Rating Your Psychotherapist

Original source: Rating Your Psychotherapist, a book by Robert Langs, M.D.

1. The Referral: I know of this therapist because...
2. The First Contact: This is how the first contact happened
3. The Setting: This is how my therapist's office is set up
4. The First Interaction: This is how my therapist handled the first interaction
5. The Fee: This is how my therapist handled/is handling the fee
6. The Schedule: This is how my therapist handled/is handling the schedule
7. Privacy, Confidentiality, and Anonymity: This is how my therapist handles the issues of privacy, confidentiality, and anonymity
8. The Therapist's Interventions: This is how my therapist intervenes
9. Terminating the Therapy: This is how my therapist handled/is handling termination issues

Please be advised that the "Rate Your Psychotherapist" test is only a guideline. I can not stress enough that each individual is different! You, and only you, know if your therapy is working/going to work for you. The Langes Guidelines are here only to encourage you to understand that YOU HAVE RIGHTS. And that it's ultimately YOU who decides who is best to give you the therapy you need.

Many patients feel obligated to stay with "this-or-that therapist." If you feel your therapist is the wrong therapist for you, you can change that. If you feel your therapist is great for you, it doesn't matter what any test says. Stay with your therapist and continue on your road to healing.

I hope this proves to be a helpful tool for you. It's designed to help you think carefully about your present therapist or, if you're looking for a therapist, use this as an aide in your search.

Read this letter I received from another professional before going on, and again, hear the words I just stated above.

"It is best to rate your psychotherapist from the first moment to the last. There can be no hard-and-fast rules; personal judgment will always come into play. As the ratings accumulate, keep a tally. High ratings support the work the therapist is doing, but they need to be understood in the context of the course of the therapy and how the treatment is going. Low ratings are cause for concern, but here, too, a perspective must be maintained. Consider the total picture of your life and combine that with the ratings of your psychotherapist, and use all available information for your assessment."

Reproduced from: Rating Your Psychotherapist, a book by Robert Langs, M.D.

TABLE 1: The Referral
Rate Your Therapist
I know of this therapist because:

Sound Answers

• My local Medical Society/Mental Health Association/professional organization recommended him/her.
• My family doctor recommended him/her.
• He/she came to see me for a consultation when I was in the hospital.
• A friend who's a psychiatrist/psychologist/social worker/mental health professional recommended him/her.
• My employer/principal/lawyer recommended I see him/her.

Questionable Answers

• My former/present therapist recommended him/her.
• He/she is the therapist I was assigned to in a group practice/clinic.
• He/she is at the clinic where my health plan requires me to go.
• I picked him/her out of the phone book.
• I pass his/her office on my way to work.

Unsound Answers: Reconsider Your Choice of Therapist

• I saw his/her name in a telephone book/on television/in the paper.
• He/she works in a different section of my office complex
• His/her office is in my apartment building.

Dangerous Answers: Beware of This Therapist

• A coworker/social acquaintance/relative sees/used to see him/her and says he/she is good.
• I used to see him/her with my parents/children/spouse in family therapy and I liked him/her.
• My daughter/son goes to school with his/her daughter/son.
• I've heard him/her lecture and he/she sounds like a good therapist
• He/she is my minister, so I know him.
• I've read his/her books/seen him/her on television/heard him/her on the radio.
• His wife/her husband is one of my friends.
• I met him/her at a party and he/she gave me his/her card. I took a course from him/her and he/she seemed really insightful.
• I used to date him/her/I'm currently dating him/her, so he/she must know me pretty well.
• He/she is one of my father's/mother's colleagues.
• He/she is a coworker and seems bright and helpful.
• He/she is a friend/used to be a friend of the family.

Table 2: The First Contact
Rate Your Therapist
This is how the first contact happened:

Sound Answers

• I made the contact by telephone.
• The therapist answered the phone directly.
• The therapist had an answering machine/service and returned my call the same day.
• The contact was brief and to the point, handled professionally, and by the therapist alone.
• A definitive appointment was made - to occur within a few days of the call.
• The therapist gave me directions to his/her office.

