This is the second of three articles on how to find a therapist. In the first stage, you accepted a recommendation or referral, or you identified therapists in your area, ranked them, and made an appointment.
The process is not complete. In your first session, you can assess your therapist…
Your first session with a therapist is an important part of the process of finding a therapist. In the first stage, you made an appointment with a complete stranger. Now you can meet your therapist and either confirm your decision or back out of it.
Some therapists begin with written tests, so you do not talk very much. This is legitimate, but it makes it difficult for you to assess your therapist. If your therapist wants to begin with written tests, it might be helpful for you to ask to spend the first session talking over your difficulties. You could say that you are anxious to understand the process of therapy, and how it relates to your condition (which is probably true). If a psychotherapist refuses to talk with you, leave the session immediately.
This may be the time to consider language again. Psychotherapy depends on communication at a very deep level. If you and your therapist do not share a mother tongue, or if one of you has an accent that the other cannot tune in to, then therapy is unlikely to work well.
If you find that language or accent is a serious barrier to communication, do your best to explain the difficulty. Speak at half speed, pronouncing each word clearly. Do not raise your voice. Indeed, it can help to speak very quietly, forcing the therapist to listen hard. Express sorrow that you are having to leave. After explaining as best you can, leave the session immediately.
If the barrier to communication is less serious, you might do well to continue to the end of the session and make a decision later.
The key ingredient of any form of psychotherapy is a clear and unmistakable feeling that your therapist understands and likes you as a person, understands your difficulties, and is genuinely confident about being able to help. In therapist jargon, this is called a therapeutic alliance.
Second best is if you have the beginnings of a therapeutic alliance, but it needs some work. If hardly anyone has ever really understood you or liked you as a person, and your therapist made a huge effort to understand you and like you, that’s OK to be going on with. If hardly anyone has ever understood your difficulties, and your therapist made a huge effort to understand them, that’s OK to be going on with. If hardly anyone thinks you can be helped, and your therapist is genuinely willing to try, that’s OK to be going on with.
But if other people understand you and like you, and understand your difficulties, and think you can be helped, but your therapist doesn’t, then the therapeutic alliance failed — it’s likely that this therapist will not be able to help you.
Some therapists try to bluff their way around this. For example, they might rely on written exercises to avoid personal contact, or they might explain that their methods do not involve a close alliance. If your therapist makes any excuses like this, seriously consider trying a different therapist.
You can make this assessment at the end of your first session (although it is often obvious after five minutes). Trust your own judgement. A therapeutic alliance is a clear and unmistakable feeling. If that feeling is missing or doubtful, seriously consider trying a different therapist.
If you do have that clear and unmistakable feeling of alliance, then your therapy has begun. You do not need the rest of this article.
Ditching a therapist
If you decide to ditch your therapist after one session, try to make sure that the therapist understands your reasons. If you did not explain during the session, telephone or write a short note to explain. Be as specific as you can in one or two sentences.
If you were referred to the therapist by another health professional, explain your reasons to that person too. Discuss the possibility of finding a different therapist. Ask how you can be sure that this other therapist will be any better.
If you meet resistance, offer to have a second session with the therapist (unless the problem was a severe language barrier). But only agree to a second session if the therapist is registered for the specific type of therapy (orientation) that you are being referred for. You can find information about orientations and registration in the previous article here. If the therapist is unqualified or a trainee, express a firm preference for a referral to a registered therapist.
If the therapist was your own choice, go back to your list of therapists and try another. Don’t assume anything about other therapists just because you failed to get on well with one (or more than one). Therapists are all different. You might have to try several.
Stronger tactics — NHS
If you are an NHS patient, then you might have to use stronger tactics to get a referral to a suitable therapist.
You might want to consider using a mental health advocate to discuss your approach with. You can probably find advocates in your area by searching the Internet, or by asking your local Citizens Advice Bureau, or by starting from the Rethink website.
One possible tactic is changing your GP. A few GPs are mental health specialists in their own right, and you might find it helpful if you can transfer to one.
Another possible tactic is to have treatment from a neighbouring NHS mental health trust. You are not limited to receiving NHS treatment from your local NHS trust.
A further tactic is to make a formal complaint. This only works if you have clear-cut evidence that you have been badly treated, and it can take a long time. But people who have made successful complaints against NHS trusts have sometimes found that they get much better treatment afterwards.
Stronger tactics — private
If you are a private patient, and if you have paid for the first session in advance, then you might want to try to get a refund. The first step is simply to ask for a refund in writing. You could do this in the same letter that you use to tell the therapist about the reasons for your decision. Many private therapists will simply agree to a refund straight off, if you have given clear reasons.
If the therapist has behaved badly or is clearly inadequate, then you could threaten to make a complaint if the therapist does not provide a refund.
You probably don’t want to go to the trouble of actually making a complaint, but if you do, contact the organisation where the therapist is registered. If you picked an unregistered therapist…well, that’s why you should pick a registered one.
Remember that getting refund is not your main aim. Your main aim is to get effective treatment, and for that you go back to the list you made in the first stage of this process, and try a different therapist.