How to choose the right psychotherapist

So, you have made up your mind and do not intend to postpone this step. You go to a psychotherapist! Yes, but which one exactly? And how do you know if he is trustworthy? Five Psychologies readers spoke about their experiences. We asked clinical psychologist and psychotherapist Elena Sokolova to comment on these stories.

Criterias of choice

“The first time I was looking for a psychotherapist on the Internet,” says 48-year-old Nina. — Not knowing the difference between specialists, I acted from the opposite. Psychoanalyst? I don’t want this to last ten years. Psychiatrist? I’m not crazy, I’m just trying to figure out what’s wrong with me.

I chose a psychologist — she also took near me. The first meeting went badly: she was constantly distracted, answering calls. I didn’t go to the second meeting. Several months passed before I turned to another psychologist.

Psychologist commentary. It is useful to have an understanding of the traditional methods of psychotherapy in advance — this will avoid pseudo-specialists. In addition, you need to find out about the reputation of the person you are going to see. Ideally, after the first meeting, there should be a feeling that you feel better, easier because someone really listens to you, is attentive to your feelings, tries to understand and help.

The environment in the office, the appearance of the therapist, the way he greets you, how punctual and at the same time natural he is, are all factors that encourage you to trust him. But if in doubt, talk to him about it.

A good therapist will take your doubts and use them to figure out together where your fears and attitudes are manifesting, and where he is really doing something wrong. This will be another step towards establishing trust. A bad therapist will not pay attention to your doubts or come up with an excuse for himself. So you will have the feeling that he does not understand you.

What to ask at the first meeting?

“At the first session, I laid out all my problems,” recalls 36-year-old Raisa, “and the psychotherapist told me: “We will meet twice a week, for a session of 5000 rubles.” I agreed, although I could not afford such expenses. It wasn’t until a few weeks later that I talked to him about it. He asked how much I was going to pay and how often I wanted to meet.

We discussed it. Then I realized that at the first meeting I did not ask him anything. I have completely relied on the therapist, just as I rely on other people — to the point that I lose myself. By imposing a tariff and frequency of meetings on me, the therapist encouraged me to respond to this and thereby begin to change.

Psychologist commentary. At the first meeting, the therapist tries to understand what your problem is in order to choose the direction of psychotherapy. But you also need to ask questions. Ask him what kind of training he received, whether he is in any association that has its own code of professional ethics.

If the therapist refuses to answer these questions, you should be alert. Be careful: at the first appointment, the psychotherapist should offer to discuss the practical side of your relationship (frequency of meetings, their duration, payment, possible sanctions for missed sessions). In this case, a qualified psychotherapist will be guided primarily by the diagnostic criteria obtained during the initial interview with you.

Be critical, but avoid projection: dissatisfaction with the therapist’s work can be a sign of your resistance to the psychotherapy process. You may be aware that you need the help of a specialist, but unconsciously shy away from reviewing behaviors or relationships that, although they make you suffer, but (by force of habit) seem safer than the uncertainty of the new. In this case, it is easier to declare all specialists to be bad, so as not to undergo such an unpleasant, as a rule, long, and often painful procedure as psychotherapy.

However, if you don’t feel at the first meeting that this is «your» therapist, you can go to another specialist.

Should I see my friend’s psychotherapist?

“When I was fired, I decided to consult a psychologist and turned to my friend Seva for advice, because I knew that he was pleased with his psychotherapist,” explains 28-year-old Sergey. — And a few months later I fell in love with Natalya, whom I met at the same Seva.

I talked a lot about my feelings in the sessions. And suddenly Seva announced that he had made an offer to Natalya! I was confused. Of course, the psychotherapist, to whom my friend continued to go all this time, knew about his intentions. He kept our secrets, but I still felt betrayed. It was very hard.»

Psychologist commentary. There are advantages to going to a specialist who has been recommended to you — no need to make inquiries, because a friend can certify the competence of his therapist. But a situation where two patients know each other and are simultaneously being treated by the same specialist is unacceptable.

The therapist runs the risk of being caught between two fires. The patient’s trust will conflict with his duty of secrecy. Unless it’s family therapy, he should refuse to take them. Another thing is if the therapy of a friend or close relative is over: then there will be no conflict of interest.

For the work to be effective, you should not seek help from specialists with whom you have business contacts; with whom you are related, intimate or friendly. In this case, all its participants find themselves in an intricate and ambivalent relationship.

Man or woman?

“At 17, I suffered from an eating disorder,” says 25-year-old Alina. The doctor suggested psychotherapy. I agreed on the condition that it would be a man. I think I was hoping to seduce him, to convince him that I was all right, and thus avoid difficult self-digging.

