. Psychiatrists are medical doctors that complete their general medical training, and then go on to specialize in psychiatry. Most psychiatrists focus on prescribing and managing psychotropic medications (medications uses to treat mental health issues). Although psychiatrists sometimes provide therapy, they typically focus on medication management, and often work in collaboration with a psychologist who provides the therapy.

If you go to a psychiatrist for therapy, be sure to ask them about their specific training and experience in providing therapy. Many psychiatrists do not have significant training and experience providing therapy. Here are some questions to ask:

• How many therapy patients do you see?
• How long have you been providing therapy?
• What was your training in providing therapy?
• What kind of therapies do you provide?

If your are going to choose a psychiatrist for therapy, be sure that you are clear and comfortable with their explanation of their experience and training in providing therapy. Master’s level mental health professionals include:

Licensed Professional Counselor (LPC or LCPC): Licensed Professional Counselors are required to complete a two-year master’s degree in counseling or clinical psychology (M.A. or M.S.), two years of supervised post-degree experience, and to pass a written professional counselor’s examination to be licensed.

Licensed Clinical Social Worker (LCSW): Licensed Clinical Social Workers must complete a two-year master’s degree in social work (M.S.W.), two years of supervised post-degree experience, and pass a written social work examination to be licensed.

Licensed Marriage and Family Therapist (LMFT): Licensed Marriage and Family Therapists complete a two-year master’s degree (M.A. or M.S.) with emphasis in family therapy, approximately two years of supervised post-degree experience, and must pass a marriage and family therapist examination to be licensed.

Licensed Psychological Associate (LPA): Psychological Associates complete a two-year master’s degree in clinical or counseling psychology (M.A. or M.S.), two years of supervised post-degree experience, and must pass a psychological associate’s licensing examination.

It’s also important to understand that the titles “Therapist”, “Psychotherapist”, and “Counselor” are not legally regulated. This means that anyone can legally market themselves under those titles, and they may not have any related credentials or experience. For example, a high school drop out can legally market themselves as a “Psychotherapist.” Be very wary of anyone using any one of these titles only. Be sure to clarify his or her credentials, and only go to someone that has a verified licensed to practice.

What is one mistake most patients make with their therapist/therapy?

Make your top priority and most important goal to find someone that is a great match for you. When you find someone that’s a great fit, it can really be amazingly powerful and effective. If you don’t have the right person for you, it can easily be a waste of time and money.

Just because someone comes highly recommended or has impressive credentials doesn’t mean they’re right for you. The therapy relationship is its own special kind of relationship. You can have a very smart, well-trained therapist and a really bright and motivated client, but they just may not be a good match for working together.

It can and often does take meeting many different people before you find the right one. The most common mistake people make is to talk to one or two people that aren’t a good match for them, and decide that therapy “isn’t for them” based on just those few meetings. This would be like deciding that you can never be in a romantic relationship because you dated two people and it didn’t work out.

Keep in mind that to tell your story over and over again to someone you’re just meeting can be daunting, but it’s really worth the investment and time and energy when you find the right person. Think of it this way, how many hairstylists did it take for you to find the one that knows how to cut your hair the way you like it? Aren’t your personal growth, success, and happiness worth the same amount of time and effort?

Another thing to keep in mind is that it shouldn’t take weeks to figure out if someone is the right match for you. When you find a really good match you will likely know it immediately, usually after just one session, but definitely by the second or third. If you’re undecided after three meetings, move on to the next.

What should a patient look for in a therapist?

A client should look for a therapist who not only has experience with their presenting issue but also someone with whom they feel a connection with. It’s hard to determine this via email, so it’s best to call a potential therapist and talk with them via phone for a few minutes (often a few minutes is all they have available given their schedules!) and go from there. It often takes a few sessions to build rapport so be patient with the process.

What is one mistake most patients make with their therapist/therapy?

One mistake most clients make in the therapy process is being impatient. Therapy is a process and it often takes several months, depending upon presenting issues, to gain better insight and for the therapist to fully analyze and offer solid guidance. Think of the therapist as a guide and not a magician who can magically give you solutions to your problems. Often the best way to treat the problem is through insight oriented questions the therapist asks and it empowers the client to devise their own solutions.

