- Attaining a better understanding of yourself, your goals and values
- Developing skills for improving your relationships
- Finding resolution to the issues or concerns that led you to seek therapy
- Learning new ways to cope with stress and anxiety
- Managing anger, grief, depression, and other emotional pressures
- Improving communications and listening skills
- Changing old behavior patterns and developing new ones
- Discovering new ways to solve problems in your family or marriage
- Improving your self-esteem and boosting self-confidence
Do I really need therapy? I can usually handle my problems.
Why do people go to therapy and how do I know if it is right for me?
10 million Americans receive psychotherapy every year. And there's a good reason for this: therapy works! At least it does if you find a good, effective therapist. But how do you select a "good, effective" therapist, one who will truly help you? First, it is important to address some common myths about therapy:
Myth #1: A therapist attended an excellent university, so she must be good, right?
Not necessarily. Training is important, but it doesn't guarantee that a therapist is effective. Good therapists and bad therapists graduate from top-notch universities. Looking at the diplomas on the wall is not the best way to select a therapist.
Myth #2: A therapist has a doctoral degree, so he must be good.
Degrees are important, as are other credentials, but they should not be the main criterion for choosing a therapist. In fact, many marriage and family therapists, as well as clinical social workers, have a master's degree—and yet they are highly effective.
Myth #3: A therapist has written numerous books and scholarly articles on counseling and therapy. Surely, she is an effective therapist.
Writing books and scholarly articles is important, but does not an effective therapist make. Just because someone is a prolific writer does not mean that she's an effective therapist.
Myth #4: A therapist uses only "scientifically validated" techniques, so he must be effective.
This is probably the biggest myth of all. Actually, the research shows that techniques have relatively little to do with effective therapy. Many people think that if techniques work in medicine, then they should work in psychotherapy. However, what many do not realize is that psychotherapy is not a medical procedure. Instead, it's a relational endeavor, an interpersonal process. So when a therapist claims to use only "scientific" techniques, it really doesn't mean much in terms of whether or not she's effective—and it's not a good reason to select a therapist.
So how can one select a good, effective therapist?
Extensive research on how psychotherapy works can help answer this question. The evidence shows that the primary determinants of effectiveness in psychotherapy are the human and relational elements. In other words, a good, effective psychotherapist is not a "junior physician" wielding medical-like techniques. Instead, an effective therapist is a warm, caring, empathic, and knowledgeable person who knows how to interact with a client in a way that is healing. If you want to find a good, effective therapist, look for that kind of person. Following are some descriptors of effective therapists.
Characteristics Based on the Research
1. An effective therapist begins by focusing on the personal and cultural needs of the client to determine the best therapeutic approach. There are many "brands" of psychotherapy. Therapists who are attuned to the latest research do not impose their particular brand on clients. Instead, they begin by talking with the client to determine, in a collaborative way, the type of approach that best fits the client's needs.
2. An effective therapist gathers routine feedback from clients relative to how the client feels about the therapy and the therapist. In other words, instead of being "therapist-centered," effective therapists are "client-centered." The client is regarded as a partner who knows, better than the therapist, whether therapy is working. In short, effective therapists engage the client as a full partner in the healing process by routinely checking with the client to see how the therapy is going.
3. An effective therapist is interpersonally sensitive and skilled. Effective therapists listen. They extend empathy, acceptance, and care in ways that are emotionally healing.
4. An effective therapist is culturally aware and realizes that every relational encounter is, in a sense, a multicultural encounter. Effective therapists have cultural humility and are open to learning from their clients.
5. An effective therapist supports and activates the self-righting potentials of the client. In other words, effective therapists do not take away the client's power by insisting that "doctor knows best." Instead, they realize that the client's own potentials are the power center of effective therapy and they do everything possible to support and activate those self-healing potentials.
There are thousands of good, effective therapists who have these qualities, but they are not always easy to find. Take the time. Go to some "trial" sessions with different therapists if necessary. It's worth the effort to find the kind of therapist I've described—and if you do, I predict your life will never be the same.
What is therapy like?
What do I need to tell my therapist? (from Andrea Bonior, PhD)
People have all different levels of comfort when it comes to talking about difficult things with their therapists, just as people can vary greatly within their real-world relationships. We all know those people who are all too willing to dive into a potentially difficult conversation with gusto-- they'll send a soup back a second or third time if it's not exactly the right temperature, whereas at the other end of the spectrum, some otherw will eat a cold soup-- even with a hair in it.
For those who have anxiety around awkward or potentially conflictual situations, and they're experiencing something difficult within their therapy, therapy itself is the very place to work through that. In fact, not only are certain difficult topics important to bring up in the therapy setting, but that setting itself can provide the ideal place to talk not only about the topic, but why it's so difficult for you. It's very important to remember that you can get the most out of therapy when you bring up what you are truly thinking and feeling-- even when-- or especially when-- it involves the therapy itself. If you don't want to say it, you can bring in a piece of paper to have the therapist read, spelling out that you need to have a conversation that's difficult. Here are six common topics that can be tough to talk about, and why you're doing yourself a favor if you can put them on the table.
