A Client's Guide to
Hiring a psychotherapist can be a daunting task and the need to find someone often occurs at times of di-stress when we are least able to choose wisely. Deferring to the power of an expert is tempting but it is wiser to be adequately informed about what to expect from the relationship with your psychotherapist and what sort of commitment it requires from you.
Starting psychotherapy means above all beginning a relationship. Unfortunately, qualifications provide little guarantee that a psychotherapist will be right for you. This is because the breadth and depth of their lived experience matters as much as their technical and academic knowledge, And what matters most is their ability to get into rapport with you and your concerns. If you are someone who presently meets with a counsellor or psychotherapist, or who is contemplating it, these guidelines are intended to help you both with your initial choice of practitioner and with getting the best from the psychotherapy relationship.
Clarify your intentions:
Use your practitioner to reality test what you want out of your time together. In this sense, 'paths', and having maps and nourishment for the 'journey' may be more relevant than destinations.
That counselling/psychotherapy meets a wide range of needs in many different ways For example, there is fire-fighting/rescue work, helping you get through tomorrow/next week; recovery work, letting go of redundant learning; and flourishing work, re-inventing yourself, or creating a new piece of life.
That your practitioner is not there to meet your needs but to help you identify your needs and help you find ways of meeting them yourself.
To check out your practitioner's life experiences that may be relevant to your issues. Do they have children? Are they in a relationship? Have they been divorced? Been in business? Worked on an assembly line? had a job in a large corporation?
To ask your practitioner where, and how, and with whom, they trained. Remember in listening to their response, that one of the functions of a psychotherapist or counsellor is to model being fully human. Zest, vigour, love, delight, wit and even vulnerability may matter more to you in the long run than their PhD's, psychology degrees or other formal qualifications, including psychotherapy and counsellor trainings.
Questions to ask yourself:
- Is there a clearly defined contract between you for the work you are doing?
- Is the work you do with your practitioner being driven by your needs?
- Is the work confined to your sessions, with no homework between them? The effectiveness of the work is dramatically improved by you carrying it into your life. And in the long run it costs less.
- Does your practitioner encourage you to take yourself seriously? To regard yourself as a project?
- Does your practitioner hold a good balance between supporting you and challenging you?
- Does your practitioner negotiate directly and openly?
- Does the room you meet in unnecessarily limit the kind of work you could do together? Is it full of valuables, or so cramped, small or public, that you wouldn't feel able make loud sounds or vigorous body movements?
Good practice comes in a wide range of varieties. There are lots of different styles of psychotherapy and counselling, probably hundreds. Some involve physical contact, many don't. Some are primarily verbal, other styles, favour imagination and play-acting. These differences are often more a matter of starting points rather than fundamental differences.
It is good to remember that, while life experiences are widely divergent, our bodyminds are strikingly similar. Because of this, therapies or counselling that are effective in helping us for example, deal with grief and anger, or fear, seem likely to share many common elements.
Pointers to good practice:
- Your practitioner has good rapport, by which I mean s/he has good attention, listens well, responds warmly and with feeling, where appropriate.
- Your practitioner acknowledges values a variety of ways of working with clients. S/he presents from time to time an array of models, maps, schemes, or other nourishment for the work you do together.
- Your practitioner is careful to distinguish between propositions, suggestions, advice, recommendations, and their opinions, whether personal or as a practitioner.
- Your practitioner holds a balance between psychological, political and structural origins of the issues you bring to the sessions.
- Your practitioner is actively engaged in helping you take charge of your work in, and between, the sessions. (Essential for primal and other deep/advanced levels of work).
- Your practitioner holds that healing and change come less from the therapist than from you as a client; and more than either from the rapport between the two.
- Your practitioner will be open to objections from you and will be able to admit to any mistakes they happen to make.
Some basics of good practice:
Expect your practitioner to be scrupulous about the confidentiality of what goes on between you. This confidentiality extends to any supervisor with whom s/he discusses your concerns. (Perhaps the only exception would be a situation where your practitioner believes that a third party may be in danger)
Expect clear agreements about:
- How much you have to pay.
- how long the sessions are.
- arrangements about cancellations.
- whether and when you can phone up.
- how many sessions you may need.
Be sceptical of:
- A practitioner who creates entanglements between you around agreements/disagreements, session etiquette, arrangements/bookings/payment etc. which then have to be unravelled in the sessions.
- A practitioner who doesn't openly and directly negotiate changes in the contract between you, including implicit contracts based on custom and practice. Especially if this involves physical contact.
- A practitioner who constantly talks in medically related language, i.e. about health, sickness, pathology, cure, normality etc.
- Too much analysis of causes and origins.
- No analysis of causes and origins, no maps of the territory you are exploring.
- A practitioner who psychologises everything, including the relationship between you and him/her, particularly when you express dissatisfaction with lack of progress/development/change.
- A practitioner who politicises everything, so that all your difficulties are ascribed to capitalism, 'men', 'women', 'the state' etc.
- A practitioner who too often pours out the riches of their knowledge and skill, so that you feel swamped.
- A lack of self-disclosure in your practitioner.
- A practitioner who is rigid about cancellations, postponements, or changes to session times when there is adequate notice of the alteration.
- A practitioner who often seeks to tell you what to do outside the meetings through advice, recommendations, or judgements.
- A practitioner who never offers advice, suggestions, recommendations, or opinions.
- A practitioner who constantly directs all your work towards catharsis and who is unwilling to help you with planning, problem-solving etc.
- A practitioner who seem unwilling, or unable, to handle your deepest/strongest emotions.
- A practitioner who seems unwilling, or unable, to openly discuss/deal with, sexuality.
- A practitioner who seems to rely a lot on authourity in a way that invites you to defer to their expertise.
- A practitioner who seems to lack spiritual and/or political perspective.
- A practitioner who seems unable to demonstrate the qualities that s/he recommends.
- A practitioner who seeks any kind of contact outside of the meetings, more specifically one who offers or accepts sexual contact.
If you feel mistreated:
If you can, raise your concern right away.
Even if your concern is unclear, or has been growing gradually over a period, don't let this stop you from raising it.
Leave the relationship, and find another practitioner. If you can, say why you are leaving.
Keep in mind that an actual present time grievance may also carry an emotional overlay from some similar episode from your past.
If raising your grievance isn't given a hearing, or there isn't enough of a recognition of your concern from the practitioner, ask to make contact with their supervisor, or practitioner support group.
Except where otherwise indicated, these screens are maintained and © 1995,1996,1997,1998,1999,2000, 2002, 2003,2004 Denis Postle. All rights reserved. Last updated 30th May 2004