How to Choose a Therapist

Most of us are not at our best under pressure. Similarly, when depressed, anxious, or otherwise stressed and in crisis, the patience and clarity of thinking needed choose a therapist might well be in short supply. So here are a few pointers, things to consider, when you decide to consult someone for psychological assistance:

1. Ask a friend if he or she is able to recommend a therapist with enthusiasm. Also be sure to request that your acquaintance explains “how” the therapist was helpful. Not all counselors are equally adept at treating every problem, so your friend’s recommendation should be carefully considered in light of whether your issues are different from your friend’s. You might also ask your physician for a recommendation. A good way to phrase the question is, “If you needed to get a therapist for someone you loved, who would you choose?”

2. Internet searches of various kinds can help find a good person. Various organizations list therapists who perform a certain type of therapy or work with certain types of problems. An example would be the Association For Behavioral and Cognitive Therapies: www. abct.org/ The National Register of Health Care Providers in Psychology is another such group: http://www.nationalregister.org

3. Some information about the therapist is usually available on web sites such as those mentioned above. If the therapist has a web site of his own, you will usually find out a good deal more.

4. What kind of therapist are you looking for? There are many choices. Clinical Psychologists are doctoral-level professionals (Ph.D. or Psy.D) who typically have completed four years of training beyond their college Bachelors degree and had additional instruction and supervision in the form of a year-long internship, often within hospitals or clinics. In most states psychologists cannot prescribe medication, but have received more graduate training in psychological evaluation (testing) and therapy than is typical of any of the other disciplines who perform therapy.  Psychiatrists are physicians trained in medicine, who also receive specialized training during a psychiatric residency. They can and do prescribe medication and a number of them also do therapy. Clinical Social Workers generally have a Masters Degree obtained in the course of two years of post-college study, in addition to practical experience and a history of supervision. Marriage and Family Therapists usually also have a Masters Degree and may have a similar amount of training as do the social workers, although their education is not identical to that group. All of these disciplines encourage and sometimes require therapists to continue their study via post graduate course work, supervision, and reading.

4. What kind of therapy do you want? In part, that might depend on what kind of problem or problems you have. Psychodynamic psychotherapists will tend to pay much attention to early life issues including unresolved feelings toward one’s parents, and the potential impact of additional events that occur during the growing-up years in an attempt to free you from repetitive patterns of behavior that might have started at that time. Cognitive behavioral therapists use CBT to focus more on present day concerns, attempting to help you take steps to alter the automatic and self-defeating thoughts that influence your mood and fuel your depression and anxiety, as well as assisting you in changing your behavior. They spend much less time on early life events as a rule, and do not usually consider “insight” into the causes of your troubles to be crucial to assuaging your emotional pain. Marriage and family therapy aims to treat couples and family systems, usually meeting with the marital pair or family group rather than with one person at a time.

5. Try to determine how much experience your potential therapist has with a given kind of problem. Some therapists specialize, for example, in treating alcohol and drug abuse and are certified in this field (CADC or certified alcohol and drug counselor). If you have anxiety issues, on the other hand, ask your therapist how many people he has treated with this condition. Similar questions might be asked of someone who you wish to consult for the treatment of depression or schizophrenia. Don’t be afraid to ask. Any reasonable professional in the health care field will welcome your making an informed decision.

6. Other factors might be considered. How active do you want the therapist to be? Some tend to direct the therapy, while others are more comfortable listening to you and responding to just those issues that you believe are important. Some people choose therapists based on gender, believing that they will feel more comfortable with one or the other sex. Age of the therapist is important, since it tends to be correlated both with professional experience and life experience. If you believe that not everything in life is learned in a classroom, you will probably want to see someone who has a few gray hairs and who has been married with children.

7. Financial considerations often enter into the choice of a therapist. MDs are usually the most expensive people to see and Masters level professionals are the most economical. Ask your therapist about what he charges for his services and what portion, if any, of his fee is covered by insurance. Some communities have public mental health agencies that offer therapy at a heavily discounted price, although they often have long waiting-lists. A portion of therapists will discount their fees if you can make a good case for such a discount.

If you go through your insurance company, it is likely that they will steer you toward a practitioner who has a contract with them and has agreed to discount his fee to you. Understand, however, that the discount also typically benefits the insurance company, since they will have to pay less money in benefits if you choose a provider who is in their network. Therefore, their recommendation comes with a degree of self-interest.

Be aware that (as the old saying goes), sometimes “you get what you pay for.”

8. Some people choose not to use their medical insurance to pay for counseling. They make this decision because they have concerns about the impact of a mental health diagnosis on their future ability to get life or disability insurance, and the possibility that having a “pre-existing (mental health) condition” will complicate their medical coverage should they ever change jobs or go for a period without insurance and then attempt to obtain it again.

