by Jill Holm-Denoma, Ph.D.
Whether I am asked this question by students in my Clinical Psychology course at the University of Denver, potential clients who have heard about my private practice (therapydenver.webs.com), or friends who are having a tough time, I almost always struggle to offer an articulate response. I completed a B.A. in psychology, a M.S. and Ph.D. in Clinical Psychology, teach regularly about the benefits of using empirically-supported assessments and treatments, and offer what I think is “good” therapy, so if I have trouble describing what someone should look for when trying to find a “good” therapist, it must be almost impossible for the average therapy consumer to know how to proceed! In fact, when recently trying to locate a “good” therapist for a loved one in a geographic location with which I was unfamiliar, I was left disoriented and frustrated with my online and phone book searches. What differentiates a “good” therapist from a not-so-good or even average therapist? How can a given client be sure that s/he is selecting a “good” therapist with whom to work? After having given these questions much thought, here’s what I’ve come up with:
1. Therapy clients should familiarize themselves with empirically-supported treatments (ESTs): It might not be ideal to expect the average therapy consumer to educate him/herself about ESTs , but if that consumer wants to be sure that a potential therapist will offer the front-line treatment for a given disorder, s/he would benefit from knowing what the front-line treatment is! Thankfully, it is relatively easy for clients to learn about ESTs by visiting: http://www.div12.org/PsychologicalTreatments/index.html. At this website, a therapy consumer can search by disorder (if s/he already knows or suspects a particular diagnosis) or by treatment type.
• Scenario A: A therapy client knows his/her diagnosis. In this scenario, the consumer can search the website above to see which ESTs exist for his/her disorder. Once a therapy client has a good sense of what ESTs are available for the problems s/he is experiencing, s/he can seek out a therapist who offers those treatments.
• Scenario B: A therapy client does not know his/her diagnosis. In this scenario, the client may be able to develop a sense of his/her likely diagnosis by talking to his/her physician, taking well-validated online screenings (http://psychcentral.com/quizzes/), and/or reviewing symptoms of many common disorders at a high-quality website like the one maintained by the National Alliance on Mental Illness (NAMI; http://www.nami.org/Template.cfm?Section=By_Illness). Alternatively, the client may request a one-time diagnostic assessment with a potential therapist. I am NOT suggesting that clients attempt to self-diagnose, as that should be left to a professional; however, I am suggesting that if a client has a sense of what types of symptoms or syndromes are affecting him/her, s/he will be more easily able to identify the types of ESTs that might be most helpful. Once s/he knows a diagnosis, s/he can search the website above for appropriate ESTs.
2. Therapy clients should get therapist recommendations from professional organization listings or research-based psychology programs: Many professional organizations, such as the Association for Behavioral and Cognitive Therapies, keep online directories of active members who are therapists (http://abct.org/Members/?m=FindTherapist&fa=FT_Form&nolm=1). It is not guaranteed that each therapist listed in the directory practices ESTs, but by virtue of having taken the time to register with an organization aimed at dispersing ESTs, chances are relatively high that the therapists in the directory have some awareness of and training in such therapies. Likewise, if an APA-approved clinical or counseling psychology program exists in one’s geographic area, a therapy client could find out whether the program offers therapy through an in-house training clinic (as these usually offer ESTs and state-of-the-art training to therapists). If an in-house training clinic is not available, the Director of Clinical Training for these programs should be able to recommend local providers who specialize in ESTs.
3. Therapy clients should request a brief interview with potential therapists: Based on the results of the procedure described in step 1 (above), a therapy consumer could contact a potential therapist and ask a few questions. Specifically, s/he might ask the types of questions listed below and expect answers similar to those given in parentheses from a “good” therapist:
• How do you choose the treatment you offer each client? (I use ESTs for each disorder.)
• If you were to work with a client who met criteria for XXX disorder (e.g., Major Depression), which treatment would you use and why? (I would suggest Cognitive-Behavioral Therapy and a psychiatry consult, because CBT is an EST for depression, and because research suggests that the combination of CBT + an anti-depressant is the most effective treatment for depression.)• Do you use a treatment manual, and if so, which one(s)? (Yes, I use a manually-based CBT protocol for depression that is described in Treatment Plans and Interventions for Depression and Anxiety Disorders by PBB guest author Robert Leahy & Stephen Holland.)
• How have you been trained in this therapy? (My graduate program trained me in ESTs, I completed a pre-doctoral internship during which I conducted CBT with depressed patients regularly, and I attended a CBT workshop last year.)• How do you know that your clients are getting better? (I give routine assessments in which I evaluate the presence and intensity of symptoms. If therapy is working, symptoms should decrease over time. Research indicates that half of clients see meaningful symptom reduction in 8 sessions and that 74% of clients do so after 26 sessions (Howard et al., 1986).)
Basically, a “good” therapist will quickly convince you that s/he is aware of ESTs, uses them regularly, and has the appropriate training needed to conduct them. S/he will also indicate that s/he will conduct an objective assessment regularly to track treatment progress. This type of information may also be available on the therapist’s website.
4. A therapy client should choose a therapist with whom s/he feels rapport: Studies have provided some support for the idea that common factors such as the therapeutic alliance are related to therapeutic outcome. Moreover, if a client does not feel comfortable with his/her therapist, s/he will likely not want to return to therapy at all. Therefore, it is important for clients to find a therapist with whom they feel good about working. However, I want to be clear that having a good working relationship with a therapist is a necessary but not sufficient criterion for a successful therapeutic outcome (link). Said differently, without a good therapeutic alliance, therapy is not likely to be rewarding for the client…but having a good therapeutic alliance is not enough! Clients should strive to work with a therapist with whom they feel comfortable *AND* who provides ESTs. It does not have to be one thing or the other.
It is important to note that most people who are seeking out therapy are acutely distressed, and their resources for conducting a thorough search for a “good” therapist are likely limited. In such cases, clients may want to seek out the help of a loved one when doing some of the steps outlined above. Although doing this type of investigative work on the front-end will take precious time and energy, it will likely result in a better, more efficient therapeutic outcome.
If you would like to learn more about this and other topics discussed here, PBB suggests that you consult their online store for scientifically-based psychological resources