how to find a good therapist

I think I'm already too good at questioning myself, entertaining alternative perspectives, doubting my motives and so on, which seems to be a lot of what therapy offers people. I'm trying to build up positive things rather than just removing problems. but yes, it's a lot of not knowing, & I'll stay in limbo while I consider my options

I expect this varies by health authority etc but I assume there's normally a waiting list for NHS therapists? I was told (erroneously it turns out) that I could self-refer to a mental health team in the same building as my GP surgery, but they told me I have to go through my GP which will depend on being able to get an appointment (the next available online one is in a month, but I can sometimes get one on the day if I call at 8:30).

I suppose what I'm getting at is am I better off just not bothering trying the NHS and pay up for a private one? I'm kinda skeptical about NHS therapists in the first place given someone I know's experience with them, which was as soon as they found a reason (smoking weed in this case) to discharge them they did. "Oh you smoke weed? Well I can't help you then, bye! Go and see a drugs counsellor". Of course in that person's case, there was no drugs counsellor for weed in that health authority, so brilliant work there by the NHS once again. I did manage to get CBT via the NHS around the same time, but while it wasn't quite that bad, it was similar in that once they'd talked through the basics of CBT and mindfulness they pretty much said that was it, see ya later, you're all sorted now.

I think I've been quite lucky in that my GP is also a mental health specialist, and Lambeth - in my case anyway - was fairly quick and effective at setting up CBT (I had my first appointment within a week and a half of seeing my GP). During the course of the CBT, the counsellor suggested that I might benefit from further NHS therapy separate to CBT, that looked more at other areas. I think at some point I will want to go private, but I'm going through this process first before doing that. If you've already been through this process though, then I guess maybe going straight to a private one might be the right answer here.

Are you still on the south coast? I've got a friend who's had a very good experience with a therapist in Brighton if you want a recommendation (it's a centre and they evaluate you for the best therapist).

I am still on the south coast, but not in Brighton any more. A recommendation might help. Tbh I don't really know what the fuck is going on in my life at the moment.

i’ll DM you some stuff CP. i was in a bit of a pinch recently and decided i’d kick off the nhs process while exploring private options just so i felt i was doing something, which kind of helped in itself alone with anti-depressants (and i was lucky that the cbt has been positive so i postponed the private option for the moment).

as i said upthread, my brighton friend interviewed several therapists (who ranged from the fucking awful to the really good) before selecting someone. not sure if you’ve got the time or energy for that but it did mean she ended up with someone she’s found really good.

take care mate.

I wouldn't be sceptical about NHS therapists per se, as they're quite likely to work privately too - there isn't a clear line.

My NHS therapist specifically warned me not to mention drugs in our first session questionnaire as she'd be legally obliged to pass me on - she thought it was a stupid rule and wanted to warn me. I think the inference was that it would be fine to talk about drugs, just not in the first session.

So - from a small amount of experience - I'd be confident with an NHS therapist but it depends on urgency - it could take a while for the referral - and cashflow - if you're going private make sure you can afford at least six weeks. Whatever therapist you use it's fine to set a deadline (e.g. "I can only afford four sessions so let's do our best in that time"). I'd be cautious of any therapist who disagreed with that.

i had an nhs therapist before and they were excellent. it took a long time to get a slot tho, like a year. i dunno if this is different to your experience but my nhs gp centre was referring people to counselling run by mind, the charity.

you got 12 weeks if referred, for free. this is some years back so not sure how it works today.

From my experience the most important thing is finding rapport w/ your therapist - they could be great for someone else with different problems, but if they're not working for you then they're not any good. This is the issue w/ NHS stuff, it takes so long to get any sessions at all that if you find yourself with someone who you can't talk to then you're basically screwed. Also, yes, over-reliance on short courses sucks.

I'm now with the Br1ght0n Th3rapy C3ntr3 and my therapist is excellent, would definitely recommend. I'd suspect that it's too far for you to make weekly trips, though?

^ think that's the one my friend goes to emil.y - also says she has an excellent therapist.

