Research over many decades has not produced universally accepted answers among mental health professionals about what makes therapy effective. However, almost all therapists and researchers would agree that the relationship between a client and therapist is a key factor in the success of a therapy. When a person experiences his or her therapist as accepting, respectful, caring and able to understand, most if not all of the ingredients for change are present. The quality of the relationship has been shown to influence the outcome of therapy far more than the therapist's technique or a person's diagnosis. (For more information, seeDoes Therapy Work?)
As daunting as the task of choosing a therapist seems, you do have what it takes to make a good choice. You don't have to sort out the differences among the hundreds of therapeutic techniques or the types of training therapists receive. Instead, your own intuitive reactions to talking with a therapist can be a reliable guide to your decision. Your thoughts and feelings - rather than a therapist's credentials, reputation or techniques - are vitally important because they reflect the potential for you to develop a helpful relationship with a therapist.
That means that a therapist who comes highly recommended by a friend isn't necessarily someone you'll choose for yourself. That should depend on the test of your own reactions to this therapist. By the same token, you might read a self-help book and decide the author is just the therapist for you. But it's possible that in your first phone conversation the therapist's style of relating leaves you feeling uneasy. Better to look elsewhere.
Of course, trusting your intuitive reactions when you're confused and upset isn't easy. And you may be unsure what therapy is supposed to feel like when it's starting off well. I urge you to not rely on what you've seen in movies and television programs as a guide to how therapy works. Frankly, there's lot of crap in the media presentation of therapy. So here is a suggested approach to finding a therapist.
Ask friends, coworkers, physicians, etc. for names of therapists, keeping in mind that no matter how much someone else likes and respects a therapist, you'll still need to form your own opinion. If you're limiting yourself to therapists on your insurance company's list, the same caveat applies. Just because a therapist meets the credentials requirements of an insurance or managed care company, that doesn't mean you'll be able to form a helpful relationship with him or her.
By the way, in a 2004 survey published in Consumer Reports, only 20% of respondents got the name of their therapist from a family or friend - but they had better outcomes than those who got their therapists' name from an advertisment or their employer (insurance company). Commented Dr. Gregory Simon (a psychiatrist), "People are more likely to ask their friends and colleagues who knows a good mechanic than who knows a good psychotherapist. If one can screw up the courage to ask, word-of-mouth recommendations are very good."
Plan to call several therapists before making a first appointment. Most will be willing to spend 5 or 10 minutes talking with you to answer your questions. What can you ask? For starters, ask about their training (where and when), how long they've been licensed and how long they've been practicing, what kind of experience they've had, whether they might recommend a book that reflects their approach to therapy. All of these facts give you useful information about the therapist, but just as importantly you'll start to get a feel for how s/he relates and communicates. Feel free to ask, too, about fees, days and hours of appointment availability, and how insurance is handled.
Keep in mind that telephone conversation excludes many cues and signals that are ordinarily part of people's face-to-face interactions. This initial conversation can help you decide whether you want to consider a therapist any further. Or, for reasons that you won't necessarily be able to put your finger on, you could decide to not set up an initial appointment right then. That's okay; just say you plan to talk with several therapists before deciding whom you'd like to meet in person. With other therapists your phone conversation might lift your hopes; but only a face-to-face meeting (or two or three) can give you enough to decide on "the fit" between you and the therapist.
At the start of your first appointment with a therapist you may feel both anxious and hopeful. How you feel by the end of that first appointment can tell you a lot (though not everything) about your fit with the therapist. Here are some questions to ask yourself about your first appointment:
Did I feel safer and more at ease as we talked?
Did I feel that this therapist could understand my life experiences?
Did the therapist seem genuine and authentic, like a real human being? Or did s/he seem distant or rigid?
How did I feel about how the therapist responded to my questions?
After the appointment, did I feel a little lighter and more hopeful than I had been feeling? Did I feel a little better about myself or did I feel worse about myself?
Did the therapist seem like someone I could come to trust?
Was I able to understand what this therapist said to me? If I didn't understand, did I feel it was okay to ask him or her to explain?
Even if I didn't necessarily agree with some things s/he said, did they seem like relevant and reasonable ideas that were worthy of consideration?
Did the therapist seem to want to listen and learn about me as a unique person or did s/he seem to apply ready-made, "one-size-fits-all" answers to my problems?
After your first appointment with your therapist you may feel ready to meet with him or her again and get down to work together. On the other hand, you may be certain that it's not a good fit. If it doesn't feel right, even if you're not sure why, don't force yourself to pursue the matter further. There are lots of therapists to choose from.
It's also possible that you won't be able to reach a clear-cut decision after the first session. In that case I'd recommend you meet again and see how it goes. Talk with the therapist about your experience of the first session and see how s/he responds. The therapist's responses may help you clarify what you want to do.
Many people feel unsure about how to choose a therapist. That's understandable because choosing a therapist differs from choosing another professional like an attorney or a tax advisor. It's not even like choosing a physician (on the rare occasion one can make that choice these days). After all, you're looking for someone to whom you can entrust your private feelings and thoughts, your hopes and your fears. And for all practical purposes that someone will be a stranger to you - at least in the beginning. No wonder it seems like a fateful choice.