Ten basic rules for sane and healthy treatment. 1. Great Therapists Are Where You Find Them
It does not matter what the person's training is. Intelligent, insightful, empathetic people with a sense of humor and of boundaries appear with anything from a nursing degree to an MD and ten years of psychoanalytic training. On the other hand, a person whose only training is a crazy mother, a weekend of reflexology, and a fondness for dream interpretation is not a great bet. The Internet has made it easy to look up anyone and see if they got their degree out of a Cracker Jack box or have been convicted of a crime. The bad news is that the only way to know if you have the wrong therapist is to sit with that person. And even then, you may not be sure if the problem is her or you... ever. But if the problem persists over months, it's probably time to stop—no matter where the fault lies. (You don't have to blame the oil or the water for not mixing.)
2. Therapy Is Not—By and Large—Fun
A shrink who has candy in bowls, delightful music playing, handknit afghans on the couch, and a tendency to compliment you on everything from your outfits to your high I.Q. is not doing her job. (Unless you came into therapy saying, "I don't give a damn how I get in my own way, just make me feel better"—in which case, you have found the perfect therapist. You may also want to consider gigolos and recreational drug use.)
3. Your Therapist Is Not a Friend
Don't get me started on how much your therapist is not a lover, or anything that even resembles a lover. Back rubs, lunch dates, and flirty e-mails are not part of the deal. The deal is: safety, security, and structure. A therapist who doesn't know this is an actual menace to you.
4. Time Is of the Essence
A therapist who can't start on time, can't end on time, who screws up your appointment more than once (you have to cut these people some slack), who needs to eat lunch while you talk, who takes phone calls during your session, or who in any way indicates that every minute of your session is not deeply important is not for you. If you really like the person anyway, bring this issue up. If things do not dramatically improve immediately, bail.
5. Nothing Wrong with Nuts
An eccentric therapist (tatty old furniture, orthopedic sandals worn with leopard-skin bustiers, or walls decorated with elk heads) is not necessarily a bad one. People do not become therapists because they are profoundly normal. If what comes out is sensible and sensitive, don't worry too much about the trappings. (If what comes out is "In a past life, I was burned at the stake" or "On my planet, we do things differently," head for the hills.)
6. Impasse, Plateau, or Dead Shark
Most little kids go through a period of regression before their next developmental spurt. Most adults do, too. (Remember the marriage-phobic, slacker boyfriend you dumped—who married a nice woman six months later and is now the father of three and a softball coach? You met him before his developmental leap.) In therapy, a longish dull period can precede a lot of movement. However, a very long dull period, in which you and the therapist seem both bored and bewildered, may signal that (a) you're done...for now, (b) you're done...with this person, or (c) you're done...until you're ready to try again. How to tell the difference? Bring it up with the shrink.
7. What If Your Shrink Says Stay and You're Ready to Go?
First rule: They work for you. Second rule: If you've always respected this person's judgment (not the same as liking them) and they say, "You're not ready to go," think twice. After you've thought twice, see the first rule. If you're wrong about stopping, you can go back—and you will have learned something.
8. How to Succeed by Really Trying
Successful treatment should feature some resolution (you don't just talk about leaving the house and why you can't—you actually do leave the house), some understanding that holds up under pressure (even when you and your husband are having a terrible fight, you manage not to say the things that make his head burst into flames and your marriage collapse), and some self-awareness that helps you move the psychic furniture instead of stubbing your toe for the millionth time.
9. What's So Good About Goodbye
It's probably time to wrap things up when the two of you are happily, even cozily, chatting about this and that week after week. His Shar-Pei, your flower arranging, his kids, your kids. It's wonderful that you've come to enjoy each other's company and your problems have been resolved. That's why it's time to stop. It should hurt; you're ending something that has been valuable and significant.
10. Where's the Rope Ladder?
Some therapies require an emergency exit: a therapist who makes sexual advances (whether in the name of repairing your self-esteem or his or her own uncontrollable desire); therapy that has gone on for 25 years during which you have changed nothing but your socks; therapy in which you're comforting/advising/reassuring your tearful/paranoid/anxious therapist; couples therapy in which the therapist has remarked, with some feeling, on how attractive your spouse is.
11. The Funny Thing About Referrals
You have to be your own Geiger counter. The guy who helped your friend overcome impotence, agoraphobia, and a fear of commitment may leave you cold and, worse, uninspired. It is best to check out the credentials (see #1) of anyone you seek treatment from, and it's great if someone you know and like has seen and been helped by that person—but it is never all you need to know. One man's Freud is another person's Froot Loop.