By Matt Boden, Ph.D. and Howard Berenbaum, Ph.D.
At some point in our lives, many of us will try psychotherapy and then decide whether to continue to engage in a full course of treatment with that provider (which may last for weeks, months or years). This decision is, typically, based on a judgment of whether the benefits of a course of psychotherapy with a given provider are worth the cost in terms of finances, time and effort.
Through conversations with friends, family and colleagues, we have come to believe that most psychotherapy clients don’t know how to judge whether they are receiving quality treatment that will help them to achieve their goals. To facilitate this judgment and decision, we propose 10 questions for any client to ask their provider.
All therapists should be willing and able to provide “good” answers to these questions no later than the third session. Good answers provide information that will help you assess your therapist’s competence, whether treatment is evidence-based and time-limited and whether your therapist will systematically monitor your problems/symptoms/challenges. Good answers will also clarify your therapist’s views on your case and make clear whether treatment aligns with your goals and values.
“Bad” answers, by contrast, provide no useful information. They are vague, unclear, confusing or indicate you are receiving less than ideal treatment, perhaps from an unqualified therapist.
Ultimately, discussion guided by these 10 questions can build trust and facilitate your therapeutic relationship. Be empowered to ask these questions and find a therapist and treatment who best suits your needs.
A good answer might go something like this: “You have asked for my help to reduce your symptoms of worry. I will address these issues, by helping you to increase your psychological flexibility while living according to your values.”
A bad answer may look like this: “It will require more sessions for me to know and to be able to tell you.”
A good answer could sound like: “Your worries seem to attach themselves to everything you think about. You feel like the worry helps you to avoid bad outcomes, but your life has become small. You spend most of your time at home, where you feel safe, but isolated, numb and depressed.”
A possible bad answer might sound like: “We’ll figure this out together.”
Good answer: “Using Acceptance and Commitment Therapy (ACT), I will help you to identify and live according to your values despite your worries. Your life will become bigger, and you will react less to particular states of mind and mood.”
Bad answer: “Whatever you want it to be.”
Good answer: “You will learn to use a variety of techniques to live according to your values in the present moment regardless of the challenges you face. For example, you will learn acceptance and mindfulness techniques.”
Bad answer: “You have to experience the treatment to understand how it works.”
Good answer: “In the first session, you completed measures of psychological flexibility, mindfulness, depression and worry. You will complete all measures again at the end of treatment, and some measures a few additional times. Improvement will be indicated by higher scores on measures of psychological flexibility and use of mindfulness, with no change or less depression and worry.”
Bad answer: “Sometimes I will ask you if you are doing any better than when you began therapy. I will try to do this on a regular basis.”
Good answer: “This treatment will require approximately 12, 50-minute sessions. In approximately the tenth session, we will examine your scores on the measures completed that week to determine whether we can stop therapy after the twelfth session, or if it would be better to add a few more sessions.”
Bad answer: “I don’t know how many sessions this will take. We will know when to stop when you feel better.”
Good answer: “I expect you to be on time, be sober, be open and honest and to complete homework assignments between sessions. I will regularly ask for updates regarding your well-being and functioning, and for feedback regarding how you think we are doing.”
Bad answer: “I expect you to trust that I know what I’m doing, and to follow my lead throughout therapy. I expect you not to ask a lot of questions. I am the expert. You can expect me to help you to get better.”
Good answer: “There are other psychotherapies that might help you, including cognitive therapy. Medications, such as venlafaxine, might also be helpful.”
Bad answer: “This is the best treatment for your problem. I wouldn’t worry about other treatments.”
Good answer: “There is modest research support for ACT for anxiety disorders and for depression. I will provide you with a website address where you can review articles about the treatment and supporting evidence.”
Bad answer: “The type of treatment I practice can be applied to fix just about any problem. I’ve had a lot of clients who improved from my treatment.”
Good answer: “I received training in ACT for anxiety and for depression from an accredited graduate school and internship and have practiced ACT professionally for 10 years.”
Bad answer: “I have many years of experience.”
Ultimately, when we make the choice to begin psychotherapy, we have to keep in mind some practical considerations. Is this process helpful and worth the time, money and effort? As a client, you have the right to clear communication from your therapist as you navigate these questions. We hope that our guiding questions will help start an important conversation.
As a program evaluator and researcher with the U.S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Matt Boden, Ph.D. directs efforts to improve the mental health of Veterans and their treatment providers. He is a licensed psychologist in the State of California.
Howard Berenbaum, Ph.D., is a Professor of Psychology and Psychiatry at the University of Illinois. He is a fellow of the Association for Psychological Science and is a past president of the Academy of Psychological Clinical Science. His research focuses on the intersection of psychopathology and emotion.
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