How do you find a psychotherapist that you can trust?

[David Baxter PhD]

How do you find a psychotherapist that you can trust? An Interview with Judith D. Schwartz
by Therese J. Borchard, Beyond Blue
Friday February 26, 2010

A while back I published an excerpt from Judith Schwartz's amazing book, The Therapist's New Clothes. Her words left me with many more questions than answers, so I've decided to interview her about the unique and complicated relationship between a therapist and her client. Judith is a journalist and author whose latest book, The Therapist's New Clothes, is a memoir about training as a psychotherapist--and a cautionary tale about the seductions of therapy. Her website is Judith D. Schwartz / Judy Schwartz - The Therapist's New Clothes - Good Writing Matters

Question: You have written a brave and bold book about not making psychotherapy your God. Wow. Can you give us five warnings signs that you've become too dependent on psychotherapy?

Judith:

• Your treatment becomes more interesting to you than other aspects of your life
• Your mind keeps running in psychotherapy mode much of the time
• A therapy appointment is not merely the highlight of your day/week, but the time that feels most "real"; all else pales in comparison
• If someone questions whether your therapy is helping, you get extremely defensive, even enraged
• The mere thought of having to miss an appointment sends you into a panic

Question: How does a person go about finding a psychotherapist that she can trust?

Judith: Credentials and reputation are important but not a guarantee. I'd be wary of anyone who tries to impose restrictions on you, or is so invested in a treatment philosophy that you don't feel he or she is really "getting" you. You want someone who is trying to understand where you are as opposed to fitting you in to a particular view or treatment school.

Question: And finally, how do you make peace with the fact that you can't fix yourself entirely?

Judith: That was never the problem for me -- I would gladly have remained unfixed if I felt okay. I felt miserable all the time (what I now know as mixed anxiety and depression) and bought into the idea that "working out my issues" was the only way to get better. The effort I devoted to psychotherapy treatment reflected my desperation to feel better. Now that, thanks to medication, I am better, I need to accept that I'm not going to feel okay all the time. I have to remind myself that I'll have low or anxious days, and that this doesn't mean that I'll never feel okay again. That's what I have to make peace with: the fact that I'll always have that fear.

 

[Banned]

I can definitely, without question, relate to these points:

Judith:

• Your treatment becomes more interesting to you than other aspects of your life
• Your mind keeps running in psychotherapy mode much of the time
• A therapy appointment is not merely the highlight of your day/week, but the time that feels most "real"; all else pales in comparison
• If someone questions whether your therapy is helping, you get extremely defensive, even enraged
• The mere thought of having to miss an appointment sends you into a panic

That's pretty much how I felt my first three years in therapy. It was only my last two years before I left that I was able to have a more appropriate, for lack of a better word, attitude towards therapy. Before that, it was my WHOLE life. All I thought about and I could focus on nothing else. That was really, really hard. I was really grateful when I realized my attitude had shifted and I was less "obssessed" with therapy and everything about it.

 

[Ryan Howes]

I should start with admitting I haven't yet read Schwartz' book. I've heard a bit about it, both good and bad - it is a well-written, compelling story of a woman with complicated depression issues who seeks answers through her own therapy and eventual training as a therapist. It is also a cautionary tale warning readers of the pitfalls of becoming dependent on your therapist.

I agree with the idea that an unhealthy dependence on a therapist or therapy can cause problems. Handing over control of such important areas of your life is a risky proposition. It goes too far when the client views the therapy or therapist as the only hope for a cure.

But I stop short of agreeing with the idea that all dependence is bad. I think many healthy, helpful courses of therapy include a period where the client depends on the therapist. It can be a corrective experience for them to trust and depend on someone who truly has their best interests in mind. I also believe good therapy eventually works toward the client gaining independence, and any expectation that the client should remain dependent forever is not healthy (nor ethical). The five points shared by Schwartz are not always signs of a bad dependence on therapy, in my opinion. If you'll indulge me, I'll go point by point:

- Your treatment becomes more interesting to you than other areas of your life

For many clients new to therapy, this is exactly their experience and I don't think it's always bad. They find their latest hobby is discovering parts of their self and uncovering motivations and figuring out why they do what they do. It's exciting, and I think quite healing. There are many people who find themselves consumed with TV, Facebook, addictions, weight loss, novels (sorry, Twilight) or new dating relationships. Why not spend a few weeks consumed with the fascination of better understanding yourself? Yes, if it lasts a year it's probably a problem, as would any obsession.

- Your mind keeps running in psychotherapy mode much of the time

Again, during early stages of therapy, this is not only common, but often helpful. The process of therapy teaches people a new way to view their life, their interactions and their choices. There's a saying: when you're a hammer, everything looks like a nail. For a while, the excitement of learning a new worldview causes clients to become hammers that see nails everywhere. They might think: "There are two people fighting: why don't they use 'I statements'?" or "He's being a jerk, I wonder what pain he's had in his life?" It typically subsides once the new views are incorporated, and it could be a problem if it continued to be the only lens through which they viewed their world. But early in therapy, this is just a way we practice our new knowledge.

- A therapy appointment is not merely the highlight of your day/week, but the time that feels most "real"; all else pales in comparison

If a client has come to expect rejection, disappointment and indifference in their relationships, therapy is going to be very different. If they let themselves trust the attention, care and support the therapist offers, it will probably become a highlight of their week. The goal, of course, is to work toward finding and nurturing similarly stable and supportive relationships outside therapy, but for a while, therapy may be the best thing they've got going.

- If someone questions whether your therapy is helping, you get extremely defensive, even enraged

This really depends. Some people get defensive when any important relationship is questioned. Your marriage? Your therapist? Your parents? Your God? It's difficult when an outsider questions something this personal. If someone is inquiring about your therapy, it may actually be an indirect attack on you ("You're dating him? Is your therapy working??"). When people backseat drive on your therapy, anger is a common response. Feeling intrusion when you feel therapy is helpful will spark anger. I think if someone unreasonably defends therapy despite obvious problems, we would have an issue.

- The mere thought of having to miss an appointment sends you into a panic

Okay, written as it is, I would agree. A true panic about a missed session is over the top and probably signifies an unhealthy dependence. But feeling sadness, anger, loss or deep disappointment about not having your hour where you are understood and listened to seems reasonable to me.

My long-winded point is, I don't think all dependence is bad. A certain level at certain stages of therapy can be some of the best stuff therapy has to offer. I agree that it can go too far, and I'm glad Schwartz' book is around to point out the problems dependence can cause. But it has its value, too, and I think that needs to be said.