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Are You Going to Walmart for Therapy?

5 Considerations to Assess for Quality Therapy

Written by Adrienne Loker, LCSW, EMDR, SE

We often don’t think about #therapy as a job we’re hiring for. But let’s get this straight: Your therapist works for YOU. And if it’s not working out, then they’re not working for you.

You have every right to screen your therapist for appropriateness of fit. Many people who are new to therapy don’t have a comparison for contrast, so they’re at risk for settling for mediocrity. The truth is, not all therapists are made equal, and we all specialize in something different.

There are general practitioners, much like a primary care physician, who have a wide landscape for what they treat, but are limited in scope for how deeply they can treat some presenting issues.

There are specialists in just about every niche you can think of: executive functioning, #trauma, substance use, family issues, LGBTQIA+ community, therapists who see therapists, complex and shock trauma, you name it.

If you’re new to therapy, or perhaps you’re feeling as though you’ve plateaued in your journey, here are a few things for consideration:

1. Insurance vs. private pay

One of the first things people do when looking for a provider is look for someone who takes their insurance. This is completely understandable, as therapy can be quite expensive. And there are some phenomenal therapists who are in network with many insurance companies.

Think of it this way: Therapy is an investment, much like college. Most private pay clinicians specialize in unique approaches and populations, spending thousands of dollars per year to invest in their own learning. On the rates provided by insurance companies, they wouldn’t be able to afford to invest in their professional development, which directly impacts the service that the consumer receives.

At our practice, for example, our team of practitioners all possess advanced training that allows clients to get their lives back sooner, such as EMDR, Somatic Movement Therapy, Internal Family Systems, and Psychodrama. While the cost might be more up front for private pay, the nature of the work shortens the therapeutic relationship and ends up being more cost effective in the long run.

In addition to considering the financial cost, there is also the cost of emotional labor to weigh. The majority of our clients come to us after experiencing a therapeutic relationship whose skills did not match the clinical need. This often reinforces shame narratives of feeling inherently broken – too broken for therapy to work.

2. License isn’t everything

Another important aspect to finding a therapist is their credentials. Many potential clients erroneously confuse license with competence. While a professional license does indicate a certain amount of years of professional experience, it does not automatically suggest that a provider is of any particular quality.

While most licensed practitioners have worked hard toward their license, many are able to skate by, just checking the box of their 100 hours of supervision and not actually having their skills and own biases challenged. At the end of those hours, they get to demonstrate their ability to pass an inherently racially discriminative licensing test.

To give you an idea of how vastly different supervision can look, I have supervised clinicians who expect that our time can be spent complaining about their colleagues without me getting a word in edgewise, and I’ve also supervised clinicians who are ready to learn about theory, how to apply new skills, and have their own personal experience challenged and explored when it inevitably shows up in their sessions.

Instead of overvaluing a license, I recommend looking at their training, skillset, and work experience. There are plenty of Residents in Counseling (future Licensed Professional Counselors) and Supervisees in Social Work (future Licensed Clinical Social Workers) who have a more comprehensive work history, possess a stronger skillset, or even have a more natural gift of therapy than some of their licensed counter parts.

3. Certificate vs. certification

Any time we attend a training, we receive a certificate of completion. In fact, some profit hungry continuing education providers come up with random alphabet soup to reflect a training that only took 2-3 days to complete.

Becoming certified in an approach takes commitment that spans time and energy – sometimes requiring more than what a clinical license requires. For example, to be #EMDR trained is a 6-day process, spread out over a couple months with 10 hours of consultation. In addition to this process, to become certified in EMDR requires 12 hours of continuing education approved by the EMDR International Association, as well as 20 additional consultation hours. Proof of continuing education is required yearly to maintain the certification.

EMDR certification is low hanging fruit. Other certifications, like becoming a Somatic Experiencing Practitioner, can take at least 3 years to complete the training modules. Plus, there are 30 hours of consultation and personal sessions required.

Knowing the difference between a certificate that took a weekend and certification that took years helps you hone in on your clinician’s commitment to advancing their skillset and their level of competence.

4. Theoretical framework

A therapist’s theoretical framework shapes how they view and approach your specific needs. Do they understand the impact of larger systems, early attachment needs, oppression, culture, normative expectations, and political climate on your symptoms? Do they believe primarily in medicine? Do they believe that your symptoms can be resolved by changing your thoughts? Do they believe that your nervous system is wired for healing? Do they believe you just need to face your fears? All of these beliefs set the tone for the clinical interventions to be used. And many theoretical frameworks that are considered best practice haven’t had adequate sample sizes outside of the white, cisgender, able-bodied, heteronormative experiences.

5. Have they been to therapy?

It may be hard to imagine, but there are therapists who have admitted that they don’t believe in therapy. Our practice believes that we are the ceilings to which our clients can rise. If we’re not tending to our own internal landscape, then we are unknowingly offering a dysregulated nervous system to join with our client’s nervous system.

While it’s expected that all therapeutic relationships pause throughout time, it’s important to know that your therapist believes in their own services and has the insight and integrity to seek such services out as those times arise in their lives.

I am not suggesting that your therapist inappropriately disclose personal details of their life, however, it would do a lot to shatter the stigma of receiving therapy just to know that they had their own experience - whatever that experience might be.

At our practice, we know how it is to experience our clinical modalities, because we have worked in a helping relationship where we’re on the receiving end of help. This allows us a unique perspective of the vulnerability to address certain issues head on.

We hope this list has been helpful in determining the right therapist for you. You can screen people on Psychology Today, or type in the search engine what type of therapy you’re interested in or what your symptoms are. To get an idea of what kinds of therapy modalities are out there, take a minute to peruse Our Skills on our website. Don’t forget to sign up for our Newsletter to receive tools you can use at home to regulate your nervous system. Feel free to send us an email directly with topics you’d like us to write more about:

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