How to find the right mental health professional

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No matter who you are, there will probably be a time in your life when you feel overwhelmed, facing problems and emotions that seem beyond your control. At times like these, it’s a good idea to seek out the support of a professional therapist to help you talk through your feelings, offer an outside perspective, and identify solutions.

The evidence in support of therapy is solid. Though people who don’t seek therapy often improve anyway, people who do seek therapy are more likely to improve, and they improve faster. A review of 475 outcome studies found that the average therapy client winds up better off than 80 percent of untreated people, concluding that “psychotherapy benefits people of all ages as reliably as schooling educates them, medicine cures them, or business turns a profit”[1].

That study reflects the average treatment effect among all types of practitioners and all modalities of therapy. So which practitioners and modalities are the most effective? Interestingly, some studies show that most therapy clients are highly satisfied, and that outcomes are good regardless of the modality or the therapist’s level of training and experience[2].

These studies have led some researchers to conclude that all modes of therapy are pretty much equally effective—a conclusion known as the “Dodo Bird verdict,” after the Dodo Bird in Alice in Wonderland who says, “Everybody has won, and all must have prizes!”

For some disorders this makes sense. Among clients with depression, the mere fact of having someone listen to their problems may be sufficient to activate the brain’s reward circuitry and improve symptoms[3].

But for other problems, the evidence suggests that certain therapies work better than others. Obsessive-compulsive disorder and anxiety disorders, for instance, respond primarily to exposure treatments[4], which are a kind of cognitive behavioral therapy (CBT).

CBT has been shown to be highly effective for the treatment of depression, anxiety, and post-traumatic stress[5]. A review of 28 studies from 26 publications examined clients six months and one year after treatment and found that for anxiety disorders and depressive disorders CBT was more effective than other modalities, especially psychodynamic therapy[6]. For other disorders, CBT was no more effective than the other modalities.

The American Psychological Association (APA) advises therapists to make clinical decisions based on three factors: their own skills and clinical expertise, the application of therapies based on the best available research evidence, and a personalized assessment of each client’s unique personal characteristics, preferences, and life circumstances[7]. So when looking for a therapist, at minimum you should find someone who’s able to do those three things.

Most psychologists also advise finding a therapist you click with—someone you feel comfortable with and who seems to understand you. The APA suggests asking the following questions of a potential therapist[8]:

  • Are you a licensed psychologist?
  • How many years have you been practicing psychology?
  • What experience do you have helping people with similar problems to mine?
  • What are your areas of expertise?
  • What kinds of treatments do you use, and have they been proven effective for dealing with my kind of problem or issue?
  • What are your fees, and do you accept my insurance?

The APA also offers a psychologist locator here.

?References

1. Smith, M.L., & Glass, G.V. (1977). Meta-analysis of psychotherapy outcome studies. American Psychologist, 32, 752–760.
2. Wampold, B.E. (2007). Psychotherapy: The humanistic (and effective) treatment. American Psychologist, 62, 857–873.
3. Blood, A.J. Iosifescu, D.V., Makris, N.N., Roy, R.H., Perlis, D.N., Breiter, H.C., et al. (2010). Microstructural abnormalities in subcortical reward circuitry of subjects with major depressive disorder. PLoS One, 5.
4. Lilienfeld, S.O. (2013.) Closing the Science-Practice Gap. APS Observer, 26.
5. Stewart, R.E., & Chambless, D.L. (2009). Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of Consulting and Clinical Psychology, 77, 595–606.
6. Tolin, D.F. (2010). Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review. Clinical Psychology Review, 30, 710–720.
7. American Psychological Association. (2006). Evidence-based practice in psychology (from APA Presidential Task Force on Evidence-Based Practice). American Psychologist, 61, 271–285.
8. American Psychological Association (2016). How to choose a psychologist.