I've been going to see a private therapist for the past few weeks. It's mainly been going OK, I think part of my "problem" as such is allowing myself to have a problem. A lot of my cyclical ruminations involve hating myself for even having a problem, because most of my family have some kind of problem either with each other or being mistreated in some way, and I suppose I look at that and think I got off easy really. So I judge myself for feeling bad because at least nothing like that ever happened to me, so why am I so fucked up inside? The reason I'm posting this, and I kind of don't want to post this because this thread is public and while I trust everyone who posts on this thread anyone can read this and use this against me, is because at my last therapy session my therapist said I need to work out what I want to achieve from going to see him, and then he said "I'm not trying to get rid of you" but that made me think actually he is trying to get rid of me, because I'm doing therapy wrong or something. I know this is probably part of the issue in the first place, I think everything I do is wrong so of course I think I'm fucking this up somehow. But I don't really understand what he said. Maybe he thinks he can't help me. Maybe I'm annoying him. I thought the whole point is I don't know how to help myself, that's why I'm going to see him in the first place. WTF am I supposed to say to him. He's the professional here. That's why I went to him, I'm trying to make an effort here. If I knew what I needed I wouldn't need therapy!! I had a bit of a mental block in that session where I shut down completely and couldn't really speak, and he said I looked distressed, and I said well that's something that happens sometimes, and he said it looked like a coping method from some childhood trauma, and I said well, my childhood was fairly shit but not really traumatic. Then he said I was probably blaming myself for my parents' divorce because kids do, and I said well not really, I was 4, I was too young to blame myself or understand relationships and all my memories of my dad when he was at home were bad, so I only remember being happy he was gone. I never thought it was my fault. I dunno, I'm not sure but maybe I annoyed him by disagreeing with him, because I was very sure that I never thought it was my fault they split up and we kind of argued about it. Argh.

I suppose now I'm thinking he's a shit therapist and just going for the easy option. Oh, your parents are divorced? That must be it then. It sucks because I thought he was alright and I've just spend £200 for fuck all. What's the fucking point.

Wait. He argued with you when you told him you never thought it was your fault your parents divorced and that you mainly remembered being glad when your dad left? God, I hate lazy incompetent therapists. They are the worst. Is there some professional accreditation bureau you can complain to about him?

Counterpoint: the therapist might be doing a fine, if clumsy, job. The argument came *after* a mental block where ... you say you shut down completely and couldn't really speak. And that is very challenging to figure out, even for a therapist. The therapist was likely trying to understand what was going on inside your head during your pause, and went into his drawer of tools, some of which involve asking irritating questions, taking stabs in the dark, and considering the possibility of transference/distortions. You responded (as truthfully as you could) that the therapist's theory about your childhood was incorrect, and he probed a bit more to make sure you weren't just reflexively minimizing or denying an uncomfortable truth. It must've been really frustrating for both of you.

Hours or days later you're still thinking about whatever happened. Even if you've lost some trust in the practitioner, you've used the process effectively to rule out (by exclusion) some common causes of the distress that brought you into his office in the first place. I think your best bet is to go for another session and explain – exactly as you did here – that you are annoyed at the extent to which he fixated on the divorce as a root cause of your issue.

Good luck, btw. My second from last therapist tried to pin all of my issues on my adoption. (I was an infant adoption).

That sounds shit CP. It feels to me from your description that he's not really engaging with your difficulties there. I restarted therapy privately with a therapist I'd seen before Christmas last year on the NHS.

That therapy had ended with three or four perhaps contradictory things:

• The therapy had made me more anxious and worried about stuff, but in a way that made me feel i had to carry on, because i now felt i needed to lay those anxieties to rest. And that response in itself worried me. As if it hooked you in.
• I'd never done therapy before and didn't know whether this therapist was good or what good looked and felt like.
• I felt, especially with the curt way it ended, that maybe she didn't really like me as an analysand (is that the correct term?). I knew that she was a professional, but i still felt some basic sympathy (in the 'sympatico' sense) would probably result in better therapy.
• I didn't really know whether i needed to be in therapy. As you say CP, how do you know what are fears, whether your pains and anxieties are commensurate with others' etc. Unanswerables and doubts like that all get bundled up for me into the question 'Should I be here?'
• With the prospect of going private with the same therapist there was the question 'do i really want to be paying £60 a week for this?' That's a large sum, and i'm trying to be more careful about the how the value of my skills and expertise as it is represented in my pay packet at the end of the month gets converted into value for me.
• linked to that, how do you know when you're done? Obv taking Larry David as a real world example, the comedy of constant therapy doesn't appeal to me at all (not least from a f'ing cost pov).

