Credit - Illustration by Giulio Bonasera for TIME
Research has consistently shown that people who have a good relationship with their therapist get the most out of therapy. But figuring out which mental-health provider is the right fit for your personality and needs—not to mention, who’s affordable and available—is a daunting task.
“I tell friends that they should like talking to their therapist and feel like their therapist likes talking to them, because a strong relationship will generally lead to better outcomes,” says Emily Maynard, a licensed therapist in California. She acknowledges that it can be hard to find the right fit, and doing so sometimes requires casting a wide net—and not getting discouraged. “I see people sticking it out in a situation they don’t feel is helping them because they’re embarrassed or ashamed or don’t want to hurt the therapist’s feelings, or don’t know that they have other options,” she says. “It’s important to normalize that different therapists work in different ways, and work well with different issues.” Conversely, not every therapist has the expertise and training to appropriately treat every problem—for example, religious trauma.
Most practitioners offer free 15-minute phone consultations before you book an appointment; otherwise, you can use that first session to figure out if you’d like to work together.
With the guidance of Maynard and other mental-health experts, we’ve put together a list of 12 statements to reflect on before your first meeting. On a scale from 1 (strongly disagree) to 5 (strongly agree), rate the following statements according to how important they are to you.
You want your therapist to be the same gender as you.
While research indicates that a therapist’s gender alone typically doesn’t influence the outcomes of treatment, some people naturally feel more comfortable with a certain gender—perhaps because of a previous trauma—or with a non-binary therapist.
It’s fairly easy to ascertain what gender a therapist identifies with: Most list it on their website, and online therapist directories, like those run by Psychology Today and Good Therapy, allow users to filter results by gender. Therapist Emily Maynard also suggests utilizing resources like the National Queer & Trans Therapists of Color Network.
You want your therapist to be around your age.
“You might want a therapist who’s your age because of relatability, and because it feels like it increases your chances that you’ll be seen and well-understood,” says Naomi Torres-Mackie, a psychologist at Lenox Hill Hospital in New York City and head of research at the Mental Health Coalition. On the other hand, someone might seek out an older therapist who they feel mirrors a caregiving figure, which can be “soothing and comforting.”
A younger therapist, who’s earlier in their training, might be more adept with telehealth platforms, mental-health apps, and other technologies. But you might feel that an older provider has “been around the block a few times,” Torres-Mackie points out, and value their extra wisdom and experience.
Age could also affect how much you pay: Early-career therapists are typically cheaper than those who have been practicing for decades. At some universities, graduate students who are studying psychology offer low-cost therapy—and because they’re supervised by an instructor, it’s almost like having two therapists for the price of one.
Choosing a younger vs. older practitioner is a personal decision. While you can certainly ask a therapist their age, not all will provide it, says Lynn Bufka, associate chief of practice transformation with the American Psychological Association. As a workaround, “it’s reasonable to ask someone how many years of experience they have.” But, she adds, age “doesn’t make much difference in terms of outcome.”
Your therapist should have an identity similar to yours, including religious affiliation, race, and/or cultural background.
Working with a therapist who has a similar lived experience to yours can offer security and affirmation. That’s especially true if you’re seeking therapy to deal with a cultural or religious issue, says Bisma Anwar, a licensed mental health counselor with Talkspace. In that case, “you’ll want to go to someone who really understands the context of it.”
But there can also be value in working with a therapist who has a different identity and can broaden your perspective. Anwar, for example, is Muslim, and her therapist is not. Some of her peers feel strongly about connecting with a practitioner who has the same religion and culture, but she’s pointed out to them that it can make the already difficult process of finding a therapist even harder, because of how much you’re narrowing the pool. “My therapist doesn’t share my religious background, and doesn’t share my culture, and I’ve still been able to build a really great connection with her,” she says.
Working with a therapist from a different background can even be healing, says New York-based psychologist Naomi Torres-Mackie. For example, if a person of color who has experienced racial trauma meets with a white therapist, “the assumption would certainly be, this white therapist won’t get it. They can’t understand me,” she says. While that might be true to an extent, it also presents the opportunity “to have a very meaningful, deep relationship with somebody who is white and represents the folks who have been harmful to you.”