He was a good therapist, he did not allow himself to be manipulated, and we worked together for two years. Later, I worked with a female psychotherapist in order to regain my femininity. The gender of the psychotherapist was important to me, but I think it helped me that both of them were well acquainted with the problem of anorexia.

Psychologist commentary. If you feel more trust in men or women, listen to yourself. Your therapy will be more constructive if you do not start it with a confrontation or a forced concession. Gradually you will come to explore the unconscious motives for your choice. The task of the therapist is to help you understand the reasons for overly biased preferences.

How do I know if this therapist is right for me?

“I had a period of difficult relationship with my husband, I was confused and went to a psychotherapist,” admits 32-year-old Larisa. — He advised: «Leave the house and have dinner with a friend», «Do not answer him.»

I could not follow his instructions, I felt guilty and needed new advice. When I realized that I interrupted any argument with my husband to call the therapist and find out what he thought about it, I stopped going to him.

Psychologist commentary. Avoid psychotherapists who involve you in an addiction relationship. Experiencing difficulties, we seek help from another person, whom, consciously or unconsciously, we endow with great power: we pin our hopes on him and are convinced that he will help us. Therefore, we can say that the psychotherapist is bad in one single case — if he abuses his influence on us.

It is unacceptable to use the patient to improve one’s own social and financial situation, increase self-esteem, or get rid of feelings of loneliness with his help, creating and maintaining dependency relationships. The psychotherapist must take care of the patient’s welfare, promote the development of his independence, maintain confidentiality.

These rules help the therapist refrain from directive advice and recommendations, thereby showing the patient that he respects his personality, sees his resource opportunities and encourages attempts of his own choice, even if sometimes the patient encounters failure.

In addition, the psychotherapist has no right to establish friendly or (especially!) sexual relations with the patient. Violation of any of these rules, even if it seems quite harmless, suggests that something is wrong with this specialist. And it is better to refuse his services.

World Charter of the individual undergoing psychotherapy

This Charter was adopted in Vienna on July 14, 2002 at the Third World Congress on Psychotherapy, which brought together 4000 specialists from 80 countries, including Russia.

1. The right to respect for the dignity of the individual. A person who undergoes psychotherapy has the right to respect for his own dignity, his mental and physical integrity, without discrimination, regardless of the content of his request or his mental state.

2. The right to choose. A person undergoing psychotherapy has the right to freely choose a method and a psychotherapist and, if he considers it necessary, to reconsider his choice.

3. The right to access information. A person undergoing psychotherapy has the right to know what method the psychotherapist uses, as well as his qualifications, education and to which professional association he belongs.

4. Conditions of psychotherapy. The conditions of psychotherapy must be clearly defined before any commitment is made: forms (verbal, emotional, bodily…), duration and frequency of sessions, expected duration of treatment and conditions for its prolongation or termination, cost (fees, fees for missed sessions).

5. Right to privacy. The psychotherapist must undertake to keep in absolute professional secrecy everything that is entrusted to him during psychotherapy. Confidentiality is a sine qua non of the therapeutic relationship. But confidentiality in some cases is limited by applicable law.

6. Moral obligations of the psychotherapist. The psychotherapist is obliged to comply with the code of ethics of the professional association to which he belongs. To get acquainted with this code, it is enough to express a request. The psychotherapist has no right to use trust for manipulation for political, sectarian or personal purposes (emotional dependence, economic interests, sexual relations…). Otherwise, he is responsible for it.

7. Complaints procedure. In the event of a complaint or grievance, a person undergoing psychotherapy may seek help from professional associations or judicial authorities.

The full text of the Charter is published in the book by S. Ginger and A. Ginger «A Practical Guide for Psychotherapists» (Academic Project, Mir Foundation, 2010).

What to look for

When a person feels helpless, he becomes an easy prey for scammers. Here are a few points that will help you recognize dubious psychotherapists.

• He does not give clear answers to questions about his education, the method he uses.
• He refuses to discuss the practical side of your relationship (frequency of meetings, duration, payment).
• He calls you at home. He makes an appointment outside his office.
• He makes you explicit hints, or you feel like the object of his sexual interest.
• He is familiar. He uses esoteric or scientific jargon.
• He is late for his scheduled session.
• He is talking on the phone during the session.
• He asks you to pay for several sessions in advance.
• You get the feeling that he does not hear you.

One, and even more so several of these features in the behavior of a psychotherapist should alert you and encourage you to interrupt therapy and find another specialist.