Christie Bates is a Licensed Professional Counselor and a Minister of the Embracing Simplicity Contemplative Order. She has provided over 10K hours of Brainspotting to clients and mindfulness practitioners seeking trauma resolution, creative expansion and spiritual growth. She never tires of witnessing the transformation Brainspotting brings about.
When seeking a new mental health therapist, most consumers might begin by looking at fees, office location, policies, and maybe the candidate's philosophy of care. These questions can help you narrow down your field of choices, whether you are new to therapy or feel like a veteran.
Essential questions to assess your potential mental health therapist
1. "To whom are you accountable?"
If you are interviewing a prospective therapist in an agency, get the name of the clinical supervisor and how to get in touch with them. If you ask a self-employed therapist this question, they should mention their licensing board. Ideally, the therapist's website should link to their license verification to make it easy for you. Bonus points if a self-employed candidate participates in regular peer consultation: This is a way of saying they continue to seek feedback and improvement even when they are free to practice without supervision.
Why it matters
The licensing process is imperfect and outdated in many locations. Still, being able to review a therapist's license tells you that – at least at the beginning of their career – they went through a strenuous process to ensure their fitness to treat vulnerable clients. It will let you know if they are current in their obligations to the Board. It's also how you would learn of formal complaints to the Board and their outcome. That helps you avoid giving too much credence to uninvestigated complaints that can appear in online reviews just because a client might not like a therapist's recommendations.
Some states' licensing boards even include information on where your prospective therapist trained, has worked, and whether they belong to any professional organization or have any awards. It's helpful if your candidate is involved in their professional community.
2. "Do you provide weight-inclusive/weight-neutral care?"
Weight-inclusive/weight-neutral care is the ethical provision of healthcare based on the growing body of evidence that body weight is not a predictor of health and that weight-inclusive care leads to better health outcomes. Weight inclusion/neutrality also indicates awareness that people come in all shapes and sizes – that weight is not a behavior but is a trait like height.
WI/WN healthcare providers show respect for all clients through their practices. They provide physical and emotional safety by providing offices and furnishings that accommodate larger bodies. They do not prescribe disordered eating behaviors such as "calorie deficit food plans."
To be clear, mental health therapists should not be giving nutritional advice. If a client needs nutrition advice, the ethical therapist is aware of the prevalence and danger of eating disorders and is careful to refer clients only to weight-inclusive nutritionists and dieticians who are less likely to trigger disordered eating behaviors in clients.
In WI/WN healthcare, larger-bodied clients receive the same high caliber of care as smaller-bodied clients. For instance, if you were a larger-bodied person and presented to a WI/WN doctor's office with somewhat mysterious symptoms, you could feel reasonably secure that the same tests and questions would be asked of you as would be put to a thinner or small-bodied person.
Why it matters
You deserve to have reliable mental health care from a professional who is fully educated and has done the work to challenge their own internalized weight stigma. Research indicates that when compared to the weight normative approach (i.e., the attitude toward higher weight that is prevalent in mainstream culture) weight inclusive/weight neutral healthcare leads to desired outcomes such as decreases in anxiety and depression, increase in self-esteem, improvements in physical health markers, higher engagement in various forms of movement, and less reluctance to seek healthcare when needed.
Weight-inclusive/weight-neutral care is competent care. A mental health therapist who is weight-inclusive/weight-neutral can help you heal from cultural, legacy, and individual injuries to your body image. You can experience being fully alive beyond the constraining focus on weight and size.
3. "What do you do for your self-care?"
You have every right to ask this. Every trained therapist receives instruction on the importance of self-care. Self-care supports their longevity in the field and allows them to provide you with the most skilled and ethical care. Not every therapist follows through. You want one that does.
The point is that your professional, who by definition spends so much time thinking about and facilitating another person's process, should also be giving themselves that kind of attention and care. Ideally, your therapist would have a therapist, spiritual director, minister, or another practitioner they see regularly.
Why it matters
Healing of mental and emotional suffering in the form of licensed mental health counseling, pastoral guidance, spiritual companioning, or contemplative therapy is not the result of treating the brain like a machine: It involves an exchange of energy between people. When you seek support, you want someone who exhales after they inhale, don't you? Otherwise, the air they inhale becomes toxic.
Put another way: If you seek help from someone soaking up stress and suffering like a sponge, you want to know they're wringing out at least a couple of times a week. When I supervised counselors and clinical associates in my residential treatment days, those clinicians who had an ongoing self-care practice had noticeable advantages over their peers who didn't. The former not only tended to perform more skillfully at work than the latter, but they also reported feeling better about life in general, even though we were privy to some very acute situations.