If identity match is high on your list of requirements, start by diving into online therapist directories. Most allow you to filter results based on factors like language, sexual orientation, and faith. If it’s still unclear how your therapist identifies, don’t feel shy about asking during your first conversation.
You’re interested in a specific type of therapy.
Some of the most common types of therapy include psychoanalysis, cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and eye movement desensitization and reprocessing (EMDR) therapy. Many overlap, and therapists often use a blend, depending on their clients’ needs and preferences.
To get a feel for what to expect, New York-based psychologist Naomi Torres-Mackie suggests asking three questions during the first session:
How do you practice?
What theoretical orientation do you subscribe to?
What modality do you use?
If you’re not familiar with the differences between, say, CBT and DBT, dig deeper by asking follow-up questions that will capture the experience. For example, Torres-Mackie advises, ask your therapist to walk you through a typical session, and find out whether there will be an agenda and if you should plan on between-session assignments. For example, homework is common with CBT: You might be instructed to write in a journal or do role-playing exercises.
You feel strongly about the type of feedback you want to receive.
Compatible communication styles can help any relationship work well, including in therapy. One way to tell if it’s a fit is that you find the way your therapist delivers feedback palatable.
Mental-health professionals who specialize in psychoanalysis tend to “allow the client to do most of the talking, maybe offer some validation, and just really listen a lot throughout the session,” says Abby Wilson, a psychotherapist based in Houston. They might ask questions that guide the client to make their own connections and insights, and structured feedback is limited. CBT practitioners, meanwhile, are typically more direct and solutions-oriented, and offer abundant feedback about your thought processes, assumptions, and more.
To get a feel for your potential therapist’s style, ask them these questions: Do you offer a lot of feedback and direction, or are you more hands-off? Do you spend most of the session asking questions, or do you adopt a more observatory role? Do you tend to focus on affirmation, or gently challenging your clients? Do you provide any written feedback?
Experts stress that you get to play a role in shaping your own therapy experience. If you meet with a therapist who nods their head throughout much of your session, and that doesn’t suit you, tell them that you were hoping for more active feedback. And keep in mind that communication styles might naturally evolve as you get to know each other: “I’m direct when I feel like the client and I have a really great relationship,” says Bisma Anwar, a mental health counselor with Talkspace. “It’s built over time.”
You’re looking for specific expertise.
Lots of people who pursue therapy are dealing with a specific issue, like childhood or religious trauma, an eating disorder, or career struggles. In those cases, it can be helpful to secure a therapist with specific training, experience, and expertise.
Google and online directories are your friend, “because if somebody’s an expert in something, they’re going to market that,” says Houston-based psychotherapist Abby Wilson. During your first conversation, she recommends asking: Have you treated people in similar situations to me, and what was the outcome? Did the clients drop out or experience success? Expertise is “definitely important in finding the right fit,” she says.
It’s important that your therapist is your intellectual equal.
A sense of intellectual kinship can be “important because it’s related to trust,” says therapist Emily Maynard. “Can I trust this person knows at least as much about the world as I do? If so, then I can trust their expertise in therapy.”
It might take time to determine if you and your therapist are intellectual equals, or even (sometimes even more importantly) if you just vibe well. One clue is if you have similar vocabularies. Inquiring about what licenses and certifications a therapist has, and what professional organizations they belong to, is another way to get a feel for intellectual priorities. Abby Wilson, a psychotherapist based in Houston, suggests asking: “What do you believe sets you apart from other therapists, and what do you enjoy most about being a therapist?” Responses can shine a light on passion and sophistication.
You can also ask your therapist if she’s been in therapy herself, and how recently. Not everyone will feel comfortable answering, but those who reveal that they have their own therapists are, in a way, demonstrating their investment in the system, and that they believe therapy is effective. “Therapists who do really high-quality work tend to have done a lot of work on themselves and been in long-term therapy or are currently in therapy,” says Naomi Torres-Mackie, a psychologist in New York. “I’m in my own therapy, and I will be as long as I’m practicing clinically.”
You want to define success the same way.
