What Questions to Ask:
I am often surprised by the lack of questions asked by new clients. I make it a point to offer a chance to ask me a few questions. Most clients will say they don't have any, and want to know when can we start. To be honest with you, I think that it is really important to ask a few good questions before you start with your therapist, even if they have been recommended to you.
I have often wondered why prospective clients don't ask many questions. Possibly it is difficult to know what to ask. Or maybe there is a sense that the therapist is an authority figure and people feel disinclined to ask pertinent questions. Possibly, there is an assumption that credentials automatically mean you know what you are doing. Here are a few tips on what you might consider asking.
Even if you are not particularly interested in the answer, it is a good idea to ask a few questions upfront. This gives you a sense right away for your therapist. A highly skilled therapist might not be a good match for you personality wise. If this is someone you are going to hire to share your deepest struggles with, then you need to know you might feel comfortable with them before you get started. Clients sometimes have difficulty discontinuing and then starting over with a new therapist once they have started to open up and share their story.
Even if you don't have a clue about psychology or theory it is a good question to ask. A well grounded counselor should be able to answer this question easily and give you a sense of their approach. There is a wide range of theory bases and they vary in how they approach a problem. If you don't feel at ease with hypnosis for example and you start with a Therapist who relies on it in counseling, then you may not be compatible.
If you are looking for a faith based counselor then you may need to know what faith means to that therapist. Does it mean that they went to church a few times growing up or does it mean that they live out their faith daily? A good therapist-client match can be a real dynamic environment for positive growth and change. Clients need to understand that they have a say in the relationship and they should feel free to ask such questions upfront. You are in fact hiring someone to help you with your life. Go ahead and ask.
A very brief summary of some common theory types (These descriptions barely scratch the surface):
DBT (Linehan)- Dialectical Behavioral Therapy is all the rage right now. Insurance companies even reimburse for it (quite frankly a big deal considering their lack of support for mental health). It is based on Eastern Religion practices of mindfulness/meditation practices. If you are desiring to stick to a faith based therapy choose instead a Cognitive Behavioral, Person Centered, or Rational Emotive therapist who has an active faith. Or make sure the DBT therapist has a strong faith and can point you back to faith principles while using DBT workbooks/exercises to improve insight. I personally don't recommend a blending of the two.
Cognitive Therapy (Beck)- Based on the concept that how one thinks is reflected in how one feels and behaves. If you address dysfunctional thought patterns than you modify feelings and behavior. The goal is a "cognitive shift" in which misperceptions are discovered and moved to a more balanced position of function.
Behavioral Therapists (Pavlov, Skinner)- The concept is that behavior needs to be changed first and then cognitions, and feelings will adapt. Concepts of conditioning, social learning, behavior modification are predominant. Understanding is not important.
Person Centered (Rogers)- Based on the concept that when a client is provided with an environment of acceptance a client will work toward "self-actualization" on their own. The therapist provides unconditional positive regard while the client works out their issues of concern.
Rational Emotive (Ellis)- Addresses how our emotions are linked to our behaviors and linked to our thoughts. Finds an Activating Event and analyzes how the thoughts and behaviors are connected to it, and then works to modify the thoughts (irrational beliefs) to modify reactions (Emotional Consequences).
Gestalt (Wolfgang von Goeth and others)- Therapist will engage in dialogue rather than focus client on a goal. Purpose of the dialogue is to increase awareness. Gestalt is understanding of the shape of an entities form. Pictures and symbolism are used to capture the "Gestalt" or shape. Clients are encouraged to do their own decision making. Various therapy models may be used in the context of the therapeutic relationship. Focus on the "here and now" or present awareness of present issues as opposed to lengthy analysis of the past.
Analytical Psychotherapy (Jung)- Focuses on the unconscious psyche and archetypes (i.e. the self, the persona, the shadow). The goal is to become more conscious trough psychotherapy, dream analysis and a process of self knowledge.
EMDR- Eye Movement Desensitization and Reprocessing (Shapiro)- An 8 phase treatment based on information processing therapies. Traumatic memories are paired with a series of eye movements (mimicking REM sleep patterns), and tapping (soothing movements). The pairing has been found to produce diminished trauma symptoms and resolution of the memory. It has been found to be effective for severe trauma including veterans with PTSD. Select a therapist with demonstrated training in the method.
Psychoanalysis (Freud)- emphasis on analysis of the subconscious and dream interpretation. Traditionally this is the one where clients lie on the couch and look away from the therapist while the client speaks. Many of the concepts are still used in current theories but through different means. Dream interpretation, and analysis of the unconscious and conscious states are common components. Transference (the clients projected reaction to the therapist) and counter-transference (the therapists reaction to the client) are used to increase understanding.
