How to find a therapist
Tuesday, September 8, 2009 at 08:21AM This evening I’ll
be doing an event at The School of Life with Brett Kahr on the subject “How to
make sense of psychotherapy”. Which is a great topic, and apparently the talk
is already sold out with a very long waiting list – I don’t attribute this to
my brilliance but to people’s hunger to find out about therapy (and of course
to Brett’s brilliance). So this seemed like a good time to put up this post
which I’ve been working on for a while. It’s long, and I thought of posting it
in multiple parts over several days, but really that’s just annoying for anyone
who wants the information. So here it all is.
This post was
inspired partly by chats with some friends, and partly by the fact that I think
the advice on the BACP website and on the site of the UK Council for
Psychotherapy is just… not very helpful to anyone who isn’t already an expert
on therapy. (I have a theory that the reason these organisations put up lists
like this and think they’re sufficient is that they’re very useful to the
people who work in these organisations - because they know half the therapists
on the lists personally, and understand the subtle differences in each description.)
I remember when I arrived back in London after living in New York and wanted to
look for a therapist, I found these directories totally useless. This post,
basically, is all the advice I wish someone had given me then.
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I make no secret of
the fact that I’ve had, and been significantly helped by, psychotherapy. At
least, I think I make no secret of it. If there are any members of my family
reading this who don’t know: hi, I’ve had therapy.
But really, I’m
pretty open about it in conversation with friends. Which is probably why, at a
rough estimate, about a dozen of my friends have asked me for my advice about
finding a therapist in the past three or four years. I can understand why: the
world of therapy is dauntingly incomprehensible if you’ve never done it before.
Plus, in the UK at least, there’s a huge stigma in admitting you’ve had/you want
help of this kind. It’s a shame, because psychotherapy can actually help,
whereas some of the alternatives that somehow have less stigma in Britain –
like binge-drinking to ‘forget your woes’ – do much more damage.
A few years ago I
saw a woman on a TV money makeover show who was spending literally thousands of
pounds a month on ‘psychic hotlines’ because they gave her space to discuss her
feelings about the breakup of her 10-year relationship. The host, I think it
was Alvin Hall, said “instead of spending all this money on psychic hotlines,
go and get yourself a good therapist. It’ll be so much cheaper.”
When he came
back for his three-month follow-up visit, she’d done really well with all his
other pieces of advice but was still spending £300 a month on ‘psychics’.
He
said “what did I tell you to do about this?”
She looked at him and said “yeah,
I just need to grit my teeth and give them up.”
“And get therapy,” he said.
“Just
grit my teeth and go cold turkey on the hotlines,” she said.
She literally
could not hear him telling her to get therapy because, I think, in the UK
people hear “you need therapy” as “you are a damaged, broken, hopeless
individual who can never achieve normality and happiness”. The stigma is so
strong that it’s really hard for many people to seek the help they need.
Anyway, having had
a few of these conversations, it occurred to me that perhaps I could write a
post here with all the advice I’d give to a friend who asked me how to go about
finding a therapist. Just in case there’s anyone out there who wants to find a
therapist but is too embarrassed to take the first step of asking how to do it.
A couple of
disclaimers:
1. I am not a doctor, a therapist, or trained at anything much
except writing down my opinions and making up fictional stories in my head about
imaginary people. All this advice is based purely on my experience and that of
people I know. It’s partial and possibly biased. Although it’s the best advice
I’m able to give, you’re going to have to make your own minds up about what’s
right for you; that’s your decision not mine.
2. This advice is very London-centric.
Although the basic principles probably apply pretty much everywhere I’m only
going to recommend named organisations that either I have used or which people
directly known to me have used. I’ve only ever sought therapy in London and in Manhattan,
and in Manhattan everyone I knew was in therapy and so all had useful
recommendations to make. This is advice for people who live somewhere – like
London – where there’s still a therapy stigma, and people do not routinely swap
stories about their therapists over brunch at Sarabeths.
