Will You Be My Therapist?
Expert Advice on Finding the Right One

As a patient, it is your job to participate in the process, experts say. You aren't in therapy to receive wisdom like a bolt from the sky.

by Elizabeth Bernstein in The Wall Street Journal of Sept. 22, 2014

People write me from time to time to ask, "How do I find a good therapist?"  I went to Prudence Gourguechon, a Chicago psychiatrist and psychoanalyst and past-president of the American Psychoanalytic Association, to find out what people entering therapy should look for in a therapist, how to establish the relationship and what the best ways are to work together to maximize treatment.

To find a therapist to try out, Dr. Gourguechon recommends asking friends if they know of someone they can recommend. If a friend has his or her own therapist, ask the friend to ask the therapist for a referral. Refrain from seeing the same therapist that a close friend or family member sees. If you can't find a word-of-mouth recommendation, she suggests using a website such as Psychology Today; professionals post information about themselves on its "Find a Therapist" feature. See Dr. Zuccolo's listing on Psychology Today.

When you see a promising listing, check out the therapist's website. Does he or she write well and view things similarly to how you do? At the first meeting, Dr. Gourguechon says, pay attention to the fit. Are you comfortable with the office environment and the person's style of relating? Do you get the sense the therapist has a good preliminary understanding of what you are going through? "You should feel that they are tuned in and on your wave length, and that you can expect the relationship and understanding to deepen," Dr. Gourguechon says. Within the first few meetings, the therapist should take a thorough history, give you a diagnosis and articulate how he or she can help. "They need to come up with something of a formulation that says: 'This is what I think your problem is, this is how I think it developed and this is what I can offer you," Dr. Gourguechon says.

There should be a treatment plan—specifying how often you will meet, for how long and what type of therapy you will have, such as cognitive behavioral therapy or psychoanalysis. The therapist also should be able to acknowledge his or her limitations. For example, if you have a major mental illness and you go see someone who does cognitive behavioral therapy, he should explain that while this therapy is helpful with many issues, you may need more help. Like good physicians, effective therapists are good listeners. "You want an open-minded person who doesn't put you in their box, but gets to know you in all your complexity," Dr. Gourguechon says. "You want to hear: 'Let's keep talking.' You want to hear uncertainty—'It could be this or it could be that.' You want to hear an exploratory, curious stance." "It's like when you go to a financial planner," she adds. "You can tell if they are really thinking about your needs and who you are as a person, or if they are just trying to sell you a product with the littlest effort." As a patient, it is your job to participate in the process, Dr. Gourguechon says: "You are not there to receive wisdom or a bolt from the sky. You want expertise. But in many ways you share in the expertise." Dr. Gourguechon's tips for maximizing the therapeutic relationship:

  • Don't edit yourself in therapy. Let thoughts float to the surface. This will help your therapist understand what is really bothering you the most, on an unconscious level.
  • Find out what your therapist wants you to do, and try to do it. If you have difficulties with any of it, talk about them. Don't pretend you are going to try a suggestion if you aren't actually going to try it. Don't pretend something is working.
  • Ask questions. If you don't understand something your therapist says, ask him or her to clarify. If something isn't helping, or you don't feel better, ask why not. Your therapist should be able to give you an explanation.
  • Give your therapist feedback. He or she will make a lot of suggestions and interpretations. Some will be good and some won't, Dr. Gourguechon says. Share your reactions, both positive and negative.

"Some people think just coming to therapy is going to change things for them, but it doesn't work that way," Dr. Gourguechon says. "You have to venture out trying to change, and then come back with reports on what is working and what isn't working. It's an active process, where there are constant adjustments on both the patient's and the therapist's part."

And how can you tell if you've gone as far as you can with your therapist—that it's time to break up? If you feel that your therapy has stalled, the first thing to do is talk to your therapist about it, Dr. Gourguechon says. Ask why he or she thinks it isn't working and request an updated treatment plan. Your therapist should take you seriously and not become defensive. You might not like the answer ("Sometimes it takes a long time to change"), but you should get a clear one. "If they say, 'Just keep coming and we will keep doing the same thing—and they have no rationale for why you will feel different in a year when you haven't yet—that's not too promising," Dr. Gourguechon says. Of course, sometimes it can be part of therapy to get angry. You'll need to talk that through with your therapist and examine together whether you are recreating a pattern. Another option, if you feel stalled, is to tell your therapist you want a second opinion and see what kind of response you get. "They should say, 'That's great, let's see what someone else thinks,' " Dr. Gourguechon says. One big indication it may be time to leave: A relationship that feels empty, one-sided or like an ordinary friendship. "The therapeutic relationship should be a challenge. You should be learning new things about yourself," Dr. Gourguechon says. "Maybe not every day or every week, but pretty consistently. There should be progression."