Finding an Evidence-Based Therapist: A How-To Guide

Finding an Evidence-Based Therapist: A How-To Guide January 16, 2017

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So you’re an atheist, skeptical, science-minded, secular and/or non-woo-believing person, and you need a therapist. You’ve heard the horror stories of friends who have gone to get treatment for their mental illness, to receive grief counseling, or to work towards bettering their relationships, only to have their lack of religion targeted as the source of their problems and been subjected to proselytizing. Some have gone to a supposedly secular therapist only to be blindsided by outdated, pseudo-scientific approaches. You’ve contacted the Secular Therapist Project, but no luck–maybe they didn’t have any contacts in your area, the person you found didn’t take your insurance, or the suggested therapist simply wasn’t able to help you with your particular issue. You’ve gone to Psychology Today’s Find A Therapist lookup (the most comprehensive list of psychological professionals in the US) and entered in your zip code… and now you have dozens or hundreds of options. How do you narrow it down and make sure the therapist you opt to see will provide you with thoroughly non-religious, evidence-based care?

Luckily, Ari is here to put that fancy psychology degree to work for you and provide you with a step-by-step guide to finding a qualified, science-backed and secular therapist to help heal whatever ails you. Here are 4 simple steps you can follow to determine who to trust and who to avoid when selecting a mental health professional.


 

Step 1: Check Their Credentials

 

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Like you would with any healthcare professional, you’ll want to make sure you only entrust your care to a well-educated, fully-qualified individual, not just someone who claims to be one. Here’s a breakdown of the different levels of education and qualifications to look for (and to avoid) in a potential therapist in the US.

**Note: This list is limited to talk therapists and does not include psychiatrists: doctors who dispense psychotropic medications. Some psychiatrists provide a limited amount of talk therapy to augment medication, but most typically refer out to master’s and doctoral-level therapists to provide that service for clients who would benefit from it.

 

Education

You can think of qualified talk therapists as coming in two tiers: basic and deluxe. Neither is inherently “better” than the other, but each is uniquely suited to treat different types of concerns.

Your “basic” therapist holds a master’s degree: either a Master of Arts/Sciences (MA or MS)–typically in counseling–or a Master of Social Work (MSW), each of which take approximately 2-3 years of full-time classwork and supervised practice to receive. Most programs also require the completion of a research thesis. These sorts of therapists are qualified to treat the most common psychological issues, including depression, anxiety disorders, PTSD, phobias, eating disorders, OCD, ADHD, mild to moderate autism spectrum disorder, and problems in family and romantic relationships. They are the most common type of therapist and as such are typically more easily accessible and affordable than the “deluxe” tier.

This other breed of therapist, who are more accurately called psychologists, hold Ph.D.s in clinical psychology. It takes on average 5 to 6 years of full-time study to obtain this degree. In addition to the classwork and supervised practice hours that master’s-level therapists also complete, Ph.D. students are required to conduct and present highly-specialized original research on the causes, prevention, diagnosis and treatment of mental illnesses. They often end up focusing their research and study on an illness or family of related illnesses, making them experts in the identification and treatment of those particular disorders.

As a result, Ph.D.s are uniquely qualified to treat less common disorders, like dissociative disorders, personality disorders, bipolar disorder, and psychotic disorders such as schizophrenia, or more severe cases of issues which could otherwise be treated by a master’s level professional. They are also the ones to go to if you need official evaluation for a diagnosis, especially if you suspect an uncommon diagnosis. There are far fewer Ph.D. psychologists in the US than master’s-level therapists, so they are in high demand and can be difficult to get an immediate appointment with, but if you’re dealing with a concern that you think requires more specialized treatment, this is probably a better bet for success than your basic talk therapist.

Psychology Today lists the school(s) each therapist earned degree(s) from, year of graduation and number of years in practice under the “Qualifications” heading. As always, your mileage may vary; a therapist who received a degree from an Ivy League school isn’t always going to be a better fit for you than one who studied at a state school. Similarly, someone who’s been in practice for 4 years might happen to know more about your specific issue than someone who’s worked for two decades. But this will at least give you an idea as to their level of knowledge and suitability for you. If someone got their degree from a heavily religious institution, for example, or has only been in practice for a year or two, you may want to take pause before putting stock in them.

