How to find a therapist
This evening I’ll be doing an event at The School of Life with Brett Kahr on the subject “How to make sense of psychotherapy”. Which is a great topic, and apparently the talk is already sold out with a very long waiting list – I don’t attribute this to my brilliance but to people’s hunger to find out about therapy (and of course to Brett’s brilliance). So this seemed like a good time to put up this post which I’ve been working on for a while. It’s long, and I thought of posting it in multiple parts over several days, but really that’s just annoying for anyone who wants the information. So here it all is.
This post was inspired partly by chats with some friends, and partly by the fact that I think the advice on the BACP website and on the site of the UK Council for Psychotherapy is just… not very helpful to anyone who isn’t already an expert on therapy. (I have a theory that the reason these organisations put up lists like this and think they’re sufficient is that they’re very useful to the people who work in these organisations – because they know half the therapists on the lists personally, and understand the subtle differences in each description.)
I remember when I arrived back in London after living in New York and wanted to look for a therapist, I found these directories totally useless. This post, basically, is all the advice I wish someone had given me then.
I make no secret of the fact that I’ve had, and been significantly helped by, psychotherapy. At least, I think I make no secret of it. If there are any members of my family reading this who don’t know: hi, I’ve had therapy.
But really, I’m pretty open about it in conversation with friends. Which is probably why, at a rough estimate, about a dozen of my friends have asked me for my advice about finding a therapist in the past three or four years. I can understand why: the world of therapy is dauntingly incomprehensible if you’ve never done it before.
Plus, in the UK at least, there’s a huge stigma in admitting you’ve had/you want help of this kind. It’s a shame, because psychotherapy can actually help, whereas some of the alternatives that somehow have less stigma in Britain – like binge-drinking to ‘forget your woes’ – do much more damage.
A few years ago I saw a woman on a TV money makeover show who was spending literally thousands of pounds a month on ‘psychic hotlines’ because they gave her space to discuss her feelings about the breakup of her 10-year relationship. The host, I think it was Alvin Hall, said “instead of spending all this money on psychic hotlines, go and get yourself a good therapist. It’ll be so much cheaper.”
When he came back for his three-month follow-up visit, she’d done really well with all his other pieces of advice but was still spending £300 a month on ‘psychics’. He said “what did I tell you to do about this?”
She looked at him and said “yeah, I just need to grit my teeth and give them up.” “And get therapy,” he said.
“Just grit my teeth and go cold turkey on the hotlines,” she said.
She literally could not hear him telling her to get therapy because, I think, in the UK people hear “you need therapy” as “you are a damaged, broken, hopeless individual who can never achieve normality and happiness”. The stigma is so strong that it’s really hard for many people to seek the help they need.
Anyway, having had a few of these conversations, it occurred to me that perhaps I could write a post here with all the advice I’d give to a friend who asked me how to go about finding a therapist. Just in case there’s anyone out there who wants to find a therapist but is too embarrassed to take the first step of asking how to do it.
A couple of disclaimers:
1. I am not a doctor, a therapist, or trained at anything much except writing down my opinions and making up fictional stories in my head about imaginary people. All this advice is based purely on my experience and that of people I know. It’s partial and possibly biased. Although it’s the best advice I’m able to give, you’re going to have to make your own minds up about what’s right for you; that’s your decision not mine.
2. This advice is very London-centric.
Although the basic principles probably apply pretty much everywhere I’m only going to recommend named organisations that either I have used or which people directly known to me have used. I’ve only ever sought therapy in London and in Manhattan, and in Manhattan everyone I knew was in therapy and so all had useful recommendations to make. This is advice for people who live somewhere – like London – where there’s still a therapy stigma, and people do not routinely swap stories about their therapists over brunch at Sarabeths.
Having said all that… here are Some Good Ways to Find a Therapist
1) If you have friends who are in therapy, or who are therapists, ask their opinions and advice. Your friends may recommend their own therapist, another therapist they saw who they didn’t click with but think might work for you, or they might ask their therapist for a recommendation. Friends who are therapists will have an even wider network to recommend from. This is a lovely simple way, and probably won’t work if you live in the UK. However, I include it first because I think it’d be better if we were able to do it like they do it in Manhattan.
