How do I find the right therapist for me?

Many people delay starting therapy not just due to the difficulties navigating the logistical process but because they aren’t even sure what kind of therapist they want. How are you supposed to know who to choose? How do you know they’re going to be a good fit? How do you know they’re good at their job? It can be especially overwhelming for first time patients who aren’t sure what to look for.

The most important part of therapy is the relationship that forms between the patient and their therapist. The most skilled clinician in the world isn’t going to be able to get through to a patient without a strong therapeutic alliance. Patients have to give up maladaptive crutches they’ve been using for a long time and step out into No Man’s Land on their own, trusting that with the therapist’s guidance, they will make it out on the other side. Tools alone won’t get you there. The patient must trust the therapist. It will require confronting challenges and vulnerabilities that were previously avoided. Therapeutic work, particularly in cases involving trauma, will inevitably come to a point where the patient has to let go of something they are holding tight and trust the therapist’s perspective over their own. Substituting your judgment with someone else’s, even when you may not agree and even if it makes you feel scared and unsafe, is one of the most difficult parts of the process. You will be more likely to let go and embrace a new world if your therapist is walking beside you when you do.

Therapy looks very different from the other side of the couch, and providers know things about the process that are inaccessible from the patient side. Take a glimpse behind the veil and ponder some new angles you may have never thought about.

Different therapists have different process goals.

Many approaches have different ideas about what constitutes good mental health; there actually isn’t a universal definition of what makes a person healthy. At a baseline, therapy helps a person to improve their functioning. Mental health conditions are defined as impairments in emotional, social, and occupational functioning that significantly decrease the individual’s ability to manage the tasks of daily living. Some therapists focus on behavioral coping strategies to increase functioning, and may consider treatment successful once symptoms are alleviated and the individual feels confident in their ability to manage their day-to-day responsibilities. Behavioral therapy may not necessarily focus on emotions as a dominant indicator of well-being and may not base progress on how happy or fulfilled a person feels. A behaviorist approach may be fine if a person is primarily concerned with managing a normal life routine, but most likely will not be very helpful if a person has more introspective goals.

Someone who is more interested in deeper exploration and greater understanding of themselves, their wants, needs, and emotions should look for a therapist who emphasizes or seems comfortable with psychoanalysis. People tend to assume all forms of therapy grapple with complex psychoanalytic concepts, such as the ego, defense mechanisms, and the subconscious. But that’s not true! It’s entirely possible to provide therapy that never touches on any of these abstract concepts in assessing the patient. Entire branches of psychological thought can only be accessed after an intentional effort to understand the complexities of psychoanalysis. Being well-versed in psychoanalytic theory requires an extensive amount of separate, in depth study. Most counseling programs typically include training in behavioral interventions, so a psychoanalytic therapist is likely to know both. But a behavioral therapist may not, and it should not be assumed that they do. When a patient is disappointed that therapy seems to be more surface level than they expected, it’s likely the provider isn’t particularly specialized in or oriented to psychoanalysis. And that’s ok! Not all therapists prioritize a need for introspection the same way not all people do – who’s to say you have to in order to lead a happy, comfortable, or fulfilling life?

Therapists sometimes have certain specialties designed to attract the populations they are most interested in working with. Some therapists are more generalist, and others may prefer screening for potential patient needs that they know they are not well-suited for. Therapists are mindful of fit as well, and some may be more particular about selecting for patients who will maximize odds of successful treatment within their skill set. If a therapist tells you they cannot work with your condition(s) or level of care, this is not a personal rejection or an indication that your issues are particularly severe or out of the ordinary. Therapists have to know their limitations in order to provide ethical and competent care. Not every therapist can treat every condition. So it’s a good idea to decide whether your goals are more behavioral or introspective, and ask the therapist which orientation they prefer. (Tip: if a therapist seems unsure how to define or describe “psychoanalysis,” they probably do not place a heavy emphasis on its tenets in their practicing.) A person who is more concerned with issues of identity, trauma, emotional needs and self-actualization should look for a psychoanalytic therapist. Integrated Insight Counseling is a psychodynamic practice that prioritizes healing and growth in addition to behavioral management.  

Personality and fit matter a great deal.

It is a shared journey just like any other. 

One of the biggest concerns about picking the right therapist is fit. If personalities don’t mesh, therapy can feel like a chore for both parties. It’s perfectly ok to look for a therapist that you appreciate and like as a person, as well as find competent. Therapy is more impactful when the relationship is enjoyable and would be desirable outside of a professional context. If you feel like you don’t even like your therapist as a person, that’s a good enough reason to continue your search.

