How do I find the right therapist?

Reflecting on six months (500 clinical hours) of Social Work practicum from Forensics to the Walk-In, I wonder how do clients come to find a therapist?

        I just completed the first 500 clinical hours required to earn my registration as a Social Worker and I couldn't be more happy! For the last five months, I was doing therapy at a walk-in clinic. This was particularly exciting because I would never know who was going to walk through the doors and what kind of problems they would be presenting. The time I spent there was an amazing experience for me and I feel that I did very good work. While ending a first session with clients, we would say our goodbyes, they would thank me for working with them and often times tell me that they were glad they came in, that they just didn't know where to turn to or how to find a therapist that could suit their needs.

Before working at the walk-in, I don't believe I spent too much time thinking about where my clients were coming from. I have always just assumed that I would be working in a specialized field (as I was before in Forensics) where clients were treated as patients and referred to me specifically as a part of the multidisciplinary health team. A unique set of circumstances surround the families, couples or individuals I have been working with over the last five months. Specifically, people seeking out a therapist. How do they do it? Googling terms such as the ones found below return a variety of respectable results.

Cognitive Behavioural Therapist in Hamilton ON or Cognitive Behavioural Therapy

Therapists in Hamilton ON or Psychotherapist

Family Therapy in Hamilton ON

When trying to narrow down more specific specialties in Google, the results get difficult to sort when searching for a Teen or Children's Mental Health therapist.

From the above search results you can get a lot of information but how can you be a critical consumer of what you're reading? How can you tell a good, qualified and experienced therapist apart from the others? I recommend you begin by looking at the credentials. For example, does the person hold a Masters degree in Social Work, Clinical Psychology, Marriage and Family Therapy, Divinity, Chaplaincy, Education or something else? These are typically signified by the letters after their name, for example, MSW is a Master of Social Work. M.Div., is a Master of Divinity, M.Ed., is a Master of Education.

For those who like to read, I would encourage you to look up some of the different professions, their education standards and what you can expect from someone who works in one discipline in contrast to another. I know for me when I was applying to graduate programs, I specifically chose social work. Not because I believe that social work is superior to any other discipline that practices therapy but because the social work approach of doing therapy and working with people speaks to me personally.

        The next thing you want to look for is if the therapist belongs to a college or professional association? This is an important point because a therapist holding registration with a college or professional association is what protects YOU as a consumer. For example, RSW represents Registered Social Worker or RMFT denotes a Registered Marriage and Family Therapist. Being a Registered Social Worker (RSW) means that the person with those letters after their is a member of the college of social workers. This registration is what grants someone the right to call themselves a social worker or they may also use the term psychotherapist. Some disciplines do not have colleges but professional associates such as, Marriage and Family Therapists have high standards for their registered members.

Do the therapists you're looking at have their CV or resume on their website? Hopefully they do, this is another source of information for you. Check out where and when they earned their training and what other professional activities they have participated in to qualify them to work with you.

Now you have an understanding of the therapists credentials and training, their discipline (social work, marriage and family therapy, chaplaincy, etc.) and knowledge around membership to a college or professional association you can begin digging a little deeper and figure out if their approach to therapy works for you. This is a question of whether or not the therapist has the practical knowledge and competence around the specific problems you may want to talk about. For example, seeing a Cognitive Behavioural Therapist about chronic masturbation may not be the best course of action. Sure, a Cognitive Behavioural Therapist may pick-up on an underlying Obsessive Compulsive Disorder or some anxiety but psychotherapies dealing with sexual difficulties including compulsive masturbation involve specialty training.

The above situation would be a completely appropriate question for you to pose via email or in person at an initial session with a therapist, "Do you think you could be constructive in helping me deal with.." A good therapist will have the courage to say no or refer you to someone else who they believe has the expertise to work with you on a specific problem. Alternatively they may feel confident and explain what their approach will be and tell you that they might consult with someone else at times who has expertise in this field or at least get supervision around the topic specifically to make them the most efficient and safe therapist they can be at the work they do.

