Updated: Aug 27, 2020
Ultimately it's a question of "fit," feeling" and availability.
QUESTIONS TO ASK BEFORE YOU MAKE AN APPOINTMENT
Outside of “I have this specific insurance and this is the only therapist with available time” there are sometimes other things to consider when choosing your therapist.
Obviously, some logistical questions are good to ask. Do they have openings? Does it fit your schedule? Can you afford their fee? Can I get to the office with public transportation? Do they offer remote teletherapy? Are they flexible with cancelations? Do they see people with my specific issue?
IS THIS A RELATIONSHIP I WANT TO BE IN?
The most important way to think of therapy is that it is a relationship. In fact, I once said that to a patient and she became extremely uncomfortable. Not only was she extremely relationship averse, but she also had a very limited view of what relationships actually are and can be, particularly healthy ones.
In its simplest form, a relationship is two people who are "in the state of being connected." Connection. In all its complicated and beautiful glory, you want to have a connection with the people in your life. We are relational beings. Even if we do not want to be. Even if we avoid them, sabatoge them and resent them. Relationships make up our lives.
I know that at the coffee bar I go to, there is one barista who absolutely starts my day on the right foot. Actually, the ritual of walking my dog to get coffee generally starts it off pretty good. But I smile immediately when I see a certain employee. I don’t seem to mind if the line takes longer. My transaction takes an extra minute or two because we exchange pleasantries that have becomes somewhat more involved then simply if I want a single or double. She does not know my name but she knows my dog loves the dog treats she gives her. She makes me feel noticed, remembered, special. And, if possible, my flat white actually tastes better. If my day can be so affected by my barista, how much more important is the connection between the person who sees me at my most vulnerable and gently guides me to a better version of myself?
HOW DOES IT FEEL?
From the moment you call to book an appointment, to the waiting room, to the initial “hello?” These things all have the opportunity to make you feel more comfortable and safe or sometimes less so. Maybe you felt they were impersonal on the phone, maybe you find their waiting room sterile or maybe you just didn’t really feel any warmth. Or maybe you sat on their couch, wondered how the two of you weren’t friends already and pinched yourself for waiting so long to book an appointment.
When I first opened my private practice I had to sublet an office from another therapist. Good news, it was an affordable option when I didn’t have any clients yet and it was furnished and ready to go. The problem, it wasn’t my furniture and it wasn’t my style. She was someone not concerned with esthetic. She believed in putting the least amount of herself into the decorations so it could be a blank slate, which was aligned with her theoretical orientation. But to me it felt sterile. I didn’t even feel at home in the office. How could I expect my patients to get a good feeling for me? In fact, when I finally moved to another office I decorated myself they could not believe the difference. It was clear that my own office was more congruent to my personality. It fit better. And it just made an overall better experience for my patients and myself.
DOES IT SEEM LIKE A GOOD FIT?
Therapists generally practice using certain modalities. Or at least a combination thereof. Many are fairly interchangeable but there can also be found a distinct difference between some. Many patients never even realize that the therapist is using a modality at all, unless they specifically inquired.
Therapists that practice from a psychodynamic background- think Freud- will likely ask you many prompting questions. They may provide little verbal feedback and little to no personal information. They would like to uncover the psychological forces behind your emotions and distress.
Some may operate from a family systems background. You may find yourself working with your therapist the first few sessions developing elaborate genograms illustrating your family patterns and defenses.
Some practice more cognitive behavioral therapy or dialectical behavioral therapy, and you may find yourself filling out worksheets, encouraging you to carefully consider various thoughts throughout your day and analyzing your behaviors. They may as you to experiment with new behaviors and new thoughts.
Some practice from a humanistic standpoint and it will become clear that they already believe you have an inherent ability to heal. They see you with unconditional goodness. They will see your humanness and encourage you to do so too.
Some will practice Acceptance Commitment Therapy, Emotionally Focused Therapy or Mindfulness. They will help you gain awareness of your emotions. They may ask you to sit with negative thoughts and learn to increase your tolerance to negative emotions. They may give you exercises to do in times of stress such as deep breathing.
Again, it is not necessarily super important to identify a modality, or to even care. But if you are someone who’s very true core belief is that mindfulness is “hippy bullshit” and you would prefer a tough “kick in the pants” (quote is from a real client) then you may prefer a solution-focused therapist or perhaps a life coach.
So, the best advice is to figure out if your styles align. Most therapists are trained in many modalities and can accommodate the patient. But I still believe we have certain expertise and modalities that fit our personalities better. I often share a little about myself. Maybe that I moved to a new city and had trouble making friends as well, or that I need to reschedule because I will be going to Europe with my family. I have visibly noticed the change in my patients when I tell them this. Some love the familiarity, knowing that I am a person too. Some get uncomfortable and its almost as if I popped a bubble of a blank slate therapist who fell off their high horse.
DO YOU LIKE THIS PERSON?
Finally, do you like your therapist? Do you think your therapist likes you? When I was a therapist in training I wanted to just learn the most effective modality. My teacher said the most important indicator of success in therapy is whether you think the therapist cares about your progress. So ask yourself that question. You will be investing in a lot of time together for the foreseeable future.
If you decide you like your therapist, awesome. That probably means they like you too! But if things come up in therapy like they ask too many questions, seem bored or you don’t feel you are progressing. It might not be because the fit is wrong, they might just need to know how you feel.
At the end of the day therapy is a relationship. You are basically starting as two strangers, from two different worlds, with different defenses, different approaches and different beliefs. Its not always easy to work together. (That is also how I start a couples session!). But if you come with a feeling of love and unconditional positive regard for the person in front of you then you can work out the other things.
I have expertise in certain human responses and you are an expert in your life. Our therapeutic relationship will be like no other relationship you will have. Not in your regular life and not even with another therapist. We create it, sustain it and move it forward. Its sacred, I truly believe that. There is not one moment that I take for granted the privilege of a complete stranger coming to me for help. Even though sometimes I know we aren’t the right fit.
Final word of caution. I have had clients that come in and tell me that they haven’t had good experiences with their last five therapists…that is likely an issue that is greater than a “fit” and you might want to stick it out with someone and see what that is all about.