How to choose your shrink

In 2018, 38% of the world’s population went to see a mental health professional[1]. More than one in three people! Since the rise of the Internet and the increase in emotional isolation[2], and since going to the shrink no longer hurts your reputation, there is a demand… and also an offer.

So how do you choose?

 

Shrink… what does that actually mean?

Therapist is not (yet) a protected title in Switzerland, you and I can use it: my janitor, my insurer and my doctor can call themselves a couple therapist, a cat therapist or a soul therapist. Just like shaman or healer[3].

– Psychologist is a university degree rewarded after a generalist training on psychic functioning. A psychologist may have many specializations during or after her[4] title, for example in sports psychology, occupational psychology or career counselling.

– In Switzerland, the title of psychotherapist is protected at the federal level since 2013. This title is available to holders of a degree in medicine (psychiatry) or psychology. A psychotherapist is qualified to accompany a person in psychological distress, and the way to do so will depend on her approach (her technique) as well as her character. It should be noted that economic criteria are taken into account: in Switzerland, doctors are reimbursed by basic insurance, psychologists by complementary insurance[5].

– Psychoanalyst is one of the many psychotherapeutic approaches, made famous by Woody Allen and eventually by Sigmund Freud.

– Psychiatrist is a medical specialty title. A psychiatrist is a doctor authorized to perform a medical act: medical prescription, work stoppage, for example. These doctors are mainly trained to make a precise diagnosis, and often to match it to a drug.

 

Why would I go to see a shrink in the first place?

“By going to see a shrink, you could get better. And you don’t want that! You have always managed to escape from shrinks despite your intense psychological suffering. Why suddenly give up after all these efforts?

Know this, going wrong gives you a type and allows you to inspire pity, which is very important for you. Seeing a shrink could lead you to take responsibility and finally deal with your own problems. And that’s terribly tiring. »[6]

 

…for her method?

In Switzerland in 1994, there were about 250 recognized psychotherapeutic approaches[7]; some of them having conflicting values, it’s useful to get informed. To give an example, one famous approach assumes that Man is born with destructive impulses and that his behaviour can be corrected, while another famous approach assumes that Man is born virtuous and that culture corrupts him.

We can therefore choose our therapist because we have affinities with her approach, or because our symptoms are considered more easily curable with a particular approach. If I have a phobia of flying and I have to take a plane on a business trip in 3 weeks, a brief solution-oriented therapy will be appropriate; however, it will not be a good choice if I want to understand where my existential discomfort comes from and achieve lasting results.

 

But which method?

Numerous studies have shown the effectiveness of psychotherapy regardless of the approach[8].

Important also to know is that a shrink’s approach is equivalent to initial training, and that often shrinks are trained all their lives (at least we hope so), more or less absorbing various techniques and experiences gleaned through training, intervisions, supervisions and meetings.

Some therapists even develop their own method:

 

Shit happens…

Jorge Bucay, an Argentine psychiatrist, classifies approaches according to whether they work with the future (typically the cognitive-behavioural approach), the past (typically psychoanalysis) or the present (typically humanistic approaches such as Gestalt or the person-centred approach). He takes the example of a guy who shits in his pants, and tells his friend he’s going to see a shrink. He comes back 5 weeks later; his friend tells him:

“Back already? How was the therapy? “and he answers:

“I still shit in my pants, but now I’m wearing plastic panties” (the shrink took care of the future)

He goes to see another shrink and comes back 5 years later; his friend:

“How was the therapy? “and he answers:

“I still shit in my pants, but now I understand why” (the shrink took care of the past)

He goes to a third shrink and comes back five months later:

“How was it? “and he answers:

“I still shit in my pants, but now I don’t give a shit” (the shrink took care of the present)[9]

 

…for the person she is

The title is a guarantee of some quality of training, and the person of some quality of service. For example, there are excellent therapists with solid training and/or experience who do not meet all the academic criteria to be part of a professional order.