9. Remember that the most important element in obtaining a therapist is getting a person who is accomplished, talented, experienced, and a good fit for your therapeutic needs. You should also have a sense that he really cares and wants to help. While some of the other considerations mentioned previously might be important, if the therapist can’t help you, nothing else really matters. When you meet the therapist (see my blog post “What to Expect in Your First Therapy Session“) he should be able to convey expertise, compassion, and competence, as well as giving you a sense of hope. Don’t settle for less.

Infidelity and Its Treatment

https://i2.wp.com/upload.wikimedia.org/wikipedia/commons/1/11/Lana_Turner_in_The_Postman_Always_Rings_Twice_trailer_2.jpg

The names don’t really matter. Today they are Tiger Woods; Mark Sanford, Governor of South Carolina; and John Ensign, U.S. Senator from Nevada. Tomorrow they will be someone else. Every day, there are other names, little known, but causing no less pain.

How does it happen? How does it happen that people who claim to live by well established moral norms, who have taken a public oath to remain faithful to their spouse, violate that promise? There are several reasons:

1. Power and celebrity = opportunity. People in positions of power and celebrity have more opportunity than most to be unfaithful. They are surrounded, sometimes literally, with admiring and attractive younger people. As Oscar Wilde said, “I can resist anything, except temptation!” The famous and powerful have plenty of that.

2. Contiguity. You might think that the separation of sexes in some religious fundamentalist societies is unfortunate or wrong, but it does keep opportunity at a minimum. In modern Western secular civilization, men and women work together, eat together, and travel together on business. Repeated contact with a sympathetic business associate, pulling together with that person as a team on a business project, creates not just the opportunity for sexual contact, but the chance to get to know and like one another. Perfectly moral and decent folk can find themselves stirred by the presence of a person to whom they are not married, even though they weren’t looking for anything outside of the marriage.

3. Disinhibition. Alcohol and drugs. If you are around sexually attractive people in a party atmosphere or when you are “under the influence,” your judgment and hesitation are more likely to be set aside.

4. The “Great Man” rationale. More than once, I’ve heard men justifying the concept of infidelity in the case of those who are accomplished and powerful. Often, the rationale includes reference to the role that “the great man” plays in benefiting society. According to this line of reasoning, the “heroic” figure is thought to have earned the right to live by a different set of rules than the common man, and should be given the chance to be compensated for his contribution to society by being allowed multiple sexual partners.

5. The “It won’t hurt anyone” rationale. The faithless sometimes persuade themselves that there is nothing wrong with their behavior so long as anyone who might be injured (spouse/children) never knows about it. This is akin to the old philosophical question, “If a tree falls in the forest, but no one is present to hear it, does it really make a sound?” What the argument ignores is that the transgressor is changed by his act of betrayal, that he must tell a continuing set of lies in order to maintain the fiction of his character, that he risks his partner’s physical health in the event that he has become a carrier of a sexually transmitted disease, and that it is impossible to guarantee that the secret will never be revealed.

6. Mid-life crisis. Poor humanity. Poor man. We age, we lose our youthful good looks, sometimes our hair, our virility, our energy, our strength, our stamina. The antidote? A youthful or new sexual partner who, for a time, can help us shut out the dreaded and self diminishing passage of time.

7. Solace. The ups and downs of life are inevitable, even in the luckiest of lives. The best marriages are not immune to the daily stress that  takes a toll on a spouse’s ability to be compassionate, encouraging, and supportive. Financial worries, business reverses, family illness, house keeping, and child rearing soon diminish the “date night” and honeymoon atmosphere of the early days of the relationship. A fresh and sympathetic set of ears, all understanding and acceptance, often develops into something more, and something sexual.

8. “It’s not natural.” Some people, mostly men, justify infidelity with the notion that man was not meant to be a monogamous creature and the flowers of the field (i.e. the opposite sex) were meant to be enjoyed.

9. Longevity. At the turn of the last century in America, that is, about 1900, the average life expectancy was about 50 years. By that standard it was usual for marriages to be relatively short, 25 to 35 years at the most, many much shorter. No longer. Many now last 50 years and more. What happens in that time? People get older, their bodies change, and their personalities alter as well. When I do marital therapy, I usually ask couples what initially drew them together. The most frequent answer I get is something like, “He was hot and we had a lot of fun.” Thirty years on, it goes without saying, he isn’t so “hot” and they sure aren’t having fun.

In order for marriages to thrive into mid-life and beyond, the couple has to work very hard at the relationship, to keep the sexual spark alive despite physical changes and familiarity, and to see to it that personality alterations are compatible or synchronous. Too often one partner wants the marriage to be exactly as it was at the beginning and believes that both the personality and physical changes in the other person amount to a breach of contract. Meanwhile, the other might feel held to a contract that is no longer appropriate to the current state of the couple’s life together and to their age, personality, and experience. One or the other very well may see infidelity as tempting under such circumstances.

10. The scoundrel factor. Although an injured spouse sometimes believes that “evil”  is the most likely explanation for her spouse’s betrayal, in most cases it really isn’t. Most people don’t set out to behave badly and many feel guilty when they do. That said, there are certainly more than a few cads among us, and they do with impunity what others only do with hesitation, a troubled conscience, or not at all.

