Treatment

Deciding on the Right Therapist

It can be intimidating to find a therapist once you've made the decision to seek professional support.  There is no perfect, cookie-cutter algorithm for choosing a therapist; however, there are a few useful things to think about as you decide.

Gender

Choosing a male versus a female therapist may seem like no big deal to some people, and it may seem like a dealbreaker to others.  Even if it doesn't seem like a major factor to you on the surface, think about the problems and concerns in your life.  Would you feel completely comfortable talking about these things with someone of your same sex?  What about the opposite sex?  Do you have an immediate reaction to imagining one or the other of those scenarios?  For example, some people have a hard time discussing a divorce with someone of the same sex as their former spouse.  Think about how your therapist's sex may or may not influence your experience in treatment, and how much this matters to you.

Theoretical Orientation

"Theoretical orientation"is a fancy way of saying "approach to treatment."  All therapists approach therapy from their own unique perspective, and every client responds differently to a given approach.  Some therapists stick closely to one theory that informs treatment (e.g., Cognitive Behavior Therapy, Dialectical Behavior Therapy, Psychodynamic psychotherapy), but many therapists pull from several theoretical orientations to shape the way they approach therapy.  A good way to find out about a potential therapist's theoretical orientation is to ask how she believes change happens in therapy.  Listen carefully to the answer, and think about how this does or does not fit with your own ideas and comfort zone.  If you are someone who prefers less structure, and your potential therapist tells you he makes an agenda at the beginning of each session and assigns homework at the end, you have something to consider when making your decision.  Also remember that sometimes it can be good for us to stretch a bit beyond what we're used to.  So if the agenda and homework really appeal to your rigid streak, consider how it might be immensely helpful for you to find a therapist who pushes you to become more comfortable going with the flow.  Therapy is about change, after all!  You may be getting the sense that there is no "one size fits all" therapist, and you're right.  Feel free to ask many questions about how your potential therapist's orientation will play to your own strengths and vulnerabilities.

Specialty

Although many therapists have what's called "generalist" training (meaning they have experience and training working with many ages and problems), most therapists do have a particular area of specialization.  For example, there are many therapists who work a lot with children and adolescents.  Although many of those same therapists are also trained in working with adults, you may decide to seek someone who works more often with adults than with children to help you improve your relationship with your supervisor at work.  As with gender, this may be more or less of a factor for you, but it is worth considering.  There are also many different areas of specialization.  Some therapists are really experts at working with anxiety, some with depression, some with grief, some with trauma, and so on.  There is often a fair amount of overlap with psychiatric problems (for example, many people with anxiety also deal with depression), and most therapists treat a diverse range of problems,  so looking for someone who sees only people exactly like you is probably going to leave you with very few options.  However, you do want someone who has familiarity and experience with what you are dealing with, and you should ask about this in your search for a good fit.

Practical Stuff

This seems pretty straightforward, but it's worth saying explicitly!  Therapy is an investment of time, money, and energy, and it is important to think about the reality of how a particular therapist will fit into your life.  Does she have a schedule that is compatible with your own?  Does this therapist take your insurance, or will your insurance reimburse you for some number of sessions?  If not, can you afford to pay out-of-pocket?  If it's a financial stretch, is it worth it to work with this particular person because of specialization, theoretical orientation, or recommendation?  Is his office close enough to your work or home to be convenient?  Can you arrange with your supervisor to take a late lunch or leave a few minutes early to make a therapy appointment during the work day?  Think carefully about the practical realities of your resources, and what's most important to you in fitting therapy into a balanced life.

Don't Let the Rules Hold You Back

After thinking about all of the above things, plus whatever else is important to you, you may feel it is an insurmountable task to find the right person with the perfect combination of features. Remember that sometimes the best outcomes in our lives are the result of surprises.  When searching for  a therapist, you may find that you connect very well with someone who does not fit your list of "must-haves," or who is someone you were skeptical about at the start.  As with many things in life, it's about finding the balance between narrowing it down to choices that make practical sense for you, and being open to finding something outside your expectations.

Bottom Line

Only you know the factors that will allow you really to invest in and stick with therapy for long enough to make meaningful change.  Effective therapy that results in lasting change does not happen overnight, and does not happen with just any fit between patient and therapist.  Meaningful change in therapy requires dedication of resources from you.  If there are things that make it especially difficult with a particular therapist, keep looking for the right fit.  Improving your relationships, psychological well-being, and self-esteem is worth the effort and time it takes to find the right therapist!  And remember, when in doubt, ask lots of questions and pay attention to your own gut feelings.