Ways to Find a Therapist
1) If you have friends
who are in therapy, or who are therapists, ask their opinions and advice. Your
friends may recommend their own therapist, another therapist they saw who they
didn’t click with but think might work for you, or they might ask their
therapist for a recommendation. Friends who are therapists will have an even
wider network to recommend from. This is a lovely simple way, and probably won’t
work if you live in the UK. However, I include it first because I think it’d be
better if we were able to do it like they do it in Manhattan.
A brief detour into my own story: when I
lived in Manhattan I came to a crisis point in my life. I didn’t like my job, I
didn’t like the life I was living in my free time, I was dissatisfied with my religion,
I was in love with a man who wasn’t able to love me back and terrorists had
recently flown a couple of planes into two big nearby buildings. As was my
wont, I went and complained and cried at my New York friends who all listened
very sympathetically and, at the end of each conversation said “have you
thought of seeing someone?” By which they meant, a therapist. And because all
of them had seen not one but several therapists they were able to flick through
their mental Rolodexes until they came up with someone they thought might work
for me, and one of these recommendations was, in fact, perfect. This is lovely
but unless you have a lot of therapy-literate friends, it won’t work for you.
So we go on to…
2) This is my big piece of advice, the
thought that if you came to me and asked me about this in private I would
present to you like precious treasure:
go to a referral service.
Such places
exist. They are run by professional organisations. You get to sit down for a couple
of hours with a very experienced therapist, tell them all the things that are
troubling you, and then they have a think and send you to someone who, in their
opinion, will suit you. This is how I found my therapist in the UK. This is how
many people I know have found therapists who work for them.
I know of three
referral services which I can personally recommend on the basis that they made
referrals with which I or people I know have been happy. They are all based in
London but I believe they do referrals nationwide; at the very least, they
should be able to put you in touch with an organisation in your area that makes
referrals.
Founded by Susie Orbach, although I believe she's now no longer associated with it (not that I know why she left, but... therapeutic groups and people seem to be constantly having spats with one another which are not comprehensible to the outside world. Therapists do not, in case you’re wondering, seem to be
perfectly enlightened beings of peace and harmony themselves; like any other kind
of doctor, their ability to help you heal isn’t necessarily related to their
own health). The WTC do really good work, but only see women. If you’re a woman
I recommend them very highly – go there without delay.
The Association for
Group and Individual Psychotherapy (AGIP)
Honestly, sometimes I feel quite
cross with therapists. AGIP is a good organization, which has found excellent
therapists for people I care about. But when you go to their website and click
on the ‘find a therapist’ link it takes you to one of those useless lists of therapists
rather than to their extremely useful *referral service*.
But apart from their illogically arranged website, they are good. They also
have a low-fee service for students and people on benefits.
Centre for
Counselling and Psychotherapy Education
Why do therapists need so many
different professional bodies? What is the difference between them? I don’t
know, but if any therapist reading this could enlighten me that’d be great. The
CCPE has a rather more sensibly organised website than AGIP, and their
referrals service has worked for several people I know. I’ve had less personal
contact with them than with the WTC and AGIP, which is why I put them third, but
a doctor friend mentioned them to me and I know people who’ve found very good
therapists through their referrals.
3) This is less of a method than a piece of
advice. When you meet a therapist, do not worry about their “analytical
framework” or their model or their school of thought. They may say things to
you like “I’m a neo-Freudian” or “I’m a Lacanian”, or “I work in a
psychodynamic structure”. Ask them to explain what this means in practice to
the work you’ll be doing together. The differences between these various schools
are often, to the untrained patient, pretty much invisible. The key question to
ask yourself when you meet a therapist is: do you feel comfortable with them?
Do they seem like they understand what you’re talking about? When they speak,
does what they say make sense? [If it makes sense and stings a bit but only in
the good way that makes you feel like you’re understanding something new about
yourself, you are probably in good hands.] Do you feel like you can open up to this
person? Do they seem intelligent? Do they seem to ‘get’ you? Trust yourself (I
shall be returning to this refrain). Trust your own ability to pick someone who
you can work with. Do not worry about whether or not they have ‘neo-Kleinian
leanings’.
