And the benefits of your taking notes during a therapy session. Excerpts from an interview with psychologist Nando Pelusi

is therapy working

Jan. 1, 2017

Some people put therapy on their list of New Year’s resolutions. But how does a person find the right therapist—and know when the therapy is working?

Nando Pelusi, a psychologist and advisory board member of the National Association of Cognitive-Behavioral Therapists, discussed what contributes to therapy’s success. Most important is the relationship between the client and the therapist, says Dr. Pelusi, who has had a private practice in New York City for 20 years. Some edited excerpts from his interview:

How does somebody know if therapy would be helpful?
Dr. Pelusi: If you feel like you’re blocking yourself, defeating yourself, feeling emotionally unstable, avoidant, or pessimistic, then you’d benefit. If you’re avoiding something you want to do or doing something you don’t want to do. Say you are attracted to someone but run the other way when you see them. Or you decide to cut down on alcohol but you keep drinking.

What is a good way to find a therapist?
I recommend the therapy directory on the website of Psychology Today. You can look up location, type of therapy, the therapist’s experience. Narrow your list down to half a dozen candidates and call them. Some will give a free phone consultation. When people call me, I answer questions on how I work and tell them my approach. If there is a good fit, we will set a meeting up. You can also get recommendations by word of mouth.

How can a person recognize a good therapist?
Ask yourself: “Do I like this person and do they understand me? Do their comments make immediate sense and do they explain me to myself in ways that make sense?”
You are looking for someone who is a good fit with your personality. You want someone who can complement or balance your weaknesses. If you are cerebral, you might want somebody who has an appreciation of your nonverbal passion. If you are overly emotional, you want someone who can explain your emotions to you.

Are there red flags?
Be wary of anyone who insists on overly exploring the past, or blaming others, including your parents. Run from someone overly formal or aloof. Therapy can, and should, be fun.
Watch out for somebody who doesn’t answer direct questions—if they try to turn it around and talk about why you are asking. You should feel free to ask relevant questions and expect direct answers.
If they push what they think you should do, get up and walk out.

What is the best way to open up about difficult topics?
A good therapist is a collaborator, a John Lennon to your Paul McCartney. You can start with smaller problems to test out how your therapist handles them, and if you like their judgment go deeper.
If you are avoiding opening up because of shame, then I recommend you talk about why you are avoiding talking about certain things. A good therapist will find a way to frame the issue as a source of potential growth.

What should a client do in between sessions?
Some say this is where the real therapy occurs. You should challenge yourself every week to overcome some habit or to take some risk. Did you talk to that person you are attracted to?
I think the people who do best in therapy take notes, during the session and after. I have clients who come in and read notes from their week.

Can a person learn to trust a therapist?
Trust is not something you learn, it’s something the therapist earns. Use your judgment and gut to see if your emotions and behaviors are getting stronger. If they ask the right questions at the right time and a light bulb goes off, that is when you start to trust them.

How long should therapy go on?
Therapy can be very short—a dozen sessions can significantly improve on self-defeating habits and emotional vulnerabilities like depression and anxiety. However, some habits and thinking styles go very deep and may require more time. When you feel stronger and like how you respond to the world and other people, you can end it. You can always go back for booster sessions.

Should clients follow their therapist on social media or ask personal questions?
I’m happy to share my personal foibles and answer questions about my life. I can understand some curiosity and don’t see any harm in humanizing the therapist. If you’re curious, look your therapist up. It’s natural.

Is my therapist looking me up?
They might be, but that could be a good thing if it informs the work. The important thing is that they are honest with you about it if you ask.

How can clients know if they have a good working alliance?
It should feel like you’re both working to solve the same problem. If you feel like you come out of it with the power to make changes within you, the alliance is working.