By Philip J. Rosenbaum, Ph.D.
Among the most pressing questions people ask when choosing a therapist is, “Will they understand me?”
This is an important question.
Studies have consistently shown that no matter what type of therapy we select, the therapeutic relationship is the single most important factor leading to change. And a sense of being understood is an important component of the therapeutic relationship.
Very little is as painfully disappointing and discouraging as working up the courage to attend a therapy session only to feel like the connection with the therapist is off. And yet it is not always so clear what makes for the best therapeutic relationship.
Who Will Understand Us Better: Someone Similar to Us, or Different?
Some people look for therapists with whom they share similarities, with the hope this will increase the possibility of being understood. They look for a therapist with a similar background. They consider age, gender, identity, sexual orientation, biography, interests, and so on.
Other people look for therapists who they think will not be like them. They want a therapist who doesn’t know their culture, or who may offer a different perspective and worldview.
Sometimes, people focus their search on the expertise of the therapist. They are looking for someone with experience germane to their lives, such as a specialty in athletics, performance anxiety, eating disorders, etc.
We May Not Find Exactly What We Want
While most therapists would probably agree that patients should pursue their own preference, for many reasons it is not always possible to find that ideal qualifications match. Sometimes, a popular therapist may not have availability, or a desired specialist may not be available locally.
But moreover, people are infinitely diverse and complex. They come from different backgrounds, countries, and social classes. The chances of one professional meeting all, or even most, of our criteria may be a challenge. This, of course, can be frustrating and present a real obstacle.
The best advice: Take the risk of meeting with a therapist even if you are worried about not having enough in common. This may be scary, but experience has taught me that therapy can still certainly succeed in these situations, because apart from our differences, we all share a need to feel listened to and understood—and this is precisely what all well-trained therapists offer.
What To Expect
Most therapists work to develop a relationship based on understanding each patient as a unique individual. We do this by trying to get to know each person as thoroughly as possible, so we can personalize treatment to fit his or her needs.
We work to address what is meaningful to the specific person. This involves being as curious as possible and not making assumptions—we put aside much of what we think we know and open our minds.
For instance, while I have ideas about what being a “perfectionist” means, what’s important to me, as a therapist, is determining what this idea means to the person sitting in my office. I put aside my own thoughts and feelings about perfectionism, so I can listen to what I am being told. I try to keep myself open, and not make assumptions or judgments.
For 28-year-old "Jessica," for example, I knew that being a perfectionist meant not only doing her work flawlessly, but also always dressing and acting this way as well. She came to therapy dressed stylishly and worked hard to be "a good patient.” She explained that she would constantly replay and analyze interactions with friends and colleagues in her head, looking for smallest mistakes to “fix” and “improve.”
While I initially thought Jessica was primarily scared of losing control, by listening to her and not over her, I came to understand her perfectionism as related to ambivalence about intimacy, as well as guilt she felt about her accomplishments, looks, and capabilities. This was in addition to worries about making a “mistake”—in her mind, always just around the corner—and not being “good enough,” especially when compared to others.
I was surprised because Jessica came from modest means and had worked hard to earn what she had achieved. But she was keenly aware of how much she wanted to achieve, which felt competitive, an uncomfortable and unwelcome feeling. Understanding these feelings was an important step in our building our relationship.
Talking About the Relationship Is Important
Of course, not everyone will find a therapist to be a good fit. In therapy, our differences and our concerns about not being understood are important. I encourage my patients to bring up what does not feel right, what I’ve not understood, or what does not seem to be working. This can be intimidating, but it can also be empowering and freeing. And it will help lead to a better working relationship. Even if it doesn’t go as well as you might hope, it can help clarify what to look for in your next therapist.
Philip J. Rosenbaum, Ph.D., is a clinical psychologist, psychoanalyst and is the Director of Counseling and Psychological Services (CAPS) at Haverford College. He received his psychoanalytic training at the William Alanson White Institute. He is the editor of the recently published book Making Our Ideas Clear: Pragmatism and Psychoanalysis and is also in private practice in Philadelphia.