Before I launch into what makes an ‘effective’ or ‘ineffective’ Therapist, I would like to begin with a quote. The quote concerns the elements of a true connection between people and is pertinent because that is fundamentally what a client looks for in a therapist and what makes Therapeutic work effective. Without doubt, Therapy is founded on the relationship between Therapist and client and without an authentic connection, Therapy is just words.
I do not recall where I first came across this quote but I feel it speaks of what a first meeting between a Therapist and Client is might be like. Here, the client questions the Therapist, sharing what she feels is important: The desire to grow; Courage and an appetite for life; Acceptance and growth in the light of Personal Trauma; Resilience and courage in the light of suffering; Unfettered Joy; Authenticity, Congruence and Fidelity; Genuine beauty and happiness; Courage and Perseverance; Strength, Willpower and Morality; Belief and Support; to know what is real and to be at peace with oneself. These things and much more besides are what separate a great Therapist from other more mediocre and pedestrian Therapists.
It doesn’t interest me what you do for a living.
I want to know is what you ache for
and if you dare to dream of meeting your heart’s longing.
It doesn’t interest me how old you are.
I want to know if you will risk looking like a fool
for your dream
for the adventure of being alive.
It doesn’t interest me what planets are squaring your moon...
I want to know if you have touched the centre of your own sorrow
if you have been opened by life’s betrayals
or have become shrivelled and closed
from fear of further pain.
I want to know if you can sit with pain
mine or your own
without moving to hide it
or fade it
or fix it.
I want to know if you can be with joy
mine or your own
if you can dance with wildness
and let the ecstasy fill you to the tips of your fingers and toes
without cautioning us
to be careful
to be realistic
to remember the limitations of being human.
It doesn’t interest me if the story you are telling me is true.
I want to know if you can disappoint another
to be true to yourself.
If you can bear the accusation of betrayal
and not betray your own soul.
If you can be faithless
and therefore trustworthy.
I want to know if you can see Beauty
even when it is not pretty every day.
And if you can source your own life
from its presence.
I want to know if you can live with failure
yours and mine
and still stand at the edge of the lake
and shout to the silver of the full moon,
It doesn’t interest me to know where you live or how much money you have.
I want to know if you can get up
after the night of grief and despair
weary and bruised to the bone
and do what needs to be done
to feed the children.
It doesn’t interest me who you know or how you came to be here.
I want to know if you will stand in the centre of the fire
and not shrink back.
It doesn’t interest me where or what or with whom you have studied.
I want to know what sustains you
from the inside
when all else falls away.
I want to know if you can be alone with yourself
and if you truly like the company you keep
in the empty moments.
from the book The Invitation by Oriah Mountain Dreamer
Buy the book The Invitation by Oriah Mountain Dreamer from Amazon
Choosing a Therapist who is capable of offering you effective Therapy is sadly not as easy as it might first seem. It is not a case of sticking a pin in a telephone directory or choosing the nearest Therapist or the first Therapist with a ‘friendly’ voice who answers the phone. As with all goods and services Quality is an issue. Even with something as commonplace as shoes, Quality is still an issue. Not all shoes are the same; there are shoes that look great, fit and wear well and are comfortable and there are shoes that despite their appearances, pinch, damage your feet, fall apart and are unfit for purpose. And this is, as it is, with all products and services, regardless of any attempts to legislate against it. In the end, it always comes down to the consumer; to make a choice and live with the consequences. The question is: How does one make an informed choice.
Therapy, is no different from any other profession, it has its dedicated Professionals who work hard to grow and improve their abilities, skills and understanding and do their best for their clients and there are those that do the bare minimum and manage to keep clients because the client for at least a while, knows no better and has hope. Many Therapists, once qualified, believe that they have somehow ‘arrived’ and that there is no need to do anything more and so sit on their laurels doing the bare minimum to get by without thought or consideration for consequences and the effect they have on their clients.
Here we wish to offer the client hope of a better Therapist. If clients are informed as to the nature of Therapy and what makes an effective Therapist then clients will have power and the ability to choose what is best for them. Therapists that fall short of that make will not be engaged by clients and therefore will have to improve through hard work and training. This will improve the profession as a whole and its reputation.