 

Licensure

Acronyms like LCSW, LMFT, LPC, LMHC, etc. refer to specific professional licences to practice mental health counseling. Both master’s and doctoral-level therapists must obtain one or more of these qualifications in order to practice counseling legally in the US. Each license has slightly different requirements in order to obtain and maintain them, but none is inherently better or worse than another, and for treating most common mental health issues, they are functionally equivalent. Each requires a graduate-level education, a large number of supervised practice hours (typically in the thousands), and an exam. Check your state’s requirements for each type of licensure if you’re interested to learn more.

 

Who to avoid

If a potential counselor does not have any of the degrees or licenses listed above, they are not a qualified professional–don’t even consider them! Here are a few such people that you are likely to come across:

In most cases, you will want to avoid M.Divs. These are people with degrees in theology, not psychology. If someone advertising themselves as a counselor holds an M.Div and no other degrees, they are not qualified mental health professionals and should never be entrusted with mental health care. However, some M.Divs and other clergy members known as pastoral counselors study psychology or social work alongside their theology degree. If a person with a degree in theology also boasts an MA, MS, MSW or Ph.D, they may be worth considering, but proceed with a good deal of caution, as they are much more likely to come from a religious perspective than your average therapist.

You should also beware of life coaches. Again, these are not mental health professionals and are in no way qualified to treat mental health concerns. Some may have graduate-level training in one field or another (usually business), but life coaches are not required to attain any specific level of education, undergo supervised practice, pass a rigorous exam or adhere to ethical standards set by a licensing board. Life coaching may be appropriate if you need help furthering your career, breaking bad habits or achieving your life goals, but if you are in psychological distress, don’t seek treatment from a life coach.

And for the love of all that is good, don’t even give a first glance (much less a second) to your average minister, priest, pastor, or any other flavor of religious leader. They have absolutely no training or expertise whatsoever in psychology or social work and should be entrusted with your medical care about as much as any random person on the street – which is to say, not at all.

 

Step 2: Take Note of Religious Affiliation

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Once you’ve weeded out clearly unqualified individuals, the next step is to narrow it down to people who are both properly trained and aren’t interested in disseminating their personal religious agenda.

If you’re searching on Psychology Today, take a look at the right side of the page under the “Client Focus” heading. Is there a religious orientation listed? Is there any overtly religious language in the name of practice or in the therapist’s biography? If so, cross them off your list outright. Don’t worry, this isn’t simply religious discrimination based on the personal beliefs of the practitioner. When a mental health professional lists a religious orientation for their practice, they are not simply letting their personal beliefs be known, but advertising that their practice adheres to a specific religious dogma.

No matter their personal religious beliefs, a therapist who practices non-religious, evidence-based treatment will not advertise a religious affiliation of any kind to potential clients. If a practice or individual therapist makes a point of listing a religious affiliation, you can be sure that this is not a secular environment and that religious ideology will play a role, large or small, in their approach. For example, if a therapist lists a Christian affiliation, make no mistake that they are attempting to cater specifically to Christian clients and will operate within a Christian worldview – if they wished to serve all people equally, they would not label themselves as a Christian therapist and risk alienating potential clients of other faiths or no faith.

Here’s a testament to my claim that even personally religious therapists do not use religious language in their practice if they are committed to providing secular, evidence-based treatment. When I was looking for a therapist in Arkansas, I was very careful to avoid anyone who I suspected would be overtly religious. The therapist I chose, naturally, did not list a religious affiliation on her Psychology Today profile. While I was seeing her, she was well aware that I was an atheist. For the 8 months I saw her she never once mentioned her personal religious beliefs, much less tried to convert me or push religiously-inspired pseudo-psychology on me. One of our sessions even focused on my fear of the end my consciousness at the moment of death, and she never even mentioned the possibility of an afterlife. I assumed she was herself secular. When I stopped seeing her due to moving states, I decided to look her up on social media…  where I found out she was actually a devout Christian. She did what any responsible professional should do–separated her religious beliefs from her practice, respected her client’s right to religious autonomy, and used only methods borne out by research to treat my mental illnesses. The point I’m trying to illustrate here is that it is totally possible (and common) to receive quality secular treatment from a therapist who is personally religious, and any therapist is worth their salt will probably never discuss their religious beliefs with you to begin with.

