Finding Effective Help - Part 1

Back before I was a therapist, choosing a therapist felt like torture. Now that I know how it all works, sadly, it’s not much better. “How do I choose a therapist” is one of the most common questions people ask me now that I am one.

There are a ton of variables: do I want to choose a psychologist, a counselor, a marriage and family therapist, or a clinical social worker? Should I look for someone who uses EMDR, CBT, REBT, DBT, Adlerian, psychodynamic, gestalt, or person centered? Should I look for someone with a specialty in sex therapy, or addiction, or personality disorders, or eating disorders, or depression, or anxiety? Do I need individual, couples, group, or family therapy?

The short answer (and way oversimplified) is that it probably doesn’t matter. What?! What a frustrating and over-simplified answer. I know. But here’s why I say that.

There is no scientific evidence that psychologists or counselors or any particular licence results in better client outcomes; and believe me, they’ve looked for it. Many mental health professionals want to believe that their training/profession/schooling provides something unique and better, but there is no evidence to support this.

Further, while the evidence is clear that therapy is useful and has long-term positive effects on mental health, the search to find a *type*, theory, or modality of therapy that is more effective than others has also been fruitless so far. Certainly it’s easy to find studies that show EMDR is effective (or “evidence based”), but studies do not show that EMDR is consistently more effective than person-centered or CBT. One caveat to this is that there is some evidence that some techniques may be better for some types of specific issues. For instance EMDR seems to be quite effective for PTSD, and DBT seems to be quite effective for personality disorders, but the evidence seems to indicate that these differences are generally small. Again, outcomes seem to be less about specific techniques being more effective generally, and more about specific modalities being a good fit for the client and for the therapist. Does the modality feel good, and work well within their beliefs and worldview?

While it certainly can be helpful (and sometimes important) to seek out someone who has a particular knowledge or specialization in sex therapy or eating disorders... simply finding someone who has knowledge about the issue, or a certification in a specialty is no indication that they will be a good therapist for you.

And the question of individual, couple, family, or group is mostly a matter of personal preferences and circumstance.

Gah! Frustrating right?!

This frustration boils down to one intractable problem: “a good therapist for me” is really about a mysterious quality the researchers like to call “Therapeutic Alliance” and that term boils down to a bunch of squishy questions like “do I feel heard and seen?” “do I feel like my therapist likes/cares about me?” “do I feel safe?” “do I like my therapist?”. It’s just so hard to quantify and measure. And “Therapeutic Alliance” can be difficult to figure out even as you are sitting in the room with this person, especially if part of your mental health struggles include being a people pleaser, being overly submissive to authority figures, or feeling like you are supposed to like everyone.

And just to complicate things even further, no therapist is right for everyone. A therapist who would drive you crazy could be a great fit for your partner or your mother or a friend.

Stay tuned for more thoughts on this topic in Part 2.

Lisa Butterworth, LPC, NCC has a masters degree in Clinical Mental Health Counseling from Idaho State University, primarily working with issues of relational health, faith transitions and journeys, women's issues and sexuality. ​She is the founder of the popular Feminist Mormon Housewives website and support group.

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