Ep. 51 - How Do You Know If Your Therapist Is Right for You?

Finding a therapist can feel overwhelming, especially when most people aren't sure what all the different titles, credentials, and specialties actually mean. Dr. Andrew Rosen and Dr. David Gross talk honestly about what patients should know before starting treatment, from licensing and training to the differences between therapists, psychologists, psychiatrists, and coaches.

Along the way, they explore some of the less talked about realities of the mental health profession. They discuss why many clinicians are drawn to the field, how personal experience can both help and hinder treatment, and why professional boundaries matter. The conversation also touches on the power dynamics that naturally exist in therapy and the importance of making sure treatment remains focused on the patient's needs rather than the clinician's.

They also look at what effective therapy should feel like over time. From setting goals and reassessing progress to recognizing when treatment is helping and when it may be time to move on, Rosen and Gross offer practical guidance for anyone seeking mental health care and wondering what to expect from the process.

Contact the Docs:

Email: twoshrinksandamic@gmail.com

Contact the Docs:

Email: twoshrinksandamic@gmail.com

Transcript

SPEAKER_01 0:08

I'm Dr. David Gross, psychiatrist. I'm Dr. Andrew Rosen, psychologist. And we are two shrinks on a mic. Today we're going to uh talk about what we're calling therapist confidential, uh basically talking about some of the issues we met raised last time, which is that in many respects the field of mental health is a bit of a uh landmine in that uh as we said last time, you know, if you if you're going to go see an internist and a primary care doctor, you have some idea as to what they do. But for the most part, whether it be psychiatrists or therapists, uh psychologists, master's level therapists, um, I think the public has very little understanding as to what they do. In fact, when you go to uh uh uh council meetings in various towns where they bring up uh mental health uh issues, oftentimes the counselors there, the council people are not aware of the difference between a psychiatrist and a psychologist. And so the general public really doesn't know exactly who we are and what we do, which makes it a problem in terms of picking a therapist. Uh and we're gonna talk today about some of the uh difficulties and uh some of the uh trade secrets, so to speak, in our field.

SPEAKER_00 1:21

Thanks. In terms of trade secrets, uh I think we're gonna go a little bit uh to the um uh towards the end of the continuum in terms of revealing and acknowledging some of the things that people over the years have thought of mental health professionals. Um it's not unheard of for people to say, well, you know, all your shrinks are kind of crazy to begin with. Or um I wouldn't want to be the the child of a shrink because they seem to be the most messed up. And obviously that's kind of just an exaggeration in most cases, but the truth of the matter is that um a lot of people go into the field of mental health for the um goal of not only helping other people, but for trying to help themselves, an awareness of I have things that disturb me and bother me or things that I've been through, and uh maybe I understand it better so that I can help other people while I'm helping myself. An example of it really becomes more obvious in the uh rehabilitation community, the drug rehab community or alcohol uh rehab community, where in most treatment centers, the people who are doing the treatment are actually people who have been in recovery. So it's uh not unusual to have clinicians, whether they be psychiatrists, psychologists, social workers, mental health counselors, et cetera, uh having had a history of their own issues and their own problems. And that could be a good thing in certain respects, but it could also be a bad thing if the uh issues that the clinician that you're having to see uh the issues hopefully are resolved. It does mean that uh it's not typical that you see somebody who has overt problems, but one needs to consider that the mental health professional is not this person of perfection who has no issues. And it's important to just acknowledge that.