However, unless it coincides with other concerning factors mentioned in this article, don’t necessarily be put off if a therapist says they will work with clients to improve their “spiritual well-being,” or similar phrases. This kind of language typically means either one of two things: (1) that the therapist has a secular approach but will respect and work with the specific religious needs of the client, or (2) the therapist is using “spiritual” as a cultural synonym for “emotional”. If the therapist’s biography uses the word “spiritual” in this sort of context but they do not list a religious affiliation or have any other red flags on their profile, it’s probably safe. If you’re concerned about it, don’t be afraid to call or email them to ask for clarification before you decide to commit to an intake session.

Here’s another small trick I’ve learned: go back to the “Client Focus” section and see what’s listed under “Categories”. If they specifically list being open to LGBTQ clients, you can safely bet that they are secular. To be sure, there are some religious therapists who also happen to be LGBTQ-friendly, but if a therapist makes a point to be inclusive to these clients and also doesn’t suffer from any of the red flags above, you can be highly confident that they are socially conscious and open to serving clients from all walks of life, which strongly indicates a secular practice.

 

Step 3: Beware of Pseudo-Psychology Buzzwords and Treatments

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Just like any other science, psychology is unfortunately not immune to infiltration by woo. For someone without a background in psychology, it can be hard to decipher the lingo and know which treatments are valid and which are not. Watch out for these key terms in a therapist’s modality, treatment orientation and biography — if you see any of these, it should give you pause.

 

Psychoanalysis (Related terms: Psychodynamics, Freudian, dream interpretation, repressed memories, excessive usage of unconscious/subconscious)

In common parlance, psychoanalysis (and its more modern cousin, psychodynamics) is often used interchangeably with “talk therapy”, but among psychological professionals, this term refers specifically to the theories and practice of Sigmund Freud. Freud believed that all psychological issues stemmed from unresolved childhood conflicts (mostly of a sexual nature, as in the infamous Oedipus complex) many of which occurred in the first few years of life before memories can be formed and stored. These unconscious desires cause one or more of three components of the mind – the id, ego and superego – to become overly weak or strong, resulting in psychological distress. The therapist helps the patient to identify these hidden conflicts through methods like free association, dream analysis, and projective tests like Rorschach’s inkblots. Once these repressed memories and feelings are recovered into the conscious realm of the mind, they can finally be resolved and the patient will be freed of their distress.

These theories (and I use that term loosely) were concocted by Freud and his associates based on their personal observations and philosophy and were in no way based on research. In fact, many of Freud’s claims cannot be scientifically tested and are unfalsifiable. The majority of those that can be tested have been thoroughly debunked. Those that do happen to hold a grain of truth (such as the existence of the unconscious) often operate totally differently from Freud’s claims and have been incorporated into other evidence-based treatments. In other words, no evidence-based therapist would claim to practice psychoanalysis or psychodynamics, especially as a primary modality.

Even in the absence of these specific terms, you can sometimes spot psychoanalytic influence in a therapist’s biography. If they rely heavily on appeals to the unconscious or repressed memories in their treatment narrative, claim they can interpret dreams to reveal deeper illuminating significance, or assert that most or all negative psychological outcomes stem from forgotten conflicts in infancy and early childhood, they likely have a psychoanalytic bent to their practice and should be avoided.

**Important note: There are legitimate, evidence-based uses of the term “unconscious” which are well-established by research and not related to Freudian theory. If you are interested to learn more, I recommend reading the book Blink by Malcolm Gladwell.

**Other important note: The word “psychotherapy” should not be confused with psychoanalysis and is not a red flag when looking for a qualified professional. Psychotherapy is simply another term for mental health counseling and does not refer to any specific treatment method.

 

Regression Therapy (Related terms: Age regression, past life regression, hypnotherapy)

This technique comes in two major flavors: Kinda Woo and Super Woo. Both are total bunk scientifically, but the Super Woo version has a supernatural flair in addition to the pseudo-science for bonus nonsense.

