(….continued from Part 1)
Google the words, “questions to ask therapist” or “how to find the right counselor” and you will probably find the same list of questions:
How long have you been in practice?
What is your training?
What is your therapy style?
How many times do you recommend I come?
I’m sorry, but I don’t think those questions (or answers) tell you anything important.
So, I’ve put together a list of things I would tell a friend who was looking for a good counselor.
It’s all about goodness-of-fit. One therapist might be excellent for someone else, but not for you. For instance, I know a man really knows how to help families in trouble. But he is not warm and fuzzy. He rarely looks to the past; what happened in the families of origin. He simply looks at the problem that the family is currently facing and says let’s change that. He would not be the therapist for me.
That being said, the most important factor when looking for a therapist is to ask yourself, “How did I feel talking to him (or her)?”
Study after study has shown that counseling works, although no study has been able to conclusively say which style of therapy or therapist is the most helpful. (There is one caveat: Exposure therapy is the most helpful treatment for phobias). The only thing that matters is the connection client and therapist are able to build.
While trying to find a counselor I encourage you to pay attention to every little detail — everything is important and says something about the therapist.
The Phone Call
Was the counselor warm and friendly? Or did she sound too busy and irritated about being bothered? Did she sound nervous; inexperienced? Did she have expertise with your particular issue? Did she return your phone call within 24 hours? Did she sound like she cared? The therapy relationship starts with that very first interaction.
Did the room seem cozy? Warm? How close were the chairs? How far apart were you from the counselor? Were there tables between you? Was there distracting background noise from other offices? Did the room’s smell make you feel good or bad? Did the lights come from bright fluorescents or dim lamps?
I’ve been in offices where the therapist sat on the opposite side of the room, armored behind his desk. I’ve been in sessions where a supervisor towered over me as I sank down into his couch. I’ve had gigantic coffee tables barricade me from a quick access to the door. I’ve done counseling (during my training) in bright cafeteria-type rooms that didn’t offer a personal or safe setting.
In my office, I make sure there are no coffee tables blocking me from my client. I offer a triangle of seats to choose from so that I’m not looking head on at my client. I pay attention to the distance – not too close, but not too far. I have a background white noise maker, to dampen hall noise.
I rely on four lamps rather than the bright overhead lights. It’s hard enough coming in and spilling all your emotional guts — lighting makes it easier. I have pillows and soft blankets that clients use for safety. I have a couple candles that smell like soothing lavender, and I think my clients associate the smell with safety. I want my counseling office to be one giant safe container where people can talk about anything.
How does he start the first session? Does he have you sign a consent form and tell you about his fees? Does he tell you your client rights?
What you tell a client is confidential up to a point (Counselors are required to seek outside help if you are suicidal or intend to harm to others.) Does she tell you how to file complaints or grievances with the state if you feel she did something unethical? Are her credentials posted on the wall? Does she give you an explanation about how therapy works? Does she ask you if you’ve been in counseling before? Does she ask you what worked with previous counselors? What didn’t work? Does she give you time to ask her questions?
The first thing I do with a client is to let them choose where they want to sit and I follow their lead. I let them know they can curl up on my couch, recline the chairs, etc. Then I give a brief explanation of the client forms and make sure they have a copy. I ask, “How are you feeling about being here?” If they are nervous, I explain how totally normal that is:
“Counseling can be kind of awkward. You’re coming in telling a total stranger very personal things.”
Now, ask yourself: Do I click with this person? A counselor is different from a friend (you’re paying her to be honest with you), but you should at least feel friendly towards your therapist. If you don’t, find another one. Is she easy to talk to? Does she have a sense of humor? Does she seem like she knows what she is doing?
We’ve all seen the therapist who says things like “How does that feel to you?” I catch myself saying that to clients and I always chuckle. Yes, that’s a good question, but if your therapist simply nods, says “hmmm” or “I see,” but offers nothing more, you need to find another therapist. Look for one who offers you insight. Who gives you choices. Who points out your successes and your contrary thinking. A good counselor broadens the road and helps you see what you can’t see.
How do you feel?