What is one myth about therapy or treatment that you would like to bust?

I believe one myth in therapy is that the therapist has all the answers. Every person is different and every presenting issue is different, so allow the process to take its course; allowing the therapist to provide a full assessment and do the homework your therapist assigns to assist with finding solutions. Most of the work in therapy happens outside of the office.

What should a patient look for in a therapist?

Knowledge, knowledge, knowledge. A therapist should have an ability to educate, communicate, and connect. They should have an expertise in the particular area in which you need help.

What is one mistake most patients make with their therapist/therapy?

A common mistake that is made in seeking therapy, is not understanding that seeing a specialist is crucial. You cannot get the same results with a general therapist. This has been understood in the medical field for ages.

What is one myth about therapy or treatment that you would like to bust?

The myth we come up against often is that there will be a magic pill that will fix your problem. Behavioral therapy takes motivation, effort, and willfulness. It is every bit as important as a psychotropic medication. Behavioral therapy really does physically change the brain.

What should a patient look for in a therapist?

First, you need to feel comfortable with the therapist’s demeanor and approach. You want to have the sense, early on, that he or she “gets” you, or is thoughtfully and earnestly working toward that. Ultimately, it is essential that the therapist grasps your fundamental reasons for entering therapy, and is actively working to address your concerns within his or her treatment approach.

What is one mistake most patients make with their therapist/therapy?

I cannot fully accept the question because of the word “most”. However, at least for clients working with me, here is one possible pitfall to work through, should it arise:

Two people are in the room. Although it is not my job to direct you or convince you, therapeutic neutrality, in my opinion, is a fallacy. Better that I make many of my responses explicit, so that we can talk things through. I consider this approach respectful of my clients and, most frequently, liberating and relieving for them.

What is one myth about therapy or treatment that you would like to bust?

Funny, this is partly answered in my last response. Therapists have wildly different approaches, theoretical models, and personal styles. In my approach, neutrality is a myth. In fact, if I withhold all my responses and views, you will feel alone. For the egotistical client who likes to hear him or herself talk, that is unproductive. For the insecure client, who seeks reassurance and perspective, it is also unproductive, even injurious. Many smart psychotherapists may disagree, but this is my approach – and that of like-minded “intersubjective” colleagues. I respect my clients’ need to challenge me and to respond to challenge. Hence, our growing therapeutic relationship and collaboration is an integral part of the treatment.

What should a patient look for in a therapist?

Patients should look for two main things in a therapist:

A therapist that has a lot of experience with the issues they want help with. Many therapists say they work with issues that they do not have a lot of training or experience with. Don’t be afraid to ask any therapist to discuss what their background is with your presenting problems, and how many hours per week they typically work with those issues.

A therapist that they feel comfortable with, and can open up honestly with. This is crucial for therapy to be successful for you! You have to feel physically and emotionally safe with this person that you barely know, where you can imagine yourself disclosing personal, vulnerable information about your life. If for any reason you don’t feel safe or trusting after an initial phone call or therapy session, trust your intuition. Strongly consider seeing someone else. The only exception to this is if you have already started therapy, because sometimes you may project something from your past onto the therapist that has more to do with you than them. In these cases it can be good grist for the mill of productive therapy to discuss your feelings and perceptions with your therapist before moving on.

What is one mistake most patients make with their therapist/therapy?

Patients often focus exclusively on symptom relief, which is understandable. There are times when this is totally appropriate. But there other times when it’s important to get to the source of the symptom or problem, to make sure it does not reappear later in your life. You can check this out with your therapist before deciding you are ready to stop therapy.

What is one myth about therapy or treatment that you would like to bust?

The one myth about therapy that I’d like to bust is that it’s nothing like what is portrayed in movies or television shows. People don’t lie on couches and go to therapy four times a week anymore like they do on these shows. Also, in these shows, therapists are often shown in unethical or compromising situations. In the real world of therapy, such therapists are far and few between. Most therapists have very high moral standards and work very hard to help their patients achieve their goals. It’s unfortunate that therapist lives often get sensationalized in the media to attract more viewers.

