The Ultimate Guide to Finding a Good Therapist
1. Why doing your research matters
The words “maybe you should talk to someone” have been repeating in your head. You’re starting to realise you might need some help and you’re considering therapy. Great!
Who you choose as your therapist is not a decision to rush though. Therapy requires a significant investment of time, money, and emotional energy. Clients who find the right therapist for them and have the right attitude towards therapy are far more likely to experience the change they’re looking for and leave therapy with a sense of achievement. Clients who aren’t able to do this are likely to experience uncertainty and ambivalence, and will either leave therapy with their goals incomplete or stay indefinitely but remain unsatisfied with the experience.
If you want to maximise the potential for successful therapy, then you’ve already taken an important step by choosing to read this post. The process of therapy starts before your first session and it really starts when you go looking for your therapist. Something is driving you to seek help, and if you take the time to reflect on that, you can figure out what you most need.
2. What kind of mental health professional do you need?
Credit: KMA Therapy
Firstly, you’ll want to be sure about whether you need to see a psychiatrist, psychologist or psychotherapist. Unless you’re looking for help managing medication, you’re unlikely to want to see a psychiatrist, as they are usually more focused on this aspect than on delivering therapy.
Meanwhile, both psychologists and psychotherapists provide therapy, but they often take distinctively different approaches to doing so.
For example, if you think you need an assessment (such as for ADHD, autism, or a mental health disorder) or you’re looking to address something in 10 sessions or less, then you may want to see a psychologist as the Medicare rebate can help to bring down the cost to be about the same cost as a psychotherapist.
However, if you’re looking to work on an issue that may take longer than 10 sessions, such as exploring the lasting impact of your childhood or finally addressing psychological issues that have persisted for many years, then it will likely end up being more affordable to see a psychotherapist (as they generally charge lower fees) and their training is more likely to be directed towards those issues.
However, more than anything you’ll want to base your choice of whether to see a psychologist or psychotherapist on the therapist’s individual character and approach, rather than what profession they are.
3. What kind of therapy is best for you?
Underneath it all, most therapies aren't that different. Ultimately, the therapist counts much more than their therapy.
If you’ve decided that you need to see a therapist, it’s natural to want to know a bit about what kind of therapy they practice. Be warned that it can be easy to overrate the importance of this though. While there can be a temptation to try to figure out what is the “best” therapy, the truth is that no such thing exists.
For example, while cognitive-behavioural therapy (CBT) is sometimes described as the “gold standard” of therapies, this is more reflective of the fact that it has a relatively shallow focus. CBT places little consideration on a person’s developmental history or a deeper exploration of their emotional structure, which means it is easier to implement for shorter periods than many other therapies and makes it more affordable and practical to study.
Numerous long-term studies show that other therapies, such as psychodynamic therapy or interpersonal therapy, are just as effective for many issues. Basically, at best, some therapies are better for some issues than others, but no specific therapy is the best for every person or for every issue.
There are hundreds of therapies and not one of them is “the best”
The one caveat to this is that if you’re confident you have a specific issue, it’s worth learning about which therapies have been specifically developed to address it. For example, EMDR, Somatic Experiencing, Sensorimotor Psychotherapy, and more are all designed to work with trauma and the body.
My own professional specialty is in resolving attachment issues, which are often the underlying cause of dissatisfaction and insecurity in people’s relationships, and contribute to many different psychological issues. So, I use the Three Pillar Attachment Repair Method, as it is the only comprehensive treatment designed specifically to help a person to develop a secure attachment style.
Describing which specific conditions are best suited by a specific therapy is deserving of its own post, but if you feel that this might be the case for your issue, then it would be worth seeking out advice from a knowledgeable person as to what’s more likely to help, or at least enquire as to whether the therapist you’re considering has been trained in something appropriate for that issue.
Again though, it’s best not to become overly focused on the specific model of therapy. As we will explore further below, research has found that the type of therapy is, most of the time, only a minor factor in determining the outcome of therapy.
4. Why the therapist is 40 times more important than the therapy
In fact, research suggests that the therapist’s character and approach is potentially 40 times (!) more influential on the outcome of therapy than the type of therapy they practice. Practically, this means most people should spend less time finding the best therapy and instead be looking for the best therapist (for them).
Why is it that the therapist’s professional character matters so much? Well, it’s a bit complicated but it’s very important. Understanding this will not only help you find a good therapist but also set you up with the right attitude to make the most of therapy. It’s based on knowing what makes all therapy work, regardless of which specific therapy you end up doing.
The universal qualities of therapy
It was first suggested as far back as 1936 that what unites therapies is more important than what separates them, and in the last few decades various academics have pointed to mounting evidence to argue this point. In 1992, Michael Lambert examined psychotherapy outcome research and found four areas of different factors that contribute to successful therapy. He also assigned hypothetical percentages to how much they were each responsible for the change that occurred during a person’s time in therapy. Later research sought to assign more exact percentages, based on detailed analysis of outcomes.
Michael Lambert found four areas of factors that contribute to therapeutic outcome. He argued the type of therapy was one of the least important.
