I am a 45 year-old married woman with three teenage children. I have been depressed for many years and am thinking about seeing a therapist. I am very well known in the entertainment industry and am not comfortable asking my friends or family for a referral. Can you give me some suggestions about how I can go about finding a therapist who will, hopefully, be able to help me.
– Rebecca G., Sagaponack and New York City
I am impressed that you have finally decided to get some help, since it’s too difficult and unnecessary to deal with life’s ups and down on our own. Choosing a therapist can literally be one of the most important decisions someone can make in their life and has the potential for far-reaching consequences — both positive and negative.
More and more people today are seeing therapists for a variety of reasons including depression, loneliness, anxiety, bipolar disorder, substance abuse of various kinds, sexual abuse and relationship and sexual problems. It is unrealistic to think that the average consumer will know how to go about choosing the right therapist. You need to be consumer savvy.
The following are some suggestions to help you find a therapist that is right for you:
1. Get a referral from someone you trust. Do not be taken in by splashy ads, television appearances or “likes.” And remember that your best friend’s therapist may not be best for you!
2. Make sure that the therapist you choose has considerable clinical experience and specializes in your particular problem(s). It’s not possible to be an expert in everything.
3. Ask yourself whether you would prefer working with a woman or a man.
4. Check his/her license and make sure that there are no past or pending malpractice complaints filed against your therapist.
5. Expect that your therapist will ask you a lot of tough questions about your family background, relationship history, sexual history, previous psychiatric problems including possible hospitalizations, suicide attempts thoughts and gestures, medications that you take (prescription and over-the-counter), possible addictions, history of sexual abuse, sexual assault, affairs and gender identity issues. Though many of these questions may be difficult for you to answer, it is vital for the therapist to know these facts so that she will be able to make an accurate diagnosis and treatment plan. This is only possible if the right questions are asked and that your answers are truthful.
6. Ask yourself after the first few sessions whether you are comfortable with your therapist. Don’t expect a strong level of comfort instantly. Like any relationship, it takes time for trust to develop. However, if you continue to feel uncomfortable after several sessions, remember that there are other therapists with whom you will be able to connect. There should never be any inappropriate advances, sexual, verbal or otherwise that occur between you and your therapist.
7. Does your therapist respect your time and call you back within 24 hours including evenings, weekends and holidays, if necessary? The fact that the health insurance companies often poorly reimburse therapists and psychiatrists for out-patient mental health should not be your concern. You want to work with someone who you can count on, especially in emergencies. You are entitled to sessions lasting a minimum of 50 minutes. I find that longer sessions work even better, particularly in the beginning. My own patients find that two-hour or even longer sessions help to achieve results faster.
8. Your therapist needs to have some type of communication with your primary care doctor in order to rule out any physical problems or prescription medications that may be contributing to or even causing your mental, emotional and psychiatric issues. After a couple of sessions your therapist should be able to tell you your diagnosis, including a detailed treatment plan. I also believe that anything less than weekly sessions, at least in the beginning, will not give you the best possible momentum to achieve success in your therapy. If money is a problem, try to negotiate your fee with your therapist or even suggest a payment plan. Don’t be afraid to ask for what you want! Remember your therapist is not an all-knowing god or goddess.
9. You should ask whether your spouse, parent, siblings or children will need to participate in your therapy. Clearly, if you are having relationship difficulties, it is essential (assuming that you feel safe) that your significant other participate at some point in your therapy. Some therapists only deal with the individual patient and will refer you to a couple’s therapist or family therapist if needed.
10. In my professional opinion, your therapist should fully understand your family background and help you see how the past has affected your current situation and problems. And even though we can’t change history, it is vital for you to understand how and why you may have learned your self-destructive, self-sabotaging or destructive behaviors. This will help you learn to be mindful about living your life in ways that are in your best interest moving forward.
11. Ongoing evaluation is necessary in order to determine how well (or how badly) your therapy is going. Expect that at times you will feel considerable pain, since effective therapy helps you take a hard look at yourself and your life — past and present.
12. The question of medication often comes up. Although no one likes to go on medicine, there are certain clinical situations that absolutely require a combination of medication and psychotherapy. Please don’t beat yourself up if you have found that massage, acupuncture, energy healing, meditation, vitamins, exercise and healthy eating have not helped to alleviate your symptoms. Brain chemistry is very complex, so let the experts do their jobs. And if you do need to go on medication, find a skilled psychiatrist, who specializes in psychopharmacology, who will work with you to ensure that you are on the right medication and the correct dose.
13. Successful therapy depends not only on your therapist’s expertise, but also how much time, work and energy you are prepared to put into your therapy. In my own practice, I assign homework after every session for individuals as well as couples.
14. Finally, remember to spend at least as much time researching your therapist as you would deciding on which car, computer or cell phone to buy.
Good luck on your therapeutic journey!
Beatty Cohan, MSW, LCSW, AASECT is a nationally recognized psychotherapist, sex therapist, author of For Better for Worse Forever: Discover the Path to Lasting Love, columnist, national speaker, national radio and television expert guest and host of The Ask Beatty Show on the Progressive Radio Network. She has a private practice in New York City and East Hampton.