Tuesday, January 1, 2013

To a Better Approach to Finding a Therapist

     I am starting to think that the current model of psychotherapy initiation and execution is flawed and inefficient.  The current mode for client intake goes something like this:

  1. Client searches internet/newspaper or asks advice from friends/family about a practice they know and trust.
    1. If they search the internet exclusively, they forego knowledge of therapy jargon and choose based on the marketing skill and beauty of the site.  
  2. Client calls therapist and hopefully asks some probing questions about means of therapy and history of the therapist.
  3. Client agrees (or disagrees) with therapist, shows up (or doesn't), and is counseled. 
  4. Client leaves therapy in relief of symptoms/presenting problem (could take time) or leaves therapy frustrated and upset that they lost money (or sanity).
     I think what irks me the most here is that the client dos not have the means to make an intelligent and educated choice about the therapist.  If a therapist works for Ralph, my friend's brother's boss, how do I know that the therapist will help me?  Word-of-mouth is inaccurate.  Looking over internet websites, while more accurate, is prone to folly when it comes to word choice, money spent, and therapist countenance.  It seems like there are too many factors with which a therapist could accidentally hang himself.
     There is a much better way to advertise counseling correctly/accurately.  It starts with understanding who the client is.  Steps three and four above describe the counseling process and any reaction afterward.  Any negative remark about therapy would be avoided if proper screening occurs at the front end.  I think there should be some kind of questionnaire that the client is required to take that shows what type of therapy might work best for him.  Therapists speak of "meeting the client where they are" - something that, I think, extends far beyond what questions to ask.  Certain clients might do better with a behaviorist while others could gain relief with an emotion-focused practitioner.  If such an exam could be constructed, it would be simple to match clients of a certain temperament to a counselor that would best fit them.
     There are two complications that come to mind here.  Other than the overhaul of the system (which no one likes).  The first is insurance and the second is accreditation.  I think that insurance companies would subsidize only the top nth percent of the therapists who provide care, based on the democratic process of choosing the ones who practice must.  This means that those practicing CBT would land insurance money while analysts wouldn't (this, of course, assumes that CBT would be matched to more people while psychoanalysis wouldn't)!  This would ensure that more therapists would train as CBT practitioners (and that schools would only teach CBT) and that fringe clients would have a mismatch when seeking treatment.  
     Accreditation here refers to the process through which a therapist gains the right to practice a certain orientation.  More schools would open up (probably called institutes, offering certificates) and more specialized training would be received.  
     I talked on December 24th, 2012 about abstract versus concrete practice.  I rather think that such a topic also has relevance here.  How constrictive would a therapist be in his practice?  Could they use techniques from other schools?  How is such a thing maintained?  Would therapists be required to amass further training in the future?
     This prompts yet another issue that would be the backlash to such a stunt.  If we made it normal to test clients on their "therapeutic temperament," would we not also require this of therapists?  If a prospective therapist is interested in such a study, would it not behoove him to take such a test to find out which speciality is best for him?  I am unsure of this.  To take it further, if a current student of existential psychotherapy takes the exam in the middle of his education and receives back an answer of behaviorism, would he then be required to change tracks or relocate his education?
     A huge part of this discussion is choice.  I think I put it on ice for awhile with this.  Should clients have the right to choose their therapists as they see fit?  Yes! Even if it doesn't help them?  Yes!  That's the beauty of choice.

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