Thanks to HBO's Melfi, May Foster, and Paul Westin we've all been exposed to some of the different ways therapists work, and the unique relationships that come to life once the therapy door closes and a session begins. Or in Tony's case, what begins after you've just been busted for ripping out your favorite pages from the magazines in the waiting room.
Every therapist works drawing from some sort of belief system or clinical theory. The tips I'm offering will undoubtedly reflect mine, but I'll try to keep them general so they're flexible enough for people to apply to a wide variety of practitioners. I'm excluding therapists who practice adhering to a specific formula, like cognitive behaviorists, because that isn't my expertise, and will stick to recommendations for more general psychotherapy or psychoanalysis.
1. Finding a therapist is like dating. You want to feel like you click, and you want to feel like you want to see them again. If you're not feeling it, shop around until you do. Go to as many consultations as you need - some therapists will even offer them for free. Remember, you're the consumer and you should be happy with the service you're paying for.
2. In the beginning, it's common to feel anxious, but make sure your anxiety is just the normal response to spilling your guts to a total stranger, and not a response to something about the therapist that makes you uneasy. Trust your instincts. And if you're starting therapy in part because it's difficult for you to trust your instincts, pay attention to how you feel after the consultation, or between the first few sessions. If you leave without learning something helpful or feeling somehow understood; if you feel like you worked hard to be clear and the therapist didn't get it; if you feel disrespected in any way; or if you feel somehow ill at ease about returning, those might be signs the chemistry isn't right.
3. You need to feel like the therapist is really listening and responding to the intimate specifics of your life. This sounds basic, but there are lots of therapists out there who appear to be listening to you, when in fact they're a little more intent on waiting for an opportunity for you to listen to them so they can regale you with their expertise.
You don't want to feel like your life is being crammed into the therapist's theory; you want to feel like the therapist's theory is informing their ability to be finely tuned to your experience. A simple example of this that comes to mind, is when one of my colleagues was referring to a young woman who came in for a consultation and chose not to return because the commute was going to be inconvenient for her. She said she'd given it a try, because the therapist had come highly recommended, but getting to the consultation had confirmed for her that she should look for a therapist closer to her office or home. The therapist treated this exclusively as her resistance to being in therapy.
A therapist shouldn't make an assumption like that so quickly. It could have been resistance, but it could just as easily have been something else, like the client's desire to protect her ability to commit to treatment by making it as practically convenient as she could. It also could have been that she didn't like the therapist during the consultation and chose not to reveal that as her reason for not wanting to continue. Unfortunately, the therapist held fast to her impression, and left no room for the client to be anything other than resistant.
4. A therapist can't accommodate your every wish, but they should be open to hearing what you need in order to feel comfortable enough for the treatment to work. For example, if the therapist is on the quiet side, and you feel you need more interaction, ask for it. I've had clients ask me to be more active, and others ask me to be less. Therapy is a partnership, and an effort should be made to find a way of working that suits both of you. If your styles clash and a compromise can't be reached, it's fine to look for a better match.
5. Beware interventions that seem showy or canned. I think my field often does a disservice to clients this way. To me, too much technical language or too many dazzling psychological pronouncements can be an indication of therapists stroking their own egos. You want what they say to feel connected to your private experience, not to a textbook.
6. Everyone wants their therapist to be empathic, intelligent and well trained. But the quality that's perhaps the most crucial to good treatment is that they be self-aware. No therapist is perfect, but their awareness of what's "about them" is at the very foundation of how they listen to anything that's "about you." It will also make or break the understanding of what each of you contributes to what occurs in the relationship you build together, and if the therapist isn't accountable for what they say or do, the client will be in danger of being scapegoated.
7. When someone comes to see me for a consultation and they're nervous and want to know what therapy should feel like, I always say: therapy should make you feel more you. That's the best gauge I can give.