Wednesday, January 25, 2012


By: Randy Walton, Ph.D.

Finding a Therapist - Selecting a therapist
When you call a prospective therapist, get the basic questions regarding fees, insurance, location, scheduling, and how soon you can be seen, out of the way with the receptionist or office manager if there is one. You can also ask to schedule a five minute phone call with the therapist or counselor to discuss your needs and interests, and determine whether it is likely to be a good “fit”. An unwillingness to give you five minutes to ensure a good fit should cause you to be skeptical about whether that therapist is right for you. Respect the therapist's time and keep the phone call to five minutes or less.  
If you speak with a therapist on the phone, it is likely that the therapist will ask you about the problem or concern that prompted you to consider therapy. This is a legitimate question to help him or her answer your questions, but you do not need to go into detail on the phone. Remember, the goal of this phone call is to get an idea about whether this therapist will be a good fit for you.  Briefly describe the concern, problem, or goal you would like to address in therapy.  Don’t worry about trying to diagnose, offer your interpretation of the problem, or provide a detailed history. Describe what prompted you to consider therapy at this time and/or what you would like to change.
You can also ask some of the following questions or others you think relevant.
  • Do you have experience working with people who have concerns and goals similar to mine? If so, have you had success with them?
  • What therapeutic approaches do you use?
  • How many sessions do you average per client?
  • Do you monitor progress and outcomes? Tell me about it.
  • What do you do if a particular therapeutic approach is not helping?
When talking with a prospective therapist listen for answers that reflect an emphasis on a good therapeutic relationship and the importance of your participation. Listen for an emphasis on client resources, strengths, and capabilities; these will be the basis on which solutions and positive changes will be built. Listen for answers that reflect a therapist’s flexibility in adapting or changing treatment approaches based on whether you are experiencing improvement or not. Compare the therapist’s answers with your own views of how change occurs. If the therapist identifies with a particular therapeutic approach, philosophy, or orientation, consider whether it is consistent with your theory of change. If it is different but you still think it has some merit, try it out. Your input and participation in therapy is essential in getting the results you want.
Over the past fifteen years there has been an increased emphasis on what are called “evidence based treatments”. These are specific therapy approaches for specific problems or disorders; they are called “evidence –based” because they typically have at least two research studies supporting their effectiveness for the treatment of the specific problem or disorder. Consequently, these therapeutic approaches or treatments have sometimes been recommended as the treatment of choice for particular problems or disorders. However, just as medications effective with certain disorders are not effective for everyone with that disorder, the use of specific evidence based treatments is recognized as just one factor associated with positive therapy outcomes.
In an August, 2005 policy statement, the American Psychological Association (APA) adopted a less rigid perspective which incorporates decades of therapy outcome research regarding effective therapy practice. This APA statement emphasizes that therapy services which “have a high probability of achieving the goals of treatment” involve integration of the best available research [e.g., evidence based treatments] with the therapist’s clinical expertise and the client’s characteristics, preferences, and response to treatment. The APA further indicates that “ongoing monitoring of patient progress and adjustment of treatment as needed are essential…”1 You should be skeptical if you encounter a therapist who emphasizes one approach to therapy with little flexibility or willingness to consider other approaches. Research demonstrates that the most effective therapists adapt their approach to their client, and whether the client is experiencing and reporting improvement or not. The most effective therapists do not try to force the client to fit their approach, or persist in using an approach that is not helping.
If you decide on a therapist who seems like a good match, schedule an appointment and give it a try. If you meet with the therapist and feel comfortable with their style, approach, and genuine interest in you, keep working with them. If you meet with a therapist and do not feel it is a good match, talk with the therapist about your concerns and what might be more helpful to you. If the therapist does not seem receptive to your questions and feedback, consider a different therapist. Finally, not all problems are most effectively addressed with a therapist, or by therapy alone. Some problems can be better addressed through other means, or by services in addition to therapy, e.g., support groups, case management services, or medication. Therapists who are willing to consider alternative options or “wraparound” services are more likely to be effective because they are likely to be more focused on what is right for you. 
Finally, keep in mind that research on therapy outcomes indicate that when therapy is successful, positive changes begin to occur early in the therapy process, e.g., the first 4-5 sessions. This has been found to be true whether the therapy is short-term or long-term. Everyone is different, but if you are not beginning to experience significant change by about the 4th or 5th session, discuss this with your therapist. Ask for his or her ideas about what is occurring, and whether a different approach or different therapist might be useful.  Remember, you are paying the therapist to work with you, and your input and participation in the process is essential.
1American Psychological Association Statement: Policy Statement on Evidence-Based Practice in Psychology (August, 2005)

Randy Walton, Ph.D., is a Licensed Clinical Psychologist who works full-time as Lead Clinician at Colonial Behavioral Health, and conducts a part-time private practice ( in the Williamsburg, Virginia area. He has been in full-time clinical practice for over 25 years.