Choosing a Therapist or counsellor

Finding a therapist or counsellor

It can be tricky to know where to start when you're looking for someone to talk to. Here are a few ideas for getting started ...

• There is no clear difference between therapy and counselling.
• Trust your gut feeling - research suggests that 50 - 80% of the effectiveness of therapy comes from the quality of rapport between the therapist and client.
• You are hiring a service provider - even if you are doing so at a time when you feel all over the place and don't understand the options available, know that you are the one in the driving seat.
• Write down a few notes on the following:
  
  • What you want the therapy to achieve for you?
  • How urgent is your need (days, weeks, months)?
  • Do you need someone with specific skills, such as lifting depression, managing pain, recovering from bereavement, reducing anxiety?
  • What are your available resources in terms of finance, time?
  • Do you have a strong preference for male/female, in-person/online, church connected/outsider?
• How will you know if therapy is making a difference? Will you be able to do things you couldn’t before because it triggered panic attacks? Will your mood lift, enabling you to start enjoying things more? Will you be able to be more assertive in a problem situation? Will you be happier in a relationship (or decided how to leave)? Will you be able to make a decision about something you were stuck with? Do you need to be accompanied safely through a turbulent period?
• Make a list of possible starting points for your search such as websites, word of mouth colleagues/friends, workplace provision.
• Set aside an hour to start the ball rolling - that may include phone calls/emails to 'gateway' people/organisations or starting a long list of possible therapists to approach directly.
• If you decide to go with a 'gateway' approach you will have a session with someone whose responsibility is to make an onward referral. If you decide to approach individual therapists directly then make a shortlist of about three people. 
• For your shortlist study their websites and find out how you feel about them - does what they say and how they present themselves resonate for you?
• Contact each of them by phone or email with a handful of practical questions about them to start as conversation openers – do they have availability, how much do they charge, do they offer a one-off exploratory session, how do they typically approach a situation like yours, what is their training, etc – are they helpful, responsive, do you feel a rapport, do they take your questions as serious and legitimate?
• Arrange an exploratory meeting with one or more of your shortlist - you are interviewing them as much as they interviewing you. Do you feel comfortable with this person, do you trust them, do you have reason to believe they are competent to help you with your problem?
• Set up your contract/working agreement with them.

Reasonable expectations ...

• Clear goals. What is the purpose of this course of therapy? What is not working in your life and what do you want to be different? It may be that this is the first thing on the agenda in therapy session if you're not already clear before you seek help.
• How will you know if therapy is making a difference? Will you be able to do things you couldn’t before because it triggered panic attacks? Will your mood lift, enabling you to start enjoying things more? Will you be able to be more assertive in a problem situation? Will you be happier in a relationship (or decided how to leave)? Will you be able to make a decision about something you were stuck with? Do you need to be accompanied safely through a turbulent period?
• The contract should cover:
  
  • Costs, missed appointments, communication outside appointments (if any), complaints procedure, etc.
  • How and when the therapy 'contract' will end, and how to review and either curtail or extend it? It should be easy to end therapy. If you are feeling you don't want to upset the therapist or don't know how to end the relationship you probably haven't got a proper 'contract'.
  • Therapeutic boundaries. What contact, if any, is okay outside the formal sessions? Is the therapist providing pastoral care or crisis availability, or solely therapeutic work in the sessions?
  • Confidentiality boundaries, especially in situations where there may be dual or multiple layers of relationship (either personal or professional) now or in the future.
• It's reasonable to expect to see evidence of change/results in the first few sessions. If you’re not getting what you need, or at least clearly making improvements, then maybe consider changing therapists. 
• Are you getting help in actually changing the problem or are you just getting better at describing why you have the problem?
• Do you retain control and autonomy in the process? A therapist should not insist on specific courses of action including informing other people (with the exception of statutory disclosure requirements).
• Good therapy is different from getting your attention needs met. We all have legitimate attention needs and there are times when normal life doesn’t meet them. But if that becomes the primary (even if unspoken) value of the therapy then it’s not therapy and it may start undermining your capacity to get your attention needs met in normal life.

Worrying traits and potentially dangerous therapy

Things that might make one wary of a therapeutic approach include:

• “Black box magic”–  I can’t tell you about what it is or how it works - you just have to trust me. A therapist should be able to describe what they are doing and have at least a decent framework for explaining how they work.
• ‘No pain no gain’ or ‘you have to feel worse before you feel better'. You should expect to feel somewhat better and/or feel you’ve taken a step in the direction you want to go with every session. Don't hang in there trusting that 'the professional knows best' if you're feeling worse.
• Over-emphasis on prestigious qualifications or lengthy training. What matters is whether a therapist is actually any good at what they do.
• Some approaches are contraindicated in depression, especially psychoanalytic approaches because they can make depression worse. Depression can be a life-threatening condition (suicide and non-specific reduced life expectancy from all causes) so this matters.
• People who have suffered trauma (e.g. accident, bullying, witness, injury) can be repeatedly re-traumatised and distress increased by therapies that involve re-visiting and talking about the experience. Swift and non-voyeuristic approaches are safer and more effective.
• Therapists should know how false memories (e.g. of abuse) are created in order to not unwittingly generate them. This ties in with an understanding of the common everyday trance state, power relations and the uses and risks of suggestion. Some therapists think that if you are not a ‘hypnotherapist’ then you’re not using trance – they frequently are whether or not they are aware of it!

Although much of the above ought to be covered by accreditation as a blanket safeguard or quality assurance, that's not always the case in practice. Sometimes accreditation can be more of a confirmation that the person has been through the training, pays their subscription to the organisation they belong to, and hasn’t had a complaint against them serious enough to get dismissed.

Generally, look for someone who belongs to some professional body or larger organisation and has some form of reflection and accountability built into their practice rather than a completely lone independent practitioner.

http://www.itsgoodtotalk.org.uk (BACP)

https://www.psychotherapy.org.uk/find-a-therapist/ (UKCP)

http://www.bpc.org.uk/find-a-therapist (BPC)

http://www.counselling-directory.org.uk