“Get some help.”
Some nagging voice in (or outside of your head, very annoyingly) may have said these words to you. I think these are fantastically important words, but then again I’m a therapist, and then again, I’ve been helped myself, lots, by therapy.
For reasons that people might or might not understand, they’re not content with the way their life is working. They’re not happy with their relationships, their work, or themselves. Or maybe they’re trying to work through a big decision, or they feel stuck, or they want to quit smoking. There are all sorts of reasons we seek help.
And good therapy does really help. It can even be life-changing. When client and therapist are working well together, they form a real relationship, bigger than the sum of two parts, with the potential for all kinds of positive outcomes - for both of them.
So, what is good therapy? And how do you know it’s good? And how do you know someone is not worth your time and money?
The best way to find a good therapist is a recommendation from a doctor, from another healthcare provider, or a personal connection through friends and family. Failing that, online therapy is an excellent way to find and research the right person to team up with.
There is a conundrum, however, because at the same time that the need for therapy has exploded in these post-covid, turbulent times, the number of therapists out there has exploded too, as well as therapeutic methods and training. When people are feeling anxious, depressed or burnt out, among other problems, the whole task of finding a good therapist to see them through tough times, can be just another burden on their minds.
Ultimately, good therapy is about YOU. It’s an enquiry into you and your life that’s facilitated and witnessed by your therapist in a committed, and real relationship (ie it’s not transactional; you’re paying your therapist, sure, but they’ve put in an awful lot of time and money into deepening their helping skills, and it’s an honest exchange of commitment).
So, therapy is also about what your therapist brings out in you. Here are some questions to ask, and ideas to think about. (Read Part Two for how to think of your own approach to therapy, and Part Three to help you recognise the signs of therapists you should avoid!)
Who are they?
Where did they do their training?
What kind of training?
What kind of qualifications do they have?
How much experience?
What kind of references can they give you?
What kind of continuing education are they involved in?
Do you like them?
So - where did they do their training?
Let me start by saying that there are excellent therapists out there who have had only a moderate degree of training; and there are terrible therapists with PhDs.
In general, though, you should look for someone with at least a diploma in a modality that you like the sound of, from a reputable governing body that you can research a bit. Of course, your therapist should have some experience, and a good reputation.
When I say, what kind of training?... I mean, what’s the framework for their methods? We tend to think, therapists are therapists, but that’s really not the case. There’s everything from psychoanalysis (the Freudian thing) to Person-Centred Therapy (How do you feel about that?) to Internal Family Systems Therapy (how different parts of you and roles you play are interacting with each other), to Cognitive Behavioural Therapy (CBT). And so many more conceptual frameworks and methods and healing tools that are, to various degrees, developed and researched. (Narrative Therapy; Attachment Theory; Archetypes, Biofeedback etc.)
[A note on CBT: the main reason that there is so much CBT out there is that it’s the only form of talk therapy that can be measured in short-ish randomised controlled trials. Resulting measurements are turned into data that can be compared to before-therapy and after-therapy. CBT is therefore ‘evidence based’, whereas most other forms of therapy haven’t been broken down into numbers in the same way. However: the fact is, almost all forms of therapy are C, B and T. On some level all modalities look at your conditioning, your emotions, your beliefs, and the patterns of behaviour that come from them.]
There are loads of somewhat alternative but well researched and respected therapies too, like hypnotherapy and EMDR, Mindfulness and other forms of taught meditation, and acupuncture. These have a strong evidence base, ie, many studies over many years establishing positive psychological outcomes.
EFT, and TAT, the modalities I’ve trained in, and other “energy therapies” that use a mind-body-spirit approach, have a strong base of scientific evidence behind them. They’re not at all flaky. But: your therapist should be able to discuss them with you in a way that gives you confidence, both in the therapy and in the fact that they know what they’re doing.
Regarding my own approaches working with patients, I’ve experienced a lot of eye-rolling and scoffing when I try to explain what I do and why. But having used these more holistic energy techniques on myself and clients for many years, together with classical biopsychosocial training, I am pretty confident that they not only help, they can speed up and integrate positive effects better than any talk-only therapy. It’s a both-and thing; talk therapy works, but talk therapy with the addition of energy therapy can make the therapeutic relationship a real launchpad to change, in an easy, no-struggle, and even exciting way.
And by the way, it’s not all woo-woo in a session with an energy therapist. Sometimes people just need to tell their story. They need their story to be heard, and to matter. Maybe they’ve never been able to do that before. That’s really, really important. They don’t need or want to be fixed, they just want to be seen. So therapy should be led by you. If you want to just talk, unload, and reflect, that’s exactly what you should be doing.
When I mention qualifications and references, it’s good for all of us to be reminded of the interconnected way that therapy works, and very importantly, how this relates to ethics. A good therapist will not only be open about their methods, but they will want to provide you with information on the ethical framework they follow, not just to help you, but to protect you. Are they registered somewhere? Do they offer a consent form that describes their methods? Do they offer you a free, short-ish conversation before any money exchanges hands, to see if you want to work together? Those are great ways of offering you confidence.
Another is a treatment plan, another is some early clear demonstration of empathy, ie really listening to you and being flexible, without coming up with ways to “fix” you.
They should also let you lead the process, and not impose anything on you; they should not be defensive or offensive, they should be genuinely interested in you, not in selling you a package of sessions (a dead giveaway).
In your first session, the two of you should come up with at least a rough treatment plan (ie do you just want help quitting smoking, or help making a big decision, or do you want to deal with some deeper issues?).
Also, this is huge: They should know when they’re out of their depth or not the right therapist for you, and should be happy to refer you to someone else; they should explain this to you in ways that don’t make you feel bad.
Also huge: They should be 100% open and easy to talk to about things like fees, progress, gaps in understanding and trust, and any questions you might have – without becoming defensive and/or prescriptive.
Less tangibly, you have to click somehow; it can’t be a chore or punishment to see your therapist. Why?
In study after study, of all different sorts of therapeutic modalities, the one factor that has emerged as an indication that therapy has been successful in helping patients, is the client-therapist relationship.
Given that a lot of therapy ends up centring round relationships (to people, selves, substances and processes etc), it makes perfect sense that the therapeutic relationship needs to be good, solid, trusting and open.
So – if therapy is about you, and what you want out of it, have a think about what works for you. Everyone is different, and entitled to be.
And don’t for a minute feel insecure about trying out a few different therapists and therapies. You absolutely have to like your therapist and be onboard with the process.
To sum up:
1. Figure out their qualifications and registrations and reputation;
2. Figure out how they work, and if that appeals to you, and if it fits with what you’re looking for;
3. Talk to them either on the phone or in person before signing up to anything, to work out whether you’re a good fit;
4. Review your treatment and relationship with them from time to time, and discuss your thoughts with them.
5. Don’t be afraid to ask them anything or discuss anything. And if it’s not working, don’t be afraid to tell them why, and ask them for a referral to someone else. Any good therapist will appreciate your honesty.