SPEAKER_01 3:25

Yeah, I think it's helpful to talk about some of the basics to begin with. Um you want to make sure that uh your mental health clinician uh is licensed in the state that they're practicing. And getting licensed in that state requires uh uh passing uh requirements in terms of training. You have to be at a a credential treatment uh therapy program in uh graduate school or medical school and then psychiatric residency program. But then you have to take a license exam and pass it. Um that then gives you the right to put up a shingle and practice. Um mental health professionals who then decide to uh be insurance providers have to then get credentialed by the insurance company, which requires providing the company with uh information about training, licensure. Sometimes it requires you provide ev evidence of malpractice insurance, um, and and then you can get credentialed by the insurance company. Uh in the state of Florida, where where we practice, um uh, for example, you can't uh you can't practice uh if you have a master's level degree in psychology. Many other states you can. In Florida, you need to have either a a social work degree and be licensed, a mental health uh degree and be licensed, marriage and family therapy, and uh a PhD or a psy-D. Uh the Psy D programs are a relatively new development in in mental health uh uh because they're clinically oriented. Uh the PhD programs require research and a thesis, and they're more geared towards academia. But the Psy D programs are a bit shorter, but they're really more clinically oriented. And this day and age, most of the psychologists I've seen, at least in Florida, uh graduate from Psy D programs. Um getting a license levels the playing field to some degree, but then after that, it's a little bit of the Wild West. And the reason I say that is that the book learning in um master's level programs or doctoral level programs or psychiatric residency programs are all going to be similar. Uh they're there they're credentialing bodies that require these programs to have a curriculum that meets their expectations. So the book learning is going to be about the same. But how that person then takes that learning and applies it out in the field can be totally different. And and an example of that is if somebody decides they want to learn um uh a technique of of therapy called dialectical behavior therapy that was originally developed for borderline personality disorder, uh, they may then turn around and apply it to everybody. You know, one size fits all, and that's something we've talked about before. And that could be a real problem. Uh so in in many respects, part of the theme that we're going to be raising today is the concept of uh holistic mental health care, the fact that you need to see the entire picture and not just hone in on one area and apply the treatment that you're well versed in.

SPEAKER_00 6:24

Yeah, all of the disciplines that you just mentioned, Dave, in the state of Florida, uh to to call yourself a psychiatrist or a psychologist or mental health counselor, you have to have graduated from uh a program that is uh documented and approved and certified, and then you have to be able to pass the licensing exam of that state. Uh but historically it didn't always work that way. I remember years ago I attended in New York City the what was called the Left Leftkowitz hearings, and this was at a time where there was very little uh legal control over the mental health disciplines, and many people would call themselves a psychotherapist. But there is no license or actual training for the title psychotherapist. It was a way for people to say that they were mental health professionals, but they weren't. They would just call themselves a psychotherapist, and nobody could say anything about it. They put their name and their degree in the yellow pages, and then the unsuspecting person who was looking for help would go to that quote-unquote psychotherapist. Now, you don't find too many people using that title, but the new title that's out there quite a bit is the life coach. Now, a life coach is somebody who has no experience, no training, no formal training, and there's no license, but they've decided to help people. And they call themselves a life coach, and it's really caught on a lot in social media, and there's actually some fairly uh well-known life coaches, and uh not to say that all of them don't help, but when people go to see a life coach, it may be somebody who just needs a little life coaching, whatever that might be. It might be about career, it might be about something uh w related to motivation, but it also may mean that somebody who really has a bunch of serious problems might end up with the life coach and actually not only not get help, but actually be mistreated. So it's very important to go back to look for a person who is licensed in one of those disciplines and then has gone on for more training. Because when you graduate any program, you know very little. You know the basics. It would be like going to uh a physician or a surgeon who just graduated and just maybe hadn't seen their first patient yet. You wouldn't do that. You want somebody with experience and somebody who has documented uh evidence that they've been through different kinds of training programs. Same thing in mental health. So you can find that information, and if they don't have any documented advanced training and fellowships or uh ongoing training in a particular area like anxiety or depression, et cetera, then best to stay away and find somebody who has more training.

SPEAKER_01 9:21

Now I don't know if I told you this, Andy, but when I first came to uh Florida many moons ago to go to medical school at the University of Florida, I found out to my surprise that at that time in the state of Florida, the only thing that you needed to be able to say that you're a licensed therapist was to have a diploma from school. So I I knew of a psychiatrist in uh in Gainesville who had his uh public school diploma on his wall, and that's what qualified him for it. Uh that that changed pretty quickly after that, and Florida then developed pretty strict guidelines for licensure um in the state of Florida, and now it's not easy to get a license at all. Um in in psychiatry, um uh besides getting uh a medical degree from a medical school that's a certified medical school, you need to go for a residency training program that's certified. Um, you also have the option to get board certified, uh, which requires uh uh special testing. And I know that they have that in psychology as well, uh, to become a diplomat. Um and many, many insurance companies and many other organizations uh that uh hire mental health professionals, psychiatrists require the board certification. Um I'm not sure it made me a smarter psychiatrist or a better psychiatrist, uh, but it it's uh a hurdle to to jump through. Uh if you're seeing somebody who's not board certified, it doesn't mean that they're an inferior psychiatrist. Uh may mean that they didn't think it was important, or it may mean that they uh had trouble taking the test. Uh and those tests were pretty pretty difficult.

