Working as a therapist can be just as complicated as it can be rewarding. For starters, when dealing with another human, many factors are impossible to predict and control. Add to the mix that many clients don’t know what exactly they’re looking for, and might not know how to even conceptualize the problem at hand. Therapy is hard work!
Since I’m a clinical psychologist practicing therapy and engaged in the therapist community of Berlin, you’d think I could easily find my way in the jungle of mental health care providers, right? Well actually, no! Even I get a headache from the murkiness of matching people in need of support with the right provider.
What makes it difficult to choose a therapist, is how many factors have to be taken into account. Maybe you’re looking for someone practicing a particular type of therapy, in a specific language, who has a certain style of working, a specific age, gender, sexuality, ethnicity, price, specific areas of expertise, or someone who is covered by the insurance. On top of this, you’ll need someone with availabilities that match your own, and with a location that isn’t too far away for you to travel — unless you want to opt for an online therapist, that is.
I’m making a big deal of how hard it can be to find the right therapist, for you to know that you are far from alone if you’re finding the whole ordeal difficult and confusing. I’m also making a big deal so that you’ll read on and hopefully feel inspired and supported by my guide on how to choose wisely.
See, even though it’s a complicated affair — also for a psychologist needing therapy or helping a friend find appropriate therapy — there are questions you can contemplate that will make the search for a suitable therapist more clear. These questions combined with often overlooked aspects of what makes for a good match will be unfolded in the following.
So, let’s get started with the things you need to know to make a good choice in therapist.
The match means most
Study after study shows that what is important in deciding the outcome of therapy (i.e. whether therapy will have a helpful effect) is the relationship between the therapist and client. This relationship is often referred to as the therapeutic alliance, which comprises not only the agreement on the therapeutic goals and the methods used to reach these goals, but also the bond between therapist and client. And what’s a bond, you’re maybe asking. In therapy, it refers to the mutual liking of therapist and client, the feeling by both that there is good communication, and the mutual willingness to work together. Reports on the part of clients that “My therapist understands and cares about me,” and feelings from the therapist that “I enjoy working with this client” are typical indicators that a good bond exists.
There have been numerous studies examining the relationship between the therapeutic relationship and outcome, virtually all of which indicate that a positive alliance is indeed associated with successful outcome.
With this in mind, choosing who this person will be truly becomes a significant task. Therefore, when looking through different listings, asking friends, your general practitioner or your local support group, know that you’re allowed to schedule initial consultations with different therapists (you can even find therapists who offer free trials or only charge half price). During the first session you can get a gist of the potential for a good alliance.
Sometimes it might take meetings with several therapists before you find someone where there’s a good match. The most important thing to remember is that you are certainly allowed to ask open questions to the professional you are meeting for the first time. Furthermore, know that you are not obliged to come back once you have been to a first consultation.
Criteria to think of when choosing a therapist to work with
Before choosing which therapist(s) you’d like to book an initial session with, it’s good to first figure out which preferences for therapy you have, i.e. ask yourself if there are some basic characteristics that your practitioner has to have. For example, do you have wishes for the therapist’s age, gender, ethnic or racial background, language skills, sexual orientation, training or other things? Maybe you simply know that you’ll be more comfortable working with a woman, or with someone who shares some of your own cultural experience. Or would you prefer working with someone in your native language?
But before narrowing down your search with these different factors, let’s work through some of the variables that people contemplating therapy seem most concerned about.
1. Age. “I want a very young therapist”, said probably no one ever. This is understandable, since many believe that age equals wisdom. But it doesn’t always— and compassion fatigue, burn-out, or not keeping up with clinical trends in the profession can be greater risks with older therapists. Of course, the age preference depends quite significantly on your own age. If you are 60, then you may not want to work with someone who is 29. But if you are 50, then it might feel more possible. And if you’re 20, well then obviously, a therapist who is 29 will seem perfectly mature. Also, know that it can be a positive experience to work with trainee therapists who are under frequent supervision. As the saying goes: Two brains work better than one.
