Tilted Forum Project Discussion Community  

Go Back   Tilted Forum Project Discussion Community > The Academy > Tilted Life


 
 
LinkBack Thread Tools
Old 01-24-2011, 06:34 PM   #1 (permalink)
Crazy
 
zenda's Avatar
 
Location: London, England
How to Choose a Counsellor or Psychotherapist?

I mean .... How?

Introduction
I'd touched on the question in another thread. Amonkie mentioned it was a topic of general interest and could be useful as a separate thread. This could, therefore, be a place for people's answers to that question, and also for your experiences and anecdotes.

The subject is close to my heart. From 1989 until 2003 I was working with the British government and a disparate array of therapy/healing organizations to create national standards for accreditation and accountability. These did not diminish the likelihood of any particular therapist assisting or screwing up the clients' attempts to achieve their outcomes. They did serve to give the clients a sense of security and subordination in the therapist's office, but had little bearing on whether the therapist would actually do good work. The dream had been that a standardized and well-monitored system of accreditation would protect clients. The reality was that, as with any well advertised product - many of which are backed up by official-sounding labels, the potential client needed, additionally, to learn the skill of conducting their own assessment.

A client's first contact with a counsellor/therapist is typically when a problem has been identified and is approaching 'amber alert' status. Often a sense of shame can delay someone's seeking to hire the services of a psychotherapist or counsellor until well into the 'red' stage. This can be a difficult time to make wise employment decisions, and is therefore especially important for roadmaps and guidelines to be ready and available.

This thread could become a knowledge-base to resource individuals when they are about to pick up the phone to contact and hire a counsellor and decide what, if anything, they want to do. I will start the ball rolling with my own angle:


My Perspective
If you're looking up some names in a directory, then it's great if you can talk about specific counsellors with any of your friends who might have been to one, that would be good. I'm not talking about "Oh, my therapist is Sooo good ... I've been seeing him/her three times a week for the last 6 years .... he/she's Sooo supportive, and is evening finding time to fit me in for a fourth sessions per week." ... noooooo not that. Such therapists do exist, and they have good pedigree and can provide good justification. When it's Problems which actually Bring us to a counsellor, typically they'll have some time-basis and need to be sorted soon, because people are hurting NOW. The consequences of NOT solving it are piling up now.

A better reference could be something like "I saw them for a few months and am now feeling more like I know what I want to do and how to do it. Initial sessions were twice a week for a couple of weeks, but rapidly went down to once a week and then once every two weeks. After three months, we agreed that I should see how things go and make an appointment in three months time for feedback and debriefing, though I was free to call to ask questions if need be." Also "The therapist and I discussed what I wanted to achieve, What EVIDENCE would count as success at different stages ..." This is the kind of evidence which, as early as possible, would let me know a: what progress meant, and b: the extent to which I was progressing." This is important, so you know whether to go back for the second session and for each subsequent session.

The therapist should be willing to sort that out in the first phone call, or, during an arranged phone call or meeting BEFORE money changes hands. Indeed, my personal insistence takes it further than some therapists would be comfortable with: The therapist should provide some demonstration/advice/intervention which the client may take away for a few days to find out how well it works for their problem. That is what is needed before agreeing paid work. My view is that YOU are interviewing a future employee, and they have to have ways of satisfying you that they can do the specific job you will be paying them for. The kind of counsellor I reckon is needed is one whose keenest intent is that you will find your 'best thinking' and your 'strongest feeling' so YOU may make YOUR best decisions, and that you may have the clarity and discipline to follow those decisions AT THE SAME TIME AS being very sensitive to feedback ... ie what specific effect it has on each person concerned - including you.

Beyond that, evidence of progress must be available, week by week, to both parties for the purpose of checking worth of continuing sessions. Some outcomes might take a long time, however, in that case, they need to be chunked down so the roadmap has plenty of rest-stops and check points. There are some outcomes ... eg spiritual questioning, or unfocussed mid-life crises whose progress is difficult to assess week-by-week. For those, I recommend special attention be given to chunking down to observables.


Conclusion: A call for many perspectives.
Well, I've given you some of my perspective. I look forward to your adding your perspectives and questions, and with the kind assistance of Amonkie, present the following questions for those who may appreciate some points of focus, stepping stones and springboards into this discussion.