SPEAKER_00 10:56

Um I think it means that you're finding somebody who wanted to sharpen their pencil as much as they could, somebody who wanted to learn more, demonstrate more, stay with the learning process, and actually document it. It doesn't mean that they actually are better at what they do, but it does demonstrate somebody who's really serious about being the best they can be.

SPEAKER_01 11:19

And then that raises the question as to how do you know somebody is good? I mean, now everybody gets on uh Google and looks at Google reviews, and they help some. You know, they will talk about the the the front staff and they'll talk about you know how comprehensive the individual is. Um and it helps to look at that. Um uh it's interesting. I have a website and uh I have uh articles I've written on the website, but the the number one item on my website that uh people tell me about gave them the most confidence in calling me for the first time was a a video I did with a a psychologist in town where we're talking about depression. He was interviewing me because it was his video program, and there they got a chance to see who I was and and how I sounded, and that's and I think that's the difficulty. Um a lot of individuals now will will go see their their new primary care provider and they'll go for a meet-and-greet meeting, which makes a lot of sense. You know, the the the physician needs to know that uh this is going to be a good match, and I think it's most important that the patient knows that uh this physician is somebody who's okay for them. And that's the same thing in mental health. Uh it's nothing wrong with meeting with uh your prospective mental health provider a few times to get a sense of where who they are and what they're like. I mean, if the first time you sit down with your mental health professional and start talking about all the problems in their own lives, you know, you've got an issue there. And unfortunately, that's much more common than people realize. I'm not sure what motivates that. I think a lot of the times uh mental health professionals uh lose the luster and lose the uh the spark they have and use the therapy section as an opportunity to ventilate themselves, which is totally inappropriate and unethical, and it's not part of the guidelines for either psychiatry, psychology, or social work or any of the other master's level mental health disciplines. But sit down with that individual and get a sense of who they are. Um in addition to that, you can get a sense of how comprehensive the initial evaluation is. I mean, I've I've uh been impressed over the years, because both of us have been around for a long time, that people that that you meet with and people that I meet with will come away and say, you know, that was the most comprehensive set of questions that I've had before. Uh in psychiatry, you know, somebody who's conscious will often stop at uh the first complaint, which was I'm depressed, and immediately conclude after that that that what's needed is an antidepressant medication rather than getting the entire picture. And the entire picture has to include, you know, the medical information, which we call the biological, the a sense of where that person comes from in their childhood that helped uh modulate and mold their psychological mechanisms, uh good and bad, as well as the uh uh the life context they live in now. You know, what's the social situation they live in? Are they in a good social support system, or are they isolated, uh, they have a job that they're happy with, et cetera. So finding when you sit down with that individual and you and you get a sense that they're covering all the bases, then you know you're in a good office. But if it looks like it's just focused on one area, which may be the area of expertise and interest that person has, then you've got a problem. And and we see that both of us in in in the drug rehab industry, where uh clinicians who are uh are rehab specialists will hone in on the drug issue and the drug history rather than getting the whole comprehensive history that they need to get.

SPEAKER_00 14:46

Yeah, you know, you just ri reminded me of a line in a movie. I can't recall the name of the movie, but it was uh uh a line it was uh somebody who was pretty narcissistic who said, All right, enough about me, now let's you talk about me. And when you see a clinician who seems to be eager to talk about themselves, then I think you can pretty be sure that you're in the wrong place.

SPEAKER_01 15:13

Uh yeah, that reminds me of a clinician in town whose chair was elevated higher than the uh other chairs in the office.

SPEAKER_00 15:21

That'll show them. And and but there's a lot of that going on, whether it be uh just verbally talking about something of their own experiences, presumably to get the patient to really feel uh like you understand me. Uh or even I know there's people who put personal information on the websites and on social media about their day-to-day life and the problems they have. And again, presumably to demonstrate, you know, I understand you and and here's what I did to help myself. But in general, I don't think that's what motivates it. I think what motivates uh a lot of self-disclosure from from clinicians is they have the need to be heard as well. And maybe nobody's hearing them, so now they have a good audience. Patients who want to be connected, they want to have a relationship with their therapist, and now they have somebody to relate to. So it's it's always been frowned upon to do self-disclosure. Certainly once in a while, a clinician, you, me, or anybody will have some self-disclosure, you know, uh for for maybe superficial reasons like uh you know, your car or where your office is or something like that. But um we've always been trained to keep as much of a blank screen as possible and not make it about us. But when you see a clinician who's making it about them as well, or even 50-50, then it's just inappropriate and and to be frowned upon.

