#TBT: The Therapy Relationship

Here are some thoughts from the archives on choosing  a therapist who will be a good fit for you.

The Therapy Relationship: What Makes a Good Fit?

Research shows that the quality of the therapeutic relationship is an important component of successful therapy, along with the training and experience of the therapist. I would go so far at to say that it is the foundation of therapy and the context in which healing occurs.  Certainly, without a working relationship in place, no techniques are likely to be very effective!

Those who have experienced trauma( Big T or little t) in the context of relationships are thus faced with quite a dilemma.  Relationships in the past have led to wounding:  abandonment, betrayal, unmet needs.  Now a relationship in which to heal must be sought. It makes sense that in the aftermath of  trauma  there are a host of responses that make connection difficult.  As I have written previously, childhood trauma can cause the disruption of basic developmental tasks such as self-soothing,  seeing the world as a safe place,  trusting others,  organized thinking for decision-making and avoiding exploitation.

Does it ever feel like a double bind? To seek to feel safe in the therapeutic relationship when relationships in general feel dangerous?

How have you navigated that?

As a potential client, what cues do you look for to feel safe enough to begin therapy?

Do you start assessing even prior to the meeting? I have had some clients give me feedback that even tone of voice on a therapist’s voice mail message can factor in.

As a therapist how do you address the issue of safety and the relationship?

I find it is important first of all to name the dilemma. I acknowledge all the ways starting therapy can be a challenge.  Sometimes taking that first step is one of the hardest parts! I also believe and express to potential clients that I see trust in me and the process as something that will develop over time.  I strive to earn trust by being trustworthy: authentic, consistent, matching what I do to what I say.  I also believe that a good therapeutic relationship is not free from empathic ruptures or miscommunications. There is no perfect relationship, not even in therapy. Instead, what matters is how we address disconnections and  how we do the necessary repair work.

I’d love to hear input from both sides of the therapy relationship.  Below are a list of factors that come to my mind. What about you?

How do you try to assess a potential therapist? What makes for a good enough fit?

  1. Ease of access: How can you contact the therapist? Do you prefer phone,  email.  How quickly does the therapist respond?  Does too much phone tag turn you off?
  2. Location: I am always surprised at how many clients pick a therapist based on location alone! How far are you willing to travel? Do you want in person therapy or would some form of online therapy work for you? Do you consider the type of office space? How accessible it is by public transportation?
  3. Availability: How soon can you be seen? What hours and days are appointments available? Is the therapist available for more than one session a week? In between scheduled or crisis contact if needed?
  4. Credentials: Do you have a preference for a psychologist? A social worker? Does the type of degree or training matter to you?
    Information on types of therapists
  5. Identity Demographics: Do you want to have certain things in common with a therapist? Do you have a preference for a particular gender, age, race, ethnicity, religion,  sexual orientation? Some of these may be initially apparent, others not.  Do you want a therapist to disclose some identity information? Therapists: are you comfortable/willing to do this? How much is too much? Sometimes people from marginalized groups (like the LGBT communities) want to seek LGBT therapists.  Is it enough to know that your therapist is knowledgeable and affirming about your culture or do you seek a shared identity or background?
  6. Areas of expertise: Is the therapist experienced with the issues you present? How do you know? Is the therapist licensed? Do you know how to access that information? What is the therapist’s theoretical orientation? Are they trained in specific techniques like EMDR, found to be effective in treating trauma? Does the therapist practice trauma-informed care? If treating dissociative disorders, are they aware of the Treatment Guidelines developed by the ISST-D?

Pragmatics like location and availability as well as a therapist’s professional training and expertise are all important factors to consider. But what about the sometimes more subjective factors? I truly believe that therapy is as much an art as a science. The therapist’s self (as expressed within appropriate ethical boundaries) factors into the equation. Being authentic, consistent, insightful, able to model expressing emotion, the ability to be present with hearing unspeakably painful truths, conveying warmth and understanding,  humor can all factor  into the healing relationship and show up in different ways in each therapist.  A therapist who is a great match for one client may not work for another.

Interviewing potential therapists to ascertain goodness of fit is crucial! You may want to write out a list of questions or concerns in advance, to make sure you cover all your bases.Dr. Bessel van der Kolk suggests that trauma survivors also consider their experience of the potential therapist: “Pay attention to whether the therapist really wants to hear the troubles you have to tell.  Ask yourself, ‘Do I feel validated? Is the therapist really listening to my story?’”

Trust your gut and intuition, but also work to sort out past triggers.  Is your gut telling you this therapist won’t work for you, or are you feeling scared of therapy in general? Can you determine that in one session or do you need several to make an informed choice? Unless there are huge red flags( unethical behavior,  lack of education regarding trauma,  homophobia/transphobia,  for example) I really encourage potential clients to share their misgivings and concerns with the therapist.  How this is addressed will tell you a great deal! It is important that any therapist listen to your critiques with empathy and non-defensiveness.

What do you look for when seeking a therapist? And how do you know it when you see it?

I’d love to hear your thoughts and experiences!

Kathleen Young, Psy.D.

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2 Responses to #TBT: The Therapy Relationship

  1. maggiejay64 says:

    As an incest survivor I never imagined working with a male therapist. I met him through my partner who had gone to him for depression. I wasn’t impressed with him then but I was struggling with issues around being a workaholic and making an appointment seemed to appease my partner. Little did I know that this person would change the course of my life. I am sure his intellect, knowledge of theory and experience played a part. But as a survivor I responded to his calm manner and his willingness to respect my space. It was almost three years before any physical contact like a handshake. This was very important because I knew I would dissociate during our sessions and I needed to know he would be in the same place when I was present again. It was his dependability, predictability and willingness to tolerate my inability to make eye contact for almost two years. He gave little outward reaction to the details of my story, I couldn’t rattle him despite my best efforts. Knowing I could reach out to him between sessions if needed helped me to feel safe when my feelings overwhelmed me. I did not call often but knowing I could was huge. I know it was difficult for him to go at my pace sometimes but he did because he never wanted to hurt me, that is what came through in his approach. It took years for me to believe it and it could only be the culmination of many actions because words didn’t mean much.

  2. Rachel says:

    I’m learning as I go, and this article is relevant to where I am right now. I think patience is important for me. I also have a general medication phobia since throughout my life I have always been so sensitive to medication, even the kind that works well on me, and have had terrible side effects along the way. Combined with a real fear of doctors, I can be hard to treat and the trust issue takes a long time with an MD.

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