I'll be interested to hear from people who have not had counselling/therapy - what are your thoughts and feelings?

I'll be interested to hear from those of you who are involved in the psychotherapy/counselling field or have had counselling

When did you first seek it out and why - Ie Dr required, self choice, marriage counselling as last resort?

To what extent did you seek it remedially - to solve a problem, or generatively - to evolve to embrace future possibilities?

How did you select your psychotherapist or counsellor?

What concrete help, if any, do you feel your sessions actually provided?

Having considered the above, what advice would you give someone? What would be the very most important things they need in order to make their wisest choice?
__________________
ZENDA
zenda is offline  
Old 01-25-2011, 01:15 AM   #2 (permalink)
Eponymous
 
jewels's Avatar
 
Location: Central Central Florida
Been to many therapists, counselors, psychiatrists and psychologists over the years.

Yet this does not make me an expert. For me, I refuse to spend time with anything but an Licensed MSW, or is it LCSW? Those with higher degrees are always standing in the doorway with the prescription pad and seem more concerned with their image than the patient's well-being. Again, this has been my experience.

The last two therapists I was lucky enough to find through my insurer, but I had to base my decision upon location so I would lose the least amount of time from work, as I was visiting on a weekly basis when I worked an 8-5 shift.

The first one was fabulous. She did refer me to a psychiatrist early on to get me on medication, but she taught me how to deal with difficult emotions and within months was able to wean off the anti-depressants. Sadly, the insurance only covered a certain amount of therapy and I couldn't afford to keep going out of pocket. If I could afford to go, I'd probably still be seeing her.

A couple of years later, I had a mini-breakdown of sorts and was referred to another through the EAP at work and did not like the therapist at first. After 3 or 4 visits, I began to see that although her methodology was different, she was going to be able to help me, too. She did. No meds.

Since these two helped me the most, I'd suggest that anyone undergoing any type of emotional stress should be able to see a therapist, even if only for the weekly affirmation. I always felt so good when I walked out of a session and think most could benefit. In both of these particular cases, there was an issue I sought help for but have tools that still help me cope today.

Although I don't advise selecting based on location, I was lucky. I'm not sure that friendly referrals would work as different personalities might not find the same relatability. I guess a phone interview might offer some help in choosing but I tend to think it takes at least 2 - 3 visits to know if it'll work. Makes me think that a trial of 4 visits would be nice.
__________________
We are always more anxious to be distinguished for a talent which we do not possess, than to be praised for the fifteen which we do possess.
Mark Twain
jewels is offline  
Old 01-29-2011, 08:54 AM   #3 (permalink)
Insane
 
ganon's Avatar
 
Location: in my head
I do counseling, not as a vocation but as a free service. I have a masters in it. I think that Jewels is quite correct in talking about the affirmation. You don't want to pay to have a friend, but that kind of "fit" is crucial. You don't want to feel like the counselor is working against you. I recommend that people see a qualified counselor as soon as they recognize that they feel out of control in some area. I also belief people should find a good counselor to go to when they are feeling fine, just as a check up, like they do with a yearly physical. And I am not saying that to generate money for the profession, I do it for free. I have been through a ton of counseling, individually and group therapy.
The one seeking it out should not wait until it is a last, desperate act. We all need to be proactive in our life. And if the counselor doesn't do standardized tests or evals when you start with him/her, be wary. There has to be a baseline to work from. Also, the counselor should give homework. There are some of my thoughts.
__________________
"My give up, my give up." - Jar Jar Binks
ganon is offline  
Old 01-29-2011, 10:56 AM   #4 (permalink)
Une petite chou
 
noodle's Avatar
 
Location: With All Your Base
Research is really important.

Psychology Today has a great listing where providers post up their credentials, background, areas of expertise, preferred orientation, etc. This can be really helpful.

Word of mouth... ask around. Ask your primary care doctor or any specialists. "Is there anyone you've heard good things about? Or anyone you tend to refer people to for similar issues? Is there anyone you would not recommend for any reason? Why or why not?"

Google search them... I know it may sound silly, but they might have their own website, blurbs from college, dissertations, etc.

