TalkifUwant | Counseling | FL | DC | MO

Online Talk Therapy services for residents of Florida, District of Columbia and Missouri.

Is My Therapist Any Good?

Kurt LaRose MSW LCSW

As first published in 2005, updated in 2011 and revised 2019

There is research that suggests the key to whether or not counseling works is not the method of treatment 22, so much as it is the relationship between the therapist and the client. Another consideration is the therapists own beliefs about their ability to be effective and if the counselor pursues interventions to improve their effectiveness 23.  To be sure methods in care matter.  Specialties in mental health however are increasingly limiting generalist, eclectic and person in environment interventions.

Specialists matter.  Hypnotherapy, battering and domestic violence, LGBTQ treatment, and online models are areas to consider.  Increasingly, as neuroscience is built into the training of mental health provider models of care, bias becomes less and less a driving factor to talk therapy and the harder science paradigms do.

For an interesting take on the impact of bias in treatment see the LGBTQ article here and check out the eclectic paradigm in mental health applications too.   The merging a softer “social” science that incorporates a bit of the more genetic, biological aspects of the brain and body will guide improved practices for mental healthcare more and more.  Besides, today’s well informed mental health consumer expects as much!  K. LaRose

Rapport, as it is often called, means that there is a working relationship between you and the practitioner to such a degree that there is trust, communication, goals, and a sense of success and/or direction.  In order for any treatment to occur, rapport must exist whether you are new to therapy, or even if you’ve been going for some time.

The therapeutic process can become problematic if rapport becomes a higher priority than treatment interventions.  If the therapist and the client become so mutually reinforcing to each other that meeting each week becomes a time of catching up, chatting, having a few laughs, maybe even a few cries, and talking about other people of significance (and insignificance) it is not therapy that is taking place.  The client/therapist relationship, in this case, is not necessarily a clinical one.  And, if it is not therapy that is taking place each week then why pay for it?

If someone has been seeing a therapist regularly for 6-12 months (generally a long time depending on why therapy is indicated), the issue of most significance is to what degree the person is experiencing social, occupational, emotional, and/or psychological change.  People go to counseling for the purpose of finding some kind of improved satisfaction in life and/or to avoid some kind of difficulty in life.  But regardless, improvement is a key consideration.

And realizing that the definition of what constitutes improved change in a persons life as largely a subjective determination, the issue can be reduced to a few simple key questions:  Do you believe that your life is changing for the better under the care of your current therapist?  Is the change that you’re experiencing one that you are pretty certain will impact you positively in the distant future?  Do you envision a time when you will NOT need to see the therapist?  Lastly, what do you expect is a normal time frame for counseling services?

I remember being told once that a person had been seeing a therapist for many many years because they felt that they always needed someone to talk to. When I suggested that maybe what they needed was a friend, the person said something pretty interesting: “friends shouldn’t cost $90 (or $155) bucks an hour.” –K. LaRose

But before good therapy can begin, there must be a good assessment, followed by an intervention.  Therapy interventions are usually designed to effect change in a person’s life, often in a relatively short amount of time.  Of course, the time that treatment lasts varies based upon many factors: treatment model used by the professional, whether or not a mental disorder exists, the type and severity of the mental disorder, and whether or not pharmacological therapy is also indicated.  Regardless of these variables, however, is the issue of change.  If change is not being experienced by the client, it may be time to consider a new treatment strategy.

Every client who enters therapy should expect a few things from the professional who they are seeing or who they are going to see for help.  Your therapist should tell you what the problem is, and if there is a problem the clinician should explain whether or not your particular problem merits a mental disorder diagnosis found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.  Either way, the therapist is likely to have some kind of a written plan for treating you and you should likely review the plan.  In looking at the treatment plan (or therapy intervention) here are a few additional things to consider:

  • How many sessions will I need to attend: how long will each one be and for how many weeks do I need to come?
  • What are the treatment goals for me and do I agree with them?
  • How will my progress in treatment be measured and/or tracked?
  • What is the fee for each session and does my insurance cover it?
  • If my insurance is being billed, do they require a mental disorder diagnosis before they will pay for my counseling sessions?

If you were never given a formal treatment plan with a certain number of indicated sessions to treat your particular issue, then you might want to question whether or not a plan of action exists.  It is also possible that your particular disorder is such that a specific number of sessions cannot be certain (usually true with more severe mental disorders), or that the therapist you’re seeing uses what is known as a “strategic model” of intervention.

Either way a formal treatment plan should be developed by whoever is going to treat you in therapy.  You as the client have a right to know what your therapist is thinking in the way of treatment strategies, the number of expected sessions, and the treatment goals.  Treatment goals, treatment methods, and specific interventions can usually be established following an initial assessment interview, and a written report is often available within a matter of three to four weeks.  With the practice of LaRose a complete treatment plan is created during the consultation, after which clients are asked to go over and review it to be sure there is agreement and an idea of a treatment trajectory that will work!

Rev 6/27/19