On choosing a therapist

Paradoxically, perhaps, it’s probably never been more difficult to find, let alone choose, a psychotherapist.  This has nothing to do with ‘supply’: if anything the ‘market’ is saturated with talking therapists of all persuasions.  Furthermore, the web has now made it easy to search for a therapist in a particular area, with particular skills and interests, and even within a particular price range.

However, this is the crux of the problem: over-supply leads to too much choice, which in turn leads to total confusion and, in some cases, paralysis.  In other words, it becomes impossible to choose because there is so much to choose from.

Just to give a simple, but real example.  If you Google ‘psychotherapist in Surrey’  you will throw up over 630,000 results.  ‘Psychotherapist in  Hampshire’ will give you well over one million.  You get nearly two million with ‘psychotherapist in London’.   Of course, the more web savvy amongst you might be more precise about constructing your search terms, but you will still get overwhelmed with results.  And it’s also worth considering that if someone is in crisis or feeling terrible – which may well be the trigger for looking for a therapist in the first place, they are not likely to be in the mood to construct elaborate Google searches!

However, I may be jumping the gun a bit here.  Surely, if someone is looking for a psychotherapist they will go to their GP first, who will then refer to them to someone locally?   This is true – up to a point.  If you go to your GP complaining of anxiety, depression or some other ‘common’ psychological problem, you may be referred to psychological therapy on the NHS.  In reality this means referral to your local IAPT (Improving Access to Psychological Therapies) service, which offers short-term talking therapy, and is mainly based on cognitive behavioural therapy (CBT).  Depending on where you live you may be looking at quite a long waiting time before seeing anyone.  And if you are looking for something more exploratory or longer term, you are likely to be out of luck.

I say ‘may’ be referred because the evidence so far is that referrals to IAPT are very low (something in the order of 12-15%) relative to the number of people who are thought to suffer anxiety and depression.  Many GPs are still prescribing medication as the primary (and in many cases, only) treatment.  And it is likely that many people are not going to their GP at all even though they may be suffering unbearably.

But what of those people who choose, for whatever reason, to ‘by-pass’ their GP completely and look for a therapist themselves?  Some will use their existing social networks, i.e., they may already know of a psychotherapist in their area or be recommended one by a family member, friend or colleague.  Many people, however, are likely not to have such contacts, and may embark upon a steep learning curve to get themselves the right therapist.  And, of course, nowadays many people are likely to start this journey by using the internet.

And this brings us back to where we started: how to find – and, more importantly, how to choose, a psychotherapist.  I would like to suggest that there are two ways to go about this.  The first is what might be described as the ‘rational choice’  or ‘rational self-interest’ approach, and is the one you are likely to find recommended (although not necessarily using that terminology) by many psychotherapy organisations and individual therapists.

Essentially this means deciding upon a set of criteria, e.g. desired outcome, price, location, gender, experience, qualifications, expertise in a particular field, etc, and then looking for therapists who fit such criteria.  Bearing in mind that such an approach is likely to present you with quite a number of therapists who fit the particular criteria, you will then have to find a way to ‘short list’ them and then to make a final decision regarding the best therapist for you.  This probably seems perfectly reasonable and is, in fact, how some people appear to choose their therapists, although perhaps quite not as explicitly as I’ve laid down here.

In fact, this way of choosing a therapist is often a reflection of how some people make other choices in their lives, e.g. where to live, what job to have, even what partner to become involved with.  On this basis, choosing a therapist becomes just another (rational) choice, and is made in order to further that person’s self interest in some way or another.

However, one thing that psychotherapy, and especially psychoanalytic therapy, tells us, is that when people act in their (apparent) self interest, this can have unforeseen, and sometimes tragic, consequences – both for them, and for other people.  In other words, human beings are not quite as ‘rational’ as they like to think they are.  Or, more precisely, rationality itself is rooted in irrationality.  Consequently, if people do indeed choose their therapists as they choose their partners, jobs, friends, etc, then perhaps alarm bells should start ringing.  After all, very often it is the problems they have with their partners, their jobs, their friends, that bring individuals to therapy in the first place.  And such choices of partner, job, friends, etc were all apparently based on ‘rational self interest’……

And this brings me to an alternative way to find and choose a therapist.  Rather than starting with a list of criteria, you could start by asking yourself what’s really bothering you.  This might seem pretty obvious, especially if, for example, you are experiencing intense anxiety or chronic depression.  However, it is still worth reflecting on what might be causing such feelings; for example, a particular relationship, a work situation, etc.  Then you could think about how psychotherapy could help, i.e. what you would want out of therapy.  Again, this might seem obvious: to feel better, to make all those horrible thoughts and feelings go away.   However, you might also want to reflect a bit more and think about whether you simply want those thoughts and feelings to go away, or whether it might be worth exploring them a bit more, to gain a greater sense of where they are coming from and what they might mean to you – and what your life might be like without them.

If you have got this far, then you are already in a position to make a fundamental choice: far more fundamental, in fact, then which particular therapist to choose.  It’s the choice between the ‘quick fix’ or the ‘deep fix’.  In other words, between trying to get rid of or alleviate your symptoms as quickly as possible; or spending some time working with them, exploring what they mean to you and how they function in your life.  Of course, when it comes to choosing a particular therapist,  you will undoubtedly still be thinking about cost, location, etc.   And at the end of the day, it may well be something ‘trivial’ that tips the balance in favour of one therapist or another: what they look like, their website, their name, the town or even the street they live in, or whatever.  But it’s precisely such ‘triviality’, such ‘detail’ that you might wish to also think about in relation to your desire to go into therapy in the first place.

Of course, if none of this worries you, if you really couldn’t be bothered about such things, and would rather just have a therapist that gets the job done, then you have already made your choice…….