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Tip Day: Picking out a therapist

Posted Dec 01 2010 10:28pm
I am smack-dab in the middle of trying to find a new therapist.  As I mentioned last week, TNT is leaving clinical practice, and I am left trying to find someone new. 

I hate finding therapists.  It's painful, time-consuming, and really, really tough.  So with me once again playing therapist picker-outer, I thought this week's Tip Day would be a great time to discuss what I've learned about picking out a therapist (this is the 13th time I've done this--I think I qualify as an expert!).

{{I realize some people don't have the fortune of being able to pick out a therapist.  The system where you are is that you get what you get.  If that's the case, I apologize.  However, I hope that what you read is useful for helping you figure out if you can apply for a new treatment provider or help them help you better.  I have choice, but with choice comes really steep medical bills for insurance and co-pays.  Win some, lose some, I guess.}}

1. Get referrals from people you know and trust. It might be a medical doctor.  It might be a friend or someone from the community who has also had an eating disorder or other mental health issue.  Or a guidance counselor at school.  Also check with your insurance company to see who might be covered and in-network. This way, you already know some things about the therapist--the basics of how they practice, that they're reputable, how much you might have to pay, and so on.

2. Don't rely too much on referrals.  Opinions are opinions, and not everyone sees the same thing in every therapist.  What I might find reassuring may drive you bonkers.  It's important when gathering data to separate fact from opinion.  That a particular therapist practices CBT is a fact.  That your friend finds them a total flake-azoid is an opinion.

3. Nice isn't the most important factor.  Of course we want our therapists to be nice.  Most of them are--misanthropes typically don't go into clinical psychology.  There are times when nice and kind and gentle is probably the right response.  But there are lots of times, especially when dealing with eating disorders, that firm and direct needs to take precedence over hand-holding.  The work of recovery is hard and miserable, and I've had therapists that were too nice and didn't push me into recovery.

4. Find out what treatment modalities they use.  I'm not especially keen on overly emotion-focused, insight-oriented psychotherapy.  I know many people find it helpful and useful, which is great.  For me, I like the acronym therapies: CBT, DBT, and ACT.  I like that they have evidence to show they are effective, and I like that they are much more concrete and practical.  So do your homework.  Find out which types of therapies you think would be most effective to help you move into recovery.

5. Ask them what causes eating disorders.  For me, this is the #1 screening question I use.  Because if I hear things like "unresolved childhood issues" or "boundary violations" as what causes eating disorders, I will run for the hills.  It means that, fundamentally, this therapist and I will not get along, will not see eye to eye on what I need to work on, and also that I know more about EDs than my therapist.  It's an easy way to gather information, and I often ask it right off the bat so that they don't have a chance to try and tell me the answer they think I would like to hear (this isn't that I think a therapist would really be blatantly dishonest, but it is human nature--heck, I've done similar things).

6. Find out their professional affiliations.  If you are trying to find a therapist for your eating disorder, then ask them if they're members of NEDA, of AED, of IAEDP.  Not all areas have an ED specialist, so you can also ask things like how many eating disorder patients do they treat, have they had any special training in eating disorders, do they know of a colleague who knows more about eating disorders, that sort of thing.  Good therapists will be impressed that you're asking this, so don't hesitate.

7. Ask hypothetical questions.  No, not the "if a tree fell in the middle of the forest..." types of questions.  But things like "If my parents called with questions, how would you respond?" Or "If I needed a higher level of care, what would you do?"  Or "If my symptoms increased, how would you handle it?"  It's good to know these things before a crisis hits, and it can also give you an idea of how the therapist generally handles issues, and how knowledgeable they are about EDs.

8. Don't let one bad apple ruin everything.  Bad therapists exist.  They might be a bad fit for you, or irresponsible, or whatever.  That's one therapist out of many.  Just because you found one bad apple doesn't mean that therapy doesn't work or that you're never going to get better.  It means you just found a bad therapist.  That's all.

What have you found helpful when searching for a therapist?  Share in the comments!
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