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How to choose a therapist

Choosing a therapist is an important, and potentially life-changing decision. Research supports 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 and their approaches are well-suited for a given concern - and it's costly. Fees can be up to several hundred dollars per session, it can require significant time commitment, and can mean temporary discomfort for long-term gain.

Meanwhile, the choices for how to do therapy are at an all-time high. The number of approaches continues to increase, 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.

What do you want out of it?

What do you want out of therapy? 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 stop repeating. You might feel a nagging sense of guilt or shame that seems to affect you across situations. 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.

Therapist specialization

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 types of concerns or mental health disorders (e.g., grief, PTSD, chronic illness), as well as a therapeutic approach or orientation.

There are far too many different approaches to therapy to cover in a blog post. However, below is a brief summary of some common ones. In addition, many types of therapy will fall under the umbrella of two approaches – cognitive-behavioral therapy (CBT) and psychodynamic therapy.

Cognitive-behavioral therapy (CBT)

CBT is an approach that has a wealth of scientific background for efficacy in just about every mental health disorder, including the common ones of anxiety disorders, depression, and PTSD. It is aimed at reducing symptoms of these disorders, which often include unpleasant moods, maladaptive beliefs and attitudes (e.g., pessimism), health-related symptoms like poor sleep, and impaired functionality in daily life. It accomplishes this change in symptoms by making changes to your thoughts and behaviors. When adherent to the model, CBT is time-limited and directive, meaning that a therapist will have an agenda and will likely recommend in-between session practices like worksheets. Adherent CBT will also include symptom questionnaires to assist in diagnosis and to track improvement over time. CBT is designed to be a short-term treatment (usually about 12 weeks, although 6-20 weeks are also common) and is the most insurance-friendly approach because of its evidence base and brevity.

There are specific therapies within CBT that might be more recognizable by their name, such as:

  • Behavioral activation (for depression)

  • Exposure therapy (for anxiety disorders and phobias)

  • Exposure and response prevention (for OCD)

  • Cognitive processing therapy and prolonged exposure therapy (for PTSD)

These specified CBT interventions are also time-limited, problem-focused, and highly evidence-based.

Two common therapies related to CBT: Dialectical behavioral therapy (DBT) and acceptance and commitment therapy (ACT)

Dialectical behavioral therapy (DBT) and acceptance and commitment therapy (ACT) are also within the CBT family. DBT focuses on helping individuals with strong emotions learn to manage emotions, be more effective interacting with other people, increase mindfulness of thoughts, and cope with moments of distress without doing something you'll regret later. It has particularly good research evidence for people with borderline personality disorder, eating disorders, self-injury or suicidal thoughts, and substance use disorders.

ACT is a behavioral therapy that’s based on acceptance of your emotions, thoughts, and circumstances (rather than resisting or trying to change them), mindfulness, defining your personal values, and taking ‘committed action’ to align your life with those values. It has strong evidence of efficacy for a number of psychological disorders, including anxiety disorders and depression.

What you might like:

  • If your goal is reduction of symptoms of a mental health disorder, there is a ton of evidence behind CBTs for that. You might notice the difference within weeks or even days!

  • You will learn strategies to manage symptoms on your own, so with good maintenance, you can enjoy the benefits of these strategies permanently

  • It is practical, efficient, and cost-effective

  • Insurance is more likely to cover it

What you might not like:

  • A CBT therapist’s agenda might mean less time and flexibility to talk about anything other than the identified problem

  • Because it focused on the present moment and symptoms, you might not have much time to process the past, or “the big picture”

  • Can feel like it is surface-level

As a last, important note about CBT, many therapists will blend it with other approaches, like psychodynamic therapy or client-centered therapy, so it might be less rigid than it sounds above. This depends on the individual therapist or clinic setting.

Psychodynamic therapy

Psychodynamic therapy (PDT) is another very common approach. Rather than targeting changes to thoughts and behaviors, PDT focuses on developing insight as a source of change and freedom. There are many specific schools of thought within psychodynamic therapy, but common elements include providing a supportive space to process past and present experiences, identifying and understanding recurring life themes or patterns, dream interpretation, understanding how life experiences have shaped who we are today, and exploring what comes up in the relationship between the therapist and patient.

Psychodynamic therapy has been put to the test in scientific research less often than CBT approaches for psychological disorders. There is evidence that it might be as effective or more for personality disorders, and as equally effective as depression, compared with CBTs. However, for other problems, such as anxiety disorders, OCD, or PTSD, there is little evidence for PDT or evidence it is likely to be inferior to CBT. Keep in mind that in most of this research, levels of disorder-specific symptoms are the outcome, and that might not be your primary goal.

