Though there are many factors to consider in choosing a psychotherapist, the final decision will, and should, probably rest, as in choosing a spouse, on whether or not you “click” with this person. Some of the other factors are:

THE THERAPIST”S OWN PSYCHOTHERAPY: There is no perfect person, and, by extension, there is no perfect parent and no perfect psychotherapist. To minimize the possibility of blind spots, and of the therapist’s problems getting entangled with your own, be sure that your therapist has had substantial therapy of his/her own! At least one year of therapy is minimal, more is better. Also, be sure your therapist has someplace to bring his/her own questions about what is going on in your therapy. Your therapist should have someone s/he consults with regularly, i.e., some sort of supervision or ongoing psychotherapy. (Peer supervision is fine.)

With excellent health insurance, you may be able to choose a therapist freely. Some insurance companies have a list of therapists they reimburse. Some insurance companies use a managed care system in which a limited number of sessions are authorized at a time. The therapist has to make periodic reports to the insurance company (which I see as an invasion of my client’s privacy) to get additional sessions authorized. Many have no insurance. Paying for therapy entirely our of pocket can amount to hundreds, even thousands of dollars. Many therapists have “sliding scales”, but a private practitioner can only slide so far, and the further h/she slides, the fewer clients s/he can slide for. If either therapist or client resents the financial arrangement, it will interfere with the therapy! Clinics often have very low fees or will even see people for little or nothing. However, clinics vary in their willingness to let you change therapists if you are not happy with the first one. Many clinics have waiting lists, often several months long. Some areas have more than one clinic. Check for government, especially county mental health clinics, hospitals, charitable agencies related to religious denominations, family and children’s services and university psychology departments. These last often have clinics in which they train their advanced graduate students under faculty supervision. Students often make up in enthusiasm for what they lack in experience, but students usually rotate each semester, so you will have several therapists if you are in therapy for any length of time.

: There is no way to be absolutely sure of the competence or honesty of psychotherapists, lawyers, medical doctors, or auto mechanics. Seeing a licensed professional, however, a psychologist, clinical social worker, psychiatric nurse, or psychiatrist, at least means that your therapist has some reasonable amount of basic training. Furthermore, licensing boards have extensive power to discipline professionals. Therefore, if worst comes to worst, you have the licensing board and the professional association to complain to. Even the very few unethical practitioners know this, and may toe the mark because of it. With unlicensed practitioners, you have very few ways to check them out in advance, and very little recourse if things go wrong. Health insurance will not reimburse for unlicensed practitioners.

Psychiatry is a medical specialty, as is cardiology, gynecology or pediatrics. After four years of medical school, the psychiatrist earns an M.D. S/he is now a medical doctor, but not a psychiatrist. A residency in psychiatry means working and being trained in a psychiatric setting for four more years. A prolific psychiatric author, Dr. Chessick, writes in one of his books that a residency can be anything from an excellent training program down to “giving the new psychiatrist the key to the locked ward and saying ’go’”. Psychiatrists are experts on mental illness and on the interaction between biological and mental processes. In large metropolitan areas, you will find many psychiatrists who are highly trained and expert psychotherapists. In other areas most psychiatrists rely primarily on medication or other medical interventions, such as, electroshock treatment. Many of these psychiatrists have little training in, and do little or no psychotherapy

Psychology is a broad field with many specialties. Here, we shall deal only with those who work directly in mental health, clinical and counseling psychologists. These psychologists are experts in the processes of cognition (thinking), emotion and behavior. They are trained in various types of psychotherapy in order to

help people use their processes of cognition, emotion and behavior to cope better with their lives. They are also trained in psychological testing which is sometimes used to help evaluate these processes. Some psychologists would like to have limited prescription privileges so they could also prescribe psychotropic medication. A few psychologists have been trained to do this, but, so far, no state licenses psychologists to prescribe. There has been a small project in the military in which a very few specially trained psychologists have been allowed to prescribe. A doctorate in psychology takes four to six years, and includes at least one year of internship or traineeship. The differences between the letters Ph.D., Ed.D., and Psy.D. after a name are relatively minor. In my case, the most significant difference was that I had to take fifteen more academic points than the Ph.D. candidates while they had to pass examinations to show they had a reading knowledge of two foreign languages. Some psychologists serve residencies after earning their doctorate in which they receive further training while working in a mental health setting.

A masters degree in social work (MSW) takes two years, and includes field work assignments in which the student works in an agency under supervision.. In New York State, most health insurance will only reimburse for the work of social workers after they have an “R Number”. To get the “R Number” they have to have six years of supervised experience. Many professionals seek further training beyond their basic degrees. Ask your new therapist what training and experience s/he has had since graduate school. As in many other things, experience is the best teacher! Psychologists often have other specialties, e.g., neurological psychology or ADHD. For most therapeutic issues, however, there is little difference between seeing a psychologist or a social worker, especially after they have had some years of experience.

