A Primer on Choosing a Therapist

If you have (or have had) a therapist, how did you choose them? Finding a good therapist can be challenging! Sometimes clients ask me for help choosing a new therapist because they’re moving out of state. Or, they want to know how to support a friend or family member in seeking a therapist. And at the end of most of my posts, I mention seeking out a therapist, so you can personalize what you’ve read.

But how do you choose a therapist? Choosing a therapist can have strong emotional undertones: If you’ve never seen a therapist, you may have no idea where to begin. If you’ve had a bad experience with a therapist, you may be reluctant to try again. And if your last therapist was terrific, you may be worried you won't find a new therapist to replace them.

On top of that, therapy, like any other area of specialization, has its own language. Words like orientation, interventions, and certifications have meanings unique to the therapeutic world, and terms like cognitive-behavioral therapy and internal family systems are specific to therapy. Unless you’re a therapist, making your way through all the jargon can be challenging!

As a therapist, I believe there are two primary considerations in choosing a therapist: Whether their skills match your needs, and how comfortable you feel with the therapist.

I agree with the research that suggests the foundation of therapy is a positive relationship between therapist and client. However, therapists and clients can have a positive relationship, and still end up spending most of their time chit-chatting, rather than engaging in therapeutic work.

How does that happen? It’s usually a mismatch between what the client needs, and the skill set of the clinician. And because your potential therapist obviously doesn’t know much about you when you first meet, it’ll benefit you to know a little about therapy and therapists, so you can choose wisely when you’re seeking a new therapist. That way, you won’t waste months (or even years) with a therapist you like, but who doesn’t have the skills you need.

First, learn a little about your potential therapist’s orientation. A therapist’s orientation describes how therapists think people get hurt, and how people heal. Orientations are like roadmaps for therapists. They determine what therapists listen for as they’re listening to clients, and they provide therapists with guidelines for how to respond to clients.

There are over 400 orientations in the United States alone, so knowing every single orientation of them is unrealistic, and happily, unnecessary. What you can (and should!) do is ask your potential therapist about their orientation. Ask them how they see their orientation, and ask them to explain how that plays out in the work they do with clients.

If a potential therapist isn’t able to clearly explain their orientation to you, and how it will affect you as their client, that’s a bad sign. You’re considering therapy because you don’t have a roadmap. If your potential therapist doesn’t have one either, chances are good you won’t get to where you want to go.

Many clients stall out in therapy—that is, they’ve been in therapy for years and they’ve made a little progress, but now they feel “like I’m just talking to a friend.” Sometimes this happens because their therapist isn’t trauma-informed (we’ll talk about that in a moment).

It can also happen if the therapist is a good listener, but doesn’t know how to listen for what you need them to hear. If your therapist doesn’t know what they’re listening for, they won’t be able to respond to you when you say it.

As an example, I’m an attachment/emotionally focused therapist, and I believe the way the people who raise us see, hear, and respond to us as children becomes the way we see, hear, and respond to ourselves and others as adults.

When I listen to clients, I’m listening for information about their childhood experiences of being seen and heard (or not). We talk about how those experiences impacted them, and we explore how they can heal from those experiences.

When I meet a potential new client, I ask them if this sounds like the kind of therapy that would be helpful for them. Most of the potential clients I talk to say this is exactly what they're looking for! -- the people who raised them had difficulty seeing and hearing them, and they want to heal from those hurts.

Occasionally, a potential new client will shake their head and say, No, I really don’t want to focus on my childhood that much. When that's the case, this potential client isn't a good fit for me. I encourage them to look for a therapist with a different orientation. Depending on their needs, I might suggest cognitive-behavioral therapy or solution-focused therapy, because those might be more in alignment with their preferences.

There's one more thing you should know about orientations: If a therapist tells you they’re “eclectic,” or “integrative,” this usually means the therapist incorporates aspects of several different orientations. There’s nothing wrong with being eclectic or integrative (I consider myself an integrative therapist), but sometimes therapists use this term because they don’t have an orientation.

In order for an eclectic or integrative therapeutic style to be effective, the therapist has to put some thought into why they’ve chosen to use a variety of orientations. More importantly, they need to know how to put all those orientations together to make a cohesive roadmap. If your therapist doesn’t have an orientation, they don’t have a roadmap.

In addition to determining if your potential therapist’s orientation is a good fit for you, you’ll want to know about the interventions they use. Interventions are skills and tools therapists use to help clients, in addition to their orientation. Internal family systems, emotional freedom technique (commonly known as tapping), parts and memory, brainspotting, hypnosis, and EMDR are all examples of interventions. Therapists may also use art, music, dance, sand tray, or nature as interventions.

Ask your therapist to briefly explain the pros and cons of the interventions they use, and how these interventions work with their orientation. When I meet with a potential new client, I explain that I use internal family systems interventions, tapping, and sandtray therapy interventions, because these interventions support my orientations. Internal family systems and tapping are all ways to learn to see, hear, and respond to yourself as your own caring parent, both when you’re in session and during the 163 hours a week when you’re not seeing me. Sand tray therapy interventions are an effective way to access trauma that’s hard to talk about.

