Embarking on the search for a therapist is an act of bonafide courage. I know this from experience, not only as someone who fields calls from nervous-sounding prospective clients, but also as someone who has, on many occasions, sought therapy myself.

A story about the latter: Years ago, when I was in graduate school, I embarked on a quest to find a therapist. It’s something we’re required to do as part of our training so that we know what it’s like to sit “on the couch”, but I was also looking for someone to help me manage some life stress, both in and out of grad school. So I picked up the phone and made some calls. The first person I spoke to was very pushy about my setting an appointment, and feeling bullied into it, I did. I went to one session, felt unheard and misunderstood, and declined to schedule a second one.

If I weren’t an aspiring therapist myself, that might have been the end of the story, but I needed to believe in the process of therapy. Furthermore, I needed someone to sign off on my personal therapy hours so that I could graduate to the second year of my Masters program. So I kept looking. It was hard, and it was frustrating. One therapist stood me up for our second session and then made excuses rather than apologizing. Another spent 15 minutes of our first session telling me about how devastated she was that her daughter was hoping to go to college in New York.  Six therapists later, the story has a happy ending: I found someone who I felt understood me and was able to help me with the concerns I brought in, and I saw her for a year and a half.

I’m telling you this not to dissuade you from embarking on this process, but because I want you to understand that when I say that the decision to look for a therapist is an act of courage, I really mean it.

There are a lot of therapists out there. Some are very good, and some are very bad – unprofessional, unethical, disinterested, even exploitative. But most therapists are not really bad. Most therapists follow ethical standards to the best of their ability, consult with colleagues if they feel stuck, and bring their personality and their skill set to their work in the most healing and helpful way possible. So why, then, can it be so hard to find a good fit?

 

Because therapy, at its core, is a relationship.

What does that mean? In short, it means that although there are over 700 different “therapeutic orientations” or perspectives that mental health professionals align themselves with, a meta-analysis of several of these found that there was only one factor that actually effected real, lasting change in therapy. That factor was not the specific words that a therapist used, or whether their interventions had been scientifically validated as evidence-based. Here’s the ONLY factor that made a difference:

The client felt positively about the therapeutic alliance. Or, in layman’s terms, the client felt that their therapist liked them, did not judge them, was honest with them, and valued them. And this makes sense… because while some of the therapists I saw on my aforementioned quest were really unprofessional in a way that I found off-putting, most of them, I felt, just didn’t “get” me.

If a therapist doesn’t “get” you, it could mean that they don’t understand (or have a willingness to understand, or the ability to understand) your perspective on your problem that brought you to therapy in the first place. But it could also mean that while they’re very experienced or knowledgeable about your presenting concern, they just don’t understand something else about you – part of your identity, your background, your generation, your culture, your worldview, the way you live your life. And sometimes a lack of knowledge is okay.  Some therapists may say, “you know, I’ve never worked with a first-generation Iranian-American who identifies as a lesbian… can you tell me what that’s like for you?” And if that’s handled respectfully, that therapist might still be a good fit.  But sometimes, often for a reason you might not even be able to put your finger on, something just doesn’t “click.”

Finding a therapist can be a bit like dating. You may need to try several people before you find something long-term, and even someone who’s wonderful might not be the right fit for you.

 

Some suggestions:

I wish I could give you a fool-proof formula for avoiding these pitfalls and finding the perfect therapist off the bat, but there isn’t really a secret way to do this. What I can do is give you a few tips:

1. Use available search tools.

The best known of these is the therapist finder on Psychology Today. This is the largest directory of therapists in the United States.  You can search by specialty, location, fee, etc. Another good directory is Good Therapy.

If you’re looking for a therapist that specializes in something in particular, type that into Google. It may lead you to a specific therapist, or to a directory that specializes in what you’re looking for.  You may also consider asking friends and family members if they have any recommendations of therapists they know personally or have had their own positive experiences with.

2. Contact the therapist by telephone rather than by email.

About 75% of the inquiries I get from clients who want to schedule an appointment are by email rather than by telephone. I’m more than happy to respond to these inquiries, but always ask to speak to the client by telephone prior to our first session.  I want to evaluate whether I can help them with their presenting concerns, and I also want the opportunity to verbally connect.

Calling rather than emailing also gives you the opportunity to discern what the therapist’s first reaction to you is. When you ask someone by telephone if they can help you with Problem X, you can tell a lot from their tone of voice – whether they enthusiastically say, “oh yes, I love working with people who are dealing with Problem X! I’ve done a lot of that!” or whether they respond in a way that makes you feel judged or unconfident. This initial response to your query can give you a lot of information right off the bat.

3. Take full advantage of the phone consultation.

Most therapists will offer you some phone time to assess whether they feel they can help you, and to help you evaluate whether you feel they’re a good fit. When you’re talking with someone you’re considering going to for therapy, ask open-ended questions (something that requires more than a “yes” or “no” response) and trust your gut. Some examples of questions you might consider are:

  • How would you help someone who is dealing with my problem?
  • What is your experience with and level of knowledge about X problem/diagnosis/lifestyle?
  • What is your philosophy of how people make changes in their lives?

By asking probing questions, you can make an educated decision about whether someone is likely to be a good fit for you.

4. Out yourself, if possible.

This one is hard.  It requires a great deal of vulnerability, and people often go to therapy to talk about things they’ve never discussed with anyone before.  But when possible, this is also the best way to evaluate whether a therapist is going to be able to help you.

Here’s what I mean by “out yourself”: That thing you’re most nervous to tell the therapist you’ll be working with? If you can, tell them on the phone. If that’s too hard or overwhelming, ignore suggestion #2 and tell them in an email.

These might be things about your identity, such as:

  • “My family doesn’t know this, but I identify as transgender.”
  • “I’m a black woman, and I felt like the last white therapist I saw didn’t believe me when I talked about microaggressions.”
  • “I’m in a polyamorous relationship.”

(Bonus points – you can also evaluate, when you disclose things like the above, whether your therapist knows what these words mean.)

Or things about your history or a problem you have, like:

  • “I struggle with an eating disorder.”
  • “I was sexually abused as a child.”
  • “I just got out of jail.”
  • “I’m addicted to methamphetamines.”

If you have a secret you’ve been carrying your whole life and don’t feel able to tell a stranger, that’s okay. Hopefully, through working with a supportive therapist, you’ll be able to get there over time. But if you feel emotionally able to, it can be really helpful to find out off the bat if a therapist is going to be able to hold what you’re handing them. If a therapist doesn’t have the experience, training, or personal belief system to effectively support you through what you’re dealing with, it’s much easier to figure that out early than after six months of therapy.

5. Trust your gut.

At the beginning of this article, I told the story of my own lengthy and frustrating search for a therapist.  I made an appointment with the first therapist who returned my call because she was very aggressive about getting me to set one, but I knew going in that I wasn’t going to feel very comfortable with her.  Ultimately, when you’re looking for a therapist, you need to feel good about your choice.  If your gut tells you something isn’t going to work out, it probably isn’t.  Hold out for a therapist that makes you feel excited about taking the important step to make positive changes in your life.  That person is much more likely to be able to help you.