Choosing a Therapist with a Psychodynamic Perspective

If you value my approach but feel that going it alone isn’t for you at the moment, here are some guidelines for choosing a therapist who might have a compatible orientation.  I’ll begin with some general suggestions about how to interview any mental health professional; I’ll conclude with specific suggestions for finding one who’ll offer you insights and guidance similar to those provided on this site.

First of all, remember that you are the customer and you have the right to ask as many questions as you like about the potential therapist’s background and credentials.  What degrees does he have and where did he earn them?  What professional licenses does she hold?  Is she a marriage and family therapist, a psychologist, a social worker, a psychiatrist (which means holding a medical degree)?  You can ask about internships, where they received their on-the-job training, and how many years they’ve been practicing.  If you’re in pain and hungry for help, it’s difficult to remember that you need to make an informed decision, the best you can make, and not simply sign on for treatment because one of your friends recommended her own therapist, or your physician referred you to his colleague. The answers themselves may not mean a lot to you (one university versus another, for example) but the process of interviewing the potential therapist can give you a lot of insight.  You might find she’s an authoritarian type who feels irritated by being questioned; maybe he seems insecure about his background and lacks the kind of confidence and experience you need. Beware the charismatic therapist who exudes the over-confident aura of knowing everything.

Most states have laws requiring mental health professionals to provide you with a statement of their policies about issues like cancellation, privacy, vacations, etc., but there are other areas where you might want information.  Here are questions you could ask:  What are your areas expertise?  Have you worked with many clients suffering from [name your pressing issue]?  What are your views on length of treatment and frequency of sessions?

Questions you should NOT ask:  Are you married?  Do you have kids?  Are you gay?  How old are you?  The therapist is entitled to his or her privacy and that information is none of your business unless he or she chooses to disclose it.  (You may notice that I speak frankly about my internal dynamics but am careful to keep the details of my personal life private.) I’d also beware of the therapist who discloses TOO much personal information.  This may indicate poor boundaries.  The therapy is about you, after all, and your therapist is NOT your social friend, however you may feel about one another.

Also feel free to schedule more than one evaluation appointment.  You don’t have to make up your mind after one session, nor do you have to interview only one person at a time.  As I said, you are the customer and you should approach this decision in a way that will give you as much information as possible.

As for finding a therapist with a specific orientation, that’s a greater challenge.  The mental health profession at present is dominated by cognitive behavioral theories and psychopharmacology.  I’m not saying anything against those orientations, but if you want treatment akin to my approach, your search may be difficult.  In addition to holding licenses as a clinical psychologist and marriage and family therapist, I was trained as a psychoanalyst; as part of my training, I had to go through years of treatment myself.  Most people think of psychoanalysis as an outdated modality that began and ended with Sigmund Freud, but in fact, it has grown enormously and continues to evolve.  Specifically, I was trained in an area of pschoanalytic thought known as “object relations”. If you find someone who describes him- or herself as having “an object relations orientation,” you may have gotten lucky.  Psychodynamic psychotherapy, depth psychology, transference-based therapy, insight-oriented therapy — these are some terms that also apply to the kind of work I do.

The most important element in making your choice is how the therapist makes you feel.  If he makes you feel all warm and fuzzy, totally accepted for who you are, I’d look elsewhere. If she intimidates you, seems controlling or has poor boundaries, I’d likewise move onto the next candidate.  In my first session with my own therapist, he made some observations about me that made me extremely uncomfortable and seemed undeniably true.  Feeling at ease isn’t the best indicator; feeling understood is what matters. The distinction here is between sympathy and empathy.  What you’re looking for is a person who can speak the truth to you, however uncomfortable it might make you feel, not someone who expresses a great deal of sympathy but doesn’t startle you with unexpected insights.

I don’t do Internet or phone therapy, but if you’d like to ask for specific advice about consulting a professional, please feel free to contact me:  AfterPsy@gmail.com.

I hope this help!

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

Author Photo

A photo of the author in Rocky Mountain National Park, one of his favorite places on the planet.

8 comments

    Choosing a therapist (PhD) is like finding “love.” Not literally because that would be inappropriate. But you know it when you meet the therapist. You leave the appointment feeling empowered as opposed to violated or embarrassed.