On the 'sympathy' (for shorthand), she said, after a lot of careful structuring her answer away from whether she liked me or not, without actually saying that (which is fine - i don't need her to *like* me as such), she said she was happy to take me as a patient, and that furthermore i shouldn't feel worried to broach these i guess metatopics. She said that many therapists try to retain a sort of blank face in response to questions about the relationship between therapist and patient, but that she felt these needed to explored if they were there because one way or the other this was a relationship and it wasn't helpful for either person to withhold themselves.

On how you know whether you're done she said that one problem with therapy is that your patients are also a source of income. It is perfectly possible for the patient to feel, sometimes maybe often rightly, that they are hooked on the therapy for reasons that aren't beneficial to them. My therapist said she looked to decrease the frequency of the sessions when she felt it was useful, to avoid co-dependency, and would sometimes introduce breaks to see how patients coped, and would also tell them when she felt the therapy was no longer necessary or useful.

Both these answers really helped answer another question - they gave me confidence in her and made me feel that this was a good therapist for me to be with.

On whether I needed to be there, i described how i'd made some efforts at the beginning of this year to tackle some of the issues we'd covered last year. I used the analogy of learning something, where when you achieve the first thing or level, it's easy to think 'yes! i've done it' when you've only just begun, while a whole mountain still lies ahead of you, and that it can be hard to reproblematise something when you've got it sorted, or in the learning analogy, hard to go back to a position where you feel very inept again.

After that word and analogy salad, I said 'So, is there a mountain? Do I need to be here?' And she said she felt yes, I did, at least in part because i'd said i was focused on trying to resolve things. I got the impression that indifference to the process would be a problem for her (while anger, resentment, fear, etc would be fine obv).

I find it difficult know fully the grounds she has to say that, and even she said in her experience both patient and therapist just know.

I've gone into such detail, because a lot of this came back to me when i read your post. A lot of his questions sounded challenging, which i would have found very unhelpful and clearly and understandably made you go into your shell. For me, the answer to 'you need to work out what you want to achieve from coming to see me' is 'i don't know, that's why i'm here, and i want to understand what's wrong with me and help make it better' (or whatever the therapy equivalent of 'make it better' is - awareness, coping etc). 'cos i can't at the moment, and that's fucking me up, and i need your help here please'.

I think if you have to say that then there's something a bit wrong, but i'm not in your situation and obviously wasn't there. I also don't see how telling someone that something looks like 'a coping method from childhood trauma' is going to help at all. If they feel that's the case, I'd expect them (solely from my own experience) to say something annoying like 'it's interesting that you've done this. can i ask you about x period of your life' and then perhaps later say why they wanted to explore that and allow you to answer as you did.

aiui it would be unusual to say the least to suggest that you are to blame for anything (tho of course that doesn't mean we don't feel guilt for things for which we're not to blame).

it does sound like he's clumsy. would you be able to bring up the things you've said here with him? that might help clarify the relationship?

Fuck these therapists. What clout or backdrop does he have to judge you. So ducking out of touch.

I find it hard to trust any therapist who hasn't Been down in the dumps. Or tried drugs.

Thanks everyone, you've given me some things to think about.

I'd like to strike the 2nd post I made saying my therapist was shit from the record as drunken ranting, the main post though I think is fairly accurate.

I think you're probably right, soref that I put him in a difficult position by clamming up. The thing is I can't even remember what he asked me that caused me to do that. I think it was something fairly innocuous, running through what I do remember I think I said I'd been a bit stressed by work and wasn't very focused that day and he asked where I felt stressed. Looking back I think maybe he was looking for signs of anxiety like feeling it in my stomach? I have no idea why I just went blank, I think after a while I'd forgotten what he asked me and I just sat there going "er, I dunno" for a bit.

