Ep. 52 - How Do You Know If Your Therapist Is the Right Fit?

Finding help is hard enough. Figuring out whether the person helping you is actually the right fit can be even harder.

Dr. Andrew Rosen and Dr. David Gross take an honest look at what patients should pay attention to when choosing a therapist or psychiatrist. They talk about the difference between credentials and true specialization, why experience matters, and how to recognize when a clinician may be bringing their own beliefs, biases, or personal issues into the treatment room.

The conversation also explores what good treatment should feel like from the patient's perspective. How much information should a clinician gather before making recommendations? What questions should you be asking? How long should improvement take? And when is it time to consider finding someone else?

Along the way, Rosen and Gross discuss collaboration in treatment, realistic expectations for recovery, the role of therapy and medication, and why patients need to be active participants in their own care. The result is a practical, thoughtful guide for anyone trying to navigate the often confusing world of mental health treatment.

Contact the Docs:

Email: twoshrinksandamic@gmail.com

Contact the Docs:

Email: twoshrinksandamic@gmail.com

Transcript

SPEAKER_00 0:08

Hi, I'm Dr. David Gross, psychiatrist. And I'm Dr. Andrew Rosen, psychologist. And we are two shrinks and a mic. We're going to continue our discussion about the nature of the landscape of mental health care. Because it's really, I think, the way we can be of most help to our audience who are trying to maneuver their way through the minefield sometimes of mental health care because it can be confusing. We've talked about, you know, the nature of therapists and psychiatrists and psychologists and master's level therapists as well, but it's also important to talk about um how do you know that you're with the right person? You know, how do you figure that out? I mean, oftentimes you you can tell that you're with the right family doctor or primary care practitioner because they take what you're saying seriously and they send you for the tests you need to go for and they prescribe the right medication and give you an antibiotic when you've got uh an upper respiratory infection that needs one. But it's I think it's much harder with uh mental health professionals because, as we said before, the whole field of mental health is a bit amorphous. I mean, it's a bit more difficult to define it. Um you can't use the same kind of criteria that you'd use for um an internist where you can check to see where they're s where they're trained, and and you know for sure that if they're trained at a at a certified American uh residency program that they meet the same criteria in most of the programs around the country. But in mental health it's tougher. And how do you determine between uh a psychologist and a master's level therapist who's either a social worker or a marriage or family therapist or a mental health counselor versus uh a psychologist? And if you determine you want to see a psychologist, how do you determine between a PhD psychologist and a psy-D and psychiatrist? The same issue is there because the training is about the same for the most part, but their experiences and what they bring to the experiences, what they bring to the career, to their own career and their practice can be different. So that opens up a whole bag of worms that I'll let you take from there, Dr. Brooks.

SPEAKER_01 2:13

Here come the worms. Yeah, what one of the things uh that came up uh just the other day, actually, Dave, you sent me an article that was, I think, in the Wall Street Journal or the New York Times, and it was about how uh today, in in today's times, many clinicians, many therapists are taking the focus off the individual and whatever their particular problems are and their history and the and their situation, and kind of transferring it over to more of a social uh issue and c in terms of the times that we live in. And many patients, whatever their issue might be, if it's a woman, tends to be the problem is because of the way men are, and if it's a man in treatment, it's because uh of some difficulty he must be having uh getting out of the male stereotype and maybe being uh less of a man and more into being uh you know, having a feminine side. But the whole thing is it's trying to fit the particular problem of the individual into more of a social uh context. And and uh many times it regardless of what the individual issues, problem uh the individual's problems are, the focus tends to be on uh trying to maybe deal with or prove that the world we live in today or the social climate we're in is the pro is the cause and the problem. Now, we all talk about this um methodology that we approach with, and that is the biopsychosocial model, which does take into account the social aspects of a person's problems. But one of the things that we've seen more and more is that many clinicians have an axe to grind, and they take that ax and apply it to the situation. So what also has uh an impact on this is when you're looking for a clinician, and very very often now it's on websites, you'll look for uh a person, let's say, who treats anxiety, and then you'll look and see their credentials, and they say they specialize in anxiety, but they also specialize in 20 other things. My belief is, and I think yours, David, as well, is what you want to find is somebody who really specializes in a particular problem, and because they'll know that problem better, but maybe avoid the person who is specializing in a particular method, and that is because very often a person will apply the method to the problem and to the person, regardless of whether or not that particular problem is is most uh beneficial being treated by that particular orientation. So look for somebody who has a specialty, doesn't have an axe to grind, and um doesn't necessarily only treat with one method.

