September 5, 2000There is lots of advice people can give you about a lot of things in life. Choosing a therapist is one such thing, and like with most advice, you have to take what you can use and discard the rest. There is no magic formula for finding a good therapist, one you trust and feel comfortable with.
I'm also going to be realistic in this essay. Realistic in the sense that not everyone has a choice between the very best and the second best. Often our choices boil down to the lesser of two evils, or a choice between multiple candidates who don't stand out from each other. Our choices are further hampered by the system in which we're making that choice, whether it be managed care, an insurance company, or a public sector environment.
I cannot guarantee (and indeed, I would be foolish to do so) that anything written here will bring you a better therapist.
Referrals: Trusting Another Person's Judgment
Referrals are one of the most common ways a person nowadays finds a professional. Whether it be a doctor, a dentist, a heart surgeon, or a plumber, we use the referral system extensively when it comes to dealing with professionals. Why? Well, there are few resources available that allow a person to check into a professional's performance. The thinking goes that if they treated a friend, family member, or another professional well, they will treat us well, too.
It's a fairly good assumption, and a good starting point. The trouble is that a lot of people end their quest there. They believe that since this person came recommended by some other person you trust, they must be good and will work best for you. Nothing could be further from the truth. Unlike a plumber, a dentist, a heart surgeon, or even your general physician, a therapist needs to have a close, professional relationship with you. If that relationship cannot exist, then it will be difficult to build upon it with therapy.
Relationship: Necessary But Not Sufficient
The professional relationship you have with your therapist is the foundation for all the psychotherapy and change that follows. Without it, it is likely that little substantial change will occur. With it, but without a fairly skilled or experienced therapist, it is likely that little substantial change will also occur. So while it is a necessary component of good therapy, it is usually not sufficient in and of itself.
This underlines an important point -- if you do not feel comfortable or learn to trust your therapist over time (trust is built over time; don't expect to always feel like you trust your therapist since day one), it is unlikely the therapy will be very helpful to you. In my five years of helping people online, I've heard hundreds of stories from people who were in therapy relationships that were not helping the person because they simply didn't feel comfortable with the therapist, didn't respect the therapist, or simply didn't trust them.
I say, "comfortable," but I don't mean comfortable in the sense that therapy should be like settling into watching your favorite television show, or hanging out with a friend over coffee. I mean comfortable in terms of feeling safe in revealing aspects of yourself and your innermost thoughts and feelings. I mean comfortable in terms of feeling like you are 50% of a team effort to help you feel better and explore change in your life. Sometimes you will feel very uncomfortable in therapy with a good therapist, and that's okay. A good therapist will often challenge your beliefs and assumptions, not only about the issue that is bothering you, but sometimes about some of the very foundations of your life. Therapy is often not a very comfortable experience, but it is one where you should feel like you can go to the next session with your therapist and not feel like you're being judged, humiliated, or categorized.
Skill & Experience: More Pieces of the Puzzle
No therapist learns in a vacuum or a classroom the skills necessary to treat other human beings in helping them change their lives. Clinicians study by doing real psychotherapy on real people in real settings, often university clinics and community mental health centers. It is only by doing that a therapist learns the realities of helping people with their problems. Because of this, inevitably the therapist that has more experience -- all other things being equal -- is likely to be of more assistance to a person than a person who has less experience. It is to your benefit (statistically, anyway!), to seek out therapists who have greater experience.
But skills matter as well. A therapist who has had years in treating a certain type of problem, but hasn't kept up with the latest treatment techniques, might not be as well-equipped to help you as a lesser-experienced therapist who has those skills. So the skills acquired through education and training are also an important factor in the equation. The question that remains, then, is how do you determine what kinds of skill and experience level your therapist has?
Ask and You Shall Receive
Surprisingly, the answer is that you have to ask the therapist and trust that their response will be honest. (If they are not honest in their response, they are hardly a person you will want to be in therapy with for very long anyway.) Sure, you can try out the first referral you receive from a friend or another professional (such as your general physician). But if that particular therapist has had no experience in treating your specific problem or has no skill in order to do so, then the referral -- while well-intentioned -- is useless. Well, not completely useless, as you've now narrowed the field down by -1.