2. Gender. This is usually a strong element in people’s choices and many people agree that it matters a lot. If you have a preference for one gender over the other, you might as well follow it, but it could also pay off to second-guess your instinct. For instance, if you can’t imagine working with a woman because you think you have mother issues, couldn’t there be a value in working specifically with a woman?
3. Sexuality and gender expression. If you are a member of a sexual or gender minority (gay, lesbian, bisexual, transsexual, transgender, intergender etc.), or if you are into a very specific sexual practice that you think might shock a therapist, then you will already have been thinking about how this impacts on your choice of therapist. Evidently, you need someone non-judgmental — which, ideally, all therapists should be, though this isn’t always the case. But do you need someone who resembles you or is it enough with a therapist who has the necessary experience? If you have a preference about this aspect of therapist choice then try to find someone who shares or has experience with your orientation/gender expression/sexual practice.
4. Ethnicity and cultural experience. With the dimension of ethnicity it also makes sense to ask yourself whether you want to see someone who resembles you. Or could someone open to understanding what it is like to be you help just as much? It’s important to remember that any good therapist should be culturally competent, meaning that they are attuned to differences in culture of all kinds and considerate of how these differences — particularly differences between the therapist and the client — might affect the therapeutic process.
However, when considering the above dimensions, it’s perfectly alright to think it will be helpful to work with a therapist who has a specific background working with people from a certain minority or with a particular kind of identity. These groups and identities might include persons of color, LGBTQ+ folks, and many others. Because marginalized identities can come with unique challenges, therapists who specialize in working with these groups may be able to provide more sensitive support.
Furthermore, you might prefer to work with a therapist who shares one or more aspects of your identity (and/or values) simply because that cultural experience can give you common ground and help you feel confident that they understand your struggles. If you prefer to work with a therapist who shares your background, you can search for therapists who share your values, or ask the therapist you’ve chosen about their experience with individuals of different cultural identities during your initial consultation.
5. Special Expertise. It is important to realise that, though some people have distinct issues i.e symptoms — such as panic attacks or insomnia— many clients simply feel a lack of meaning and seek a sense of purpose in their lives. If you do have specific symptoms you are struggling with, make sure that your prospective therapist confirms they have some experience in those areas.
Keep in mind that it’s always good to think of symptoms as signalling that an underlying problem exists and needs to be addressed. Good therapy should include both symptom relief and working on the actual core conflict.
What type of therapy is then right for me…?
Nowadays there are many kinds of established therapeutic approaches, including psychodynamic psychotherapy, solution-focused therapy, cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), gestalt therapy, and Jungian psychoanalysis (to name just a few).
Don’t worry if you are not sure what particular approach would be suited to you. Your first appointment will be an assessment where you can discuss your issues and goals for therapy. Also, you may find that you are interested in more than one modality, but luckily many therapists are also what is known as ‘integrative’ or ‘eclectic’, meaning they are trained in several types of therapy they can mix to best match your unique preferences and issues.
If you don’t have any experience with therapy as of yet, it might be helpful to learn a bit about common therapeutic approaches and find ones that seem appealing to you, so you can search for practitioners with experience in those approaches. Here is a short list of common therapy approaches and the type of challenges they deal with:
Acceptance and Commitment Therapy (ACT). This type of therapy rests upon the tenet that most psychological suffering comes from two things: 1) that people are caught up or entangled in their own thoughts, and 2) that people struggle to avoid or get rid of unwanted thoughts and feelings. This is why the ACT counselor will assist the client in dropping the struggle and distancing him or herself from the difficult thoughts and emotions. The goal is for the person to have increased psychological flexibility by practising being in the present moment with openness to our experience, and taking action that is guided by his or her values. To reach this goal, mindfulness is often practised in the ACT process.
Cognitive-Behavioral Therapy (CBT). This type of therapy focuses on the interplay between thoughts, feelings, physical sensations, behaviors, and the social context. In CBT, the initial focus is on alleviating symptoms and the identification of negative thoughts, feelings, physical symptoms and actions related to these. The next step is evaluating thoughts and deciding on strategies and tools in order to make the desired changes. The therapy can also focus on the life experiences, assumptions, life rules, norms and values that affect the patient’s interpretations, self-image and worldview.
