By: Alexandra DeWoskin, LCSW
Recently I was presented with an interesting question from the husband of a couple I have worked with for a while. He is considering starting his own individual therapy and said he was finding the search process to be daunting. He wondered if there was a central list that rated therapists so that he could find the best one.
This was an interesting question. While I understood he was looking for a very easy solution to his dilemma, what is best for one person is not necessarily what is best for another person. I explained it would be next to impossible to create a best of therapist list because a therapeutic relationship is so subjective.
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I asked my client why he and his wife have stayed with me as their couple’s therapist. He said, “because we like you and trust the work we have done.” This is a clear example of why it is so important to consider what skillset and personality traits are important to you. And, chemistry is so subjective and can’t be measured.
We don’t have a best of list for friendships, romantic relationships, mentors, personal trainers, etc. These relationships start with some sort of attraction and build (or not) from there. A relationship with a therapist is also a relationship. When determining what qualities we want and need in any relationship, we ask ourselves what is important to us.
These could be personality, style, trust, empathy, respect, safety, communication style, interests, background, alignment with your identity, morals and values and ethics, chemistry. The same applies for a helping professional.
And, in this case, specialty, training, availability, cost/insurance accepted, cultural and religious background, and online or in-person, are also be important. Also, sometimes other factors like age, gender, and religion, may be important.
Our backgrounds can be a huge determining factor as to whom we may be attracted to. For some that might mean someone feels motherly and for others a friendly vibe. And, there are so many possible scenarios in between. There can be a perception right off the start that your therapist is going to be able to really understand and relate to you based solely on the attributes a client assigns the them upon first impression.
Studies show that a therapist’s ability to show warmth, genuineness, and empathy is key to their ability to form a therapeutic alliance.
Just like in any relationship, it is very important that you also take into consideration that chemistry plays a huge role. And, this is not something that can be measured or quantified. You either feel it or you don’t. The idea that the relationship between the therapist and patient is essential to good treatment has been reinforced by multiple research studies over the years. An American Psychological Association study found that the type of therapy mattered less than the therapeutic relationship and how they got along.
Clients are more likely to change their lives when they feel supported by their therapist. Therapists are all well trained and some have specialties. Some use a specific theoretical model as they practice. But, unless you like your therapist, feel comfortable, and feel it is a fit, no amount of training is going to be enough. Think about who you normally ask for help in your life (i.e. a sibling, parent or close friend). What about that relationship and how they relate to you is most helpful to you?
A relationship with a therapist is an intimate relationship. You are sharing your deepest, darkest feelings, emotions, desires, and background. This a relationship that must feel safe. And, this is often something that it is immediately felt or not. Safety is also measured subjectively. I’ve had clients who were immediately drawn to the feel of my office space or my bio and picture…even before we sat down to chat.
I always offer a phone chat with prospective clients prior to setting up an appointment to let them ask questions and get a feel for me and my personality. Therapists expect people to be unsure about many things and should welcome inquiries. Here are some questions to ask on a phone consultation with a potential new therapist:
- What are your fees?
- Do you accept my insurance? (Have your insurance card handy)
- What do your credentials mean for me?
- Do you have experience working with people who have concerns like mine?
- How do you approach helping people?
- How do the sessions work with you? (How long is each appointment? What will we do?)
- How long might I be working with you? (How many sessions do people have with you?)
See how you feel about their responses. Is there good communication and a mutual willingness to work together. The alliance isn’t just made up of a bond between the therapist and the patient, it also has to do with agreement on the goals of therapy and the methods used to reach those goals.
Some people just need to vent, other people want feedback, other people want tools and to know what they can do next, and others want a mixture of both. Remember, You are making the final decision about fit.
A referral is a good place to start when seeking a therapist. Maybe you have a friend who swears by their therapist. But, remember, we are all attracted to different things. Also, ask yourself if you will feel comfortable seeing a therapist your friend sees. Even if the therapist is great at confidentiality, if you have a perception that might be a problem, it will impact your ability to feel safe.
