Asking the questions

It always surprises me that people rarely ask questions when they start therapy. I cover all the legal and administrative issues as you'd expect. I also like to get an idea of what people's expectations are. People seem comfortable with that. It's expected that I ask the questions.

Yet embarking on a therapeutic relationship is not an insignificant matter. I wouldn't allow a surgeon to operate without asking about his or her experience with my particular situation and outcomes achieved. Why should a therapist be any different? A good therapist-patient fit is essential. Therapists are not 'one size fits all' and sometimes it may be necessary to 'trial' a couple before finding one that feels right. Asking some of these questions (as appropriate) at your initial session may be all you need to gauge suitability.

What are your qualifications?

You wouldn't hire an electrician to plumb your bathroom, would you?

What professional body do you belong to?

Membership of a professional body usually requires attainment of a certain level of proficiency/ training.

How long have you been practicing?

Can demonstrate both experience and stability in the profession.

Do you have regular supervision?

Deminstrates ongoing commitment to personal development.

What kind of therapy do you practice?

Important to have some understanding of what to expect or to know if the therapist practices a modality that you personally do not feel comfortable with.

What experience do you have with my particular presentation?

What outcomes have you experienced?

You need to know you're getting someone experienced for your particular issue.

Have you ever been in therapy yourself?

It can be beneficial to know that your therapist has experienced being a patient. A good therapist will be happy to be open (to a certain degree) about personal experience in therapy.

What do you think? As a client, any questions you'd like to ask but don't? Why? As a therapist, what do you feel about these questions?

No sex please

'No Sex Please, We're British' says the movie/play title. Apparently that's due for an update, with a re-edit to ' No Sex Please, We're Therapists'.

Of course, it's no joke. There are very strict ethical guidelines with regard to therapist-patient relationships. Yet according to psychiatrist Professor Carolyn Quadrio from the University of NSW, one in every ten male therapists will have sex or develop an intimate link with a female client. Between one and three percent of female therapists will do the same.

Maybe I'm naive but these figures really surprised me. Anyone have any thoughts on this?

I understand that in the therapeutic process, particularly in the setting of good rapport and the discussion of often very intimate subjects, the potential for a blurring of boundaries can be great. When the therapist is the one person who has listened, seemed to understand or appeared to care for the patient, patients can come form a close bond with their therapist. This is a situation that requires very careful management.

Professor Quadrio's research is important in that it gives some indicators of the therapists most likely to be at risk of letting things get out of hand - those who were dealing with their own depression or experiencing difficult times and thus vulnerable to the adoring client, bad eggs who "prey" on clients and "ego maniacs". Professor Quadrio explains that this last group are the hardest to identify because these individuals are often highly talented and admired by colleagues and patients alike.

Professor Carolyn Quadrio will present her findings today at the World Psychiatric Association conference in Melbourne. It looks like a very interesting conference with many interesting speakers, including a personal favourite of mine, Professor Paul Salkovskis, who has undertaken extensive work on hypochondriasis/health anxiety (an area of particular interest) and obsessive-compulsive disorder. You may have seen his recent series "The OCD House" on the ABC.

Ah, if only I was in Melbourne...