Some Things to Ask Yourself When Selecting a Therapist by Dr. Deb Hirschhorn

Some Things to Ask Yourself When Selecting a Therapist

By Deb Hirschhorn, Ph.D.

When you buy anything important – a car, a home, a Pesach vacation – you do some research. You find out what works, what doesn’t, what should happen, etc. But for some reason, it seems people plunge into therapy without much expectation of how it “should” go – and are often disappointed. So I’ve made a list of the top three bullet points you most likely would not expect but are more important in selecting your therapist than anything else: • Is this person nice?

Now that may sound strange. What does “nice” have to do with expertise and experience? Isn’t it more important that they know what they’re doing?

No! Don’t get me wrong. Of course, they need to know what they’re doing, but that is not and ought not to be at the top of the list.

Here’s why: We are basically emotional beings. We make decisions through emotion. And we trust – or don’t trust – through emotion.

When you must open up your vulnerabilities to a therapist – and there is no way around doing that if you want to solve the deeper emotional problems in your life – then they better be nice, kind, caring, empathetic, compassionate, sincere, authentic human beings.

Does that mean forget experience? Of course not. But I have heard of a lot of damage done by clinicians who were working in the field a long time and had the necessary education, and yet let their arrogance, ego, personal problems, lack of self-insight, or misjudgment combined with a lack of caring damage a person, perhaps for years.

Here’s a non-therapy example. Suppose you go to a medical doctor for a medical problem. The person doesn’t have a good “bedside manner.” That is, he or she doesn’t seem to connect with your fears about the problem, the pain you have from the problem, or, in fact, your intense wish to live. But you choose this doctor because of their expertise. They are at the top of their department in the medical school, have published articles, and so forth. Now, down the road, they must make a decision: Should they aggressively fight a tumor that is almost down to nothing, just to finish it off but take a risk that the chemicals will kill the patient, or should they be more conservative in their approach? The kindly, emotionally sensitive doctor might opt for the more conservative approach which reduces the odds of death even though time might be needed in the future to finish off killing the tumor with chemicals. The “expert” who just wants to get the job done might make the wrong decision. • Does the person “get” me?

More important than the therapist’s level of expertise on paper is the feeling you get when you’re talking to them. Do they get it? Are they listening? Can they read between the lines? Do they pick up the nuances?

One of the most important jobs of a marriage is attunement. Each member of the couple must “get” the other or there is a disconnect that feels insurmountable and depressing. Well, all that is possible, but it takes therapists who themselves are attuned in order to do so. How in the world can a person who misses the boat teach someone else not to?

So then the next question is: As the consumer looking for a therapist, how can you tell if you’re “gotten”? How do you feel “felt”? Are there any signs to look for to tell if the therapist really understands your position?

There are, indeed, but you yourself have to be a tiny bit vulnerable in order to run the test. You have to share a bit of something and see if the therapist picks it up. That’s good because when they do, you not only know that they understood you intellectually but also they can “feel” you. There is an exchange of information at a non-conscious level that you will feel.

The interesting thing here is that if you’re closed off to the therapist, they may still get you anyway (if they are good at reading the signs), but you may not know it. You may be too concerned about playing your cards close to your vest to realize that they understand that you’re doing exactly that, playing your cards close to your vest. In this instance, they might get you but you didn’t realize it.

So to be able to measure the therapist’s ability here, you would want to be tuned into the interplay between the two of you and just a bit vulnerable. • Does this person have the tools to help me make the changes I need to make?

Let’s say they told you their tools. How would you know if those are good tools? When I was up for a new computer, I did my homework. Believe me, I had no interest in “gigabytes” and other such technological stuff. But how else would I compare? (That’s probably why I haven’t gotten one in a number of years; who has time for that?)

There are literally thousands of methods in the psychotherapy world, but they fall into just a few categories: 1. The therapist is an excellent listener and expects you to figure out what you need on the basis of having put it all on the table. Such a therapist may provide interpretations as well.