What should a patient look for in a therapist?

There are many things you will want to look for in a therapist, from areas of expertise to affordability. But ultimately you need a person with whom you will feel comfortable talking about very uncomfortable things. You should be able to talk about your deepest secrets without being judged. You might fear being judged, but you need to be able to trust that your therapist won’t do so. If she or he is a good fit in this way, then almost everything else will work out.

What is one mistake most patients make with their therapist/therapy?

Sometimes clients feel uncomfortable asking questions of their therapist. So they don’t speak up and end up building some ill feelings towards her or him. For example, your therapist asks a question about your sex life. You don’t understand why and you don’t want to answer, but you do anyhow. That’s unfortunate, because you can end up feeling disempowered. Any therapist who views your work together as a partnership will welcome your questions and concerns about your “treatment.” I’m always glad to hear from my clients – whether they’re happy or confused about our work together. Making sure your relationship with your therapist is solid will only help you better attend to the reasons you came to see him or her in the first place.

What is one myth about therapy or treatment that you would like to bust?

I’d like to break the myth that it is wrong to see a therapist for an extended period of time. I’ve heard people say that you should deal with your issues and get out of the office and into your life. In my opinion, it’s more nuanced than that. Your “length of stay” with your therapist is not an indication of sickness. It’s merely a reflection of how you use therapy to support yourself and your life. Some people benefit from only 3 to 5 sessions. Others see a therapist for years. There are too many factors in our complicated lives to say what approach is best. And suggesting that someone should be “done with therapy” when they actually aren’t only serves to stigmatize getting help and shame the client who is doing so. And it is quite possible to see a therapist and “live your life” at the same time!

What should a patient look for in a therapist?

First of all, do your homework and find someone who is well trained in general and who, when helping you for your particular problem, is practicing in an area that is one of their specialties. If you need help with pain disorders, for instance, find someone who knows a lot about pain disorders. If you need sex therapy, find a certified sex therapist. If you have a chronic illness, find someone who has experience helping others in that situation. Start there. Ask questions on the phone before you even make an appointment. You can usually do better if you don’t pick someone who is a generic, one size fits all therapist, unless you need help for a very common problem.

Next, since you are going to spend a lot of your resources (namely, time, money, and emotional investment) on this relationship, I think it’s important to find a therapist who is on your wavelength. The process of doing therapy involves making an alliance with this stranger in the service of understanding yourself better, talking about what has not worked in your life, figuring out what you need, and figuring out what you need to do to get it. In order to make this process work, you have to reveal a lot about yourself your foibles, your mistakes, and painful or upsetting things that have happened to you in the past. It’s not fun. You have to turn over the rock and look at the crawly things underneath. It’s a lot easier to be honest and get to the heart of things if you feel an intuitive sense of being understood by the therapist. Pick someone you’d like to stand with you and turn over the rock.

What is one mistake most patients make with their therapist/therapy?

I think you’ll get the most out of therapy if you take responsibility for keeping a journal of what goes on in the sessions. Then you can review what was said later in the week and let it marinate. I know that there is something totally magical in what goes on in therapy, so it’s not like I expect you to have linear memory for what occurred. But if you don’t come out of a session with at least one new idea or insight about what’s going on with you, then there is something wrong with the therapy. But you have to write it down, because it took you 50 minutes of work to get to this understanding that was probably too upsetting or difficult or new to come to on your own. And if you don’t write it down, you’ll lose it. As if it had been a dream.

What should a patient look for in a therapist?

First decide what it is you want to work on in therapy, then search around and find the person whom you feel could best help you with attaining that goal. For example, I am a spiritually oriented therapist and I work specifically with individuals who are looking to incorporate spirituality in their healing or recovery. When clients call me, right at the beginning I ask them what they are looking for and why they felt drawn to contact me. You have to see if the therapist is the right match for you and if they have the expertise in the area you are seeking to find help with.

What is one mistake most patients make with their therapist/therapy?

