As a psychologist, one of the most common questions I get – right up there with the ever-popular “oh, so are you analyzing me?” – is some version of, “how do I go about finding the right shrink?”
In part 1 I wrote about the idea of fit, and the importance of the relationship. The person with whom you choose to work has to match your problem, your expectations, and your needs. S/he also has to have the skill set that will help you. Probably most important you have to feel good in the relationship. You have to trust your shrink, because s/he’s likely to see you at your best and your worst.
One of my commenters described a good shrink as an emotional Sherpa. My beloved Maddie said her image was of a bellhop at a really high end resort – someone to help you unpack your baggage, without judgment, helping you make decisions about how to arrange your things.
Both of those images work for me, because in both cases they say something about the person you choose, but they also say something about you. There’s no point in picking a trustworthy shrink if you’re not willing to work on your stuff, and that means being vulnerable.
So far I’ve told what you’ll find in virtually every article about choosing a shrink: the relationship is the most important thing, and s/he has to be a good fit with the right skills for you right now. But now what? How do you go about figuring out whether this is the right shrink for you?
Interviewing your emotional sherpa: ask these questions
Is this a mental health problem?
Start first with a question that people often skip, both patients and therapists: can mental health care address your problem? If your life is a financial wreck, you are ass-deep in debt, and you’re unemployed, you don’t need a shrink. You need a practical approach to solving your immediate, practical, problems. It’s one thing to learn to cope with tough life circumstances that you can’t change, but helping someone adjust to a crappy set of circumstances to which there is a practical solution is just not helpful.
What kind of shrink do you need?
If you think you need medication, you’ll be looking for a psychiatrist in most jurisdictions. A few states and the military now allow medication-trained psychologists to prescribe. Psychiatric nurse practitioners can also prescribe, but may have less training in doing therapy, unless they got that training a different way. Often it’s a trade-off: psychiatrists know medicine, but they often don’t do therapy; psychologists, social workers, and counselors are trained for therapy, but usually don’t prescribe meds.
Do the skills match the problem?
You’re trying to determine whether this potential emotional Sherpa has the skills you need. Look them up on the internet: what kind of training is listed? Do they have a website that lists specialties? Does the training and the problem you’re experiencing match? If I have panic attacks when getting on a plane, and I need to get better so I can travel for work, a person who specializes in women’s issues and eating disorders might not be my first choice. They might be able to help, but I’m looking for a closer match if possible.
If you know a shrink personally, ask for a referral.
No, better yet, ask for several. When people ask me to recommend someone, I try always to give them at least three names, assuming I think they are all equally competent, because I don’t always know who will feel right.
Ask a trusted health care provider for a referral.
Instead of asking “Who would you go see?” ask “Where would you send someone you really cared about?” I get better answers that way, because we take care with the people we love that we might not take for ourselves.
Interview your Sherpa.
a) Call your prospective shrink, and ask if they will do a 30-minute interview with you to determine fit. In person is great, but phone can work, too. Sometimes people will charge at least a nominal fee, and sometimes not. Personally, if someone isn’t willing to take some time to make sure you can work well together, or isn’t at least willing to answer some questions over the phone, I’d move on. But if your choices are limited and you have to end up paying, clarify that the first session is exploratory. You’re working on finding the right shrink, not yet to commit.
b) Tell him or her a little about what you’re after, and ask if that’s a familiar issue in their practice. If I needed bypass surgery, I wouldn’t pick the person who’s done 1 or 2; I want someone with a track record. Same with psychotherapy.
c) Ask about that track record. How they answer that question can be as important as the content. If the answer sounds arrogant, or too good to be true, it probably is.
d) Ask about where they studied and what approach(es) they use. Here, too, the way they answer can be as important as the content. Can s/he articulate their style and method? Can they flex without being ungrounded?
e) Ask about the mechanics of the sessions, and make sure they fit your life.
f) Ask about finances, insurance, all the practical issues you need to make sure you can manage.
g) If there’s something really important to you, make sure s/he is comfortable. If your religion is really important to you, you don’t need your Sherpa to share your beliefs, but you need to feel respected. Same for sexual orientation, racial identification, gender identity, disability, educational and child-rearing choices, etc. If it matters to you, it deserves respect.
Now go home and digest.
Let yourself percolate for a day. How did you feel in the office? Were you comfortable? Did you feel heard, respected, maybe challenged a little? You want to be comfortable, but you don’t need a bosom buddy so much as someone who will help you see things from a different perspective. Can s/he stretch you to be your best next?
A last caveat as you digest: if you have any little alarm bells that go off, trust them. I almost never regret attending to intuitions that say, “This is not for me,” but I often regret ignoring them.
As long as this list may seem, I could write a chapter on each of them. We didn’t even get to the issue of evidence-informed practice; that’s another chapter itself! I hope this will give you a starting place – please use the comments for questions, additional tips and ideas, war stories, or to tell us how it worked for you.
Dr. Les Kertay
P.S. I’m grateful to my readers, commenters, and friends who contributed to this list, and the clients who, over the years, taught me the things that matter most to them.