Many times when I see lawyers (or their family members) for assessment at LCL, I go on to refer them to an outside provider for ongoing therapy/counseling. Unfortunately but necessarily, often the first consideration in choosing a provider is a review of the individual’s managed care provider list. (I always hope the list includes people we know.)
Beyond that, I usually discuss with LCL clients the differences between various forms of therapy – the most basic distinction is between cognitive-behavior and psychodynamic, but there are also a number of techniques in which some therapists have specialized training, most of which have their own paradigms for conceptualizing problems and mechanisms of improvement. In addition, I give thought to individual therapist factors such as gender, personality, and attitudes.
Most of the literature comparing psychotherapy options focuses on the treatment model. Studies that get published virtually always purport to show that one therapeutic modality is superior to another (or to a no-treatment condition) for a given kind of problem. What is often ignored is that therapy success is determined more by the individual therapist than by his or her technique or treatment model. Another perspective making the same point is that the relationship between therapist and client/patient is of key importance. A former classmate of mine, now a renowned psychology professor, reminded me about this at a recent reunion – it’s not a new finding, but keeps turning up in new ways every several years. It probably isn’t even limited to therapists – there is also a growing literature on patients’ reactions to medical providers based on their quality of concern and attention.
When seeing a therapist, people generally want to feel that they are heard and understood, and that the therapist can be trusted with confidential information, often including information that has never been disclosed before. The Rogerian school of therapy, no longer particularly in vogue, seems to have correctly identified that, most importantly, a useful therapist conveys a combination of empathy, genuineness, and warmth (or unconditional positive regard). A further complication is that recent studies suggest that patients who are harder on themselves may also find it harder to trust a therapist, or to see him or her in a positive light.
The take-home point from all of this is that the particular therapist you see makes more difference than the technique or orientation. [Of course, I still suggest you avoid fringy, zany-sounding techniques and unlicensed practitioners.] On one hand, if you are to benefit from therapy, it’s worth seeking to allow yourself to trust the therapist. On the other hand, if you don’t feel understood by or connected to or trusting of a therapist after a few sessions, it may be in your best interest to consider another referral.
Jeff Fortgang, PhD