Ways of finding a therapist which might
seem sensible but about which I have my doubts:
1) Getting a
referral from your GP. I realise this is controversial and I’d be the first to
admit that it’s just my highly inexpert opinion. However, my friends who have had
NHS therapy have had decidedly mixed results. Some people have found it just
fine, some really helpful, but some have found it useless. The thing is… the
NHS don’t give you a choice in therapist (as far as I can tell) and don’t do a
detailed referral session like a private referral service does. I think there’s
a bit of a lottery about whether you’ll end up seeing someone highly
experienced or someone who’s been on a three-week counselling course. And I
think there’s something quite powerful about the experience of private therapy
in which you choose the person yourself, you know that you’re paying them, you
say how long you want to go on for.
Having said that,
therapy is extremely expensive. If you’re unemployed or young or on a low wage,
a private referral service will probably be able to find you a therapist who
works on a sliding fee scale (down to £5 a session in the case of the Women’s
Therapy Centre, I believe) but it still won’t be free. If you are really in
dire financial straits, going to the GP for NHS therapy isn’t a bad idea, but
do try to find out what the qualifications are of the person you’re seeing, and
if you think the person doesn’t work for you, do go back to your GP to discuss
it rather than feeling that you have to soldier on with someone who's not appropriate for you.
If you’re able to,
though, I think you’re likely to get better continuity of care, greater choice
in therapist, and probably someone more experienced and better qualified if you
don’t go through the NHS and instead bite the bullet and pay for private
treatment. I love the NHS, they are wonderful for acute conditions, but I think
they can fall down on treating long-term or chronic problems, and
psychotherapy can be a long-term business.
2) Going to, eg, the BACP website and
finding someone in your area.
I know they offer
this service on their site, and it might seem like a good way to go about it
but just… don’t. I’ve tried finding a therapist this way. I ended up meeting
about half a dozen women in north west London who all seemed very similar, I
got exhausted and demoralised telling them all the same story of my life, and
really didn’t have any way to decide between them. While it’s a good idea to see
more than one person before you make your final selection, you should really be
‘interviewing’ people who’ve been recommended to you for some reason; either
someone you know has seen them and thinks they’re good, or your friend’s
therapist thinks they might work for you, or your friend who is a therapist
thinks their approach would be right for you, or a referral service has
recommended them. If you pick someone purely based on geography, the field is
likely to be too large to make a useful decision.
Having said this,
if you live in a remote area of Scotland, this may be the only way you have to
find a registered psychotherapist within 50 miles of you. If so, have at it.
A few bad signs
Here are some signs
that this therapist is not right for you. Some of them have happened to me, and
some to friends. This list isn’t exhaustive (see above re: how I’m not an
expert) but in my opinion if you find yourself in one of these situations, you
should probably be looking for someone else.
1) I put this first
because it’s the most important, but I should say that it is *very rare*. The
following things have never happened to me or anyone I know; they’re in no way
common. You need not fear that you’ll have to search long and hard to find an
ethical therapist, and especially if you use the referral methods I suggested you
should have no problem whatsoever. However, unethical behaviour does occasionally
happen and I think it’s quite empowering to know where the line is, and to
understand that some things are *not OK* and that you should *walk away*.
So, the top reasons
to look for a new therapist include: if your therapist becomes in any way
violent, aggressive, demanding or hostile. If they try to invade your private
life. If they call you at home except to rearrange an appointment. If they make
sexual advances to you. If you feel they’re overly touchy-feely and you tell
them to back off and they don’t. If they don’t think it’s a problem that they’re
also treating your mother and your husband. If they have more than one
relationship to you – that is if, in addition to being your therapist they’re
also your boss, your next-door neighbour, your cousin or your friend. If they
tell you that getting naked with them will help you overcome your inhibitions
or that you should give them lots of money (more than you’re paying them for
sessions) to help with your healing. Really these are things that should have
you reporting them to their regulatory body.