Therapy can be looked at in at least two ways: Some people see it as a quasi-medical procedure designed to “cure” certain psychological/psychiatric defects. Others see it as an educational process designed to develop human potential, and enhance the clients ability to cope with and enjoy life. Clearly it has aspects of both. Those who emphasize the first view tend to look for specific techniques that have demonstrated effectiveness and can be prescribed for specific problems. For example, Desensitization is the therapy of choice for simple phobias. Unfortunately, many phobias are not simple, they are embedded in extensive personality problems. Desensitization might still help, but only in combination with more comprehensive approaches. Using desensitization alone would be like treating tuberculosis with a cough suppressant. Those who view therapy primarily from the second perspective tend to look for general approaches that promote psychological growth.

You may be told about Evidence Based Therapy (EBT). Most therapists who talk about EBT take the first approach mentioned above. They look for techniques that have been “proven” in Random Controlled Trials (RCT), studies with carefully selected subjects who have a “pure” diagnosis and are treated by therapists using a manual to insure uniformity of treatment. The subjects are randomly assigned to treatment and non -treatment groups. (Note that such studies compare the treatment being studied to no treatment at all. They do not compare one treatment to another. Many approaches are too complex to be easily put in a manual.) Unfortunately, such pure diagnoses are rarely found in practice. Much research of this kind has been done with Cognitive Behavioral Therapy (CBT). It has been shown to equal medication in relieving depression. (The combination of CBT and medication is better than either alone.) CBT has NOT, however, been demonstrated to be more effective than any other approach in promoting general emotional and psychological growth, or even in relieving depression. Studies and surveys have indicated that psychotherapy is generally effective at promoting growth, but no approach has been shown to be significantly more effective than any other. That, of course, is an average. A particular approach may be more effective with YOU than any other even if it is not more effective on the average. Some therapists are generally more effective than others! Furthermore, a therapist that was effective with someone else, may not be as effective with you, and visa versa. It may well be that different approaches work best with different people, or even with the same people at different times. Therapists gravitate toward approaches that fit their personalities. You should too. Look for a therapist whose primary approach suits you, but who can muster techniques from other approaches when appropriate. Rigidity in a therapist is not a good sign.

The following descriptions of some of the major approaches to psychotherapy may help you decide what to look for, and what you’d rather avoid.   Note that there are institutes that teach one or another of these approaches to graduate mental health professionals, however, many professionals focus on one or more approaches without being certified by such an institute.

Behavioral Therapy

Behavioral therapy grew from the work of Skinner, and Pavlov. Pavlov showed that organisms, including people, respond to stimuli, e.g., a bell, by expecting whatever has followed it in the past. Skinner showed that organisms will repeat an action that has preceded a desired result. By producing the result an organism desires whenever a certain action/behavior is manifest, we can modify the frequency with which the organism manifests that behavior. For example, by providing food whenever a rat pushes a lever, we can increase the number of times the rat pushes the lever. Behaviorism considers the organism to be a “black box”. We know what it does, but not what goes on inside. Even thoughts, sensations, and emotions are considered behavior, and are, thus, outside the box. In psychotherapy, behaviorist techniques work best where the behavior is very specific, and where it is clear who has the right to decide what behavior is desirable. Desensitization for specific phobias is an example of a very useful behaviorist technique.

Client Centered Therapy

Client centered therapy is designed to provide an atmosphere in which the client's natural tendencies toward personal growth, integration, and self actualization can emerge. It is believed, and the belief has considerable support in research, that growth in therapy will be enhanced to the extent that the therapist is a) empathetic, i.e., understands the client's feelings, b) caring, i.e., demonstrates "unconditional positive regard" for the client, and c) congruent, i.e., genuine or honest in the relationship. Therapists of many points of view use client centered techniques along with other more active, more directive, or more historical approaches.

Cognitive Behavioral Therapy (CBT)

The theory behind CBT is that our emotions and other behavior is caused by our thoughts. Therefore, if we can teach people to think rationally, we can stop them from having depression, anxiety or other unwanted feelings. An early cognitive behavioral therapist was Albert Ellis. He called his therapy, “Rational Emotive Therapy”. Studies have shown CBT to be as effective as anti-depressant medication in reducing depression. Combining CBT and medication has been more effective than either alone. Other studies have shown that all therapeutic approaches are effective. Cognitive behavioral therapists will point out irrational ideas that contribute to depressed feelings, and assign homework in which the patient practices refuting the irrational thoughts and replacing them with rational ones. For this writer, a major drawback of CBT is the possibility that the therapist will decide what is rational for the client. Nobody has a monopoly on rationality or truth.

Eclectic

Eclectic therapists use a combination of techniques and ideas from many therapeutic orientations. Their choice depends on their experience and training, and on their judgment about what will work best in each situation. Almost all therapists are eclectic to some degree. Some eclectic therapists have developed a broad understanding that encompasses ideas from many sources, others are casting about because they have not succeeded in developing an integrated point of view.