Some of the approaches and theories that are under the umbrella of psychodynamic therapy are:

  • Relationally Focused Psychodynamic Therapy (RFPT)

  • Psychoanalysis

  • Jungian Therapy

  • Object Relations

  • Intensive Short-Term Dynamic Psychotherapy (ISTDP)

What you might like:

  • You will gain lots of self-knowledge broadly, that goes beyond your “presenting problem”

  • There is focus on the whole person, rather than a problem-or symptom-focused treatment

  • You will have a longer-term and meaningful relationship with a therapist

  • You will have more time to discuss what you’d like

What you might not like:

  • If you have a mental health diagnosis, there is probably less evidence for PDT, or the research may indicate that is less effective than CBT

  • It is based more on theory than empirical research compared to CBT

  • Many courses of treatment will be longer, meaning more time commitment and expenses

Providers’ titles

It can be confusing to understand the titles and degrees of counselors, therapists, and coaches, and what that means about the training and expertise. Here is the meaning of some of the most common titles and degrees.

  • 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 assessments. 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 in the absence of 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, respectively. They can provide therapy and diagnosis independently, and they have at least 3-5 years of training in therapy before being licensed. Mental health counselors tend to have slightly more training in psychotherapy, social workers tend to have more training in managing practical issues such as help obtaining social services, and marriage and family therapists tend to have more knowledge about therapy in those formats. although there is significant overlap.

  • 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, many services that are advertised - such as supporting behavior change, improved quality of life, finding purpose, improved self-esteem and self-compassion, etc. - are services therapists are trained in.

Think critically about what kind of training 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 to have access to a provider’s education, credentials, and licensure status. If that information seems to be buried or avoided, it might be a red flag.

Sense of alliance

There considerable evidence showing that the "therapeutic alliance" affects the outcome of therapy, regardless of the type of therapy. This is more than just rapport or 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 your therapeutic alliance, ask yourself: Do I feel generally supported, and like they give me the benefit of the doubt? Do I feel judged? Am I confident that what we're doing will help me reach my goals? Do I feel like I can talk to them if I disagree with something? Therapy isn't always comfortable, and you are likely to have some of these feelings at some point. However if you feel they're a problem more often than not, or you can't work through it with them, it might be worth having a conversation about it or looking elsewhere.

Match with identities

Some evidence has indicated that therapists who match a patient’s identity and lived experiences can 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, many therapists can offer a safe environment and a respectful and humble attitude toward experiences they haven’t had themselves. If you're part of a group that is minoritized (i.e. experiences discrimination, oppression, or other-ing), it might be worthwhile to get a sense of a therapist's attitudes and awareness of issues affecting you during a consultation.


Therapy is expensive. Expect session fees to be between $100-$250 per session, depending on the provider and the area you live in. It might be hard to take an honest look at the overall cost. But, while weighing the cost, remember to compare it to the cost of not doing it.

In addition, here are some ways to make therapy more affordable:

  • Look for someone who is on the board with your insurance

  • 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. Many therapists choose to 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, the more likely this option will make a big difference.

  • Superbills are receipts of psychological services that can be submitted by a provider or you to request reimbursement. It can make a meaningful difference, but it will depend on your policy for out-of-network care.

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 about their approach, get a sense of whether your therapeutic alliance would seem easy to form, and determine whether they show understanding of issues related to your identity. I suggest doing consultations with about 3 therapists who seem like good fits on paper. While most therapists offer free 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.

Be wary of the addiction treatment industry and retreat models

Given the extra high cost and time investment for addiction treatment centers/rehab facilities and other retreat-based interventions, many people will be surprised that they are often unethically run. Many programs advertise their providers as specialists without having the expertise or training to do so. Evaluate for yourself the credentials of program providers and the quality of the proposed treatments. Aggressive sales techniques, lack of transparency about provider credentials, and not being able to clearly communicate the treatment techniques and their evidence base are red flags. You can read more about that here:


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.

Additional resources:

Psychology Today has a thorough description of many more types of therapy:

*Crits-Christoph, P., Gibbons, M. B. C., Ring-Kurtz, S., Gallop, R., Stirman, S., Present, J., ... & Goldstein, L. (2008). Changes in positive quality of life over the course of psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 45(4), 419

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