Choosing a therapist can feel overwhelming and the need to research interventions and modalities to understand which one is best. Then, find a therapist using that modality who is someone you are comfortable to open up to for an hour at a time to ‘get better.’
Imagine if almost none of that really mattered as much as you thought? Would that make choosing a therapist easier for you?
The research is clear on this topic, and so while my own experience reinforces what I am writing, it is not all coming from anecdotal data.
I was lucky enough to have met and consulted with Scott Miller in my career, one of the creators of the Outcome Rating Scale and Session Rating Scale tools that I use in my practice, every session, with every client. These tools allow me to understand what outcome the interventions are having (positive or negative) as well as how each client feels about how I am working with them (again, positive or negative).
With each session, I am able to see if the client is perceiving a change from what we are doing, and how they feel about myself as their therapist as well. This data is priceless when it comes to positive outcomes in therapy.
According to Wampold (2001) in ‘The Great Psychotherapy Debate,’ alliance accounts for 60% of the outcome of treatment while model and technique account for just 8%. Let those numbers sink in for a moment. Essentially, the more that you align with your therapist, the way they work with you, and how they relate to you and your presenting issue will have a greater effect on positive outcomes of therapy than the interventions alone.
‘A therapeutic alliance has three elements: 1) There is connection; 2) there is mutual agreement about the purpose of therapy; 3) there is mutual agreement about the methods you will use in pursuit of this purpose. All three elements are necessary,’ (Shedler, J. 2013 Psychology Today). This truly captures what alliance means and gives you, the client, some insight into what to identify.
Two words that I use quite often in therapy are ‘collaborative’ and ‘invitational.’ The reason that I use them so often is due to everything I have learned and that is reinforced in the literature. I can only be a part of the outcomes in therapy by collaborating with each client on what makes sense as a next step and if that is something that seems reasonable and realistic. It would be easy to simply tell clients what to go out and do, but not very effective. Therapy is collaborative and effective therapy is invitational in all aspects.
The Session Rating Scale tool allows me to measure alliance and make changes immediately for the following session. It contains scaling questions across four domains: Relationship, Goals and Topics, Approach or Method, and Overall. Each is rated by the client and then a conversation occurs to give insight into how I can ensure that I am working as effectively as possible for what the client identifies as important in the sessions. Novel idea, that the therapist needs to understand what is working and not working to achieve best results rather than an expert ‘top-down’ approach that the therapist knows best.
So when choosing a therapist, ask questions that will allow you to get a sense of how you relate to the person and how their style may align with your own outlook. Your outcomes will likely be far better than seeking someone that does that one therapy that someone stated was the one to find.