How to Choose a Therapist

Your therapist’s skill at building a strong relationship with you that allows you to collaborate will matter more than the type of treatment you receive.   

How do you go about finding a therapist?

In the end, the answer is common sense. Look for someone with whom you think you can build a strong cooperative bond.

When you have a few providers in mind, take them for a test drive. Many will offer a free initial consultation or first session.

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How to find a therapist

To begin your search, check out listings of providers online from sites like Psychology Today or Goodtherapy.org. Providers will describe their specialties and treatment approach and often post a photo. You can ask friends or family if they work with a therapist they like — their therapist may be able to provide recommendations. A spiritual leader — from any tradition — can also be a good resource, says Ryan Howes, a practicing psychologist and author of “The Mental Health Journal for Men: Creative Prompts, Practices & Exercises to Bolster Wellness.”

“They're not necessarily trained in psychological issues and want to be able to help, so they probably have a list of folks that they like to refer to,” he says.

As you’re evaluating options, consider some important questions.

Why do you want therapy?

While a therapist may not ask the question so bluntly, you need to know the answer. What are good reasons for seeking therapy? And what are your reasons?

“If someone is feeling depressed, if they're feeling anxious, if they're having problems in relationships, or problems with communication, difficulties with finding their purpose, or their meaning in life,” Howes says, “these are all great reasons to try out therapy.”

In your trial session, state your problem as clearly as you can, and it will be easier to see if the therapist can help you address it. Let’s say you’re there because your wife insisted you go. See if you and your therapist can arrive together at a reason of your own.

Do you want short, focused help, or more long-term guidance?  

Cognitive behavioral approaches tend to be short term and focus on changing your thoughts about a problem — say, you’d like specific guidance on how to stop worrying about your teenagers when they’re out at night. Psychotherapy explores the roots of a problem (you want help resolving anxieties that seem to crop up often) and takes more time. There are many schools of psychotherapy, but your relationship with any therapist is the most important factor.   

Do you care about level of training or price?

Some therapists work with a master’s-level degree, such as family and marriage counselors. Others, often psychotherapists, have a PhD in psychology, while psychiatrists have been to medical school (which allows them to prescribe medications like antidepressants). Many people see a therapist to talk things through and see a psychiatrist less often to evaluate medication.

In addition, many health insurance plans have significant deductibles. A therapist’s fee will count against the deductible — meaning you’ll pay for care out of pocket until you hit the limit. If price is a factor, community clinics often offer good free or low-fee programs. Teaching hospitals and therapy institutes in large urban centers may also offer low-cost consultation.

Paying more doesn’t necessarily mean better care, Howes says. “Research has shown time and again that it’s the quality of the relationship that actually has the best predictor of outcome,” Howes says — more so than even a therapist’s experience, degree, or level of training. However, “typically people working for free or very low-fee clinics are oftentimes trainees, people who are just getting started or just learning the trade, and the people with the higher-end practices tend to have more experience.”

What kind of therapy do I need?

People in the profession think about the differences between various schools of therapy and an alphabet soup of names based on charismatic leaders. You might hear that a therapist is “Rogerian” (after Carl Rogers) or “Ericksonian” (after Milton Erickson) or uses “dialectical behavior therapy” or “cognitive behavioral therapy.”

But many therapists will tell you that they use a mixture of approaches as needed to bond with a particular patient. After a team evaluated 16 meta-analyses, the American Psychological Association concluded that a therapist’s bond with you is more important to success than the treatment method.

More specifically, one meta-analysis of 21 studies found that when therapists share their own feelings about the patient or relationship, the patient improves. Another meta-analysis of 107 studies backs the idea that it’s best when the patient and therapist agree on the patient goals and collaborate. Tailoring treatment and being responsive to the patient’s quirks, which the field calls responsiveness, is also backed by research. Using questionnaires before each session to assess your symptoms may be annoying, but that’s backed by research as well.

What are your beliefs?

Therapists are as varied in their beliefs and approaches as the human race itself. Providers work from a variety of spiritual traditions, from Buddhism to Christianity, and incorporate varying philosophies into solving life’s problems, from existentialism to the 12 steps of Alcoholics Anonymous. Of course, you don’t need to agree with a therapist on everything. It can help to work with someone who shares your spiritual, philosophical, or religious beliefs, particularly when addressing issues like motivation or depression.

How to decide a therapist is right for you

After sessions with perhaps three people, step back and trust your gut, Howe says. “You really have to just kind of say, how do I feel? Do I feel comfortable talking with this person? Do I feel like I can be myself? That sort of data right there is the most important, more so than the number of degrees on the wall.”

Being easy to talk to is essential. But you also need someone who seems skilled about your particular issues.

Look for someone who balances guidance with reflective listening. He or she should be focused on helping you make specific, concrete changes in your life and discovering what may be holding you back from achieving your goals.

If your therapist doesn't fit your needs

Once you’ve signed on, don’t ignore any discomfort you may begin to feel after a month or more. Therapists aren’t there to judge or condemn, and they should follow stringent ethical guidelines. If they overshare personal information, violate physical boundaries, or show a pattern of other inconsistent or inconsiderate behavior (for example, being late to appointments), try another therapist.

If you feel your therapist can’t respond to you but is sticking to his or her own program, or pushing goals you don’t care about, that’s another danger sign. Working through conflicts with the therapist is linked to better outcomes. Don’t be afraid to ask questions or speak up.

As you enter this new world, congratulate yourself.

“Mental health is a big part of physical health,” Howes points out. “When people have healthy relationships and they're emotionally healthy, they're going to seek out medical services less frequently.”

If you're seeking help, you’ve put yourself on the path to a happier, more fulfilling life.

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