A brief detour into my own story: when I lived in Manhattan I came to a crisis point in my life. I didn’t like my job, I didn’t like the life I was living in my free time, I was dissatisfied with my religion, I was in love with a man who wasn’t able to love me back and terrorists had recently flown a couple of planes into two big nearby buildings. As was my wont, I went and complained and cried at my New York friends who all listened very sympathetically and, at the end of each conversation said “have you
thought of seeing someone?” By which they meant, a therapist. And because all of them had seen not one but several therapists they were able to flick through their mental Rolodexes until they came up with someone they thought might work for me, and one of these recommendations was, in fact, perfect. This is lovely but unless you have a lot of therapy-literate friends, it won’t work for you.
So we go on to…
2) This is my big piece of advice, the thought that if you came to me and asked me about this in private I would present to you like precious treasure:
go to a referral service.
Such places exist. They are run by professional organisations. You get to sit down for a couple of hours with a very experienced therapist, tell them all the things that are troubling you, and then they have a think and send you to someone who, in their opinion, will suit you. This is how I found my therapist in the UK. This is how many people I know have found therapists who work for them.
I know of three referral services which I can personally recommend on the basis that they made referrals with which I or people I know have been happy. They are all based in London but I believe they do referrals nationwide; at the very least, they should be able to put you in touch with an organisation in your area that makes referrals.
Founded by Susie Orbach, although I believe she’s now no longer associated with it (not that I know why she left, but… therapeutic groups and people seem to be constantly having spats with one another which are not comprehensible to the outside world. Therapists do not, in case you’re wondering, seem to be perfectly enlightened beings of peace and harmony themselves; like any other kind of doctor, their ability to help you heal isn’t necessarily related to their own health). The WTC do really good work, but only see women. If you’re a woman I recommend them very highly – go there without delay.
The Association for Group and Individual Psychotherapy (AGIP)
Honestly, sometimes I feel quite cross with therapists. AGIP is a good organization, which has found excellent therapists for people I care about. But when you go to their website and click on the ‘find a therapist’ link it takes you to one of those useless lists of therapists rather than to their extremely useful *referral service*.
But apart from their illogically arranged website, they are good. They also
have a low-fee service for students and people on benefits.
Centre for Counselling and Psychotherapy Education
Why do therapists need so many different professional bodies? What is the difference between them? I don’t know, but if any therapist reading this could enlighten me that’d be great. The CCPE has a rather more sensibly organised website than AGIP, and their referrals service has worked for several people I know. I’ve had less personal contact with them than with the WTC and AGIP, which is why I put them third, but a doctor friend mentioned them to me and I know people who’ve found very good
therapists through their referrals.
3) This is less of a method than a piece of advice. When you meet a therapist, do not worry about their “analytical framework” or their model or their school of thought. They may say things to you like “I’m a neo-Freudian” or “I’m a Lacanian”, or “I work in a psychodynamic structure”. Ask them to explain what this means in practice to the work you’ll be doing together. The differences between these various schools are often, to the untrained patient, pretty much invisible. The key question to ask yourself when you meet a therapist is: do you feel comfortable with them?
Do they seem like they understand what you’re talking about? When they speak, does what they say make sense? [If it makes sense and stings a bit but only in the good way that makes you feel like you’re understanding something new about yourself, you are probably in good hands.] Do you feel like you can open up to this person? Do they seem intelligent? Do they seem to ‘get’ you? Trust yourself (I shall be returning to this refrain). Trust your own ability to pick someone who you can work with. Do not worry about whether or not they have ‘neo-Kleinian leanings’.
Ways of finding a therapist which might seem sensible but about which I have my doubts:
1) Getting a referral from your GP. I realise this is controversial and I’d be the first to admit that it’s just my highly inexpert opinion. However, my friends who have had NHS therapy have had decidedly mixed results. Some people have found it just fine, some really helpful, but some have found it useless. The thing is… the NHS don’t give you a choice in therapist (as far as I can tell) and don’t do a detailed referral session like a private referral service does. I think there’s a bit of a lottery about whether you’ll end up seeing someone highly experienced or someone who’s been on a three-week counselling course. And I think there’s something quite powerful about the experience of private therapy in which you choose the person yourself, you know that you’re paying them, you say how long you want to go on for.
Having said that, therapy is extremely expensive. If you’re unemployed or young or on a low wage, a private referral service will probably be able to find you a therapist who works on a sliding fee scale (down to £5 a session in the case of the Women’s Therapy Centre, I believe) but it still won’t be free. If you are really in dire financial straits, going to the GP for NHS therapy isn’t a bad idea, but do try to find out what the qualifications are of the person you’re seeing, and if you think the person doesn’t work for you, do go back to your GP to discuss it rather than feeling that you have to soldier on with someone who’s not appropriate for you.