SPEAKER_00 5:22

You know, I I I thought that article was excellent. It was the New York Times, and uh, but I found myself wondering after reading it why it was that there is that kind of change in focus. Um and then I realized we and we talked about this the last in the last podcast that a lot of people bring their own issues who are therapists uh or psychiatrists into the consulting room. And and and behind the trying to uh uh deal with uh a person's individual problems and then trying to put it into a cluster of uh social issues and uh uh uh uh societal issues, I my sense was that there was a lot of frustration, anger, maybe even burnout. And so that's that's important to take into account. But the other issue about finding a clinician who really is specialized in that area, you can take, for example, uh trauma, psychological trauma. Uh most therapists will say, um, or psychiatrists will say that they treat trauma. But how many of the therapists are specialized in treating trauma? For example, how many have had a uh a formal course on uh EMDR, which is one of the treatments uh that could be most effective for trauma, or an individual who is treating individuals with maladaptive personality traits, and states that, yeah, I I I do I do DB DBT, dialectical behavior therapy, I took a weekend course. It's not the same. And and that's and that's part of the problem. But we have a field that um uh is a little bit loosey-goosey in those areas because of the uh lack of rigidity over qualifications. Um in our state of Florida, uh in the 1960s and early 70s, the only thing you had to prove to the licensure department in the state of Florida to become a therapist is to have a diploma from a school. It doesn't have to be a training school. So one of one of the psychiatrists in Gainesville where I trained had uh diploma from his uh grade school on the wall. Uh it's it's that kind of change that's been problematic. And and uh um it it it's also important, I think, to if you if you're meeting with a therapist or psychiatrist and you and you feel like there's something missing, to pay attention to that and and sit with yourself or talk with uh people who you trust and try to figure out what it is that's not right.

SPEAKER_01 7:49

There's an old concept in uh in psychotherapy uh that deals with something called transference and countertransference. And transference is is what a patient might uh uh bring into the treatment in terms of their experiences with other people in their lives. Countertransference relates to the therapist having issues or or um problems that they will then sometimes inadvertently apply to the patient. So, for instance, not that this might happen typically, but let's say the particular therapist has just gone through a really tough divorce. And then a comp couple comes in or an individual comes in and is having marital problems. The question is, how skilled is that therapist at not letting whatever issues or residue of uh of his own divorce be applied to this particular relationship issue? And there's so many examples like that where, you know, the therapist is a human being and their ability to separate out, to be aware of, but also partial out their gut feelings and their own histories and their own problems from letting it come into the treatment room and then be worked out on that patient. So it's very important for the for any patient to be aware of is the is my therapist somehow injecting his own issues and problems and belief systems into my situation, or is he trying is he being able to be very objective and neutral? That's a big one.

SPEAKER_00 9:26

You know, when you think about the training involved in becoming a therapist, whether you're a psychiatrist that does psychotherapy or master's level or doctoral level, um the training involves learning more about yourself. And and you know, the book learning is is the same as we've talked about before, but it's not just book learning alone. Uh a good bit of the training for becoming a psychotherapist is to be supervised by experiential, by experienced therapists and knowledgeable therapists who can give you feedback about yourself and help you identify where there is counter-transference, and we all have it. And it's important to acknowledge that it exists. Realizing that you have it is really the is really the challenge, because then you can begin to recognize I cannot let my own reactions to this uh story or this individual color my own comments and my own guidance in the process. Um and if you think about that concept of transference that you raised, um you're really trying to get the the patient, the client, to transfer their own issues onto you as a figure so that you can help them interpret what they've been doing to you. Uh and the only way to do that successfully is to recognize that your own uh psychological makeup and and and how you can be that kind of uh blank screen to allow the transference to occur. Um so it's it's uh it's really important to get a sense that of the therapist that when you're sitting with them that they're going to be uh listening well and and taking in the information and not immediately stepping in with judgmental uh issues and and comments, but they need to be able to process it for them for you and then give you feedback that's helpful.

