Tip Day: Picking out a therapist

I am smack-dab in the middle of trying to find a new therapist.  As I mentioned last week, TNT is leaving clinical practice, and I am left trying to find someone new. 

I hate finding therapists.  It's painful, time-consuming, and really, really tough.  So with me once again playing therapist picker-outer, I thought this week's Tip Day would be a great time to discuss what I've learned about picking out a therapist (this is the 13th time I've done this--I think I qualify as an expert!).

{{I realize some people don't have the fortune of being able to pick out a therapist.  The system where you are is that you get what you get.  If that's the case, I apologize.  However, I hope that what you read is useful for helping you figure out if you can apply for a new treatment provider or help them help you better.  I have choice, but with choice comes really steep medical bills for insurance and co-pays.  Win some, lose some, I guess.}}

1. Get referrals from people you know and trust. It might be a medical doctor.  It might be a friend or someone from the community who has also had an eating disorder or other mental health issue.  Or a guidance counselor at school.  Also check with your insurance company to see who might be covered and in-network. This way, you already know some things about the therapist--the basics of how they practice, that they're reputable, how much you might have to pay, and so on.

2. Don't rely too much on referrals.  Opinions are opinions, and not everyone sees the same thing in every therapist.  What I might find reassuring may drive you bonkers.  It's important when gathering data to separate fact from opinion.  That a particular therapist practices CBT is a fact.  That your friend finds them a total flake-azoid is an opinion.

3. Nice isn't the most important factor.  Of course we want our therapists to be nice.  Most of them are--misanthropes typically don't go into clinical psychology.  There are times when nice and kind and gentle is probably the right response.  But there are lots of times, especially when dealing with eating disorders, that firm and direct needs to take precedence over hand-holding.  The work of recovery is hard and miserable, and I've had therapists that were too nice and didn't push me into recovery.

4. Find out what treatment modalities they use.  I'm not especially keen on overly emotion-focused, insight-oriented psychotherapy.  I know many people find it helpful and useful, which is great.  For me, I like the acronym therapies: CBT, DBT, and ACT.  I like that they have evidence to show they are effective, and I like that they are much more concrete and practical.  So do your homework.  Find out which types of therapies you think would be most effective to help you move into recovery.

5. Ask them what causes eating disorders.  For me, this is the #1 screening question I use.  Because if I hear things like "unresolved childhood issues" or "boundary violations" as what causes eating disorders, I will run for the hills.  It means that, fundamentally, this therapist and I will not get along, will not see eye to eye on what I need to work on, and also that I know more about EDs than my therapist.  It's an easy way to gather information, and I often ask it right off the bat so that they don't have a chance to try and tell me the answer they think I would like to hear (this isn't that I think a therapist would really be blatantly dishonest, but it is human nature--heck, I've done similar things).

6. Find out their professional affiliations.  If you are trying to find a therapist for your eating disorder, then ask them if they're members of NEDA, of AED, of IAEDP.  Not all areas have an ED specialist, so you can also ask things like how many eating disorder patients do they treat, have they had any special training in eating disorders, do they know of a colleague who knows more about eating disorders, that sort of thing.  Good therapists will be impressed that you're asking this, so don't hesitate.

7. Ask hypothetical questions.  No, not the "if a tree fell in the middle of the forest..." types of questions.  But things like "If my parents called with questions, how would you respond?" Or "If I needed a higher level of care, what would you do?"  Or "If my symptoms increased, how would you handle it?"  It's good to know these things before a crisis hits, and it can also give you an idea of how the therapist generally handles issues, and how knowledgeable they are about EDs.

8. Don't let one bad apple ruin everything.  Bad therapists exist.  They might be a bad fit for you, or irresponsible, or whatever.  That's one therapist out of many.  Just because you found one bad apple doesn't mean that therapy doesn't work or that you're never going to get better.  It means you just found a bad therapist.  That's all.

What have you found helpful when searching for a therapist?  Share in the comments!

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hm said...

Boundaries is a biggie for me- for a therapist, dietitian, doctor, whatever. If they are lackadaisical about their own professional boundaries (hesitant to discuss, waves away your questions about needing to sign things for privacy reasons, oh-we-don't-need-to-worry-about-that kind of an attitude) then they will probably have no respect for your personal boundaries either. This goes along with tip #7- definitely ask questions about how they would handle your family calling them, other members of your treatment team calling them, if they discuss their client cases with colleagues and/or a supervisor, how they would react if they ran into you in public. They ought to have well-constructed answers to these things on the tip of their tongue. Perhaps one might answer differently than another, and you'll have to decide which answers you can tolerate. But if they're wishy-washy or indecisive, that might not be a safe place to dump and process your most intimate issues- it's no fun to be shocked by a sudden display of poor boundaries later on.

Anonymous said...

Hi Carrie! I am also looking for a therapist and I liked your idea of asking what causes an eating disorder, but I realize that I don't know what a good answer would be. In fact, I am not sure either what causes an eating disorder. Could you tell me or maybe even write a post about it? :)

Cathy (UK) said...

I guess the main thing I would say here is that we have a totally different healthcare system and health culture in the UK. We are not 'big on therapy'. Few people have therapists.

If we have an ED the first port of call is GP. GP refers us to specialist ED therapist/psychiatrist if we meet specific criteria. If we are sufficiently sick - either physically or mentally we get NHS funding to go into an EDU - where we are rapidly re-fed and therapy focuses mainly on CBT, DBT and 'body image' (yuck - regarding the latter... says she as a non-fat-phobic former anorexic...).