If you’re able to, though, I think you’re likely to get better continuity of care, greater choice in therapist, and probably someone more experienced and better qualified if you don’t go through the NHS and instead bite the bullet and pay for private treatment. I love the NHS, they are wonderful for acute conditions, but I think they can fall down on treating long-term or chronic problems, and psychotherapy can be a long-term business.
2) Going to, eg, the BACP website and finding someone in your area.
I know they offer this service on their site, and it might seem like a good way to go about it but just… don’t. I’ve tried finding a therapist this way. I ended up meeting about half a dozen women in north west London who all seemed very similar, Igot exhausted and demoralised telling them all the same story of my life, and really didn’t have any way to decide between them. While it’s a good idea to see more than one person before you make your final selection, you should really be ‘interviewing’ people who’ve been recommended to you for some reason; either someone you know has seen them and thinks they’re good, or your friend’s therapist thinks they might work for you, or your friend who is a therapist thinks their approach would be right for you, or a referral service has recommended them. If you pick someone purely based on geography, the field is likely to be too large to make a useful decision.
Having said this, if you live in a remote area of Scotland, this may be the only way you have to find a registered psychotherapist within 50 miles of you. If so, have at it.
A few bad signs
Here are some signs that this therapist is not right for you. Some of them have happened to me, and some to friends. This list isn’t exhaustive (see above re: how I’m not an expert) but in my opinion if you find yourself in one of these situations, you should probably be looking for someone else.
1) I put this first because it’s the most important, but I should say that it is *very rare*. The following things have never happened to me or anyone I know; they’re in no way common. You need not fear that you’ll have to search long and hard to find an ethical therapist, and especially if you use the referral methods I suggested you should have no problem whatsoever. However, unethical behaviour does occasionally happen and I think it’s quite empowering to know where the line is, and to understand that some things are *not OK* and that you should *walk away*.
So, the top reasons to look for a new therapist include: if your therapist becomes in any way violent, aggressive, demanding or hostile. If they try to invade your private life. If they call you at home except to rearrange an appointment. If they make sexual advances to you. If you feel they’re overly touchy-feely and you tell them to back off and they don’t. If they don’t think it’s a problem that they’re also treating your mother and your husband. If they have more than one relationship to you – that is if, in addition to being your therapist they’re also your boss, your next-door neighbour, your cousin or your friend. If they tell you that getting naked with them will help you overcome your inhibitions or that you should give them lots of money (more than you’re paying them for sessions) to help with your healing. Really these are things that should have you reporting them to their regulatory body.
I think a lot of people worry that their therapist is going to brainwash them – I know I worried about this – and that they won’t know enough to say ‘stop’. Therapy can seem very mysterious, and it’s hard to know what to expect and whether they’re “doing it right”.
A friend of mine once said that it was hard for her to appreciate good modern art because she didn’t know what bad modern art was. In this spirit, I highly recommend reading this article about Masud Khan, a respected London therapist who was eventually struck off. He was a Bad Therapist – at least to many of his patients – and it is Not Rocket Science to spot why. My impression is that Wynne Godley came from a world and a time where people had never discussed what one could expect to happen within a therapy session, and he second-guessed his own ability to work out what was right for him. And of course Masud Khan was highly plausible. The world’s changed, but the important lesson is: trust yourself. However well credentialed they are, if they suggest you leave your wife to hook up with another one of their patients, it’s time to report them.
This is the major caveat. All the other problems on this list will just end up wasting your time, but if you think the therapist is actually manipulative or damaging, run for the door.
2) They just don’t seem to understand what you’re saying. I had a therapist like this once – she was the one I’d picked after seeing half-a-dozen entirely randomly chosen women from the BCAP directory and having no idea how to choose between them. I only saw her for a few sessions, but each time I shared something that was troubling me she got an “I’m concentrating really hard now” frown on her face, and then made a reply which indicated to me that she didn’t have the least idea what I was trying to communicate. She was a very nice woman, she just wasn’t as bright as I needed her to be. It’s important to have a therapist who you think is smarter and wiser than you. If you think there’s no one out there who is smarter and wiser than you, go to a referral service, tell them that, and then enjoy how they find you someone to work on your superiority complex.
