Last updated: Apr 22, 2008
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Bruce E. Wampold, PhD, a professor of counseling psychology at the University of Wisconsin–Madison, analyzed data from 6,000 patients seeing more than 500 therapists and found that all schools of talk therapy can workif the therapist is competent and in sync with his or her patient. Watch this top psychiatrist explain why it's important that you feel liked by your therapist, and why a growing number of experts are recommending a cognitive behavioral therapy approach for depression.
"It's important that you agree on the purpose of therapy and how you will accomplish that," says Keris Myrick, 46, of Pasadena, Calif., who has treatment-resistant depression and is a veteran of the mental health system. But finding the right mix of chemistry, experience, and area of expertise can be elusive.
Ask, "Have you been here?"
"I'm a little biased here, but I think you should go with someone has had to go through the process of therapy," says Jayne Bloch, a psychoanalyst and member of the National Psychological Association for Psychoanalysis Institute in New York City. "You're taking this journey to places unknown; it helps to go with someone who's been there before."
Psychologist Gary Seeman, PhD, offers one free therapy session to skittish potential patients who come to his Northern California offices. "That is not common practice, but you can find therapists who are willing to do this," he says.
Some patients, like John Head, of Berkeley, Calif., luck out. "I chose a therapist the wrong way, based on who was closest to where I live. I didn't ask any questions about methods, training, philosophy. But as it turns out, I got someone very good."
Joseph, 55, had a different experience. He cycled through four therapists in his 25-year quest to find relief for debilitating depression. "I went to one old tweedy guy who said you have to commit to coming for two years. I never returned."
"Then I went to a woman therapist who wasn't bad, but she was very laconic and we never connected. Every time I brought up antidepressant medicine she would turn around and look it up in the Physicians' Desk Reference. It was not very reassuring."
He suffered unnecessarily for years as this therapist tried and failed to help him. Eventually, he says, "she threw up her hands and referred me to another, more aggressive therapist who I couldn't stand but went to anyway until he eventually died." Joseph finally landed in the office of a psychopharmacologist who put him on the correct medication. "Three weeks later I felt normal," he says. Watch this hilarious video and see evidence that this subspecialty doesn't take itself too seriously.
Keris Myrick has found success with a therapist who works as a collaborator when she feels well, but who is willing to take the reins when she is in the depths of despair. "Sometimes he says, 'You're not well enough to make this decision now, you have to trust me to make this decision, and when you are well we can discuss it.' I like that," she says.
Shared goals matter
While it may be impossible to avoid such experiences, agreeing on goals and a timeline in the very first session can help.
It's also a good idea to ask what your therapist will expect of you. Myrick switched therapists when the homework her cognitive-behavioral therapist assigned made her feel childish. "For example, we were to read a newspaper, pick an article, and talk about it. This was to help with concentration, but I was feeling worse at the end of therapy sessions."
Research suggests that shared goals and the feeling of being liked and deeply understood are better predictors of a good outcome. "Therapy will be unnecessarily difficult if you and your therapist don't get along, don't like each other, or are working at cross-purposes about the goals of treatment," says William C. Sanderson, PhD, a professor of psychology at Hofstra University in Hempstead, N.Y.
Personal style matters too. Says Seeman: "You don't want someone who really needs to unload and solve problems to be working with a therapist who sits there nodding."
Some people may feel more comfortable with either a male or a female therapist, or one of certain race or age. John Norcross, PhD, professor of psychology at the University of Scranton in Pennsylvania, believes that in some patients, very specific preferences can make a difference.
"There is nascent, emerging evidence that if a patient has a strong preference of therapist, that should be honored," Norcross says. "Some of that makes perfect sense. If a woman's depression is due to sexual assault, she may feel more comfortable with a woman therapist."