This article considers a remarkably under-discussed process in psychotherapy: how to choose a suitable therapist.
Considering psychotherapy can be a big decision. It involves a significant investment of time, energy, potentially money, and trusting another human being with some of your most personal thoughts, feelings and experiences.
As in previous articles, it is difficult to fully separate out the right type of therapist for a particular client from the right type of therapy. Whilst both factors are seen as important to different degrees in getting a good outcome from psychotherapy, it is an area of significant debate in healthcare research.
That being said, there appears to be a clear area of consensus: that the matching of client, therapist and therapy is frequently the most important factor in psychotherapy being effective and useful. Trying to get this matching right is ultimately the focus of this piece.
Perhaps a good place to start is to consider what sort of psychotherapy you’re looking for. Has anyone ever helped you to understand what your options are and what they should be? Have you ever been given a choice of therapy? You may find it helpful to read more about some of the core well-established therapeutic approaches:
- Cognitive Behavioural Therapy
- Psychodynamic Psychotherapy
- Cognitive Analytic Therapy
- Person-Centred or ‘humanistic’ psychotherapy
- Family and Systemic Therapy
You may have a good idea of the type of psychotherapy you’re looking for already, perhaps based on previous experiences of therapy, or your own reading and research. It might seem like an unhelpfully obvious thing to state, but the way a therapist will approach you, listen to you, ask you questions, and respond when you’re struggling, will be shaped as much by their training and therapeutic allegiances as perhaps their own personality. Arguably the two things aren’t so separate.
Before booking an appointment, it can be helpful to ask a therapist about their background, training and experience in psychotherapy and how this influences the way they work with their clients.
As multiple forms of ‘psychotherapy’ exist, many different professional groups are able to complete basic training in psychotherapy and call themselves a ‘psychotherapist’. Perhaps surprisingly, ‘Psychotherapist’ is not a protected legal title. Different types of psychotherapist require differing levels of academic qualification, specialist training, clinical experience and supervision in order to register with an accredited professional body. Ensuring your therapist is accredited with a professional organisation provides you with some assurances that they are trained to a minimum standard and that they are professionally and legally accountable to a regulated organisation.
A good rule-of-thumb when shortlisting potential therapists, is to be wary of professionals who provide very long lists of areas of expertise in either problem-type or therapy-type. Being willing to work with a vast array of different problems and experiences is not the same as being highly trained or experienced in a particular field. If you are seeking help for a specific challenge or difficulty, consider whether you want to see someone with the training and experience to call themselves a specialist in that area, or whether you simply need someone who will not judge you, who will not give advice, and is willing to listen. The experience of each therapy is very different.
Many therapists will recommend an initial phone conversation, perhaps around 15 minutes long. This should be both free and non-obligatory (i.e. is not contingent on you booking an appointment), and provides you with an opportunity to ask any questions you might have, in addition to giving you an early sense of what it feels like talking to this person, and whether it would be useful to meet for an assessment.
The assessment is also an opportunity for you to get a sense of whether you can work with a particular professional. Although the assessment process is often structured very differently to therapy, we usually ask our clients to spend some time thinking about how they found the experience afterward before considering arranging a therapy appointment. Did you feel listened to? Supported? Safe? Accepted?
Another useful recommendation is to have a brief review of the therapy relationship several sessions in. We usually check-in with our clients around the 4th session – does it feel like we’re on-track? How are you finding the sessions? What is it like working together?
Considering your own identity and diversity can be helpful here too. For instance, would it be more or less difficult for you to work with a therapist who was much older or younger than you? Could your therapy experience be influenced by the therapist’s gender? Is having a therapist with knowledge of your own cultural background important? Part of considering a potential therapist is about which of these areas you and a therapist can work through, which differences may be strengths, and which may require a closer matching.
When thinking about your approach to seeking therapy, it can also be worth considering your own experiences of past relationships, particularly with people who have been in ‘supportive’ or ‘helping’ roles, particularly parents, teachers, colleagues, and partners.
How easy do you find it asking for help? Is there anything that happens when you are struggling or in need that you think could happen with a therapist?
Are you someone who downplays problems in order to feel ‘ok’? Or might you be someone who has been let down a lot and doesn’t want to get their hopes up?
We are all needy individuals who have experienced challenge and difficulty as part of growing up, and our experiences of being in need and of being helped (or not) will also influence how well things go when we seek out potential therapists.
There is no exact science that can definitively link you to the best possible therapist for your unique circumstances, and indeed it may take several enquiries until you find someone you feel you can work with. It is important to use information to be empowered by choice rather than limited by options. When people do not have access to choice, there is a danger that clients begin to tell themselves that they cannot be helped, or that they are somehow the obstacle to change. Often, the reality is that clients have never truly been given options around who they see and how they work together with someone. Many years of psychotherapy research into the matching of therapy and therapist ultimately reach the same consensus: when people are supported to get the matching right, they generally achieve their goals in psychotherapy.
