Excerpted with permission from
Therapies: What Are They? Do They Work? By
Dr. Margaret Thaler Singer and Janja Lalich, copyright 1996 by Dr. Margaret
Thaler Singer and Janja Lalich, by Jossey-Bass Inc., Publishers, 350 Sansome
Street, San Francisco, California 94104 (800-956-7739). Available through AFF’s
"Crazy" Therapies: What Are They? Do They Work?
The Therapeutic Relationship
The relationship between patient and therapist is unique in
important ways when compared to relationships between clients and other
professionals such as physicians, dentists, attorneys, and accountants. The key
difference is present from first contact: it is not clearly understood
exactly what will transpire. There is no other professional relationship in
which consumers are more in the dark than when they first go to see a
In other fields, the public is fairly well informed about what
the professional does. Tradition, the media, and general experience have
provided consumers with a baseline by which to judge what transpires. If you
break your arm, the orthopedist explains she will take an X ray and set the
bone; she tells you something about how long the healing will take if all goes
well and gives you an estimate of the cost. When you go to a dentist, you
expect him to look at your teeth, take a history, explain what was noted, and
recommend a course of treatment with an estimate of time and cost. Your
accountant will focus on bookkeeping, tax reports, and finances, and help you
deal with regulatory agencies.
Consumers enter these relationships expecting that the
training, expertise, and ethical obligations of the professional will keep the
client's best interests foremost. Both the consumer and the professional are
aware of each person's role, and it is generally expected that the professional
will stick to doing what he or she is trained to do. The consumer does not
expect his accountant to lure him into accepting a new cosmology of how the
world works or to "channel" financial information from "entities" who lived
thousands of years ago; or for his dentist to induce him to believe that the
status of his teeth was affected by an extraterrestrial experimenting on him.
Nor does the patient expect the orthopedist to lead him to think the reason he
fell and broke his arm was because he was under the influence of a secret
But seeing a therapist is a far different situation for the
consumer. In the field of psychotherapy there is no relatively agreed upon body
of knowledge, no standard procedures that a client can expect. There are no
national regulatory bodies, and not every state has governing boards or
licensing agencies. There are many types and levels of practitioners. Often
the client knows little or nothing at all about what type of therapy a
particular therapist "believes in" or what the therapist is really going to be
doing in the relationship with the client.
In meeting a therapist for the first time, most consumers are
almost as blind as a bat about what will transpire between the two of them. At
most, they might think they will probably talk to the therapist and perhaps get
some feedback or suggestions for treatment. What clients might not be aware of
is the gamut of training, the idiosyncratic notions, and the odd practices that
they may be exposed to by certain practitioners.
Consumers are a vulnerable and trusting lot. And because of
the special, unpredictable nature of the therapeutic relationship, it is easy
for them to be taken advantage of. This makes it all the more incumbent on
therapists to be especially ethical and aware of the power their role carries in
our society. The misuse and abuse of power is one of the central factors in
what goes wrong.
Questions to Ask Your Prospective Therapist
Ultimately, a therapist is a service provider who sells a
service. A prospective client should feel free to ask enough questions to be
able to make an informed decision about whether to hire a particular therapist.
We have provided a general list of questions to ask a
prospective therapist, but feel free to ask whatever you need to know in order
to make a proper evaluation. Consider interviewing several therapists before
settling on one, just as you might in purchasing any product.
Draw up your list of questions before phoning or going in for
your first appointment. We recommend that you ask these questions in a phone
interview first, so that you can weed out unlikely candidates and save yourself
the time and expense of initial visits that don't go anywhere.
If during the process a therapist continues to ask you, "Why
do you ask?" or acts as though your questioning reflects some defect in you,
think carefully before signing up. Those types of responses will tell you a lot
about the entire attitude this person will express toward you - that is, that
you are one down and he is one up, and that furthermore you are quaint to even
ask the "great one" to explain himself.
If you are treated with disdain for asking about what you are
buying, think ahead: how could this person lead you to feel better, plan
better, or have more self-esteem if he begins by putting you down for being an
alert consumer? Remember, you may be feeling bad and even desperate, but there
are thousands of mental health professionals, so if this one is not right, keep
on phoning and searching.
How long is the therapy session?
How often should I see you?
How much do you charge? Do you have a sliding scale?
Do you accept insurance?
If I have to miss an appointment, will I be billed?
If I am late, or if you are late, what happens?
Tell me something about your educational background, your degrees. Are you
Tell me about your experience, and your theoretical orientation. What type of
clients have you seen? Are there areas you specialize in?