I think a lot of people worry that their
therapist is going to brainwash them – I know I worried about this – and that
they won’t know enough to say ‘stop’. Therapy can seem very mysterious, and it’s
hard to know what to expect and whether they’re “doing it right”.
A friend of mine
once said that it was hard for her to appreciate good modern art because she didn’t
know what bad modern art was. In this spirit, I highly recommend reading this
article about Masud Khan, a respected
London therapist who was eventually struck off. He was a Bad Therapist – at
least to many of his patients – and it is Not Rocket Science to spot why. My
impression is that Wynne Godley came from a world and a time where people had
never discussed what one could expect to happen within a therapy session, and
he second-guessed his own ability to work out what was right for him. And of
course Masud Khan was highly plausible. The world’s changed, but the important lesson
is: trust yourself. However well credentialed they are, if they suggest you
leave your wife to hook up with another one of their patients, it’s time to
report them.
This is the major
caveat. All the other problems on this list will just end up wasting your time,
but if you think the therapist is actually manipulative or damaging, run for
the door.
2) They just don’t seem
to understand what you're saying. I had a therapist like this once – she was the one I’d
picked after seeing half-a-dozen entirely randomly chosen women from the BCAP
directory and having no idea how to choose between them. I only saw her for a
few sessions, but each time I shared something that was troubling me she got an
“I’m concentrating really hard now” frown on her face, and then made a reply
which indicated to me that she didn’t have the least idea what I was trying to
communicate. She was a very nice woman, she just wasn’t as bright as I needed
her to be. It’s important to have a therapist who you think is smarter and
wiser than you. If you think there’s no one out there who is smarter and wiser
than you, go to a referral service, tell them that, and then enjoy how they
find you someone to work on your superiority complex.
3) They talk about
themselves a lot. Now, different therapists have different views about this.
Personally, I like a therapist who I know nothing about; it prevents me from
trying to tailor my responses so they’ll like me more. Some therapists think it’s
important to share their reactions at times, or to tell stories from their
personal experience which shed light on what you’re discussing. However, I have
a friend whose counsellor spent most of their sessions telling my friend about
his holidays, his new conservatory, his grandchildren, his partner’s career… that
isn’t therapy, it’s a chat. If you find you’re doing more listening than
talking, something’s probably gone wrong.
4) You just don’t
vibe with them. Again this comes down to: trust yourself. Listen to them,
observe them, observe how you respond to them. If you feel instinctively you
want a female therapist, or a male therapist, or a black therapist, or a gay
therapist, it’s OK to follow that hunch. (They may want you to talk about why
you made that decision. Therapists are like this, always asking questions about
stuff.) If someone seems on paper really right, but when you meet them you just
don’t feel you can open up, they’re not for you. Carrie and Danielle have a
lovely little post about choosing a therapist based on their style.
If this is important to you, go with it. I knew I felt comfortable with my
therapist in Manhattan when she quoted from one of the more obscure Shakespeare
plays in our first conversation. It is OK to choose based on weird and personal
things. Our personalities are weird and personal. As President Bartlett once
said: run towards yourself.
A few things that
may feel uncomfortable but aren’t really bad signs
If you ever take a
course in massage, you’ll be taught about the difference between “painful pain”
and “grateful pain”. I love that phrase, “grateful pain”. When they rub you in
that place where it hurts and it makes it hurt more but at the same time you want
them to carry on doing it because you know it’s making something release and when
it’s done you’re going to feel better? So yeah, again, like much of this it all
comes down to instinct. Therapy’s not always pleasant; sometimes you end a
session feeling like shit. I think mostly one can tell if it’s grateful pain or
not. However, these are some things that might seem on the surface like the
therapist isn’t really doing their job but which probably mean it’s going OK:
1) ‘They’re so quiet!’ This is something
that can throw people. A therapy conversation isn’t like a normal conversation.
