One choice could change your life.
After my experiences with different therapists, I still feel like I don’t know how to properly choose one who is a great match for me. I’ve been really fortunate with therapists so far for the most part, but I feel like by now I should be able to tell in the first session how therapy with a particular counselor is going to go. The only thing I can usually tell from the start is if the therapist is a clear “no” from me. As helpful as that is, it doesn’t do much to narrow down the rest who seem good.
I’ll admit I don’t have much of a detailed checklist. I don’t ask my new therapists enough questions, or maybe I don’t ask the right questions. I’ve been treating the initial session more like a meeting of two strangers getting to know each other over coffee rather than an interview of a professional who will be paid to help me process my deepest thoughts and feelings. I’m a bit too casual about it. I feel like I take it seriously, but my method of going with my gut feeling and winging the rest seems kind of risky when I think about it.
Therapists can be very different in their sessions from the way they are in real life. It’s similar to how most people behave a bit differently at work than they do at home. I’m kind of okay with it and kind of not. It’s an uncomfortable concept that a client risks emotionally trusting in a total stranger who might be very different than they appear. That’s why I tend to think of it as similar to dating someone you met on a dating app, making Psychology Today the equivalent of Therapist Bumble.
I think with therapists it’s more important than in other professions that they appear closer to who they say they are, because their personality and their issues can make such a big difference in therapy. There are less concrete ways to measure their abilities than there are for other professions such as medical doctors or electricians.
A therapist’s personal preferences, boundaries, and skills might not line up with how they seem on their profile page, and there simply isn’t a reliable way to know without interacting with them, so ultimately, it’s client beware.
Therapists can seem like they’re great at working with almost any kind of client. The reality is they all too frequently overestimate their capacity to subdue their built in biases and limitations when it comes to helping certain clients in certain situations. Sometimes it’s small enough things that it doesn’t hinder the therapeutic process. Other times it does. I think this is one of those things that a client just has to be mindful of and be willing to bring up an issue if they feel something is bothering them. The client needs to be brave enough to communicate their discomfort and also needs to be willing to walk away if it doesn’t appear the issue is getting better in the way they need it to. It’s similar to what therapists are trained to do in those situations, but clients need to be aware too and not leave it fully up to the therapist’s judgment. Therapists might be trained, but they’re still only human.
Boundaries are also a two way street. Many therapists spell out their boundaries in the first session. Others don’t. I haven’t found that it makes much of a difference in the longterm what people say on first dates or in first therapy sessions. Someone’s boundaries on paper aren’t always their boundaries in real life. You don’t really know what someone’s boundaries are until they’re tested. I’m not advocating that clients test their therapist’s boundaries, although I’ve certainly done it, but it’s something to keep in mind. Also, therapists, as with most people, are more likely to pass a boundary test in the first few sessions than they might be twenty sessions later. The same is likewise true for a client’s own boundaries.
As a client, it’s tempting to trust that the skills that a therapist has listed in their online profile are accurate, but a therapist’s skills will only become clear as they pertain to a certain client, once those skills are actually being put to use. Furthermore, many therapists can have the same skills in varying degrees and each of them may perform better or worse when combined with specific clients.
As I’ve yet to mention insurance companies and the role they play in the therapy process, let me comment on them now.
Fuck insurance companies and fuck this fucked up, unaffordable healthcare system.
Now, here’s what I generally do when screening a therapist or meeting with one for the first time:
- I get a read on if I feel physically safe around them, or virtually safe, as applicable. Basically, if I sense something is off or get a bad feeling, I’m out.
- I don’t usually ask them about their boundaries. I wait for them to bring it up. If they seem to have an organized way of presenting their boundaries and seem inclined to clarify them from the start, it can be a good sign.
- In addition to noting how well they seem to be at doing the basics such as listening, I also like to bring up a few things that are important to me and pay attention to the therapist’s reaction. I try to work things into the conversation naturally. An example is I almost always mention something about sex in the first session. How they respond usually gives me a good idea of how safe I’ll be to talk about that topic later on. If a therapist is uncomfortable with a topic that’s important to me, that’s a “no” for working together because I don’t want subjects that are relevant to me to be severely limited in my therapy.
- I pay attention to a therapist’s body language. This is more reliable than what they say. If a therapist says something and their body language doesn’t match what they’re saying, then I trust what I see instead of what I hear.
- If I’m curious about a therapist, that’s good. If it’s to the point of distracting from the work then it can be bad, but for me to stay engaged I need to have some interest in the therapist as a person. The opposite of that is also true. If I find them too distracting then it’s a “no” as well.
I don’t feel like I can give an adequate list of red flags, or even yellow flags. Beyond the obvious, there are less obvious signs that may or may not indicate incompatibility and future problems. A client should already have their own basic boundaries in place. Beyond those, I think it will vary from person to person based on their personality and history. A small yellow flag could indicate a hidden red flag or it might be an automatic response a client has based on their past, which might not apply to the current situation. Or it might be slight enough that it doesn’t threaten the therapy work.
I’m simply not great at the yellow flags part, or at least I feel like I’m not. I’ve felt judgment from therapists but it turned out to not get in the way of the work. I’ve also experienced the opposite. So much of it I feel is case by case. I also can’t say I genuinely believe in or agree with the way therapy is structured in general and I definitely don’t like the concept of fake or approximate relationships. That part of my personality might make me more likely to get and keep therapists who don’t have strong professional boundaries because I don’t look at things in the same textbook approved way. Instead, I look at it through the lens of my boundaries, and if their boundaries and mine happen to align enough then I seem to experience progress.
The bottom line is try to choose wisely in the beginning and stay aware as therapy goes along. It can be complicated depending on the particular therapeutic relationship, but catching issues when they first arise is usually better than waiting to see how things go and just hoping it’ll get better.
And that’s my unthorough and somewhat inconclusive guide to choosing a therapist.