Research since Lambert’s work has found different kinds of common factors, some of which he covered and others which he did not. While there isn’t a unified agreement on what the factors exactly are, some consistent themes have emerged. I’ve compiled the ones for which there are the most evidence below and I’ll explain what they mean for you as a potential client.
Let’s break them down one by one.
Extra-therapeutic change
What you do outside of therapy has a big effect on how therapy goes for you.
This is what is going on in your life outside of therapy. It’s relatively intuitive this should matter so much: most people spend just under an hour in therapy each week but 167 hours living the rest of their life.
So, one of the first things to understand before starting therapy is that it can’t fix everything and that what happens in the rest of your life will have the biggest impact on how you feel throughout your time in therapy. Knowing that therapy can only change so much means that it’s important to also put attention on other things in your life (such as eating healthily, exercising, spending quality time with loved ones, and all the other things that research has shown to be widely effective for improving mental health), and to think carefully about the kind of work you take on in therapy.
It might not be advisable to work on processing trauma when you’re in an unstable work situation or to try to repair attachment wounds when your partner is going through a tough time and needs your support. This doesn’t mean you should avoid therapy though! You just need to come to an understanding with your therapist that their job in this time is to focus on supporting you with emotional and practical resources rather than exploring your issues too deeply.
Common Factors
Therapeutic alliance: In terms of choosing a therapist, this is the big one. The relationship you build with your therapist will define therapy for you. When choosing a therapist, people often look for qualifications or training in certain therapies. A therapist’s professional manner and personality are usually more important than this though.
So, what does the research show?
Well, good therapists seek to:
Collaborate with their clients to create mutually agreed upon goals and a structure to treatment that is clear but not inflexible.
Attune to their client’s emotions, particularly when engaging in therapeutic interventions.
Accept their contribution to interactions, identify problematic issues in the relationship, and do their best to manage their reaction whenever therapy touches on something that affects them.
If a problem in the relationship arises, they quickly become aware of it, and proactively seek to resolve it and repair any damage done afterwards (which usually leads to a lastingly positive impact on the relationship).
See the client in a consistently positive light, don’t disclose too much about themselves, and are responsive to what the client shares about themself.
So, empathy, collaboration, and owning one’s part in the relationship are all important therapeutic attributes. So much so that I’ll go into each of these a bit further.
Empathy and collaboration are central to all good therapy.
Empathy: This might seem like an obvious need, but it’s more complicated than most people think. Some therapists are not very empathetic, which might work in a small minority of instances but usually limits the safety and growth that most people can expect. Other therapists are very empathetic but can’t communicate this in ways that are useful for their client. You should expect to feel understood by your therapist though, perhaps even more than anyone else in your life makes you feel. If you don’t feel understood by them, therapy is unlikely to go well. This might seem obvious, but I mention it because sometimes when therapy isn’t working it can cause clients to question whether they’re doing some wrong, when in fact it may be that the therapist is not doing a good job of understanding them.
Collaboration: Therapists should be working with the client, not for the client, from the start. Clients need to take responsibility for their change in therapy (more on that later) and therapists need to support them to do so. A good therapist should start by asking their client for relevant personal and historical information, then develop an understanding of the client that they share with them, and finally create a treatment plan that the client agrees upon. This shouldn’t be a passive acceptance of what the therapist suggests either! The client should feel empowered to disagree with the therapist when they haven’t understood something or when they’re not confident in the plan. The therapist should then continue to re-work their understanding and plan until the client feels confident in it.
Responding to client feedback: While some people might want to believe in a perfect therapist, in reality no such person exists. Therefore, every therapist should be aiming to grow for the entirety of their career. No matter however experienced they may be, no therapist will always respond in the right way to a client or know what their client needs without asking them. Therapy is a highly varied, imperfect endeavour, and therapists who aren’t open to feedback are very unlikely to create the specific conditions that each client needs. Therapist complacency and dogmatism may be why some research shows that early career therapists are more effective than their veteran peers.
You should feel confident that your therapist is open to hearing from you if you feel that things aren’t working and they should proactively seek out feedback on whether the work you’re doing together is meeting your needs. Basically, if there’s a problem you expect that they’ll address it (even if you do still sometimes need to be the one to raise it).
Facing your problems: Here’s a bit of a dirty secret about some clients (and their therapists): they don’t actually want to do what it takes to change. Unfortunately, successful therapy usually involves some sort of confrontation with difficult feelings and situations. Different therapies will focus on different areas, but whether it’s unconscious fears, anxieties, wishes, beliefs, feelings, fantasies, or real-life situations, research shows that facing them is usually linked to positive change. This may just be imagining the difficult situation or thinking about it - for example expressive writing is an effective exposure technique - but even if it makes clients feel negatively in the short-term it usually leads to positive long-term outcomes.
Mastering skills/taking action: While CBT might have its shortcomings, one thing it does do well is encourage clients to take action in their lives. As mentioned above, what happens outside of therapy will contribute significantly to the success of therapy. A good therapist should encourage their client to learn new skills, both in and out of the therapy room, and then begin to apply them in the rest of their life. Engaging in structured tasks to work towards goals is one reliable method for making therapy effective.