Questionable-to-Unsound Answers: Reconsider Your Choice of Therapist

• Someone made the appointment for me (not an emergency situation).
• I met the therapist in person at a walk-in clinic or in a hospital emergency room.
• I called and left a message, but the therapist didn't get back to me for a day or so.
• The therapist was booked up - he/she couldn't see me for weeks.
• I made the appointment with a secretary.
• I had a long talk with the therapist when I called him/her - he/she asked lots of questions about my symptoms and history.
• I conveyed a sense of emergency, but the therapist didn't seem to take me seriously.
• I got off the phone and realized I didn't know how to get to the therapist's office.
• The therapist didn't seem to want to end the conversation, even though we had covered all the essential information.

Dangerous Answers: Beware of This Therapist

• Someone made the appointment for me so that I'd feel obliged to go.
• The therapist had his/her spouse call me back and make the appointment.
• The therapist didn't get back to me, and when I called again, I found out that he/she had forgotten.
• I told the therapist that it was an emergency, but he/she was completely insensitive to my situation and told me to make an appointment for later in the week.
• The therapist told me all about himself on the phone - where he/she went to school, what he/she believes about therapeutic technique, what his/her spouse does for a living, etc.
• Having ascertained my problems, the therapist prescribed medication over the phone.

Table 3: The Setting
Rate Your Therapist
This is how my therapist's office is set up:

Sound Answers

• He/she maintains a private office in a professional building.
• There is a bathroom readily accessible from the waiting room.
• There is a door in the therapist's office that allows me to leave without having to go back through the waiting room.
• The furnishings are tasteful but not obtrusive.
• The windows have shades or blinds that are closed.
• The office is soundproof.

Questionable-to-Unsound Answers: Reconsider Your Choice of Therapist

• He/she maintains a home-office separate from his/her living quarters.
• He/she shares the waiting room with other therapists, so I'm usually not alone there.
• He/she has an office in a clinic.
• The only bathroom is just off the therapist's consultation room.
• I always meet the next patient in the waiting room on my way out.

Dangerous Answers: Beware of This Therapist

• He/she uses his/her living quarters as an office.
• When I go to my therapist's home-office, I'm aware of his/her family.
• My therapist's office isn't soundproofed; you can hear what's being said inside - particularly if someone is shouting or crying.

Table 4: The First Interaction
Rate Your Therapist
This is how my therapist handled the first interaction:

Sound Answers

• He/she seemed to be concerned and listening.
• He/she said very little - restricting comments to attempts to help me understand myself better.
• He/she answered no questions, but sought more exploration from me.
• He/she said nothing of a personal nature.
• Except for an initial and concluding handshake, there was no physical contact between us.
• In the second half of the session, the therapist briefly stated that he/she could help me and then proposed a set of ground rules for treatment.

Questionable-to-Unsound Answers: Reconsider Your Choice of Therapist

• He/she was angry.
• He/she was indifferent.
• He/she was seductive.
• He/she talked almost as much or more than I did.
• He/she asked a lot of questions, which broke my train of thought.
• He/she kept giving me his/her personal opinions and told me about his/her private life.
• He/she gave me specific advice on how to handle my problems.
• He/she asked me to lie down on the couch for the consultation hour.
• He/she tended toward nonsexual physical contact - such as giving my hand a reassuring pat when I was nervous and upset, etc.
• He/she didn't say anything about whether he/she could help me or what the ground rules of therapy would be.

Dangerous Answers: Beware of This Therapist

• He/she was very demonstrative physically - hugging me, touching my arm or shoulder
• when talking to me, etc.
• He/she came on to me sexually.
• He/she was verbally/physically assaultive.
• He/she was downright unprofessional - very personal in his/her responses and
• self-revealing.
• He/she was exceedingly manipulative.

Table 5: The Fee
Rate Your Therapist
This is how my therapist handled/is handling the fee

Sound Answers

• He/she proposed a single, reasonable, fixed fee.
• He/she didn't barter or bargain with me.
• He/she holds me entirely responsible for the fee; I can't use a third-party payer.
• He/she won't let me build up a debt.
• He/she won't accept gifts or other forms of compensation beyond the agreed-upon fee.
• He/she has not changed the fee during the therapy.
• He/she holds me responsible for the fee for all scheduled sessions.

