Finding the Right Therapist for You – Part 2: Your Role as a Client (Written in 2014)

Please check out Part One of this two-part series. This post is about your role and rights as a client. As I said in the previous post: therapy should not be something that is done to you. Rather, it should be something you do together with your therapist. For the sake of self-disclosure, I will remind you of my personal theoretical approach. My approach to therapy mainly comes from a postmodern client-centered approach (with some cognitive therapy interventions). If you remember from the first post, my theoretical approach dictates how I see a client, how I see my role as the therapist and what kind of techniques and methods I will use in therapy. My belief that clients should be active co-participants in a therapeutic relationship is influenced by my theoretical orientation. Basically, keep in mind throughout this post that not all therapists will agree with everything I say here. These are my beliefs and these are the things I stand for.

As clients, I believe that you are the consumer and the therapist is providing a service for you. Therefore, it is important to find a therapist that is best suited to be able to provide the best possible service for you. Finding the right therapist is like finding a partner. There should be chemistry. This potential therapist should work to gain your trust and create a safe space for you. And the both of you should be compatible enough that it is possible for the both of you to effectively work together to accomplish your therapeutic goals. As stated previously, this is the time to pay attention to the therapist’s theoretical orientation. Additionally, there is another factor to focus on: the therapist’s personality. Therapists are humans with all the accompanying strengths and flaws. If the therapist’s personality grates on your nerves or simply does not complement yours, you’re going to be distracted from accomplishing your goals in therapy.

Relatedly, think about coming out to the therapist during the intake process, aka that first meeting where the therapist asks you a lot of questions about your past, your personal life and the reasons why you decided to seek therapy. I know the idea of coming out to a therapist as queer, trans*, polyamourous, kinky, etc. may feel nerve-wracking and scary as all hell, but it is actually very helpful in the long-run. A therapist cannot provide care that is designed for you if they do not know enough about you. It is important to ensure that a therapist has the experience and the skills necessary to help someone from your community or communities. Even if, let’s say, your gender does not play a role in the presenting problem (the problem you are coming to therapy to deal with), if a therapist has negative biases or is ignorant about these issues, their ignorance may block them from being able to provide effective therapy. It would be hard to feel comfortable discussing your phobia of talking on the phone if your therapist somehow blames every problem you’ve ever had on the fact that you are genderqueer. Also it is impossible to provide effective therapy to a client without understanding them in their proper context. How can I possibly fully understand a client’s needs and goals if I don’t understand how being Chinese, queer or an immigrant interacts and influences their perspective? How would I be able to tell the difference between reasonable anxiety that comes from being a person of color in a racist society from a maladaptive anxiety that comes from an anxiety disorder without understanding their subjective reality? That said, your potential therapist does not have to be an expert on everything. That would be impossible. A therapist just needs to be open-minded and empathic. Your potential therapist may not know everything there is to know about being polyamourous and that’s fine. However, this therapist should be willing to do some research. You are not obligated to school your therapist on poly-101. It really is not that hard to go look it up on the internet and it would distract from therapy if your therapist kept asking you to explain how you can possibly date more than one person every other session. A therapist should be able to admit when they are not knowledgeable about something and should be willing to put in some work for the sake of the therapeutic relationship.

So congratulations, you bravely walked into their office, filled out the intake forms and then came back a second time for a therapy session. Damn right, good for you. Now that you have chosen a therapist, don’t feel like you are locked in. Do not be afraid to switch therapists and walk away from one if they are not meeting your needs. I have talked to some people who stick with incompatible therapists for much longer than they should because they feel as if they can’t leave. Your therapist is not your parent. You have power. You are the consumer. You can always find someone else if this therapeutic relationship isn’t working out. That’s not to say that you should just leave if there’s a bump in the road. Therapists are not perfect. I’ve bumped heads with my former therapist a couple times. The sign of a good therapist is their willingness to be flexible and their ability to apologize if they have made a mistake. Another thing to keep in mind is that there is a difference between feeling uncomfortable because you are dealing with your issues in therapy and discomfort because a technique or therapist simply is not working for you. If you are feeling uncomfortable or upset, talk it out with your therapist. They should be willing to talk about what is going on between the two of you in session (aka metacommunication). If a technique isn’t working for you, your therapist should be willing to modify it or scrap it altogether. A therapist that is not willing to be flexible and talk to you as if you are a competent adult isn’t a therapist that I would want personally.

