How To Evaluate Psychotherapy: Just the Facts

Brad sounded worried when he talked about leaving the therapist he had worked with in Minnesota. Tall and confident in his career as a human resources manager for a Fortune 500 company, Brad managed to carry himself elegantly despite his constant anxiety, depression and acid reflux. Plagued by ulcers for much of his adult life, Brad had found that talking with his therapist had calmed him down and helped him to think straight.
However, after five years of weekly therapy, the anxiety and depression that plagued him continued, and the acid reflux still required ongoing medical attention. Relocating with his wife to the Delaware Valley, she had encouraged him to seek therapy that might help him to master his anxiety and depression. Although Brad liked the idea of structured lessons on how to outthink depression, he was fearful about changing the type of therapy. When Brad and his wife and I met, Brad asked some legitimate questions about how to evaluate therapy.
“I was worried about how long the therapy was taking but my therapist in Minnesota explained that I needed to understand how my family upbringing impacted my anxiety and depression. He was pleased with the progress we made in the five years. I asked him about the newer approaches that provide research about the effectiveness of the approach, but he said these things are very hard to measure, so I shouldn’t worry about the research.
That confused me even more. How do I know if therapy was working and what shall I do next?” His steady gaze met my eyes as he asked me to help him figure out what to do next.
Skills based credentials. Therapy has often been called the “talking cure,” since the exchange of words between the client and therapist looks like what is going on. In reality, therapy offers much richer experience than the simple exchange of words and advice. Psychotherapists have been solidly trained in clinical nursing, psychology and social work.
Since anyone can hang a shingle and advertise himself or herself as a psychotherapist, it is crucial to know how to recognize credentials. These include substantial knowledge in their field of expertise, decades of experience in clinical practice, passing exams for certification from professional associations, academic publications in area of expertise, and business skill. Other values include integrity, sound judgment, enthusiasm for their work, and ability to connect with others. The field is intensely skills based.
What is therapy worth? Locally, a Ph.D. with 15 years of training may charge up to $300 hourly for their skills, while a less credentialed clinician may work for the $40 paid by the insurance company for brief managed care work. As in other professional realms, greater training, skill and experience is customarily more costly, and is sometimes valued more highly.
Evaluating therapy. To help Brad evaluate his earlier therapy, I encouraged him to ask himself these questions and suggested that the answer to each question needed to be a firm, “Yes!”
1. Did you set therapy goals for the first year of your work and did you achieve them within the first year of work?
2. Does your therapist indicate solid and deep expertise in the specific area you need to address? For example, if you seek couples work, what training has your therapist had in this specialty area? Is this indicated through publications, credentials?
3. Does your therapist offer you specific intervention techniques and strategies to address your problems both in the session and at home? Does therapy seep into the corners of your life, your heart, and your values?
4. Do you find that you implicitly trust your therapist’s judgment in helping you work out your own answers to your concerns?
Is your therapist the catalyst for your growth? Does your therapist “get it” quickly and deeply as you speak with him/her?
5. Does your therapy bring you closer to who you are inside, to the person you want to be with those you love, and to the fullness that your life can bring you? Can you see these changes within the first six months of work?
The Gift of a Life Time: Psychotherapy is a major investment of money, time and energy. It needs to bring you ongoing benefits that enhance your life month after month, or it is not worth your investment. Like Brad, I invite you to ask the questions he asked in evaluating the avenue to personal growth and fulfillment.
To consider: If you are in therapy, is it working for you? If you are considering therapy, how do you find out the credentials and expertise before choosing your therapist? This investment in yourself is worth careful shopping. It could change your life.
(Coche of Stone Harbor educates the public in mental health issues. She can be reached at jmcoche@gmail.com or 215-859-1050.)