Finding a Good Therapist

After you have decided to find a therapist, and you meet them and you begin. How do you know you have a good therapist? How do you know that what you need from them is going to be met?

Therapists are human beings, and they make mistakes. They say something too deep too quickly, or make an assumption, or look a little glazed over for a moment… This can happen from time to time. But the experience of being in therapy is much bigger than these little moments between you.

Your therapist should be open to your questions about their practice. What is your therapist’s theoretical framework? What is your therapist’s approach to helping people with your particular concerns? Where did the therapist get their training? If you get a sense that the therapist doesn’t want to answer or is impatient with you, keep looking, especially if it bothers you.

Your therapist should have an idea how long treatment should take, ideally.

Your therapist should check in with you about how treatment is going, on a regular basis.

Your therapist should, at least on the surface, appear to be organized and grounded, as a person. As I said before, they are humans, they’ve had bad experiences, they have problems too, but their problems should not spill into your therapy.

Your therapist should seem like an individual person, rather than a textbook. You should be able to get a sense of their personality in sessions. They use themselves in sessions.

Your therapist is not dominating the conversation with anecdotes about their own lives. They should spend most of their time listening and encouraging you to speak, explore and process.

Your therapist should adhere to ethical rules and guidelines. They don’t invite you to parties, or accept your invitations to barbecues or make uncomfortable suggestions. In Colorado, it is illegal to have a dual relationship with your therapist, including dating and sexual relations. They are in a position of power in your life and it would be exploitative and abusive to engage you in non-therapeutic activities.

Your therapist should inform you prior to the start of treatment of the above, to make sure you are going to be a good fit to work together. Your therapist should be confident enough to say, “we might not be a good fit, I can help you find someone who is.”

If you think I am a good fit for you – give me a call and put me to the test! www.aliceriley.net

Online Therapy Part II

So it has been 4 weeks or so since I became active with the online therapy company.

Here’s the breakdown: The first two asked to be transferred within 2 weeks. One transferred and I think the other ended up cancelling. Not a good fit. The first one gave me a “bad” review however, when I talked to the quality assurance therapist, she saw how engaging this client would have been difficult no matter what (and she was demanding that I respond 7 days a week) and gave me some good hints about her process. The second one, I think got offended because I didn’t receive her message after a week and I was sending her notes about getting her engaged in treatment. She didn’t respond to asking about working with me despite my error. This month, one client decided she really didn’t like texting, and because it’s a slower process than traditional therapy. So... a rough start.

But even in traditional therapy, a therapist has to take time to get to know people otherwise how can we really be helpful? One of the hints is that after 2 more weeks, you ask about how the client likes the platform? Then you ask about your work together. You propose this structure during the introductory 10 minute free video chat. Seems to help set a pace for clients. Will do.

So now I have about 5-6 clients, most of whom are new but engaged in the process. I can pick up a max of 4 new clients per week. I have done some brief video chats with them, which I offer in the second week. Some like that, some don’t. But they all say they like seeing my face so they know who they’re texting – they see my photo on the profile page but I don’t see theirs. I more easily match stories to faces so it helps me keep track a lot. I have a client in the UK, which is really interesting, and the others are in Colorado, near and far. Picking up clients is a bit like bidding on a cow at the State Fair – you have to be scanning the “online office” when they post new clients to be matched. You have to check for your state and then reply quickly if it’s someone you want to work with. I have found that Fridays are good days but it means connecting over the weekend a bit so they don’t get discouraged. For just one person here and there I can manage that. It feels a little trollish to be doing that, vs going out with the kids or friends…

I tell people I respond at noon(ish) and 8:30(ish). We have to check twice a day. Some people write more than others, obviously. One person asked me to write even if she didn’t, just to let her know I was there and thinking of her. Sometimes I find myself still out running errands or at lunch at noon so there’s a little issue with time management here and there. And my younger daughter is staying up a little later so I switched from 9 to 8:30 to get a jump on tucking in time. She’s ten but she still likes me to stay with her until she falls asleep. I both love and loathe it… On Fridays I respond around 5PM while I am at Taekwondo with my aforementioned child. That way everyone’s weekend can begin…

So this has been a private practice supplement and also a JOB as a practitioner. Very interesting as an experiment in a new treatment modality and a social movement. I honestly wish I had heard of it 2-3 years ago, I could have used the side income, the experience. But here I am… Jumping in with both feet. In October I begin a “Business School Bootcamp for Therapists” program to help me revv up my practice and give me some skills to be successful. I can’t afford not to be, and I really like being my own boss. I will likely write about my upcoming experience and new insights into this whole thing. 

Countertransference

If there is one thing I stress to students and anyone I supervise... it's "get a handle on your own stuff." What does this really mean? I see a lot of posts about behaviors people need to stop doing, for example, complaining or worrying, nail biting.

But first you must be aware that you do these things at all. And most people are NOT because they can be very unconscious. Long before I knew this is what I wanted to do, I went to therapy for a year. I was 17 and I had issues, suffice it to say. I didn't think this therapist was any kind of guru but I learned what I needed to learn and threw away some of his sexist, assuming and occasionally belittling crap about me. I can laugh about it now! I also went to therapy in my 20s because my father was terminally ill but I went for ten years anyway. After I got married and had a baby, I was in marital therapy *surprise!* So I have done some time on the couch, and I think ALL therapists should. Why? Because you need to be aware of your own stuff! I cannot say this enough!

Counter-transference is the therapist's reaction to the client's reaction to them. Or to their story. Last week I saw a couple - only for two sessions. One wanted to work on the marriage, and the other was done with her spouse. I don't really want to see couples, and I was glad when they decided to stop coming. Why? Because I have gotten divorced, and clearly not long ago enough. My mind wandered and I struggled with staying focused on them because I could see all the similar issues. I also have a client who is getting divorced but it's a little easier to manage my feelings with just one person - I tend to align myself with one person vs staying in the middle - I am not a good mediator. Well, it is something I can work on. I have my areas of expertise and I do not have to be an expert in all things.

During my marital counseling time, I found a therapist whom I adored. She was an older lady (we both thought she resembled my mother but she was nothing like my mother as we found out!), French speaking Swiss ex-pat, elegant, and had this uncanny way of using her own counter-transference to work with us (I am sure this was her Institute training but she was gifted). She allowed her feelings to surface based on what each of us said. She used those feelings to respond to the person who was talking and not talking. I loved her and eventually went to see her on my own from time to time.

I once went to a training on counter-transference where we watched some film clips - Ordinary People, and Dead Man Walking are the two I recall the most. Any film with therapy scenes or
difficult issues are good opportunities for therapists to think. If you were sitting across from a sociopath on death row and he started making sexual innuendos - how would you handle that? Watch the movie - she did great. Granted - you'd feel pretty uncomfortable. Angry even - how dare he? Be aware of those things. Narcissistic people will piss you off constantly, be aware of that. Those feelings are telling you something not just about you but about your client.

The California psychiatrist Irving Yalom MD writes great books about therapy - I recommend them. The book "Love's Executioner" is specifically about counter-transference and is a must read on the topic. I have learned more from his books than any class or supervisor. While I was reading his book, "The Gift of Therapy" I got stuck on a chapter and stopped reading it. I mentioned this to a colleague and he asked what the chapter was about because it had triggered something in me... well of course it was something I was having a reaction to - I don't recall at this moment what it was. My point is that these things are all signs that point to our issues and we must listen.

Therapy is a GIFT. Managed care has made it all about billing hours and time limits, sadly, but if you really want to be a good therapist, dig deep into yourself and not only learn about yourself, but learn from your therapist. If you are not learning - find someone else who can be your guru.