Another thing to keep in mind: a therapist is not supposed to give you advice. It is not their place. A therapist is supposed to help you become independent by, for example, providing you with coping skills, teaching you techniques, and/or making you aware of your own inner strengths. Giving a client advice fosters dependence on the therapist by creating a situation in which the client feels like the therapist has all the answers. The client may not think they can come up with answers to their problems on their own and feel as if they would be incompetent without their therapist. This is not the kind of situation a therapist should encourage. If a client has a problem, an effective therapist would help the client brainstorm ways to resolve the situation on their own so that if they ever find themselves in a similar situation, they will be able to handle it without their therapist’s help. I would be incredibly wary of a therapist who dispenses advice or tries to “fix” your life.

Again, please don’t forget that, as the client, you have agency. The therapist is not your lord and master. They are not better than you. They are not smarter than you. You are the expert on your own life experiences and they are the expert on therapeutic approaches/techniques. You deserve respect for your expertise. In my opinion, a therapeutic relationship should be based on mutual respect, collaboration and trust. Don’t be afraid to stand up for yourself and seek out what is best for you. You are important and you deserve the best.

If you have questions or suggestions for future topics, please feel free to send an email to me at queeringpsychology@gmail.com or tweet to @QueeringPsych on Twitter.

Finding the Right Therapist For You – Part 1: Theoretical Approaches (Written in 2014)

This is part one of a two-part series regarding how to find the right therapist for you. A number of people have been requesting these posts for months and I am finally able to put this up. In this post, I will give very brief and basic descriptions of some of the more prevalent theoretical approaches that therapists work from. Knowing a therapist’s theoretical orientation/approach is incredibly important. All therapists are not the same. I have heard the following statements countless times from people: “My therapist is so awful! This proves therapy just doesn’t work for me!” Then I usually say, “Damn, I’m really sorry your therapist didn’t work out for you. What theoretical approach was your therapist working from?” And then I usually get a blank stare. Theoretical approaches determine how a therapist views you as a client, their role as a therapist, their relationship with you and what techniques they will and will not use. Think of theoretical approaches like a pair of glasses with which your therapist views the world. As a client, I think it is very important for you to know the theoretical orientation of a potential therapist. It is something that you really should consider when you are trying to figure out if a specific therapist is right for you. Do you want to simply focus on your anxiety symptoms? Do you want to talk extensively about your childhood? Do you want to figure out your place in the world? Different approaches focus on different aspects of life and different aspects of human psychology. Finding a therapist whose theoretical approach fits with what you are looking for can help avoid being with a therapist who simply is not compatible with you.

In this post, I will describe each approach by asking the following questions: “How Does This Approach View Clients and/or Humanity?,” “How Does This Approach View the Role of the Therapist?,” “How Does This Approach View the Therapeutic Relationship?,” and “What Are the Overall Goals of This Approach?”. I am only describing some of the many approaches and, as stated earlier, these descriptions are basic. This post is meant to serve as a diving-board for your own research.

Classical Freudian Psychoanalytic Therapy and Modern Psychodynamic Therapy

Psychoanalytic therapy is basically what first pops into everyone’s head when they think about therapy. Sigmund Freud is the founder of psychoanalytic therapy and his work influenced all of modern psychotherapy. Every theory that came after Freud’s was either inspired by or in retaliation of psychoanalytic theory. Psychodynamic therapy is the more modern version of Freud’s classical psychoanalysis.

How Does This Approach View Clients and Humanity?

  • In Freudian psychoanalytic therapy, human behavior is motivated by unconscious and irrational urges. Freud believed that humans are inherently savages that were reined in by society.
  • Human psychology can be split between things we are aware of about ourselves (the conscious) and things we are unaware of (the unconscious). Becoming aware of the unconscious parts of ourselves is the main goal of psychoanalytic therapy because with this awareness comes choice and change.
  • The experiences people have early on in their childhood have a huge impact on who they are as adults.