The most common mistake patients make with their therapist is thinking that the therapist is in charge or he/she is going to “do” something for them. The therapist is more like a guide sitting beside you and is going on a journey with you. Ultimately you are the one in the driver’s seat, and you have to learn how to think critically, take control of your life, and learn to change bad habits, false thinking or perceptions. You are the one who has to take responsibility for making shift happen. The therapist can guide you by giving you the tools you need to make these changes happen but in the end, you are the one who has to do all the work.

What is one myth about therapy or treatment that you would like to bust?

The one myth in regards to therapy is that people often think psychologists are trained to read your mind or that they are always analyzing you. That may be true about some therapists but certainly not true about “all” therapists. Instead, many of us are trained to listen intently to our clients without passing judgments, drawing quick conclusions or putting them in categories. By listening intently, we allow feelings of empathy and compassion to rise and through that connection, together we become agents for growth and change.

What should a patient look for in a therapist?

Experience and knowledge in the area(s) you are seeking treatment for. Just because a therapist has been practicing for many years or has several degrees, doesn’t mean he will be a good fit for a patient’s specific needs.

Professionalism and competency – Does the therapist return the patient’s call or email in a timely manner? Is the therapist punctual and consistent with sessions? Does the patient feel that the therapist understands and can provide an explanation of his problems and symptoms?

Trustworthiness – Part of the therapist’s job is to make the patient feel physically and emotionally safe. The latter is only possible when the therapist communicates verbally and non-verbally that he is someone the patient can trust.

Listening skills – Does the patient feel or sense that the therapist is listening to him?

Self-insight – An effective therapist is self-aware and able to separate his issues from his patients. If the therapist brings up his problems when the patient is talking about his, this might be an indication that the therapist is overstepping self-disclosure boundaries. If this occurs, the patient should bring up this concern with the therapist.

What is one mistake most patients make with their therapist/therapy?

In my practice, I’ve found that a lot of patients will wait until the last 5-10 minutes of the session to talk about a substantive matter or issue. This is understandable, as it can be difficult or anxiety provoking for a patient to talk about painful memories or experiences. However, it is these memories and experiences that deserve the most time during session.

What is one myth about therapy or treatment that you would like to bust?

That therapists are professional advice-givers! I believe patients already have the answers to their problems before they even step foot inside a therapist’s office. The therapist’s job is to help patients access and embrace those answers so they can make positive changes. If you need advice, ask a family member or friend!

What should a patient look for in a therapist?

A patient should interview any prospective therapist. He/she should trust his/her reactions (feelings and thoughts) about being in the “room” with the prospective therapist. Is the therapist empathic about what the patient brings? Is the therapist listening to what the patient says? Does the therapist bring forth a genuine caring attitude with exploring in more depth what the patient may be saying? Does the therapist have an open attitude of not “jumping” to premature conclusions about anything; e.g., cutting off the patient; or making any early statements of “knowing.” Can the therapist stay open with the patient to exploration of any and all issues? Has the therapist had post-Master’s training beyond graduate school? Only a Certified or Licensed Psychoanalyst is required to have had personal and in depth therapy himself/herself. Such informed professional can then have a better opportunity of “tuning in” self and being with the prospective patient. One cannot take anyone further (emotionally) than one has gone oneself. Does the therapist answer questions posed by prospective patient in an open and respectful manner? Does the therapist regard any and all topics presented by prospective patient as areas of concern without dismissing such topic(s)? Can the therapist not offer advice?

What is one mistake most patients make with their therapist/therapy?

Patient(s) may “quit” too early if he/she is uncomfortable with the exploration of the therapist. Sometimes a therapist may be blinded by something a patient may bring up (some therapists do not have genuine “real” experiences with the issues a patient brings. Thus, the therapist sometimes kills the treatment prematurely. There are no “bad” patients. There are uninformed therapists. There are topics and issues the therapist does not want to explore (as he/she is uncomfortable). If the therapist is “uncomfortable,” one can only multiply the uncomfortable feelings of the patient by 100! Other times a patient assumes a flight into health. Sometimes a patient reaches a comfortable peak in therapy and is too threatened to “go further.” He/she then takes a stance where he/she tests the therapist and if the therapist is not skilled sufficiently, forces a rupture in the therapy. An example of this may be found on my web site in an article entitled Therapist to the Therapy.

