How to Choose a Therapist

I've often been asked what to look for when choosing a therapist. It’s hard to say exactly which ingredient is the most important, but a good rapport is certainly a vital component of a positive client-therapist alliance. When clients feel that they are understood in an environment with genuine concern, it is easier to expect positive results.

Beyond the therapeutic alliance, there are also three essential points to consider:

1. The qualifications and credentials of the therapist
2. The therapist’s familiarity with specific issues
3. The style and/or structure of therapy

Therapist qualifications and/or credentials

You should be informed and confident about the qualifications of your therapist. Most therapists have a master’s or doctorate degree, with specialized skills in certain areas. A doctorate in clinical psychology is the highest level of training available in psychotherapy, but unless you’re dealing with a complex psychological problem you may not need this level of expertise—a good social worker or marriage and family therapist is very well suited in many cases to help clients with certain “life situations” and mild to moderate anxiety or depression. The important thing is to confirm the person has high-quality training and is prepared to help with your situation. Google the schools and programs listed on your therapist’s online biography to confirm the schools are accredited by the:

• American Psychological Association (APA) for clinical psychologists.
• Council on Social Work Education (CSWE) for social workers.
• Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) for marriage and family therapists.

Whether in person or online, choosing the right therapist is an important decision.

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Most importantly, confirm your therapist is licensed. I am shocked at the number of individuals providing therapy, especially online, with no license. Clinical psychologists, social workers, and marriage and family therapists will all have verifiable licenses by searching for that state’s “office of professions” website on Google. Feel free to ask any therapist you're interviewing if there is an official state licensing website where you can verify their licensure. A good therapist will welcome your question and see it as you practicing good self-care. If the person balks or becomes defensive, that could be a red flag.

If you’re seeking coaching only, then no license is legally necessary. However, many people find that a license in psychotherapy is helpful in a coaching relationship because the therapist’s training in the mind and relationships are highly applicable to most coaching goals. I find both therapy and coaching are extremely important in many situations, and a blend often works best (see my page theracoach.me for more information).

Familiarity with your particular issue

Your needs are unique and it is important for therapists to have experience in handling similar cases. Here are some guide questions that may be helpful:

• How often do they treat similar cases to yours?
• How many clients do they see per week, and how many of those clients have issues similar to yours?
• What kinds of therapeutic solutions and techniques do they see as helpful for situations like yours?
• How many sessions are typically required to get results?
• Do they see your situation as requiring short-term or long-term therapy? How many sessions typically constitute “short term” or “long term”?
• Will they give you homework? If yes, will they take the lead to follow up each week to see if you're doing it, or will you be expected to do that? This one is important—many therapists expect you to bring up last week's homework assignment yourself. Personally, I think that, in most cases, it should actually be the therapist who takes ownership of bringing up the homework, since part of the client's issue may be avoidance of the topic.

These are legitimate questions and should not make a therapist uncomfortable. Resistance to discussing their experience, qualifications, or vision for your treatment puts an early strain on the potential to build a positive working relationship. If necessary, cite this article to explain why you are asking these key questions.

Don't be afraid to ask questions and interview the therapist to make sure they are the right fit.

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Style and structure of their approach

The treatment approach will also be an important consideration. The two main approaches in therapy today are psychodynamic and cognitive-behavioral. The main difference between these two approaches is the role of the unconscious: the unconscious plays a key role in psychodynamic approaches, while the cognitive behavioral approach focuses on thoughts and behaviors that are clearly identifiable.

Psychodynamic therapists often let the client start the session by talking about whatever is on his or her mind, even if that means the client is silent for long periods of time. The psychodynamic therapist searches for hidden meanings and unconscious patterns, and helps the client to gain awareness of how these patterns affect their daily life.

The cognitive behavioral therapist is more likely to take the client’s statements at face value, then help the client evaluate the beliefs and behaviors associated with those statements; and then give homework to help shape those thoughts and behaviors to produce specific desired results.

Ask your therapist if they take a more psychodynamic or cognitive behavioral approach. Ask them if they typically assign homework and offer structured therapy sessions, or if treatment is more “open-ended.” There’s no correct answer to these questions—but you, as the client, have a right to know what kind of treatment you’re potentially beginning. If goals or outcomes are important to you, ask your therapist if they typically define goals at the start of treatment and how often those goals are reviewed with the client.

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It is important to find a therapist that makes you feel comfortable

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If you have been in treatment with your therapist for a period of time, you should feel comfortable asking your therapist to review treatment goals and progress on a regular basis. If the therapist responds to this request in an elusive or confrontational manner or makes you feel uncomfortable, I encourage you to share this perception with your therapist and then either reach an understanding where you feel comfortable discussing goals or consider finding a new therapist.

Moving Forward

Your choice of therapist is extremely important. Genuine concern in a warm and caring environment where you can engage in open expression is essential. In addition, a skilled therapist will also have the qualifications and experience to develop an approach that matches your needs.

Therapy requires an investment of time and money as well as emotional effort. You owe it to yourself to make sure your investments are handled with care. If you’re not sure exactly what kind of therapy or therapist you’re looking for, or you want to understand your options more fully before committing to any one therapist, try consulting with at least three professionals before choosing. Feel free to be open with therapists about the fact that you’re “shopping” or “interviewing” to find the right fit. A good therapist will support you in this and even ask non-judgmental questions or provide more information to help you explore and define your needs.

Do you have more questions on how to choose? There is an entire chapter on the specific factors of choosing a therapist in my book, Nervous Energy: Harness the Power of Your Anxiety. This chapter is about choosing a therapist specifically for higher functioning people, but the tips in this article apply more broadly to many situations.

To find a therapist near you, visit the Psychology Today Therapy Directory.