    My experience has been that as my life changes, a therapist can become “wrong” for me. I had a great therapist. But the *moment* my dad got a diagnosis of colon cancer, he described placing my dad in a nursing home so that I could continue *my* life. The problem was that dad had literally just cared for me as I fought cancer. Caring for my dad was a given. It was non-negotiable. I was so offended that the therapist would think I could abandon my dad that continuing was not a possibility.

    In fact, I haven’t trusted a therapist since.

    Fortunately, my psychiatrist understands me and my healthy respect for elderly parents. (I do try unsuccessfully to turn him into a therapist . . . darn)

    Great blog. I enjoy it very much.

    Thanks, Cheryl. I’m sorry to hear about your former therapist. This is what sometimes passes for empathy in my profession! I suppose he thought he was trying to help you look after your own needs, missing the fact that caring for your father out of love and gratitude was your primary need.

    Another excellent and highly practical blog Joe.
    I would underline how the actual answers a potential therapist gives are less important as the way in which they answer, it’s the process which is important, and will continue to be…
    For people in the UK, I’d also add 2 more questions to Joe’s list, “Are you in supervision and in personal therapy yourself?” These are two requirements for continuing ethical practice, not just as an intern or trainee, which I believe differs from the States?

    Great article. I disagree, though, about questions a client should NOT ask. We should be able to say anything in therapy, to ask anything. It is up to the therapist to tell us what they consider appropriate and what they prefer not to answer. I think it is a good test, actually, to ask them these questions. First to gauge how they feel about such questions, second to see if they are comfortable answering, third if they are comfortable explaining to us their boundaries, fourth because answers to these questions might make a difference to us (sexual orientation is important for some clients, for example). I personally don’t like to bump up against my therapist’s boundaries by overstepping them, I would prefer to know them in advance.

    I wouldn’t disagree — I think you should be able to say or ask anything in therapy. I guess the way I deal with these issues, rather than defining a boundary for my clients, is to try to find out what it means to them — whether I’m gay, married, have children, etc. I find it often reveals some interesting assumptions or fears that provide grist for the mill; as a result, more often than not, the client finds it less important to know the “answer” than they had expected.

    This is a long overdue and welcome post in my opinion, and a good idea to offer some pointers & advice to potential clients of therapy or analysis, I wish I had been aware of this website and seen this post two years ago when I was therapist hunting. I spent AGES looking for a therapist, I had two specific life issues to address which I was clear about, and wanted a motherly woman therapist but I also needed someone who understood the cultural issues in my background, (an issue which I find often overlooked by therapists who think it doesn’t matter, when in my repeated past experiences with therapists it has always mattered as I started feeling like a cultural artefact of fascination for them,or my background/identity was ignored, feelings of loss & alienation ignored, the extended family ignored… I got fed up with it. The other issue is illness/disability, an issue also not tackled properly by therapists and analysts in my experience who don’t seem to know how to treat such people). I found both the motherly woman who I was intent on seeing, and then an analytic one who was not a motherly woman & more culturally appropriate ….. I was torn between the two and thought about seeing one for a while and then the other. In the end I gave up on the lovely, well qualified and experienced motherly woman and settled for the psychoanalytic male, because I needed “interpretations” regarding unconscious processes which were causing problems which I didn’t understand, and had failed to understand repeatedly. He threw some comments & questions in my direction which seemed to hit me sideways, and they did intrigue me – because I couldn’t answer them! For once I was speechless. I realised the woman was not going to interpret anything regarding my Unconscious, which I really needed, though I suppose she might have made me feel all “warm & fuzzy” inside and at least would be agreeing with the status quo as I saw it … so I consider myself lucky to have taken the plunge and unfortunately had to reject her, I felt so guilty… I think I made the right decision in the end, but I think the more complex one’s background and cultural background, the harder it is to find the right therapist…. I have certainly had to think long and hard. For instance, psychoanalytic therapy or psychoanalysis are quite different from other therapies (existential therapy, person centred therapy, integrative therapy, etc), and I came to the conclusion, after experiencing a bit of everything over the years, that only psychoanalytic therapy offered real long-lasting change, because of the interpretations of the Unconscious. Even then it hasn’t been without problems, which were unexpected. It’s a real minefield out there.

    Since I started working by Skype, I have found that working with people who live in other countries challenges me to enlarge my cultural perspective and question my own cultural assumptions. I agree that it’s a neglected topic.

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