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Evaluate Your Therapy

Therapy grounded in controlled scientific research with a sane, well educated and trained, competent, responsible, licensed mental health provider can be a positive experience for many people. For some, it may be vital. For example:

  • people with bipolar (manic-depressive) disorder may be more stable if they take a medication such as lithium under the supervision of a psychiatrist
  • for people with borderline personality disorder, staying in therapy for an extended period of time without dropping out can be crucial for achieving long-term improvement in symptoms

As a result, anyone who is currently in therapy should think carefully before terminating it, taking a break, or switching therapists. Deciding whether to seek or continue therapy and choosing a therapist are personal choices; no one else can make those decisions for you. It is your responsibility to check your therapist's degrees, training, qualifications, licensing status, and beliefs carefully before beginning therapy, because it is you who will live with the results of therapy.

Unfortunately, there's no guarantee that a particular therapist is informed, responsible, or even sane. You can and should check whether or not a therapist has a relevant academic degree and a license, but degrees and licensing do not guarantee that a person is keeping up with clinical and academic research or that they are basing their therapy on research findings. (On the other hand, if your therapist has no degree and especially if he or she is not licensed, you should be worried. What your therapist doesn't know can hurt you, and if an unlicensed therapist hurts you, there is no licensing board you can readily report the therapist to.) Therapists who base their therapy techniques on superstition, myth, and ignorance are disturbingly common, as are therapists who are themselves mentally ill.

Worse still, there is no sure-fire way to determine in advance whether or not a particular therapist is sane, informed, competent, and responsible. Obviously, an incompetent, ignorant, irresponsible, or mentally ill therapist will not tell you about his or her problems. Since therapeutic relationships are confidential, getting a meaningful reference is difficult. Even when therapists are grossly incompetent and unethical, former clients rarely file complaints with licensing boards, and licensing boards rarely take timely, decisive action when a complaint is received.

So even after you have checked out a therapist's qualifications and beliefs to the best of your ability and begun therapy, it's up to you to continuously evaluate your therapy and your therapist in order to protect yourself. Keep in mind that good therapy may actually be less pleasant than bad therapy, and that a therapist who challenges you to take responsibility for your life, your choices, and your future is better than one who teaches you to blame all problems on other people and your past. As one retractor wrote, "Robert [a good therapist] was a strong advocate of cognitive therapy (an approach to therapy that tries to change some of the patient's habitual modes of thinking) and tried it several times with me. I resisted it most of the time because it required so much work on my part. It was so much easier to continually rehash old memories and blame my parents for all my problems .... After awhile Robert became increasingly frustrated with me. I wanted to act like a hurt child, but Robert encouraged me to be the adult I was and take responsibility for my life." (True Stories of False Memories, p. 240)

Remember that you always have the right to a confidential second opinion at any time, with or without your current therapist's knowledge or permission. If you have serious doubts about your current therapist or the therapy he or she uses, it is probably wiser to get a second opinion from a responsible, licensed medical professional like your family doctor (or someone he or she recommends) than from a colleague your therapist recommends, since a truly irresponsible, ignorant, dogmatic, or incompetent therapist will recommend someone who is like-minded and equally incompetent.

The best way to protect yourself is to become an informed consumer. I strongly recommend that anyone who is in therapy or considering therapy read Beware the Talking Cure by Terence Campbell, Ph.D. Campbell explains many common mistakes made by well-meaning but ill-informed therapists and how to spot bad therapy or a bad therapist before it's too late to save yourself and those you love from the devastating effects of bad therapy.

In an appendix to Beware the Talking Cure, Campbell provides a list of questions for evaluating your therapy, spotting common problems, and helping to decide whether you should talk with your therapist about the problems, seek a second opinion, or perhaps switch therapists for your own protection.

Dr. Campbell has kindly given permission to reproduce the list of questions online. Here is his explanation of how to use the questions to evaluate your therapy.

Copyright 1994 by SIRS, Inc. Reprinted by permission from Beware the Talking Cure, p. 247-251. All rights reserved.

Afterword: Hiring and Firing a Therapist

Choosing a therapist is a mind-boggling endeavor. Neither a therapist's degree, nor his professional identity, predict his competence. Moreover, one cannot assume that an older, experienced therapist possesses greater competence than a younger, inexperienced therapist. Experienced therapists are more inclined to cling tenaciously to an obsolete paradigm.

Above all else, training-supervisory experiences determine a therapist's competence. Though they are relatively few in number, there are therapists who have undertaken training organized around live, moment-to-moment supervision. These training-supervisory experiences enhance their ability to develop well-defined courses of therapeutic action.

Since live supervision usually involves a group of supervisees, they also learn from observing each other. Because they enjoy greater objectivity as a result of their training, these therapists respond more effectively to their clients' needs.

In contrast, a therapist who has never been observed by a supervisor or a colleague is a therapist who can conceal his incompetence behind closed doors. He understands very little about his weaknesses--and his strengths--as a therapist. Consequently, he does not know what he needs to do to increase his therapeutic competence. Training that emphasizes live supervision is the best standard for evaluating a therapist.

Prospective clients should not hesitate to ask a therapist about his training. Such questions are altogether necessary and appropriate. Any therapist who refuses to answer, or responds evasively, is a therapist to avoid.