Do you use hypnosis or other types of trance-inducing techniques?
Do you have a strong belief in the supernatural? Do you believe in UFOs, past
lives, or paranormal events? Do you have any kind of personal philosophy that
guides your work with all your clients?
Do you value scientific research? How do you keep up with research and
developments in your field?
Do you believe that it's okay to touch your clients or be intimate with them?
Do you usually set treatment goals with a client? How are those determined?
How long do you think I will need therapy?
Will you see my partner, spouse, or child with me if necessary in the future?
Are you reachable in a crisis? How are such consultations billed?
After the Interview, Ask Yourself:
Overall, does this person appear to be a competent, ethical professional?
Do I feel comfortable with the answers I got to my questions?
Am I satisfied with the answers I got to my questions?
Are there areas I'm still uncertain about that make me wonder whether this is
the right therapist for me?
Remember, you are about to allow this person to meddle with
your mind, your emotional well being and your life. You will be telling her
very personal things, and entrusting her with intimate information about
yourself and other people in your life. Take seriously the decision to select a
therapist, and if you feel you made a mistake, stop working with that one and
try someone else.
How To Evaluate Your Current Therapy
What if you have been in treatment a while? What do you ask
or consider in order to help evaluate what is going on? The issues below may
Do you feel worse and more worried and discouraged than when you began the
Sometimes having top access one's current life can be a bit of
a downer, but remember, you went for help. You may feel you are not getting
what you need. Most important, watch out if you call this to your therapist's
attention and he says, "You have to get worse in order to get better." That's
an old saw used as an exculpatory excuse. Instead of discussing the real
issues, which a competent therapist would, this response puts all the blame on
you, the client. The therapist one-ups you, telling you he knows the path you
have to travel. It's an evasion that allows the therapist to avoid discussing
how troubled you are and that his treatment or lack of skill may be causing or,
at the very least, contributing to your state.
Is your therapist professional? Does he seem to know what
he is doing? Or do features such as the following characterize your therapy:
The therapist arrives late, takes phone calls, forgets appointments, looks
harassed and unkempt, smells of alcohol, has two clients arrive at one time,
or otherwise appears not to have her act together at a basic level.
The therapist seems as puzzled or at sea as you do about your problems?
The therapist seems to lack overall direction, has no plans about what you two
The Therapist repeats and seems to rely on sympathetic platitudes such as
"Trust me," or "Things will get better. Just keep coming in."
The therapy hour is without direction and seems more like amiable chitchat
with a friend.
- Does your therapist seem to be controlling
you, sequestering you from family, friends, and other advisers?
with anyone else, thus cutting off the help that such talk normally brings to
an individual, and making you seem secretive and weird about your therapy?
Does the therapist insist that your therapy is much more important in your
life than it really is?
Does the therapist make himself a major figure in your life, keeping you
focusing on your relationship with him?
Does the therapist insist that you postpone decisions such as changing jobs,
becoming engaged, getting married, having a child, or moving, implying or
openly stating that your condition has to be cured and his imprimatur given
before you act on your own?
Does the therapist mainly interpret your behavior as sick, immature,
unstable? Does he fail to tell you that many of your reactions are normal,
everyday responses to situations?
Does the therapist keep you looking only at the bad side of your life?
- Does your therapist try to touch you?
Handshakes at the beginning and end of a session can be routine. Anything
beyond that is not acceptable. Some clients do allow their therapist to hug
them when they leave, but this should be done only after you've been asked and
have given your approval. If you are getting the impression that the touching
is becoming or is blatantly sexualized, quit the therapy immediately.
Are you noticing what we call "the rolling chair syndrome"? Some therapists
who begin to touch and encroach on the bodies of their clients have chairs
that roll, and as time goes by they roll closer and closer. Before you
realize what's happened, your therapist might have rolled his chair over and
clasped your knees between his opened legs. He may at first take this as a
comforting gesture. Don't buy it!
Does your therapist seem to have only one interpretation for
everything? Does she lead you to the same conclusion about your troubles no
matter what you tell her?
You might have sought help with a crisis in your family, a
seemingly irresolvable dilemma at your job, some personal situation, a mild
depressed state after a death of a loved one, or any number of reasons. But
before you were able to give sufficient history so that the therapist could
grasp why you were there and what you wanted to work on, the therapist began to
fit you into a mold. You find that, for example, the therapist insists on
focusing on your childhood, telling you your present demeanor suggests that you
were ritually abused or subjected to incest, or that you may be a multiple
personality - currently three very faddish diagnoses.