How To Find ‘Dr Right’

Consumer choice can be overwhelming! With so many different therapists offering private mental health services, how do you choose?

Using over 20 years of experience in delivering MH services in London and Glasgow - as well as my experiences of searching for therapeutic support myself - I offer this 5-point guide to using talking therapy. I hope it helps.

1) ‘Most expensive’ may not equal ‘best’!

We might often say ‘buy cheap, buy twice’, or believe ‘you get what you pay for’. Different professional backgrounds and training will certainly relate to what a therapist can help with and how; and usually psychiatrists and psychologists will be at the more expensive end for this reason. However, psychodynamic psychotherapists and different counsellors may be more beneficial for other types of difficulty, or they might have an expertise in a particular problem and usually have lower fees. Don’t be tempted by the shiniest apple.

When I left the NHS and began looking at setting up privately, I was surprised at the difference in fee, therapy qualifications and experience in the private therapy realm. Having met many excellent and skilled therapists over the years who would never charge extortionate fees to help a human in distress and having also known of a number of therapists who were far less skilled but great at marketing, I have learned that what a therapist charges is not a good indication of what you will get. If you are comparing two therapists with equal training and one charges much more, consider the fact that that the difference in fee might have nothing to do with what they are offering.

2) Ask yourself the following questions:

What am I actually feeling?

How much is it affecting my life?

How long has this been going on for?

What if I talked this problem through with an expert listener, might this be all I need?

Do I want medication, guidance on ‘what to do’, or am I looking to delve a little deeper into why I often feel like this?

Do I know of a type of therapy I want to try?

Use your answers as a guide to the type of therapist you contact - below is a brief summary of what different types of mental health therapist can do; go to the appropriate governing body website for further details. Although two therapists might have the same qualification, therapeutic skills may vary according to where someone has trained and worked, for how long, and under which supervision. Don’t be shy - do your research!

Psychiatrists are trained by the NHS as medical doctors first, and then undertake further training in psychiatry (usually approximately 10 years in total). They can diagnose mental health problems, prescribe medication for it and typically understand mental health in a more biologically-based way. Many psychiatrists have undertaken further psychotherapeutic training in addition. For more severe and enduring mental health problems, complex needs and/or specific diagnosis, this is your MH professional. Consult the Royal College of Psychiatrists for further information.

Clinical psychologists (CPs) are trained in a clinical doctorate degree (DClinPsy) by the NHS after completing a first degree, usually in psychology (often 9 years training in total). Training usually comprises of a number of NHS clinical placements alongside lectures, where we learn to use a range of talking therapies for different problems, across the lifespan. As a general rule of thumb, I would recommend looking for a CP with varied experience at different services, and with a good number of (NHS) years in the particular field matching what you are looking for. Also look for people who have been supervised by therapists you would rate, judging by how they describe themselves and the area they work in.

Counselling psychologists are trained with many similar skills but not by the NHS. Often jobs advertised by the NHS can recruit counselling psychologists and clinical psychologists to the same post, so skills can be similar. Both clinical and counselling psychologists must be registered with the HCPC and bound by these professional codes of conduct. If your emotional difficulty is affecting work, relationships, or ability to function and you are prepared to be quite active in the process of change, find a clinical or counselling psychologist who has experience in the field you need.

Psychodynamic Psychotherapists have undertaken four or more years of clinical training, and can work with clients to get to a deeper level of understanding of difficulties and may mostly see clients longer-term and with more frequency (eg more than once a week). In this type of therapy, the therapist is often less ‘directive’ in the process and the client often does most of the talking. Look for people accredited by the UKCP.

Other counsellors will usually have completed a Masters degree and describe themselves according to the type of help they can provide, e.g. bereavement counsellor, person-centred counsellor etc. and they might be more suitable for someone with less complex emotional difficulty. If you are facing a life challenge and want some short-term emotional support, find a counsellor that has expertise in what you want to speak about and make sure they are accredited. Have a look here for more information.

3) *Trust your gut*

With all the right qualifications on paper, if - when you speak with someone or meet them for the first time, something doesn’t feel quite right - do not ignore this! The most important thing is your relationship with your therapist (research evidence shows that this is the most important factor for good outcome, even above the type of therapy used). A really good therapist is going to be skilled at building a good connection with their client, or calling it if someone else might work better for you. It might be frustrating to try someone else but finding the right fit will definitely be worth it.

In my own experience of looking for a psychotherapist, I met one who got the session times wrong twice, another who rationed the number of tissues available and a third who was kind but ineffectual; all with the right qualifications but not the skills, I felt. I have also met clinical psychologists who lack the knowledge or skills I would expect, and a few who have had questionable views on diversity. Make sure you ask what you need to, in your first meeting, to ensure you feel safe.

4) What to ask your therapist

From the very first encounter, consider your personal needs and don’t be shy about asking the therapist how they would deal with a particular problem. Ask directly about anti-racist practice, being queer-friendly, understanding your disability or anything else particular to how you want to be treated. Pay attention to the answer; it may be the manner in which your therapist answers rather than the answer itself that gives you the best idea about whether or not to continue with them. Look for authenticity in response.
Also - in my opinion - a first assessment with an experienced therapist can help direct most people towards the type of therapy they might ultimately find most helpful. Ask your therapist what type of therapy they would recommend for the difficulties you describe, and if they can recommend someone in particular if they cannot offer that therapy. Discuss how many sessions you might need/ want, how you will both review or measure whether it’s working for you, and what will happen next if things aren’t going well.

5) What not to ask your therapist (and when)

Finally, you should feel safe to ask or say anything on your mind during sessions. A good therapist will take all your emotions and concerns seriously, won’t get defensive and will be skilled with their response. A good therapist won’t answer personal questions much though! If a conversation with a therapist was not radically different to speaking to a close and trusted friend, it wouldn’t be so useful; so feel free not to ask your therapist anything about themselves or how they are - it’s liberating! Speaking with a therapist should feel ‘all about you’ - by design - and you shouldn’t end up worrying about anything in your therapist’s life. Speaking to your therapist outside of planned sessions might be OK if your therapist has agreed to this, but otherwise important communications should be kept to planned session times. Notice your therapist’s boundaries and notice if they feel right for you.