This article is meant to help you choose a proficient psychotherapist by providing information, much of which is probably unknown to the you.

As indicated here, choosing the right psychotherapist is vital.

Health insurance companies and their focus on "evidence-based treatments" encourage you to think of psychotherapists as commodities, a as though it is the only type of treatment that makes the difference in the outcome of therapy independent of the expertise, skill, and sensitivity-awareness of the therapist and the characteristics of the patient. This is simply not true: Research has demonstrated and common sense tells us that the particular therapist and the individual patient have a substantial impact on the outcome of treatment.

So, it is a vital choice, but a difficult and even confusing one. How do you choose a psychotherapist?

If you know someone, whose judgment you trust, who is pleased with their psychotherapist, you have a good start.  But, ask this person why she likes her therapist.  Because, unless the therapist has helped the person make important changes, what would make her a good psychotherapist for you?  Isn’t change the point of therapy?

Assuming you don’t have access to a recommendation to a skilled psychotherapist, how do you find one?  Here is some information to help you make an informed choice.

What is a psychotherapist

Well, first, let’s understand what a psychotherapist is.  By definition, she is an “expert in the use of psychotherapy1,” and psychotherapy is “treatment of mental disorders by psychological methods2.”

But, in NYS, there are no licensing requirements for Psychotherapists. That means there are no educational, experiential, or any other requirements needed for someone to call him or herself a Psychotherapist.  Any one can advertise themselves as a Psychotherapist. Anyone.

That’s scary!

If you’re looking for a psychotherapist who actually has expertise in treatment by psychological methods, you’re looking for an expert in Psychology, in other words, you’re looking for a Psychologist. 

You might think that anyone who can legitimately call herself a Psychologist is an expert in Psychology. But, if you thought that, you'd be wrong.

What is a Psychologist

In New York State this means a Licensed Psychologist since it is illegal to hold oneself forth as a Psychologist without being licensed by the state to do so.  And licensing is important as there are requirements that must be fulfilled in order to obtain a Psychology License. 

Licensing is meant to protect the public from individuals who have neither the education nor the experience to be psychologists but call themselves such.

But, are you protected?

The answer is “Not really.”

If you do a web search on the term “psychologist” you will find many websites for non-psychologists.  In fact, despite the law, you will find web ads for psychologists who are not psychologists.

So, if the first step in finding the right psychotherapist for you is to look for a psychologist, the second is to ensure that the therapist is, at a bare minimum, licensed as a psychologist. 

The next step is to determine whether the Psychologist has been educated sufficiently in Psychology, i.e., does the therapist have a doctorate in Psychology. 

This step seems like it would be unnecessary.  And, in my opinion, it should be unnecessary, but NYS allows Psychology licensure of individuals with doctorates in other fields, typically Counselor Education. Such individuals can be recognized by their degree, namely an Ed.D.

If Counselor Ed was a psychology program, it would be called “psychology” and be part of a University's Psychology rather than part if its Education Department

This is not to denigrate the work of Counselors.  Simply to note that there is a difference between the training of a Counselor and that of a Psychologist, and the difference seems significant, particularly as psychotherapy and counseling are not the same process.

Thus, Step 1 is:
    Choose a Real Psychologist

Having decided to work with a real Psychologist, the next issues to consider in choosing the right psychotherapist for you are those relating to choosing a type of psychologist.

Choose a type of Psychologist

As indicated above, the degree requirements for Psychology Licensure in NYS do not require that the licensed "psychologist" have a degree in Psychology much less in Clinical Psychology. While course requirements are mandated for the Psychologist license, it is not clear what is done to verify that the courses that supposedly meet these requirements actually do. This is quite different than the extensive process and in-depth evaluation involved in obtaining American Psychological Association (APA) of a Clinical Psychology Program.

While NYS licensure requires no more than the completion of specificed coursework and post-doctoral clinical experience, the bar set by the APA is much higher3: Even those who obtained doctorates from APA approved Non-Clinical Psychology Programs (e.g., Social or Cognitive Psychology) must complete an APA approved respecialization program, requiring extensive additional coursework and appropriately supervised practica experience in addition to the internship, before it views them as ready for licensure.

Noteworthy in the differences between APA and NYS requirements is the absence of any requisite pre-degree practica for NYS licensure-acceptable training much less the required faculty-supervised, pre-Internship clinical practice required of APA Approved Clinical Psychology Programs.  This means that Psychologists who earned their doctorates from APA Approved Clinical Psychology Programs were required to have more supervised psychotherapy experience before being granted their doctoral degrees than those who graduated from other programs.

The only way to ensure that the Psychologist that you see has had the sufficient training, both course work and appropriately supervised experience, is to see a Psychologist who is actually a Clinical Psychologist, i.e., confirm that she graduated from an APA Approved Clinical Psychology Program and completed an APA Approved Internship or has completed an APA approved respecialization program by the APA as a Clinical Psychologist. To be clear, individuals whose doctorates are not in Psychology cannot possibly be Clinical Psychologists.