To me, personally, I think interpreting another person is arrogant. When a therapist thinks they can understand the complex workings of another person’s mind, I can’t explain it any other way than to say it’s rude at the very least. None of us should presume to “know” what’s in someone else’s mind. But people very often do feel listened to and understood by such therapists, especially if they do more listening than interpreting, and that is a good thing. 2. The therapist believes that behavior change is the answer. And it most certainly is, except for the problem that we can’t always act the way we wish we did and know we should. Sometimes our emotions get the best of us.

Any behavior changes that we want must follow looking inside ourselves to figure out how our feelings rule us. Which brings me to the last of the three categories.

3. The therapist works with emotions. EFT (Emotionally Focused Therapy) and Imago are two methods that I respect although IFS (Internal Family Systems) has higher applicability, greater ease of use, and zero pathologizing, so it’s my first choice.

Here’s where people will object to all emotional methods, possibly vehemently. They’re thinking: Shouldn’t we push down painful emotions? Isn’t it better to completely forget the bad moments in our personal history? The reality is that we can’t push painful emotions completely out of awareness. We may have forgotten our horrors of the past, but they make their existence known anyway through unexpected bad moods and bad habits that we can’t explain.

That’s the problem.

They leak out whether we want to get rid of them or not. They bother us, sometimes with body aches so we can pretend they don’t have emotional sources, and sometimes with unexpected breakthroughs of emotion. One time I was talking to someone who consistently maintained a cool, rational exterior, so I didn’t expect what was coming. Ethan (name is made up) was explaining an interaction he had with an employee of his: Ethan: I guess I just need a “thank you.”

Therapist: What does a “thank you” mean to you?

Ethan: I guess it means validation.

Therapist: How old does the part of you that wants validation think you are?

That was the turning point, that simple question. The person who wanted to forget pains that he didn’t even recall having had his day ruined by that question, as he later reported to me. Now, you could say,

maybe people shouldn’t go down that path to begin with. But unfortunately, there were other times when a family member or business colleague also asked an innocent question or made a reasonable request that did not feel reasonable or innocent to Ethan. Then, not only was his day ruined, but it was destroyed for the people who experienced his bad reaction.

Naturally, I wouldn’t have wanted to ruin Ethan’s day. My heart breaks for the pains my clients are in. But the reality is that without the therapy process, their many days will be ruined anyway. That is an example of what happens when the past leaks into the present.

The good news is that the next step in the IFS emotion-discovery process is healing. We learn, for example, that we didn’t feel validated when we were six or sixteen. The next step is to validate that very part of us that is still, to this day, hurting. And validate that part regularly, daily, so that it

We make decisions through emotion.

heals within us. When this process is done with a full emotional experience rather than by rote, the synaptic connections in the brain literally change, producing healing. (See my articles on Bruce Ecker or look up synaptic reconsolidation for more on this.)

The bottom line, then, in assessment of your therapist is: Do the tools do more than uncover the pain? Do they heal the pain? Anything less is not going to solve the life problems we are carrying.

What I’ve noticed is that the more vigorously a person protests that they do not want therapy, the more pain they are in – and trying to pretend to themselves that they’re not. It’s an internal war, and it isn’t pleasant. Universally, when those people do finally face what’s hurting them, it is a big relief. In fact, “relief” is the number one word that I will hear in doing this work. And universally, people report that it “feels better” to be free of the bad moods that overwhelm them. It feels good, in fact, to be in charge of their moods and sensations. And of course, it has a positive effect on their families and co-workers.

So these are my top three questions to ask yourself when looking “under the hood” at what to look for in a therapist. Yes, they need a degree and a license. They need experience. Those things go without saying, but they are nowhere near sufficient to make a decision which may save you from breaking up your family and the heartache that goes with it.

Dr. Deb Hirschhorn is a Marriage and Family Therapist. If you want help with your marriage, begin by signing up to watch her Masterclass at https://drdeb.com/myw-masterclass.

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