Choosing a therapist is an important, and potentially life-changing decision. Research shows that a range of therapies can reduce symptoms of mental health problems and improve quality of life long after the final session. However, not all therapists are great fits for a given person or concern - and it's costly! Fees can be up to several hundred dollars per session, the time commitment is real, and therapy can mean temporary discomfort for long-term gain.
Meanwhile, the number of choices is at an all-time high. The list of therapeutic approaches continues to grow, and the increased availability of telehealth means that you might be able to see someone across the state or even across the country.
So, with the high stakes and inundation of choices available, how can you choose the best therapist for you? Below, I’ve listed some guidance that can help in selecting a good fit.
1. Pick a therapist with the right specialization(s)
Therapists cannot be experts in every approach or concern – it’s just not possible! Instead, I suggest selecting who you meet with based on what they say they’re especially good at. This typically includes therapeutic approach or orientation, as well as types of concerns or mental health disorders (e.g., grief, PTSD, chronic illness).
So - what do you want out of therapy? Or - if this went well, what would be different a year from now? You might have a known mental health diagnosis that you would like to learn to manage better through practical skills. You might have had some traumatic or difficult experiences that you have never felt you fully worked through. You might have recurring patterns in relationships that you are trying to understand and put an end to. You might have strong emotions like anger or anxiety that lead you to do things you regret. You might feel like you are going through the motions and have lost a sense of meaning.
Whatever it is, give some thought to what it is you want. Doing so will help you to choose a therapist with specializations that are a good match.
See the companion article - How to Choose a Therapy - for help on choosing a therapeutic approach/orientation.
2. Evaluate the alliance
There is considerable evidence showing that the 'therapeutic alliance' affects the outcome of therapy. This is more than just liking the person! The therapeutic alliance is a sense of a collaborative relationship between therapist and patient, in which there is agreement on treatment goals, agreement on therapeutic tasks or processes to achieve those goals, and formation of a positive emotional bond.
To get a sense of the quality of a therapeutic alliance, ask yourself: Do I feel supported, and like they give me the benefit of the doubt? Do I feel like I can speak freely without fear of judgment? Am I confident that what we're doing will help me reach my goals? Do I feel relatively comfortable telling them if I disagree with something? Therapy isn't always comfortable, and you are likely to have some sort of doubt or negative feelings toward your therapist at some point. However if the answer to the above questions is "no" more often than not, it's worth having a conversation about it with them or looking elsewhere.
Some evidence indicates that therapists who match a patient’s identity can affect the alliance and predict better outcomes. Psychology Today offers a way to search for therapists based on a variety of identities (gender, race, LGBTQ+, religion, etc.) This does not mean sharing identities is necessary to have a good experience and outcome! Even with different backgrounds, therapists can offer a safe, respectful, and humble attitude toward experiences of groups they're not a part of. If you're part of a group that is minoritized (i.e. experiences discrimination, oppression, other-ing), it might be worthwhile to get a sense of a therapist's attitudes and awareness of issues affecting you during a consultation.
3. Understand providers’ titles
It can be confusing to understand the titles and degrees of people offering services. Here is the meaning of some of the most common titles.
Licensed psychologists (PhD's or PsyD's) are doctoral-level practitioners. They have at least 5-8 years of training and education in therapy and assessment before being licensed. They can independently provide therapy, diagnosis, and psychological assessment. Doctors in clinical psychology tend to have slightly more expertise in diagnosis and treatment of psychological disorders, whereas doctors in counseling psychology tend to have slightly more expertise in counseling that is not specific to disorders and in social justice issues, although there is significant overlap.
Licensed mental health counselors (LMHC’s), licensed social workers (LCSW’s), and licensed marriage and family therapists (LMFT's) hold a master’s degree in counseling, social work, or marriage and family therapy. They can provide therapy and diagnosis independently, and they have at least 3-5 years of training in therapy before being licensed. LMHC's tend to have slightly more training in psychotherapy, LCSW's tend to have more training in managing practical issues such as help obtaining social services, and LMFT's tend to have more knowledge about therapy in couples and family.
Psychiatrists are medical doctors (MD’s) who can prescribe medication, diagnose mental health disorders, and some - not all - provide psychotherapy. They have completed medical school as well as at least 4 years of specialization in psychiatry.
Life coaches do not necessarily have any training, education or licensure. It is not regulated, meaning that anyone may legally use the title. While life coaches cannot legally offer "therapy" by that term, there is significant overlap. Many coaching services - such as supporting behavior change, improved quality of life, finding purpose, improved self-esteem and self-compassion, etc. - are services therapists are trained in. If you are looking for treatment or management of a diagnosed mental health disorder, or think you might be suffering from something undiagnosed, this isn't a good option.
Think critically about what kind of training and expertise someone has and how well that matches what you need, and don't be afraid to ask questions. It's your right as a patient/consumer to have access to a provider’s education, credentials, and licensure status.
4. Estimate and reduce cost
Therapy is expensive. Expect session fees to be between $100-$250 per session, depending on the provider and the area you live in. A realistic look at the overall cost can be overwhelming... but, remember to compare that to the cost of not doing it.
In addition, here are some ways to make therapy more affordable:
Look for someone who accepts your insurance policy
Seek a therapist who accepts pay on a sliding scale basis. This means that patients pay a fee that is scaled to income and/or financial resources, and it can mean a significant reduction in total cost. Some therapists offer at least some spots for sliding scale patients, and even if that is full, they may be able to put you on a waitlist. The lower your income/financial resources are, the more likely this option will make a big difference.
Superbills are receipts of psychological services that can be submitted to insurance to request reimbursement. It can make a meaningful difference, but it will depend on your policy for out-of-network care.
5. Do several consultations
I strongly recommend doing several consultations before choosing a therapist. Most therapists will offer free consultations lasting 15-30 minutes before a first appointment. This is a chance to describe what you want, ask questions, get a sense of whether your therapeutic alliance is headed in a good direction, and determine whether they show understanding and expertise about your concerns.
I suggest doing consultations with about 3 therapists who seem like good fits on paper. While most therapists offer consultations, most will also require that you are not seeing anyone else for individual therapy at the same time, so the ability to shop around ends with the consultation.
Conclusion
The investment that therapy requires is way too big to choose a therapist lightly, and there are so many to choose from! While nothing is a 100% guarantee, there are ways to make an educated choice about the best next step - and I hope the above guidelines will help.
