How to Choose a Therapist
Finding a therapist or counsellor can feel overwhelming, especially if you've never looked before
Andrew Samuels shares his thoughts on some of the things that might help you decide
Click here to use welldoing.org's questionnaire to find a therapist
I have to admit that simply following your intuition and inclination is not such a bad way to go. This is particularly true if you know a fair bit about therapy, such as the various different approaches. It is even more of an option if you have a clear sense of what you want to achieve in therapy. But what if you want to approach this question more systematically? Let's work through a few variables that, from my experience, people contemplating therapy are concerned about.
I have never heard of anyone saying 'I really want a very young therapist'. This is understandable if we agree that age equals wisdom. But it doesn't always – and burnout or not keeping up with clinical trends in the profession are greater risks with older therapists. Not to mention illness and death being more likely.
A lot depends on how old the prospective client is. If you are 60, then you may not want to work with someone who is 35. But if you are 50, then it might feel more possible. It is surprisingly effective to work with trainee therapists who are under intensive supervision – two psyches are better than one.
This is usually an incredibly strong element in people's choices and I agree that it matters a lot. I think that if you have a preference for one sex over the other then you should follow it, but it would also pay to be a bit reflective as well. If you can't imagine working with a man, maybe because you think you have father issues, isn't that perhaps exactly the point at which you need to second guess yourself? There are many more female therapists than males but this is rapidly changing. And there are still more women in therapy as clients than men, but the picture is also changing. (I have a practice that is 50-50 men and women, for example.)
If you are a member of a sexual minority (gay, lesbian, bisexual, transsexual, transgender, intergender etc.), or if you are into a very specific sexual practice you need someone non-judgemental. But do you need someone who resembles you, when it comes to sexual preferences and behaviours? Professional opinion is divided about this but most of us agree that if a client has a strong view about this aspect of therapist choice, it should be respected.
You can filter by therapists who describe themselves as LGBTQ+ affirmative by using the welldoing.org questionnaire.
Do you want to see someone who resembles you? Or would someone open to understanding what it is like to be you be as useful? I would be careful if a white therapist seems excited at the exotic possibility of seeing a black or Asian client. They may be in the grip of what academics call 'orientalism', a rather unhealthy fascination with non-Western cultures. Also, be very careful, if a white therapist seems to know a lot about your own ethnic background and wants to display that knowledge.
Money and class
These things are also tremendously important, and not just when it comes to setting a fee. Dealing with money first, many therapists have sliding scales and/or low cost vacancies (though these tend to fill up, for obvious reasons). If you contact a therapist whom you discover you can't afford, don't be shy to ask them for advice. But there is also an aspect of 'money and class' that concerns what I'd call cultural and political attitudes. Does the therapist exude middle class or highly 'respectable' values and opinions? Think about how comfortable with that you are going to be. When you visit a therapist to check them out, look around their room and make your own evaluation. This business of finding a therapist is most definitely a two-way process.
The therapist's demands
Some therapists want quite a lot of money upfront. Walk away! But many therapists do have rules that guide their practice. Some want to see their clients more than once per week. My own preference is for once or twice weekly work but I think that three times weekly does help some people provided they have the time and money. I am not aware of any research that shows that more than three sessions per week helps anyone but you will find some therapists suggesting it. As important as frequency is duration and everyone asks 'how long will it take'. I can only give my personal answer: you should be thinking initially in terms of 18 months, but it is not uncommon for people to stay for 4-5 years. Some stay much, much longer and, for them, there is a kind of maintenance aspect – a bit like regular gym attendance!
It is important to realise that, though some people have distinct issues – such as panic attacks or sex problems – many clients just feel a lack of meaning and purpose in their lives. Therapy is quite good in the general lack-of-meaning area because, without ignoring the spiritual dimensions, it is not going to thrust people (back) into organised religion. If you do have specific problems, make sure that your prospective therapist confirms they have some experience in these areas.
When I started, we were not allowed to advertise at all. Now, nearly everyone has a website and many are listed on directories. I think some of these websites, ones that stick close to the basic facts, are very useful. Others strike me as seductive and enticing and they make me a bit suspicious. On the other hand, even a purple prose self-description by a therapist is better than going into the situation cold. Yes, photos matter.
School of the therapist
It is fashionable to say it is irrelevant. It does matter, a bit – and it is, I think, an important bit. Basically, you want to see someone with whom you can eventually make a deep and trusting relationship – but you don't want this forced on you. Most psychoanalytic, psychodynamic, integrative and humanistic therapists fit this description. If you have couple or family issues, then definitely consider a couple, family or child therapist. I caution people against putting a child into solo therapy prematurely, before family matters have been considered first.
Don't forget that when therapists talk of the client's role in 'co-creating' the therapy process, they really do mean it. It is hard work, far from fun, and very different from taking the pills. Also, reflect on the possibility that your therapy is your own business and really begins when you start to think about it. Even before you meet a real therapist, there will be a therapist in your imagination.
There is always an element of luck and deep coincidence in choosing a therapist – what Jung called 'synchronicity'. This means that, whether instantly or gradually, the client and therapist discover that they were somehow 'meant' to be working together. But if that doesn't happen, don't worry, because easy claims for synchronicity often mask a failure to deal with important and difficult questions.