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.

1. Has your therapy limited itself to giving you a better understanding of the difficult situations in your life?
   Yes  No
2. Do you feel more worried and discouraged since you began therapy?
   Yes  No
3. Is your therapist so preoccupied with your insight that he neglects to outline specific courses of action for you to undertake?
   Yes  No
4. Is your therapist intensely interested in the minutiae of your fantasies, feelings, and/or thoughts?
   Yes  No
5. Does a great deal of your therapy seem to focus on issues that are trivial or obscure?
   Yes  No
6. Is 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)?
   Yes  No
7. Despite a situation where you have felt ready to terminate therapy, has your therapist repeatedly advised you not to?
   Yes  No
8. Does your therapist focus primarily on the events of your childhood and overlook the present-day issues of your life?
   Yes  No
9. Does your therapist overemphasize your deficits and shortcomings while ignoring your strengths and resources?
   Yes  No
10. Does your therapist frequently tell you things about yourself which seem wildly speculative?
    Yes  No
11. Does your therapist spend a good deal of time explaining how you supposedly feel about him?
    Yes  No
12. When differences of opinion exist between you and your therapist, does he almost always insist that you are mistaken?
    Yes  No
13. Does your therapist seem to see himself as intellectually superior? Yes  No
14. Does your therapist appear to distrust you; is he quick to assume that you are merely victimizing yourself and sabotaging your therapy?
    Yes  No
15. Does your therapist insist that he is a much more important figure in your life than he really is?
    Yes  No
16. Does your therapist frequently talk about other people in your life, but refuse to include them in your therapy despite their availability?
    Yes  No
17. Does your therapist attribute malevolent motivations to other people in your life, and indict them as a result?
    Yes  No
18. Does 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?
    Yes  No
19. Has 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?
    Yes  No
20. Is your therapist a remote, aloof individual who exhibits all the human warmth of a computer?
    Yes  No
21. Has your therapist insisted that you cannot discuss you therapy with anyone else in your family?
    Yes  No
22. Has your therapist become a good friend with whom you spend most of your sessions chatting amiably?
    Yes  No
23. Have you assumed that your therapist is competent merely because he seems to be a pleasant, personable individual?
    Yes  No
24. Does your therapist act as if he provides you with a uniquely important relationship that is unavailable to you in other sectors of your life?
    Yes  No
25. Does your therapist seem to assume that he is a charismatic figure?
    Yes  No
26. Is your therapist committed to pursuing ill-defined goals such as 'growth' and 'existential quests?'
    Yes  No
27. Does your therapist seem so bound and determined to be your friend that he disregards the resolution of your problems?
    Yes  No
28. Is your therapist preoccupied with telling you about his own feelings?
    Yes  No
29. Does your therapist seek to determine where some feeling or emotion is located in your body?
    Yes  No
30. Is your therapist more concerned about how you experience your feelings, compared to what (or who) influences those feelings?
    Yes  No
31. Does your therapist seem more interested by what transpires in a session, than by what transpires in your life outside of therapy?
    Yes  No
32. Does your therapist expect that you should imitate him and adopt his values?
    Yes  No
33. Does your therapist assume that his relationship with you will suffice to resolve your problems?
    Yes  No
34. Does your therapist often seem as bewildered and confused by your problems as you are?
    Yes  No
35. Does your therapist rely on sympathetic platitudes advising you to 'trust yourself' and/or 'be kind to yourself?'
    Yes  No
36. Has your therapist subjected you to any kind of physical ordeal?
    Yes  No
37. Instead of planning a therapy session, does your therapist merely react to whatever direction a session spontaneously takes?
    Yes  No
38. Is your therapist unaware of who is included in your family and how they influence you?
    Yes  No
39. Instead 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?
    Yes  No
40. Is your therapist unresponsive to the idea of including other people in your therapy?
    Yes  No

If you answered "Yes" to only one or two questions, the chances are better than fifty-fifty that your therapist is competent. You and the therapist will probably be able to resolve whatever doubts you have about your therapy.

If you answered "Yes" to between three and five questions, it is imperative that you and your therapist resolve your concerns. Otherwise, therapy may deteriorate into a waste of your time, money, and energy.

If you answered "Yes" to between six and nine questions, you need to seriously discuss the direction of your treatment with this therapist. Nevertheless, do not feel too optimistic about the outcome of such a dialogue. A therapist who provokes this many "Yes" answers is likely very entrenched in antiquated methods and approaches. You may find it necessary to fire this therapist.

If you answered "Yes" to ten or more questions, you need to carefully question your therapist about the relevance of your therapy. If the outcome of this discussion fails to reassure you, decisive action is warranted. Rather than walk away from this therapist, or even trot, consider sprinting from therapy as rapidly as you can. Any therapist who elicits this many "Yes" responses is likely incompetent. He or she is probably doing you much more harm than good.