Before this seems like a character assassination and the damning of Therapy as a profession and vocation I will offer the following. Therapists are human beings and as such are subject to the same failings, frailties, issues and concerns as any other human beings and therefore when ‘interviewing’, (first meeting with), a Therapist take time to discover who your Therapist is. Look to understand the Therapist as more than the sum of her parts. Try not sit in judgement but rather ask yourself, ‘Can I work with this person and can this person work to help me?’ Do not be afraid to answer their questions openly and in turn ask personal questions of the therapist and gauge how they respond; after all, You are going to employ them and they are going to work for you. Are they defensive, avoidant or deflecting? Are they unreasonably nervous? Are they distant? Are they interested in you? Do they listen and understand? Do they seem competent? Is their understanding of relationships and communication more developed than yours? And are they able to communicate with you? How dedicated to their own personal and professional development are they? Do they continually work on themselves using their chosen models to promote their own development or are they deluded into thinking that they do not need to and that they are better than that?
While it is reasonable for a therapist to maintain a certain level of anonymity and privacy; questions concerning their commitment to personal and professional development, and their ability to form and maintain relationships both professional and private are reasonable. Therefore do not allow a Therapist to ‘press gang’ you into not asking questions with the notion that the Therapist needs to maintain their anonymity in order to facilitate the ‘Transference’ within the relationship, as this notion does not apply here. The questions asked to establish Therapist relational credibility have no bearing on such matters. And in terms of Transference, clients project as do ‘all’ people, regardless of the ‘truth’ or self-image as expressed by a Therapist. If an individual’s projections could be overcome by the other person expressing a self-image then one would not need Therapists. People believe and perceive what they believe and perceive not what they are told to believe and percieve. Also the notion that ‘Therapy is about the client’ and therefore Therapist ‘self disclosure’ is both unnecessary and unwarranted is unreasonable is not true. While it is true that ‘therapy is about the client’ it is more true to say that ‘Therapy is about the client in a relationship with their Therapist’ and therefore the Therapist, her personally, beliefs, values, thoughts and experiences are all significant factors because the relationship is built and maintained by the Therapist. A Therapist’s ability to form healthy nurturing authentic relationships is more significant than their training and clinical experience, (this is a proven fact). Therefore, you as a client have every right to ask reasonable questions in order to establish for yourself their Therapeutic credentials beyond their Qualifications and clinical experience.
We are however not suggesting that clients seek ‘Perfection’ from a Therapist or that Therapists should never make Mistakes nor do ‘Stupid Stuff’. We recognise the importance of a Therapist’s humanity with all its frailties, faults, foolishness and failings that makes a Therapist approachable. That it is exactly a Therapist’s humanity and their ability to recognise it, accept it and work with it both in themselves and others that makes a Therapist. What we therefore suggest that is not unreasonable that a Therapist have the ability or at least make an attempt to recognise themselves and their effects within their own lives and relationships. That they have a deeper awareness of what they are doing, the mistakes they making and the effects that they are having. And in so doing work towards a better understanding, tolerance and acceptance of themselves and others and to make their own Personal Development a priority for the improvement of their client work and not just pay lip service to it.
Key Factore in Therapy
As we have already mentioned, a key factor in the efficacy of Therapy is the Therapeutic Relationship between client and Therapist, however, what is unexpected is the level of significance. If asked, most people would place Training, Qualifications and Clinical Experience as having the greatest significance with respect to the efficacy and outcomes of Therapy, however they would be mistaken. Many studies have shown the following order of significance with respect to factors that impact on therapeutic outcomes:
(Asay and Lambert 1999 ‘The Empirical Case for the common Factors in Therapy….’ Which supported Lambert’s earlier, 1992, observations).
These statistics are not only unexpected but also highlight a problem. Training, Qualifications and Clinical experience are all measurable, quantifiable and comparable, however, such information about a Therapist will avail you not. While it is important that a Therapist is properly trained, Qualified and has experience, this will not tell you how effective a Therapist is and thus we have a dilemma.
Initially Therapy has little effect on ‘Client extra-Therapeutic variables’ which are ‘personal’ and ‘environmental’ factors outside the Therapy room and client ‘expectations and hope’ which she brings with her to the therapy room. In the long term these things will undoubtedly change as therapy progresses and thus their impact change but at the outset of therapy they are as the client brings them and impact on the therapy as they impact on the client and her life as a whole.