SPEAKER_01 11:07

One of the areas that uh has become kind of a hot subject, even in the therapy situation, is uh uh and we've been reading about it in the media as well, is families breaking apart and people not being able to talk to each other because they're on the opposite sides of political issues. Uh but that also comes into play in the therapy situation. So um what happens if you have a uh a therapist who's um on one orientation side of the spectrum and then the patient's out another side, how does that get worked out in the therapy, both uh overtly and and even in subtle ways? So one of the my pet peeves about our profession in general is uh I I'm a firm believer that if you're gonna be providing therapy, you should have had your own, or some semblance of it, even if it's a a short course of therapy. Uh in my own training, because I also trained as an analyst, they had to have four years, a few times a week. Uh I'm not saying that's necessary for everybody, but there should be some time where a clinician, I believe, uh, you know, takes time out to take a look at what it's like to be on the other side of the couch or the or the treatment room and to at least look at to highlight their own issues that might play a role.

SPEAKER_00 12:25

You know, one of one of the core components of the the d interaction in the consulting room is the concept of unconditional acceptance. Um easier said than done. I mean, let's say that you're uh a Democrat and you can't stand the Republican Party and Republi what Republicans are doing, or vice versa. Um you can't let that sway your thinking if somebody comes into your office and they're they start talking about all their Republican principles, or if if or a Democrat that comes in to talk about it. So being able to provide that unconditional acceptance recognizes, it requires you to recognize how you feel internally when somebody comes into the office with something that's different than you're used to and something that makes you uncomfortable. Um you have to be able to learn how to let that roll off your back and and be able to proceed in and providing a decent, well-rounded caring. Um, individuals I've seen who um have life situations that I can't say that I'm particularly in favor of, um, if I come in to that session and begin to be critical of it, I'm no different than their parent. And that's not not helpful at all.

SPEAKER_01 13:35

What do you do as a clin as a clinician if you uh are one of these people who never talk to their family members, or let's say they don't talk to they haven't spoken to their mother in 20 years, how do you help that patient who comes in and is struggling with a relationship with their mother? These are just I could go on and on. We both could about these kinds of scenarios, but you can't blame it on the mother. You know, as objective as possible. So for the patient, you know, our urging would be look for somebody who's got a lot of good training and um does have a specialization, and when you meet with that person, you get a good feel in terms of uh of what you just described as, you know, unconditional regard and willingness to look at things, you know, from different points of view and and as objective as possible.

SPEAKER_00 14:31

You know, we've talked before. Um the initial interaction with uh mental health clinician uh is to be able to provide them with a history. Um and the clinician needs to listen well and also to ask questions to try to get more information out. Um and how they ask those questions, I think, make a big difference. Um you know that besides this, did you also experience that? And and um and uh or I'm sure being raised by a parent who treated you that way or having that kind of traumatic experience in childhood had an impact upon you. And so it's there are questions you can throw out there that help elicit more information, but gathering all that data is absolutely critical. So it needs time and it requires that the the the clinician you're meeting with, the therapist or the psychiatrist, uh, is open to gathering all that data before coming to a conclusion. And we've talked before about how some people jump to conclusions too quickly and end up going in the wrong direction in terms of treatment. But once once all that data is gathered, then it's very reasonable for the individual who's seeking help to get a clear picture as to what the clinician thinks is wrong, whether they be diagnoses or patterns of behavior or uh behavior or past experiences that are negatively impacting upon their lives now, but to get an idea of of what's wrong. And after you get an idea of what's wrong, the next step is what kind of treatment do we need to proceed with, and what would be the goals of treatment? You know, individuals who have been uh uh anxious and scared and and and obsessive and having panic attacks for the past 15 years, uh they're not going to get better right away. And then and you need to hear that. You need to hear that it's a process, that it's it's not gonna be a quick fix. And in my my profession as a psychiatrist, I have to tell people that you know no pill is a magic bullet. That it you may need a pill and you may need a form of psychotherapy, and you and you need to do both oftentimes. But to really specifically ask about what's the nature of the treatment, what are the goals we want to reach, and how do we proceed, uh is very, very important. Um I've been impressed with therapists in the community who will say, you know, the after I've gotten all this information, you really need help from somebody who specializes in this particular area of treatment, and it's not something that's in my ballpark. And that's somebody who's being a very honest, open, and caring th clinician. Um all too often, and and I'm sure you've had the same experience, therapists will take on problems that are beyond their scope of experience and training. And it's oftentimes a mistake, but you know, it's a the field is a competitive field, and there there's lots of uh uh d uh difficulties in trying to get individuals uh into their office and stay busy, and so that l allows uh clinicians to take on cases that they really shouldn't be taking on.