Sometimes, too, you just have to give them a call. For instance, I called one guy looking for assistance for a friend and he had an answering machine with his own voice, no receptionist, and he called us back after-hours. That says something to me. Plus, I did drive by his office and liked the location, set-up (private entrances for each therapist). If you don't "click", it's not going to work. If you don't like the office, location, anything else, it can affect the therapeutic alliance.


Oh, I'm working on my PhD in clinical psych. I've been providing therapy or support to kids since 2000 in several different settings.
__________________
Here's how life works: you either get to ask for an apology or you get to shoot people. Not both. House

Quote:
Originally Posted by Plan9
Just realize that you're armed with smart but heavily outnumbered.
The question isn’t who is going to let me; it’s who is going to stop me. Ayn Rand
noodle is offline  
Old 01-29-2011, 11:56 AM   #5 (permalink)
... a sort of licensed troubleshooter.
 
Willravel's Avatar
 
Nice, noodle! That's really impressive. Are you going the PhD at home route, like National University, or are you actually attending a school physically? After I graduated, I intended to go back periodically to school, but I have such trouble finding time.

As for choosing a psychologist, never, ever see people who aren't licensed. When you first call to schedule an appointment, remember to inquire as to the degree the professional holds. If there's no 'counseling' or 'psychology' in the degree, go another route. I've found a few counselors that only have religious degrees practicing and they're not going to provide you with the same level of quality as someone properly educated. If during the initial session you find that you're uncomfortable at all, don't be afraid to ask for a referral. The first session is as much an evaluation of the counselor as you, and if you're uncomfortable, it's going to make the process more difficult and likely longer.

Otherwise, as is said above, ask people for recommendations.
Willravel is offline  
Old 01-29-2011, 12:40 PM   #6 (permalink)
Une petite chou
 
noodle's Avatar
 
Location: With All Your Base
I'm with the only APA-accredited distributed learning program, Will. It requires everything that a traditional program requires (practica, internship, etc.) but the classes can be online, at a national session or self--directed within limits. We're required to have over 350 face-to-face or residency hours in the first two years to ensure that our program is in compliance. I'm finishing up my second year, now. Out of five.

/threadjack

I also agree with Will that you need to check into licensure. And find out what the requirements for calling yourself "licensed" in your state/country are. I know plenty of LCSWs or MSWs under close supervision by licensed individuals that are exceptional counselors and therapists. I'm picky as hell about who I'll do therapy with and how I do therapy with because you know, as a counselor/therapist, who you're going to be able to develop a relationship with and whether your orientation is typically effective with the referring problem. For example, I am existential in orientation, but CBT in intervention. This does not gel well with certain types of disorders and I wouldn't take on those persons because it's not ethically sound. It wouldn't be fair to develop that therapuetic trust with someone knowing that your intervention style is typically not effective. Which is why you need to ask about their orientation, experience, typical methods in therapy.

A brief note on "homework" in therapy... not all modalities use it. Not all intervention styles require it. It doesn't mean that that modality is less effective, just different. People prefer it either way. Some of the "homework" is just to think and pay attention with my kids. They can't handle another "assignment" and I'm not going to cause yet another meltdown at home with a tangible assignment. Just things we'll talk about the next time, etc.

Carry on.
__________________
Here's how life works: you either get to ask for an apology or you get to shoot people. Not both. House

Quote:
Originally Posted by Plan9
Just realize that you're armed with smart but heavily outnumbered.
The question isn’t who is going to let me; it’s who is going to stop me. Ayn Rand
noodle is offline  
Old 01-30-2011, 03:23 PM   #7 (permalink)
Upright
 
I am not sure which forum to post in but I think this one is correct. This thread was written in response to one I had posted in another forum.This is the route I chose regarding a counselor.It would be hard to find a counselor and sneak away from my business for appointments without my wife finding out.I decided to come completely clean with her regarding my needs and wants in marriage and how her sister fills the empty spots.At first she thought I planned to leave her but I reassured her I had no intention of that.I only want both of us to live happy fullfilled lives.She seemed genuinely suprised that we had a problem.I explained to her that I was suprised she was oblivious to the problem(although she was uncomfortable with the relationship I have with her sister).I haven't been sleeping at night,lost 20 lbs. in 2 months(have never been overweight to begin with) and spend waaaaay too much time with her sister.I also told her that our marriage of 22 years has become stagnent.We are so busy that we never concentrate on our relationship and I had no intention of spending the rest of my life this way.She was very receptive and wants to make it better.I talked to her about couples counceling or individual counceling.Both of us will do either if we have too.In the interim,I bought some relationship books that we are both reading.I have finished two of them.My perspective is completely different now.Our communication is much better.She has just started to read the books.I will see how we do,continue to look for a councelor to help us and I am very relieved that she now knows exactly how I feel.I did not want to do counceling without her knowledge.I hope this is a proper path to take as I have never been in this position before.
car guy is offline  
Old 01-30-2011, 03:28 PM   #8 (permalink)
Banned
 
