Martha Beck shows you how to duck the psychotherapy quacks and find the right couch for you.
I just love therapy. I savor all its varieties—physical therapy, music therapy, sports therapy, whatever—but psychotherapy is my favorite. My inner life, not to mention my career, is built on a foundation of headshrinking premises and techniques. That's why I'm always surprised to find out how little most people know about being therapized. Some seem to assume that it's reserved for the total whack jobs who eat sod and perform strip routines at the DMV. Others are once burned, twice shy—they've bravely gone for help, had a terrible experience, and given up on therapy altogether.
If you're in either category, you might want to reconsider. Good psychotherapy is one of the best things you can do to improve your experience on planet Earth. There have been times when it has literally saved my life. Nowadays I put it in the same category as chocolate: I could live without it, but since it boosts serotonin production and makes things more fun, why should I? This article is meant to help you figure out whether you might benefit from therapy as much as I do. And if the answer is yes, it will also provide some guidelines on how to choose a therapist who can meet your needs.
Do You Need Shrinking?
The term mentally ill certainly applies to some people who need psychological help, but for most clients, the model of illness is less appropriate than the model of injury. Therapy is most effective for basically healthy people who have been grazed—or hit smack in the heart—by one of the infinite arrows of outrageous fortune: trauma, persecution, rigid judgments, lost love. Whatever their cause, until treated by a skilled healer, emotional wounds can lame as badly as a broken limb.
This isn't to say that every emotionally wounded person needs therapy. The human heart can be healed by any intimate connection with a psychologically savvy individual. Psychologist Alice Miller calls such people the "compassionate witnesses" of others' emotional experience. If you're blessed with one or more of them, you can survive devastating circumstances with relatively little psychological damage. In the absence of compassionate witnesses, however, even a relatively mild emotional injury can fester. When it comes to our hearts, the old adage isn't quite true: Time heals only those wounds that are shared and understood.
There are literally thousands of diagnostic tests you could take to determine whether therapy might be useful to you. (I've included one on this page that you might want to try.) When you come right down to it, though, you have to answer only two questions to know whether counseling could improve your life:
Do I always or almost always feel joy in living?
Do I have a loving, open, honest relationship with at least one other person?
If the answer to both these questions is yes, you don't really need psychotherapy (though you might still enjoy it). If you got one yes and one no, seeing the right therapist could vastly enhance your quality of life. If the answer to both questions is no—in other words, if you are not only suffering but suffering alone—you need and deserve what good therapy can give you. Martha Beck shows you how to duck the psychotherapy quacks and find the right couch for you.
Some people think that going into therapy is like buying shoes or hamburgers, that what you get from one McTherapist is basically what you'll get from another. Others believe that the costliest therapist is bound to be the best, or that an Ivy League degree ensures a terrific product. Wrong, wrong, and wrong. Finding the right therapist is more like dating than shopping—and you, the client, are always the one who pays for the date. Unfortunately, the times you need therapy most are the times you least feel like conducting market research, but you owe it to yourself to keep looking until you find a good match.
It's useful to start by asking people you respect for recommendations (the near universal approach is to request this information on behalf of "a friend"). If no one you talk to knows a good therapist, try calling the psychology or social-work programs at the nearest university—usually the administrators can recommend several good clinicians. Once you get a name, schedule a single session, not necessarily to bare your soul but to see if this particular therapist will be able to help you.
For example, I've found that what I like in a therapist is an anthropological, duality-based Jungian foundation, with a hint of behaviorism for practicality, overtones of oak, and a fine, dry finish. No, wait, that's what I like in a merlot. The truth is that you don't have to know one word of psychobabble to pick the right shrink. After your trial session, just answer two questions:
Do I feel that this person truly hears and sees me?
Is there any part of me that wants to go back for more sessions?
