Finding the Right Therapist (For You)

Parts of this blog post are adapted from the“Becoming Trauma-Informed” course offered by Jake Ernst MSW, RSW at Straight Up Health. 

Blog post written by Lama El-Hanan, Straight Up Health

Therapy is a potentially invaluable resource that can help individuals deal with pressing emotional issues and cope with life’s challenges. People attend therapy for a myriad of reasons, including mental health concerns, difficult life transitions, and complex trauma. When in the market for a new therapist, it is critical to keep in mind that mental health practitioners can vary greatly in their credentials, skill level, experience and therapeutic approaches. It is also important to note that what works for others may not necessarily be the greatest fit for you. With this in mind, we have compiled a list of questions to ask yourself if you need help figuring out whether you have found the right therapist. 

Is there a good therapeutic alliance? 

In the context of mental health care, the therapeutic alliance is a working relationship between a therapist and their client which is aimed at benefiting the latter. A good therapeutic alliance is characterized by three essential qualities--an emotional bond of trust, empathy, genuineness and respect; an agreement on the tasks and objectives of treatment; and collaboration and mutuality. Although many factors impact whether or not therapy will be beneficial for the client, studies have consistently shown that the quality of the therapeutic alliance is the number one predictor of positive therapeutic outcomes. The therapeutic alliance is critical to the healing process because it has the potential to create a space of safety and support that allows clients to be vulnerable, “explore issues heretofore avoided, and...attempt new behaviors” . This concept is supported by neuroscience. The human brain is neuroplastic, meaning that it has the potential and capacity to reorganize itself by forming new neural connections throughout life. The therapeutic alliance allows the client to perceive safety through its focus on present-centered relating that involves eye contact, warmth, engagement and emotional attunement. This feeling of safety fosters the development of new neural pathways, which “in turn contributes to the repair of attachment injuries and provides the positive social interactions that are essential for the health and growth of the client”. 

Is the therapist trauma-informed? 

The therapeutic alliance fosters healing by creating a sense of safety and support for the client. But these feelings can be harder to access for clients who have experienced trauma. Deb Dana, LCSW describes trauma as a physical and psychological response which impacts an individual’s internal sense of safety as well as their ability to trust in themselves, relationships, and the world. Trauma comes in various forms and has both individual and systemic dimensions. Trauma-informed care (TIC) is an approach that recognizes the pervasive nature of trauma and the potential of mental health services to be traumatizing and retraumatizing for individuals. It is aimed at ensuring that therapeutic environments are safe(r) and less triggering for clients. Trauma-informed therapists are equipped with a knowledge and skill set that enables them to anticipate what may cause harm and provide an environment where “big feelings are treated with safety and care”. Trauma-informed practices include: framing the client as the expert on themselves; allowing the client to give voice to the pace of therapeutic work; affirming the client’s lived experiences and identities; and being responsive to the client’s accessibility needs. 

Does the therapist have a strong understanding of privilege and oppression? 

Developing a comprehensive understanding of the systemic aspects of trauma and mental health is critical to providing TIC. For many marginalized individuals, feeling safe and supported in therapy requires that their therapist empathizes, affirms, and strives to understand their identities and lived experiences. This means clients should not have to expend emotional labour educating their therapist on the basics of privilege and oppression. It also means that clients should not be forced to defend their identities and lived experiences. Gaslighting clients by forcing them to question their own experience of their oppression is harmful and inappropriate. It is important to note that for some marginalized people, a therapist who has a good understanding of privilege and oppression is not enough. Feeling safe and supported means working with someone who shares their identities and experiences of marginalization. This too is perfectly valid.  

Does the therapist behave ethically and professionally?  

Abiding by ethical and professional codes is essential to fostering a safer therapeutic environment as it helps to create healthy boundaries between the therapist and client. Any form of romantic or sexual advances on the part of the therapist is wholly unethical and should be reported to the professional body to which they belong. However, unethical behavior goes beyond sexual advances. It can involve offensive comments, violations of confidentiality, and financial wrongdoing. In the realm of professionalism, therapists should not share details about their lives with the client in a manner that is irrelevant and inappropriate. Although sharing or self-disclosure is a common and widely accepted therapeutic technique, it should be done in a careful and intentional way that is aimed at benefiting the client. Self-disclosure should not be used to flip the therapeutic relationship and put the client in a position where they have to soothe and care for the therapist. Another key aspect of professionalism is accepting and incorporating feedback. The therapist should make the client feel safe and supported in speaking their mind and voicing their discomfort or concerns. The therapist should also take accountability if they cause harm, regardless of the intent behind their words or actions. 

Conclusion

Although the questions above are a great guide for helping you find the right therapist, it is critical that you ultimately tune into your own instincts and inner wisdom. When you feel physically, spiritually, and emotionally safe in the therapy room, you will know that you have found the right therapist for you. This is even more so the case when you are being particularly vulnerable and discussing uncomfortable thoughts and feelings. 

Bibliography

Bogo, Marion. Social Work Practise: Integrating Concepts, Processes, and Skills. New York:

Columbia University Press, 2018.

Ernst, Jake. “Becoming Trauma-Informed: Week 1”. Google Slides presentation, Zoom Video

Communications, July 7, 2020.

Ernst, Jake. “Barriers to Becoming Trauma-Informed: Week 2.” Google Slides presentation,

Zoom Video Communications, July 14, 2020.

Geller, Shari M. “Therapeutic Presence and Polyvagal Theory: Principles and Practices for

Cultivating Effective Therapeutic Relationships,” In Clinical Applications of the

Polyvagal Theory: the Emergence of Polyvagal-Informed Therapies, edited by Stephen

W. Porges and Deb Dana, 106-126. New York City, NY: W.W. Norton & Company, Inc., 2018.