SPEAKER_01 16:59

You know, you're raising a very important issue, which uh I've been aware of uh ever since I got into this field, which is the uh the power that the mental health clinician has in the consulting room, the power they have over the individual they're consulting with, because i i i i the the the the patient, the the individual comes in for treatment, again, like I said, is not sure exactly what's going to happen. And and the therapist, the psychiatrist, psychologist is the one who has all the answers, supposedly. And you've got a captive audience in that consulting room, and that's a and that can be a problem. Um I found over the years that the more that uh people can see me as a real person without uh uh having boundary issues and talking about personal things is uh is important. You know, there'll be some things that that I will share, like when I've had the birth of a grandchild, which was a wonderful event, uh patients enjoyed that information being shared. But to sit in the office and talk about uh you know your marital problems or the difficulties you had uh the other day with some kind of incident is totally inappropriate. But the power there is is tremendous. And I think the important thing is to is for the mental health professionals to respect the presence of that power. That oftentimes the individual who's sitting in the uh the patient's chair is feeling somewhat helpless and dependent. And um, how we influence them can be can be very good, but it also can be very, very bad. Uh there had been issues uh in mental health care for a long time of inappropriate sexual boundaries in the therapy office, and uh uh that that has been an issue. And for some people, there have also been problems with uh inappropriate business arrangements made in the therapy room. So the concept of power is really very, very important and and needs to be recognized. And uh people who come in for treatment needs to recognize that they have power as well, that then they don't have to be passive and and they have a decision whether or not this individual they're sitting with can be helpful for them going forward.

SPEAKER_00 19:03

I think it's always important uh what we've done is to communicate that this is a collaborative effort to help whatever the issues are that that person has. It's not a power struggle, it's not a power play. And just because I'm the one with the training and the experience and you're coming to me for help, uh should never be exploited. And sometimes that exploitation is really a malignant exploitation where you and we've heard stories, whether it be people famous or not, where because of the power of the clinician and the the nature of the relationship, one person being uh in a situation with problems and the other one presumably, the clinician presumably in a position of of uh tranquility and and life under control, sometimes that in uh inequality is really, really taken advantage of by clinicians. And um sometimes they're very conscious of it, and sometimes it's uh for money, and sometimes it's to get patients to never leave and to you know come in every day and and and so on and so forth, even when it's not indicated. So not to make it seem like such a bad uh possibility when you go to see a clinician, I think it's just a really important to realize that just like any field, just like any part of life, uh there's always a certain segment of it that may not be uh up to par, and we need to be aware of it. And w whether it's uh in in in our religious institutions or it's in our medical uh institution or legal institution or or anything. There's always something to watch out for. And we're just trying to give you the heads up on some of those things. But overall, mental health treatment is a really, really good thing and very helpful, and we have all kinds of personal and anecdotal examples that we feel good about in terms of our ability to help people. And there's lots and lots of well-intentioned, good, well-trained clinicians out there. You just need to know what to look for.

