How to Choose a Therapist or Counselor
Choosing a therapist can feel like a daunting task.
Especially if you have waited to look for one until you are in an immense amount of pain. It can also feel overwhelming and vulnerable to choose the person with whom you will be sharing intimate details about yourself and your life. This makes it especially important to choose wisely and to give yourself permission to try a few people before settling on one.
Picking a therapist or counselor that you work well with is important because the right fit will mean the difference between a healing and growing experience, and an alienating or harmful experience. But finding a good therapist can be difficult. Even with all our social progress to de-stigmatize therapy and counseling, there is still an element of secrecy around the profession that can make it challenging to find the right one.
To help make this process easier here are some tips to help guide you in this process.
What Is a Therapist?
First, it is important to understand what a therapist or counselor is and what they do professionally. Overall, a therapist’s job is to help people develop awareness and insight into their thoughts, emotions and behavior. We also help people learn how to manage stress, manage conflict, and take actionable steps toward their desired change. If you struggle with a mental health condition, part of our job is also to help you understand the condition, how it affects you and manage it so that you can achieve the highest level of well-being. But not every therapist does all these things, all the time.
Which brings us to the second point, not all therapists are created equal. Each therapist or counselor generally has a niche or a specialty they work in, and each therapist will have a different degree of experience. A therapist in the state of California will have a master’s degree in Counseling Psychology or Clinical Social Work and will be licensed with the Board of Behavioral Science either as an Associate or as a fully licensed clinician. If they are an Associate, they will be working under another therapist whose job it is to supervise them.
Many therapists come to the field later in life so when looking for a therapist do not assume that their age reflects their experience in counseling. Check their credentials and degrees when possible.
A Few Things to Know That Your Therapist Is Not:
A therapist cannot prescribe medication, medication treatment or make medication recommendations because it is out of the scope of practice for a therapist. While a therapist can recommend that you see a doctor or psychiatrist to see if medication is warranted, they cannot make that determination on their own. A therapist might work with your doctor or psychiatrist to help monitor the effectiveness or side effects of the medication, or as part of a treatment team, but that is where their involvement ends.
A therapist cannot do a psychiatric assessment for you, for this you will need a psychologist who has been trained in assessment. Your therapist can confirm treatment, share observations and progress made, but cannot make recommendations based off this information.
Finally, a therapist isn’t a friend who listens to your woes and tries to give you advice. A therapist is there to help you process and change emotional, relational, or behavioral issues that cause you pain or keep you stuck. Feeling close to your therapist and feeling safe with them is extremely important and a normal part of the therapeutic relationship but if you start to have expectations toward them as you would a friend or they begin to treat you like a friend take this as a sign to reestablish boundaries.
What to Consider When Choosing a Therapist
When deciding on a therapist we usually consider these four things: specialty, personality, cost, and scheduling.
Know Your Purpose
Before you start looking for your therapist it may be helpful to ask yourself these questions:
What difficulties am I currently experiencing?
How are they affecting me? Consider your emotions and thoughts as well as the negative impact they’re having on your life.
What do I hope to gain from therapy? What do I hope will be better as a result?
Many times, people just know that things in their life aren’t right but find it hard to describe in words. This is normal and okay. If you are unsure exactly what is wrong, it can help to narrow the search using general terms like anxiety, depression, marriage issues or stress. Then read a few therapist profiles and as you read them notice which ones make you feel seen and understood, this is a good indication that you have found a potential match.
Personality Fit
Of all the factors in choosing a therapist, finding one that you click with is perhaps the most crucial. Hundreds of studies show us that the therapeutic alliance, the relationship between therapist and client, is crucial for the success of therapy.
“Generally, the best predictor of success in therapy is rapport—feelings of trust and respect between the participants, a therapeutic alliance. When there’s no rapport, there’s no therapy.” -Dr. Noam Shpancer PHD
A positive, supportive relationship is based on several factors, including:
Personalities: A positive connection (but not a friendship) with your therapist is vital. This is often referred to as a sense of rapport.
Trust: You should trust your therapist enough to discuss your thoughts, feelings, and behaviors.
Authenticity: A good therapist is honest and genuine, demonstrating knowledge but omitting jargon (appearing as an expert but not as a know-it-all).
