For many of us who have a mental illness, therapy is an essential component in our quest for healing and wholeness. Choosing a therapist who will assist you in that journey is vital. However there are several factors which one needs to consider. Among these are: the therapy method the therapist employs, the personality of the therapist in question, and the ease in which you can engage the therapist.
As an illustration of all of these factors in play, I will relate my experiences in choosing my therapist, which had its challenges, pitfalls, and successes.
I suffer from a bipolar disorder, complicated by PTSD and a history of alcohol dependency. I have been in therapy for most of my adult life, and my journey toward healing encompassed the employ of numerous therapies and therapists depending upon which problems I needed to address. I have had good therapists and bad ones, and the methods of therapy ranged the full gamut: from cognitive behavioral therapy to dialectical behavioral modification.
I first sought therapy in my early twenties to address the emotional abuse I was subjected to in childhood. I had extremely low self-esteem, was often suicidal, and had difficulty with intimacy. These conditions made it difficult to engage socially, and I often used alcohol as a social lubricant, which later manifested itself in dependence. These problems led to legal mandates for therapy, which put me in the unenviable position of court supervision. In that position, one has less choice in selecting a therapist who will address all of the problems that one faces, and often leads to substandard care with therapists that are often overworked, and interested in only addressing the addiction component of one’s problems. This means that the total picture is often overlooked, which leads to relapse, and no therapeutic resolution.
After that hurdle, I encountered the problem of finding a therapist, who could address all of my problems. As a gay man, I needed to find a therapist who was understanding, even more, empathetic to my sexual preference. That quest was riddled with futile attempts in finding a therapist who would understand the nuances of gay culture, the fear and grief issues relative to the unfolding AIDS crisis, and social isolation I encountered by being gay in the early 80’s. I encountered a therapist who later was removed from my case because of his attraction to me, and numerous female therapists who while stating that they “understood” what it was like being a gay man, really had no clue in comprehending the challenges a gay man faces in a predominately heterosexual world. I had shame based behaviors which needed to be addressed, and an inculcated outlook, stemming from childhood, of self-loathing. I needed to be healed in these areas, because I refused to be ghettoized from career participation in the larger heterosexual world of international trade, and I faced unique challenges in building a social support system that embraced my litany of pathologies.
When I was diagnosed with a bipolar disorder later in life, I needed to find a psychiatrist, who could prescribe effectively. In most cases this meant that I had to employ a therapist from the same provider as well. I have encountered the fact that most providers will not assign you a psychiatrist without your commitment to see one of their therapists as well. This often leads to the unique dilemma of having an effective psychiatrist, while seeing a therapist in whom you cannot relate, of visa versa. I have been in one such situation where the result was I had to leave the provider altogether, setting me back months in recovery.
After many false starts and disappointing therapeutic encounters, I found a therapist in whom I had complete trust and who, as a gay man, undenounced to me, offered real understanding of my issues, and communicated with me effectively, non-judgmentally and in real dialogue which challenged me to renounce past mistakes in behavior and self-perception. He was aggressive enough not to let me fall back into behaviors which no longer served me well, yet sensitive enough to realize when to pull back and let my psyche rest to digest the new challenges in behaviors and self-perceptions I was undertaking in the road to healing. The result was brilliant and enlightening. I was engaged with him for nine years, a period of substantial healing for me. When he left to take on a new position, I faced abandonment issues which needed to be addressed, because he has been such a supportive component in my life.
My journey in finding the right therapist, has led me to make the following conclusions and observations which I would like to share with you. They are:
- Find a therapist who will engage you in REAL dialogue. Are they looking at their watch during your sessions? Do they have written assignments which they want you to complete for your next session? I want to be engaged, not schooled.
- In selecting a therapist find one in whom you have total trust. I typically can know if my therapist is a person in whom I can confide my deepest, darkest secrets in two or three sessions, by observing their countenance, posture, and choice of language. I am not in session to be judged or told what I must do, I need to purge dysfunctional self-images and behaviors. I need a therapist who can VALIDATE my feelings, not JUDGE them.
- Beware of therapists who ask intrusive questions you are not comfortable in answering. I have had a therapist who asked such questions as: “What do you think about when masturbating?” or “What are your sexual fantasies?” Remember that therapists are people too, subject to dysfunction, or purely selfish motives. If you find that this is the case, terminate the relationship IMMEDIATELY. You no not need additional problems, or a therapist who only is there to gratify warped self-serving interests.
- Do NOT allow yourself to be pigeonholed by social services into addressing one problem without addressing other, often underlying, issues you may have. In my case, I was singled out as having an addiction problem which social services sought to address solely, without considering the underlying problem of PTSD and mental illness, from which I sought relief by self-medicating with alcohol. If dually diagnosed, make sure that your therapy addresses ALL of the issues you have, or risk relapse, and an exacerbation of the root causes of your dysfunction.
- Finally, be proactive in your therapeutic care. Shop around. Remember you are the consumer, in a therapeutic market place full of choices. Don’t settle for an effective psychiatrist, but an ineffective therapist, or visa-versa. Find a therapist who will be effectively aggressive in challenging your toxic behaviors or self-images, yet sensitive enough to pull back and let your psyche rest to digest the changes you are going through. Remember YOU need to set the pace in which your therapy progresses, NOT the therapist.
Marc is a volunteer at Dance in the Rain, a non-profit organization located on Cape Cod, dedicated to providing peer to peer support to people with mental illness, and emphasizing a “Whole Person Approach” to enable healing and wholeness.