Exercise: reflect on what you need
So, now you’ve learned all this, reflect on what the right fit of these qualities is for what you most need at this time. Do you need someone more gentle, who will help you feel safe and able to relax more? Or do you need someone who’s more willing to challenge you and hold you accountable for taking action? Do you have clear goals for why you’re coming to therapy, or do you only have an intuition about why you need it, and so you need someone who can start by helping you figure out why you’re even there? Would it be good if they were male, as a complementary opposite to all the female support you have in your life? Might it help if they were older than you, so that they have a longer life of experience to draw on in providing advice, or around your age, so they can relate to you better? Think about the characteristics of someone who is going to help you feel driven to do the hard work of therapy.
Specific Factors
One study suggested that the type of therapy is only 1% responsible for whether therapy is successful!
These are the specific theories and techniques of individual therapies. Remember when I said that research suggests this isn’t that important? Well, Michael Lambert estimated the impact of the individual therapy as 15%, but follow up research found it to be as little as 1%! Again, if you’re experiencing certain issues, such as trauma, then a specific therapy may be a good idea, but remember that the essential lesson of this post is that the type of therapy is usually a lot less important than the type of therapist.
So, knowing all this, how do you actually find a therapist?
5. Practical tools to find a therapist
The most common methods to find a therapist are to ask for a referral from a GP, to look in an online directory such as Psychology Today or Good Therapy, or to seek out a word-of-mouth recommendation. Each one of these options has its own benefits and drawbacks.
Word of mouth: A recommendation from a knowledgeable person you trust is worth its weight in gold, but you’ll want to be sure there’s enough degrees of separation between you and any mutual contacts that the therapist might also be seeing, and in particular with the person who recommended them.
GPs: Mental health is the main reason people visit their GP, so they should be able to suggest someone, but GPs’ mental health literacy is variable and their recommendations are more likely to be restricted to psychologists. It can feel reassuring to see a medical professional for advice though, so if this is what you need to feel comfortable to explore your options then go for it.
Therapist directories: Directories will give you the most options to choose from and allow you to filter for specific attributes, but without a personal or professional recommendation it can be hard to really know what a therapist is like from their profile alone. Organising an initial call (which many therapists offer for free) can be a good way to test out a potential connection. Check out their profile or website to see if this is something they offer. Oh, and ask lots of questions about the important qualities mentioned above.
Psychology Today offers the largest therapist directory online
6. When to stick with a therapist and when to move on
It’s important to find a therapist you have confidence in. When you believe that therapy will work for you, it’s more likely to do so.
Expectancy
The final factor is about your hope or belief in the rationale or effectiveness of therapy. Basically, expecting that therapy will work helps it to work! Luckily, therapy can still work for those who are more skeptical - provided they get the right therapist. I’ve put expectancy at the end because how you feel about this will continue to develop after you start therapy.
Once you’ve found a therapist you think could be right for you, make sure you give them at least a few sessions to see how it goes. After three to four sessions, you should feel relatively confident and even excited about continuing with this therapist. If you’re feeling ambivalent by this point, it’s probably worth looking for another one, as your lack of confidence will reduce your motivation to work hard and trust in them (the expectancy and therapeutic alliance factors). While it can be disheartening to have to find another therapist after you hoped you’d found the one, staying with a therapist who’s not right for you is sunk cost theory in action. So if it’s been a few sessions and you don’t feel a ‘click’ with your therapist…
Keep looking! There are many good therapists out there, but they can be hard to find, as they often have a lot of clients because of their good reputation. However, they may have a waitlist for when a place in their schedule opens over time and there are also good therapists without a full caseload because their marketing and referral systems aren’t great. Keep looking through different channels and updating what you’re looking for based on what you did or didn’t like about your previous therapy. There may not be a perfect therapist, but there is a ‘good enough’ therapist for everyone; it’s just about the not-so-simple matter of finding yours!
Finally, an equally important part of therapy is deciding when to finish attending. While wealthy, neurotic New Yorkers might want to continue seeing their psychoanalyst three times a week for the next twenty years, most people are looking to get to a point where they feel they no longer need ongoing therapy, or at least that they can comfortably take a break. Ideally therapy should conclude when you feel a strong internal sense of change or that you’ve completed the goal you came to achieve, although sometimes you may have to decide to stop because you’ve realised you’re not going to be able to get what you hoped for, at least not with this therapist.
Final advice
One last piece of very important information! Once you’ve started therapy and you think the therapist you’ve found is the right one for you, it’s important you understand that you are also essential to successful therapy. A good therapist will also know this and play their part in helping you to see yourself in this light. Although the therapist may be an essential ally to help you come to terms with difficult emotions or to teach you a new skill, every client needs to see that their own courage, hard work, and openness are the vital ingredients that make change possible.
As I said at the beginning, the process of therapy has already begun for you. By reading this post and taking the time to learn about what therapist you need, you are already choosing to be the person you need to be to make therapy work. So congratulations, you’re off to a great start!
Good luck in your search and if you have questions about finding a good therapist, feel free to contact me.