How Does This Approach View the Role of the Therapist?

  • The therapist is the expert and is the one who will provide the insight. The therapist makes insightful interpretations based on what the client has told them so the client can grow and change. Interpretations include calling attention to and explaining the meaning behind a client’s behavior.
  • In classical Freudian psychoanalysis, the therapist tries to remain anonymous and emotionally detached from clients to encourage transference (a client’s unconscious rehashing of old feelings and reactions from past significant others onto the therapist). The therapist explores these feelings and reactions as a window into the client’s unconscious thoughts and feelings. This approach assumes that the client acts in similar dysfunctional ways with the therapist as they do with other people in their lives.

How Does This Approach View the Therapeutic Relationship?

  • Classical psychoanalytic therapists want to remain emotionally detached from clients in order to provide insights and interpretations. In contrast, modern psychodynamic therapists see a solid and healthy therapeutic relationship as an important part of creating change.
  • The psychodynamic approach views emotional communication with clients as another way to learn more about the client and to build a connection with the client.
  • Sessions are fewer and shorter than traditional Freudian psychoanalysis (nearly every day of the week for many years).
  • In the current psychodynamic approach, clients and therapists sit face-to-face, instead of lying on the couch.

What Are the Overall Goals of This Approach?

  • Making the unconscious conscious (classical Freudian psychoanalysis).
  • Increasing the client’s ability to function in society.
  • Reducing symptoms and resolving internal conflicts.

Adlerian Therapy

How Does This Approach View Clients and Humanity?

  • Human are motivated by their desire to relate to others in society.
  • Humans have agency in their own lives, but their ability to make choices is limited by biological and environmental factors.
  • It is our feelings of inferiority and insecurity that motivate us to become better.
  • Clients are not sick. They are discouraged by life and this discouragement results in dysfunctional behavior.

How Does This Approach View the Role of the Therapist?

  • It is important for a therapist to be able to see the world from the client’s point of view. It is essential that an individual be understood in the full context of their life.
  • The therapist takes on the role of teacher and encourages the client by making them aware of their strengths.
  • The therapist helps the client create goals for therapy.

How Does This Approach View the Therapeutic Relationship?

  • The therapeutic relationship is collaborative, as the client and the therapist work together to create change.

What Are the Overall Goals of This Approach?

  • Encourage discouraged clients.
  • Help clients better understand how they see themselves and the world, which should avoid the repetition of symptoms.

Existential Therapy

How Does This Approach View Clients and Humanity?

  • This approach asks the question: “What does it mean to be human?”
  • Humans are constantly changing in response to the conflicts of life.
  • This approach focuses on how humans deal with being alone in the world and how they handle the anxiety that comes with it.
  • Humans are free to make decisions within the environmental and social limitations of life. Humans may not be able to control exactly what happens to them, but they can control how they deal with it.
  • This freedom comes with responsibility and the choices people make comes with consequences. Trying to avoid one’s responsibilities or trying to avoid making choices results in existential guilt and anxiety.

How Does This Approach View the Role of the Therapist?

  • The therapist helps clients explore their current values to see if these values are benefiting them.
  • The therapist confronts clients with the fact that they must become their own person and not allow others to define who they are. Clients are encouraged to accept responsibility for their actions.

How Does This Approach View the Therapeutic Relationship?

  • The therapeutic relationship is seen as a sample of other relationships in a client’s life.
  • A caring, respectful therapeutic relationship is more important than being an objective, detached professional.

What Are the Overall Goals of This Approach?

  • To help clients see the ways they are not living fully authentic lives full of freedom and responsibility.
  • To help clients face their anxiety and create meaning lives.

Person/Client-Centered Therapy

How Does This Approach View Clients and Humanity?

  • People are trustworthy and are capable of creating constructive change.
  • Clients already have the strengths and assets within them to overcome their problems.

How Does This Approach View the Role of the Therapist?