SPEAKER_01 21:08

You know, after after that initial evaluation session, whether it's uh one meeting, two meetings, three meetings, four meetings, or even more, because sometimes it takes time to figure out what's going on, uh, it's then very important to have a sense of what the goals are. What what what are you targeting the treatment at? And those targets can change over time. So it may be that, you know, in your talking therapy, the initial goal was to deal with uh uh marital issues. But after that, there may be other issues that are present. That is uh, you know, what what are some of the psychological factors that led to the marital problems in the first place in yourself as a spouse that can then get worked on? So coming up with uh initial, more immediate goals. Um you and I tend to see people who are in in crisis and and they have an acute situation. So oftentimes we we have to focus on the crisis issue, but After that, um, we typically will then focus on some of the core issues. And a good example of that is when um I'll see somebody with a panic disorder and severe anxiety that you can be working with as well. Um both of us know that continuing with cognitive behavioral therapy will be important, but you can't really do much effective cognitive behavior therapy unless the anxiety level is somewhat lowered and the panic attacks are stopping and the person's able to comply with the recommendations that you'll make for cognitive behavioral therapy and practice and techniques. And so that's where stepping in with medication can be very, very important, as well as education, because part of our role in the beginning is to uh decrease the individual's fear that they're crazy, that I really must be uh inferior and and uh out of my mind and that something seriously is wrong, uh, to help them understand what the nature of the problem is, the fact that they can get better and this is what they need to do to get better. And so uh coming up with a set of goals is really important. Um but you know, one of the things that I've heard, and I'm sure you have as well, repeatedly from individuals who have had therapists in the area that they've worked with for a long time, they'll say to me, I'm not exactly what sure what's going on anymore because it's almost like this person's my friend, and we're just talking about what's happening in life, you know, rather than working on some of the issues. And that's why it's important, I think, in in any kind of therapy environment to to to huddle again and and and kind of reboot the process and begin to question, you know, what what do we have to work on next? And if we don't have a whole lot to work on, then maybe we'll touch base uh much less frequently and maybe not need to touch base at all. I tell people frequently when uh their episode of a single episode of depression is gone and they've recovered and they no longer need to be on medication that says, I'll you know, I'll keep my door open, but you there's no need for you to come back to see me anymore. So viewing treatment as an ongoing dynamic process where you always have to reevaluate what the goals are and where you're heading and what's the plan is very, very important.

SPEAKER_00 24:04

I always tell my patients, you know, one way or another, my goal is to get you to the point where you don't need to see me anymore. It'll go from need to see me to uh uh uh more of an option to see me and maybe at some point intermittently see me. But my goal is to get you to be freestanding, independent, have a new, as I call it, operating system so that you can go do life in a more happy, genuine, tranquil way. Um but it's never uh the intention to just uh form the kind of therapeutic relationship where it's forever. Now, there are some people who do see me for many years, and it's more a situation of uh main maintaining their tranquility and and uh harmony in life and um sometimes it's new situations come up that are challenging the well-being of the person, but uh for the most part it's to get you to, as one of our clinicians says, to get you to fire me, to not need me any longer. And um part of that's because we have we do good work and so we are very busy. We don't need to, like some people, need to hold on to patients, believe it or not. Thank God we don't need to do that because we do good work and even in our office uh everybody has that kind of experience where they do good work and people move on. And that's the way it should be.

SPEAKER_01 25:30

You know, the we've talking about the the power of the uh of the consulting room and and and and firing your therapist, um that power itself gets uh uh individuals to come in for treatment to feel beholden on the clinician, the therapist who they're working with, and even though they feel like they're just spending money and spinning their wheels and getting nowhere with the therapy, they feel uncomfortable saying, I don't know that you can be helpful for me anymore, or even questioning what what's the role of therapy at this point and what are the goals we want to shoot for. So that that power itself creates a bit of a of a paradigm where there's an unequal uh dependence and and has to be recognized. And um, you know, the at the end of the day, the mental health field is uh uh money-making field. I mean, it's a job like any other job. And there are therapists out there who I'm sure um uh recognize that somebody who comes stays with them for a long time, it's almost like having an annuity. But it's always reasonable to question where you're at in therapy and what where we're going and what's the goal to move forward. Um and and it it's hard. And I've often had to uh uh advise uh individuals coming to see me who had concerns about what's the purpose of therapy to, you know, to sit down with their therapist and say, let's let's let's do a a recap on where we've come and let's talk about where we need to go in in a very objective, uh positive way. Um and that could be difficult. But as we've talked before, uh therapy work and psychiatry for the most part is subjective. I mean, we rely upon the words that are being said, as the patient relies upon the words that we have that we say. So um it's not an easy process, but at the same time, I'm hoping that uh this discussion is helpful for all of you, even though it's uh some of this is not comfortable to talk about, but it's the reality of the of the mental health scene. And I'm Dr. David Gross, psychiatrist.

SPEAKER_00 27:26

And I'm Dr. Andrew Rosen, psychologist, and this has been Two Shrinks in a Mike. Bye bye. The Two Shrinks in a Mike podcast is for informational and entertainment purposes only. The views expressed are those of the hosts and guests and do not constitute medical, legal, or professional advice.