"Help: I need a great therapist!".
Article Type: Column
Subject: Psychotherapists (Practice)
Psychotherapists (Personal narratives)
Author: Reidenberg, Daniel J.
Pub Date: 06/22/2009
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2009 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Summer, 2009 Source Volume: 12 Source Issue: 2
Topic: Event Code: 200 Management dynamics
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 218313997

It was going to be another typical presentation and panel discussion. At a suburban, middle class community parent night, people came to listen and to learn. The key note presentation this particular night was on anxiety and stress in students--specifically teens--a burning topic in many parent's minds today. Sitting in the audience were 250 parents, eager to hear how to recognize if their child's stress was "normal" or "abnormal." Desperate to hear from a parenting consultant on how to help reduce stress for today's teens, the parents listened to the presenter as she advised them to do the following: limit television and computer time, eat family meals together, keep open lines of communication about "tough" topics, and spend quality time together. It seemed all too basic to me, and (my opinion), by the looks in the parents eyes, to them as well. I could see the questions in their eyes and the thoughts they had: But how do I know if my child is more stressed than other teens? Where's the line that crosses between normal teenage angst and abnormal, diagnosable, and treatment-required anxiety and depression? How do I keep my kid from drugs, suicide, and gangs? I didn't hear many answers, rather more of what was in the speaker's book (which she was trying to sell that night--none sold I'm told) than any practical advice for parents.

After a 5-minute break we re-grouped and the panelists (I was one of them) began the last part of the night. A school counselor, district supervisor, the speaker, and I gave brief introductions and commentary on anxiety and depression in adolescents. During the introductions, audience members were given small pieces of paper on which they could write questions to be submitted to the panel. The only doctor on the stage and an expert on suicide, I fully expected a question about self-injurious behavior, suicide (and attempts), or medications. However, much to my surprise and delight, the first question I received was one that made my night and became the focus of this article: "What are the keys in finding a great therapist (for our teen) vs. a good one? What should we look for in a professional? PhD, Master's, MD, etc.?" Wow. At that moment, the night had a new meaning for me. What a great question; it is important for all of the parents but also for the members of the American Psychotherapy Association. In my mind, this question also presented an interesting look into the eyes and minds of our clients, or parents of our clients.

For the sake of this article, let me put aside the research on what makes a good therapist and share with you my answer to the question and reason why I answered as I did. Let me also indulge you to broaden the question to all clients, not just teens.

My response: "This is a great question, and my answer might surprise you. I don't think yon need to find a great therapist. You need to find a good therapist." It seemed as though they were a bit stunned by my answer. I said, "Find a therapist that you can trust, that your child will talk with and one that is good--good enough." I then suggested that the parents "talk with others they know and trust to get a personal referral; talk with the school to find out if they have worked with someone before and how that went for the student and family; be open to trying different therapists until you find the right fit; and most importantly, know that sometimes good is good enough." A parent then said, "But what about their degree? Does that matter?" My response was, again, probably surprising to the audience: "A degree is about years of education and training. Some of the best therapists I know don't have an MD (the most years of schooling). I know other therapists that have a doctorate degree (PHD, PsyD), and some are 'bad' and some are 'good.' You shouldn't base who is great or good on a degree."

Why in the world would I have said these things? Shouldn't I have told them to find the person with the highest degree attainable, the most letters after their name, the longest resume/vita of experience, publications, presentations, and affiliations? Why didn't I suggest they seek someone with the most years of experience, the largest practice, the longest waiting list? Maybe they could tell who was a great therapist by how plush or fancy the office was since that therapist obviously made good money and must have a lot of clients or referrals? Maybe I missed the point, and it should be the person with the best ad in the phone book, the best Web site, or brochures? Of course there are also some states/ health insurance plans with "rankings" of their providers; surely they could use this and find the person with the highest ratings and that person would be a great therapist. Maybe, and maybe not.

