How Do You Know He/she Is Good?

[Trembling]

I am trying to find out how do you know if the therapist is good?

My hubby had a therapist but hubby moved now to another country and will start with a new doc. He was not really satisfied with the first one, but therapists are very limited where we lived. The good thing, he got meds which helped him to stay partially under control...He suffers from CPTSD in connection with alcohol problems and depression.

How does a "correct" therapy usually start? Maybe you can advise with your experience, I really would appreciate.

Thanks!

 

[Hashi]

Trembling, do you mean choosing a therapist to see, or when you've been seeing a therapist for a little while and are wondering if it's working?

Also, are you able to say why your husband wasn't really satisfied with the other one? I think that might be important, because it's not just about whether a therapist is "good" generally, but also whether he/she is a good match for you.

 

[BlueOrange]

I think that this is a really important question, and I'm not sure how to answer it. I'll take a stab at it, and am very interested in feedback on the helpfulness and accuracy of my answer.

DANGER SIGNS
Therapist has found that every patient they've seen has the same cause of their problems, which needs the same treatment (less dangerous if diagnosis is complete and therapist is a specialist)
Therapist does not ask about family
Therapist does not respond to feedback when told by patient that patient does not feel safe
Therapist tells patient what they are thinking and will fight to defend their claims about patient's internal state (eg "The reason you hit your wife is because you hate women." "I don't hate women, I get really upset and can't cope with it" "You might not be willing to admit it, but you hate women") (This one is from my experience, and I was so frustrated every time I had to deal with this idiot, that when I got home I was in an explosive rage - which was the final nail in the coffin for my first marriage. Some 'anger management counsellor' he was!)
Therapist is unable or refuses to assist on small issues / assistance on small issues is repeatedly unhelpful
Therapist overly keen to medicate
Therapist breaches expectations regarding physical contact (the normal limit is a handshake, but there are therapies that involve a physical component which may be helpful - the point is that there are clear and observed limits)
Therapist claims full responsibility for the outcome
Therapist claims that their treatment never fails
Therapist refuses to discuss risks of medication or other interventions
Therapist claims that any medication or other intervention is risk free

COMMON FRUSTRATIONS IN GOOD THERAPY
Therapist appears to be obsessed with finding out about family
Therapist refuses to talk about diagnosis
Therapist gives indirect responses to direct questions (eg: Q:"Should I do [X]?" A:"How do you feel about doing [X]?")
Therapist is asking questions that are difficult to answer and may seem irrelevant
Therapist does not understand an explanation that was perfectly clear to the person giving the explanation
Therapist always seems uncertain or doubtful (eg: T: "It seems to me that [X]." S:"Is it or isn't it?" T:"That's how it seems at this time.")
No apparent progress on big issues
Very tired after therapy
Anxious about therapy

FEATURES OF GOOD THERAPY
Therapist asks difficult questions
Therapist is usually asking questions as opposed to providing information
Therapist does provide information, carefully and selectively
Therapist is consistently non-threatening, even when being difficult
Relationship with therapist is imperfect and sometimes difficult

 

[BlueOrange]

Another warning sign:
Therapist claims to be the ultimate authority on pretty much anything

A good sign:
Therapist is respectful in their response to patient's own research (doesn't have to agree, does have to treat it with respect)

 

[Trembling]

Hashi,
I meant when you start seeing a new one, how will they usually approach the patient? Our or his therapist here, did not try get to the real issue. He knew just a few things about my man's past, but was mainly focusing on stabilizing him with meds. Not that this was bad, but my hubby felt that the therapist was not really into the main problem, which resulted in him not wanting to see him when he felt really bad.

Today hubby is going to see the new therapist for the first time.

BlueOrange,
your reply was indeed helpful, and you pointed out the issue about "important to medicate", another thing our therapist did was telling my man he was bipolar, without any test, but only because of mood swings, and after a while we heard from another patient that this was one of his favorite diagnoses.

If I think back, when I mentioned this forum and how much it helped me to better understand PTSD, he never even replied to it, he somehow ignored me.

Thank you both, and I hope my love will "connect" this evening in a positive way!

 

[BlueOrange]

Hope the new therapist goes well!

 

[Trembling]

Hi!

My hubby was surprised by the complete different approach of the T.
He described him as extremely slow, like he was analyzing hubby's replies prior to asking the next question.
I am not sure if this T. is the right one, but at least my man made another appointment.
Time will show if he is willing to work on his past.

Thank you!

 

[maddog]

A good and productive therapeutic relationship can take time to bloom, so I think it's wise advice to make another appointment and keep going forward, one small step at a time, unless or until it starts to feel wrong and/or too many of those negative tick boxes start to be ticked. While there are some key factors of competence, professionalism and interpersonal effectiveness which are pretty much deal breakers, a lot of what makes or breaks the relationship is the individual fit between the two people, and it's much harder to define that one on paper.

It's an emotionally draining journey in the early days, so I really hope this therapist is the right one.

Maddog

 

[BlueOrange]

I think I should add to my list
"It feels like it's going really slowly" as a common frustration of good therapy.

I've recommended Brett Wilson in the recommendations forum, but I spent a number of sessions with him before walking away and deciding that he was useless, then going back a few months later. There's a lot of skills that I needed to learn: 'how to be a patient in a therapeutic relationship' is a something that's hard to learn, and rarely addressed specifically. It's also hard to explain :(

A key factor in my decision to go back to Brett was a realisation that although I didn't talk about the things I wanted to talk about in the sessions, I did find that I was better able to deal with those things myself in between sessions. He was very subtle, and I didn't understand how he was helping me for some time. (And didn't want to be helped in many ways, which meant that if he'd told me what he was doing, it might not have worked.)

Perhaps the evaluation of a therapist can be done through a few questions:

"Am I better at dealing with things when my therapist is not in the room, than before I started seeing this therapist?"
"Is this therapist helping me to build my independence?"
"Am I finding that I'm more able to communicate with a wider range of people?"
"Do I feel safe in a wider set of circumstances, or safer in situations that were already OK?"

A yes to any of those questions suggests that something is going right, and it might be that the therapist is helping.