What does this mean for you?

It suggests that Step 2 is:
    Choose a Psychologist who graduated from an APA Approved Clinical Psychology Program or was accredited to be a Clinical Psychologist by the APA.

Another difference in types of psychologists that you may find important is this: The APA approves Clinical Psychology Programs that award two distinct types of doctorate degrees.

Technically, the difference between the Ph.D. and the Psy.D. degrees in Clinical Psychology is that the Ph.D. requires that original publication-quality research be conducted before the degree is granted.  In addition to the more stringent degree requirement, Clinical Psychology programs have more demanding acceptance requirements4, and award fewer doctoral degrees than Psy.D. programs, this latter being an unsurprising outcome given the difficulties involved in completing an original, publication-quality research dissertation.

Does this difference matter to you? That's for you to decide. However, I believe that being required to do original, publication-quality research compels a crispness of thinking that reading about research does not and that the greater difficulty in being accepted into and then completing the requirements of a Ph.D. program are important. But then, having a Ph.D., I'm not exactly unbiased.

Decide if the difference between Psychologists with Ph.D.s versus Psy.D.s is important to you. If it isn't, ignore Step 3.

If, however, you agree with me, Step 3 is:
    Choose a Psychologist with a Ph.D. degree.

By following Steps 1 - 3, you can identify a well-trained Clinical Psychologist who should be proficient. To ensure that you've found someone whose expertise is above what I would consider minimal, you will need to look for more.

Choose a Clinical Psychologist with
depth and breadth of experience

What does having depth and breadth of experience mean for a Clinical Psychologist?

It means having worked with patients with a variety of diagnoses and with whose psychological and psychiatric difficulties vary in severity.  This means experience working with Inpatients (i.e., hospitalized patients) and Outpatients, and having triaging experience so that the therapist knows how to effectively evaluate suicidal risk as well as knowing what problems can be treated in her office and what require more intensive interventions.

It is in an Inpatient setting that one learns an essential lesson. Namely, how effective and comparatively quick psychotropic medication can be in ameliorating symptoms for some patients. To refrain from advising a patient to obtain prescriptions for psychotropics when needed likely means prolonged suffering for the patient.

Having depth and breadth of experience means extensive experience with both assessment of psychological problems and psychiatric diagnoses and treatment of them including particularly the use of a wide range of treatment modalities (e.g., behavioral, cognitive, and psychodynamic treatments).  The need for extensive assessment experience seems obvious. If you don't know what the problem is, how do you help ameliorate it? But you may wonder, why is experience in a variety of treatment modalities so important?  Because, as they say, "if all you have is a hammer, everything looks like a nail."

The more extensive and diversified the therapist's treatment-modality experience the greater number and type of intervention she has available with which she can help you.

Oftentimes a client will need help in making a decision, in choosing a course of action. In such a situation, a good therapist helps not by advising but by providing information that helps her client herself make the decision. It is here that a therapist with extensive real-world experince becomes an invaluable resource.

What does the above tell us?

It tells us that Step 4 is:
    Choose a Clinical Psychologist with depth and breadth of experience in her field and in the real world

Choose a psychologist who meets all of the above criteria and you will have chosen a professional who is likely to be a highly proficient psychotherapist.

The Gifted Psychotherapist

Psychotherapy is undoubtedly an art (which uses science as an underpinning). If you want someone who can not only help resolve your current symptoms, but can also help you live a more fulfilling life now and in the future, you want an outstanding psychotherapist. While there are no steps for finding the gifted psychotherapist, here are some issues to consider.

Look at the psychologist's resume.  Has she won any awards or special recognition for her abilities as a clinical psychologist?  Was it a real award or something one can buy (e.g., listing in some “Who’s Who” catalogues)? Was it for clinical practice? research? both?

Has she demonstrated exceptional expertise, depth of understanding, creativity? Has she done anything to make her stand out from the crowd.

Does she display in-depth reviews of her work?

Does she utilize external resources in her work so that her patients can learn skills outside of sessions?

Ask yourself the question "What has this psychologist done that evidences extra-ordinary skill and expertise? And, what has she done that demonstrates that she cares about her clients and about people in general?For a therapist's caring about you is part of what helps you you feel and do better.

Endnotes

1 (Oxford American Dictionary,1980, copyright by Oxford University Press, Inc., published by Avon Books, New York, NY.)

2 Ibid

3 See the APA's Policy on encouraging respecialization training programs for more details.

4 Psy.D. Clinical Psychology graduate programs accept more applicants than Ph.D. programs, overall, median, and, most significantly, proportionally (32% of applicants accepted for Psy.D. vs 7% for Ph.D. programs). In addition , more Psy.D.s are awarded annually. (http://www.apa.org/workforce/publications/11-grad-study/applications.aspx)