Transactional Analysis (Berne)- Addresses three prevalent ego states in within each individual; Parent, Adult, Child. The idea is that we function out of ego states and our response to life will reflect either a Parent, Adult, or Child ego state. Ego states are considered patterns of feelings and experiences as related to behavior. TA therapists use simple vocabulary and set up treatment goals for their client.
Adlerian (Adler)- Individual psychology is interpersonal in recognizing how we interact with others. Emphasis on choices, family history and social interactions. People are studied in the contact of social interactions. The meanings we interpret from life will influence our behavior. Emphasis on meanings and perceptions drawn from life.
Family Systems (Whitaker, Ackerman, Bowen, Minuchin)- Families typically come in with an "identified patient" (symptom bearer). The goal of the family therapist is to modify the family relationships to attain harmony and balance so that the symptomatic behavior is alleviated. The focus is not on the individual but on the system of the family. Concepts of triangulation, double bind, marital schism and enmeshments are addressed.
Side note: I always say you want to make sure you have a sane therapist, not a "psycho" therapist... Har har!
Why choosing a Licensed therapist is important:
After moving to Colorado from Illinois where requirements for private practice are stringent I was shocked to learn that in Colorado you do not even need to have a degree to become an "Unlicensed Psychotherapist." I personally find this appalling because it fails to protect the public from untrained therapists who have not had the training to learn the skills of the trade.
It also fails to protect the counselor from severe pathology. Most clients are high functioning individuals who just want to improve their life. Other clients can be incredibly manipulative and even dangerous. I, myself, have been in life threatening situations.
Please select a therapist who is licensed. This shows that they have dedicated a lot of time and effort to learning how to be effective at helping people. Their skills have been tested and their knowledge base has been established through at least one, if not two, 4 hour examinations on counseling skills. If you want a good therapist but cannot afford a licensed therapist choose a therapist who is working toward licensure. They should have lower fees but are meeting weekly with a licensed therapist to help them with their cases and then are studying to take the examination.
What the letters mean:
LPC- Licensed Professional Counselor
LCPC- Licensed Clinical Professional Counselor
LMFT- Licensed Marriage and Family Therapist
PsyD- Doctor of Psychology
PhD- Doctor of Philosophy (Can be specifically in Psychology)
CADC- Certified Addictions Counselor
What theories do I adhere to?
Well, first and foremost I feel the ultimate therapist is the Holy Spirit, "But the counselor, the Holy Spirit, whom the Father will send in my name, will teach you all things and will remind you of everything I have said to you." John 14:26 He is described often as a counselor. I rely most on Him, and often as clients are sharing their problems I am praying inwardly at the same time asking, "show me how I can help this client." He brings to mind what I need from my training and experience to help clients through their circumstances.
I feel it is unfortunate that some Christians (Authors, Pastors) are opposed to counseling. I assume this is a result of bad experiences from inexperienced therapists, or therapists who rely heavily on secular philosophies rather than faith principles. Again, that is why it is important to interview the therapist you are hiring to help you. Pastors should meet with and interview any therapist they are considering using as a resource for them. A good faith based counselor can really help support pastors who are very busy overseeing ministries.
In my approach, I draw from a range of theoretical methods. My graduate school training taught all of the afore mentioned methods. However, I utilize Cognitive-Behavioral, Rational Emotive, and Person Centered Methods most frequently. If it seems a present behavior is linked to a past experience or event I will spend time there exploring the connection to add insight. I feel insight gives you the freedom to choose how you will proceed rather than just reacting automatically to life as it happens to you.
Dreams can also add insight and are often rich with symbolism that can be looked at to draw from the pre-conscious states. However, I don't spend too much time on dreams because they can also be overemphasized. An occasional peek into dream states can open up a fresh perspective.
An example of dream symbolism, is a frequent dream that I have. When I step out of my comfort zone by accepting a challenge I often dream that I am standing on the edge of a cliff with my back pressed against the outer wall of a house (house offers comfort). I'm usually on a small ledge and considering how I will proceed. This reflects my fear and awareness that I am not in my comfort zone.
I also rely heavily on the concept of forgiveness. What's the point of analyzing past hurts if you don't forgive those who have injured you. Forgiveness releases you from the burden of bitterness and buried rage that finds its outlet in other unhealthy ways that can damage our relationships, "Refrain from anger and turn from wrath; do not fret-it only leads to evil." (Psalm 38:8). The lack of forgiveness brings about more hurt for more people. Forgiveness is not tolerance of abusive or hurtful actions, firm boundaries may be important. It is an acknowledgement that a wrong was done but a decision is made to forgive and let go of bitterness.
I know that was a lot of information but I hope it is useful as you now are armed with a sense of what to ask your prospective therapist.
Best wishes to you in you personal journey toward health,
Gretchen
Resource:
Current Psychotherapies, 4th Edition by Raymond Corsini and Danny Wedding; F.E. Peacock publishers, Inc. Illinois, copyright 1989.