The prospect of beginning therapy can be a daunting one. Admitting that there are problems in your life, behavior, and/or relationships that you cannot resolve on your own is humbling, and this factor alone prevents many people from seeking professional help. However, it is far from the only roadblock impeding a therapeutic journey.
A question I often get in both my personal and professional lives is, “How do I find the right therapist?” As someone who has been in therapy multiple times myself, I know firsthand the confusion and stress of trying to find a clinician I feel comfortable with. There are so many different therapists out there, all of whom seem to specialize in a different type of issue and claim that their modality is based on one of many different acronyms ending in “T”. That is before you try to wrap your head around the difference between social workers, counselors, doctors, and limited licenses. While searching for a new therapist, I often found myself at the point where I finally just give up and call the next therapist I find with a blurb in Psychology Today that seems to fit my needs and whose headshot is not too intimidating.
Unfortunately, this whole process may be rendered moot because of the high demand for services. Currently, many clinics are receiving more requests than they can fill at once, meaning that many of us will be left to idle on a waitlist for months while we wait for the next available clinician. When you consider the possibility that after going through all of this trouble you may still end up with a therapist that does not meet your needs, the thought can be extremely discouraging. What do you do at that point? Do you force yourself to commit the time and finances towards a therapist that you do not connect with, or do you sign up for another waitlist and begin the process all over again?
I have heard countless horror stories about people having poor experiences in therapy (I have also had a few of my own!), and these generally start with the therapist. Whether they come across as judgmental, are horrendously unethical, or simply don’t seem to “get” you, a poor therapist or finding someone who is a poor fit for you can derail your healing process. Unfortunately, it is difficult to know prior to meeting whether a therapist will be a good fit for you, but my hope is that after reading this you will have an idea of what to look for in the beginning stages of therapy and how to make an informed decision as to whether your therapist can meet your needs.
Possibly the most confusing part of finding a therapist is trying to wrap your head around different modalities that therapists use. Seeing terms such as CBT, DBT, ACT, EFT, psychoanalysis, eclecticism, and countless others might make you feel like you need to take a psychology course just to understand what type of therapy you want to try! While it is worthwhile to have some sort of understanding of all of these methods, I want to emphasize that this does not need to be a be-all-end-all situation. Research shows that most common methods of evidenced-based practice (such as the modalities shown above) are more or less equally effective in treating most psychological conditions when used by skilled therapists, regardless of their type of license. That is because all of these methods share certain similarities. After analyzing these methods, researchers identified Four Common Factors that are present in nearly every example of effective therapy: Unconditional Positive Regard, Empathy, Therapist/Client Relationship, and Genuineness. Looking for these in your sessions with your therapist is the best way to determine if you have found someone who is a good fit for you.
Unconditional Positive Regard
No one wants to feel judged after finally mustering the courage to share their most embarrassing, shameful, and difficult experiences and thoughts out loud. Being vulnerable in therapy is a risk; you are letting someone see your true, unfiltered self and trusting/hoping/praying that they will not throw it back in your face. The therapist’s office should be a place where you can drop the pretenses and masks you wear in your daily life without fear of backlash or criticism. Therapy simply cannot work if that is not true, and it is the therapist’s responsibility to listen and respond in a way that makes you feel safe to be yourself.
That is not to say that your therapist will not challenge you or point out patterns that undermine your progress towards your goals. However, the difference between hearing “that was a stupid decision” (actual example of what a real-life therapist told my friend!) and “it sounds like that choice did not have the outcome you wanted” is enormous. An effective therapist will observe and challenge, but never criticize. If you gifted your therapist with your trust and received ridicule in return, a breakup is in order.
Building on the previous factor, unconditional positive regard is not possible without empathy. When you sit down for a session, ask yourself this: “Do I feel like this therapist has a grasp of how what I am sharing is affecting me?”. Note that pure understanding is not possible unless we therapists somehow find a way to live inside our clients’ heads, but that does not mean that they should not recognize the gravity of what clients share.
A key component of empathy is active listening. Does your therapist’s behavior in session communicate to you that you are their number one priority during your meeting? Are they making eye contact, are they showing that they are acknowledging you, can they repeat back what you are saying?