4. "Do you enjoy any expressive/creative outlets?"
This question is related to self-care but from a different angle. Professional self-care is for the professional part of a person. A creative outlet is for the whole person. Creative outlets don't have to be high art: It's often better if they're not.
Creative outlets can include everything from Athletics to Music to Zebra study. Some helpers choose to keep their creative outlets private due to their therapeutic orientation. That's fine, but your potential therapist should be able to let you know that they do something regularly that feels like an outlet to them.
They don't have to make a part-time job out of it. As my client roster grew beyond full in 2020, I was fortunate that poet and friend Ellis Elliott began her Bewilderness Writing classes. Just one hour a week of freeform writing – added to other things I had been doing when carrying a normal workload – energized me tremendously during a time when many of my colleagues complained of feeling drained.
Why it matters
Attuned therapy is receptive. A therapist takes in more than a person's worth of life in a day, which adds up to hundreds or thousands of experiences, images, and emotions each week.
Creative practice is expressive. It helps move energy through the body and allows a person to create something new from that input. This results in fresh energy, not just recycled energy.
5. "What ongoing education/training invigorates you?"
The reality for most professionals is that some of our continuing education fall into the "important but repetitive" category, which can be like hearing the flight attendant's instructions at the beginning of every flight. The redundant training is valuable and necessary because repetition of basic knowledge helps keep the information available when the brain needs it. This question will help determine if your candidate seeks training that builds on those foundations to develop new skills and expertise.
Why it matters
As important as experience is, it's not the only thing. My observation is that a passion for the work and an ongoing openness to learn – from fellow professionals and directly from clients – seem to provide strong protection against compassion fatigue and therapist burnout. In your relationship with your therapist, especially in the beginning, you may need to borrow their hope that life can be better for you. Confidence in their practices allows them to lend you that hope in abundance. In my roles as therapist and spiritual director, my trust in mindfulness, particularly in Brainspotting, has allowed many clients to get started until they found confidence through their experience.
Closing
Choosing a new therapist can seem overwhelming with all the options available, especially when you have less energy or clarity than usual. These questions will help you narrow down the field of candidates and lower your anxiety about this decision.
Fortunately, you don't have to take the energy, time, and expense to ask these questions in person or on the phone. Therapists often answer these questions when building their websites. Visit mine at the link below for an example of a website that gives you the information upfront.
Christie Bates, Brainspotting Practitioner, Contemplative Minister
Rev. Christie Bates is a Licensed Professional Counselor and Spiritual Director who utilizes Brainspotting to help clients and contemplatives find and process material stored in the brain. Before launching her private practice in late 2017, she had worked in residential addiction and trauma treatment settings for over 10 years. In those settings, she served variously as Family Counselor, Clinical Coordinator, Contemplative Trauma Specialist and Director of Co-Occurring Disorder Programs. Then and now, she has served a wide range of people seeking emotional freedom - including professional creatives, industry leaders, public-facing individuals, and their families.
References:
Wegela, K. K. (2008). Listening beyond the words: working with exchange. In L. Hoffman (Ed.) Brilliant sanity: buddhist approaches to psychotherapy (pp. 225-238). University of the Rockies Press.
Common Factors Theory - an extensive collection of research on what we know - and don't know - about how to predict therapeutic outcomes - en.wikipedia.org/wiki/common-factors-theory
Dugmore, J., et al. (2019) Effects of weight-neutral approaches compared with traditional weight-loss approaches on behavioral, physical, and psycholog- ical health outcomes: a systematic review and meta-analysis. Nutrition ReviewsVR Vol. 78(1):39–55.doi: 10.1093/nutrit/nuz020
Mensinger, J., (2016) A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial. Appetite 105, Elsevier Ltd.http://dx.doi.org/10.1016/j.appet.2016.06.006
Rhee, E. (2017) Weight cycling and its cardiometabolic impact. Journal of Obesity & Metabolic Syndrome 2017;26:237-242 https://doi.org/10.7570/jomes.2017.26.4.237
Tomiyama1, AJ, et al (2016) Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005–2012. International Journal of Obesity. 15 March 2016; doi:10.1038/ijo.2016.17
Tylka, T., et al. (2014) The weight-inclusive versus weight-normative approachto health: Evaluating the evidence for prioritizing well-being over weight loss. Hindawi Publishing CorporationJournal of ObesityVolume 2014, Article ID 983495, 18 pages http://dx.doi.org/10.1155/2014/983495
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