Category Archives: Finding a Therapist

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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Is TeleCounseling the Next Big Leap Forward for the Helping Professions?

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(c)2014-2015 Rick Macnamara LCSW

Many social media sites allow us to use the phrase “It’s Complicated” next to our relationship status and for many of us, that is no exaggeration. All the modern conveniences that were supposed to make our lives simpler and more empowered just seem to add extra layers of complication and frustration. Even finding nurturing and healing time for ourselves between caring for others can be almost impossibly complicated and so we put our own self-care on a back burner. But now, thanks to improvements in technology, access to a healing professional can be as close as your laptop, tablet or smart phone.

In the 1960’s, NASA commissioned a study of what became known as telemedicine to reach patients in rural areas or who were otherwise isolated by disability. Telemedicine allows a clinician to speak over a video chat program with someone many miles away from their hospital, even someone on the other side of the world. Typically, their medical information is displayed on the screen and it enables the practitioner to provide ongoing health coaching and assessment to persons who otherwise would not have access. In New Jersey and other areas, telemedicine is also used by psychiatrists working in one hospital who can interview patients at another hospital and make recommendations for treatment.

As telemedicine technology has improved, it is increasingly used by counselors and therapists who “meet” with patients over a secure connection rather than the patient having to travel to the professional’s office. This means that a patient can easily fit in a 45-minute counseling session after the kids are in bed or before picking them up at soccer practice, right from their own couch or easy chair with a hot cup of tea right next to them.

This same technology can easily be adapted to other types of professional practices. Job coaches, spiritual counselors, even energy workers may find this to be a new way to connect with clients who might otherwise not have found the time to travel to their office for a session.

Setting up a therapy session is the easy part. There are a number of excellent software platforms that provide a virtual waiting room, instant payment by PayPal, even the ability to send helpful written materials in real time. The software is fast and easy to install.

Just as you would during an initial phone contact or first office visit, you should always make sure that the professional is properly credentialed and, if required by State law, has a current active license. Another consideration for this new way of meeting with a helping professional is that the Video chat used should be HIPPA-compliant so that your personal and health information is safe and secure. It was recently discovered, for example, that Skype does not provide this sort of confidentiality and many professionals are now moving to services such as SecureVideo and Vsee that uses military-grade encryption.

Technology may be part of the complication of our lives, but Online Therapy technology could become part of the solution. A quick search on the internet can show you a new world of convenient connections with someone who will listen to you and help you find ways to reduce your stress and make your life less complicated.

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