In fact, the most important factor in therapeutic success is the quality of the relationship between you and your therapist, more so than his method or even his ability to do psychotherapy[10]. This is why it is important to form your own opinion by testing your candidate therapists: by listening to the feeling you have with them, first by phone and then in session.

Also allow yourself the freedom to change your mind; sometimes the feeling gets more refined and modified during the sessions, and a sense of loyalty can inhibit a willingness to interrupt follow-up when it may be appropriate. If this is the case, you’re at risk of wasting time and money (at a minimum).

 

So what?

The methods are so different, the therapists so different, that it is better to be advised by someone you trust (another professional or a friend who knows you well).

Searching the Internet can be useful; sometimes there is a description of the therapist and her work, which can give you a first impression, especially of her values.

Allow yourself to feel during the first session: would this therapist be suitable for me? Did I feel comfortable, listened to, trusted? When you get back home, take time to feel and reflect.

It sometimes takes courage to see someone, especially the first time. According to Seneca, Paracelsus and Carl Rogers, acceptance is the basis for change[11]. By accepting your suffering and getting an appointment with your therapist, you have probably already started the therapeutic process – and alone!

 

Cet article existe aussi en Français

 

 

[1] According to IPSOS (a French survey company). And according to the Federal Statistical Office, in Switzerland in 2012, 15.1% of men and 20.7% of women consider themselves to be experiencing moderate to high psychological distress

[2]« (…) la psychologisation de notre culture, à l’origine d’un immense développement des professions de soins, et plus particulièrement des professions «psys», est liée à l’effritement du lien social dans la société démocratique postmoderne » (the psychologization of our culture, which has led to an immense development of the care professions, and more particularly the psychological professions, is linked to the erosion of social cohesion in post-modern democratic society) (Nicolas Duruz in L’Hebdo, september 23^rd, 2004)

[3] By the way, there are some that I would recommend more easily than others full of titles

[4] This article is a translation of « Comment choisir sa psy ». I used the feminine in the article, because in Switzerland 83% of psychologists and 80% of psychotherapists are women (Federal Statistical Office, figures from 2013 to 2018)

[5] Or by basic insurance if they work in the same premises as a psychiatrist (called delegated psychotherapy)

[6] Translated from Gourion, D., Muzo (2016), Cinquante puissantes raisons de ne pas aller chez le psy. Paris, Lattès

[7] Duruz, N. (1994), Psychothérapie ou psychothérapies ?, Paris, Delachaux et Niestlé

[8] Read for example Lambert & Bergin (1994), The effectiveness of psychotherapy. In: Bergin, A.E., Garfield, S.L. (Eds.), Handbook of Psychotherapy and Behavior Change, 4^th ed. John Wiley & Sons, Oxford, England, pp. 143 – 189; Smith et al., (1980), The Benefits of Psychotherapy. Johns Hopkins University Press, Baltimore, MD ; Stiles et al., (1986), Are all psychotherapies equivalent? Am. Psychol. 41, 165 – 180 ; Wampold et al., (1997), A meta-analysis of outcome studies comparing bona fide psychotherapies: empirically, « all must have prizes ». Psychol. Bull. 122, 203 – 215

[9] Freely adapted from Bucay, J. (2013), Let Me Tell You A Story : Tales Along the Road to Happiness, Europa Editions

[10] Crits-Christoph et al (2011), The dependability of alliance assessments: The alliance – outcome correlation is larger than you might think. Journal of Consulting and Clinical Psychology , 79 (3), 267 – 278 ; Horvath et al (2011), Alliance in individual psychotherapy. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Evidence-based responsiveness (2^ème éd., pp. 25 – 69). New York: Oxford University Press, quoted by Nienhuis et al (2016), Therapeutic alliance, empathy, and genuineness in individual adult psychotherapy: A meta-analytic review. Psychotherapy Research, 28(4), 593–605

[11] « As soon as I accept myself as I am, I change; here is a curious paradox. » Rogers, C. (1961), On becoming a person. New York, Houghton Mifflin Harcourt