Shop For A Psychotherapist To Avoid The Lemons

I'm a big fan of psychotherapy. I do, however, believe that not all psychotherapy is equal. It takes good training, good skills, and unique qualities that can't be boiled down to a formula. FINDING good psychotherapy can be the difference between misery and the freedom to live a fulfilling life. Patients and their families must be be deliberative and well-informed as they search for the right treatment.

*assuming they HAVE a choice, which of course is not true in some countries or for people without money or insurance or proximity to qualified treatment - or the mental wellness THEY need to "shop for a psychotherapist as they would a flat-screen."

Shop For A Psychotherapist To Avoid The Lemons

"Some therapists fear that the push for evidence-based techniques will restrict their ability to connect with their clients on a deeply human level, that they'll be doing cookbook therapy.

Scott Lilienfeld, a clinical psychologist at Emory University, says a good psychotherapist can do both."


  1. Being a nurse for the last 31 years has taught me that physicians are just people. Some are extraordinary practitioners and some are down right negligent. Most fal in the category between the two. Within this spectrum I would like to choose someone who falls on the higher end of skill. And I do think practicing medicine and psychotherapy is a skill. Many people are capable of book learning but the ability to apply and learn from their continued knowledge and experience is quite different. I believe to be a really good practitioner, you must be able to think outside the box. I have seen many who only follow the book. They may barely examine or listen to their patients. Their scope is limited to a narrow spectrum of care. This is where you lose as a patient.
    It's so true that we as a society scrutinize a purchase of a car or appliance far more than a treating physician. Unfortunately, peer referrals are not always reliable. They are sometimes based on friendship or mutual financial benefit. My most effective way to fund the best treating practitioner is to talk to people in the field, nurses, docs, ask them who treats their family. Ask to interview a propective therapist. Defensiveness is a clear sign that they don't respect your right to ask...

  2. Two years ago when I was looking for a therapist I found interviewing them really useful too. The first one was too old school, just sat there looking all formal and scaring the whatsit out of me while I talked. The second was very badly informed, told me that gaining weight didn't matter (I was drastically underweight at the time), that half of my meals should be green leafy veg and that I needed to "re-parent" myself. Um, no. The third was wonderful and completely integral to my recovery. She wasn't an ED specialist but I'd been through ED treatment before and knew what I needed to do - I just needed someone to support me and help me learn new coping mechanisms. I think lack of confidence on the part of the client can make it really hard to say no sometimes - I didn't actually turn down the first two therapists, I just didn't show up again! I would be braver than that now and tell them exactly what I thought - but I'm glad I at least had the guts not to stick with someone who clearly didn't have a clue.

  3. Evidence based care doesn't mean that a provider finds one small research study on a type of therapy and blindly applies it to all patients. That's preliminary evidence only.

    Real evidence based care generally means there is a weight of evidence for or against a particular type of treatment and the types of clients/patients who would benefit should be relatively known (though not always). Generally, evidence based treatments have been scrutinized by professional organizations and scientists prior to recommending they be used in a broad fashion. This type of scrutiny is generally more than a typical individual practitioner would perform.

    IMO, whenever there is an evidence based type of care, this should be fully embraced as the first line care for everyone who has benefited from this type of care in the studies. I'm not sure what is so scary about that!

    If someone does not respond to the first line of attack, another can be chosen later on a more individual basis.

    This approach should give the best outcomes to the highest number of people from the get-go. Too often we see that evidence based care is given second or third or last-and it works! In an eating disorder, where malnutrition is an ongoing risk (with it's attendant injury to the body and brain of the sufferer), it doesn't make sense to save the best therapy for later.

    Of course humanism should be part of all care, evidence based or not!!!!

  4. Thank you for putting the * * bit in Laura - you know you'd get grumbling from me if you didn't!
    There isn't a complete lack of choice in our system - for a start there's always "take it or leave it" and, unless totally geographically isolated everyone here has some choice of GP. Also, limited though it often is, free care on the NHS always has evidence behind it - one problem though is that there is very little evidence in some areas, another is that many therapies offered, while evidence based and closely and well supervised, are very short term and that can be a problem for many.

  5. as a former psycotherapist and a consumer of therapists for myself and my daughter, I've learned one important characteristic that is most important to assess when shopping for a therapist.

    Yes, they should be trained in evidence based treatment for the condition but they also should be able to identify that each client is unique, that all clients will not benefit from the exact same approach, and that they should be able to acknowledge their limitations.

    My experience with clinicians who are not open to change, and not open to hearing when something is not working is a barrier to progress.

    I work with a wonderful CBT therapist who is very open minded to learn about new techniques, and to see each client as a unique case.

    She is open to learning from me and applying with her other clients.

    Although she has many years of experience and has been a leader in her field, her humble and openness to learning new information is very refreshing.

    Those who don't want to change or learn something new, are therapists to avoid.


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