Questionable-to-Unsound Answers: Reconsider Your Choice of Therapist

• He/she let me decide what I wanted to pay.
• He/she gave me a fee range.
• He/she told me that he/she was charging more (or less) than his/her customary fee.
• He/she says that I don't have to pay the fee when I go on vacation, take business trips, get sick, attend a wedding or funerals, etc.
• He/she accepts third-party payment (from parents, an insurance company, a governmental agency, etc.).
• He/she gives me/accepts small gifts on rare occasions.
• He/she lets me build up a temporary debt when I'm having a hard time financially.
• He/she takes the fee in cash (and keeps no record).
• He/she asks to be paid in advance of the sessions.

Dangerous Answers: Beware of This Therapist

• He/she is willing to falsify a fee to an insurance company for me.
• He/she negotiated a barter arrangement with me, which bypasses taxation.
• He/she gives me expensive gifts and accepts them from me.
• He/she accepts financial tips/stock information from me.
• He/she traded me a low fee for cash payment.

Table 6: The Schedule
Rate Your Therapist
This is how my therapist handled/is handling the schedule:

Sound Answers

• He/she arranged a definite schedule for my therapy - day, time, frequency, and length - and these have not changed through the course of my therapy.
• At most, the schedule has changed because of a major change in my work/school schedule or life circumstances or a new and major professional commitment by the therapist.

Questionable-to-Unsound Answers: Reconsider your Choice of Therapist

• There are minor and occasional shifts in the time and length of sessions; a rare emergency hour.
• There isn't really much of a fixed schedule.
• When I don't come, I don't have to pay, and I can have makeup sessions.
• As therapy was coming to an end, my therapist decided to reduce the frequency of my sessions - a sort of tapering-off strategy.
• He/she has lapses, but rarely: extending or shortening an hour, failing to be there for a scheduled session.

Dangerous Answers: Beware of This Therapist

• He/she repeatedly changes the time and/or day of the sessions.
• He/she often starts late because other patients stay past their scheduled times.
• He/she often lets me stay longer than my scheduled hour, particularly if there's no one else waiting to see him/her.
• He/she has asked me to shift my hour so he/she can see some other patient during my scheduled time.
• He/she has canceled sessions in order to vote, move into a new house, take his/her dog to the vet, etc.
• He/she keeps recommending that I see him/her more often than I want to.
• He/she often walks out with me and hangs around making small talk before the next patient comes in.

Table 7: Privacy, Confidentiality, and Anonymity
Rate Your Therapist
This is how my therapist handles the issues of privacy, confidentiality, and anonymity:

Sound Answers

• He/she is not deliberately self-revealing.
• Total privacy and complete confidentiality have prevailed throughout the therapy.
• When I ask my therapist about himself/herself, the response is an attitude of listening and exploration.
• He/she has not prescribed medication.
• He/she does not take notes and does not record the sessions.

Questionable-to Unsound Answers: Reconsider Your Choice of Therapist

• He/she, on rare occasions, has offered a personal opinion or alluded to his/her professional status.
• He/she is obligated to send specific reports to my employer.
• He/she has to provide nonspecific information to the agency that pays for my therapy.
• He/she occasionally offers opinions or information about himself/herself if I'm persistent enough.
• He/she prescribed medication when I was in a state of extreme emotional dysfunction.
• He/she does not usually make physical contact with me, but has done so on rare occasions, for example, when I was experiencing a sudden traumatic loss.
• He/she sometimes takes notes when I'm talking.

Dangerous Answers: Beware of this Therapist

• He/she is more like a friend than a therapist - telling me about his/her own life, introducing me to his/her spouse, offering me the use of his/her books/home/car, etc.
• He/she talks about my material in his/her books/lectures/classes.
• His/her secretary clearly knows a lot about what I've said in my sessions.
• He/she videotapes our sessions for use with his/her psychiatric residents.
• He/she spends so much time talking about himself/herself that I have to fight for my own therapeutic space.
• All I have to do is say I've been feeling depressed, and he/she will ask if I want medication.

Table 8: The Therapist's Interventions
Rate Your Therapist
This is how my therapist intervenes:

Sound Answers

• He/she doesn't say anything most of the time; I do most of the talking.
• When he/she intervenes, it's almost always to explain the unconscious basis of my problem in light of my unconscious perception of something the therapist said or did.

