To Find a Therapist, Use Your “Gut”

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©2014-2015 Rick Macnamara LCSW

As a therapist in private practice, it is unethical for me to treat friends and family, and so people who know me often ask how someone can find a good provider of counseling or addiction services. It’s an important question and I advise them that there are guides available on line with lists of good questions to ask the prospective provider, but most of these guides don’t point out that the most important consideration is how you react when speaking with them the first time.

In popular usage, how you react to another person is called the “gut feeling”; some people call it the “bullshit detector” or “doesn’t pass the smell test” and if cultivated through self-monitoring, this extra sense tends to sharpen over time. In the helping professions, we refer to this as developing self-regulation or “counter-transference”, referring to the feelings the therapist has toward the client in reaction to the client’s feelings about the therapist. Sometimes it is all the therapist has to work with.

When I first began working therapeutically with clients during my graduate internship, my clientele was very challenging; I was assigned to work with mentally ill chemically addicted homeless men and women in an urban homeless shelter system. In addition, many had prison or at least county jail records and had a mistrust of anyone in authority, even a counselor. I recall complaining to my mentor, a former NYPD Detective, “How am I supposed to accomplish anything with these people? They lie all the time.”

His response stayed with me over the years and I paraphrase it here for purposes of brevity. “You’re going to have to work with their lies and your gut. That’s all each of you has right now.”

My mentor and I had many conversations during that internship year about how to use my own reactions to a client to help them to get some positive change in their lives. I discovered, for instance, that whenever a client’s words made me feel really good about the work I was doing with them, I should watch for the other side of the coin when they suddenly hated me. This reaction of my “gut” might be a good indication for me that my client was suffering from what has been called Borderline Personality Disorder and I might then refer them to a program using DBT (Dialectical Behavioral Therapy). In other words, my “gut” was telling me that I really could not work with that client because their best hope was a specialized type of therapy in which I had no training.

Most of us in the helping professions develop these self-regulation skills to a heightened degree; those who don’t can run into serious trouble like “falling in love with” their client, misdiagnosing, subconsciously keeping clients dependent on them, and other pitfalls of our professions. And those who encounter the helping professions as clients can, over time, develop a similar “gut” sense if they did not have one before from their life experiences.

So when someone asks me how they can find a good provider, I tell them that through their life experiences they already have abilities to make good decisions and to detect BS. I give them this simple guide:

  • Have a phone conversation with the prospective provider about the issue that brings you to therapy and see how they react. And, even more importantly,
  • See how you react to their reaction or lack of reaction. Don’t accept a prospective therapist telling you to save your explanation for the first session. I routinely give a free fifteen minute session to all my new clients to give us both the opportunity to see if we have a good fit; don’t let a provider rob the both of you of that opportunity.
  • If something in your “gut” is telling you this may not be the right person for you, tell them that and see how they react. If they seem interested in discussing your “gut” feeling with you to help you clarify what it is you are feeling, they may be exactly the person you need. But if they react by saying, “Well, maybe I’m not the therapist for you” without any further discussion, they may not be the person.

Most guides to finding a therapist will tell you to ask about their years of experience, their license, their treatment philosophy, etc. and these are all good things to know. But paying attention to your reactions to each other in the beginning of therapy makes an important human connection that is much more important to resolving your issue than the provider’s curriculum vitae.

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