I don’t know what to ask my therapist to decide if we are a good fit! I don’t even know what my options are!
This is a common feedback I often receive from those who are considering therapy. Choosing the right fit with a therapist can be a daunting experience in itself. This could be especially so if we have had bad therapeutic experiences in the past.
As a client, what are your preferences though?
Clients may be surprised to be asked, and assume that therapy is like other practitioner-led ‘treatments’. Like when you visit the doctors, you do not tell him or her what medications you’d like to take or how you’d wanted to be treated. You tell them your symptoms and they prescribe you what they think is useful for your issues.
Well, sure, many doctors work that way.
But not all doctors have the same philosophy of care.
Philosophy of Care
Philosophy of care. Such big terms. Do not get fazed by it and stay with me a little longer as I explain what it means and how it can help you as you go on your search for a therapist you can click with.
I was introduced to this notion while I went through my pregnancy.
I am a firm believer of how a good birth experience affects how fast I recover and in turn impacts on maternal mother and child bonding. I will need an obstetrician and a paediatrician who can support me to achieve what I want.
Yet, with no experience giving birth, how do I go about even finding the right doctor?
I had the good fortune of a doula accompanying me throughout my pregnancy. As she patiently explained what my options are giving birth in Singapore and what decisions are in my power to make to get the kind of birth experience that I am hoping for, I was given the opportunity to think through my own preferences as we drew up my birth plan.
Go Therapist Shopping
An advise from one of my doula that has stuck with me till today was to go doctor shopping!
Essentially, visit different doctors. Ask them how they work. Look not only at their bedside manners (i.e. managing our anxiety, showing empathy or building strong rapport with patients) but whether they believe in the same care goals and values as you do.
If your philosophy of care is to recover with as few interventions as possible, an aggressive medicalised approach is just not going to cut it.
And as I surrounded myself with care providers of the same philosophy of care, I felt held and supported. Even if I did not experience the birth that I hoped for, I know I will still be empowered to make the right decisions in any birth situation I find myself in.
I don’t not mean going for therapy with different therapists at the same time. That’d not be healthy as different therapists may provide contradicting advises which confuse us more than we probably already are.
Go interview different therapists. Find out their views of mental health struggles and how they’d work with your presenting issue. As you chat with them, you should be able to get a feel of their philosophy of care.
It is one thing to know your therapist’s philosophy of care. It is another to know what your preferences are before you can decide if your philosophy of care even fit your therapist’s.
Top 4 areas of Preference for Therapy
Research suggests that clients’ psychotherapy preferences make valuable contribution to outcomes in therapy. It can be a good starting point for a genuine exchange about how you can get the most out of their psychotherapy.
Aside from the usual questions around therapeutic contracts (i.e.g number of sessions, session fees and payment terms etc), I recommend 4 main areas to reflect on as you figure out your therapy preferences.
Do you prefer for your therapist to:
- Therapist Directiveness vs. Client Directiveness
- focus on specific goals or not?
- give structure to the therapy or allow it to be unstructured
- teach you skills to deal with your problems or not?
- give me homework or not?
- take a lead in therapy or allow me to take the lead instead?
- Emotional Intensity vs. Emotional Reserve
- encourage me to go into difficult emotions or not?
- focus on the therapy relationship or not talk about the therapy relationship?
- encourage me to express strong feelings or not?
- focus mainly on my feelings or thoughts?
- Past Orientation vs Present Orientation
- focus on my life in the past or present?
- help me reflect on my childhood or on my adulthood?
- Warm Support vs. Focused Challenge
- be gentle or challenging
- supportive or confrontational
- interrupt or keep me focused
- support me unconditionally or challenge my behaviour if they think it’s wrong.
Adapted from the Cooper-Norcross Inventory of Preferences (C-NIP) developed by John Norcross and Mick Cooper, these 4 areas form part of a standardised instrument which was developed with the goal of stimulating dialogues between therapist and client. You can find a copy of the instrument here.
If you are completing this questionnaire for yourself, please ensure that you have someone whom you can talk to should any of the questions cause any distress. In the unlikely event that you are distressed after completing the questionnaire, you can contact Samaritans or other mental health hotlines.
A doula helped me give birth to life by empowering me with options I never knew I had and walking alongside me as I figure them out. She has since inspired me to think about what philosophy of care Encompassing Therapy and Counselling holds:
It is not only to provide good existential therapy. I strive to be a therapy doula by supporting clients to find the right fit with their therapist.