SPEAKER_01 17:32

So one of the things that uh as a patient I think is important uh to understand when they come to therapy or they come in for treatment is uh uh should I have any expectations in terms of time frames? You know, i it's clear that almost no problem is gonna be fixed overnight and medication isn't as isn't the magic bullet and and so on and so forth. But uh you know, there's gotta be some degree of uh ability to kind of know when should I start thinking about maybe this isn't helping me by now. Is it is it a month, is it three months, is it six months, is it nine months? And one of the things that I think we both have the ability to do is uh when somebody comes in and we've seen them once or twice, we get a sense as to how severe the problem is and the and the depth of it, and we can pretty much predict, are we looking at a a kind of it to get some degree of improvement where the person feels like, you know, I don't feel as bad right now. Is that gonna be like a two-month thing? Is that gonna be a three-month or a six-month thing? Are we talking about this is gonna be, you know, a major overhaul of issues and it could take a year or two? We have the ability to give some estimates on that, and I think it's important for patients to hear that estimate. It doesn't mean necessarily that we're gonna be held down to it, but but uh we should be able to give some time frame so that people walk out of that office the first or second time, having some idea of how long I'm gonna do this for, and you know what's reasonable to think in terms of a prediction for uh some degree of recovery. And and I think most people who especially people who specialize in a particular problem can give that. Not not not to the day, but sometimes I jokingly say when somebody says, you know, when am I gonna feel better? And I'll say, well, let me look at my watch, they know I'm kidding about that. But, you know, we can come up with some rough estimates. So I can say, look, I I think, and and we have data to support it, like for treatment of panic disorder and other anxiety disorders, we can see significant improvement in, you know, 12 to 20 weeks. So we know, okay, we're looking at three months, four months, five months. You should be really significantly feeling better. And that's with or without medicine. We have time frames available.

SPEAKER_00 19:56

And you know, because we treat a lot of individuals with anxiety disorders, um, oftentimes it becomes a multi-step process. It's and it's helpful for people to recognize that there there may be stage one, stage two, and stage three. So, for example, if somebody who's experienced a number of significant traumatic life events and as a consequence of that has developed panic attacks, uh we'll tell the individual that we first need to help calm down the panic before we can do anything else. And so stage one is going to involve uh sometimes medication and certainly a certain amount of cognitive behavior therapy and mindfulness and meditation and relaxation techniques to get a handle on the panic attacks. But the panic attacks are just the tip of the iceberg. The next step really is to identify the nature of the trauma and then to put together a plan of action to begin to help the individual get rid of some of the long-lasting effects of life trauma. Uh and then in that individual, for example, there may be some need to do some marital therapy since the the spouse has had a hard time understanding what's going on with their spouse and the panic attacks. And if you haven't had a trauma experience in your life, it's hard to understand what it's like to be traumatized like that. And so then a certain amount of education and and and family or couples therapy will need to be done. So viewing it from the perspective of a number of steps is often helpful and helps some helps the individual who comes for treatment to recognize that, well, we've got to work on this. It's not gonna be overnight, and and it's it's a reasonable process to proceed with.

SPEAKER_01 21:25

It's just really important for all patients to have some sense of how long will this take, and and so they don't step into this dark abyss and hope that somewhere in the next decade, you know, I'll I'll feel better and I can leave. We do have the ability to uh be much more definite about that. And again, that's going to be based on the level of experience and training of the clinician. And if you don't get that sense, if you're walking out of there the first few weeks or even month and feeling like I I don't know. What's going on? I don't know what the goals are. I don't know how long this is going to take. You might be in the wrong place.