Zeraph's Avatar
 
Location: The Cosmos
Shrug, I've seen 3 now, counselors. None of them helped me. But then my stuff seems more genetic. Plus I have a BA in psych, so I know half the stuff they're already using/talking about. They like to analyze the situation (whatever yours may be) and then tell you to be mindful. Umm ok. Doesn't help me. Thanks.
Zeraph is offline  
Old 01-30-2011, 03:46 PM   #9 (permalink)
... a sort of licensed troubleshooter.
 
Willravel's Avatar
 
Zeraph, how does that make you feel?
Willravel is offline  
Old 01-31-2011, 05:29 AM   #10 (permalink)
Crazy
 
zenda's Avatar
 
Location: London, England
Quote:
Originally Posted by Zeraph View Post
... They like to analyze the situation (whatever yours may be) and then tell you to be mindful. Umm ok. Doesn't help me. Thanks.
Quote:
Originally Posted by Willravel View Post
Zeraph, how does that make you feel?
Reminds me of a variant known as Zen Therapy.
Client lays on a couch and pours our h/er soul
Therapist says ... in a Sigmund-Freud Accent "Und Zen?"



Hi All
Thank you so much for your responses.

CarGuy: Yes! Your thread was the seed for this one. I'm glad things are moving forward in ways which look like they'll be good for all parties. Additionally, as a resource for people seeking counselling, I reckon it is inspiring, and that you've provided a demonstration of the wisdom of Ganon's words:
Quote:
Originally Posted by ganon View Post
......The one seeking it out should not wait until it is a last, desperate act. .....
You've approached all this in a timely fashion and your post also triggered a response in me which is relevant to your other thread, so I'll bump it, copy your post from here, and add my reply. Here, you've introduced two of three further ways this thread may open out.


1: Self help ... read books.
Alone, these may sometimes provide enough of what's needed to resolve the difficulty. Then again, they might resolve the difficulty but not some "underlying" or "outlying" issues, or, possibly, not resolve the difficulty itself; in which case reading them has a positive trouble-shooting step, a robust clarification of what might be needed when seeking outside assistance.

Consulting self-help books can be an important resource and I will start a thread: http://www.tfproject.org/tfp/tilted-...ml#post2868366 and cross link it with this one.

2: Talk with the person/people involved in what you're dealing with.
This can be a brilliant step. There are cases when the people involved putting their heads and hearts together is a resource. There are times when it IS the solution and thereafter, difficulties cease to become problems on account of their getting shared and dealt with. There are other cases when talking with the people involved means the 'problem-solving' becomes a shared activity but not solvable without outside help, in which case the seeking may become a shared project. In either case, early disclosure of concern and intent will reduce likelihood of the other party experiencing a sense of betrayal or sense of being locked-out of being part of the process. Warning: I'f you're in an environment of triple A A-holiness, or one of hot-cold sweet-psycho, then consider bypassing this route and go directly to seek outside assistance.

I will not start a thread about how, when and if to talk about challenging things whilst in a world where some find it difficult to listen. It seems to me that this Tilted Community has not only got this covered, but has been developing it as a core skill since the year dot.


2b: Talk with 'peer support groups.' .. again, inspired by CarGuy's post, but added by me: This has similar considerations to 1 and 2. This may the route to direct solution, however, if not, is a valid step for trouble-shooting, clarifying, and considering appropriate next steps.


3: How to be a chooseable psychotherapist/counsellor
Inspired by Noodles' emphasis on the consellor's role in choosing a client. Thanks, Noodles.