The best indication of fit is whether there is genuine bonding and attachment. While it is necessary to have certain boundaries that aren’t present in personal relationships, efficacy will be limited without true emotional attachment. Genuine bonding can’t happen unless people are sharing and mirroring each other for their real emotions. A good way to gauge this is how a therapist handles personal disclosures. Disclosure is a tool that, when used effectively, helps to foster attachment even within the constraints of the professional boundaries. The therapist shouldn’t be talking about themselves or their personal life because they are self-absorbed or want to be the center of attention – they should be carefully giving you authentic emotional content that you can relate and connect to without overstepping the boundaries of too much information. Effective disclosure helps the patient see the therapist as a person and the relationship as more real and less transactional. Therapy is a temporary and professional relationship, but it should still be a real one. The relationship may need to end some day in ways that wouldn’t happen with chosen friendships, but the feelings of what make a relationship work should be the same. That’s the real caring and connection of authentic attachment based on the unique personal bond fostered between two people as individuals.

The therapy relationship is one of reparenting. Emotional and relational unfulfillment often come as a result of parenting that lacked proper boundaries. The parent may have been either too intrusive, too distant, or alternately both. If you feel like emotional sharing results in the therapist being overwhelmed by your feelings or you become overwhelmed by theirs, this is a sign that the rhythm of give and take hasn’t found the right balance of over- and understimulation. Meeting emotional needs requires meeting people where they are and backing off before becoming intrusive. We feel most seen when our boundaries are respected and can trust that the other can intuit them without being told. Be mindful of sessions having a good mix of difficult work but also all the other elements that make relationships worthwhile – fun, laughter, genuine interest and curiosity, and nonverbal understanding. It should not always feel like work, and you should not always have to work to ensure the therapist “gets it.” If it feels like you explain yourself a lot and often leave session feeling frustrated or misunderstood, it’s probably not a good fit. You should feel you’ve gained more understanding, not less.

Therapeutic ruptures require relationship management.

Reparenting is a correction of misattunements in the parent/child relationship. In the normal mirroring process between mother and child, the infant projects his emotions outward: love when he is cared for, aggression when his needs are frustrated. Mother is supposed to accurately recognize them and then, with her own emotions, project the mirror image of what he gave her back at him. When it’s love, he gets love back so he gets double the love. When it’s aggression, what mother is supposed to do is give him back a mature, neutral reaction to his infantile rage so he doesn’t get the same intensity of his aggression back. What he gets instead is a more manageable, soothed, and toned down form. The infant ends up with a surplus of positive love emotions and tolerable, modulated aggressive emotions. He will end up biased with positive affect and love and trust for others as the general root of his temperament and personality. The therapist cannot match your anger or frustration and argue and fight back like a friend might; they must contain your negative emotions, understand them, and give them back to you in a more tolerable form. They should not be amplifying them. This teaches better emotional control and regulation just as a form of relating. They cannot give you what you need if what you need is to argue back and forth; you must still feel heard even when you and the therapist disagree.

Ruptures and disconnection are the result of failures of empathic attunement. This happens when one does not accurately perceive, understand, or respond to another’s emotions. Responding empathetically maintains a sense of harmony that reflects understanding and acceptance. When someone can’t connect with or accurately interpret another’s emotions, they may be confused, not paying attention, or defensive. The feeling of falling out of sync and not being seen and heard can be very hurtful, especially to people who are sensitive to feelings of rejection. It can trigger feelings of neglect and invalidation, making a person feel meaningless. Over time, repeated failures of attunement create emotional distance, insecurity, and mistrust. Insecure attachment, low self-esteem, loneliness, and feelings of worthlessness are all rooted in persistent misattunement - when the other person continually gets it wrong.

This is obviously not good for the therapy relationship. If empathic failures happen too often, therapy is hurting, not helping. It’s repeating the same traumatic injury of not being seen that causes sensitivity to rejection in the first place. It reinforces a belief in one’s worthlessness. Many patients start to withdraw when they feel failures of attunement and are more likely to end services. However, it’s also important to recognize that in a good functional working relationship, failures and ruptures should be given the opportunity to be repaired. The therapist should be adept at recognizing and addressing failures, without always needing the patient to point it out. For the patient’s part, they must accept at the outset that mature and reciprocal relationships do not require perfect empathic attunement. The other person in any relationship is going to occasionally fall short and disappoint. The patient needs to be prepared to work through those feelings of rejection, if they wish to truly trust the therapist, and recognize that it’s not fair to expect the other person to always get it right every time. The therapist will sometimes get it wrong, and it is in fact this need for both parties to adjust that builds secure attachment. When the other gets it wrong, we must first attempt to correct them and help them learn how to get it right. People don’t always know how to please you, and should be glad for direction. Relationships are a two way street. Both parties must exercise agency to goal correct and remain in sync.

