When you find yourself in a state of prolonged psychological distress, it can be overwhelming just thinking about getting professional help. Add to this the dilemma of trying to be sure that you’re actually investing your time and money wisely when you finally do choose a therapist. It can certainly be a daunting task, even more so if undertaken during a time of stress.
There are many factors to consider when selecting a therapist and which therapist to use. This article is by no means exhaustive, and these are mostly issues I’ve had in the past when looking for a good therapist for myself, as well as issues clients have brought up with me about their experiences in searching for a therapist. Certainly, there are many excellent therapists out there working in a variety of different contexts; however, to claim there aren’t dangerous, useless, or outright predatory therapists out there, as well, would be misleading people. Here are five concerns I think anyone seeking therapy ought think carefully about before committing to a therapist.
1. Not all therapists are equal
The first thing to consider when choosing which therapist is good for you is to acknowledge some basic facts: Therapists are people and therapy is a highly personal experience. No two therapists are equal in quality, skillset, and experience. Some therapists are better at dealing with depression, while others will be better at dealing with relationships. Some therapists have a strong moral code (not necessarily religious), while others are moral relativists. Some therapists also have their own issues- a therapist might feel unreasonably envious of pretty women and can’t listen compassionately to a pretty woman talk about how significant her problems are. These therapists might pretend to care, may even do a convincing job of pretending to care, but it is essential that a therapist genuinely cares and does not simply act caring because they are paid to. Your therapist should see you as a whole person, deserving of sincere compassion and understanding.
There is no effective way for a central authority like a government bureaucracy or a union like the American Psychological Association to supervise and hold psychologists accountable. The government bureaucracy can’t do it because government bureaucrats don’t have the experience and expertise required to know if a person deserves a license to practice or not. If they did have that expertise, one would hope they were actually working as a therapist instead of wasting their valuable talents issuing pointless licenses that do nothing to protect people from rogue therapists and perhaps even serve to increase the danger by lulling people into a false sense of security about their well-being with a therapist. Unions like the APA are primarily concerned with advancing their own financial interests through partnerships with pharmaceutical companies and increasing the wealth of their membership, not with improving the quality of therapists and treatment.
2. Are you paying too much for your therapist?
The second thing to consider is how government subsidies affect the practice of psychologists. In Australia, as in many other countries, the government provides subsidies in the form of rebates for people seeking the services of a therapist. The typical rate for a therapist in Australia starts above $100/h and quickly exceeds $200/h. Indeed, the Australian Psychological Society recommends a fee of $241 for a one hour appointment (often shortened to a 50-minute “therapeutic hour”). If you’ve had a one hour session with a therapist at any of these price points, did you feel they actually provided $100 or $200 worth of value to you in that hour? The bottom line is that therapists are often grossly overpaid and this creates several problems. When you over-pay someone for a job, they can develop an exaggerated view of themselves and their importance. People paid on a commission (per sale or service rendered) work much harder on a lower commission. Don’t get me wrong; underpaying someone can be just as bad, too, but it’s a difficult matter managers have to deal with when deciding how much to pay people: not too little, not too much. In this case, you are the manager and the therapist works for you. Overpaid therapists are often poorer quality than therapists paid fairly for their ability and time.
The reason why therapists are overpaid is because of how the government subsidises them. If you charged $60/h for your clients, and had plenty of business at that rate, but the government offered to cover $50 of that, would you charge your clients only $10? That was the theory, but in practice therapists instead increased their charges to $110/h. This is because, as far as the client is concerned, they are still paying the same amount of $60/h. The problem with this is that it is immoral. The therapist is enriching themselves at the expense of taxpayers while not making themselves any more affordable to their clients nor providing any additional value in their service. A therapist needs to be a moral person; they cannot be a moral relativist or opportunist ripping off their clients and the public. (For this reason, I do not ask for any government subsidies for my services. As a philosopher, I appeal to your moral judgement and for you to exercise it to live a better life. It would be hypocritical of me to tell you to be honest and respectful of yourself and others, if I am being dishonest and disrespectful myself.)
3. Do they teach you how to fish?
The third issue is that therapists have a financial incentive for you not to get better. So long as you are depressed, miserable, and dysfunctional, you have need of their services. Instead, many therapists employ a perversion of the maxim “give a man a fish and he eats for a day, teach a man to fish and he eats for a life time.” Their version goes like this, “soothe the client’s pain and get some money today, heal the client completely and lose your income stream.” It is sadly not uncommon for people to see a therapist for years and show no signs of improvement in their mental health. Unethical therapists do not mind this at all. They like these clients, as it gives them income security. A good therapist should want to see you get to the point where you no longer need them, so you can move on and live your life, and open up their schedule to the next person who needs help. I am working as a therapist because I see traumatised and emotionally wounded people everywhere and I don’t want to live in a world full of emotional cripples. If one of my clients no longer depends on me, I’m happy! All I ask is they refer other people to see me when they no longer need me. I consider my excellence in job performance as my financial security, not luring people into a parasitic financial relationship after they’ve come to me for help.
