The Most Important Question to Ask your Therapist

Whether due to COVID fears, job loss, relationship conflicts, or the extreme political polarization dividing people from one another across the country, many people are turning to therapy as a place of solace. In addition to helping us feel less anxious and depressed, therapy has the potential for helping us make meaning out of our lives and discover lasting changes. In this post, I'd like to clarify what I believe to be the most helpful question to ask when looking for a therapist.

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​“What’s your specialty?” This is one of the most common questions people ask when trying to find a therapist, but it's also one of the least helpful.  Implied in this question is an assumption that a given problem has a given treatment, and finding a therapist with expertise in working with that problem will be the best way to find the best therapist.
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​In some areas of medical practice, this makes sense. If you’re having a problem like joint pain, you want to find a physician specializing in pain or joints (perhaps an orthopedic specialist, a rheumatologist, or a neurologist). This is because, in most areas of medicine, a given problem corresponds to a given treatment in a fairly straightforward manner.  Although there might be variations of joint pain, once the condition is properly diagnosed, the treatment options will be dictated largely by the diagnosis. This is because physicians who specialize in treating joint pain (whatever their sub-specialty) tend to share a common understanding of what defines the condition, what causes it, and how to treat it.  This is where psychological problems differ.
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Unlike most areas of medicine (which address physiological processes of the body), psychology addresses the operation of the mind. The mind has properties that differ from the body in important ways. Specifically, the mind is subjective in addition to being objective. Subjective domains of human experience are, by definition, more varied and expansive.  They include our experience of our bodies, but they comprise a number of other domains that are central to our human experience such as:

• Our colorful and rich emotional lives
• Our multi-layered, continuous cascade of thought
• Our attention, concentration, and memory capacities
• Our continuously dialoguing conscious and unconscious processes
• Our personal sense of agency and being-in-the-world
• Our sense of satisfaction and purpose in life
• Our sense of morality
• Our behavior and the meanings we assign to our behavior

​These domains of subjectivity are much less conducive to the methods of investigation used to study other body-based medical conditions. As a result, the kinds of treatment approaches for psychological conditions are much more varied than in other areas of medicine. In place of the microscope, psychological phenomena require a kaleidoscopic lens, where each lens yields a very different image of the object under study. The different ways problems might be defined and conceptualized in psychology is what constitutes one's theoretical orientation.
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Theoretical orientations differ across therapists. If your therapist construes your depression as a reflection of faulty thinking patterns, your treatment will focus more heavily on attending to your thought processes, challenging faulty thinking patterns, and reinforcing positive ones. Alternatively, if your therapist construes your depression as an overt symptom caused by underlying patterns of behavior that remain outside your awareness, your treatment will focus more on examining thoughts and feelings, exploring relationship patterns in context, and exploring implicit/unconscious processes. Different ways of viewing the problem lead to quite different approaches to treatment. These different treatment approaches comprise different theoretical orientations, and there is a wide variety of theoretical orientations to which therapists subscribe.

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What's Your Theoretical Orientation?

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​This is the single most important question to ask your therapist. It has enormous implications for the type of treatment you will receive and offers a glimpse into your therapist’s way of thinking about mental life. When asking what is someone’s specialty, I suspect what a person is wanting to know is whether or not the therapist will be someone who can truly help them in ways that are effective, lasting, and personally meaningful. To know the answer to these questions, a different question must be posed to the therapist - one that will lend much more meaningful insight into how he or she thinks about problems, what constitutes health, and what you can hope to achieve as a result of beginning a healing relationship with this person.
Ultimately, discovering your therapist's theoretical orientation can lend much insight into who your therapist is as a person and how they manage the therapeutic relationship, which, as the research continues to demonstrate, is one of the most important variables impacting the success of any treatment. [1]
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References

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[1] Lambert, M., J. & Barley, D., E. (2001). Research Summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy, 38, 4, 357-361.

About the author

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Tyson Davis, Psy.D. is a clinical psychologist and psychoanalyst at Glen Forest Psychological Services, LLC.  He specializes in helping individuals and couples dig deeper to make lasting transformation in their lives.  Tyson has a special interest in the study of personality development and psychoanalytic psychotherapy for individuals and couples. ​​​​

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