When you leave the office do you feel hopeful? Studies have shown a huge part of therapy is just having hope. Hope is not a placebo…the body’s chemistry really does change! How did the counselor tell you they would help you? Did she give you her theory on how counseling works? If not, ask.
Sometimes counselors make clients feel worse, but that’s part of the deal. I once had a professor whose veterinarian told him he had to peel the scab off his cat’s paw every day because the wound would cover over to quickly. Counselors peel the scabs off vulnerable places. They take clients into the storm of pain and walk beside them. But, when a client leaves the office, they usually feel relieved and lighter.
What to say?
If you’re wondering what you can say in therapy, go ahead and say it. What you think is shocking is probably mundane to an experienced therapist. It’s okay to be completely honest in a session.
Clients who pay good money to hide things from their therapist always amaze me. Most counselors are very compassionate. They typically don’t judge their clients because they understand people usually have good reasons for the crazy things they do. With enough time and talk, it’s not difficult to connect the dots in understanding why a client binges, resorts to self-injury, acts promiscuous, or has affairs.
How Many Sessions?
The client is the one in charge. She gets to decide how long she wants to see a therapist, not the other way around.
Too many clients hand over all their power and the nature of therapy is that you are already vulnerable to a person you see as having all the answers. If it doesn’t feel right after the first time, don’t go back.
Sure, it takes awhile to build trust, but you should have a gut instinct about the therapist from the very first phone call. Some people may feel better after just a few sessions. Others may need more extensive therapy. In general you should be making some significant changes within in 8 – 15 sessions.
Does it take weeks to schedule an appointment? Is the counselor easy to get a hold of and does he return calls right away? Can you book appointments via email? Is the office close? How about payment. Lots of counselors accept credit cards? Some accept insurance and others don’t. Some let you pay monthly and others want to be paid each session. What should you do if you are in crises? Will the counselor let you call? Will you be charged?
I hate that I even have to write this section. The truth is, most counselors are ethical, but there are counselors who have their own mental deficits who will abuse the intimacy and safety of a counseling setting.
Hugging – many counselors will hug a client and many won’t. The important thing to note is how safe the hug is. Is the therapist acting sexual? Usually, a side to side hug is safer. I was trained to ask myself, “Why do I want to give the client a hug? Is it about me needing it? What message would it send to the client? Will it be therapeutic or do damage?”
There are clients with certain personality disorders where hugging could harmful. If a therapist hugs you, ask yourself if it felt unnatural? Unsafe? Sexual? If so, let the counselor know you do not want to hug. On the other hand, a hug can be deeply healing for client who has just shared her darkest sins and wonders if she is still loveable.
Sexual activity between client and therapist is never appropriate. However, because therapy can be very intimate, people with unhealthy boundaries get confused. They equate emotional intimacy with sexual intimacy.
I’m not saying therapists and clients don’t ever have sexual feeling towards the other, but therapists have clinical supervisors they can discuss this with (It would not be helpful for a therapist to tell a client he or she is sexually attracted to her client). But, if the client is feeling sexual attraction to the therapist, it might be great information for the therapist and client to discuss. Perhaps, she sees herself as only having her sexuality to offer anyone. WIth that insight, she can then learn a new way of being in the world.
It’s a sad irony, that the very people who get taken advantage of in therapy are those who have already experienced boundary violations (e.g. childhood sexual abuse). Sometimes a client acts passive or seductive because of her past. A therapist who takes advantage of that is very sick. If a therapist acts out sexually with these clients, it does so much damage; clients have nowhere left to turn and a high percentage commit suicide. There is no excuse for a therapist abusing this privilege.
Following is a list of things I’ve experienced as a client or student. If you experience the following things in counseling, I would suggest you find someone new:
- Someone who shames you
- Someone who keep his distance
- Someone who towers over you or acts superior
- Someone who only addresses the reason you are there rather than having the skills to consider there may be much deeper things going on.
- Someone who betrays your confidences. If that happens, file a complaint against him or her (In Colorado the agency is called DORA.)
- Someone who tries to take too much control without asking you how scary that would be for you (For example: Telling you to write a letter to your father if he was your perpetrator when it is something you don’t want to do.)
- Someone who talks in riddles, leaving you more confused.
Can you think of other harmful or helpful things therapist do?