In addition, therapists may have licenses, registrations, certifications, or specializations (phew!). The education and training required for licensure, registration, or certification can vary considerably. As a registered dietitian, I have a BS degree in nutrition, and did a nine-month internship before sitting for a national examination. I’m required to complete continuing education to maintain my registration. Meanwhile, my dietetic licensure requires me to complete a brief form, and pay a fee.

And the expectations within each of these terms can vary, too. As a certified health educator, I completed a self-study program and took a national examination. I’m required to engage in continuing education to maintain my certification. In contrast, I have a certification in anger management, which was a 2-day program. I’m not required to complete any continuing education to maintain that certification.

So, although it takes some work on your part, it’s worth your time to ask your potential therapist to tell you a little about their background and education, and see if what they know matches what you need to learn.

Last but not least, some therapists specialize in a particular area. I specialize in narcissism recovery, PTSD and trauma, anxiety and depression, and weight management. I’ve chosen these specializations because of my personal experiences, my education and experience as a dietitian and health coach, my personal experiences, and my professional experiences as a therapist.

A therapist’s specializations can make all the difference. Because I specialize in narcissism recovery, I know, beyond what my orientations describe, exactly what to listen for, and what questions to ask, to determine whether you or someone you know has narcissistic traits.

Use your common sense if you’re considering a therapist who specializes in a dozen different subjects. It’s possible they’ve been a therapist for decades, and genuinely have extensive education and experience in dozens of aspects of mental health. It’s also possible they’ve worked with one or two clients who have the concern you share.

So, you’ll want to ask your potential therapist to tell you about their orientation, any interventions they use, any additional training or education they have, and if they specialize in any area. Ask them how they believe their background can benefit your concerns. If it sounds like your potential therapist might be a good fit, you’re ready to move on!

Once you have a feeling for who your potential therapist is as a clinician, it’s time to decide how you feel about them as a person. As is the case with any other field, a therapist can be well-educated and have decades of experience, but who they are as a human being will ultimately determine what it’s like to be their client.

So, do your best to get a feel for who they are as a human being. Many therapists offer a free 15-minute consultation so you can meet briefly in person, online, or over the phone. This gives you a feel for whether you generally feel comfortable or uncomfortable with them.

There’s no one-size-fits-all for therapists and clients. When you meet with a potential therapist, consider how their personality meshes (or not) with yours. You may prefer a quiet, calm therapist who mostly listens and speaks infrequently. Or, you may need a therapist who is energetic and engages with you often.

Ask your potential therapist about their office policies. For example, you may want to know how they handle it if you don’t show up to session on time, or if you arrive late? If you want to cancel last-minute? If you call, text, or email them outside of session? There aren’t any right or wrong answers here, but their responses will help you decide if they’re a good fit for you.

Finally, and perhaps most importantly, if you experienced trauma as a child, seek out a therapist who is trauma-informed. Don’t worry about whether you think you meet criteria for PTSD. To a trauma-informed therapist, it doesn’t matter if you have a formal diagnosis of PTSD. If you didn’t feel safe as a child, whether that’s because you experienced religious, sexual, emotional, physical, or any other type of abuse, if you were neglected, if your parent was narcissistic, or you experienced a life-threatening situation, that needs to be addressed and healed. 

Trauma is its own area of specialization. Without a background in trauma treatment, clients end up healing, a little, then spending months or even years just chit-chatting with their therapist, instead of engaging in therapeutic work. If you had a challenging childhood, adolescence, or adulthood, don’t let this happen to you!

Instead, ask your potential therapist to tell you a little about how they address trauma in sessions. As I mentioned earlier, many of my clients have spent years in therapy, only to get stuck and feel as though they’re talking with a friend, instead of getting therapeutic work done. If you’ve experienced trauma and your therapist isn’t trauma-informed, they won’t know what to listen for, let alone how to respond to your trauma.

We've covered a lot of ground today! To simplify things, if you’re looking for a new therapist, here’s a list of questions to consider asking a potential therapist:

1. First, give the potential therapist a 60-second description of what brings you to therapy.

2. Then ask:

   • What’s your clinical orientation?

   • How do you see that working with my concerns?

   • What interventions do you use?

   • How will these interventions help me?

   • Do you have any areas of specialty?

   • Are you trauma-informed?

   • How do you handle it if I am late to session?

   • What are your late cancel policies?

   • What's your policy regarding clients calling, texting, or emailing you outside of session?

3. Finally, notice how you feel during and after your conversation with your potential therapist:

   • Did you feel comfortable chatting?

   • Do you like their energy?

   • Did they listen and show concern for your questions?

   • Did you feel comfortable with their answers to your questions?

If your potential therapist has the skills you need, is responsive to your questions and concerns, and you enjoy chatting with them, you're off to a good start!

It's worth your time and effort to ask questions and consider your potential therapist carefully. As Drs. Lewis, Amini, and Lannon say in A General Theory of Love (the book that made me an attachment therapist!), when therapy works, it works because your brain becomes more like your therapist's brain. So, make sure you're choosing a therapist whose brain appeals to you!

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