Therapy isn't as simple as any couch in a storm

March 18, 1997|By Judy Foreman | Judy Foreman,BOSTON GLOBE

Maybe your boss is driving you crazy. Or it's dawning on you that your husband is acting just like your alcoholic father.

Maybe you hear voices, or think about suicide. Or get so scared you can't leave home. Or so depressed you can't get out of bed.

You decide the time has come to embark on that quintessentially American solution to life's woes: therapy. The question is, what kind of therapy and with whom?

You've heard, of course, of psychoanalysis, and probably of psychodynamic therapy, too, where the idea is to understand your current troubles by tracing them to the emotional patterns laid down long ago in your family.

You may also have heard of cognitive behavioral therapy, through which you try to change unproductive thoughts and actions, regardless of who did what to whom 30 years ago.

And if you're a denizen of New Age bookstores, you've probably heard of the more far-out stuff as well, like rebirthing, channeling, white goddess healing -- even alien abduction therapy.

You could drive yourself nuts just trying to sort it all out.

But there are some useful guidelines to navigating the therapeutic seas, say both mainstream and not-so-mainstream shrinks. Berkeley psychologist Margaret Thaler Singer, for example, co-authored "Crazy Therapies," a useful resource for anyone interested in the less traditional options.

Ultimately, of course, picking the right therapist can be as tricky, and personal, as choosing the right mate, but here are some tips that may help:

If you haven't had a physical exam lately, get one. There may be an underlying physical problem.

Shop around, which means visiting at least two therapists.

After each try-out visit, ask yourself how you felt. Did the therapist listen, or just try to sell you on his approach? Did she treat you with respect? Did you just plain like this person?

You may be attracted to both mainstream and alternative therapies, but mainstream shrinks, at least, overwhelmingly recommend seeing a licensed professional. This could be a psychiatrist (an M.D.), a psychologist, a social worker, or another professional, such as a psychiatric nurse, whose training and credentials meet a minimum standard required to be licensed by the state.

Obviously, a license is no guarantee of competence or compassion. But it's better than no license, and it should mean the therapist has studied the basics, like how the mind works, different types of mental illness, family systems and the like.

Be skeptical, by the way, of anyone who does not have a license but hangs out a shingle as a "psychotherapist." Legally, anyone from your car mechanic to your mother-in-law to a professional who been stripped of his license can call himself a psychotherapist.

Ask what training the therapist has had. Remember, a few impressive-sounding weekend workshops are no substitute for years of graduate school.

Don't pick a therapist from the phone book, a holistic health catalog, grocery store giveaways or any publication that's mostly a marketing tool. Or if you do, at least ask for references from people who know this therapist's work.

Be cautious about referrals from friends. A friend can be a great resource, especially if she's no longer seeing the therapist she suggests. But in general it's a bad idea to share therapists -- you're better off finding your own. The best bet is to get referrals from a health professional, hospital or a mental health organization.

If you do have a specific problem, it may make sense to see someone with a specialty like, say, sexual abuse -- though neither you nor the therapist should assume you fit this category without considerable discussion.

March right out the door if your therapist touches you -- other than a hello and goodbye handshake -- or comes on to you, sexually or emotionally. Some therapists feel an occasional hug is all right. Others strongly disagree.

Discuss fees upfront. Ask how many sessions insurance will cover. Ask if you will be billed for missed sessions. If you have managed care, ask if the therapist will fight for full coverage, which some insurers may make difficult. Avoid any therapist who offers to barter services, like giving you therapy for a picture you've painted.

Ask about your therapist's orientation. Does he believe it's important to understand the familial roots of your pain? Does he prefer to help you find ways to cope in the here and now? Think about how this approach fits your beliefs. Ask what evidence there is that your therapist's approach works, but bear in mind that many mainstream approaches have been found to be roughly equivalent.

A task force from the American Psychological Association recently ranked therapies according to evidence of efficacy. Some techniques clearly work, the group found, including cognitive therapy for anxiety and depression, therapy that examines interpersonal relationships in people who are depressed, and family therapy for schizophrenics and their relatives.

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