3) They talk about themselves a lot. Now, different therapists have different views about this.
Personally, I like a therapist who I know nothing about; it prevents me from
trying to tailor my responses so they’ll like me more. Some therapists think it’s important to share their reactions at times, or to tell stories from their
personal experience which shed light on what you’re discussing. However, I have a friend whose counsellor spent most of their sessions telling my friend about his holidays, his new conservatory, his grandchildren, his partner’s career… that isn’t therapy, it’s a chat. If you find you’re doing more listening than talking, something’s probably gone wrong.
4) You just don’t vibe with them. Again this comes down to: trust yourself. Listen to them, observe them, observe how you respond to them. If you feel instinctively you want a female therapist, or a male therapist, or a black therapist, or a gay therapist, it’s OK to follow that hunch. (They may want you to talk about why you made that decision. Therapists are like this, always asking questions about stuff.) If someone seems on paper really right, but when you meet them you just don’t feel you can open up, they’re not for you. Carrie and Danielle have a lovely little post about choosing a therapist based on their style.
If this is important to you, go with it. I knew I felt comfortable with my
therapist in Manhattan when she quoted from one of the more obscure Shakespeare plays in our first conversation. It is OK to choose based on weird and personal things. Our personalities are weird and personal. As President Bartlett once said: run towards yourself.
A few things that may feel uncomfortable but aren’t really bad signs
If you ever take a course in massage, you’ll be taught about the difference between “painful pain” and “grateful pain”. I love that phrase, “grateful pain”. When they rub you in that place where it hurts and it makes it hurt more but at the same time you want them to carry on doing it because you know it’s making something release and when it’s done you’re going to feel better? So yeah, again, like much of this it all comes down to instinct. Therapy’s not always pleasant; sometimes you end a session feeling like shit. I think mostly one can tell if it’s grateful pain or not. However, these are some things that might seem on the surface like the
therapist isn’t really doing their job but which probably mean it’s going OK:
1) ‘They’re so quiet!’ This is something that can throw people. A therapy conversation isn’t like a normal conversation.
After all, you don’t really want to end up finding out a lot about them, that’s
not what you’re paying £40-75 an hour for. So therapists often go quiet or just answer your words with an “mmm-hmm.” They want to let you talk. If you’re someone who doesn’t like to talk, who is often quiet in groups, this may feel a bit strange to you.
2) ‘I’m not better yet!’ Yeah, what with the rise in popularity of CBT, anti-depressants and in general the makeover-show culture people are surprised when they see a therapist for four weeks and their life isn’t utterly solved. It’ll probably take a while. Talk to your therapist about realistic time expectations (they may get cagey, it’s OK to press them and it’s OK to say “I can only afford three months of this”, although they might say you could do with more and they might be right. But life’s not perfect and they should be willing to work with what you have.
3) ‘Since I started therapy I seem to be feeling kind of worse!’ Hmmm. Yeah, this is a tricky one. It can happen, and sometimes it’s a good sign. In fact there’s probably no such thing as good therapy which doesn’t sometimes make you feel more miserable than when you started.
If you’re talking about difficult stuff, the stuff you need to talk about, it’ll
likely have a few negative effects – the idea is that the long-term effect will
be positive. Talk it through with your therapist. Don’t be afraid to tell them
that you’re afraid you’re getting worse and that it’s freaking you out. Talk it
through with good friends (and supportive family, if your family’s supportive) too. They might see improvement in you that you can’t see yourself. If you’ve got a good GP, discuss it with them too. It could be that this therapist or kind of therapy isn’t right for you, or it could be one of those things that you have to ride out. If the latter, you have my sympathy; it does suck, but it does get better.
As a final thought: if you have read this post and are still confused or have questions, feel free to leave a comment below or to email me directly. You can use an anonymous gmail address if you like. I am, as previously indicated, not trained, but I will do my best to give some pointers in the right direction. If you email me with a useful question, comment or insight, I might post it to this blog unless you explicitly say you don’t want me to do that but I will try to make you as anonymous as possible.
And if you have come to this post because you are feeling very depressed or despairing, please do call The Samaritans. You don’t have to tell anyone you’re doing it, and they really do help when you’re in a rough spot. Feelings don’t last forever but while they’re happening they can feel overwhelming. It is OK to ask for help.