Three criteria are front and center in selecting a psychotherapist: cost, schedule, and empathy. These are not the only variables. For example, academic degrees and diplomas, professional certifications or equivalent publications and experience, insurance benefits, location, and Internet reputation (say, on Facebook or LinkedIn) are also criteria. Okay, I am just kidding about Facebook; but don’t laugh too hard, we are heading in that direction. In addition, it is increasingly common for psychotherapists to call out the therapeutic agreement explicitly, sometimes in writing, managing the expectations and defining the boundaries of the therapy and its framework. In general, not a bad thing if it is handled with care – and empathy. The prospective client should expect the therapist to answer straightforward questions in a direct manner. Trust is something that emerges only over time – and as the therapist earns it. There is no substitute for “interpersonal chemistry” that works well for the client; and while not identical with “empathy,” the better part of the right chemistry is based in the therapist’s gracious and generous listening – his [or her] empathy.
One challenge faced by most prospective patients or clients, who are searching for a therapist, is that once they are in an emotional emergency, there is no time to interview several prospective psychotherapists to find a good fit. This is a case for having a periodic emotional check up just as one would have a physical check up in order to establish a relationship against a possible future crisis. However, this level of planning rarely occurs. From a negotiating perspective, the individual seeking help can seem to be “one down” in terms of leverage. However, professionals will try their best to be accommodating – and empathic. In any case, the patient/client is still responsible for making his or her own best case and being a powerful self-advocate. Once again, no easy answer here if your issue is low self esteem and loss of power. Still, while acknowledging that the variables of negotiating flexibility, schedule, and cost are on the critical path, they are not the focus of this article. That leaves the criteria of empathy. Without empathy, nothing else works.
To cut to the chase, look for a psychotherapist that is genuine and authentic in relating, providing a gracious and generous – that is, empathic – listening. If the individual you are talking with does not provide the empathy you require, keep looking. Absent a warm, empathic listening, the process of psychotherapy is indistinguishable from the more painful aspects of – dental work. It can be painful, granted that many individuals seeking a therapist are already suffering from significant emotional pain. Even in the best of situations, it is not that there are zero challenges even with empathy. The process works best as you go up to the edge of your comfort zone and press through the boundary, advancing beyond it. That takes courage – going forward in spite of being afraid; and you can expect to be acknowledged and empathized with in your efforts and commitments. But what is this “empathy” that keeps getting mentioned?
The short definition of empathy is that it is the capacity to know what an other individual is experiencing because [speaking in the first person for emphasis] I experience it too, not as a merger but as a trace affect or experience that samples the other’s experience. Thus, if one is overwhelmed by the other’s trauma and re-traumatized, one is not using one’s empathy properly. Simply stated, you are doing it wrong. Optimally, I experience a trace, a sample, a virtual vicarious representation of the other’s experience of suffering or joy or indifference so that I “get it” experientially and emotionally as well as cognitively. The boundary between self and other is firmly maintained, but the boundary is permeable in one limited sector, the communicability of affect, sensation, experience. In a larger context, empathy is the capacity that enables the other person to humanize the one by recognizing and acknowledging the possibilities for growth, transformation, and recovery in the one.
Empathy is different than interpersonal chemistry – that certain something = X that just clicks between two people such that they know they can work together. Yet empathy is the basis for this chemistry and fans out into multiple forms of relatedness and possibilities of understanding.
The more the client (and therapist!) can be authentic in the relationship, the more powerful he (or she) can be in facilitating transformation in the direction of health and well-being on the part of the patient. This is true even when the experiences that the therapist encounters are not ones that he would endorse if he lived up to all his ideals. Speaking for myself, I have made a profound, positive difference in working with clients recovering from relationship breakdowns, self-defeating behaviors, domestic violence, date rape, abuses of psychiatry in the former USSR, and diverse traumatic, confronting, unintegrated experiences. It is essential for the therapist to be intimately in touch with his own feelings and attitudes, generally as a result of his own work in psychotherapy or dynamic work as a patient. After a confidential [complimentary] conversation with the prospective client, if I think I can make a positive difference (and the client agrees), then we come to an understanding on a flexible fee and schedule. We get to work.
How does one know if therapy would make a difference? If you feel like you’re sabotaging yourself, undercutting yourself, struggling with upsetting emotions, isolating oneself, or resigned and cynical, then you would benefit for a conversation. If you are behaving in a way that you don’t want to act or not doing something that you want to do, then you would benefit. For example, you are attracted to someone but freeze up or go the other way when you encounter them; or you decide to reduce alcohol consumption or lose weight but you keep drinking or eating more than you know is healthy.
What to look for is a therapist who can provide the kind of empathic relatedness that recognizes your humanity, even amidst the effort and struggle of dealing with unattractive, challenging symptoms, not all of which the client is even willing to share at first due to doubt, shame, or previous unhappy experiences and outcomes. Sometimes it is necessary for a prospective patient to “burn through” several therapists until he finds someone that he can trust. This doesn’t means that the other therapists were “wrong and bad,” though it might mean the mismatch between patient expectations and therapists’ services took awhile to converge on market availability. In short, look for a therapist who can provide the kind of relationship that the patient/client is able to “use” to overcome obstacles, jump start growth, and facilitate transformation in the direction of positive possibilities.
The key term here is actually “usability,” not in the sense of mis-use but in the proper and powerful sense of a means to guide the person back to naturally occurring development. The differentiator between use and mis-use is – you guessed it – empathy. The more the client is open to and can make use of the therapist’s empathy, the more the client will naturally restart the process of growth away from rigid, fixed, apathetic, shut down emotional functioning toward a way of being that is alive, vital, dynamic, full of feeling, engaged for better or worse with the issues that promise to provide satisfaction and fulfillment.
[This About and blog and all its contents, © Lou Agosta, Ph.D.]