The cognitive-behavioural therapist will work with the client to bring about desired changes in these types of thoughts, feelings, physical sensations and behaviors. The therapist takes on an active role, sharing and discussing ideas and interpretations with the patient. Psychoeducation is an important element of CBT, where the therapist informs the patient of, for instance, relevant research on the client’s condition or methods and techniques to change a pattern.
Gestalt therapy. The Gestalt approach draws on the perception that in order to maximize awareness of creative potential, clients must reflect on the holistic unity of their body, mind, emotional and ecological perspectives. A rich palette of present-centred, experiential, and artistic interventions are utilized. The focus is on interpersonal, intrapersonal, and relational growth.
Jungian psychoanalysis. A Jungian analysis involves a deeper exploration of your mind with a focus on the unconscious. This method can be suitable for individuals suffering from trauma in childhood, existential crisis and/or creative blockages. Dream-work, play and the use of active imagination are important techniques that can be implemented. Focus is also oriented to what happens in the room, and the process is often experienced as a deeper meditation over your life in company with the analyst. A Jungian analysis involves 1–2 sessions a week and often goes on for more than a year.
Psychoanalysis. Psychoanalysis is a body of theory and practice that has evolved in different directions over more than a century. Some of its basic ideas include the recognition that we don’t always know or understand our motives, that we try to avoid painful feelings, that our wishes frequently conflict and that we can confuse parts of our fantasies with reality. Added to this is the understanding that many of our actions, language and dreams communicate more than we realise.
A classical psychoanalysis is often carried out several times per week over several years. Free association (saying all that comes to mind without filter) forms one cornerstone of this technique. The analyst should listen to the patient’s associations with care and curiosity in order to gradually come to an understanding of how they came to be who they are, and how this plays a role in the difficulties that they face. This can lead to greater levels of emotional maturity, character transformation and deep personal change.
Psychodynamic psychotherapy. In this approach (which is informed by traditional psychoanalysis), the counselor helps the client with their present-day problems by looking at how they may have developed from past events and relationships. Early-life experiences can develop into recurring patterns of thinking, feeling and acting, that continue to repeat in life, unless he or she becomes aware of these unconscious patterns.
Many of these recurring patterns came about when the person needed to cope or survive a situation, and were useful at the time, but as time passes, the patterns start to hold the person back in life. The counselor and client work together to become aware of these patterns, at home, at work, and in relationships, and change them to be life-enhancing. The relationship between client and counselor that develops over time is also examined to see if there are similarities to when the client interacts with others, like friends, loved ones, or colleagues. Transference in session — for example, the transferring of one’s feelings for a parent onto the counselor — can also help reveal ways that past relationships affect current relationships. The client can then work with the counselor to change that relationship dynamic to be healthier.
Solution-focused therapy (SFT). This is usually considered a briefer type of therapy which concentrates on finding solutions in the present time. The therapist will help you explore who you are when you’re at your best in order to bring more of this best-self into your life going forward. This type of therapy seems to appeal to people who want to see positive change quickly and people who think of therapy as a tool to help them bring about positive change in their life. It’s a method that generally takes the approach that you know what you need to do to improve your own life and, with the appropriate support and questioning, are capable of finding the best solutions.
As with so many other questions about therapy, there’s no single best way to determine which kind of therapy is right for you. Much of your decision will come down to personal preference, and you may even try out a few different approaches before settling on one that works well for you. Finding the right therapist is a personal and nuanced process, and you should feel free to take your time researching and trying out different options.
How do I know if the therapist I’ve chosen is The One?
Once you have narrowed down your search based on your preferences and the type of therapy that you think will suit you best, you can set up some appointments and meet a few professionals. Be prepared to clarify the things that their websites maybe didn’t reveal, such as: Are they experienced working with someone with your area of concern? Are they attuned to the cultural group that you belong to? A therapist should gladly answer these questions, and how they encounter you in the first session will give you a good idea about how comfortable you are with them. This might be the most significant suggestion in picking your therapist: trust your intuition and ask yourself if you can imagine finding trust and alliance with this person. If the answer is yes, you are off to a good start.
