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What Makes a Good Therapist?

I thought she could help me with night terrors, this nice new therapist. The night terrors started a few weeks after my son went to prison–five words I had never thought I would string together.

I’ve had nightmares since childhood, but these are extraordinary. I tumble into slumber, then wake myself screaming bloody murder, like the woman in Psycho.

It’s embarrassing to scream so loudly that my husband hears me over the TV downstairs. One night I woke my daughter, Caroline, in the guest room, propelling her up and into the hallway before she remembered that this was my new normal. She went back to bed, but only after checking on the young grandkids asleep in the distant sunroom.

They were here because my son Jacob’s wife sometimes needs a break. We get to see them more often now. Is this a silver lining? No; there are none. The kids are too young to understand, for now, what it will mean to have only phone calls, letters and long-trek visits with their dad until they are eleven or twelve, depending on things beyond our control.

He is 700 miles from us now, but in the same time zone, so when I get into bed I think of him doing the same in his cell, which he describes as more of a cubicle. I don’t ask about bars or locks, but when we visit, I count three locked doors between the metal detector and the visiting room, and even a big lock on the vending machine.

He’s started to wake up laughing, he says, and I tell him I’m known for the same thing, even–especially–when my life is a mess. I need laughter, and therapy.

It was my psychiatrist, Dr. Martin, who recommended this therapist to me, calling Dr. Carlin young but good. I forget his words: Perceptive? Warm? Effective? That’s what I obviously needed as I sat choking out Jake’s story. I’ve had anxiety, depression, hypomania—probably a bipolar II combo—for as long as I can remember, no doubt stemming from a difficult childhood with a sister prone to explosive outbursts. Then there was my violent first marriage and, oh, I’m so tired of talking about all of this. Did any of it lead to my son’s conviction and plea deal for a crime he didn’t know he’d committed?

For the record: If you pay for legal, adult pornography, and it takes forever to download, and you close your laptop to go to bed, get up the next day for work, come home, make dinner and finally open it after twenty-four hours have passed…you may find that you have unwittingly downloaded the worst thing in the world—child porn. Unless you call the FBI at once, you are guilty of receipt, possession and distribution. Even if you are disgusted, terrified and repulsed, deleting it and wiping your hard drive. With luck, you can plead guilty to the least of the charges and spend seventy months in prison, sixty for good behavior.

For years, my husband Brad, a retired therapist, had told me that Jacob was depressed. I brushed it off. He didn’t know my son well, and we hardly saw him once he married and moved away.

Jake? Depressed? I thought. He’s over the moon to be a husband and father of two amazing kids; he keeps a photo of his dad, my first husband, on his desk because he lets things roll off his back, and he was just a baby when the violence began.

I’d remind myself that when Caroline, three years older, would hear my head bashing against the wall, and the threats to use the gun on me, she’d go to Jake’s crib to comfort him. And long after the divorce, when their dad drank himself to death, didn’t Jake handle it much better than his sister?

My new therapist Dr. Carlin was great—until she wasn’t.

I came into our fifth session with a scribbled note: “Night terrors. Anger. Body changes. Anxious scratching. Feel like I’m not here.” I led with the terrors.

She had nothing for me, she said, because there were no definitive studies. Instead, she offered sleep-hygiene advice and a three-page list of caffeine counts for the beverages and treats I almost never indulge in.

Therapy can’t help night terrors? Defeated, I zoned out until I could get up, zip my jacket and give her a tight smile under my surgical mask. I left angrier than ever and even more stuck in my feeling of not really being present, even in her office.

We hadn’t talked about my son at all.

At our next session, Dr. Carlin asked if she might “challenge” me.

Okay, I thought. Maybe this is a new technique: scare the terror away.

She said–and I still see her eyes above her mask, narrowed to slits–”What if Jacob did this on purpose?”

There was a beat. I took a breath. I wish that I’d stood up, told her this question was unacceptable—that, to use her favorite term, my knowledge of his actual mistake was “evidence-based”—and left, slamming the door.

But all I got out was, “What?”

I probably protested too much: “Why would you suggest that he deserved his sentence? Even if that were true, I’d still love him, still write and talk to and visit him. I’d be even more concerned about what had led him to such a horrific act.”

I had a bit of luck that day: an appointment with Dr. Martin immediately afterward. I recounted the incident to him–a compassionate and brilliant man I’d often wished practiced psychotherapy. He promised he’d talk to her. Although I insisted I was finished with therapy, he quietly, slowly conveyed how much he thought it could help. I grudgingly agreed.