Ideally, you’re going to get something out of going to therapy. Be clear about your goals, and make sure you and your therapist both agree they make sense. It can be helpful to learn about how progress is measured; some therapists, for example, use weekly questionnaires to keep track of clients’ emotional state and symptom improvement.
It may also help to ask your therapist how they define success, says psychotherapist Abby Wilson, and how you’ll know when you’re done with therapy. Your therapist should be able to offer an estimate of how long they anticipate seeing you, given the issues you’re dealing with, and what will inform decisions to scale back or end sessions.
You only want to meet your therapist online.
Online therapy became the norm for many during the pandemic. If you’re only interested in meeting remotely, you’ll have more options now than you would have a few years ago.
It’s important to make sure that any therapist you’re considering working with is licensed to practice in the state where you’ll be based, says therapist Emily Maynard. Once that’s out of the way, she suggests turning the conversation to logistical expectations: Will you both have your cameras on? Does it matter where you’re located during the video meeting? What platform is used, and how does the technology work?
It’s also wise to ask your potential therapist what the main differences are between online and in-person sessions, and what kind of challenges to expect, says psychotherapist Abby Wilson. And keep in mind that online therapy isn’t appropriate for everyone. If someone is dealing with a high-risk issue like self-harm, an eating disorder, or suicidal thoughts, a mental-health professional might prefer to meet with them in person. Ask your therapist about instances when they would advise meeting face-to-face, Wilson advises.
Your therapist needs to be affordable.
Mental-health care can be expensive. If you’re concerned about cost, the first question to ask a potential therapist’s office is whether or not they accept your insurance. If you end up wanting to work with a therapist who won’t bill your insurance, ask if they’ll provide an invoice you can submit for at least partial reimbursement out of network.
Then, make sure you understand what each session will cost and how often you’ll need to meet. Ask what happens if you can’t pay the stated fee; some therapists offer sliding-scale fees that vary based on income. Bisma Anwar, a licensed mental health counselor with Talkspace, recommends a few favorite resources for finding reduced rates: the Institute for Contemporary Psychotherapy, Psychoanalytic Psychotherapy Study Center, and Open Path Collective.
You can also reach out to a local community center or university, says therapist Emily Maynard. Many offer low-cost options, sometimes with therapists who are currently in training.
You want your therapist to be flexible about scheduling—and easy to reach.
Therapy isn’t going to work if you don’t go. That means it’s crucial to determine if your therapist will be available when you are. To figure out if it’s a match, ask about evening and weekend hours, how long sessions are, and if you’ll have a standing appointment, or a different time slot every week, advises Lynn Bufka, associate chief of practice transformation with the American Psychological Association. What’s the cancellation policy? Will your therapist be unavailable for any planned stretch of time?
It’s also helpful to inquire about how you can expect to communicate; for example, Bufka texts with her clients to schedule appointments, but not about clinical problems—and she explains that policy at the onset. You should ask your therapist whether and how you will be able to reach them between sessions, and what kind of response time you can expect. If you need to hop on the phone, and the call stretches beyond a certain length, you can likely expect a charge, Bufka says, so make sure you’re clear on that.
How the office is set up is important.
Space communicates a lot, therapist Emily Maynard points out. “It’s important to make sure you feel safe and comfortable” in any office where you might have appointments. If you’re dealing with religious trauma, for example, you wouldn’t want to see a therapist with religious symbols displayed on the desks or walls.
You can also do a general vibe check during your first session: Are there a lot of people waiting? Does the check-in process feel efficient? Does the therapist have a support staff or manage everything themself? Do you find the space to be calming and quiet, somewhere you can think and speak, or is there distracting noise?
Another aspect of office set-up has to do with privacy, notes New York-based psychologist Naomi Torres-Mackie. Is the office street-level, with a big name-plate that says “psychotherapist”? That might mean passersby will know you’re going to therapy—does that bother you?
You should also consider whether you’d prefer a hospital setting or a private practice. Some people gravitate toward hospitals: “That feels comfortable and makes sense to them,” Torres-Mackie says. “And then there are other folks who want a more homey, warm environment, with nice lighting and plants, in which case private practice would make more sense.”