It’s not always easy assessing the various merits of umpteen therapists, cross-referencing qualifications, experience and specialities, while also, at the apex of a panic attack, pleading with a 999 telephonist to send an ambulance as you are ‘dying’. I have tried this. The results are less than ideal. Shopping for the right psychotherapist could turn a happy, uncomplicated person into Woody Allen. But at one’s saddest, and maddest, finding someone to lower your insanity to manageable levels makes exchanging on a house seem like a spa weekend. Even when in sound mental health you have to know what to look for and where to look, or else risk finding yourself at the mercy of a handsy old codger releasing childhood trauma through ‘special hugs’.
But the first, key, sobering point to bear in mind is this: the entire profession is unregulated. Anyone in Britain can call themselves a therapist or counsellor without any training or qualifications — Abu Qatada could have set up a website offering his services to treat your depression, Janet Street-Porter could, even George Osborne. ‘Counsellor’ and ‘psychotherapist’ are not protected titles. Thus, at our most vulnerable, we can be at the mercy of the most unqualified and least experienced, with often no recourse for bad treatment. The state cares not. Careless in the community, indeed.
The second salient issue involves the very nature of how psychotherapy works. Specifically, whether it does or not. Repeated research has failed to find evidence of efficacy, since an explosive study by Vanderbilt University, Nashville, in 1979, which sent 15 sufferers of depression and anxiety to see 15 different therapists, who made no more progress than another 15 — a control group — sent to fake therapists. This does not mean talking therapies are pointless nonsense, because anecdotally we know this not to be true. Rather, efficacy is hard to quantify — it isn’t testable like drugs, and everyone responds differently.
Which type of therapist, and therapy, will work best for you we will come to shortly, but there is one other crucial aspect to bear in mind: how comfortable you feel with them. This might sound woolly, but several studies have shown that it is the particular dynamic between client and therapist that’s paramount. ‘The relationship is more important than whether you see a clinical psychologist, a counsellor, a psychotherapist, a psychoanalyst, or a psychiatrist, or the type of therapy, because if you’re not a good match, you’re not going to allow that relationship to impact upon you, so it’s not going to work,’ explains psychotherapist Philippa Perry, author of How To Stay Sane. In other words, because you are sharing intimate, often difficult thoughts and feelings, then without being able to trust the therapist, the scope for improvement is limited. Perry recommends, therefore, that once you’ve whittled down therapists in your area — to ones you can afford, who seem well-qualified — it then pays to phone them up, get an initial sense of whether you might be able to work with them, and then go to see at least two. After an assessment session, you will have a better idea of whether a productive working relationship is likely, and then you can simply arrange to see the one that feels like the right fit.
‘You don’t buy the first pair of shoes you try on,’ says Perry. ‘And this is a lot more important — and expensive.’ She also advises having a review with the therapist after four sessions, to discuss how things are going and whether it seems fruitful to have more. In the selection procedure, questions of age, sex, race, religion, nationality and sexual orientation can all emerge too. If you are new to therapy, while in other areas it is helpful for one’s thoughts to be challenged, when it comes to demographics it is better, at first, to go along with them. ‘If you think all men are rapists, then you’re unlikely to open up well to a man,’ says Perry. ‘Once you’re a bit further down the road with therapy you might want to take on certain preconceptions but initially go with what you think you will feel most comfortable with.’
But prepare to be surprised on this front. ‘Many people come to therapy thinking they want a female therapist because they assume a woman would be more sympathetic and understanding, but this is not necessarily the case,’ says psychotherapist Matthew Stinson from the University of Brighton. ‘To ensure your therapist is the right one, there is something else to bear in mind. Many people like theirs and feel comfortable because the therapist constantly agrees with them, or even compliments them.’ There is a danger of the therapist colluding with the client into thinking, ‘Isn’t the rest of the world awful?’ says Perry. ‘If you find that you like your therapist but they agree with every single thing you say, you should be suspicious.’ Instead, a good therapist will help you to investigate your beliefs, thoughts and feelings and challenge you where necessary. ‘It might be, for example, that you are convinced that your boss hates you, and you interpret every word, every look, every incident as further evidence of this, when there may be another explanation,’ says Stinson. ‘Helping a client see alternative possibilities can be transformative for them.’ Thus, concludes Perry, ‘Look for someone you like who isn’t collusive with you.’
Another factor is intelligence. ‘I hate to say it but there are therapists who aren’t that bright,’ says Perry. ‘If you’re a very bright person and you go to someone who is less intellectual than you are, it can be a terrible match.’ The award-winning mental health journalist and editor Louise Chunn has set up a website (welldoing.org) to cater for this. Academic level forms one part of the questionnaire in the ‘find a therapist’ section. This questionnaire is about the most comprehensive, tailored and helpful tool in any hunt for the right therapist. Questions include the nature of the problems you want to tackle, the kind of therapeutic approach that might work best for you and the duration of therapy you would like, along with the personal traits of the therapist such as age, sex and race.
When it comes to the type of therapy, and therefore who best to administer it, there are a few other factors to consider as well. ‘First of all, how long you want, or can afford to have therapy for,’ says Stinson. ‘If you can only manage a couple of months, then in-depth psychoanalytical approaches, which delve into the subconscious, aren’t for you. Equally, if you are someone who works on a more logical, thought-based level, rather than a more intuitive level, an approach that harnesses that, such as cognitive behavioural therapy [CBT] might suit you best.’ CBT is also particularly useful in dealing with certain conditions, such as anxiety, and mild to moderate depression. For more complex, deep-rooted or chronic problems, stretching back into childhood, long-term counselling, psychoanalysis or psychodynamic psychotherapy might be a better bet.
With regard to qualifications, it helps if a therapist has ones specifically relating to counselling, clinical psychology, psychiatry or psychotherapy, rather than a generic psychology qualification, or related areas such as neuro-linguistic programming (NLP), hypnotherapy or life coaching. Ideally, it should be a master’s degree, or at least a postgraduate diploma. Professional membership matters too. And so, another helpful search tool is the website of either of the two largest psychotherapy and counselling organisations: the British Association for Counselling and Psychotherapy (bacp.co.uk) and the United Kingdom Council for Psychotherapy (psychotherapy.org.uk). These list only therapists or counsellors who are members of their own organisation. Membership to such a body means three things for the prospective client: any therapist granted accreditation will have to have shown a relatively high level of training and a certain amount of clinical experience — and, perhaps even more reassuring, should something go wrong, the client can make a formal complaint to the body. Although they cannot be struck off in the way doctors can, the therapist could at least lose their membership to that organisation and find it more difficult to gain employment.
On this subject, one other key criterion is whether the therapist has insurance or not. If they don’t, and something terrible happens, it will be much harder to sue them.
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