The Kinda Woo version stems–again–from Freud’s discredited hypothesis of early childhood psychological conflicts. Regression therapy practitioners believe that clients can resolve these conflicts by traveling back in their minds to the earlier time of stress or trauma. This differs from Freudian methods, though, in that the client does not simply recall these incidents and analyse them with the therapist’s expertise, but is influenced to such a great extent (often through hypnosis) that they truly believe they are reliving these previous experiences. Given that hypnosis is essentially a heightened state of suggestibility, there is a huge issue with false memories among those who receive this kind of practice. Practitioners often guide clients to fabricate memories through the use of leading questions, thereby giving the client a false solution to their issues and inducing a placebo effect.

A kind of “regression” (or progression) to another age is a documented phenomenon in psychology, but only in severe dissociative disorders such as dissociative identity disorder. Outside of these sorts of disorders, literal regression to another age is not possible — the client is simply in a state of heightened suggestibility and is responding to the therapist’s cues in ways they may not consciously realize.

The Super Woo version takes it several steps further down the path to complete fantasy. In this version, the client recovers memories not only of their own lifetime, but of their previous lives as well, whose traumas are equally burdensome on their current mental states. I don’t think I need to get too much into why this is totally unfounded–there’s no empirical evidence that any human has ever lived more than one life, much less that accessing memories of these lives can somehow aid in psychological health. Again, suggestibility and false memories are at play here, but on a macro scale.

 

Emotional Freedom Technique (Related terms: Tapping, thought field therapy, energy psychology, reiki)

This is quite literally the acupuncture of the psychology world. Instead of inserting needles into the skin at precise points to heal physical ailments, this technique involves the practitioner gently tapping the client’s body with the fingers as the client focuses on a specific problem or issue. The tapping occurs at specific “meridians” (yes, just as in traditional acupuncture, reiki and other forms of energy healing) in order to unblock the flow of energy or chi and promote psychological healing.

Research has shown that any benefit is entirely due to the placebo effect, so you’d be just as likely to find relief with EFT and you would by staying home and eating potato chips you’ve decided are medicinal. Precisely none of this backed up by a shred of evidence or even remotely compatible with the entirety of the scientific body of knowledge of the human mind, not to mention biology and physics.

 

Neuro-Linguistic Programming (Related terms: Law of attraction, The Secret)

Oh, dear. What can I say about this? Essentially it states that thoughts and language have direct power over the events of the universe and that simply imagining something is enough to make it real. Therefore, you can solve your problems and achieve your dreams by thinking about them and feeling it REAL HARD. I must admit I have difficulty summarizing it, as its jargon is thoroughly incomprehensible to anyone with a background in actual psychology… or, just most people. I’ll simply leave the Wikipedia article here for you to attempt to decipher and leave it at that. Suffice it to say, this is a borderline cult with such little scientific backing to its claims that even the psychoanalysts scoff at it.

Oh and also it LITERALLY APPEALS TO MAGIC.

 

So if these approaches don’t work, what DOES work?

That depends on your specific issue. There are dozens of evidence-based approaches to therapy, and what works best for you will depend not only on your diagnosis, but your personality, life situation and preferences. To get a good feel for what to look for, look at the Wikipedia page for your diagnosis (if you don’t have a diagnosis, try to make an educated guess based on what you’ve read) and read the section on treatments — it won’t be perfect, but it will give you an idea of what to start looking for. Again, there are many evidence-based treatments and what may work for you depends on several factors, but some of the most common evidence-based therapies you can feel confident about undergoing are cognitive behavioral therapy, dialectical behavior therapy, prolonged exposure therapy, exposure and response prevention, eye movement desensitization and reprocessing, and neurofeedback.

 

When in doubt… research!

The above is not by any means a comprehensive list of pseudo-psychological approaches; these are simply some of the most blatant, common, currently in vogue techniques you may come across. If you are not familiar with the modality a potential therapist works in, read up before deciding whether or not to pursue. It might not always be obvious by the name, though. Some modalities have woo-ish sounding titles (like eye movement desensitization and reprocessing and mindfulness meditation) but have robust bodies of literature to support their efficacy. RationalWiki is a good place to start learning about other pseudo-psychologies not listed here.