4. Do they care about you?
The fourth issue is the quality and type of training psychologists have. I’ve met, dated, worked with, and seen many psychologists. Some of these people are exceptionally wonderful human beings, but sad to say, most of them are appallingly average and some of them have actually been nothing more than sexual predators. The first problem with training is that nothing substitutes for experience. As in any professional field the best therapists tend to be the older ones; younger therapists lack the necessary experience. Studying out of a book does not necessarily help one to become a therapist. It does not appear to matter what kind of therapy they are practicing- philosophical, psychoanalytic, cognitive behavioural therapy, art therapy, etc- because what matters is their experience level and genuine concern for the well-being of their patient. Good therapists are intelligent and learn from their experiences to become great therapists over time. Bad therapists read diagnoses from a book or a study course and try to match them to their clients.
Many psychologists are trained out of the Diagnostic and Statistical Manual (DSM) produced by the American Psychological Association. This book provides hundreds of pages of descriptions of symptoms and diagnostic material, but absolutely nothing insightful as to the reasons why a person might be exhibiting such conditions. The choice of what goes into the DSM is decided by political and financial interests. One famous example was the inclusion of homosexuality as a mental illness when it was popularly believed to be; when it ceased to be politically expedient to classify it as a mental illness, it was removed. If, in the future, people change their minds again, I would not be surprised if it was put back in there. The point is that if psychology is a science, like physics or chemistry, then politics should not be influencing what is considered mental illness or not. We don’t have a vote whether or not carbon is an element or a compound; it is decided by reason and evidence, even if the vast majority disagree with what the experts decide. When what counts as mental illness is decided by popular opinion, then psychologists turn into political agents of mental enslavement. Furthermore, a diagnosis of a condition is only minimally useful, deterministic, and often causes a therapist to lose sight of the whole person that they are treating.
When seeing your therapist, it is important to be clear what role they are taking in your treatment. Are you the focus of the treatment or are they? Are they helping you to understand the issues you face or going off topic? Are they interested in helping you become independent of them or are they comfortable just taking your money? Do they ask you probing questions and encourage and support you in talking about difficult issues or do they let mentions of significant experiences fall by the wayside, unexplored? Are they listening to your unique experience or are they merely concerned with diagnosing you? Do they think you can solve your own problems or do undermine your self-confidence with unhelpful suggestions/instructions or imply that you are “broken” or “sick” and try to steer you towards medications?
5. Are they a drug pusher?
Finally this leads into the last issue you should consider when assessing the value of your therapist. Are they actually a drug pusher? Most people already know something about the enormous political power and influence of the pharmaceutical industry, but many people do not realise that pharmaceutical companies directly target doctors and psychologists in their marketing strategies. Sales reps from pharmaceutical companies offer medical doctors and psychologist all sorts of financial incentives to push anti-depressants on their patients.
It is probably shocking for many people to hear, after having been subjected to decades of aggressive marketing, that anti-depressants are not just unhelpful, but generally lead to a much worse long-term outcome for the patient (For a thorough discussion of this issue I recommend this book). It is easier to understand this once one thinks about other drugs like heroin, cocaine, nicotine, alcohol, etc. People take all these drugs to try to escape having to deal with their unhappiness. That makes heroin, cocaine, nicotine, and alcohol simply alternative anti-depressants. It even makes paint sniffing another form of anti-depressant. All these drugs ‘work’ in the sense that they aid the person in avoiding confronting their uncomfortable feelings and/or facts about their lives. If it is so bad to use heroin, cocaine, nicotine, and alcohol to deal with your emotional problems, what makes taking Prozac, Zoloft, Effexor, or Cymbalta any different? The first group of anti-depressants are socially unacceptable, while the second group, thanks to clever marketing and government corruption, are not only socially acceptable, but often even thought of as desirable.
This leads back to the philosophical problem with all substances taken as self-medication for depression. If sadness and anxiety are the only motivators to change your life from bad state into healthy state, then by taking drugs that suppress your sadness and anxiety, you are not dealing with your problems, merely pretending they don’t exist. This results in those problems existing for much longer, and the longer these problems go unaddressed, the more damage is done to one’s life. For example, say you are in an abusive romantic relationship, your sadness and anxiety is telling you get out of that bad relationship. If you take drugs, you might end up staying in that abusive relationship for years longer than you would have if you had not taken the drugs. That is years more of your life wasted because you did not honour and respect your feelings. This is what alcoholics do; they might hate their job, so they drink to make their job bearable, instead of just leaving their job to find one that is far more suitable for them.
I prefer a drug-free approach because I want my clients to learn to honour and respect their feelings, to become comfortable and accepting of their feelings, and learn healthy strategies for responding to the demands of their feelings in order to create a happier life for themselves. Drugs hinder this progress a great deal. While they may make one’s life bearable in the short-term, only self-knowledge and self-esteem will produce lasting, long-term results by enabling you to function as your own therapist throughout the rest of your life.
The best person to evaluate whether or not a therapist is good for you is yourself. You need to understand that you are a paying customer and should expect value for the money you pay to a therapist. If you are not paying for a therapist yourself, because the government or someone else is covering the cost, you need to keep in mind how the people paying for your therapist would feel if you were to waste their money on a service that is not actually helping you, not to mention wasting your own time and delaying your own progress. By exercising discretion in your choice of therapist, you will help to weed out the bad therapists, and in turn, help to promote the good therapists, thereby improving the quality of mental health services for yourself and everyone else.