The simplest way to check for empathy is considering whether your therapist makes you feel like they care, and that you and what you have to say is important to them. As the client, you should feel valued and that your unique self, strengths, and struggles are recognized.
When you think of “congruence, consider it is as “genuineness”. Essentially, this is a therapist’s ability to be themselves. You can test for congruence by asking: “Is this therapist a real, authentic person in session, or does it feel like they are acting out a role in some boring therapist cosplay?” Does your therapist truly care about helping you? This may be the point that other therapists are most likely to take issue with in this post, but I believe that it is helpful for clients to see that therapists are also people with interests, cares, struggles, families, etc. That does not mean a therapist should monopolize your session time talking about their lives or problems (leave swiftly and decisively if they do), but rather they find ways to share a bit of themselves to you in sessions.
There are many ways a therapist can show congruence. This may look like your therapist starting a quick discussion with you about a shared interest, taking the time to learn more about something that you enjoy doing, sharing examples from their lives that show you they can relate to what you are going through, and, above all, showing that they genuinely care about you and want to make a difference in your life. These are some of the best indicators of a therapist that is not just working for a paycheck, but enjoys what they do and is excited about helping others.
Maybe you have a therapist who is very empathetic, genuine, and always makes you feel safe, but you feel like something is missing. What gives? The final, and possibly most important factor of positive therapy is your relationship with your therapist. You could be seeing the most skilled, caring clinician in the world, but if you don’t build a good relationship with them, therapist will be likely to fall flat. It is important to note that any relationship (be it with your spouse, partner, children, friends, coworkers, etc.) takes time to develop, and this is true of your relationship with your therapist as well. As such, this may also be one of the most difficult factors to gauge. It is natural to feel awkward towards your therapist at first; working through this discomfort is actually an important part of the process! However, if that discomfort does not fade you will find yourself stagnant in therapy. Here are considerations when asking yourself whether you have a positive relationship with your therapist:
Do we share the same goals? Your therapist should know what you want to accomplish and be actively working towards helping you achieve your objectives.
Does my therapist understand the importance of my culture? Your therapist should show an understanding of your cultural background, upbringing, and values. That does not necessarily mean that you have to find a therapist of a similar age, race, gender, sexual orientation, etc., but this can be helpful. Ultimately, your therapist should recognize your individuality and do their utmost to understand what makes you, you. They can only be effective if they understand how you experience the world.
Can I trust this person? Simply put, does this person make you feel comfortable enough to disclose personal, private, and potentially painful information?
There are obviously other considerations when it comes to building a relationship with a therapist, and it can be difficult to define. However, the beauty of having a positive relationship with your therapist is even if you can’t quantify it, you can usually tell when it is there.
I want to emphasize that these four factors are your therapist’s responsibility to cultivate, and that it should be a red flag if any are not present in their practice. However, before you ghost your therapist, I would recommend that you communicate your discomfort or frustration to them. The overwhelming majority of clinicians care more about giving clients the best help possible than we do our egos; it should not hurt our feelings when our clients share their needs with us. If you decide that your therapist is not the fit you need, communicate that as well so that you can receive help in finding the match you are looking for. Therapists recognize that we will not be the perfect fit for every client that we see; therefore, you should not feel the pressure to be the perfect fit for your therapist.
TL;DR: The Conclusion
The best way to summarize the four common factors is that your therapist should make you comfortable enough to be yourself. Trying to begin therapy is hard enough without stressing about whether CBT or DBT is your ideal modality. Start by finding a therapist that shows you Empathy, Congruence, and Unconditional Positive Regard, and builds a Positive Relationship with you. As time progresses, you may learn more about what type of therapy you prefer and the type of personality you need from a therapist, but I would advise not stressing too much about that if you are just starting therapy. Odds are, if the common factors are present, the rest will follow.
If you have further questions, feel free to reach out to me at firstname.lastname@example.org. I plan to continue this series with blog posts about what your therapist’s process may look like, what your role as a client is in therapy (because you aren’t entirely off the hook!), and distinctions between different types of licenses. Stay tuned!