What is key in choosing a therapist is their ability to create and sustain a healthy and nurturing Therapeutic Relationship which is the Therapeutic arena of work. The “Quality of the Therapeutic Relationship or ‘alliance’” is one area where the Therapist can have a huge impact and it is the second most influential factor with respect to Therapeutic efficacy and outcomes. A Therapist’s Relational ability is affected by their Personal Development and therefore it is paramount that a Therapist is attentive of both his Relational and Personal development and it is not unreasonable that a prospective question a Therapist with respect to these areas.
It is also important that a Therapist apply and express their Therapeutic understandings via their chosen modality or applied theories, within the client’s ‘Frame of Reference’ (see below) and understanding. Being ‘baffled’ by a Therapist is damaging to the Therapeutic Relationship as it emphasises relational inequality between Therapist and Client and leaves the client feeling foolish or ineffectual. Therefore, it is important that Therapists be sensitive to each client’s individual way of framing and ‘understanding’ their lives.
What is not important and relates to a popular misconception is that a Therapist must have a ‘Similar experience’ to that of the client. It is not possible that a Therapist have experienced all the significant experiences of all her clients. Nor is it desirable that a Therapist have experience of the significant experiences of a client because this would only detract or distract from the Therapist’s Empathic ability. We all experience our lives in an individual way and therefore even though an event may be similar the experience of that event will be personal. It is important that a Therapist Empathically understand the client’s experience of an event rather than be districted by their own experience of a similar event. No one knows how a person feels until that person expresses that feeling and it is unhelpful when we are told ‘I know exactly how you feel because I had a similar experience’. When this happens the person is not listening and instead wants to express how they feel. If a therapist has had similar events in their own lives it is only ‘safe’ to offer Therapy when they have dealt with the fallout of that situation or made significant inroads into it. When the event and its attached emotions are still raw a Therapist will be unable to focus on their client when dealing with the similar event and instead be distracted by their own feelings and needs.
What is desired from a therapist is that they have a wide and varied experience of life, (therefore very young Therapists tend to be unhelpful), which they have had time to ‘process’ and work though as personal development. This gives a general overall experience of life and working to overcome issues and concerns; which then develops into a varied pallet of emotional depth and understanding which a Therapist can apply to many understandings of both similar and dissimilar client experiences aiding the development and expression of Empathy.Also, one must not neglect the fact that a Therapist needs to be properly trained, and qualified, supervised, indemnified and work ethically. For more, see the ‘Qualifications and Accreditation’ page.
Client Frame of Referance
Nothing of any Therapeutic significance was ever changed for a client by a Therapist. Therapists work ‘for’ and ‘with’ their clients but it is the client who controls the outcomes. Nothing of Therapeutic value can be forced or cajoled onto a client that will have a sustainable Therapeutic effect. Therapists cannot force understandings or perceptions onto client. Therapists provide and encourage insight and understanding which inform the client’s understandings and this is done within an environment that nurtures and encourages personal growth. Therapy is not a matter of discovering what is ‘wrong’ with a client’s self and world perspective and telling them what and how to change it. Therapy is not to be confused with ‘advising’ clients and Therapists are not ‘Agony Aunts’. It is also not a matter of ‘fixing’, ‘protecting’, ‘reassuring’, training or ‘solving problems’. Nor is it a matter of ‘unpicking’ the threads of a client’s life with no regard for the consequences. The breadth and depth of Therapy is defined by the client and their needs and not the needs of a Therapist to be a ‘great healer’. Fundamentally Therapy concerns itself with the personal growth and development of clients within the boundaries and needs set by them within their ‘frame of reference’. Obviously the boundaries and frame of reference may dynamically change during Therapy but again, it is the client and not the Therapist that determines the rate of change and focus of therapy.
A Therapist must respect the Autonomy and work within the client’s ‘frame of reference’ if they are to build and sustain an Experiential Therapeutic Relationship.
More to come...
Therapist Personal Qualities, Beliefs, Principles and Values
Effective Therapy and the Therapeutic Relationship is built on the Therapist’s personality, Personal Development, Beliefs, Principles and Values.
Conclusion: Good Therapist or not?
There is one question that is of paramount importance to clients seeking Therapy:
How can I tell if a Therapist is of any use?
Fortunately for many ineffective Therapists this question seems unanswerable and therefore they continue to make a living while damaging the lives of others. However, there is one simple way to assess if a Therapist is effective without entering into a long term commitment with their services: An effective Therapist will have utilised whatever training and skills they have to make changes in their own lives.