Existential

Existential analysts hold that the goal of therapy should be heightened awareness of one's existence and one's relationship to the world, and the freedom to relate to one's world differently. While the techniques of existential analysts are similar to those of other psychoanalysts, therapists of some other approaches (e.g., Client Centered or Gestalt) also have an existential point of view.

Experiential

This term is used to identify approaches to psychotherapy, such as Gestalt and Psychodrama, that emphasize the client learning primarily from his/her own experience rather than from interpretations by the therapist. Of course, this is a matter of degree. Both kinds of learning take place in any therapy. In the opinion of this writer, experiential approaches reduce the chance of ending with a client who can tell you all about her/himself, but hasn’t changed a bit!!!

Gestalt Psychotherapy

Gestalt psychotherapy is based on a theory of perception and learning. Our gestalt, or complete perception, of anything we observe is made up of two elements. The first is the figure, that which seems significant, relevant, or part of the pattern. The second is the ground, that which seems insignificant, irrelevant, or not part of the pattern. As we observe any object or situation, different things take on or lose significance, i.e., parts of the figure become ground, and visa versa. This process enables us to solve problems. For example, when I want to drive a nail, the rock at my feet is irrelevant (part of the ground) unless I don't have a hammer. If I realize it could be used as a hammer it becomes relevant (part of the figure), and I can solve my problem.

Gestalt therapy is designed to restore the process of interchange between figure and ground when it gets stuck. It makes use of direct experience rather than interpretation. It focuses on the here and now, being concerned with the past and future only as they are manifest in the present through memories, fantasies and plans.

Gestalt therapists draw their clients' attention to body language, feelings and sensations, and often ask them to act out real and imagined incidents from their lives or their dreams. By the use of such techniques, Gestalt therapists try to increase their clients' awareness of aspects of themselves and their lives that they have overlooked, or from which they have become alienated.

Humanist

"Humanist" is a title that applies to a number of therapeutic orientations, including Gestalt and Client Centered, which see the goal of therapy as the development of human potential , as opposed to “curing“ an “illness“. There is a great deal of overlap between the Humanist and Existential points of view.

Psychodrama

Psychodrama is the Link trainer of psychotherapy. The Link trainer gives one the experience of flying an airplane without leaving the ground. Psychodrama gives one the experience of coping with difficult life situations without leaving the safety of the psychotherapist's office. Using psychodramatic techniques, the therapist can help one to try different roles or behaviors, and to get in touch with feelings that have been pushed aside or repressed. Therapists of varying theoretical backgrounds borrow psychodramatic techniques, but Psychodrama has its own theoretical base centered around role theory, spontaneity-creativity theory, and interpersonal relationship theory.

Transactional Analysis

We all find ourselves having conversations in our heads. Transactional Analysis provides us with a convenient system for sorting out the different "voices"

 in these internal conversations, and for analyzing their effects on our external transactions with others, as well as on the course of our lives. Among its other advantages, TA terminology is graphic , catchy and easy for people to understand.

Psychoanalysis

This is the original psychotherapy developed by Sigmund Freud. The patient lies on a couch with the analyst out of sight behind him or her. There is a, probably apocryphal, story that Freud developed this arrangement because he was uncomfortable looking his patients in the eye. Be that as it may, in this position, the patient cannot respond to the analyst’s facial or bodily expression, and feels alone in her/his own space. This stimulus deprivation makes it easier for the patient to be in touch with inner mental, emotional and physiological processes. The patient is instructed to say anything that comes to mind, no matter how absurd or embarrassing it might be. From time to time, the analyst interjects “interpretations”. Sessions are usually held two or three times weekly. Early analysts saw their patients five or more times weekly. The analyst thinks in terms of Freudian concepts, such as, the id, the ego, and the superego, and the developmental stages, oral, anal, latent, and genital. Central to the analysis is the transference. This is the way the patient projects figures from the past onto the analyst. That is, the patient relates to the analyst in ways that he used to relate to his parental figures. This is facilitated by keeping the analyst’s personality vague through use of the couch. Most modern analysts have modified or eliminated many of Freud’s ideas, including his male chauvinism, that were outgrowths of the time and place in which he lived. Furthermore, analysis has developed in many directions. Even in Freud’s time, Adler and Jung developed competing “schools” of analysis. There are still analysts who follow the ideas of Jung and of Adler, as well as many newer thinkers, such as, Kohut, Winnecott, and Anna Freud.

Psychodynamic Psychotherapy

Psychodynamic psychotherapy is somewhat watered down psychoanalysis. It uses the intellectual ideas of psychoanalysis (e.g., the id, ego, and superego, the developmental stages, and the transference) but not some of the outward trappings, such as, the couch or sessions several times weekly.

Short-term or Time-limited Psychotherapy

When time is limited by circumstances or design, therapists and clients often try to focus on specific therapeutic tasks or areas that could be dealt with in the available time. In some situations this may be useful, but it is important to remember that nobody has really developed any technique for making therapy go faster.