Unconditional positive regard: A therapist worthy of your choice values you and believes in your ability to progress (rather than viewing you as broken or dependent).
Positive communication: Therapists should communicate openly and warmly even when pointing out areas for your growth.
Your own preferences and comfort level: The best healing work happens when you feel connected to and comfortable with your therapist. You may also want to find a therapist who is familiar with your identity. This can be especially important for those who identify as LGBTQIA, BIPOC, or Latinx.
Specialty
While most therapists see a variety of clients for various reasons, many specialize in certain areas. Some, for example, focus on depression, anxiety, or other specific challenges. Some mental health providers work with a particular age group.
Don’t hesitate to ask them about 1) their theory of change and 2) the style of therapy they use the most. Some examples of common types of therapy include:
Cognitive-behavior therapy (CBT): CBT is a helping approach that focuses on teaching people to identify and change unhelpful, negative thought patterns
Acceptance and commitment therapy (ACT): In ACT, the emphasis is on attitudes and behaviors toward value-driven goals.
Dialectical behavior therapy (DBT): This approach is useful for managing emotions and distress and involves skills training for effective problem-solving and actions.
Exposure and response therapy (ERT): Exposure therapy helps people address and reduce anxiety and phobias. ERT combines exposure therapy with response prevention to help people with obsessive compulsive disorder and related disorders break the cycle of obsessions and compulsions.
Person-centered therapy: In person-centered or client-centered therapy, the therapist’s primary role isn’t to teach skills but instead is to listen to the client and engage in discussion that helps the client discover how to move forward.
Each therapeutic approach has merit. What’s important is that a therapist’s approach is evidence-based and goal-directed while remaining flexible and open to your individual needs and experiences.
Cost & Insurance Coverage
When choosing a therapist remember that you have the right to learn, from the therapist’s office or your insurance company:
Their treatment fees (many therapists charge per 50-minute session)
Whether they accept your insurance (you might have to contact your insurance company or look at a list of approved providers on their website)
How much is covered by your insurance and how much you will pay out-of-pocket
If your insurance limits the number of sessions you may have and how the therapist honors the limit (for example, if your insurance only covers six weeks of therapy, can your therapist create a six-week plan for you or provide alternative payment options beyond six weeks?)
If the therapist takes Medicaid or Medicare
If they offer a sliding fee scale based on income
**If you are paying out of pocket please remember that you are not just paying for the hour in their office but that their fee includes several hours of research, treatment planning and resource gathering with you in mind.**
Scheduling and Location
When it comes to the more practical side of things such as availability and location it can be tempting to choose what is easiest and most convenient. But when looking for the right fit, let this be one of the final things you consider. Yes, it is important to find someone who fits your schedule, but in the long run it is better to choose the therapist that fits you best rather than the most convenient one available.
If mobility or location is an issue, there are multiple online platforms that can connect you with a qualified therapist. This is also true for your scheduling needs. Remember that healing and doing the work of therapy will require your investment financially, emotionally, and logistically. The more you prioritize it the more you will get out of it.
Key Take Away
When searching for a therapist here are some questions to ask yourself:
What is it I want to work on and are they qualified to help me?
What are my expectations of therapy?
Am I comfortable in their presence?
Did I leave the session feeling heard, understood, and accepted?
Do they have the training and experience to help me with my problem?
Do I feel confident in their ability to help me?
Do they challenge me to grow, or do I feel like I am just sharing with a friend?
Does their style and approach suit me and my needs? Or does it make me uncomfortable and anxious?
Do I feel like I can ask for what I need or voice concerns without offending or feeling judged?
You should be able to answer all these questions affirmatively if you have found the right therapist, especially the last question. Therapists are human too and they don’t always get it just right, so it is important to be able to say, “this isn’t working for me” and feel confident that they will work with you to find a different approach.
Final Thoughts on Choosing the Right Therapist
Choosing the right therapist is a personal decision that involves a few different factors. Please keep in mind that even if a therapist comes highly recommended by someone you know, they might not be the right fit for you. So, give yourself permission to look around and find what works for you. Most therapists will happily do a free 15–20-minute consultation to make sure that you work well together so take advantage of it!