  • The expertise, clinical knowledge and techniques of the therapist are not as important as the quality of the therapeutic relationship. It is the therapist’s ability to connect with the client as a person and their ability to be present for the client that truly matters.

How Does This Approach View the Therapeutic Relationship?

  • The therapeutic relationship is incredibly essential. A good, solid relationship allows the client to feel safe enough to explore thoughts, feelings and behaviors that they have not been able to express otherwise. This leads to clients being able to become their own healers and create their own positive change.

What Are the Overall Goals of This Approach?

  • Help clients recognize their strengths and become independent so they can handle problems on their own.
  • Create a safe space that will give clients the freedom to explore parts of themselves they may have been too afraid to explore previously so they can live whole and authentic lives.

Gestalt Therapy

How Does This Approach View Clients and Humanity?

  • Clients have the ability to make positive change when they are fully aware of themselves and their environment.
  • Clients have an active role in therapy as they find their own insight.

How Does This Approach View the Role of the Therapist?

  • The therapist is a guide who encourages the client to change by discovering and accepting themselves and their environment.

How Does This Approach View the Therapeutic Relationship?

  • It is a collaborative relationship in which the therapist and client share their experiences in therapy together in the here and now.

What Are the Overall Goals of This Approach?

  • To expand the client’s awareness of themselves and the environment in the current moment because change comes through awareness.
  • To help the client accept themselves.

Cognitive-Behavioral Therapies

Cognitive-Behavioral Therapy is an umbrella term for many different theoretical approaches. All CBTs use techniques/interventions that focus on the cognition (thoughts) and behavior of clients as a way to create positive change. CBTs also tend to be short-term therapies that focus primarily on reducing psychological symptoms. I chose Albert Ellis’s Rational Emotive Behavior Therapy (REBT) and Aaron Beck’s Cognitive Therapy (CT) because they are the most well-known of the CBTs.

How Does This Approach View Clients and Humanity?

  • REBT
    • People are born with the potential for both rational and irrational thinking.
    • They learn irrational beliefs from childhood and actively reinforce these beliefs throughout their lifetime.
    • Blaming the self or the world is the root of emotional problems.
    • Life experiences and events do not cause psychological issues (i.e. anxiety or depression). It is our beliefs about the event that impact our emotions and behaviors. For example, according to REBT, you are not depressed because your father died. You are depressed because of how you perceive your father’s death. Your perception therefore influences how you behave and the emotions you feel. If your perception was changed, you would feel better.
  • CT
    • Humans have core beliefs about themselves and the world that they maintain all throughout their lives. When these beliefs are not accurate, psychological problems occur.

How Does This Approach View the Role of the Therapist?

  • REBT
    • The therapist is the expert and teacher, who models rational behavior for the client.
    • The therapist disputes the client’s irrational thinking and teaches them techniques to independently dispute and replace irrational beliefs with rational ones.
  • CT
    • Therapists encourage clients to turn their core beliefs into hypotheses to be examined. Clients conduct experiments to test the validity of their beliefs.
    • The therapist asks open-ended questions to encourage clients to find their own answers to their problems.

How Does This Approach View the Therapeutic Relationship?

  • REBT
    • According to Albert Ellis, a warm therapeutic relationship is not necessary for success and can actually be harmful to the client. He believed that it could cause clients to become dependent on the therapist.
  • CT
    • A collaborative, empathic relationship is incredibly important, but it is not the only thing needed to create change. Techniques are needed too.

What Are the Overall Goals of This Approach?

  • REBT
    • Teaching clients to accept themselves, flaws and all.
    • Teaching clients how to change dysfunctional thoughts, emotions and behaviors into functional ones.
  • CT
    • Helping clients analyze their core beliefs and change them if necessary.

Postmodern Therapeutic Approaches

Postmodern theory is a reaction to modernism, which believes that there is one true, objective reality that can be studied and known through the scientific method. Theoretical approaches based on modernist thinking are founded in the idea that people who seek therapy have deviated from some objective norm and need to be put back on the right path. Postmodern theory disagrees, believing that there are multiple valid and subjective realities. Each person lives in their own reality that is influenced by the time, place and society in which they live. There is no single objective truth and, following that, there is no single right way to live.

