Choosing a therapist and working well together – Frequently Asked Questions
So, you are wanting to choose a therapist but you are confused about how to go about it. You also want to do something that helps you make lasting changes in how you live your life.
- Seems like you have already made the first step, researching different psychologists and getting a feeling for what they would be like to work with. For example, this website gives you a feel for the collaborative, evidence-based approach that I utilise.
- To be honest, it’s impossible to know for sure if a particular psychologist will suit you. You can increase the likelihood of success by:
- Being open, curious and prepared to experiment with new perspectives and put them into use in your everyday life
- Clarifying what expertise you already have about your mind and behaviours and putting that wisdom to even better use
- Tracking progress towards:-
- your therapy goals and
- progress in targeting any obstacles that are getting in the way of living your preferred life, and
- adjusting the approach of therapy based on that feedback.
Said another way, is what we are doing helpful, now? It’s a well understood process and research into “practice-based evidence” tells us how to do this effectively.
During the first session, you and the therapist will collaboratively attempt to make sense of:
- what problem – what brought you to therapy,
- why now – what precipitated the current situation,
- which experiences, personal traits and social environment contributed to the current situation, and
- why change – your therapy goals (expressed in terms of things you want to do more of).
Out of that process will fall an evidence-based way of working together. The immediate impact will be using the active ingredients of that therapy in the therapy session and (very importantly) putting the new skills and approach into practice in your day-to-day life.
You may find Acceptance and Commitment Therapy (ACT) useful if you have been:
- struggling with your thoughts (getting hooked in by thoughts and memories),
- engaging in life-interfering behaviours to avoid difficult emotions,
- not being really present (drifting off into imaging he future or ruminating about the past), or
- unsure about who and what is important to you (values).
ACT is a modern form of cognitive therapy. I am trained in ACT. You can read some more about ACT here.
If you are feeling anxious or depressed you may also you find yourself feeling unhelpfully threatened, isolated, self-critical and ashamed. It’s quite understandable given the evolutionary design of our brains and difficult to shift patterns of thinking and behaving that arise from past experiences.
Compassion Focused Therapy is particularly helpful for these kinds of experiences. CFT draws from other cognitive therapies (CBT, ACT, DBT).
I am trained in CFT. You can read some more about CFT here.
Dodo Bird Findings
The emphasis on identifying particular evidence-based therapies was challenged by the “Dodo Bird findings”. The saying is a quote from the Dodo bird in Alice in Wonderland that “Everybody has won and all must have prizes? The Dodo Bird Findings suggests that all psychotherapies are equally effective, explained by common factors such as the therapeutic alliance. The conclusion is that therapeutic success is not about choosing the right therapy (and therapist). Rather, research tells us that it is driven by other factors such as how well you and the therapist work together; your own commitment, life history and current life situation.
Practice-based evidence asks, “Is this treatment, however constructed, delivered by this particular provider, helpful to this client at this point in time?”. Practice-based evidence is powered by real-time measurement of client progress, and real-time feedback to clients and therapist. It might seem pretty obvious given what we know about improving performance in sport (think footballers and Olympic athletes) and music (think professional musicians and dancers) who have a very deliberate approach to training. Deliberate Practice (Miller) calls for a cycle of
- determining a baseline level of effectiveness;
- obtaining systematic, ongoing, formal feedback; and
- repeatedly engaging in activities specifically designed to refine and improve performance.
Improving as you go
Done well, this approach fits naturally around the therapy session. At first session, completing some brief self-report baseline measures of
- where you are with your therapy goals, and your life overall
- progress and obstacles to living your preferred life,
- current levels of common psychological distress symptoms (e.g. depression, anxiety and stress and anything specific that is the focus of therapy)
- typical things that might get in the way of being more flexible in responding to every day situations.
Plus, brief measures of progress at each subsequent session, collaborative discussion and finessing the therapeutic approach based on that feedback.
Pausing to re-calibrate
Occasionally (say at session 6 and 10), it is useful to re-do the self-reports from the first-session to inform a more detailed reflection on progress and responding with actions to refine and improve therapy effectiveness.