I am often asked this question and would like to preface my opinions by saying that they are just that – opinions. Therapists are as diverse as their clientele and I presume that all would have something to add to this discussion, or perhaps an entirely opposite perspective. If you are looking for a healing, caring, supportive, and emotionally challenging experience, this is my take.
1. All therapists are different, but I would say that the primary characteristic of importance in your therapist is that he or she tries to make you feel comfortable and wants to be present with you.
2. Having said that, everyone will be nervous at the beginning of therapy, your therapist included if he or she is human, so give yourself a few weeks to settle in. If you feel inclined, talk to your therapist about feeling nervous and he or she should response empathically.
3. Therapy can be funny and light-hearted at times, but you should not feel the need to impress or entertain your therapist.
4. Therapy can be humorous, intellectual, and emotional, but remember that intellectualism and humor can be used to defend against difficult emotions. Therapists are in the business of emotions, so you may be challenged to access your own at times.
5. You should feel safe in therapy at all times and your therapist should be able to create that safety with you.
Many of the clients I see have discussed “settling” with their previous therapist(s). He or she would listen most of the time, or was good enough is not an ideal therapeutic situation. You have the right to the right fit for you. If it isn’t ideal, talk to your therapist about what is missing. If he or she responds in a way that upsets you, say that you’re upset. If it gets to the point where you want to end the relationship because of this disconnect, talk about it. A relationship with a therapist should enhance your ability to have relationships in the real world. As a model of relationship, a therapist should encourage honesty, even when it is difficult, and should always have your interest first on the list of importance.
Step 1. Assess your needs.
What do you need and what do you want? You can have both needs and wants met in therapy with the right person. Read the following questions for guidance on your needs and wishes for therapy.
Are you going through a life transition like college, marriage, divorce, parenthood, or late adulthood?
Are you a member of an oppressed group? Is it important to you that your therapist is a part of this group or has special training around your difference?
Will it be difficult for you to speak to a stranger for the first time?
Have you had therapy experiences in the past that did NOT work? What was missing?
Are you depressed, anxious, sad, or do you have a dominating emotion that comes to mind?
Have you consulted a medical professional and if so, what does he or she recommend?
Do you just want to talk and have someone listen?
Do you want to explore your past or focus on the present? Or both?
Do you want to be challenged or supported unconditionally?
Do you want to talk about goals and be accountable to your therapist in attaining them?
Do you seek structure or freedom in therapy?
Are you more comfortable with a particular gender, and why? Would it be helpful to you to have a therapist representing the gender of comfort or perhaps to have a new experience with the gender you do not prefer?
Are you comfortable with a particular age group, and why? How would your experience be enhanced or compromised with different age groups?
What are you able to pay for therapy?
Step 2. Find a recommended therapist
Word of mouth is the most helpful way of finding a clinician but more and more, therapists are advertising and promoting themselves online. There are some websites that verify the credentials of the therapists who are advertising (psychologytoday.com, goodtherapy.org) so make sure that the therapists you read about have credentials.
Money is usually an uncomfortable topic for most people, but prospective therapists should be clear about charges when asked. Some therapists work on a “sliding scale” basis, meaning that they have different rates depending on financial need. If you are in need of financial assistance, think about what you are able to pay and ask the therapist if the rate would be acceptable.
LPC-i and LPC – These therapists are master’s level professional counselors who are seeking or have obtained a clinical licensure. You can expect to pay more to see an LPC than an LPC-Intern.
LMSW and LCSW – These therapists are master’s level social workers who are seeking or have obtained a clinical licensure. You can expect to pay more to see an LCSW than an LMSW.
Psy.D. or PhD. – Psychologists are doctorate level clinicians who perform therapy and also focus on psychological assessment or testing. Psy.D. is a newer degree plan focusing on clinical psychotherapy as well as research and testing. You can expect to pay more for a doctorate level clinician than an LPC or an LCSW.
M.D. or D.O. – Psychiatrists are medical doctors who are primarily focused on psychobiological assessment and medication management for patients. Some psychiatrists are trained in psychotherapeutic techniques but most have little training in psychotherapy. You can expect to pay the most for a psychiatrist since he or she has a medical license and can prescribe medication.
Unfortunately, when assessing therapists one can rarely tell which will be a fit on paper. You may be able to read a bio on the therapist that may help you get a feel for his or her personality and theoretical leanings, but having a conversation is the best way to assess goodness of fit.
Use the questions from Step 1 to guide you in expressing your needs and ask about their training, specialties, and areas of practice. Despite the traditional hierarchy, you may find your needs anywhere in this ranking of therapists.
Step 3: Get to know the therapist
In order to assess fit, one has to “talk the talk” in some ways to understand how a therapist operates. Read up on types of therapies and you may find that one resonates with you.
Psych Central’s article on Psychotherapy - check out the types of therapy on the left index
Ask questions and expect to get your needs met! This principle is basic to living a life with healthy self-esteem and self-care.
As always, take care.