These types of questions are often best asked in your first session with the therapist. While you can try and ask them on the telephone, therapists are notoriously difficult to get on the phone since they're in session nearly all day. Since skill and experience is also difficult to quantify -- the therapist can't usually say, "Oh yes, I've had 4 courses and know 12 techniques for dealing with problem Z" -- answers might be best heard in the context of seeing how you feel with the therapist themselves. Be forewarned that some therapists simply won't answer those types of questions over the phone at all. That doesn't mean anything in and of itself, it just means they don't feel like they can do justice to the answer on the phone in 2 minutes.
The point of a first session is to not only tell the therapist the issue which is bothering you, but to get to know one another and get a feel for whether you will be able to work with the clinician in therapy. The therapist will usually ask that you go first and talk about what brings you into his or her office that day. It is sometimes cathartic to be able to just to blurt out everything that's been on your mind and bothering you. It is, however, far more common to feel a bit anxious and uncertain, especially if this is your first time in therapy.
In either case, by sharing a biographical sketch of your life and history, as well as detailing the immediate problems of concern, you've already begun establishing a relationship with the person and may feel a certain bond with the therapist even before the end of the first session. Don't let that feeling interfere with your judgment or need to also ask your questions of the therapist. These questions will help you judge whether the therapist is someone you want to begin work with, or whether you might be better served by trying another therapist:
A good therapist will gladly answer such questions and reserve 5-10 minutes at the end of the first session for them. They will not be defensive about their answers, and they will readily admit their limitations and lack of expertise in an area (especially if that area is yours!). A therapist that won't answer such questions is probably one you can cross off your list of those you want to work with. After all, you just spent 30-40 minutes talking about your life's history and problems! A therapist that feels they can't answer a few simple professional questions relating to their work experience and training isn't one you need deal with.
During that first session, try to remember to gauge how you feel with the therapist. Do you feel he or she is judging you? Remember, it's important to feel you are in a safe, non judgmental, and supportive environment. Some therapists, unfortunately, do not foster such an environment, and so would most likely not be appropriate for most people.
What If This One Doesn't Work Out?
Our first choice isn't always our best choice. Try others and don't be discouraged that there's very little "science" to this process. Human beings are very complex and nobody's been able to narrow down why we click with some people and not with others. Similarities help, but they don't encompass everything about the personality that we may find therapeutically helpful.
Sources of finding a therapist include:
Notice also how I didn't talk much about degrees or types of mental health professionals. Why? Because nearly anybody who does psychotherapy today is sufficiently credentialed by their graduate training or licensure to make distinctions based upon degree or training fairly meaningless. Pastoral counselors, for instance, are not licensed in most states, yet offer a high quality degree of therapy. Other clinicians who are licensed often get less training in learning psychotherapeutic techniques. There are no hard and fast rules for what type of training, degrees, or certification is going to work best for you and your particular problem. So I encourage you to use it as one factor in making your decision, but probably one of the least important factors. As long as the therapist acts in an ethical manner, you feel safe with that person, they have some sort of advanced degree in a mental health field, supervised clinical experience as a part of their training, and some type of certification, license, or registration, they likely have what it takes to help you. (Professionals are much more concerned about such turf war details than those seeking help.)
We're in a new era of psychotherapy, one that stresses short-term, goal-oriented therapy and a relationship that resembles a partnership rather than a doctor-patient relationship. While that means a lot more freedom and choices available to the person seeking help, it also places more responsibility on them for making an informed decision about their therapy. The more you learn, though, the better off you'll be. While there is no magic formula for choosing the "right" therapist, I hope you'll find these tips helpful in narrowing your choices down.
Last reviewed: By John M. Grohol, Psy.D. on 13 Jul 2009
Published on PsychCentral.com. All rights reserved.