After all, you don’t really want to end up finding out a lot about them, that’s
not what you’re paying £40-75 an hour for. So therapists often go quiet or just
answer your words with an “mmm-hmm.” They want to let you talk. If you’re
someone who doesn’t like to talk, who is often quiet in groups, this may feel a
bit strange to you.
2) ‘I’m not better yet!’ Yeah, what with
the rise in popularity of CBT, anti-depressants and in general the
makeover-show culture people are surprised when they see a therapist for four
weeks and their life isn’t utterly solved. It’ll probably take a while. Talk to
your therapist about realistic time expectations (they may get cagey, it’s OK
to press them and it’s OK to say “I can only afford three months of this”,
although they might say you could do with more and they might be right. But
life’s not perfect and they should be willing to work with what you have.
3) ‘Since I started therapy I seem to be
feeling kind of worse!’ Hmmm. Yeah, this is a tricky one. It can happen, and
sometimes it’s a good sign. In fact there’s probably no such thing as good
therapy which doesn’t sometimes make you feel more miserable than when you started.
If you’re talking about difficult stuff, the stuff you need to talk about, it’ll
likely have a few negative effects – the idea is that the long-term effect will
be positive. Talk it through with your therapist. Don’t be afraid to tell them
that you’re afraid you’re getting worse and that it’s freaking you out. Talk it
through with good friends (and supportive family, if your family’s supportive)
too. They might see improvement in you that you can’t see yourself. If you’ve
got a good GP, discuss it with them too. It could be that this therapist or
kind of therapy isn’t right for you, or it could be one of those things that
you have to ride out. If the latter, you have my sympathy; it does suck, but it
does get better.
As a final thought: if you have read
this post and are still confused or have questions, feel free to leave a
comment below or to email me directly. You can use an anonymous gmail address
if you like. I am, as previously indicated, not trained, but I will do my best
to give some pointers in the right direction. If you email me with a useful question,
comment or insight, I might post it to this blog unless you explicitly say you
don’t want me to do that but I will try to make you as anonymous as possible.
And if you have come
to this post because you are feeling very depressed or despairing, please do
call The Samaritans. You don’t have to tell anyone
you’re doing it, and they really do help when you’re in a rough spot. Feelings
don’t last forever but while they’re happening they can feel overwhelming. It
is OK to ask for help.
Reader Comments (4)
1) Some referral services (the Women's Therapy Centre in particular) have waiting lists for their private practice referral service. This can be very daunting, but don't give up. The waiting lists typically move very quickly - I went onto the waiting list and progressed up it and saw someone within four weeks. I know that can seem a long time when you're in mental distress, but it is worth it.
2) Do not be surprised if, after having had a referral session, you feel worse for a few days. Referral sessions can be like this: you pull out all your problems and worries and complaints about your mother and look at them and then... there's no move toward sorting any of it out. It's OK, it's normal to feel overwhelmed by looking at everything all at once. Once you find a therapist, you'll be able to examine these things more slowly and work through them as they come up.
This is wonderful article. You covered some brilliant points here. A great resource for therapist-seekers everywhere.
Thanks for the effort you put in here :)
CoreyFounder of MyTherapistMatch.comwww.mytherapistmatch.com
I work shifts on a pattern which means I can't guarantee being free on the same day each week, and since I've seen private practice therapists in the past and never had any problem, I thought this wouldn't be an issue (for £60+ an hour you're paying for a service that suits YOU, right?). However the WTC were really sniffy about my shift work and to be honest made me feel like a huge inconvenience for working irregular hours.
I wouldn’t say it was a reason not to go to them, but if you’re not able to make the same time each week, make sure they’re fully aware of that before you have your initial referral appointment as it seems to be something that they consider problematic in terms of referring you to a therapist.I hope this makes sense and helps!