How To Tell If Your Therapist Knows What They Are Doing

I am sometimes amazed at my patients. They amaze me when I ask about their therapists. I ask about what their therapists are doing for them. Very surprised, they often tell me things like “I’ve been seeing my therapist for years,” and “She is kind of like a friend I talk to every week.”

If you are a “therapy patient,” you (or your insurance) is paying an alleged therapist to make you better. Well, often patients tell me they are doing or have been doing “nothing, really” and this I believe.

1. Ask your therapist what school they went to and how long they took to learn to do psychotherapy. Ask them what type of license they have.
Licensed Psychologist (Ph.D., Psy.D, or Ed.D.)
Licensed Marriage and Family Therapists (LMFT)
Licensed Clinical Social Worker (LCSW)
Or they might be a trainee — someone who is supervised by one of the above.

Some places use unlicensed counselors — someone who has a bit of training (but there are no requirements). This is common in drug and alcohol treatment — usually someone who has been through the program and can help newcomers navigate the system; or a crisis counseling situation, such as rape and battered women victims.

Of course prices vary depending on level of licensure and amount of training. Also, insurance companies pay for some types of therapists but not others.

In the state of California, some people get to perform psychotherapy in as little as two years after high school.

You deserve to know how much bang you are getting for your buck.

You need to know what board licenses them — that is, gives them the credentials to let them legally practice. As a consumer you will know who to complain to if you have a complaint.

Of course, deep down I believe that the more you study, the more you know. Some therapists make one wonder if even that is true.

2. Ask your therapist what “school” or “type” of therapy they practice. Most therapists will answer “eclectic,” “intuitive,” or “cognitive-behavioral.” The first two usually mean “I just do what feels right,” or “I make it up as I go along.” Of course, neither of these is terribly impressive.

There are books and manuals about how to do “cognitive therapy.” It has been researched and tested and can work as well as medicine. The problem is that almost nobody actually knows what they say, so it is always fun to ask the therapist what book of cognitive-behavioral therapy they follow.

I know one who memorized the book, gives patients homework and of course, I send her plenty of patients.

Cognitive-behavioral therapy (CBT) gets you to logically change what you believe so that you can change what you feel. You get it down to the facts. The term “camera check reality” is sometimes used.

It seems almost “naturalistic” as fairly-intelligent people actually believe this is how they get through life.

When therapists seem to be pretty much making it up as they go along, this is what they generally think they are doing.

3. Ask your therapist for their “care plan.” This is something a self-respecting insurance company will probably ask the therapist for, and you should, too.

What are the goals of therapy? How will the therapist know that you are better? For that matter, how are you supposed to know that you are better? How many weeks is it supposed to take for this to happen?

As you get this information (presumably from a therapist who is kicking and screaming) agree on mutual assessment of progress of the goal, after a certain number of weeks.

4. There are supplemental things you can ask if you actually want to get well.

Many patients don’t. They may be getting either money for disability or additional attention from their spouse.

Are there any books you can read or videos you can watch or phone apps that you could use that would make the therapy more effective?

You are literate, you know. Although there is some jargon involved, there are easily understandable references for most frequent problems.

In this information age it is generally recommended to do your own online research and confront the therapist with questions.

Just know that authority is difficult to establish and a lot of things online are written by bloggers who may be even less qualified than your therapist.

Also, do not expect reliable information about chemical treatment — be it natural or pharmaceutical. Therapists generally are not trained at all in chemical treatments, and may fear discussing them, for their lack of knowledge may lose you to another health professional.

Remember, you are in charge. It is the patient who pays the mental health professional salary. Demand skills and knowledge — you’re paying for them.