Mr. New Therapist hardly bears mentioning. A highly experienced PTSD specialist, he listened, taking notes and repeating, “Okay, okay,” after everything I told him. He declared he could help, might try eye movement desensitization and reprocessing therapy—except that, by the way, he goes away to be an Army psychologist six months a year. Oh, darn.

Again, I could not speak the words trying to punch through my head, and left saying, “See you later.” But no.

Dr. Martin understood, even giving me the word I couldn’t find to describe this clinician.

“Regimented?”

“That’s it,” I replied. I promised him I’d make a list of everything I want in a therapist.

Oh, what a list! I included every single therapist, counselor or social worker I’d ever consulted, beginning with the one in high school, for whom I had to get my mother’s permission. One after another, they were nice, somewhat insightful and ultimately unhelpful. (Most vivid is the one who let my dangerous husband and I convince her, and ourselves, that I should return to him.) All too often, these partnerships deteriorated into friendship. I needed more.

So what makes a good therapist? Insight. Goal-setting. Checking in often on how we’re doing. Sympathetic responses to my blurted worry and despair, even just a quiet “Oh.” Not advice, but guidance. Good humor. An unassailable sense–a comforting aura, if you will–of having heard and seen it all, without judging anyone, no matter what they confess. Optimism. A careful ability to unpack my defenses. A willingness to maybe listen to my poetry once in a while. Some assurance that Caroline’s biggest fear–that I will die or dwindle before her brother is out–probably will not happen.

Above all, safety. The absolute conviction that no matter what I say, I will be safe in that room with my confessor. I have worked incredibly hard to believe my son is safe in a terrifying federal prison. I need someone to help me believe that I, too–his powerless mother–will be kept out of harm’s way.

Penny Campbell (a pseudonym) says, “About this essay, I rely on Maya Angelou’s words: ‘There is no greater agony than bearing an untold story inside you.’ It turned out that my wonderful young psychiatrist sometimes takes on patients who have trouble finding the right therapist. So now I’m seeing the best therapist I’ve ever been to—one who practices psychodynamic therapy, which, even if it weren’t just the right kind for me (and it seems to be), I trust completely. And that is what counts.”

Comments

4 thoughts on “What Makes a Good Therapist?”

  1. My situation isn’t nearly as bad as yours, but I totally get it. After my daughter’s suicide I had referrals to three different counselors. I was only allotted 4 sessions with two of them, and the third discharged me after 2 sessions because I had “good insight”. Not once did I feel a sense of caring from any of them. I was just the client for that hour. I had a referral to a suicide bereavement support group – that never followed up the referral, even when someone else tried again. Why is it so hard to get help? I wish you all the best in your future efforts to receive appropriate support, which seems to be happening now.

  2. Having been a clinical psychologist, I rarely recommended my colleagues when someone I knew needed therapy. Some simply didn’t have the skills for talking with people. Others, to be honest, didn’t even care that much about their patients. When I was having marital problems in my first marriage I tried two therapists I didn’t work with. Perhaps because I was a fellow psychologist, both attempted to start affairs with me. Much later, a friend recommended a minister trained in therapy who had supervised him in his own training. I was wary but my friend talked to him about the earlier therapists. In our third session he came over to sit beside me when I began to cry…..and grabbed my breasts. End of that. In those earlier years female therapists in my field were rare so I eventually found a female lay therapist. Her major had been music. Her training was workshops. She lived in a commune where her office was. She was fantastic. My question to myself was why did finding someone decent have to be so hard? I empathize with the author in her search. She’s by no means alone.

  3. Wouldn’t it be terrific if there were a formula for the therapist who’s the right one for you? The first one I saw for just two or three sessions. I talked circles around him. The second one, one of a group within the university’s psych. program, sat silently behind his massive beard and mustache. He was not much older than I was. He said absolutely nothing for the entire session and looked as though he felt out of his element. The third was phenomenal. He was literate (I was in a PhD program in comparative literature). He challenged me on everything: “Do you think there’s a reason you’re a Medievalist?” Good question. We could only have ten sessions–that’s what would be covered by the University for therapists who signed up for a very reduced fee, because they liked working with graduate students. He had warmth, humor, and pushed me like a bull-dozer. It’s been many decades, but I’m still guided by those exchanges.

  4. I’m facing the same challenge as I write. Have had 2 of The Best over the past 50 years. A couple pretty mediocre ones, another who was pedantic and advice giving and I spose basically empathic but appeared busier preparing her next statement than actively listening. And of course these days everyone, good and bad is weeks out unless you’re really suicidal or truly psychotic.

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