During my first-ever therapy session, I noticed my therapist glance at my hands. This worried me. Am I fidgeting? What does she think about that? Should I keep my hands still? Yes, I’ll keep them still. Is that weird, though? I was so anxious that my therapist was analyzing my every word and movement, but of course, that was her job: to observe and analyze. It can be strange to be vulnerable with a complete stranger, but over time, the nervousness and awkwardness wear off and therapy can help you cope with your most pressing emotional issues.
In order to get the full benefits of therapy, though, you have to put your mental health in the right person’s hands. Even the professionals we talked to agreed that there’s no one-size-fits-all approach to therapy, and the professional that works well for someone else might not work as well for you. There are important considerations to keep in mind through every step of the therapy process.
If you’re new to the world of psychotherapy, you’ll probably start by asking friends for referrals or searching online. When researching possible candidates, you want to make sure they have the tools to solve your issues. At the very minimum, a therapist’s website should include information about their education, certifications, and specializations. There are different kinds of mental health accreditations, and a counselor’s certifications will be different than, say, a psychiatrist who can prescribe medication. That doesn’t make them any less skilled at what they do. A counselor or social generally offers more affordable therapy than may be available through your insurance plan. The specific credentials you should look for are licensed professional counselors (LPC) who have a master’s degree in counseling, psychology, or a related field, a licensed clinical social worker (LCSW) or licensed social worker (LSW). You might also work with a licensed educational psychologist (LEP), licensed professional clinical counselor (LPCC), or a licensed marriage and family therapist (LMFT), or a licensed clinical psychologist (LCP). You can verify a therapist’s credentials on the Department of Consumer Affairs website for your state.
As Laurie Eldred, a licensed master social worker and therapist in Grand Rapids, Michigan, pointed out, “It’s important for people to read the therapist’s website or online directory profile to see what they’re saying about their area of expertise.” Therapists typically specialize in specific areas, like substance abuse, family therapy, couples counseling, or even financial issues. These areas should be listed on the therapist’s website.
A therapist should also communicate what kind of approach they take to therapy. Perhaps there are researchers or scientists whose work they follow. Perhaps there are specific techniques they use in their work. Many therapists will include this information on their website, which can give you an idea of what to expect once you’re in a session. At this stage, try to keep an open mind, suggested Dr. Darin Bergen, a psychologist in private practice in Portland, Oregon. “There are many different approaches to therapy, and there is little evidence that any one therapy is better than another.” For example, there’s cognitive-based therapy, mindfulness-based stress reduction, acceptance and commitment therapy, and so many more.
Online reviews can help you find a good therapist, but they can also be problematic, writes Dr. Keely Kolmes, a psychologist in Oakland, in the New York Times. Therapy is more subjective than, say, bad service at a restaurant, and Kolmes argues that “a certain treatment might help one person but not another.” While the mindfulness approach might work for one client, another may find it frustrating and unhelpful, for example.Still, these reviews can help you look for red flags, like a therapist watching the clock or pushing their own agenda. Just be discerning when you comb through them and understand that, as Kolmes writes, “something that works for one patient at a particular point in therapy might not work for him later, when his needs change.”
Once you’ve narrowed it down to a few therapists who look promising, it’s time for a quick consultation call. Before committing to an actual appointment, reach out and ask to chat on the phone or send some questions via email. “Many of us provide free phone or even in-person screenings before setting up an appointment to feel out each other,” Bergen said. These consultations typically last 15 minutes, and you’ll want to share a bit about your background, the specific issues you’re struggling with, and what your goals are with therapy.
“During the consultation, you also have the opportunity to ask the therapist questions that are important for you to know about that therapist,” said Alisa Kamis-Brinda, a licensed clinical social worker and licensed psychotherapist in Philadelphia. “Some people are interested in knowing where the person went to school or what certifications or licenses they have. For others, knowing about their experience with their particular issue and the therapist’s success rate are more important.” This is probably a good point to ask about fees and availability, too.
Bergen added that your therapist should also be able to give you a general idea of the treatment plan for your specific issue. “Ask your potential therapist how they suggest treating your problem,” she said, “and make sure they have a response that makes sense.”