Other ways to find a therapist are to check with your insurance provider directory, referrals from your doctor, mental health organizations, and online therapy directories like www.psychologytoday.com.
As mentioned earlier, Therapists are all trained well. They obtain a Masters or Doctorate. They have 2+ years for intern experience along with their training. A therapist’s bio will reveal a therapist’s expertise in a specific area such as depression or relationships and particular therapeutic approach like cognitive behavioral therapy. Some therapists have a more eclectic approach and draw from multiple techniques.
They tailor their approach to what each individual client needs. Therapists can have a lot of initials after their names and titles. These indicate their level of education and their certification or licensure. Here are some of the more common ones.
- LCSW: Licensed Clinical Social Worker
- LMFT: Licensed Marriage and Family Therapist
- NCC: National Certified Counselor
- LCDC: Licensed Chemical Dependency Counselor
- LPC: Licensed Professional Counselor
- LMHC: Licensed Mental Health Counselor
- PsyD: Doctor of Psychology
- PhD: Doctor of Philosphy
- MD: Doctor of Medicine (i.e. Psychiatrist)
Your first appointment with your new therapist is an opportunity to determine if they are someone you’d feel comfortable working with and to develop rapport. It is normal thought to feel a bit hesitant or nervous at first. Pay attention to whether your therapist welcomes you warmly and helps to put you at ease.
Are they someone you could come to trust with your thoughts and feelings? Are they easy to talk to? Do they let you know both verbally and non-verbally that they aren’t judging you and are open to your experiences?
Do they make a point of discussing confidentiality so you know what will be kept private and if anything might be shared, and why? Are they kind and friendly without seeming like they are trying to be your casual friend? Do they act as if the two of you are a team and partnering in your care? Do they convey measured optimism and hope?
This is the start of a working relationship and process that occurs over time. It may not be easy to know right away whether there will be a good rapport between you and your therapist. Nevertheless, clients often feel a connection with certain kinds of therapists—ones who are empathic, respectful, honest, and warm. See this book on Amazon to learn more.
Not surprisingly, clients like therapists who treat them as equals; they like health professionals whose behavior, attitude, and words make them feel safe, comfortable, and valued. You will not feel “cured” following your first appointment. However, you should have a feeling of realistic hope by the end of your first appointment.
I will always ask, at the end our our first session, if they feel comfortable to schedule another session. If they don’t, I consider that a therapeutic success for them because they are exercising self-determination by making a decision that feels right for them. If they do feel comfortable, great, and we move forward to determine an appointment schedule that feels comfortable for the client.
It can take a few sessions to fully determine if you’re making progress with a therapist. Then, after a few sessions, it’s okay to re-evaluate to determine if you wish to continue. In fact, like in all relationship, you are constantly re-evaluating. Timelines can vary for everyone, and usually that timeline depends on your process and journey as the therapist is there to help facilitate that inner work. On average, therapy starts weekly, then the gap between sessions expands as growth occurs. Once it is mutually decided that progress can be maintained, a transition into a new therapeutic relationship occurs.
This could be a full transition out of therapy. This could be less frequent visits, ‘check-ups,’ coming once or twice a year or seeing your therapist as needed. All relationships evolve and change over time. The same is true for a therapeutic relationship. I have clients I’ve know for 10+ years. They don’t come regularly anymore. But they find comfort in knowing they can reach out at any time to someone who already knows them.
A therapist is not there to tell you what to do and push their agenda. They are there to help you find the path that is right for you and offer suggestions, insights, and options that perhaps you have not thought of.
They are meant to be objective. Allow therapy to act as a model space for the other areas of your life. It’s your space, so make it yours. It’s the one time and place you get to be as vulnerable and as open as you want, expect objectivity and support, without consequences. So use it to try out some of those things that are uncomfortable for you in the real world.