An effective Therapist will demonstrate their faith in their own product, i.e. their ability, and have undertaken the Therapy which they now offer you. They will have ‘healed’ themselves or be in the process of doing so. It is in the nature of becoming a Therapist that one will naturally adopt the teaching and philosophy in ones own life and if one fails to do so one must ask if one truly understands that teaching and philosophy or if one avoiding it? It is never the case that a Therapist cannot afford the time to embark on the journey of self evolution, it is a requisite that they do so, since they are themselves the tool which they use to assist others. The adage: ‘Physician, heal thyself’ is appropriate in the context of a Therapist. How can a Therapist help you with your issues and concerns; your depression, anger, stress, or fears and lack of confidence, self-worth, and self-belief if they themselves are suffering from similar issues and concerns?
Therefore, to answer the initial question as to how one might assess the effectiveness of a Therapist, all one need do is examine the Therapist and their life.
When you contact your therapist or visit them for the first time, interview them. You are an employer looking to engage an employee who is going to provide a very personal service to you. It is therefore important that you are sure you wish to employ them. Here are a few questions you might ask:
Then access the responses and how you feel about the Therapist. What is the Therapist like? Were they nervous or worried or confident? Are they courageous in their lives or fearful? Are they spontaneous in their attitudes or controlling? Were they happy to answer your questions or avoidant? If avoidant, why? What were they hiding? Are they a well rounded human being? Are they disinterested, reactive, sullen, angry, stressed, depressed, weak, controlling, distant, fixed, protective, dishonest, fearful, foolish, insecure or unsure? Or are they real, interested, courageous, confident, balanced, happy, calm, adaptive, empathic, tolerant, compassionate, spontaneous and positive?
Finally, ask yourself a few questions. Do you have faith in this person’s ability? Has this person something to offer you? Can you talk to this person knowing that they will make every effort to understand you and convey that understanding to you? Do they believe in you even though you may not? Do they value you even though you may not? Will they be Authentic with you or will they just say what you want to hear instead of what you need to hear?
Many therapists will disagree with this and claim that being aware of their issues is sufficient and there is no need to overcome them. But this seems to be paradoxical and very inconsistent. If one has the ability to help others overcome issues and significantly improve their quality of life, then why would one not employ that ability in one’s own life? Would you employ a mechanic whose car keeps breaking down, or an overweight and unhealthy fitness instructor, or a bankrupt financial advisor or Family Therapist whose children and partner hate him? Therefore, why would you employ a Therapist suffering from stress, and anger issues, relationship problems, communication issues, substance misuse, low self-esteem, depression, anxiety, obsessions, etc.? I would not.
I would want my Therapist to be fully engaged with life, experiencing it and fully able to cope with what life has to offer. I want her to appreciate and experience difficulties and overcome them. I do not want my counsellor to be a ‘victim’ of life, scrabbling from one issue or disaster to the next, stressed, depressed and unhappy or living at the whim of others or desperate and alone.
In summary, I would want a Therapist to be able to connect with me, accept me, understand me and my life from my perspective, be positive about me and believe in our ability to work together towards my solutions to my issues. I want him to be empathic, stable, authentic, compassionate, confident, sincere, wise, resilient and effective. I want him to model the behaviour, skills and attitudes that I need to make my life wonderful, and finally I want him to be an example from which I can learn.
Many Therapists have entered into the profession because they feel that they have something to offer; they believe that their experiences of life have prepared them to help others. Sadly this is not always the case. Just because a man is hungry it does not make him a chef. (It is more likely that a hungry man will be impatient and rush in order to feed himself.). It is training, relevant experience, skills, understanding, dedication and talent that makes a good chef and so it is with a Therapist. Just because someone at some point had issues in their life, it does not make them a Therapist. Solid Therapeutic training, the application of that training to others and themselves, relevant personal qualities and talent make a Therapist. (In reality, the personal issues of a Therapist interfere with the Therapeutic process and reduces Therapeutic efficacy.)
It is also a mistake to believe that a Therapist need have experienced what you have experienced in order to be of effective help and on the whole that opposite is true. If a therapist has experienced what their client has, this can be a hindrance more than a help. During a session when the client is expressing their experience, thoughts and feelings, this may key into the Therapist’s own experience and bring up their unresolved issues and shift the focus of the Therapist from the client to themselves. At this point the Therapist will be less effective as they process their own issues instead of helping the client with theirs.
More to come...