“I don’t know what you mean by “hang in with the third”. If the third turns out to be a dud, they should keep looking, or go back to the first or second. I’m all for shopping around, but eventually you have to choose someone, and the decision shouldn’t be based on some arbitrary number of therapists you’ve gone through.”
Go with whatever feels the best of the three, I didnt make that explicit but thought it was implied. It is a somewhat arbitrary number, but as you say at some point it would be worth seeing if the issue is persistence rather than the therapist.
I should make it clear I’m a psychologist, and have been a clinical supervisor for a counselling team. Im not just making this up, its based on clinical outcome research. Often what feels right to us doesnt match up with what the research tells us, and this is one of those findings - people tend to stay too long with a therapist that isnt right for them much more often than they shop around too much.
Its not so much about inefficiency as research on what the most effective aspects of therapy are, and roughly 50% of the variance in outcomes is based on the relationship with the client. Generally the most effective and immediate improvement you can make in therapy is to try another therapist if things dont feel right with the current one.
If the person is suicidal and the therapist hasnt picked up on that on session 1, let alone by session 4, that is one very good example of why it can be extremely important to try another one rather than staying with them.
I respect that you dont feel that it would have been the right advice for you. But I can only give advice on what the best odds are for a person I dont know, given nothing is certain.
So are you saying an assessment based on one session is good enough to judge a therapist? Because that’s, like, 45-50 minutes long, and most of the time you’re just running down a list of questions and not really “talking”. First dates typically last longer than that.
I’m not saying someone should stick with a therapist for several weeks at a time, waiting for some connection to develop (even though that’s kind of what happened to me). But at the very least, wouldn’t you at least recommend waiting at least two sessions until you choose someone else (barring any major red flags)? That just seems like common sense to me. You’ve already invested non-trivial amounts of time and energy seeking this person out (I had to wait three weeks to see mine). To make an ultimate judgement based on first impressions–when one’s abilities to perceive accurately might be all wacky to begin with—just doesn’t make sense to me.
But I defer to your experience on this, since mine has been limited (although I have been through three therapists and a handful of psychiatrists, so I’m not as indiscriminate as my posts may make me look).
And as far as suicidility goes, I didn’t realize that I had suicidal ideation until my third session, even though the question was asked during the first session. I simply didn’t know what that was and whatever it was, I didn’t think it applied to me. So in that case, it’s wasn’t my therapist’s fault for not picking up on all my symptoms, but rather my inability and unwillingness to communicate honestly with a perfect stranger. I don’t know if another therapist would been more sensitive–perhaps they would have been. But the manifestion of my depression was not typical; plus I was in denial about how serious it was. So I actually needed that time to slowly dole out all the information she wanted me to share with her. I hear you about patients blaming themselves for their not clicking with the therapist, but in my case I think it really was me who was sabotaging the process. Not anything the therapist was doing.
Not everyone who seeks therapy is in a “fog of illness” that takes a year to get through. Some problems benefitting from an objective opinion and advice are actually pretty minor.
I think that the method of seeking a therapist is different depending on what type of situation you’re in. I think Social Workers (MSW or other state license as in the LCSW as I mentioned above) are far superior to any other type for your basic, trivial problems of living. Just as many people prefer a Nurse Practitioner over a Doctor for routine medical issues.
If a person is seeking assistance with the ordinary confusion of life as opposed to chronic or or ongoing mental illness – which is how I read the OP – they should expect to click within 1-2 sessions or move on. Short term therapy for that sort of thing will only last 5-10 sessions anyway.
It is fairly counter intuitive so I should have explained it better earlier on.
This is also probably why its comparatively recent this kind of issue was even looked at. The traditional model of therapy is how you’ve described it, where if theres any problems its considered to be likely to be resistance or the like rather than simply a poor fit, so the assumption has been to ‘plug away’ as the first course of action when things dont feel right, and many of the reasons you’ve given are why its argued to be so.