When and how to choose a therapist

You may be at a point in your life when you feel ‘stuck’ in some way. Your head is just above the water and you are paddling hard but not really getting anywhere/not happy/very sad…….. Such are the times when we feel the need for some help beyond the kind ministrations of family or friends. But what kind of help do you need? This is not really about ‘medical’ help – physical or pharmacological – it is more about finding the right kind of service.

If you are feeling ‘stuck’, having  a problem or related set of problems that you feel unable to solve and/or are feeling worried, it might be that some time with a coach is what you need; that is, the help of a supportive problem-solving partner, preferably one with some training. Coaches are unlikely to be experts in your field, whether it be domestic or work-related, but they will be skilled in helping you to explore your issues more thoroughly, helping you to identify the goal that you want to achieve or problem that you need to address, the barriers in your way (be they actual or psychological) and developing a plan for moving forward in in some way.

If the worrying has become more pervasive and intrusive anxiety and/or persistent feelings of sadness or depression, then it may be that you should be seeking therapy. Deciding to seek ‘talking’ therapy is quite a brave move; it implies that you have recognised that your mental health are not good and  is affecting your day-to-day functioning, and that you have recognised that you need to take some steps to manage or improve it. But as we have already noted (Can You Think Yourself Well? THAP Long article), there is a bewildering array of ‘talking therapy’ approaches, and it is not easy to know where to start.

Before you begin along the path of trying to identify a suitable therapist it is useful to reflect a little bit on what you are looking for. You might pose some questions to yourself: Have I identified a specific problem? (Eg, I am in a toxic relationship that I cannot seem to get out of.) Am I feeling in need of some psychological support? (Eg, I feel persistently anxious and/or depressed and am not quite sure why and what to do about it.) Or am I on a quest for self-improvement via a better understanding of my own psychology? Of course, there may be substantial overlap, but in essence these are different kinds of issues and might require different kinds of therapeutic help. In the latter case you might be best served by finding an analytical therapist such as a psychoanalyst with whom you may engage in a long-term exploration of your mental/emotional states and responses. If you feel that you need psychological support because of distress then you will want the kind of therapist who takes a person-centred approach, responding to you with ‘unconditional positive regard’. If you want to be challenged a little more about your problem-solving tools and skills, you may want to find a therapist with a cognitive-based approach. These are not easy questions, but some reflection around them is a good place to start.

In your search for a therapist you may be happy to begin by trying to solicit some recommendations from a trusted friend or family member. Of course, the therapy process is by its very nature a very personal one and so what has worked for one individual may not work for another.  Similarly, you may want to be more private about this and so may not feel comfortable asking around.

As we discussed in our longer paper, ‘qualified’ does not necessarily equate with ‘competent’ or ‘good’, and in fact there is simply no way to know in advance or even after an initial meeting whether your chosen therapist is likely to be effective. But there are many good therapists out there, and even those who are not especially effective probably have a lot of positive intent, so to some extent you need to be prepared to take a leap of faith. There are however a few steps that you can take to narrow the field.

First go to the registers of qualified therapists. Both the British Associate for Counselling and Psychotherapy (BACP) and UK Council for Psychotherapy (UKCP) have registers of fully qualified therapists which you can explore via a number of search terms – for example, location, specialism/approach and/or type of problem. Inevitably your search will produce quite a long list which you will then have to narrow further – but how?

Secondly, and very pragmatically, identify those who offer an approach which you feel is well-defined and which you think you understand. If their description of what they do and how they do it is so shrouded in professional/obfuscating language, then you might reasonably assume that they are most interested in showing off their professional credentials and not highly client centred.

Thirdly, given that we know that the success of much therapy is based substantially on the bond or relationship that you develop with your therapist, it is important that you have opportunities to meet with potential therapists to begin to get some sense of the ‘chemistry’ between you. Do not be afraid of asking whether they offer a free initial session for just this purpose, and if they don’t, then cross them off your list. Clearly, most therapists do not offer services out of the goodness of their hearts, they are trying to make a living. But given the nature of the job, that is helping others to address their problems and distress, the commercial side of the transaction can be quite tricky to navigate. You should expect them to be very ‘up-front’ about fees/invoicing issues, but once dealt with, hopefully outside your session with them, then the issue can be put to bed. You may however encounter therapists who spend a disproportionate amount of time and emphasis in-session addressing fees and ‘terms and conditions’. You may want to reconsider any therapist whom you feel is unable to deal with these transactional issues quickly and efficiently. 

Fourthly, one of the key challenges if you are coming to therapy for the first time is your expectations: you don’t know what to expect of the therapist and you don’t know what they expect of you, and then having no yardstick for making evaluations, you have nothing by which to judge or predict the outcomes – primarily the success of the relationship. One of the key things to bear in mind is that the therapist’s job is not to solve your problems, but to help you to solve your problems. This approach will be evident from very early on in your interactions. Some therapists can take this approach to extremes and may have little or no preamble for the beginning of the session, either beginning by asking you why you are there or by sitting silently and waiting for you to speak. As a novice ‘therapee’ this can be very disconcerting. If you find that the therapist gives you very little or no help in your attempts to articulate why you are there and what your issues are, or evinces little curiosity about you, you can probably cross them off your list on the basis that this may be a reasonable predictor of their ongoing approach which may be more about their own process than about yours. 

Finally, and slightly counter-intuitively given the previous point, a therapist cannot be your friend. They need to be able to hold the boundaries of the relationship and this means being able to treat you with unconditional positive regard, conveying a non-judgemental attitude, but at the same time not getting inside your emotions with you. Neutrality is not quite the right word here, but it is something along those lines – the ability to empathise but not so completely that they cannot see other perspectives and issues to bring to the discussion. 

So, an initial session or two with more than one therapist is entirely necessary before you make a final decision about a therapist to work with. Ultimately, after following some of the pointers above, you need to allow yourself to trust your intuition about a therapist; after all you will be sharing personal information and huge amounts of emotional energy with this person and so you need to feel that they are worth that.