The 'How to Pick a Therapist' Live Chat Transcript

by Mark Sichel, LCSW

The following is based on the transcript of the "How to Pick a Therapist" Live Chat, held here on Psybersquare. The chat was hosted by Licensed Clinical Social Worker, Mark Sichel. Mark answered questions posted on the "How to Pick a Therapist bulletin board and shared what he has learned from his personal experiences as well as his 27 years worth of clinical experience. Enjoy!

Mark Sichel: Hello. I am so glad to see all of you here tonight. The reason we came up with the theme of How to Pick a Therapist is that I get many questions, both here in Psybersquare and also on my AOL message boards, about this subject.

It is a very difficult situation to be feeling vulnerable, confused, depressed, and anxious and to still have to assume the responsibility for picking someone to help with these problems. People go to therapy when they're at the end of their rope; it's a time of great confusion and upset.

The big problem people have in selecting a therapist is self-doubt. When one's life is coming apart, it's hard to take a stand that you, the consumer, have valid feelings and thoughts about the abilities of a health care professioinal. It's especially hard when you've begun some therapy with a person who then implies to you that it's your fault that you're not finding the therapy helpful.

I've been there as a patient, many years ago. I saw a therapist in college, who told me I needed twice a week analytic treatment. I was a mess and believed him, and followed his instructions. He was a Freudian therapist and didn't interact or say too much, but one day he was unusually quiet. I was lying on the couch and he was behind me. I turned around and looked at him and found him fast asleep. When I said to him, "Are you asleep?" he opened his eyes, and said, "How would you feel if I was asleep? And how would you feel if I was not asleep." I confronted him and said I just wanted to know, but he wouldn't budge from his analytic position. Finally, full of self-doubt and suffering low self-esteem, I answered his question and felt more defeated than before.

Fortunately I had the good sense to not return to the Sleeping Shrink, but for a long time, I doubted my own judgement in this matter. The next therapist I saw was a woman who was totally taken with me. She was supportive, and it was sure great to have a "fan" at this low point of my life, but after some months of her telling me how wonderful I was, I realized I wasn't benefitting from the treatment. When I told this woman I was discontinuing, she confronted me with psycho-babble about how I couldn't tolerate good feelings, and again I struggled with enormous self-doubt. Nonetheless, I knew I wasn't getting better, and knew this was not a therapist who could help me resolve my problems. Fortunately for me, some time after this I found a therapist who was interactive, confrontational in a supportive manner, and was skilled enough to help me sort out my problems.

One of our members wrote in and asked me to talk about what you tell a therapist on your first visit, and do you tell them all your symptoms and history. The member is concerned about a therapist overreacting to her symptoms of bulimia and self-injury, and fears that the therapist will commit her to a hospital against her will.

This member's concerns are very real, but she is in a bind because if she doesn't tell the therapist what is wrong with her, then they will not be able to help her. I would advise her to be frank with the therapist about her symptoms and history, and also to discuss with him or her the fear of an involuntary hospitalization. I would also advise her to begin to attend meetings of Overeater's Anonymous, where there are other people who struggle with the bulimia problem.

If I was her therapist, I would work with her based on a verbal agreement between she and I that she will attend OA meetings for support in between sessions, and with the agreement that she will take actions to stop the self-mutilation, such as calling me when she has the impulse to cut herself, or calling her OA Sponsor. The reason I'm suggesting OA is that many bulimics with whom I've worked have benefited from OA, and this person probably needs more support than just individual therapy. I personally have worked behaviorally with people who self-mutilate, and I have never needed to hospitalize a patient involuntarily.

Another member wrote in that her therapist told her that he didn't expect to live long enough to see his son graduate from law school, and the member said she still feels guilty about leaving him to work with another therapist. I would applaud your strength at leaving this man; he is needy, depressed, and looking for you to take care of him, and your perceptions were correct. I would hope that you're working with your current therapist to understand why you still feel guilty, for you did nothing wrong in reality.

I've heard many stories of therapists acting inappropriately with their patients, and your example is a good one in that you are a consumer paying for a service, and the person you're paying is asking you to provide the very service you need to him. Some patients can become seduced by becoming the therapist's confidante, but it is not helpful to them to be helping the helper. Again, I applaud your good judgement at withdrawing from this situation.

If you would like to participate in the next Psybersquare Live Chat, be sure to check the homepage for notice of upcoming chat features!

To learn more about selecting a therapist, read Everything You Ever Wanted to Know About Selecting a Therapist Part I


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