In this case, a single no is a deal-breaker. Don't waste time trying to work with someone who clearly doesn't understand you, or whom you have no wish to see again. If the therapist is a good fit for you, the comments he or she makes will give you a sense of validation and relief. Even though your problems won't be solved in one session, you'll feel relief that this person is capable of helping you bear your burdens. Keep looking until you feel the inner click that tells you the person across the room gets you. (This may not happen the way you expect. The therapist of a friend of mine asked her early on in their relationship why she was such a "crummy patient." The fact was that she had deliberately been a crummy patient at times, and when her counselor called her on it, she was pleased by the realization that he was too canny to be manipulated.)
If you begin to have serious doubts about any therapist at any time, pay attention. A few counselors lack both aptitude and training, and working with them makes about as much sense as going to a back-alley surgeon for a heart transplant. In case you need convincing, I've put together a list of Bad-Therapy Action Heroes, compiled from my own real-life experiences and those of a few friends. If you encounter a therapist who fits one or more of the following profiles, get out now.
Nap Time Shrink I know two people—both fascinating women—whose brand-new therapists fell asleep during their first sessions. If this happens to you, put your rights as a client above pity or politeness. Gently awaken your therapist—or not—and say goodbye.
Mayday Shrink The French exclamation M'aidez! (rendered in English as "Mayday!") means "Help me!" Some therapists radiate Mayday energy, meaning that they seem more depressed and desperate than their clients. I have several friends who scheduled follow-up appointments with inept therapists just to keep from disappointing them. If you feel this way, take my advice: Go ahead and disappoint. Martha Beck shows you how to duck the psychotherapy quacks and find the right couch for you. Dogma Shrink You may find that a therapist is intellectually married to some theory that doesn't resonate with your worldview. For example, I just don't believe in the classic Freudian approach, with its deep faith in concepts like penis envy. (My favorite incident on this topic occurred when a friend's 3-year-old daughter reacted to her first glimpse of a naked baby boy by commenting, "Gee, Mom, he's lucky that thing isn't growing on his face.") If your therapist seems more interested in some sort of academic doctrine than in what you're saying and feeling, leave. Remember, theories don't heal people; people heal people.
Captain Distracto Shrink This type of therapist is so preoccupied that you'd do just as well to simply stay home and think. I once visited a shrink who not only took but returned personal calls—and I mean very personal calls—during our sessions. Listening to one side of her conversations provided me with excellent material for a novel but not much for my mental health.
Roundish Flatworm Shrink The roundish flatworm is a very primitive organism from which all animal life is descended, and I use the term here to mean a person too unevolved to understand complex emotions. An example is the psychologist who told one of my clients, a firefighter, that he should deal with the trauma of carrying dead bodies out of burning houses by "growing up and getting used to it." Trying to get someone this clueless to understand you is like trying to teach a slug to juggle. Don't waste your money.
Just Plain Nuts Shrink This may be the therapist who takes up 40 minutes of your costly little hour telling you how to avoid alien abduction, but it may also be the creepy shrink who rigidly insists on ideas that feel wrong or dismisses your deepest feelings with an indifferent chortle. Sessions with a good therapist can stir up your emotional waters, but you'll still have an underlying sensation of mental clarity and emotional support. If you feel crazier, less important, and more despairing after you've spoken to a therapist than you did before your session, don't go back.
The Cardinal Rule
You can steer clear of all these nightmare counselors by remembering Goethe's phrase "Just trust yourself, then you will know how to live." Rely on this truth at every stage of the therapeutic process. Trust yourself when your aching heart tells you it needs a compassionate witness. Trust yourself when your instincts warn you that the therapist your mother or minister recommended isn't giving you the right advice. Trust yourself when, sitting in a relative stranger's office, you suddenly feel a frightening, exhilarating urge to tell truths you've never known until that very moment. Psychotherapy is about listening to someone who knows exactly how you should live your life: you. A good therapist will always end up giving you back to yourself. I can tell you from long experience, it's a gift that keeps on giving.