It is one of the foundations for my personal perspective. To be a chooseable psychotherapist/counsellor, requires that the practitioner develop a screening method which includes matching own discipline to what the client presents, and also should include developing a refined sense of one's own personal compatibility-skills, with the assistance of one's supervisor and own personal development-procedures. In practical terms: a counsellor who is well trained in stress-reduction, but who is not yet able to sit in a room with people who are going through full-on panic attacks may well have the precise skills needed, but is not yet ready to apply them with a steady hand in extreme situations.

Quote:
Originally Posted by Jewels
I guess a phone interview might offer some help in choosing but I tend to think it takes at least 2 - 3 visits to know if it'll work. Makes me think that a trial of 4 visits would be nice.
To be chooseable, I include, how to be, as a professional, a resourceful part of the client's search for solution, regardless of whether s/he shall be the one to eventually work with them. I advise that counsellors and psychotherapists of any discipline become adept at the art of referral and of educating the client on 'how to seek' ... this may include general principles such as we are developing in this thread, and also specific advice based on the individual screening/initial interview.

One further consideration, for the attention of service-providers and clients alike: The message "I'm Sorry ..... I Can't Work With You" is one which neither actually WANT to deliver or receive! To the client who has likely already suffered, tried and failed to resolve the problem, the therapist's message "I, with my specific training and experience, am not yet qualified to work with you," can sound like "I CAN'T BE HELPED." To service providers, I say that how to deliver that message alone, is worthy of a two day extended training seminar. To those seeking a provider, I say the more clear and direct you are in interviewing them, the better they will come to know whether they are ready for you, and if they say no, it will partly be because you have been respectfully insisting on a service which will suit you best. The intent of this thread is to resource you as you do that.

Best wishes
__________________
ZENDA

Last edited by zenda; 01-31-2011 at 05:32 PM.. Reason: typo
zenda is offline  
Old 02-07-2011, 06:42 PM   #11 (permalink)
Crazy
 
Location: Canada
I've never explictily chosen a therapist but in the future I plan to be more proactive in this regard.
My first was a young women, only a few years older than I. She was fine - except that she was new and let her own emotions interfer with the process. Basically, I made her cry - in front of me.
Then I saw a psychologist that opened the DSM and tried to diagnose me. I disliked that and didn't go back.
Then the husband and I saw a therapist that specialized in military and PTSD patients. She never remembered what we said - we had to cover the same stuff over and again. She gave us homework and then forgot that she gave it to us. Basically, she was useless - even though on paper she had perfect resume.

It's been kinda hit and miss.
I really support the idea that therapy should be like a mental check up. It's not permant. You go when you are 'sick' and then get better until you get a new 'sickness'.
cierah is offline  
Old 04-24-2011, 04:49 AM   #12 (permalink)
Upright
 
It's interesting how each person has their ideas on how to find and select a therapist. I had to go to the process twice, and it was not easy.
A lot of it is luck, but I wish someone had given me some tips then, so I now have compiled my own list of TOP 5 TIPS on how to find a therapist and TOP 10 TIPS on how to interview your therapist on my own blog, TheSeparateRoom.
For many aspects my tips are similar to others' but I have my quirks - for example I think you can even pick up cues from the therapy room itself, which is not something people will tell you.
TheSeparateRoom is offline  
Old 04-26-2011, 11:42 AM   #13 (permalink)
Insane
 
Location: hampshire
First shrink I was refered to had a very high success rate. This was based on his patients/clients not bothering to go back to him because he was an utter fuckwit. I went into my doctors surgery one day, and a chap I knew was being escorted out by his doctor, who was telling him he had arranged an emergency visit with the same shrink. I just knew it was going to go badly - even phoned the surgery to ask if GP could visit the chap I knew - they declined. After his one session with fuckwit, the patient went home and took an overdose. Fuckwit was called out to me because I had been a victim of a serious crime - he made matters worse.
If I were loking for a counsellor now, I would ask word of mouth - same if I have to change my doctor. Same as I would if my vet retired (he is very good - if I ask for 'ballpark advice' - he will give it to me on human stuff - explains things more clearly.)
chinese crested is offline  
 

Tags
choose

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are On



All times are GMT -8. The time now is 08:13 AM.

Tilted Forum Project

Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2024, vBulletin Solutions, Inc.
Search Engine Optimization by vBSEO 3.6.0 PL2
© 2002-2012 Tilted Forum Project

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360