What is one myth about therapy or treatment that you would like to bust?

I would like to “bust” the myth that to look into a therapy requires a weak individual. It is just the opposite; e.g., it takes courage to explore oneself. It is a strength rather than a limitation. To put oneself into question is very difficult to do. Therapy is not for anyone who might need it – it is for anyone who might want it. To explore the truth is daring!

What should a patient look for in a therapist?

Finding a therapist is a lot like dating. Each person is looking for something different, and each person has a different idea of the ideal therapist. Fortunately, there are as many different types of therapists as there are stars in the sky. Every one of them has a different background, from their life experiences, education and training, to their theoretical orientation, personality, and so on. So what should should a patient look for in a therapist?

Well, there are some basic, common sense things you should look for. First of all, make sure they are properly licensed. This information should be readily available on every therapist’s website, business cards, or any other form of advertising. If not, it is illegal, and that should be a red flag. Once you have the license number, look it up on the appropriate board’s website (Board of Psychology, Board of Behavioral Sciences, etc…) to make sure it is current and that there have been no disciplinary actions taken against this therapist.

Also, find out a little bit about their background, such as training, experience, and areas of expertise. Do you want a therapist with a similar background to yours? For example, if you’re struggling with an eating disorder, do you want a therapist that has recovered from an eating disorder herself? Or is it the connection and style that matters most to you? You get to decide, and then explore.

Make sure to ask a lot of questions. A good therapist will be happy to answer them, either on the phone, or during the initial consultation. Sometimes, you find the right therapist on the first try. You feel a connection, you feel heard, and you feel understood. You should never feel judged in any way. Other times, it takes a few tries before you get it right. The bottom line is that YOU are the one who needs to feel comfortable, since YOU are the one paying, and YOU are the one who will be opening up and sharing your private thoughts and feelings with this person.

Whomever you end with as your therapist, you should leave the first session with a sense of hope that this therapist can help you, and that things will get better.

What is one mistake most patients make with their therapist/therapy?

One of the mistakes most patients make with therapy is only coming when things seem “bad”, such as a crisis. Once you get past the crisis, that is actually when the real, deeper work can occur. It is this kind of work that will offer more lasting results, a sense that some real changes have been made, and that you are better equipped to face the next potential crisis.

What is one myth about therapy or treatment that you would like to bust?

There are many myths about therapy. One of the greatest myths I find is that patients believe just COMING to therapy is enough to fix things. This couldn’t be further from the truth. You actually have to be fully engaged in the process, ready and willing to take a deep look at yourself and your relationships, and decide that you WANT to make changes. Otherwise, no matter how frequently you come, change will not happen. The therapist cannot fix you, nor can she make you or your partner change. Rather, she can help you discover unhealthy patterns of thoughts, feelings, beliefs, and behaviors, and help you find healthier alternatives.

What should a patient look for in a therapist?

A lot of people look at a therapist’s credentials or education, their specialties and training. Those things are important, but they aren’t what make the difference between a good therapist and the best therapist for you. You can start your search by looking at web sites or directories like TherapyTribe to narrow the field to some good possibilities. But finding the right match means taking your search one step further by talking with a few different therapists. Reading what a therapist has to say on a web site can give you some feel for the person, but often talking to someone in a phone consultation or an initial appointment is going to give you a real sense of whether you can connect and trust that person to listen to your pains and your triumphs, and to help you transform problems into solutions. Talking with someone can provide something that reading often cannot – a good gut feeling, a felt experience of safety, a sense of rapport. As a patient, it’s crucial to find a therapist who helps create these feelings of comfort within you, so that you can trust that person with your most vulnerable feelings and thoughts.

What is one mistake most patients make with their therapist/therapy?

