How to get good help from mediocre therapy

If you live in NYC, finding a therapist is easy. Finding a good therapist in New York is a bit trickier.

Perhaps you're a New Yorker who feels like he or she really needs to find a therapist who's in-network with your insurance plan (I don't recommend it, but not everyone follows that advice). Maybe you don't have insurance and have found poor low-fee or sliding-scale options. Maybe you don't live in NYC and your options for therapy are limited. Finding a great fit is important and you should be picky, but you might not always have great options.

Bad therapy is bad therapy. If you don't feel a good vibe with therapist, you don't feel like you're being heard, or there's something creepy going on, head for the door. But if the therapy is so-so it doesn't mean you're destined to get so-so help. Even when your therapist doesn't seem to provide the sort of leadership you feel is helpful, you can work to make the therapy helpful by providing some leadership of your own.

At TriBeCa Therapy we work to provide excellent, high-quality therapy. Part of why we believe our work is effective is that we build the therapy with you, as a co-collaborator. This means that both you and your Tribeca Therapy therapist will be responsible for the success of the work.

Get active in therapy!

When you take an active posture to anything, not just therapy, you make it better. The truth is, we're trained to be passive, especially around those we perceive to be in authority. School is intense training for this sort of attitude. In most corners of education, at nearly all levels, our job is to show up and spend our time in class doing whatever the teacher tells us to do. If the teacher's good, we learn; if she isn't, we don't.

Television trains us in a similar way. What happens on TV is wholly beyond our control. We can change the channel (just as we can leave a bad therapist) but that's the end of our say.

In most of life, and certainly in therapy, we actually have a tremendous amount of control. You are a central character in the teleplay that is your therapy session, but you're also the co-director, the co-producer and the sole financier of the project. Sure, there's a distribution of labor, as there is on any collaborative project; you don't get to pick the curtains or decide on the length of the sessions. But there's a tremendous amount you get to decide or at least have a serious say in.

If the therapist wins, you win

Asking your therapist, in a variety of ways, how you can help make the therapy better can help you stay on the same page and the same side as your therapist. In good therapy, a therapist will give this sort of direction all the time, but perhaps an inexperienced therapist may not know to do so.

Be a tough customer

There are no bonus point for making your therapist feel good. Being active in the therapy doesn't mean your job is to make your therapist feel like he's always doing good work, for the sake of his ego. Yes, when things are working, be sure to make that clear. But pretending something that isn't working is working is a bad plan.

Be demanding

In mediocre therapy, your therapist may not give you great guidance in helping you discover what you want help with. While from a distance this may seem a surprising problem (Why would someone go to therapy without knowing what she wants?) but wanting, asking for a lot (from the therapy and from life) is not often a given. In my experience as a therapist, most people set their expectations far too low.

The result? They miss out on a critical part of great therapy: being challenged to look at the implicit limits we've placed on what we might be able to build and problems we might be able to move past. Far too many people arrive in therapy assuming they'll simply have to live with a certain about of panic, or believing they couldn't possibly have a great relationship, or change careers.  If those issues are left unexplored, you might get all the help you've asked for, which might not be very much.

Ask for directions

Great therapists give directions. They know how to create an environment where their clients get to work, in and out of the therapy session. In so-so therapy, you might need to take the lead. Consider asking:

How do you think I can get the most help from being in therapy with you?

Can you recommend any homework assignments?

What do the patients who get the most help from you have in common?

Are there other things I can try to make [symptom x] get better?

Do the work

A huge assumption that so many people bring to therapy is that going to therapy makes our lives better. This is no more true than the belief that going to the gym is what gets your body in shape. Therapy is work. Being a tough customer, asking for a lot from the therapy and from yourself, and making sure you stick to the program in and out of the therapy session is the recipe for growing emotionally, even when the therapy isn't perfect.