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This article is nearly the entire text of an article that appeared in International WellBeing, Issue 76, 1999. (Some of the introduction and the conclusion have been omitted, but the body of the article is intact). It is by Cynthia Hickman, a psychologist working in both private practice and community settings in Melbourne. At the time of writing, her telephone number was 0417 103 018. International WellBeing can be contacted on 02-9922 7800 (North Sydney) or through their website at http://www.wellbeing.com.au

Self Awareness - Choosing your therapist

Often the most difficult part of the whole process can be finding the most appropriate therapy in the first place. Following is a guide for anyone contemplating therapy or counselling.

Counselling, psychotherapy and analysis
Sometimes the words counselling and therapy are used interchangeably and indeed the line between the two processes is quite blurred. Counselling is generally a shorter process centred on the resolution of a single issue such as a relationship problem or difficulty at work.

Psychotherapy is used when there is a broader base to the matter concerning the client. This means that the issues cannot be resolved fully without looking at the client's life patterns in more detail. Deeper shifts in core areas may need to occur before the original problem can be solved. Some practitioners may use specific forms of psychotherapy such as Gestalt or Process Work, others use a combination of styles.

Psychoanalysis is a different process again. This is a much longer form of therapy where the basic structures of the person's psychological functioning are uncovered in an effort to make changes at very fundamental levels. Understandably, this process takes quite a long time, years in fact. Most therapists do a mixture of counselling and therapy whereas an analyst usually specialises only in psychoanalysis.

Therapy is a generic term describing any of these techniques. It may be used to refer to counselling, analysis, psychotherapy in general or any specific form of psychotherapy such as Gestalt.

Counsellors, psychologists and psychiatrists
Many people are unclear about the difference between each of these practitioners, especially psychiatrists and psychologists. Psychiatrists have medical training so they are actually doctors. Their approach to issues is biological and medically based. They therefore deal with mental illness and people needing medication. You would see a psychiatrist if your issue was debilitating and prevented you from functioning normally in the world.

The line can sometimes be blurred between psychologists and psychiatrists, especially when treating anxiety or depression. Sometimes a person dealing with such symptoms can see both practitioners at once. The psychiatrist prescribes the medication to make the symptoms more manageable while the psychologist will look at the psychological issues underlying the development of the disorder.

Counsellors and psychologists can actually carry out identical processes. The difference is in the level of training. At present a psychologist has to have a minimum of a Masters degree in order to practice. A counsellor on the other hand can be an engineer one day and then set up as a counsellor the next. There is no training required and no professional body to set standards and monitor the field of practitioners. So if you choose to see a counsellor make sure you ask them about their qualifications.

Some disreputable practitioners believe that a weekend workshop is sufficient preparation to begin a career as a counsellor. This does not mean, however, that all counsellors operate in this way, nor does it imply that psychologists will be competent just because they have more training. There are some questions below that can help you sort out the wheat from the chaff.

Choosing a practitioner
Before choosing a therapist make sure that you ask them some questions before going along. Firstly determine whether they are a psychiatrist, psychologist, counsellor or psychoanalyst. Then depending on your needs find out whether they offer counselling as well as the deeper work of psychotherapy.

Obviously cost will be a concern. Prices range from forty dollars to one hundred and forty. An average cost would be seventy to ninety dollars for an hour session. Price does not necessarily guarantee quality. A high price could reflect the size of the practitioner's ego or the overheads of their professional practice. A low price might indicate the level of training but it can also be about ethics. Some practitioners want therapy to be readily available to everyone so they charge less and try to see more clients to make up a reasonable income.

Most importantly make sure you check out the practitioner's level of training. As mentioned, a weekend workshop is definitely not enough but then again a PhD does not necessarily guarantee competence. It just means that the person is good in the academic realm. Academia and practice are very different things so make sure the person's training was clinically based. This means that it actually involved working with people as opposed to writing a thesis. Ask what subjects the person studied and whether they did any additional training. In my experience while my academic degree was useful the extra training in different counselling styles was just as useful if not more relevant.

Just as important is the level of experience of the practitioner. Ask them how long they have been in the field. Also check out where they gained this experience and what sort of work it was. For example ten years of experience sounds good but if it was in working with adolescents while you are looking for assistance with marital issues then the person would not be suitable.

Finally the most important question is whether the practitioner has undergone their own therapy. It is no use going to a person with a string of letters after their name if the person has not done their own inner work and developed their own maturity and self awareness. There is a saying in the field that the therapist can only take the client as far as they have gone themselves. You can't be a good therapist unless you have been on the receiving end of the therapeutic process yourself!

Once you have decided to see someone remember that during the first session you can be assessing whether this seems the right person for you. Going to one session in no way commits you to having to continue with this person. Therapy is an intimate process so it is essential that you feel comfortable with the practitioner. I remember one therapist that I went to who seemed to be watching the clock throughout the session. Needless to say I did not return. One friend told me that their therapist used to doze off during the session! Only you can decide if you feel that the therapist is a good 'fit' for you. Just make sure that you feel respected and understood and secure enough to speak frankly to this person.