One mistake is putting too much importance on the week-to-week changes in therapy, without considering the bigger picture, the long view. For instance, patients often feel markedly better after the first one or two sessions – there is an initial relief in talking about something that you have been holding in, a feeling of safety and hope that comes simply from the act of reaching out and asking for help. That improvement in mood or symptoms is important and meaningful, but it’s not the whole ball game. Rarely has the root of the problem really been addressed in those first two sessions, and assuming it has and leaving therapy prematurely only sets you up for disappointment and a false sense of hopelessness later. (I thought I cured my anxiety, but now it’s back again! I guess there’s nothing I can do.) Similarly, many patients go through a period in treatment where symptoms can intensify temporarily. Sometimes this is a sign of ineffective treatment, but other times this dip down is a necessary part of healing – the same way that cleaning out an infected wound hurts before it feels better. You should always let your therapist know if you are feeling worse, and talk about it with him or her. Sometimes changes need to be made for more effective treatment, and sometimes a breakthrough is just around the corner.

What is one myth about therapy or treatment that you would like to bust?

One myth I’d like to bust is that you need a therapist who is like you (same age, gender, race, sexual orientation, etc.) in order to feel understood. A shared experience of going through a divorce or growing up female may help you feel that your therapist “gets” you, but someone without that history may surprise you in his or her ability to deeply understand what you are going through. Indeed, sometimes too many similarities between patient and therapist can create blind spots that can get in the way of treatment. Therapists have extensive training in connecting with people who have vastly different life experience and backgrounds than their own, so don’t discount someone’s ability to see through your eyes just because they are coming from a very different place themselves.

Also consider that the more similar your therapist is to you, the more likely you may be to run into him or her out in the world, especially if you live in a smaller town. How do you feel about seeing your therapist at a concert, the PTA, or an AA meeting? Everyone has a different level of comfort with this thought, so check in with yourself before you insist on a therapist who has children the same age as yours or who has a career history in your field.

What should a patient look for in a therapist?

The most important things in selecting a psychotherapist are 1) how you feel when you first make contact with the therapist on the phone; 2) how you feel when you meet with the therapist for an interview, how well matched do you feel in terms of personality, as well as in some business basics such as scheduling, cost of treatment, and other options the potential therapist puts forward such as style of treatment, suggested, methods of treatment, time-limited or time-line open ended, and 3) how you feel in your first appointment. Whether this is obvious or under the surface of your mind, before beginning therapy you have some kind of plan regarding what problems you want to work on. In your first contact and first meeting, you will be feeling the therapist out in regards to you particular problems and concerns. If you feel some type of relief, or comfort, there’s a good chance this might be the “right” therapist. If you feel uncomfortable (beyond the usual discomfort at meeting a new person with whom you are going to have a close relationship), or disapproved of, this is probably the wrong therapist for you. If you leave this early contact feeling more uncomfortable than you felt when the meeting began, this is likely to be the wrong therapist for you. If you feel some sense of relief you may have met a really good therapist for you. Psychotherapy, no matter what style or type it may be always involves a relationship and there are subtle aspects to relationships that are difficult to articulate. We could say there is a “chemistry” between people, so how you feel, even if it is difficult to describe, is the most important thing to which you should pay attention. Psychotherapy involves a conversation between two people, do you feel like this is going to be a relatively easy and comfortable conversation? Is the potential therapist friendly?

What is one mistake most patients make with their therapist/therapy?

I really can’t answer this. I know of no one mistake that most patients make with their psychotherapist. As psychotherapists we make many many mistakes with our patients. We don’t understand their problems, we may mistake negative comments as something personal a patient is only trying to show us more his or her problems. We say something that is inadvertently hurtful, or that feels to you like a criticism. We may encourage you to do something that doesn’t interest you. We may miss some way that you are testing us and go in the wrong direction. As a therapist one thing I hope patients are able to do is to tell me when something I said made their heart drop, made them feel disheartened, misunderstood. It is when someone is able to tell me about a mistake I made, I am able correct it. In psychotherapy, it is not patients that make mistakes, is us, their therapists.

What is one myth about therapy or treatment that you would like to bust?

There is a popular belief that therapy should be difficult and even painful. Taking this a step further, some believe that many patients get ‘sicker’ while in therapy, and this may be a necessary sign of progress. These ideas are entirely mistaken and it would be great if patients learned that before they begin therapy.