It has only struck me recently what a very different system we have in the UK vs. the USA. I still have (sporadic) therapy, but only because I have co-morbid issues that fed into my AN. We just don't 'do' therapy in a big way like you do in the USA, unless we pay privately. Therapy isn't routinely offered through the NHS.

kushika said...

Anonymous -- there isn't a single answer and the "answer" is individual to every person. Many contributing factor include: abuse (mental/physical/sexual), amount of family/friend support, other psychiatric illnesses (e.g. depression), chronic physical illnesses, bereavement, personality types, low self-esteem, genetic predisposition etc. That is not to say that everyone who has experiences one of the above gets an ED. If the medically profession knew the answer so many of us would be cured so much sooner! I think you need to look to find someone who does NOT have a straight forward answer, or knows how complex ED causes can be.

Cathy, you made a very important point. Unfortunately when I got ill with anorexia there weren't ANY ED units for children in my whole county! At times they were considering sending me to a general mental health ward and tried their very hardest to keep me out of there (because everyone just eats to get out). In the end I was treated by CAMHS (child general services, but who deal with many ED cases). I had no say or choice in who was my therapist and got what I was given, which was CBT and a tiny bit of DBT training my T went on.

I'm being treated by adult services at the minute. In total I've been in treatment for 2 years or so by switching from one healthy professional to another, which is probably more than most. My OP adult services will treat me for a total of 20 sessions, so I meet her about once a month.

In fact, the reason why I got so ill before I got proper help was because when I got referred to a pseudo-professional (PCAMHS) for SI they dropped my case after seeing me twice because I went on holiday for 3 weeks! And wrote to my mum everything they said even though there was no reason to breach confidentiality. No help was offered to me when I was suicidal, so I tried to get way below the "anorexic BMI" before getting help because the NHS made me feel undeserving of help and I wanted them to hear me. Sometimes it is tragic how the NHS works but I am happy that I am able to get some help for which I would otherwise no be able to pay for.

Ashley @ Nourishing the Soul said...

These are really wise tips. I think at the heart of this post is the fact that consumers of mental health services need to be proactive and, yes, choosy, when selecting a provider. I think that many clients don't feel they have the right or the voice to ask tough questions of their (potential) therapist or feel that they cannot leave once a relationship is formed. I think that not only is important to communicate your wants and needs at the start of therapy, but continuously throughout. I'm also glad that you brought up asking about professional affiliations. While I've encountered many, many therapists who say they work with eating disorders, often it's not a specialty and they haven't worked with severe or chronic cases. While an affiliation doesn't guarantee that, it usually at least means they are invested in staying current in the field.

I posted a reader poll yesterday that you might find interesting about "What if your therapist had (in the past) an eating disorder?" : http://www.nourishing-the-soul.com/2010/12/therapist-eating-disorder/

Jen said...

Not only is this a terrific post, but the comments help to broaden the discussion. I'd like to post this in my "of note" section for parents. Is that okay?

Lisa said...

I have a really really difficult time dealing with bounadries and attachment issues with my therapist. I can't imagine leaving her. I think that the fact that you have to strength to find another therapist and how you're going about it is great. You're very strong and brave- I think your tips are all great. I was told that finding the right therapist is like finding a husband. NOT easy. :-)


Anonymous said...

I have had 11 therapists so you beat me! :)

My number one question I ask to weed them out is:

"Do you believe that people can actually recover from eating disorders?"

If the answer is no, I don't waste my time with them. I also run for the hills! :) People recover from eating disorders all the time and go on to live fulfilling lives. If they don't think people can truly recover its because they have never seen it happen. Back away slowly...

I'm recovered and happily enjoying life as its meant to be lived.

Carrie Arnold said...

Anon #1:

As for what causes eating disorders, I can give you a very long answer to that. I have some posts I've done in the past and I will try to dig them up. The breakpoint for me would be if they didn't mention biology/neuroscience/genetics.

Carrie Arnold said...

Anon #2:

That is a wonderful question! I will add that to my repertoire.

Carrie Arnold said...


Absolutely, you can add this to your blog. No need to ask. ;)

Julia said...

I was thinking about requesting a post on this exact topic, since I'm about to start looking for a therapist for the first time. Thanks so much for sharing these excellent points and thank you to the other commenters for their added insight!

Anonymous said...

I am in the UK and have been through PCAMHS, CAMHS and am now with a totally different service which focuses on therapy for youths however all is covered under the NHS :).

I have been in treatment for one and a half years however I recently started with a new therapist and I'm finding it difficult. She seems to think exactly like I don't. She's always talking about my past, childhood, family etc. Very Freudian and psychodynamic - I always say "it's simpler than that, I don't think it's that complicated" she replies "Maybe you want it to be simpler, you've simplified everything in your mind". It drives me insane!

I asked to try CBT. She said I was running away from my true problems. We're getting nowhere. What should I do? I've thought of contacting the service from above to see if they can change me but I'm afraid she'll put her foot down and return to the whole "you need to address the real issue" which she is convinced is probably my parents and attachment to my mother or something else.

Please help me Carrie, thanks xxx

Anonymous said...

I totally agree on recommendations. But I like to get them from a therapist I already like. Right now, I am going to have to change therapists because mine is too expensive and also going on maternity leave. It sucks so much, I have been through so many for many reasons - bad ones, changing insurance, me moving locations, therapist moves, etc.

My number one thing is if they are familiar with DBT and use it. DBT has changed my life and matches how I think so much. It's hard for me to explain right away how I think but that is a good indicator. I am trying to work on formulating describing how I think as I see this new person. I hate when I get annoyed about that.

I also think: always love yourself enough to find someone else if that person isn't working for you for whatever reason.

Good post!

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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Have any questions or comments about this blog? Feel free to email me at carrie@edbites.com

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