1) There is an issue or behavior you haven't revealed to them. It's quite common not to tell your therapist your deepest, darkest issues right away. And it can be fine to begin therapy talking about one main issue and being slow to reveal something going on deeper under the surface, until you feel more comfortable. But wait too long, though, and you're just wasting time and preventing yourself from working on it or understanding how significantly it may be connected to the issues you are talking about. Maybe you're okay talking about your depression symptoms, but have never told anyone about childhood sexual abuse, and can't seem to bring it up even with your therapist. Or maybe you've ommitted just how much you drink or how often you take painkillers, or your problems with binge-eating, or the fact that you have extreme road rage or are obsessed about the size of your nose. Whether it's because it's embarrassing, scary, or shameful to talk about it, you eventually need to-- so that the therapist can get the fuller picture and you can really start working on the root of the problems, rather than the more surface-y symptoms that you might be hiding behind.
It is worth noting, of course, that there are some times where your therapist might be put in a position of potentially having to report a situation to get further help. Almost always these involve imminent danger to the health or well-being of you or some other specific person. Your therapist should have spelled all this out clearly for you during the informed consent process before you started therapy. If you are unsure or concerned, you can broach the topic generally to get further clarity about confidentiality limits before giving details.
2) They have said something that has upset you. Maybe it was an offhanded remark that you felt minimized what you were working on, or a way that they interpreted something you said that you found to be condescending or unhelpful. Ideally, you would bring up your reaction in the moment-- such honest and open discussion of those interpersonal interactions and emotional responses can be the stuff that great therapy is made of. But if you didn't say anything at the time and you find that it is sticking with you and continuing to annoy or upset you, it can still be extremely useful to bring it up, perhaps even more so. For one thing, your therapist can better understand how and why they erred, and get a fuller picture of your emotional make-up that they might not have realized before. For another thing, it can prevent similar situations from getting in the way of the therapeutic process, and can help build an even more emotionally intimate relationship.
3) You are unsure if you are making progress. For many people, especially if they are conflict-avoidant, one of the most difficult conversations of all is to express doubt or dissatisfication about the therapeutic process or, even more specifically, the therapist themselves. A large percentage of people would rather just stop seeing the therapist than have this conversation and try to recalibrate whatever doesn't seem to be working. And of course, this is an understandable reaction. Some therapists are simply better than others, and even when competence is not an issue, match can be-- certain styles and theoretical orientations and personalities are more bound to click with your needs than others are. But other times, feeling stalled can be part of the therapy process itself, as there's a certain truth to the fact that sometimes you must feel worse before you can get better. This is virtually a guarantee if you are reopening old wounds or spending a lot of time talking about things that sadden or anger or frighten you. And to flee the therapy at that crucial point can be shooting yourself in the foot-- doing the work without sticking around to get the reward. So bring it up instead, and see where it goes.
4) You are having difficulty with payments. Money and financial arrangements can often feel like, at best, an annoying pest intruding upon the therapy, or, at worst, a serious stressor that threatens your ability to even be in therapy in the first place. Many therapists dislike dealing with the financial arrangements as much as you do-- that's why we became therapists and bypassed majoring in accounting. But all too often, a client may be having trouble coming up with payments, and by not being direct about it, the therapist has no idea. The client then digs themselves into a deeper and deeper hole, where they might be prone to break off the relationship without warning, or default on payments-- neither of which is going to help them feel better.
5) You feel they're not getting something. Maybe you've tried explaining a relationship or a feeling or a habit of your,s and instead of feeling understood and validated, you've felt like your therapist is misconstruing what you're saying. Or maybe they're unfamiliar with a certain aspect of what you're going through at work because they have no clue about your industry, or you feel like they're minimizing something that really bothers you. Give them a chance to get a clearer picture by talking to them about how you're feeling unheard about it. The more the therapist realizes that they're missing the mark, the harder they can try to really understand and do the work with you that you deserve.
6) They're doing something that you find disconcerting. No therapist I know will ever admit to being the one who takes phone calls during sessions, is routinely late, nods off, glances at the clock obsessively, or reveals too much about themselves. And yet I've heard clients say that they've actually experienced plenty of this in past therapeutic relationships! Of course, it is reasonable if you experience one of these transgressions that you might want to end the therapy without having a discussion about it. But if you're otherwise doing good work together, don't let it be tainted by not bringing the issue to the therapist's attention. That will give you the opportunity to see if it is just a singular oversight that can be corrected, or if it's part of a more problematic pattern that means they're not the therapist for you. If you never bring it up, you'll never know-- and you risk losing the investment you've already put in.
Andrea Bonior, Ph.D. is a licensed clinical psychologist and media commentator. She is the author of The Friendship Fix, and Baggage Check, the longtime mental health column in the Washington Post Express. She serves on the faculty of Georgetown University.
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