Once you have made a choice and have worked with a professional for some time, you should continue to ask the question of whether your therapist is the right fit. Usually, a good therapist-client fit can be pinned down by asking these two broad questions:
1. Do I feel a good rapport with this therapist?
2. Is therapy helping me make progress?
If after a few sessions nothing has changed and you’re not sure you feel a connection with your therapist, it may be time to let them know it isn’t working. You can discuss this question with your therapist and it might help the two of you assess how the journey is coming along, if you have missed any major road signs, or if you should end the process so you can try to find a therapist with whom there is a better fit.
Besides this, it’s not unlikely, especially throughout a longer process, to sometimes have negative feelings towards your therapist. Feelings of discomfort that arise in a session can have to do with the therapist somehow not being attuned, but in more long-term processes it can also indicate that something is “triggered” in the dynamic with your therapist that has to do with your own past for which the therapist now have become the carrier of. Especially psychoanalysis and psychodynamically approaches works actively with the this so-called concept of transference to free the patient from old patterns of behaviour that can lead to self-sabotage and other disappointments in life. If you do nurture uncomfortable feelings towards your therapist, this can be useful to share with them.
Therapy requires both a financial commitment and a time commitment, and this is why you’ll want to weigh certain logistical factors as you decide which therapist to work with.
Here are some things to consider:
Timing. Which days and times can you commit to therapy? Therapy sessions generally last about 50 minutes and occur weekly, though certain practitioners may recommend more or less frequent sessions. If you have limited availability, search specifically for therapists with evening, weekend, or whatever-suits-your-schedule appointments. Alternatively, you can ask therapists you’re considering upfront if they have openings at the times you need. Don’t be shy about finding sessions that fit your schedule; making therapy a manageable part of your day-to-day life can help you stick to your commitment and get the most out of your sessions.
Location. Consider the commute to and from the therapist’s office. If possible, it may be easier to see a therapist who has offices close to your home or your job. You can also consider expanding your search to include therapists who offer remote therapy sessions online, which can make scheduling easier.
Insurance. Will your insurance cover therapy, or can you expand your search to out-of-network providers? While in-network therapists tend to be more affordable, looking for one can be a long and arduous process depending on your insurance plan and location. In Germany, those who have public insurances, such as TK or AOK, can get their therapy covered in full, but then they have to find specifically a “psychological psychotherapist” (psychologischer Psychotherapeut) with a so-called Approbation and a Kassensitz. These therapists often have 3 to 6 month waiting list and you won’t have a lot of choice in regards to type of therapy (psychodynamic psychotherapy, psychoanalysis, and behavioural therapy are the only modalities that are paid for by the public health insurance in Germany). That’s why seeing an out-of-network or private pay therapist can be a way to avoid many common insurance headaches and get started with your therapy faster. Other benefits of self-payment compared to getting therapy covered by health insurance is anonymity (no documentation of personal data and diagnoses are given to official administrations), less bureaucracy (in that you don’t have to struggle with a lot of paperwork and bureaucratic processes with the public health insurance provider), and of course completely free choice of not just the therapeutic method, but also the duration, location, language, etc.
Price. It’s good to find out how much you can afford to budget for therapy. Some therapists offer a sliding scale fee for unemployed and/or students, so be sure to talk to potential therapists about whether their fees are flexible and what the cost to you would be for each session. Payments are either done before your session, after your session, or by bank transfer by the end of the month.
The process of finding a therapist is different for everyone, but by keeping these pointers in mind and focusing on what works best for you, you’re likely to find a good match in therapist. After all, the match is what matters; meaning finding someone trustworthy to join you in a journey to some of the most vulnerable and difficult places in your life.
If you have any particular concerns in finding the right therapist for you, which haven’t been covered, feel free to leave a comment or write me at firstname.lastname@example.org. You can also sign up to www.complicated.lifewhich is a platform that is being developed to make the search for the right therapist simpler and more streamlined.