Good psychotherapy should not be difficult nor should it be painful. Sure, sometimes while retelling a negative experience you endured in the past, it feels awful, or frightening generally because the memory is unpleasant, on top of which you may be worried that your therapist will think badly of you, be horrified by your story, or worse yet, your therapist will blame you for whatever happened, and will disapprove of you. But once you tell the story, you should feel relieved, and even in such a session the end result should be the opposite of painful. I will go so far as to say that psychotherapy should be should be relieving, it should be interesting, and it should even be fun. Psychotherapy is a relationship, an ongoing conversation in which you are able to tell your secrets, talk about your life and work out your problems. It should help you go where you want to go, to achieve things you have always wanted but never been able to get in your life.

In some psychotherapies you learn explicitly, you learn concrete skills, you learn how to argue with yourself about irrational beliefs, and challenge yourself to do new things. In some psychotherapies, you learn implicitly, by having a new kind of relationship with an “expert.” Psychotherapy should involve all kinds of positive experiences, both within the therapy hour and in your life outside of therapy. If your psychotherapy is painful, difficult, unpleasant, if you dread your therapy sessions, it is not a good therapy for you. This isn’t to say that you won’t have frightening moments in therapy. For example, if you have always been afraid of something, you and your therapist may challenge you to do or confront whatever it is you are afraid of, so it becomes less and less frightening. This will give you a sense of accomplishment and victory. Psychotherapy should be a welcome relief as you gain mastery over problems that have plagued you, as you overcome inhibitions and move forward.

What should a patient look for in a therapist?

One mistake most patients make with their therapist/therapy?

What is one myth about therapy or treatment that you would like to bust?

Two of the three mistakes I’d like to address in question 2 involve choosing a therapist so let’s answer questions 1 and 2 at the same time. The process of choosing a clinician is often derailed by two errors. First don’t go in thinking you know what’s wrong with you. Perhaps one out of 10 patients who come to me claiming they have OCD actually has this disorder. The same applies to those who come to see me thinking they have a sexual problem, attention deficit, bipolar disorder. “School phobia” turns out to be separation anxiety, “attention deficit” in a child an interpersonal problem or something going on at home that may involve family conflict or even bad diet, “depression” may be rage, “anger problems” may mask anxiety or reflect justifiable outrage. And so on.

Much better is to go in – or make that first telephone call – and talk about your symptoms. Report simply what happens to you, e.g. you get angry, violent, indecisive, overly fearful, argumentative, phobic, preoccupied, sour. Ask your prospective therapist if he or she has dealt with those problems – not with this or that diagnosis/disorder. Find a well-trained, experienced clinician and let him or her determine what is wrong with you. That’s one of the things you’re paying for.

Second, since you may not know what’s wrong, don’t assume you know what kind of treatment you need. Moreover, research has repeatedly shown that the type of treatment in psychotherapy – the approach – is not what determines successful outcome. Success or failure of psychotherapy is determined by other variables, most important of which appears to be the quality of the relationship between therapist and patient.

That brings us to question #1, how to pick a therapist? Again, first find one with a broad range of experience; you can look at “Credentials” at AboutPsychotherapy.com to see what kind of therapists there are and what training each type has. Then in your telephone (or email) contact look for one who has dealt not with the diagnosis you think applies to you but rather with the symptoms – i.e. behaviors, thoughts, and feelings – that lead you to seek treatment. Second and most important, find one who says things that “click” for you. Now of course that may not happen in the first session, but by the third or so you should be having some sense that the conversations are interesting, not repetitive, that you are heading into new territory. You should begin to feel that the therapist has a point of view you had not considered, that he or she asks questions and raises issues that are intriguing, even unsettling.

This brings us to the third error people commonly make in treatment, leaving just when things become exciting and productive. This is also an answer to question #3 regarding myths of psychotherapy. Psychotherapy is not a massage. There is a place in treatment for support, reassurance, and encouragement, but if that’s all you are receiving it probably won’t get anywhere. The only exception here is working with children and adolescents, and even with them productive treatment will sometimes be uncomfortable.