11. Boredom. Boredom doesn’t cause anyone to stray, but it does set the stage for the temptation. Routine can kill even the things that we love. The pattern is well-known: wake up, go to work, come home, play with the kids, do the bills, and collapse from exhaustion. Or, the stay-at-home parent’s version: wake up, make food, shop, make food, take care of the kids, do the housekeeping, make food, clean, and collapse from exhaustion. Either way, the routine is deadening and there is little room for excitement.

12. A lack of sex. Again, this doesn’t cause infidelity, but can set the stage for it. A warning here: cease sexual contact at your own risk and at the risk of your marriage. But, this is not to suggest that you should have sex only because your partner wants to.

13. Cruelty, sarcasm, and a lack of appreciation. If the marriage has turned into a battle ground, with gratitude replaced by indifference or hostility, infidelity is more likely on either side.

When the infidelity is exposed, the result is devastating to the victimized spouse. Rage, sadness, a loss of self-regard, and feelings of inadequacy are common. What did I do? What didn’t I do? Why did he do that? If he felt that way, why didn’t he leave first before he took on another partner? The devastation occurs whether the infidelity is fresh, or the betrayed person discovers it years after it occurred. The emotional clock of devastation only begins to run from the point that one becomes aware of what happened.

If a couple comes to therapy in the wake of such news, several factors go into the therapist’s evaluation of the situation. First, is the infidelity over or is it still going on? If the marriage is to have any chance, the “other” relationship has to end. Moreover, it has to end because the spouse having the affair wants it to end and believes that the marriage is worth saving, not because his marital partner is threatening to leave or because of the fear of financial devastation in the course of a divorce.

The therapist will try to gauge what still binds the marital couple together, if anything. Do they still have positive memories of their courtship? Do they have children and are they concerned about the effects of a divorce on their offspring? Are they still in love? If there is no love on the part of even one partner, therapy is almost certain to fail to recreate it.

If the both parties want to save the marriage, have positive memories of the start of their relationship, and if loving feelings still exist between them, treatment often can help to repair things. One of the first items in need of attention will be allowing the injured spouse to grieve. This will require both tears and anger, but will need to be time limited. That is, however great the injury, the victimized spouse must understand that he cannot forever bring up the infidelity to be used as a weapon when he feels unhappy or aggrieved in the future. As the old farm expression goes, “Don’t burn down the barn to kill the rats.”

Of course, apology by the roving partner will be necessary and it will take time to rebuild trust. Once the immediate crisis is over, the couple needs to look at what contributed to their estrangement and what changes need to be made in their relationship. They have to reaffirm a set of values by which to live and goals for their relationship and for the family. Changes in patterns of communication will likely be necessary, as will time and attention to each other. Serious self-reflection and responsibility-taking will be particularly important for the unfaithful member of the relationship, but the partner too must be willing to look at the possibility that he contributed to his spouse’s feelings of disaffection.

Such situations aren’t easy, but they can come out well. Good will, sincere contrition on the part of the person who strayed, and emotional generosity on the part of the victim are all key. The betrayal is never forgotten, of course. But time does its work on the scar of infidelity, just as bodily scars tend to soften and fade over time, even if they never fully disappear. Happiness and love may yet flourish.

The image above is a cropped screenshot of Lana Turner from the film The Postman Always Rings Twice, sourced from Wikimedia Commons.

Learning From Divorce

A person contemplating divorce often believes that getting rid of his/her partner is all that is needed for a happy life. If you ask him why he is seeking divorce, he will usually give you a list of his spouse’s short comings. This topic typically comes up when he is starting to date again; he will explain to his prospective lady friend that he was the victim of the personality flaws and bad behavior of his spouse.

If you are starting to date such a person, beware! There are very few marriages which fail simply because one person (and only one) behaved badly. Even when most of the blame falls on one side, the spouse still has to answer a pretty important question: if my partner was such a “train wreck,” how is it that I picked her in the first place and missed the signs of future trouble?

In other words, if you are divorcing, its crucial you know what you did to contribute to the marital problems. Additionally, unless you discover what led you to make a poor choice of a partner, its entirely likely you will exercise poor judgment once again, resulting in another flawed choice. And if you are dating someone who has a divorce in his history, its going to be important for you to know whether your potential partner is someone who has taken responsibility for his past relationship problems and worked to reform himself, rather than claiming the victim role — the innocent target of the former spouse’s misbehavior.

These issues are important to think about, especially relatively early in a new relationship, before the emotional power of love makes pulling out difficult. Even if you and your new love interest have never been married, the same questions might well apply to failed relationships in their past. Why did they happen? Why did he choose someone like that? Why have I chosen the kind of people who have disappointed me in the past? What part do I play in relationship problems?

New partners can be exciting. Early on, you will see them only at their best. The sexual spark is likely to be strong. Still, its best you think about who you are with, while your brain is in charge and before your hormones or your feelings of affection take over.