I am often asked, “How should I select a therapist?” Unfortunately, we must begin with practical constraints such as, “Is the therapist covered by my insurance?” “Is the therapist located near me?”  Once you have found some potential therapists then here is what I recommend to interview to see if the therapist might be right for you.

First, if possible select three potential therapists.  Call each one and while talking with each one ask the following question, “Can you describe to me how you work as a therapist?”  When the therapist is finished his/her explanation, if you understand how he/she works (you get it), then the therapist likely “knows” how to do therapy.  If the therapist’s responses leave you uncertain or confused, then that is likely not  a good match.  A skilled therapist can clearly state how he/she works.  If the response is unclear or vague, then it is likely the therapist does not have a solid foundation. Also, watch for therapists who tell you their goals but do not share how they accomplish them. For example, a therapist might say, “I try to establish a good relationship with my client.” While a good relationship is a critical aspect to therapy, this statement is a goal and does not express “how” the therapist accomplishes that. If a therapist makes such a comment then ask, “What is it you do that creates a good relationship?” Often therapists will respond that they “listen” which, of course, is important but what are they doing that shows they are listening and what else are they doing. Good therapists can answer these simple questions.

Also, research suggests that the specific “model” of therapy used by the therapist plays only a minor role in client outcome. While I struggle with this finding as I have a therapeutic bias that a blended “humanistic and cognitive behavioral approach” is superior to other models, the research suggests that models are equally effective, and it is other factors that contribute most to positive client outcome. The most important of these is the therapist’s ability to create a therapeutic alliance with the client. Basically, the relationship established by the therapist with the client is by far the most important factor for positive outcome. If you do not feel connected to your therapist, you are not likely to get better.

The second criteria (in keeping with my comment above and perhaps most important) is the answer to the question, ” Do I feel connected and understood by this ” therapist.  After a 10-15 minute conversation, you will have a “sense” of how it feels to talk with this therapist.  Trust your gut.  If your gut feels good, you likely have a match.  If your gut is telling you it is not a match, it most likely is not a good match.

Also of note is that years of experience, education and school attended, location of internships, etc. are much less important than how the therapist “feels” to you and if the therapist clearly expresses what he/she does.  If the therapist’s description of his/her therapy is vague, then he/she likely is uncertain about his/her approach.

Curiously, some research suggests that many therapists actually get worse with years of experience. They become more confident in their work (probably based on experience), but show a decline as they continue to make the same errors since they do little to evaluate their own skills. Therapists, as opposed to virtually every other performance based activity (such as sports, music, law, medicine, etc.) do not receive ongoing feedback on what they are doing. Therapists are rarely observed and given feedback as opposed to the other professions mentioned where feedback is ongoing.

Meanwhile as a modern note, I have a very strong bias against telehealth therapy except as a last resort. There are many reasons why therapy is best when in person. One issue is that in telehealth both the therapist and client are subject to easy distractions. It is more difficult to remain focused when you are not together in the room, and focus, especially that of the therapist, is a key aspect to the success of therapy. There can also be technical issues with audio or video transmission. From a legal and ethical perspective, the technology is subject to security breaches and potentially other people listening to the session. Therapists are required by law to ensure that the connection is secure.