Thoughts on choosing a therapist

I recently went through a process of choosing a new therapist and then I came across this article providing some advice on exactly that. I think it provides some helpful advice and a great outline of the process and major steps, broadly useful things to consider, etc. But since I’m on my 3rd therapist now I think I have some additional perspective that might be helpful to others as an adjunct to that “broad strokes” piece. For now this is just in draft form but I hope to flesh it out more soon.

While the article provides a great outline and a bit of info on things like modalities and specialties (and the particularly helpful distinction of the “challenger” vs. “listener” style), I think it misses some things that I wish I’d known sooner in my journey. When picking a therapist, in my experience one of the most helpful things is simply to understand what is out there, what is possible. Everyone seems to respond a bit differently to different approaches, so most people will need to try a few things out, and lacking a full understanding of the options and possibilities means you’re likely miss something that might help you find your ideal approach, modality, therapist, etc.

One important realization is that you might like your therapist a lot, yet their way of working might not actually give you the help you want or produce the change you may be seeking. I have been in therapy for some 10 years now, with 3 different therapists so far, and it is only now that I am starting to see certain ways of working that I am finding particularly helpful. Being able to decide the “attributes” you want in a therapist and the way(s) in which you want to work with that therapist can be tremendously helpful to finding the right person for you.

At the same time I want to emphasize that there is good research suggesting that the bond and trust between a therapist and client may contribute 50% or more to the overall efficacy of the therapy (i.e. making people feel better), regardless of modality. Like everything in psychology we need more research to know how this may work and what aspects of the “bond” are helpful, but it’s an important factor to keep in mind: how you feel about your therapist and your connection with them really does matter, and should probably be your ultimate yes/no factor.

Some additional considerations I want to elaborate with time:

  • Therapist style, push vs. validate (link to/reference Every article)
  • Structure and process (i.e. continuity, goals, etc.) vs. low structure/spontaneity (“what is alive today”)
  • Modalities, management/functional vs. deep work/transformational
  • Therapy bond is the most important (link to study) so don’t sweat modality too much
  • Tools vs. not, e.g. Daily Parts Meditation, “homework”
  • Functional work style
  • Live note taking or not
  • Medium: phone vs. video vs. in person

ChatGPT had some reasonable elaborations on my additional points, so I’ll share them here for now (note: all of the below text is from ChatGPT except the prompts that precede each colon). I still intend to write more of my own thoughts on each of these in the future:

  1. Therapist Style: Push vs. Validate: The article discusses the distinction between therapists who challenge their clients and those who primarily listen and validate. While both approaches have their merits, it’s crucial to recognize which style resonates with you. Some individuals benefit from therapists who push them to confront their thoughts and behaviors, while others prefer therapists who provide a safe space for validation and support. Reflect on your own needs and preferences to determine which style aligns best with your therapeutic goals.
  2. Structure and Process vs. Low Structure/Spontaneity: Another aspect to consider is the level of structure and process you desire in therapy. Some therapists follow a structured approach, setting specific goals and implementing a clear framework for sessions. On the other hand, some therapists prefer a more fluid, spontaneous approach, where the focus is on exploring what feels alive in the present moment. Understanding your preference for structure or flexibility can help you find a therapist who aligns with your preferred therapeutic approach.
  3. Modalities: Management/Functional vs. Deep Work/Transformational: Therapy modalities can range from management-focused and functional approaches to deep work and transformational methods. Management-focused therapies often prioritize symptom relief and practical strategies to address specific issues. On the other hand, deep work and transformational modalities delve into underlying patterns, emotions, and long-term personal growth. Consider whether you seek practical solutions or a deeper exploration of yourself to identify a modality that suits your needs.
  4. Therapy Bond is the Most Important: Research suggests that the therapeutic bond and trust between the therapist and client contribute significantly to the overall effectiveness of therapy, regardless of the chosen modality. While the specific techniques and approaches used by the therapist matter, the connection you feel with your therapist should be the ultimate factor in your decision-making process. Prioritize finding a therapist with whom you feel comfortable, understood, and supported, as this bond can greatly influence the success of your therapy journey.
  5. Tools vs. Not: Daily Parts Meditation, “Homework”: Consider whether you prefer therapists who incorporate specific tools or techniques into their practice. Some therapists may suggest daily practices like Parts Meditation, where you explore different aspects of yourself to gain insight and understanding. Others may assign “homework” assignments to facilitate ongoing self-reflection and progress between sessions. Determine whether you appreciate these additional tools or prefer a more conversation-based therapeutic approach.
  6. Functional Work Style: Another consideration is the therapist’s work style. Some therapists adopt a functional approach, focusing primarily on problem-solving and providing practical guidance. They may help you develop coping strategies and explore solutions to specific challenges. If you value a results-oriented approach and prefer a therapist who actively supports you in addressing practical issues, a functional work style may be a good fit.
  7. Live Note Taking or Not: During therapy sessions, some therapists take notes in real-time, while others rely on their memory or take notes afterward. Note-taking can have advantages and disadvantages. On one hand, it allows therapists to accurately recall important details, track progress, and refer back to previous discussions. On the other hand, note-taking may create a perceived distance or distract the therapist from fully engaging in the session. Reflect on your preferences and comfort level regarding note-taking to guide your therapist selection process.
  8. Medium: Phone vs. Video vs. In Person: With the availability of various mediums for therapy, such as phone, video, or in-person sessions, it’s important to consider your own preferences and circumstances. Some individuals may prefer the convenience and accessibility of phone or video sessions, while others may value the in-person connection and non-verbal cues. Reflect on your comfort level with different mediums and decide which one best suits your needs for effective communication and therapeutic engagement.