Finding Effective Help - Part 2
In meta-studies on the factors that influence the effectiveness of therapy outcomes, the numbers fall out approximately like this:
40% client factors (what is going on in your life)
35% therapeutic alliance
15% placebo effect/client belief (a really powerful mysterious tool)
10% modality or techniques (do they fit)
So having completely muddied the waters, what next? How do I find a “good fit” or a strong “therapeutic alliance”? And the short answer again is, it’s a roll of the dice. You have to just pick someone, go to the session and see if it feels like a good fit.
It’s great to get recommendations. I refer to other therapists all the time, and I hope this is helpful. I am mostly recommending therapists I work with on a professional level, rather than therapists I have personal experience being therapied by (I’ve had five, only three of which I would recommend). I would strongly advise getting recommendations from friends or family (unless your family and friends are the types to shame getting therapy). Or ask for recommendations from facebook or twitter or however you social media (unless that feels too exposed). It’s even totally valid to just do a google search or randomly point your finger at a name on your insurance provider’s website. Maybe you want to choose a prominent specialist; valid, probably expensive, but if you can afford it, valid. Still no guarantee that they will be a good fit, although they probably do have some good skills and knowledge to get them where they are. Maybe you are on a fixed income with no insurance. Many localities have clinics that provide no-cost or low-cost counseling (often from interns or students). Check local universities with therapy programs, or see if your locality has a directory of low-cost health services (like the Self-Rescue Manual). And once you’re in the office how do you know if it’s a good fit? Ask yourself the same questions I mention above. Do you feel seen and heard? Do you feel safe? Do you like this person, and feel they like you? Perhaps just ask does this feel like a good fit? Does the method they are using seem useful? Sometimes it will be clear on the first visit that this is a bad fit: don’t schedule a second appointment. We are professionals and we know that we can’t be a fit for everyone (if a professional can’t handle that, that’s just a stronger indication that it’s time to cut ties). You can be direct about it and provide the therapist with feedback about what didn’t work for you, or you can just forget to call back for a second appointment. Sometimes you may have seen a therapist for a while before you realize that you aren’t getting what you need, or perhaps you’ve grown beyond what they can do for you, or you just want to try something different. Maybe you feel like you reached your goals. And sometimes therapy is hard and you know it’s pushing your buttons and it’s probably good for you, but you’re not sure you want to continue. So many feelings. These too, are questions that you should be able to discuss with your therapist. A good therapist can help you to work through these feelings. If instead they become defensive or issue dire warnings about seeking therapy elsewhere, that’s a good sign that it may be time to go. Again, you can be direct about why you are leaving (I always LOVE IT when clients share feedback with me). If you’re not ready to do assertiveness, you can conveniently forget to schedule your next appointment. I wish you luck in your search for a good therapist for you.
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.