Several years ago, I spoke to my daughter's high-school psychology class--it was a sort of "parents come in and talk to the kids about what they do" event--and one of the students asked me if I could "define psychotherapy." That's a hard one; therapists argue about it all the time. "Emotional healing through conversation," is the answer that came to me. I can't recall if I'd come across it somewhere before or not--and it doesn't really matter. It's one of the better short definitions I've come across. Well, if we need emotional healing, and we seek it through conversation, how can we go about finding someone who will be able to help us?

The selection of a therapist is potentially one of the most important decisions that one can make. A therapist can help us to understand ourselves better, and see our way out of difficulties that we've lived our way into. Or, a therapist can waste our time and money, encourage dependency, provide false or useless explanations for our problems and fail to clarify our choices for understanding and living. In extreme cases, therapists have even persuaded their clients that things happened to them that really didn't, or vice versa. But how are we to decide on which therapist to select for ourselves (or our children)?

Even among physicians practicing physical medicine, all doctors aren't the same. There is a range of competence. Some doctors are especially good with certain types of illnesses or patients, and some are, in general, better than others. Physicians, their families, and people who work in hospitals usually form impressions about which doctors are better with certain kinds of problems, and which ones are generally better than others. A similar continuum of capacity exists among psychotherapists, and there's no reason why it shouldn't. People are people. Electricians, auto mechanics, surgeons, journalists, and psychotherapists all vary in capabilities, and it shouldn't surprise us that this is the case, because...well, people are people.

Now, different kinds of experience are necessary to understand and treat different kinds of problems. For example, any physician should be able to diagnose and treat a strep throat; this is a "garden variety" medical problem. But other kinds of problems, say, a giardia infection, may be more difficult to identify unless the doctor has seen that before. Any auto mechanic ought to be able to do a tune-up, but in reality some mechanics may not have worked on some types of cars before, so they may not know what to do. But a really competent doctor, or mechanic, will know, or find out.

So far, the problem of selecting a therapist is just like the problem of selecting a physician or auto mechanic. You have to find someone who knows what they are doing, at least enough to help you with the problem that you happen to have. But the problem of selecting a therapist is complicated by issues of diagnosis and relationship that don't affect physical medicine and automobile repair, or at least not to the same extent.

Diagnosis in psychotherapy depends much more on the point of view from which one looks at a problem than does diagnosis in physical medicine or automobile repair. If a client is having marital problems, is it because her husband is emotionally abusive, or her father's coldness left her unable to manage an intimate relationship, or because she is from Venus and he is from Mars? Is a man having panic attacks because of repressed anger, or because his boss reminds him of his unresolved issues with his father, or because he hasn't learned how to relax? Or do both the woman and man have biochemical disorders? If a child is having problems behaving in school, is it because he is upset about his parents' arguments, or because he has attention deficit hyperactivity disorder, or because the kind of mind and temperament he has just doesn't do well in school, with its prohibitions against movement and the active expression of curiosity?

If the car won't start, the cause can be clearly diagnosed--say, the ignition wires need replacing--and if a patient has cardiac disorder, it can be due to clogged arteries, even if that condition is a result of years of self-destructive lifestyle choices. But in the realm of personal problems, how a therapist thinks about human problems in general will strongly influence how she sees yours.

Quality of relationship is perhaps the most important variable in psychotherapy. You don't have to like your car mechanic, and he doesn't have to like you; he just has to be able to fix your car. You don't have to like your surgeon, and she doesn't have to like you; she just has to be able to cut and stitch adroitly and to correctly understand the nature of the operation you need. It does help if you have confidence in your physician--faith is often an active part in medical healing, through its mysterious power to activate our immune system. But in psychotherapy, the relationship is everything.

This means that a therapist who is perfectly competent for one person may be only moderately helpful for another, and unable to help a third, for no other reason than the variations in relationship between the personalities of the therapist and each person.

The mother of a girl whom I was evaluating made an astute observation about personal differences between therapists. Her daughter was being treated by a therapist who wanted a diagnostic evaluation of the girl and referred her to me for that. This mom was being treated by another therapist who supported that recommendation. On one occasion, when mom came to pick up her daughter after a diagnostic session, she (the mother) was in a state of obvious and considerable physical and emotional tension. The atmosphere in my office altered immediately and distinctly as soon as she came in. I commented on this and recommended that she try relaxation of some sort. Later, she observed that, of the three therapists, her daughter's was the least direct, her own therapist was somewhere in the middle, and I was at the high end of directness.

Now, note that the variable here, directness, has nothing to do with differences in competence between the three therapists. Its just that each has a different personal style of communicating with this particular mom, which she astutely recognized. Obviously, some people would clearly feel more comfortable with one kind of communication style in their therapist, others with another.

What this means for therapist selection is that someone seeking a therapist for herself, her relationship or her child may have to meet and talk with several therapists before she can develop an impression about which one she'd prefer to have helping her with the problem at hand.

The difficulty here, of course, is that such a selection procedure can be time-consuming and expensive, and still not guarantee a successful choice or a satisfactory outcome. We don't necessarily know how to pick our emotional helpers and teachers, and the ones we like most may not be the ones who can best help us to understand ourselves and our choices in life. For example, we may like a therapist who flatters us, or we may mistake absence of confrontation for agreement or approval.

A further difficulty is that people in general don't go into therapy with the goal of finding someone with whom they can make a good therapeutic partnership, or at least avoiding someone who won't be able to help them. Usually, people seek a therapist because they are driven by desperate circumstances in their lives to reach out for emotional help, and they don't have the weeks or months that it might take to find a good match; they need help now.

Most people who see me hear about me from someone else who knows me or knows about me, or else have met me at a presentation I've given. They haven't actually gone through the process I'm describing.

Nowadays, more people are being referred to a particular therapist because he or she is on their managed care insurance company's provider list; some clients have come to see me in that way. But this merely contains costs; it has nothing to do with either the quality of the individual therapist (beyond licensure, degree, etc., how would the managed care selection people know?) or the likelihood that the individual client and particular therapist could form a viable partnership.

The Internet, with its capacity for interactivity, now provides a new way for people interested in psychotherapy to seek a therapist who can develop a relationship with them that will, to some extent, achieve the therapeutic goal of emotional healing through conversation. It is said that, by reading what someone has written, a reader develops an intuitive impression of the kind of person the writer is; perhaps not a complete one, but one that contains some truth. Some therapists have written books, and sometimes clients become interested in working with a therapist whose book they hav read and found appealing. Web pages such as this one provide opportunities for such initial meetings and impressions. Of course, in person, everyone is quite different than whatever impression we have of them from their writing alone.

Written work, however, can be a potential source of misleading impressions about the writer, if it is ghostwritten. There is a service which provides ghostwritten articles on mental health topics which therapists can place in print (in local newspapers, for example) with their own photos and names, as if they had written them themselves. Such services, if not yet available on the Internet, probably won't be long in coming.

So, the state of the art of therapist selection, unless you happen to know of someone whom you are sure will be good for you and has time to see you, is that it probably has to be personal, careful, and time-consuming. Merely choosing someone because he or she is a psychiatrist, psychologist, or social worker, or licensed by a state, or a member of one of the other helping professions, is no guarantee that the therapist is either a generally skilled practitioner, or that he or she will be a good match for you.

(For more on this topic, see my article, "Three Stories of Damage and Rescue in Psychotherapy," coming in two weeks).