Joy von Steiger, PHD

     Did you know that who you choose for a therapist impacts what you accomplish in therapy?  Who your therapist is as a person, how they have been trained, and what modalities they use in their work all factor into the nature of the therapeutic relationship they are able to engage in with you. You can gather some of this information in a screening call before setting up a first appointment.  Creating a list of questions that you need answered before making an appointment will be helpful in determining who to schedule with.

Who are they?

Identity

     The therapist’s identities, their interpersonal style, their comfort with their own vulnerability and self-disclosure will all factor in to the kind of relationship they are able to develop with you.  While many therapists are reluctant to share information about themselves, it may be important for you to know how they identify with regard to their gender, sexuality, race, or other aspects of their identity before you make that first appointment.  If you are someone who needs to know, for instance, if your therapist identifies as queer or gay, ask them that question directly during your screening call. How your multiple identities intersect with your therapists’ is a very important consideration.  It may also be important to know how much work your potential therapist has done understanding their own privileged identities and how that work might help them to be able to be sensitive to the lived experience of clients with different identities, particularly marginalized identities.  If you grew up in a working class family, it might be important for you to know that either your therapist shares that identity or that they understand how their family’s class opened doors for them that may not be available to people growing up with fewer financial resources. It can be very isolating when your therapist makes comments that are insensitive.  Microaggressions at the hands of your therapist can be particularly painful and even traumatic.  

Questions to ask a therapist:

“I grew up in a working class family so need to know that my therapist can be sensitive to the particular issues that may arise for me, can you tell me a little about how you might approach that conversation?”

“I have been asking myself some questions about my gender identity and need to know that the person I work with has the skills and knowledge base to help me with that process.  Can you tell me a little bit about your familiarity with issues that may arise in questioning one’s gender and transitioning if that were to be the direction I decided on?”

Interpersonal Style

     Therapists are also introverts and extroverts, as well as being quiet or talkative.  Are you someone who needs a therapist who is actively engaged, asking questions, sharing observations, and problem solving when appropriate or would you prefer a more reserved therapist who allows you the time to slowly tell your story in all the detail you need and bears witness in an unobtrusive manner.  There is no right or wrong way to be as a therapist, but it is best to have a sense of which style will work best for you. Once you are engaged in the therapeutic process, you may find that your therapist’s style doesn’t quite help you to go deeper and make the changes you need to make. At that point, your therapist may want to accommodate you and adjust their style but this is not generally successful as who we are as therapists is often in our nature.  

Questions to Ask a Therapist:

“I am new to therapy so need someone who can be active in helping me to use the time most effectively.  How would you describe your interpersonal style as a therapist?”

“I have had lots of therapy and know what I need to be talking about. I work best if my therapist listens and asks an occasional question to challenge my thoughts.  A quieter, more pensive therapeutic style seems to work best for me. How would you describe your style?”

Vulnerability and Self-Disclosure

     The therapeutic space is for you to learn about yourself, what is important to you, what are your strengths and what are your challenges.  While having your therapist talk about themselves is often a distraction from your important work, it is important that your therapist be an authentic, emotionally engaged person.  There may be things you feel you need to know to feel safe and comfortable with your therapist and you might want to ask those questions. Some therapists feel that they are supposed to appear “neutral” and function as a “”blank screen”.  There are many reasons why this therapeutic stance can be problematic beginning with the sheer impossibility of being neutral. The therapist’s use of their own vulnerability can really help to deepen the work. Imagine how powerful it would be to have your therapist share that they were deeply moved by a story you shared about visiting with your grandmother who is dying.  Your therapist’s willingness to be emotionally impacted by you may be a powerfully moving experience and for some us may be one of the first times in our lives that we feel we are emotionally impacting someone in a deeply meaningful manner. 

Questions to Ask a Therapist:

“There may be times that I have questions about you and what you might be thinking or feeling in a session, how would you handle that?”

“I have worked with therapists in the past who were remote and unmoving and I found it very lonely.  Can you tell me a bit about your level of emotional engagement in work with clients?” 

Treatment Style

Training

     There are a variety of graduate programs that your therapist might have attended with varying levels of supervised experience and therapeutic models.  It is often helpful to have a sense of years in practice and the theoretical orientation of their graduate training. The degree your potential therapist holds is less important than the experience they have had in their training and since graduate school.  Therapists can have doctorate degrees or master’s degrees. The type of degree that a therapist has is less important than what training experiences they have had. If you are looking for therapy for your anxious 5 year old you would definitely want to find a therapist who was trained to do play therapy.  If you have an adolescent who is engaging in very risky, self destructive behavior you would want to find them a therapist who was trained to work with adolescents with high risk behavior. Learning about something in the classroom is very different from being in a treatment setting where you learned with support and supervision how to provide care that is best practices for that treatment group.

Questions to Ask a Therapist:

“My husband and I are having trouble communicating since the birth of our first child.  I am wondering if you have had formal training in couples therapy and how much experience you have had treating couples.”

“My son has been cutting themselves and seems very depressed.  Can you tell me about the treatment approach you would use and where you were trained in that approach?”

Therapeutic Orientation

     The largest categories of therapeutic orientation are psychoanalytic, relational or cultural relational, cognitive behavioral therapy (CBT), play therapy, narrative therapy, dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), mindfulness psychotherapy, and humanistic therapy to name a few.  Most therapists utilize a combination of theoretical approaches depending on the client’s concerns. In addition to theoretical approach, clinicians also have a general orientation or “lens” that they see the world through, two of the most common are a trauma informed lens and a cultural lens. 

One can determine the theoretical orientation that might be most helpful for them by creating an understanding of what they would like to accomplish in therapy.  If you are concerned about your anxiety and how to manage it, you may want to work with someone who is comfortable utilizing a skills based approach using CBT. If, on the other hand, you are troubled by the pattern of the relationships you find yourself in, then a dynamic approach such as cultural relational therapy will help you to explore the dynamics in your relationships.  If you are trying to understand how societal influences such as systemic oppression have impacted you and how to manage your anger and trauma a narrative therapy or cultural relational therapy might be helpful. When wanting to work on trauma of any sort it is imperative that you find someone who is experienced in working from a trauma informed lens and uses a strengths based model.  

Questions to Ask a Therapist:

“I am a person of color working in a primarily white environment.  I feel depressed and anxious at work and don’t know how to manage these feelings.  Can you tell me something about the approach you might use to help me?”

“I find that I am engaging in routines throughout the day that take up a lot of time and are interfering with my ability to leave the house.  What form of therapy would you recommend for me and are you trained in that particular therapeutic approach?”

       The most important indicator of a good match is feeling that the therapist is well trained in the area you need to work on, is warm, and you feel comfortable and safe.  If you see any red flags or feel at all uncomfortable, trust your gut and move on.