I think your answer to what do I want to achieve Fizzles is spot on. It seems so obvious to me, that's probably why I was confused by him asking me it.

He's probably not wrong that I was affected by my parents but I think he was fixating on the wrong aspect of it with the blame thing. It is difficult to determine what is a real childhood memory vs adult rationalisation of it, so I can see where he was coming from but I'm pretty sure I'm not making it up. I'm much more cloudy on some other stuff because I was so young at the time - my mum has told me my dad locked me in a cabinet and pushed it over when I was 3-4, and that he did other stuff (unspecified) to "toughen me up". I did tell my dad about that when I was about 20 and he denied it all saying she was trying to turn me against him. I do remember him shouting a lot. I don't really remember the cabinet thing but I do remember that there was a cabinet in the shed and being creeped out by it, but that could have been because my mum told me about it, not actually remembering it. I think it's more likely my mum is telling the truth than my dad though. Once when he was drunk he started play-wrestling with me when I was about 8 and it turned nasty and my step-mother had to get him off me. That definitely happened, so it's not unreasonable to think the other stuff did too. Thing is I told the therapist about that so that's why it annoyed me that he went for the divorce blame theory, when that seems less traumatic than the other stuff.

He has been quite good about other things. He said I have an avoidant personality. I looked up Avoidant Personality Disorder and I'm not comfortable with self-diagnosing that I have it but I certainly have a lot of aspects of it, if like most mental disorders it's a spectrum then I could be high-functioning version of it. Might just be general social anxiety though.

Anyway I'm not paying ILX so I should probably stop waffling. I'm going to give him the benefit of the doubt and keep going, at least for now. I might've lost a bit of trust but not all trust. I'm second-guessing myself now of course thinking I'm making a big fuss about nothing. But it obviously bothered me a lot.

today after ten sessions my therapist said 'so, we have ascertained that you *do* have feelings'. tearing up trees here. soon be time to take the stabilisers off. (i've been lucky – she's excellent).

just reading your last para CP – definitely waffle here. analysand's support group/how to be an analysand feels a perfectly reasonable thing to build – we have resources too!

too honest in my feeler emails; no takers

think I'll need some therapy before I'm fit to see a therapist

I had a therapist for 6-7 years and then he died 6 years ago and I never looked for another one. I need one now.

A few comments:

1. I am somewhat resistant to therapy. This shit is so hard and I seem to have limited capacity to take the intellectual insights I recognize from therapy and actually internalize them so that I can apply them to my emotional state (mostly anger issues). Therapy helped, but mostly on the margins. Regardless, I would take even that right now.

2. Previous therapist was a straight-up Freudian psychotherapist (and quite old). I might want someone a little more practical this time. I don't want someone to merely prescribe me a drug, but would want that to at least be on the table if the professional thought that would help.

3. US-based.

Any recommendations for limiting my search beyond who is in-network for my insurance?

Any help or advice is very appreciated.

go for an integrated facility with multiple providers and standards/accountability rather than just some bloke in an office, just my 2p

Trust your instincts, be prepared to kiss a lot of frogs.

For myself, one of the most important qualities in a therapist (besides compassion etc) is an ability to set structure and not just let every session be “brimstead whines for an hour”... I need goals

The way I found my current (amazing) therapist is I went to friends-who-themselves-work-as-therapists and asked them who was the best therapist they would recommend.

Thanks all for the suggestions; they are helpful.

This resonates with me:

For myself, one of the most important qualities in a therapist (besides compassion etc) is an ability to set structure and not just let every session be “brimstead whines for an hour”... I need goals

Especially since most of my issues are self-inflicted.

I tend to favor psychologists over social workers as therapists, but of course there are awesome social worker therapists and shitty psychologist therapists. But I think training in a good psychology program is better suited to individual psychotherapy practice than social work training.

You can also use Psychology Today to double check any in-network lists; some may have cringe-worthy profiles that will help you weed out the obvious NO NO NO folks.