SPEAKER_00 22:06

You know, in psychiatry, um uh one of the problems has been that um with with uh medications, uh psychiatrists will often find their favorite medicine. And they try to apply it to all problems, and and that's a real mistake. Um and some of it comes from, you know, uneasiness in in the in the field because of the fact that we don't have the same kind of science base that other areas of medicine have. But, you know, there are psychiatrists who will take their favorite pill and apply it to not just anxiety problems, but all sorts of different problems, and that can create difficulties. And so um the approach I take is to say that this is a medication I think can be of help, and then let me tell you why, uh, and that we need to balance the benefits against the side effects so that um this is a medicine that you can stay on and without having difficulties, and uh tell people that it needs time to work and you have to be patient with it, et cetera. But um the education, as we've talked before, is a significant, important part of of anything both of us do. I'm sure you explain to people the the purpose of psychotherapies and and and why it works, and I do the same thing with medication.

SPEAKER_01 23:18

And it will also explain the the synchronicity of the two. It's it's you know, most people don't know much about what goes on in the field of mental health treatment. And you know, maybe less today, maybe more people have a little bit more savvy. But uh it it's it's really like stepping into an unknown territory. So it's very important to even just to reduce some of their anxiety to get them to understand here's what we do, here's how we look for things, this is what we should expect. And and uh if you have questions and you're not sure, we need to talk about it. Very important to be collaborative. I talk to all my patients about this as a collaborative effort. And so you know, the kinds of things we're talking about today and over the last few times we've done the podcast are meant to clue people in as to what to look for, and if they're not getting it, to raise a question about am I in the right place? And and and to talk about it with that clinician. If they don't get a good answer or they're not getting a good response back in terms of listening and and willing to talk about it, then I would say you're definitely in the wrong place.

SPEAKER_00 24:30

You know, the collaborative notion you raise is a very important one because um I view the the the interaction between the clinician and the patient or the client as a true team approach. There's so much power that the clinician has, whether it be a therapist or psychiatrist, that oftentimes the the patient will be passive and allow the clinician to do whatever they think is necessary. And it shouldn't be that way. They should be a more of a we're doing this together, and I need to hear from you if you have concerns and questions. And if you're worried about medicines and you're fearful that it's going to change your personality or be addicting or something, or medicine that you'll never get off of, you need to tell me about it. And and welcoming them into this kind of uh collaborative team approach is terribly, terribly important. Um and uh some of that is influenced by the time pressure with uh insurance reimbursement and and and clinicians who see patients who uh as insurance providers, they often have to see a very large volume, and that can decrease the amount of time that they can spend with the individual, and that often leads to quick decisions about treatments without really engaging the patient as a member of the team. And I think that's absolutely critical.

SPEAKER_01 25:42

So these are just some of the things that um we feel are important for people to know about, and uh not only in terms of deciding when to go to therapy, but w who I should see, what should I look for, and what are the some of the things that I should not expect to see um and what to do if that happens. I mean, it's very uh easy to decide at some point, look, this isn't working for me. I think I should have been feeling better by now, and just to go on and on, uh I don't think that would be what's good for me. So that's when you look around for uh or ask around for somebody that might be uh more suitable for your particular problems, and don't hesitate to do that.

SPEAKER_00 26:29

And be assertive. You have to be your own advocate. It's tough when a person's got terrible depression, terrible anxiety, or marital stresses that are uh at a peak, it's very hard to say, look, I need to do this for myself and I need to ask the questions and be my own advocate. But it's very important to be assertive and and don't shy away from it.

SPEAKER_01 26:51

So if anybody has any further questions about this topic, I mean, you knew you can definitely send an email in and uh we'd be glad to answer any of it. But um I think we've kind of over the last three podcasts dealt with a lot of the details about how to choose people that to help you, and and now I think what we'll do in the next few podcasts and talk about specific problems and disorders that we've not touched on so far, and uh including trauma that would be one and uh and some of the other issues that we face every day. So um for both of us, this has uh been uh a really good thing for us to be able to talk to you about this. And I'm Dr. Andrew Rosen, psychologist.

SPEAKER_00 27:36

And I'm Dr. David Gross, psychiatrist, and we are at Two Shrinks in a Mike.

SPEAKER_01 27:41

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.