There may be readers who are presently involved in psychotherapeutic treatment. Such a reader may confront the problem of evaluating the effectiveness of ongoing therapy. This is especially troublesome because firing a therapist is a more difficult decision than hiring one.

Any client who wonders whether his therapist is effectively aiding him contends with substantial frustrations and self-doubt as he weighs what to do next. If a client terminates treatment with a therapist he regards as ineffective and/or incompetent, he is faced with the question of who he will find now to aid him.

The following forty questions are designed to help clients evaluate and make decisions about their ongoing therapy. Prospective clients can also use these questions to interview a potential therapist, and bring greater objectivity to their impressions of that therapist. Additionally, any client who has found it necessary to terminate an incompetent therapist, can use these questions to assess a potential replacement.

Evaluating Therapeutic Effectiveness

Directions: In taking this inventory, merely respond "yes" or "no," and count how many questions you answer "yes."

Note: for this online version, click "yes" or "no." When you have clicked "yes" or "no" to every question, click "Tally the Result." This form will count your "yes" answers automatically and display Dr. Campbell's evaluation of your result in a new window.

Privacy statement: the security and privacy features of web browsers mean that this site cannot tell who you are, so you can take this test in complete privacy, confidentiality, and anonymity. However, if you are uncomfortable about clicking "yes" or "no" and the "Tally" button, just count your "yes" answers by yourself and then click here to see how Dr. Campbell evaluates scores from 0 to 40.

yesnoHas your therapy limited itself to giving you a better understanding of the difficult situations in your life?
yesnoDo you feel more worried and discouraged since you began therapy?
yesnoIs your therapist so preoccupied with your insight that he neglects to outline specific courses of action for you to undertake?
yesnoIs your therapist intensely interested in the minutiae of your fantasies, feelings, and/or thoughts?
yesnoDoes a great deal of your therapy seem to focus on issues that are trivial or obscure?
yesnoIs your therapist more curious about you than he seems committed to helping you (do you feel reduced to an object of study by your therapist)?
yesnoDespite a situation where you have felt ready to terminate therapy, has your therapist repeatedly advised you not to?
yesnoDoes your therapist focus primarily on the events of your childhood and overlook the present-day issues of your life?
yesnoDoes your therapist overemphasize your deficits and shortcomings while ignoring your strengths and resources?
yesnoDoes your therapist frequently tell you things about yourself which seem wildly speculative?
yesnoDoes your therapist spend a good deal of time explaining how you supposedly feel about him?
yesnoWhen differences of opinion exist between you and your therapist, does he almost always insist that you are mistaken?
yesnoDoes your therapist seem to see himself as intellectually superior?
yesnoDoes your therapist appear to distrust you; is he quick to assume that you are merely victimizing yourself and sabotaging your therapy?
yesnoDoes your therapist insist that he is a much more important figure in your life than he really is?
yesnoDoes your therapist frequently talk about other people in your life, but refuse to include them in your therapy despite their availability?
yesnoDoes your therapist attribute malevolent motivations to other people in your life, and indict them as a result?
yesnoDoes your therapist insist that you postpone important decisions in your life (marriage, job change, educational plans), pending his permission for you to make those decisions?
yesnoHas your therapy created a situation where you feel pulled in one direction by your therapist, and pulled in another direction by someone else in your life?
yesnoIs your therapist a remote, aloof individual who exhibits all the human warmth of a computer?
yesnoHas your therapist insisted that you cannot discuss you therapy with anyone else in your family?
yesnoHas your therapist become a good friend with whom you spend most of your sessions chatting amiably?
yesnoHave you assumed that your therapist is competent merely because he seems to be a pleasant, personable individual?
yesnoDoes your therapist act as if he provides you with a uniquely important relationship that is unavailable to you in other sectors of your life?
yesnoDoes your therapist seem to assume that he is a charismatic figure?
yesnoIs your therapist committed to pursuing ill-defined goals such as 'growth' and 'existential quests?'
yesnoDoes your therapist seem so bound and determined to be your friend that he disregards the resolution of your problems?
yesnoIs your therapist preoccupied with telling you about his own feelings?
yesnoDoes your therapist seek to determine where some feeling or emotion is located in your body?
yesnoIs your therapist more concerned about how you experience your feelings, compared to what (or who) influences those feelings?
yesnoDoes your therapist seem more interested by what transpires in a session, than by what transpires in your life outside of therapy?
yesnoDoes your therapist expect that you should imitate him and adopts his values?
yesnoDoes your therapist assume that his relationship with you will suffice to resolve your problems?
yesnoDoes your therapist often seem as bewildered and confused by your problems as you are?
yesnoDoes your therapist rely on sympathetic platitudes advising you to 'trust yourself' and/or 'be kind to yourself?'
yesnoHas your therapist subjected you to any kind of physical ordeal?
yesnoInstead of planning a therapy session, does your therapist merely react to whatever direction a session spontaneously takes?
yesnoIs your therapist unaware of who is included in your family and how they influence you?
yesnoInstead of planning how to influence the behavior of someone else in your life, does your therapist merely hope that those changes will transpire by themselves?
yesnoIs your therapist unresponsive to the idea of including other people in your therapy?

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