How many sessions
This can be a very difficult question to answer. I have had clients who I thought might take up to three months to work something through who only needed two sessions. At other times what appeared on the surface to be relatively simple matters have tied in to much deeper issues so the process has taken much longer than expected. The most a therapist can do is to assess your situation during the first session and give a rough estimation of how long the process will take. [Extra note: Since this article has a wider scope than just sexual abuse, this is an appropriate comment. Hickman doesn't mention the frequency of sessions, though, which would obviously affect the time frame. Most therapists estimate abuse issues will take two to three years of twice weekly sessions - Clare]

When to see a therapist
It does not matter how small the issue might seem to you, it is still alright to seek help if the matter is causing you concern. You do not have to have suffered from any great damage or abuse to be able to make the most of the counselling process. For highly functioning individuals therapy can be more like mentoring where the therapist guides the client through the exploration of things such as creativity, meaning and vitality in life.

Types of psychotherapy
There are many different styles of psychotherapy, each with their own focus or methods. Below is a brief guide to some of the more major forms.

Art therapy
This process uses creative means such as drawing and clay work as a way to access insight into and changes within the psyche. This can be great if you are less comfortable with talking based therapies. The beauty of this therapy is that it can go underneath the mental processes and access emotional issues more directly.

Cognitive behavioural therapy
This therapy looks at how your thoughts influence your behaviours. The process is quite practical with homework exercises being given aimed at gradually introducing change. Behavioural therapy can be useful for things such as anxiety disorders and panic attacks.

Existential therapy
This aims to explore the central beliefs that underlie your life. it develops your capacity for self awareness and explores issues of responsibility and meaning in life.

Gestalt
The word Gestalt is German and means whole. As such the process aims to develop awareness of all aspects of your being so that you can take responsibility for them and make changes within your life.

Hakomi
This uses quite a meditative approach to therapy. The therapist will train you to reach a relaxed state and will then ask questions to prompt emotional responses and raise self awareness.

Jungian
This therapy is based on the theories of the psychologist Carl Jung. There is a lot of work with dreams and other symbolic processes of the psyche. You develop an understanding of the different aspects of your being with the aim of integrating these into a creative whole.

Neurolinguistic programming (NLP)
This work aims to examine the subtle ways in which your mind programs your functioning so that you can then choose to adjust this programming to result in more productive or creative behaviour. It is a fairly practical process and is used a lot in the corporate sphere.

Process Work
This form of therapy is based on the idea that all aspects of your being have some useful 'message' or function. Illness, both physical and emotional, can result when these functions are ignored or repressed. Sound and movement as well as talking are used to access and integrate these aspects of your being.

Psychoanalysis
This is the type of therapy initially developed by Sigmund Freud. You used to lie on a couch while the therapist sat behind you taking notes. These days you often just sit in a chair like other therapies. This process takes longer than other therapy because the idea is to let the material arise from your unconscious in its own time. Some people may attend psychoanalysis two or more times a week for years. If you hate therapists who do not give you any feedback then this is not the therapy for you.

Psychodrama
Psychodrama is quite a powerful way of exploring and healing aspects of your life and personality. It must be done with a skilled practitioner because it can elicit powerful emotional responses. If you hate role playing this therapy may not suit you.

Rebirthing
'Rebirthing' is really a bit of a misnomer. Most people assume that rebirthing is about re-living your birth experience but while this can occur, it is not the aim of the therapy. Put simply, rebirthing uses a deep and connected form of breathing during sessions of from half to one and a half hours. During this breathing an altered state develops where your body and psyche can experience earlier emotions and memories and new insights and revelations. This is quite a strong experience and it is probably better if included as part of a more conventional form of therapy. If you like trying new experiences this therapy may suit you.

Shamanism
The aim of shamanism is to bring you into contact with a more intuitive aspect of your being that has a connection with and understanding of the natural world. Ritual, often out in nature, is used as a tool for healing and developing wisdom. This is a non-conventional therapy but will suit those with an ecological bent or those tired of traditional, urban based forms of therapy.

Somatic therapy
A somatic therapist will apply pressure or manipulate areas of your body in order to access and move energies and emotional blocks. By accessing the 'intelligence' of your body it helps to bypass defences that you may have constructed with your mind.

Voice dialogue
Voice dialogue aims to identify the different aspects of your personality such as the child, the parent, the critic, the victim or the hero. These different aspects may be in conflict within you so the idea is that by having the parts dialogue with each other, integration and harmony may result. This is not as active as psychodrama but still some degree of role play is involved.

Benefits of therapy
Whatever therapy or therapist you select decide carefully. Remember that you are in the position to choose so do not do anything that feels abusive or disrespectful. Do keep in mind that things might seem to feel worse before they get better. This is normal because uncomfortable or painful memories may arise as the healing takes place.

Back to choosing a therapist