Of course, your therapist should be a good listener, and you can get an idea of this during your phone consultation. Just remember that “good” listening is somewhat subjective. Sure, a good therapist is typically compassionate and nonjudgmental, but “some people prefer a therapist who does a lot of listening while you vent and process, while other people prefer a more active therapist who teaches coping skills and offers more feedback,” Brinda pointed out. “Consider your gut feeling to see if it feels right talking to this therapist,” she said, but generally, “you can tell if a therapist is a good listener if you feel heard and understood when talking with them.”Beyond feeling understood, the therapist should be able to communicate that they’re knowledgeable with your issue through training and experience. You can simply ask, “Can you tell me about your training and experience in this area?” Their answer should make you feel confident they can handle your issue, but “I would recommend that people focus more on how it feels talking to them,” Brinda says. “Research has shown that the relationship between the therapist and the client plays a big role in the success of the therapy.”
If you don’t like what you get in your 15-minute consultation, be willing to shop around, suggested Dr. Jim Seibold, a licensed marriage and family therapist in Arlington, Texas. “The research has been clear about this — a good rapport with the therapist is vital to success, so make sure you find one you are comfortable with,” he said. “Ask about their expertise, education, experience, style, fees, cancellation policies, and other office policies.”
Especially if you’ve never been to therapy before, the first session can always be a little awkward. You don’t exactly storm into the office, plop down on the couch, and declare, “Okay, doc, fix my intimacy issues!” The conversation typically emerges more organically. Your therapist might ask how your week has been, then dig into the issues from there. Either way, you should feel comfortable and heard as the session progresses.
“Good therapists demonstrate good boundaries,” Seibold said. “They keep the relationship professional by limiting the personal information they share about themselves. They stay awake and alert throughout the session and do not answer their phone or check their text messages.” During your session, you should never feel that your therapist is pushing his or her own agenda or professional goals, like selling a book.They should work to support the goals of the client, Seibold said.He added that part of establishing solid boundaries means acknowledging when they may not be able to help with a specific issue you might bring up during therapy. “Good therapists refer clients who are experiencing issues outside their area of expertise,” he said.
At this point, you and your therapist should agree on a treatment plan with specific goals and objectives. The plan should include strategies that your therapist believes will help you reach those goals and might even include a time frame for getting there. Before treatment, your therapist should also ask you to sign an informed-consent document, which includes information about your rights and responsibilities as well as theirs.
You should notice that you feel supported and hopeful after your therapy sessions, said Jonathan Alpert, a psychotherapist in New York City and author of Be Fearless: Change Your Life in 28 Days. In an article for the New York Times, Alpert writes:
… if the therapist does nothing more than nod his head and provide vague utterances of reassurance like “I see” or ask questions that might seem dismissive (like the classic ‘And how does that make you feel?’), then move on. This type of therapy proves ineffective while a more positive and engaging therapist is better able to help a patient achieve optimal results.
He added that after a few weeks of therapy, you should begin to feel at least a small sense of control and change. If you don’t, it may be time to move on.
That isn’t the only red flag, of course. If your therapist constantly watches the clock, makes you feel guilty for quitting, or threatens that you’ll “plunge into depression” if you stop going to therapy. Those are surefire signs that you might not be getting the help you need, Alpert writes. “If the therapist does not seem understanding about this or tries to pressure you into becoming a client, be firm and do not go back,” Seibold warns. “If they don’t respect your need to be comfortable and confident in the professional relationship, they are not likely to respect your goals and objectives either.”
Brinda listed a few other red flags that it may be time to ditch your therapist:
• The therapist is talking more than you.
• The therapist is interrupting you often.
• Any inappropriate behaviors from the therapist (sexual or otherwise).
• The therapist has violated your confidentiality.
It’s worth pointing out that the last two red flags are also reportable offenses. You can file a complaint with the board of psychology or board of behavioral sciences for your state.
How long therapy lasts varies depending on the person; it may take months or years until you feel that your therapy is complete and you’ve reached your goals. Ultimately, therapy is complete when you feel confident that you’ve developed the skills and tools to cope with the emotional challenges that brought you to therapy to begin with. This is also why it’s important to develop a clear treatment plan at the beginning of your therapy. After all, therapy is also expensive. You want to make sure you’re getting your money’s worth. “You know therapy is complete when the client can say their goals are met or if they feel therapy is no longer leading to personal growth,” Bergen said. “We know from the outcome research that the relationship between the client and therapist is one of the most important factors for a good outcome.”