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Finding A Good Family Therapist
Rob Cooley, PhD
So many kinds of therapy and therapists! How can you wade through them all to find the right kind for you, and, even more important, a therapist who has the skills to be genuinely helpful?
Family therapists, psychologists, social workers, psychiatrists, parent coaches, counselors, and alcohol and drug counselors are the main professions.
The important things to consider in choosing a particular therapist are life and professional experience, positive recommendations (two or more is good), and your comfort level with a therapist’s personality and approach.
Though you may feel at your first session with a therapist that your problems are so urgent that you have to start in on them right away, you will be best served in the first therapy session or two if you reserve some of your attention for interviewing the therapist and coming to an informed decision as to whether you feel the therapist is “right” for you and other family members. Is he or she direct and open with you about their background and experience and in describing their approach to therapy? Do they seem confident and competent? Do you feel understood and appreciated for who you are? Do the therapist’s life experience, age and gender seem appropriate to your situation? If you do not feel a strong “yes” to questions like these, you should not be embarrassed to thank the therapist for his or her time and tell them you will not be returning for another session. No therapist is “right” for every person, family or problem, and a good therapist will respect our decision and perhaps help you to find another therapist who better fits your needs. In any case, you can find one, and taking two or three tries to get one you feel comfortable with will be well worth your trouble in the long run.
If your primary issue is problems with a child, you should start with a family therapist. (Disclosure: I am a family therapist and psychologist, so my bias may be showing here.) Family therapists are the experts on helping families understand what is not working for them and what they can do to improve their situation. And child problems almost always require changes in the patterns of family interaction, regardless of where the problem originated. Psychotherapy for one or more individuals in the family may help the individuals, but is rarely effective in solving the interact ional problems between family members; and it is much slower when it does work.
A family therapist may be a licensed marriage and family therapist, who will have some specialized training in working with families; but more important is their commitment to family work and their experience with it. Commitment may be demonstrated by membership in the AAMFT (American Association of Marriage and Family Therapists) or a state branch of that association. Salvador Minuchin said that it takes experience with about 300 families in therapy to become truly competent in family therapy, and it’s more than fair to ask a prospective therapist for an estimate of how many families they have worked with. Many licensed family therapists don’t see a lot of families, or are new to the field; many social workers, psychologists and counselors do a lot of family therapy and are very good at it.
A good family therapist will usually want to see all of the family that is living together, and some of the family members who are not, if they are available, at least sometimes. At other times, she or he will be comfortable seeing just parts of the family: the parents one time, the children another, perhaps your problem child alone at times. You as parents should feel that the family therapist understands your perspective and is working on your behalf, as well as your child’s and the family’s. That doesn’t mean, of course, that he or she thinks you are always doing the right thing! - just that the therapist has your interests at heart. Many therapists, particularly younger ones or those who have not raised children of their own, tend to become advocates for the child, or want to focus on seeing the child alone. This rarely leads to successful outcomes.
The real pitfall here, though, is that many therapists will tell you that “of course” they do family therapy. But family therapy is not very much like individual therapy, and unless they have worked with somewhere around that magic 300 number, and have gotten some significant training in family therapy through schooling or workshops, they may not be able to offer you the help you need.
If your family situation is not too complicated, or you are already getting help in sorting things out from a therapist, a Parent Coach is a good bet. A parent coach will help you, the parent(s), figure out how to manage your child’s behavior in ways that are simple and clear, and will offer you support as you do so. This approach can be effective and produce quick results.
For marriage problems, most kinds of therapists may be helpful. Some professionals specialize in marital therapy. As with family therapy, the most important issue is how much experience, training and personal focus on the area a therapist has. Probably the 300 number for experience is a good ball park here, too. Marital therapy is even harder to do well than family therapy, and you should be even more careful to get an experienced marital therapist or marriage counselor, and one with whom both partners feel comfortable. Hint: since in our culture women tend to be the “social-emotional chairpersons” in a family, they usually take more than half the responsibility for making a marriage work, and a man in the relationship may feel less competent than a woman (whether he admits it or not!) and tired of being “told what to do.” As a result, many men will feel uncomfortable seeking marital therapy from a woman, whom they may see as an ally of the woman in their relationship. That doesn’t mean you can’t choose a woman therapist, but be especially careful that she seems neutral and that the man in your relationship feels understood and emotionally safe in working with her.
While the specialty of the therapist you see is usually not as important as the experience and personality of the therapist, there are a few things to be aware of. Psychiatrists, who get an M.D. and then specialize in mental health problems, are usually focused on medication and not as willing to take the time to engage in real psychotherapy, and are often not as experienced at it. However, if one of your family members might benefit from a medication, psychiatrists are the experts who are best trained to determine which medication is most likely to be helpful. Psychologists have useful expertise in psychological testing, but their therapy expertise tends to focus on individual and group therapy approaches rather than on family issues. Social workers (MSW degree) and counselors (M.A. or M.S. degree in counseling or psychology) are the most likely to be trained in family and marital therapy, and are more likely to have been practicing extensively in those areas. Pastoral counselors, if they got some good training in family and marital therapy at some point in their careers, are often very good and are more comfortable for some people to work with. As with any therapist, you should not hesitate to explore their training and experience.
Alcohol and drug problems are an area that most therapists have traditionally had little training for, and most are not comfortable in this area. Often, they overlook possible drug abuse when it may in fact be the central issue that needs to be dealt with. If you believe alcohol or drug problems are involved, you will likely be best served by finding a person who is listed as an alcohol and drug counselor (most states now certify or license these specialists.) If you are working with another kind of therapist and suspect alcohol or drug issues are part of the problem, you should check carefully on the therapist’s expertise in this area and how willing they are to assist you in identifying and dealing with alcohol or drug problems in your family.
See FamilyIQ's course on 'Parent Coaching.'
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