Choosing a Therapist

Dear Tony,

As you know, I am a mental health researcher. One of the issues I sometimes research is what factors produce a good therapeutic relationship. Those factors are complicated and difficult to determine. But based on some of what I have observed and personally experienced, I wanted to give some advice about choosing a therapist.

I realize you might not always have a choice of therapist. Geographic and insurance (among other) factors may limit who you are able to see. But you might have a choice between a few people or be able to request a transfer. Everyone's situation is different, which means I cannot give general advice. You need to figure out yourself what your options are.

With that caveat, here are some suggestions about choosing a therapist:

The absolute primary factor is: You must be comfortable with that person. If you are not comfortable, you are not going to be open and honest, which means you are not going to be able to address the complexities of your own situation. You might be more comfortable with a certain gender or a certain age group. If so, try to request it or look for it. Do not try to be fair to the therapist. Health does not play fair. Your needs have to come first.

This ideally works both ways. The therapist might say s/he is not comfortable treating you. This is very painful to hear (I have had that happen). In the long run it is most likely for the best. But you can be left feeling like a mutant. There is not much advice I can give about that situation, except to be aware that it might happen.

I have a few warning signs that you need to find a new therapist:

1. If you cannot discuss something which you feel you need to discuss. Therapists do make mistakes, and they may cut off an important point during a session. But if you bring up this point several times over different sessions and are never able to talk about it, then you are not receiving the help you need.
2. If you disagree with your therapist and are not comfortable saying so. Or if you do tell the therapist you disagree and are repeatedly ignored.
2.a. On a similar note - if the therapist tells you things about yourself that appear wildly speculative or just wrong, and you are not able to disagree (or it is too much effort to do so).
3. Very important - if your therapist becomes enraged if you do something without his/her approval. Therapists are not supposed to become angry in session, but it does happen. But if they grow enraged if you do something without his/her permission, they are insisting on having control over your life. That is wrong - the goal of therapy should be to help you lead the life you want, not to be dependent on the therapist. The therapist should be a guide, not a caretaker.

That is all for now. I will add more suggestions as I think of them later.