Providing psychotherapy is unlike most western medicine.
Yes, training is needed and there is mandatory licensing to be able to provide care. The field has developed structured approaches to increase the chances a person will benefit from psychotherapy. There is also research to ensure that treatment approaches remain beneficial and not just traditional.
But at the end of the day, so much of psychotherapy depends on whether you feel you can have an honest, productive conversation with the person who is your therapist. This, in my opinion, is unlike many modern healthcare environments where treatment can progress whether you connect with your provider or not.
The social decision on whether you can do meaningful work with your therapist is sometimes called “fit”, and it can be frustrating to someone who is completely new to psychotherapy. I've been told that it is challenging enough to find a therapist who meets your logistical needs. Then, after all the planning, one also needs to decide whether the therapist will be a good psychotherapeutic fit moving forward.
In US healthcare, this can present a structural barrier because people are often making appointments based on insurance options, or availability, or modality of therapy offered. Fit isn’t really something a patient gets to choose ahead of time.
Yet it's incredibly important.
Psychotherapy depends largely on regular, structured conversation. If a patient feels that communication is a fundamental and consistent challenge, then progress will be hampered, no matter the good intentions of everyone involved.
However, as I've previously written, your conversations with your therapist are unlike any other set of conversations you may have. For this reason, it's important to remember that you can't judge your conversations with your therapist the same way you would a conversation with a potential new friend. The person you choose to be your therapist doesn't have to be someone you can see yourself being close, personal friends with. As your therapist, that's not the role they are trying to fill.
Rather, my perspective is to spend your first few sessions with a therapist not only reviewing key background and treatment goal information, but also evaluating the sessions for the following:
Is this a person or a setting I think I can present to weekly?
If something uncomfortable were to come up in my life or with my care, do I think I could honestly say what is troubling me?
Does it seem like the therapeutic modality being proposed is going to work for me, my learning style, and my goals?
If, after several sessions, you are concerned that there is a consistent communication or stylistic barrier happening, it is perfectly fine to bring it up. Therapists are familiar with this aspect of evaluating a new provider and should be skilled at helping you navigate whether to move forward with care.
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