In my mind, while all of the "qualifications, designations, or signifiers" I listed in the previous paragraph might mean something, do they really? How can one be sure? What would make you want to bring your teen to someone with one or several of these credentials? Would you believe that you could get in to the one person in your community with the most of these? What if you could find that one person who has the most and is "the best"? How long do you think you'd have to wait for an opening? Could you afford it? If you couldn't wait or couldn't afford it, would you feel you have to settle for 2nd best (or worse) for your child? If so, now what? Do you go into another provider with lower expectations because they are "not a great" therapist by whatever markers you've heard or decided need to exist to determine greatness? How might that impact you and/or your child's outcome or success in therapy?

I don't believe it. I don't think people should be searching for a great therapist. People need to find a good therapist, and that, in my opinion, is, at the most basic level, a therapist that they can work with and connect with, one that makes sense to them and that they can believe. This allows them to be vulnerable enough to do the work necessary to change whatever has led them to seeking help in the first place. Would you buy the argument that a great therapist might have the most years of experience but not be able to relate to your child? It just could be that a newly graduated therapist could turn out to be a great therapist for you and your child but that same person might not be recognized or seen in the community as a great therapist (yet). Don't forget: Everyone starts somewhere! What about the argument that they have the longest waiting list? How's this for my position: What good is someone that you can't see? How "great" are they to you? They are not, which returns me to my belief that a good therapist is really all you need. As a matter of fact, I believe the more good you can find the more likely you are to find a proper match, resulting in better outcomes. And what might have been a great therapist for one person might not at all be a good therapist for someone else.

So now what? If I've done nothing more than make you wonder about this and maybe even how others (potential sources of referrals) might describe you, think about this: If I asked you to describe yourself to a client, would you tell them you were "a great therapist?" Quite possibly some marketing experts would say you should, but I would venture a guess that you would be more likely to want to have others describe you as a great therapist vs. you describing yourself that way. And even if you do feel that way about yourself as a practitioner, could all of us really be that great? The answer is, of course, obviously not.

With that being said, I came up with my own personal list of tips for being a good therapist.

1. Be a good person. Remember you are just as human as your clients are. The better (I didn't say best!) a person you are, the better (again, I didn't say best or great) therapist you will be.

2. Be a responsible therapist. Practice professionally and within your areas of competence. Say "I don't know" when you don't, and be able to feel comfortable making referrals and/or getting consultation when you need to. You're not invincible, and if you think you are, you're not a good therapist.

3. Be an ethical therapist. There are few things more important than this as a basis for being a good therapist.

4. Give your clients 100% of who you are in everything you do for them (in session, charting, etc.). If you give less than this, your clients will know (as will people they tell about you). If you don't give 100% in other parts of your work for your clients (e.g., charting), I can promise that this will someday rear its ugly head.

5. Do not work in isolation. Your clients need to know you're not an island unto yourself, but that you are connected to others in the field.

6. Keep learning. New ideas are good to know and will help your clients believe that you are staying current and providing them good, quality care.

7. Never forget that you see your client in isolation (or in an isolated view), but they are part of a larger world that you don't know and/or have any impact on. Therefore, be aware of all the things you recommend and the fallout outside of your four walls that might occur for your client.

8. Make sure your clients know that your job is limited to what they give you to work with. You are not a mind-reader or miracle worker and if you are "that great" they may expect that of you!

9. Be a good role model. Live and practice the way you are telling your clients to--it will show, trust me.

10. Always remember that no client would be in your office if things in their life were just fine.

I believe the more you can practice these tips, the more you will be known as a good therapist, and some may even call you a great therapist!

One last note. I said earlier that this might give us a window into what clients are thinking about or considering when searching for a therapist. If one person is thinking this, you can be assured others are as well. What does that mean for us in our field? I think that, unless we are all going to start thinking we're all great therapists in all situations to all clients, we need to do our part to help the public understand that what they need to do is reframe the question (search): "How can I find a good therapist that can help me (my child)?" After all, isn't that the best outcome for everyone?

Daniel J. Reidenberg, PsyD, FAPA, CRS, MTAPA, is the chair of American Psychotherapy Association's Executive Advisory Board and has been a member since 1997. He is a Fellow and Master Therapist of the American Psychotherapy Association, the chair of the Certified Relationship Specialist, CRS, Advisory Board, and executive director of Suicide Awareness Voices of Education (SAVE) in Minneapolis, Minnesota. Contact him with your thoughts at dreidenberg@save.org.
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