I have left out counsellors and there is a good reason for it. Currently the term counsellor is unregulated in the province of Ontario. That means that almost anyone can call themselves a counsellor and do "counselling" with you. There is no governing body or professional standards of practice. Although there are many qualified counsellors I would not recommend seeing one. The credentials may not be the biggest deterrent for consumers, for me it is their lack of accreditation with a governing body who protects my interest as a consumer, has strong policies and written ethics around conduct and what is acceptable in practice.

Choosing a therapist is a personal experience, I'm offering guidelines around what you can look for to be an informed consumer. I will follow-up this post in the near future with more on the topic.

Really looking forward to what the next 500 clinical hours will bring,
Timothy Gordon
Hamilton, ON

An Eclectic Approach to Psychotherapy

Varying books on psychotherapy and theory from Freud, Glasser, Jung, Rogers, Selekman and Yalom.

        Ever been to a Social Worker's office where the book case is packed with expensive looking books that have interesting titles like Cognitive Behavioral Treatment of Borderline Personality Disorder, The Interpretation of Dreams, or On Becoming a Person. Sometimes I wonder if they have really read ALL of those books and if so, do all of them inform their practice? Do they hold all that knowledge in their head all at once and use what's relevant as it comes up or is it all mushed together like some messy ball of cords, tangled headphones wires and whatever else is wrapped up there, in one giant knot of information.

        Today I had the great pleasure of speaking with Gary Direnfeld, an esteemed Social Worker whose work I admire very much. We talked about the eclectic approach to counselling and psychotherapy. I proudly am a member of the eclectic approach but at times have found it difficult to give an effective overview of exactly what it means. I wish to share here the main ideas from my conversation with Gary to help clarify eclectic therapy in general and describe my own eclectic approach to doing therapy. This is especially relevant with the popularity of specific therapies, for example, Cognitive Behavioral Therapy (CBT), Psychoanalysis or other therapies that receive widespread attention. Some clients when seeking out a therapist may specifically search for a Cognitive Behavioural Therapist and not fully understand what an eclectic therapist may have to offer.

An eclectic therapist does not subscribe to one way of doing therapy. Ideally, they integrate multiple theories or explanations for human behaviour and can tie them together seamlessly. This is called Theoretical Integration which is a textbook term for a therapist who practices multiple forms of therapy, combining theories together as one. A different example of an eclectic approach in therapy is Theoretical Eclecticism which describes a therapist who uses specific techniques from different therapies in response to presenting problems. This is a matching of sorts by the therapist, using different therapies which are evidenced to best address specific problems that clients may bring to therapy.

        I find myself as a Humanistic psychotherapist with a Client-Centered approach but use many other theories to inform my understanding of causes and contributions to the problems that clients attend therapy for. This textbook/theoretical knowledge is valuable to my understanding but the real value comes from having a knowledge of the evidence related to specific therapeutic practices and applying them appropriately.

For example, many of my clients have found Cognitive Behavioural Therapy (CBT) helpful in my work with them. CBT is a treatment for all ages (adults, children and adolescents) which addresses anxiety and mood disorders, insomnia, stuttering, post traumatic stress, post stroke stress, etc. Cognitive Behavior Therapy is helpful in identifying thoughts, beliefs and assumptions that make life harder. Dialectical Behavior Therapy (DBT) is shown to be effective with borderline personality disorder, mood disorders, eating disorders, substance abuse, anger, self harming, depression and anxiety. DBT is similar to CBT in that it's a behaviour therapy but it has additional skills and learning materials as well as group skills training/education which some clients find helpful.

I also draw from Existential Psychotherapy which is useful to individual clients as well as couples attending counselling who are dealing with bereavement, grief, loneliness, fear of death or death anxiety, feeling lost in life or suffering with feelings that life is meaninglessness. Existential Therapy focuses on finding meaning in life and many clients have endorsed this approach to counselling.

The most essential part about eclecticism, is using it effectively. I ask myself, how can I make my knowledge and expertise useful to my clients.

I hope that sheds some light on how the eclectic approach works,
Tim Gordon.
Hamilton, ON