Emotions Revealed

by Therese Borchard

Finding the right therapist can involve almost as much energy and time as finding the right spouse. Instead of meeting for coffee, or appetizers and drinks, you’re spilling your guts inside a bunch of psychotherapists’ offices, trying to gauge whether all that notebook scribbling is going to translate into help or not. If you don’t know what you’re looking for, the important work of therapy can be delayed by months or years. Luckily, there are therapists like Ryan Howes, PhD, who are our tour guides inside the counseling walls. He’s like our Match.com concierge, equipping us with the right questions to ask so that we don’t spend years on the couch sitting across from the wrong notebook scribbler.

Dr. Howes is a board-certified psychologist in Pasadena, California, where he’s in private practice and is a clinical professor of psychology at Fuller Theological Seminary. He writes the blog In Therapy for Psychology Today, as well as an interview column for Psychotherapy Networker magazine. In 2012, Howes and some of his students formed National Psychotherapy Day (September 25th), a day to demystify therapy and reduce the stigma surrounding both it and mental health issues. As part of that campaign last year, he held a storytelling event called Moments of Meaning, in which therapists told true (but non-identifying) stories of powerful moments from their own work.

“Therapists are eager to tell you about things that aren’t directly related to your question of whether or not they can help you solve your problem,” explains Howes. “They will tell you where they went to school, where they were trained, what modalities they learned, what they researched, and so forth.” Instead of asking for their resume, he recommends you ask these six questions, and explains why.

1. My problem is _______. How would you go about treating that?

This is pretty straightforward. Of course, you have to know what your problem is, but even describing symptoms would help. “My problems are insomnia, worry, and anger outbursts. How would you treat that?” Hopefully the therapist’s response will either resonate with your game plan or will make sense so you’re willing to adopt a new game plan. The most important thing is that therapists are able to describe their process in a way that you can understand it. If they present a flashy, jargon-filled approach that goes over your head, you can expect to feel similarly confused in therapy with them.

2. Some therapists are more comfortable addressing the immediate problem, while others want to focus on the deeper issue. Which are you? 

Many cognitive-behavioral based therapies are focused on treating immediate symptoms, while deeper, psychodynamic-based therapies focus on the root causes of a problem. The preferred answer depends on your needs: If you need quick, immediate relief, you’ll gravitate to CBT, but if you’re willing to wait a while to reach a deeper insight, the psychodynamic theories are probably more your style. Again, the therapist’s ability to clearly communicate their approach is key here, even if they say they combine approaches.

3. Do you tend to lead the session, or follow my lead?

Another key distinction is whether a therapist is “directive” or “non-directive,” which is fancy talk for a leader or follower. Some therapists have an agenda for your session before you sit down: The gameplay is set, and you’re a passenger on this ride. Other therapists wait for you to set the agenda, either with a pre-determined topic or whatever comes up for you as soon as you sit down. Again, this is a matter of your personal style — directive appeals to some, while non-directive appeals to others.

4. What role does our relationship play in our work?

Some therapists view therapy as a laboratory: The problems you experience in the outside world will come up between us, and that’s a great opportunity to do important work. For others, therapy is more of a lecture hall — a place where you learn tools and tips to apply outside the session. It’s good for you to know which you’re stepping into. If you want to learn to confront people and want to practice that with your therapist, you’ll want therapy to be a laboratory. If you want tips for managing your OCD and just want therapy to be a resource for information and exercises, you’ll want the lecture.

5. What are your strengths as a therapist?

Not many clients ask this question, but I think they should. By asking, they’re inviting the therapist to make an honest appraisal of their strongest attributes, and at the same time asking them to point out what they believe are important therapist traits. If they say “my ability to earn fame and fortune,” well, you know what you’re getting into.

6. Have you been in therapy?

This may be an optional question for the most bold among you, but I think it’s a valid and important one. It’s essential for a therapist to spend a significant amount of time in their own therapy. In fact, as a therapist myself, I intend to be in therapy as long as I see my own clients. Why? Because it reminds us what it’s like to be on the other couch, because it helps me discern between my garbage and my clients’ garbage, because it models a lifetime process of constant introspection, and because I can learn things from my own therapist that may help my clients. You don’t need to ask specifics — or names and dates — but I think asking if a therapist has been in therapy is a legit question.

But your work is not over there. Howes thinks it’s even more important to have questions for yourself, such as:

How soon did you feel relaxed when speaking with the therapist?

Did you feel rushed to ask your questions, or were you able to go at your own pace?

Did the therapist seem to “get” your questions, or did they misinterpret or need to ask for several clarifications?

Did you feel like the conversation flowed, or was it clunky and awkward?

Did you understand the response, or was it filled with technical jargon or vague statements?

Imagine your deepest, darkest secret — could you imagine telling this person about it?

“Study after study shows that successful therapy depends on the quality of the relationship between the therapist and client,” Howes explains. “You’re much better off seeing a graduate student you connect with than a 40-year veteran and author with whom you don’t feel understood.”

Ask yourself:

1. Is this something I should take seriously and try to put right; is it something that is worth working on, and investing more energy on?

2. How much is my fault? Is it something I can change further down the road?

3. How much is outside my control; will anything I do really alter the situation or make a lasting difference?

5. Have I done everything I possibly can? Have I tried and exhausted all possible options?

6. Is it something I should put behind me, and decide to walk away from?

7. Who else has gone through a similar experience, or had this happen to them? Who can I talk to who will understand, and give me valuable help and advice?

8. What can I learn from this experience?

9. How can I build myself up again, so I have the needed strength to go forward in my life?

The Psychology of Inside Out: Emotions