When you seek help from a mental health therapist, you’re vulnerable. You’re opening up about issues you may never have discussed with anyone else and putting it all on the table. With conditions such as depression, anxiety or post-traumatic stress disorder, your therapeutic relationship could last weeks, months or longer. So it’s important that your therapist is not only professional and competent, but also the best fit for you.
Treatment style, personal chemistry and your individual goals all play a role in making a good patient-therapist match. Here’s what to look for when choosing a therapist and assessing whether your therapist-patient relationship is still working out over time.
Basics. You want to know that your therapist is qualified to treat you. “This may sound very basic, but make sure they have a license,” says Anita Gadhia-Smith, a psychotherapist who practices in the District of Columbia and Bethesda, Maryland. “If you’re seeking help with mental health issues, you want to make sure that the person that you’re working with is credentialed and licensed in some relevant capacity.” It’s fair to ask about training, she adds, as well as checking their website for experience and credentials.
Practicalities. Is therapy accessible and affordable? Check your mental health coverage and what types of insurance — if any — your therapist accepts. Both practical and clinical issues need to work well for you, Gadhia-Smith says. “If you’re going in person, you’ll need to be able to get there without enormous difficulty,” she says. “That might be an important factor.”
Comfort and trust. You need to feel comfortable with your therapist and trust that they have your best interests at heart. “You want to make sure the therapist you’re speaking with is someone that you feel you can be completely honest with,” says Gidget Smith, a marriage and family therapist and CEO and director of Etsah Solutions in New York City. “And you can tell within the first five minutes. How? Their demeanor, their response and listening to what you state as your reasoning in pursuing therapy.”
Empathy, understanding and listening. In order to confide in your therapist, feeling understood and at ease is essential. “It’s really seeing if they’re welcoming,” Smith says. “Even if they weren’t your therapist, you would still feel comfortable talking with them about anything.” With that kind of connection, she says, “That would make me feel: You know what? I need to talk to this person next week, or the next hour or next day.” On the other hand, she says, if you meet with a therapist who seems stiff, or not really listening or engaged, you might have to reconsider whether pursuing therapy with that individual is worthwhile.
Impartiality. When counseling couples, it’s important that both members feel heard not judged. “You want to make sure that both of you are in sync with the therapist you’re talking to,” Smith says. “Because once you have one person feeling more comfortable than the other person, then you’re already starting with an imbalance. You’re now no longer going for yourself, you’re going for your spouse, and then you won’t really have a successful, productive session to deal with the deeper stuff.”
Personality mesh. Personality traits to look for in a clinician can differ from patient to patient. “What’s important is to really know thyself here,” says Jeremy Tyler, an assistant professor of clinical psychiatry at the Center for the Treatment and Study of Anxiety at University of Pennsylvania. “Think about what you would really want in a person who’s going to be your therapist — because we all have very unique personalities. As a therapist myself, I bring my personality to that table. There’s still a level of professionalism, but there are going to be individual differences.”
Chemistry. Chemistry is the intangible that influences any relationship between people. Finding out if you and your therapist share chemistry early on is important, Gadhia-Smith says. When that’s the case, “It feels like a good fit, and you intuitively feel comfortable with the person,” she says. “Because chemistry is something that’s hard to predict. And just like all other relationships, chemistry matters.” You can get a good sense of chemistry in your first appointment, she adds, or even by a phone conversation. “Sometimes just speaking with someone briefly can give you a pretty good sense of whether you enjoy talking to them.”
Therapy type. Are you looking for psychoanalysis where you explore deep-seated roots of mental health issues dating back to your childhood? Or do you want a more solutions-based focus using certain tools — like cognitive behavioral therapy — to help you overcome a specific challenge or hurdle? Talk through the therapy types with a potential therapist, who can explain all the details and nuances. It can also help to educate yourself on therapy types for a better sense of what fits your needs in advance, to help narrow down your options.
Communication style. Do you want to be challenged to move forward in therapy or bask in warmth and support? “Someone who is more direct is going to call you out when they really think that they see a problem, and they’re going to be more blunt and to the point,” Tyler says. “The reality I find is that some people like that, and that’s what they need and want.” For example, he says, a patient with social anxiety may continually insist “I just can’t go” to social gatherings or the grocery store. “A more blunt response to that might be, ‘The more you avoid that, the worse it’s going to get. So we really need to come up with a plan that’s going to get you into those situations as soon as possible.'”
Goal-setting. Setting goals can help in gauging your progress. “It’s up to you as the patient to determine what your goals are,” Gadhia-Smith says. “The therapist can help you clarify that. But you should probably have some sense of what you want to do in therapy or what you want to get out of it in order to really assess whether the person can give it to you.”
Signs of progress. Progress won’t happen overnight, but you should see signs as therapy continues. How long that takes depends on where patients are when they enter therapy, Gadhia-Smith says. “So there’s not really a formula,” she says. “But as long as there’s gradual, incremental progress and steps in the right direction, that’s enough to continue and keep it going. Some people will progress more quickly than others. Some people are at a point of readiness for change, and others need some time to get there.”
Feedback loop. You should feel empowered to give your therapist feedback on how they’re doing, says Tyler, who also trains and supervises other therapists. “I encourage them to ask for feedback, especially early on when they’re starting to meet with somebody, like the first, second and third sessions,” he says. “You’re checking in to make sure you’re not unintentionally doing something to make the patient uncomfortable.” If so, he says, “It’s OK — we can adjust our style.” That’s not necessarily an easy conversation for patients to start. “Understandably, it’s hard for patients to give super-honest feedback in person,” Tyler says. However, by communicating about any issues, “You could move past that and have a really therapeutic relationship. Or it could be a reason to change directions and just go with a different therapist.”
Cultural connection. If you’d prefer to work with a therapist whose ethnic, racial, gender, orientation, age or other demographic background is similar to yours, you can seek that out. For instance, “I’m Black, — which a lot of my clientele has been seeking, especially after COVID and all these different things happening,” Smith says of her Etsah Solutions patients. Similarly, she says, “When a Caribbean patient sees me, they may feel more comfortable because I have an understanding of who they are or what their mindset may be, versus someone who does not know the culture.” However, she sees a wide variety of patients from multiple racial, ethnic, gender and religious backgrounds. “So it’s really finding someone you feel comfortable with — I don’t think that it’s always necessarily the gender role or race role.”
Inner motivation and commitment. The more you’re willing to put into therapy, the more you benefit from it. “You need to check your own motivation to grow,” Gadhia-Smith says. “Ask yourself if you’re really ready to do this — because it’s a time-consuming, expensive proposition. It requires a commitment on your part to really get something out of it. People who come for a few sessions and leave usually don’t get that much. You have to stay and work through some things and give it some time in order to make real and lasting change.”
Evolving relationship. Therapy is a process, and therapeutic relationships evolve. Before hitting the “eject” button, give it a chance, Tyler suggests. “It’s an important process that requires a lot of input by you,” he says. “So try to really meet the therapist where they are and be honest with them. If it ultimately doesn’t feel right to you, it’s OK to let them know that, too.”
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Update 03/22/22: This story was published at an earlier date and has been updated with new information.