Questionable-to-Unsound Answers: Reconsider Your Choice of Therapist

• He/she is sometimes silent for long periods of time, even though I have dreams that suggest the silence is inappropriate (dreams about people who don't understand, are insensitive, neglecting, etc.).
• He/she asks questions, repeats what I've said to clarify it, and confronts me sometimes on contradictions in what I've said.
• He/she asks questions, repeats what I've said to clarify it, and confronts me sometimes on contradictions in what I've said.
• He/she generally tells me what something I've said and asks me to say more about it.
• He/she occasionally picks up on something I've said and asks me to say more about it.
• He/she occasionally offers an empathic response, such as, "That must have been very painful for you," or "It sounds like you were pretty angry."
• He/she has occasional lapses in neutrality - sometimes gets quite angry with me/says something flirtatious/seems bored/falls asleep.

Dangerous Answers: Beware of This Therapist

• He/she is often silent for several sessions running, even though I've told him/her outright that I'm uncomfortable with it. In fact, I wind up spending a lot of those sessions talking about people who don't care about me or are afraid of a real relationship.
• He/she is constantly directing me to talk about particular issues, such as, "You haven't said anything about your mother for a while; how's that relationship going?" or "I'm interested in the fact that you were smiling when you mentioned being hurt. Why do you think you did that?"
• He/she is always telling me what I should be doing with my life, such as, "What are you afraid of? If I were you, I'd go for it."
• When I said that I resented his/her accepting phone calls during my sessions/keeping me waiting/taking notes, he/she said that other patients don't see things that way, and that I have a problem.
• He/she seems positively hostile to me -- alternately sarcastic and indifferent.
• He/she is seductive with me and seems hurt when I don't respond.

Table 9: Terminating the Therapy
Rate Your Therapist
This is how my therapist handled/is handling termination issues:

Sound Answers

• I introduced directly the possibility of ending therapy.
• My therapist interpreted my unconscious allusions to termination
• I felt a sense of new insight and deep understanding, and my symptoms had largely been resolved, so it seemed like the right time to terminate.
• I set a specific date for termination, and it remained unchanged.
• All the ground rules were maintained to the very last session - frequency, time, etc. Once therapy was over, I had no more contact with my therapist.
• The therapist maintained his/her analytic attitude to the very end.

Questionable-to-Unsound Answers: Reconsider Your Choice of Therapist

• My therapist introduced the possibility of ending the therapy because my symptoms seemed to be alleviated.
• My therapist says we have to terminate because he/she is moving to another state/giving up clinical practice/taking another job.
• My therapist proposed we terminate therapy even though my symptoms are not entirely resolved.
• I think termination is indicated, but my therapist thinks we ought to continue, despite the fact that I feel much better.
• As the termination date got closer, my therapist said we didn't need to see each other as often.
• Toward the end of therapy, my therapist began to tell me more about himself/herself and treat me like a colleague.
• I set a termination date, but we decided to move it up/back.
• My therapist arranged for a series of follow-up visits just to make sure I'm really okay.

Dangerous Answers: Beware of This Therapist

• We decided to end the therapy even though my symptoms hadn't changed very much.
• My therapist continued the therapy long after my symptoms were gone.
• My therapist told me very abruptly that we would have to terminate and never explained why.
• I decided somewhat impulsively to stop going to therapy, and my therapist simply accepted my decision without exploration.
• I decided to stop going to therapy, but my therapist insisted that I still needed help/wrote to my parole officer, saying that I shouldn't quit yet/told me that I'd be sorry.
• My therapist stopped seeing me so that we could date each other.
• When we knew therapy was ending, sessions got very informal - we'd see each other over breakfast or walk in the park, trade favorite books, etc.
• As termination got closer, my therapist stopped interpreting and began to give me advice on how to handle my life once therapy was over.
• After we stopped seeing each other as therapist and patient, we became friends.
• We made arrangements to be in touch with each other professionally after therapy was over.

Please be advised that the "Rate Your Psychotherapist" test is only a guideline. I can not stress enough that each individual is different! You, and only you, know if your therapy is working/going to work for you. The Langes Guidelines are here only to encourage you to understand that YOU HAVE RIGHTS. And that it's ultimately YOU who decides who is best to give you the therapy you need.

next:   Some Known Triggers That Cause Switching