• A perspective: What makes a good psychologist?

    To help me navigate through depression and anxiety, I've seen nine psychologists to date. I've lived in quite a few places so they have not all been from the same school of training and definitely not of the same school of thought. Some of them have been useful, some of them not so useful. Why this is the case can probably be attributed to a smorgasbord of factors.  In my experience, these have included but have not been limited to:

    Incompatibility. In this context, it isn't a simple case of compatibility of personality, but also compatibility of thought, goals, direction and care plan. To elaborate: I never went back to Psychologist number 6 because she told me emphatically that I needed intensive psychotherapy two times a week for about two years, probably longer. I disagreed. How someone (if they had been listening to me) could decide this was what I needed after 45 minutes of fact finding is beyond me. I needed help finding my way towards a separation, not to better understand why my dad only ate dinner with us kids on a Sunday. Hmphhh.

    Superiority. It's a fact of MY life that some people in the caring professions still use “boundaries” as the excuse for what just feels like bad manners. It isn't nice to walk in to a room feeling vulnerable and in need of help, and pay for someone to infer that I am, frankly, the weaker, needier and more pathetic of the two of us. I know I have problems, but I am not stupid, ignorant or incapable of seeing what is going to work for me and what isn't. This isn't lack of insight, its usually instinctive common sense.

    Out of their depth. At least with this particular psychologist, they had enough “insight” to see that they did not have the expertise or experience to deal with the particular issue I went to them with. This was a mutual agreement and I am grateful to him for being honest and upfront with me.

    There are other reasons and these are not uncommon if trawling through comments, discussions and blogs on the issue. Sure, these may not be researched studies but they are opinions from those who have had therapy, so they must be taken on board.

    Some of the attributes that these folk commonly agree make a good psychologist are typically: Trustworthiness; compassion; advanced interpersonal skills; must be ethical; emotional stability; patience; and a willingness to be wrong.

    Perhaps the biggest marker of a great therapist is the ability to hold the tension between two (or more) competing forces and discern when to lean toward one or the other. Eg: Do we rely on theory or go with our gut? Charge for a missed session or let it slide? Give a hug or refrain? Share the interpretation or wait until next session? Gratify the client's wants or help him meet his own needs? Holding this tension and deciding if and when to let the teeter-totter dip in one direction or the other is a characteristic that combines strength, discernment, resilience and wisdom.

    The best therapists are able to master the many dichotomies inherent to therapy, including:

    Objectivity/Subjectivity - Every clinician will tell you the strength of the therapeutic relationship is the most important element of change in therapy. This means the therapist and client have to get along, communicate well and care about one another. To build this rapport, therapists must empathise with the client, to a point. But take empathy too far and join a client in the depths of her grief, shame or hopelessness, and both get stuck. A therapist needs to keep one foot in the subjective experience of the client and one foot on the solid ground of objectivity. Tilt too far toward objectivity, the client feels abandoned. Tilt too far toward empathy, there is no way out.

    Emotion/Reason - Regardless of a therapist's therapeutic orientation, they must have access to both emotion and reason in therapy. Neither should be relied upon solely and the brain and gut should be used to gain understanding.

    Firm/Pliable Boundaries - Most of the time, therapists need to maintain firm, clear boundaries regarding the length of session, the type of relationship they have with clients, fees and other elements that form the "frame" of therapy. But sometimes this frame needs to flex. Glen Gabbard distinguishes boundary crossings, the occasional breach for effective clinical work, from the ethical taboo of boundary violations.

    Self/Other - Therapists need to know their own baggage so they can distinguish it from the client's issues. It takes a lot of personal exploration to avoid reactivity or defensiveness when a client's issue hits close to home. IN short, the therapist should have an idea where the clients issues end and theirs begin. Even better, they should be in an ongoing process of discovering this through their own consultation or therapy.

    Knowing/Not Knowing – It's important for a therapist to know what presenting symptoms mean in terms of diagnosis, treatment plan, prognosis, etc. But it's also important to never be too certain for risk of putting the client in a diagnostic box. Symptoms change. People grow. No two people, stories or paths to healing are exactly the same. When the therapist starts making assumptions or expecting one depressed client to respond to treatment exactly like other depressed clients, then something could go horribly wrong.

    Therapeutic model/what works best for client – is it likely then that a treatment model eg CBT, ACT, IPT (or any of the other acronyms) is going to work as effectively for each different client. It's unlikely. A therapist must be able to pull an assortment of “tricks” from the bag to create an environment of change and learning that the client responds to. Just because you think Aaron Beck is the greatest things since sliced bread, does not mean CBT is going to help everyone.

    A psychologist's area of expertise is the mind and the way it affects behaviour and well-being. How does someone retain this expertise?

    Naturally, education and training results in knowing the theory. Pursuing training opportunities helps psychologists to keep abreast with new research and other developments in the psychology world. Working with clients gives the therapist the opportunity to translate this learning in to practice. Clients have every right to ask a therapist about their training. Most people want to be certain that their therapist remains on top of new advancements in treatment. I for one, would avoid seeing a psychologist who was not ALL OVER treatment advances – including those that involve diet and other holistic adjuncts.

    I believe there is a third component and that is perhaps occasionally overlooked: Learn from the client. Nobody has more of a perspective and insight into a troubling situation than the person who has made it through to the other side. And if there is concern over your ability to work with a client on a particular issue that might be out of your scope of practice, then say so.

    ZHUCHI provides quality training for psychologists who are both green and veteran in their practice. The training is a mix of foundation skills as well as new practices and interventions for a variety of mental health problems. Wherever possible, the training embeds the client experience in to its content – ensuring that a quality control is always present for those of us who need the psychologist's help the most.

    I prefer to think of my patients and myself as fellow travellers, a term that abolishes distinctions between 'them' (the afflicted) and 'us' (the healers). ... We are all in this together, and there is no therapist and no person immune to the inherent tragedies of existence.

    Irvin Yalom

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