How to get the most out of therapy.

Therapy is not all tears and deep dives into pain. There should be a broad and flexible range of session content that doesn’t feel repetitive and gives the sense of increasing depth and complexity over time. Each successive session should be driving further ahead building on information learned and progress made in the sessions before. It should not feel like stalling or going in circles without any movement.

Here are a couple of things to focus on in order to maximum the benefits that therapy has to offer:

Collaborative goals: Not everyone comes to therapy knowing explicitly what they want to work on, and this can be puzzling for patients to figure out. Regardless of the patient’s intentions, the therapist can help to identify goals and needed areas of improvement, including things the patient may not have awareness of, adding additional goals based on practice philosophy. The patient should ask for clarification if they are wondering how the therapist’s approach is going to benefit them, and the therapist should be able to elaborate cogently.

Challenge assumptions and preexisting beliefs: It is a big waste of everybody’s time to show up to therapy every week only to argue and justify what you already think and believe. Many times people get stuck because they can’t see their life from multiple perspectives, and defending and justifying the one they already have just prevents change. You should approach therapy as an opportunity to question what you believe and why. You should be willing to explore other perspectives that conflict with or contradict your own. You do not have to give up the beliefs you already have; therapy is a place to set them aside and explore new and different ways of thinking about them. If in the end you decide your original position is most appropriate, then you may adopt it again – but you must explore other ways of thinking about it first. There is no one “right” way of looking at things. Therapy should add additional perspectives resulting in more flexibility in how we perceive things. This helps us tolerate ambiguity, question preconceived notions, and gain multidimensional perception.

Expect to actively access more vulnerability: If you are not ready to trust another person, you are not ready for therapy. Period. To go into therapy hoping to change without having to take on any emotional risk is the same self-fulfilling prophecy preventing emotional fulfillment in the first place. We cannot expect to derive any benefit from any relationship without being personally involved, withholding our real selves and hiding from being seen. You will not benefit from therapy if you do not risk emotional contact, and you will simply reinforce the disappointment that is causing you to hide your true self in the first place. You will have to be willing to step into No Man’s Land and hope for the best. Of course, this is why you want the best fit in the first place. So you can trust the risk will work out. Therapy simply will not work without trust and vulnerability.

Feel free to direct the session: A good therapist will be able to spin up something worthwhile even if the patient can’t think of anything to say. But it’s also perfectly acceptable for the patient to come in prepared to dig into some specific concern they have, and to ask the therapist if certain things can be explored. Exercise your agency. If you would like to analyze your dreams, there’s therapeutic benefit in that too. If you want to workshop a specific event, introduce it. If you have doubts about your interpretations and the work itself, ask. If something isn’t working, bring it up. A good therapist will welcome your feedback and the opportunity to adjust. Be mindful that sometimes the therapist will have to direct sessions sometimes for assessment and treatment interventions that will take time away from your immediate concerns, and that every session cannot always be about life or emotion management – and a therapist should not allow them to be. You both have a job to do, not just one, and this helps to foster mutual accountability.

Take the work from in the therapy room outside of the therapy room: This is something crucial that people don’t really think about often. Participating in therapy is trying, but it’s only half the work. The lessons learned in the therapy room have to also be applied in the person’s real life and relationships. It’s not enough to work through them without applying what is learned to change the way of doing things. If you feel you aren’t deriving much benefit from therapy, question whether you are implementing the tools and insights you are learning in observably actionable ways with friends, family, and work. If you are struggling to figure out how to do so, ask the therapist directly. It doesn’t always come intuitively how to translate therapeutic progress into real life progress, and it can help to talk through specifically how and what those changes might look like.

Overall, therapy should be a journey where you are in the driver’s seat; the therapist is just sitting in the back helping with the navigation. Therapy is a partnership, and the right therapist will empower you to heal, grow, and thrive. Take the time to find a therapist who feels like the right match for you—you deserve it.

Book a session with Integrated Insight Counseling today.