I will describe two postmodern therapeutic approaches: Steve de Shazer and Insoo Kim Berg’s Solution-Focused Brief Therapy (SFBT) and Michael White and David Epston’s Narrative Therapy.

How Does This Approach View Clients and Humanity?

  • Both postmodern approaches agree that clients are the experts of their own lives.
  • SFBT
    • SFBT believes that clients already have the strengths within them to resolve their problems, but sometimes people lose their way.
    • Clients are not reduced to a diagnostic label.
  • Narrative Therapy
    • An individual’s life is made of up stories, regarding how they perceive themselves and the world. These narratives dictate how clients live their lives and shape their realities. Psychological problems can come from the internalization of the narratives from the dominant culture, which takes away the personal agency of the individual. Modernist theoretical approaches would encourage clients to conform to the dominant narrative or simply help them to cope with the socially constructed “truth” imposed upon them by society.
    • Clients are not reduced to a diagnostic label.

How Does This Approach View the Role of the Therapist?

  • SFBT
    • The therapist helps the client become aware of their strengths so they can use these strengths to create their own solutions.
    • The therapist guides and encourages the client towards change, but does not tell the client what to change.
  • Narrative Therapy
    • The therapist has an active role, guiding the client toward change.
    • The therapist helps the client detach themselves from the dominant narratives they have internalized so they can create their own stories.
    • The therapist asks questions to assist clients in coming up with their own answers.
    • The therapist helps the client work through their problems and helps them take steps to solve them.

How Does This Approach View the Therapeutic Relationship?

  • SFBT
    • The relationship is very collaborative. Therapists are not the sole experts in the therapeutic relationship. Clients are the experts in their own lives and therapists are experts in the therapeutic process. Together, they both bring their sources of expertise to the table.
    • The therapist strives to create a relationship based on mutual respect and open communication.
    • The client sets the tone of therapy and of the relationship.
  • Narrative Therapy
    • The client and the therapist work together as experts to solve the client’s problems.

What Are the Overall Goals of This Approach?

  • SFBT
    • Goals are specific to each client and are created collaboratively by the client and therapist.
    • Goals are small and well-defined so clients will not become discouraged.
  • Narrative Therapy
    • To make clients aware of how the dominant culture’s narratives impact their lives.
    • To invite clients to create their own stories and take back their agency.

Integrating Approaches

Some therapists (myself included) prefer an eclectic approach to therapy. Meaning they combine aspects of theoretical approaches and techniques in order to fit who they are as therapists and to do what is best for their clients. Self-disclosure time: I personally work from a postmodern person-centered theoretical approach with some cognitive therapy interventions. Meaning, the way I see the world, my clients and my role as a therapist is influenced by post-modern and person-centered approaches. That said, I also see the value of some of the techniques from cognitive therapy in cases of anxiety, depression and phobias, for example. My specific theoretical orientation gives me a firm foundation to work from while also providing me with enough flexibility to work with clients as complex individuals and not as diagnoses. Integrating theoretical approaches can go wrong if not done properly. A therapist cannot just combine any theoretical approach and technique at random. The approaches and techniques must complement each other. If they conflict at their roots, the therapist does not have a proper clinical compass and is basically a ship lost at sea. No one would want that person to be their therapist.

The point of this post is to show you that all therapists are not alike. Each therapist works from a theoretical framework that seriously determines how they view you as the client, how they view themselves as the therapist and the techniques/interventions they will use. Do they see you, the client, as an equal partner-in-crime, as a student or as a patient who needs their insight? Do not hesitate to ask a potential therapist what their theoretical framework/orientation is. And then do a little research to figure out how this framework dictates the way they do therapy. This may be my personal approach showing, but do not think of therapy as something being done to you. Think of therapy as something you do with your therapist. You have power. You have agency. And I like to think that therapy works the best when both the client and the therapist work towards a common goal. Part two of this series will discuss your rights as a client.