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The Psychotherapist Association for
Gender & Sexual Diversity

How to choose a therapist.

June 08, 2017 8:09 AM | Gaylesta Blog Moderator (Administrator)

Prospective therapy clients in the San Francisco Bay Area are among the best-informed people anywhere in the world. Counseling and therapy have been embedded in the cultural landscape for decades. But too much information can be bewildering. Especially since there are many different kinds or theories of counseling and therapy and people seem to feel quite strongly about them.

The dominant paradigm for helping people with problems used to be psychoanalysis. After WWII things began to change. There were many more people looking for psychological services and most of them did not fit the profile of the ideal candidate for analysis: for one thing analysis is expensive in time and money; for another there were too few analysts. At this time people began experimenting with new ways of doing talk therapy. The great theoretical pioneers of the second part of the 20th century were mostly trained in psychoanalysis and operated in a context in which psychoanalytical constructs were part of the background. Fast-forward forty or so years. The dominant paradigm for helping people with problems is now cognitive-behavioral therapy or CBT. A dominant paradigm always provokes reactions and thinkers and researchers are now reacting to CBT in the same way as, four or five decades ago, they reacted to psychoanalysis. New ways of doing therapy are springing up.

So what do you do if you are looking for a therapist? Some clients decide on the kind of treatment they want: "I'm looking for Gottman couples therapy." Some decide on the kind of clinician they want to work with: "I want a woman, older, but not too old, and really smart." Some prospective clients come with experiences they feel they want to see reflected in their therapist: "I'm gay/straight and I want a gay/straight therapist." "I'm a divorcing heterosexual woman of color and I want to see a nonwhite female therapist with experience working with divorce and eating disorders." All these ideas are sensible. The person looking for therapy is anxious and these ideas give some reassurance, feelings of certainty and of being in control.

But they do not predict how therapy will in fact turn out. It's probably true to say that if we can predict how our therapy will turn out, we can figure things out for ourself and don't need to be in therapy.  Your CBT therapist will inevitably deviate from the CBT model at some point and work psychodynamically with you. Your Gottman clinician will also use other methods. Your therapist experienced in your issue might at some point feel to you like she doesn't get it. If this happens, it's important you and your therapist talk about it.

When choosing an eye surgeon we can research techniques and procedures and come to an informed decision. It is much harder to do this if we are about to enter therapy and when we are worried and perhaps under intense pressure. Here are some guidelines. Researchers such as Bruce Wampold and Zac Imel believe that, when it comes to therapy modality, it doesn't much matter which therapist you choose. We are all trained to work with all kinds of clients having all kinds of problems. We all make clinical choices to switch between goals-based ways of working (such as CBT strategies and sequences) and process-based ways of working (such as uncovering and working through feelings). Good therapy is good therapy irrespective of its label. But some therapists are more skilled than others, Wampold and Imel believe, and remain so over time. So the most important therapist attribute is that she or he be a good therapist. Choose someone whose office is easy for you to get to and use your gut instincts to guide your choice. Good luck in your search for a clinician and please email me if you have any questions.

Peter Geiger