If you are not sure whether a certain treatment is evidence-based, seek out info from reputable, expert sources. Unfortunately, just because you can find a treatment on a psychology website doesn’t necessarily mean it’s evidence-based. Many of these sites function more as journalistic endeavors than science communication, often playing the, “One side says X, the other says Y… We report, you decide!” card. Look for websites that cite primary research studies to support their claims and don’t shy away from admitting and addressing criticisms or weaknesses of the treatment. Wikipedia is a good place to start looking.

Try not to rely on info from organizations which are invested in pushing a specific modality. If the name of the treatment is in the website, for example, it may be run by an organization that holds the rights to trainings and materials, and has a vested interest in presenting only positive information about that treatment. That’s not to say that the information provided on that site is necessarily false, but often these sorts of resources aren’t totally upfront about information which might call their methods into question. You’d be better served by finding an information source which has nothing to gain from promoting one specific modality over another. If the treatment is being purported to cure almost all problems in almost all cases, that’s a sure sign of propaganda.

If you can get a hold of them, college textbook chapters (some of which can also be found online) are typically quite comprehensive and easier for most laypeople to understand than research articles. If you’d rather read the primary literature for yourself rather than relying on second-hand reporting, Google Scholar is a wonderful tool. Simply type in a topic you’re interested in and the algorithm will provide you with dozens or hundreds of abstracts and/or papers. If you are not used to reading scientific research publications, I recommend including “literature review” rather than “study” or “research” in your search terms. Literature reviews are type of scientific publication which summarize the relevant research in a given area and are great for getting a handle on a subject, without getting too bogged down in details and statistics.

 

Step 4: Go With Your Gut

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If there’s anything that doesn’t sit right with you about a therapist’s profile, qualifications, biography or claims, and you aren’t able to quell your doubts after doing your due diligence, don’t feel obligated to give them a chance, especially if there are other options available. If you have a well-developed bullshit detector, your first impressions and lingering nagging feelings are probably valid. Think of it like a dating situation. If you’re considering dating someone but something about them doesn’t feel quite right, you’re probably better off listening to that instinct rather than trying to force it. Further, it’s counterproductive to spend your time attempting to justify your therapist’s methods rather than focusing on your own treatment.

Just as important as the efficacy of the treatment is the relationship between the therapist and the client. A therapist could be the most qualified, knowledgeable and scientifically literate practitioner in the country, but if you don’t get along with or trust them, their ability to help you is limited. The ideal therapist for is someone who not only uses evidence-based methods, but also someone you can connect and identify with. There’s no one-size-fits-all when it comes to therapists, and individual tastes vary widely.

If you find yourself naturally gravitating towards or away from someone (perhaps based just on their Psychology Today ad or website, or even something as inconsequential as a photo) listen to that instinct. If you don’t click with your therapist after the first meeting or two, or if after a while you feel doubtful about your therapist’s suitability for you, don’t be afraid to find someone new. Therapy isn’t about an authority figure giving you advice and solving your problems for you; it’s a relationship and team effort that requires effort and input from both people involved. If you can’t be comfortable, vulnerable and exchange openly with your therapist, you may not be able to effectively identify and work on your problems.

When I was looking for a therapist last fall, I used Psychology Today to narrow it down to a handful of people who practiced evidence-based methods, specialized in the areas I needed help with, and accepted my insurance. Then I went to their websites to see if I could find out more that would distinguish them from one another. I was immediately interested in one above the others when her website showed that she also runs a dog rescue; it helped me feel that she was a compassionate person with whom I could connect. I listened to my instincts and reached out to her first, and she is now my current therapist, who I love working with. She turned out not to just be an animal lover like me–she’s also queer, progressive, eccentric and has a brash sense of humor that makes me enjoy being around her and look forward to seeing her every week, even when sessions are difficult and painful. I know I can trust her with my mental health, not only because of her methods, but because of who she is as a person. That’s the critical element in the therapist-client relationship that neither I nor anyone else besides you can determine.


 

Do you have any tips I missed, or something you’re wondering about that I didn’t cover in this article? Leave a comment below or send me an email at AriStillman4@gmail.com, and I’ll do my best to answer your question.

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