I am on a quest to find a therapist, and not just any therapist, but the right one. This may sound like a common sense requirement, but mental healthcare can be challenging to access (NBC News BETTER recently ran this article on how to get professional help when you’re on a tight budget and/or don’t have health insurance). I’ve had a couple of great therapists in my many years living with mental health struggles, but I’ve also had a couple of lousy ones, or more specifically, therapists who I just didn’t jibe with or feel were helping me. These relationships often went on longer than they should have, resulting in my sense of us both having wasted our time (and definitely my money).
“Goodness of fit is everything [in therapy],” says Dr. Colleen Cira, a licensed clinical psychologist. “Research is clear that the #1 determining factor in whether or not a client gets better from therapy is based on how strong their relationship is with their therapist. If you don't like your therapist, you're not going to get better, regardless of how well-trained they are.”
But how do you know if it’s a good fit? Here’s what therapists themselves have to say on the matter.
Research is clear that the #1 determining factor in whether or not a client gets better from therapy is based on how strong their relationship is with their therapist.
Ask yourself questions to determine how you want therapy to work
What does therapy mean to you? What areas of your life do you want to explore and how? Do you want to talk about your family, or would you rather focus on a very specific past trauma or would you just like someone to talk with about whatever might be troubling you that week? The answers to these questions may change over time, but when you first go into therapy, ideally you should have some picture of what you want.
“You should know what you want to work on [when beginning therapy],” says Dr. Cira. “Do you feel really strong that you don't want to focus on your past and only the present? Do you want to focus more on things that have happened to you in the past? Do you want someone to help you ‘solve’ your problems or someone who will really sit with you in your pain or both? These are all things you should ask yourself that will help guide your search.”
Seek therapists with specialties that match your needs
Once you know what sort of stuff you want to hash out in therapy, look for therapists that specialize in those areas. For instance, I’d like to work on treating my panic disorder and depression, so I should reach out to therapists that cite these disorders as key areas of focus.
“Try to look for a therapist that specializes in a specific disorder or the symptoms that [you’re] experiencing,” says Jamie Kreiter, LCSW and the founder of Jamie Kreiter Therapy. “The therapist should be versed in different treatment modalities. For example, a client may be looking to learn new cognitive coping skills and therefore, a therapist who is experienced in cognitive behavioral therapy would be a better fit than a therapist that uses psychoanalytic approaches.”
- “A psychiatrist and psychiatric nurse practitioner offer medication management but typically not talk therapy.
- A psychologist (PhD and PsyD), on the other hand, provides psychological testing and sometimes talk therapy, but not medication. In a few states, however, there are Medical Psychologists which have undergone additional training qualifying them to prescribe medications when indicated (Idaho, Louisiana, New Mexico, Illinois, and Iowa).
- More often, talk therapy is provided by a licensed clinical social worker (LCSW or LICSW), mental health counselor (LMHC), professional counselor (LPC) or marriage and family therapist (LMFT). All of these professionals are able to provide talk therapy services and have received similar training.”
What degree they hold shouldn’t be a top concern
All therapists must be public about their their credentials, so definitely check for that — but unless you know you need a certain type of educational background, you needn’t get too hung up on this.
“Don't get obsessed about whether your therapist has an M.D., a Ph.D., or an M.S.W,” says Keith Humphreys, professor of psychiatry at Stanford University. “Ample research shows that type of degree doesn't predict outcome in therapy.”
Empower the process of elimination by knowing what you don’t like
If you don’t know what you need, then think about what you don’t need (or like) and use that knowledge to help narrow your search.
“Do the therapist's theoretical orientations and how they practice specifically match and align with your own values? If just reading their description on how they practice online doesn't sit well with you that is a good indicator that it will not be a good fit,” says Erica Hornthal, a licensed clinical psychotherapist and board certified dance/movement therapist.
Look for someone who challenges, validates and normalizes you
Ideally, you’ll want to “interview” a few therapists before deciding on one (pro-tip: sometimes you can do this over the phone, briefly, at no charge). See if they have these qualities recommended by clinical therapist Lynn Zakeri:
- “You want someone smarter than you are. I don't mean higher IQ or degrees or something measurable, [but] someone who knows what puzzle pieces to look for when you didn't even know the pieces existed. Someone who asks the questions you need to consider, but also asks the question you never even considered asking.
- Someone who validates, but challenges. For example, [saying something like] ‘you have shown me so much self-respect in your stories about work and your relationship with Steve, so why when you are with Stacy did you do XYZ? Help me understand how that process went. Did it feel good? Etc.’
- Someone who normalizes you. You are not crazy.”
Ditch an insensitive therapist
I once had a therapist who said something pretty insulting about my dad, and it had nothing to do with my troubles but instead with his Jewish culture. She quickly defended it by asserting that she was raised Jewish. This was a red flag I tried to see past at her insistence, but I knew then and there I could not trust her anymore. This same therapist also clung hard to my weakness but never spoke to my strengths, something I then accepted without any problem because I was really comfortable with feeling bad about myself.
“Take caution in therapists who are insensitive to your beliefs, cultural practices, or [who] just focus on challenges to change without recognizing and supporting or building on your strengths,” says Mayra Mendez, Ph.D., LMFT, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John's Child and Family Development Center. “The most effective therapy experience is one that supports the client in recognizing their capabilities and using strengths to mitigate challenges.”
Trust your intuition and look for that ‘visceral’ feeling
Perhaps the most important qualification in all this? Your own intuition.
“Listen to your intuition,” says Humphreys. “If you feel instinctively unsafe with a therapist, that will probably inhibit the progress you will make. In contrast, if you feel you ‘click’ with a therapist, that's a good sign that you will be able to build a working alliance with them.”
Jor-El Caraballo, a licensed therapist, wellness coach and co-creator of Viva Wellness, notes that while there are measures that are clinical in nature there is also “a visceral feeling of just being comfortable enough to sit in a room with someone for the therapy hour. That can't be replaced and if you don't feel comfortable enough in a few sessions then it's probably best to tell your therapist this and work toward moving on.”
If this therapist can’t meet your needs, they must refer you elsewhere
I used to fear parting ways with therapists partly because I was afraid that I would be left stranded without care, but if a therapist is following their code of ethics, this shouldn’t be a problem.
“An ethical therapist will direct you to someone else if they themselves can't meet your needs,” says Humphreys, with Caraballo adding: “If your therapist reacts negatively or refuses to provide alternative referrals (which they are ethically bound to offer) then you can rest assured that you've made the best decision in moving on.”