I’m a psychologist and worked as a therapist for many years.
And while I believe good therapy can be an incredibly powerful and transformative experience, I also know that it’s often not a very positive experience….
- Sometimes this is the therapist’s fault. Many therapists are not trained well-enough or have so much of their own personal baggage or odd personality quirks that they can’t be very helpful.
- Sometimes this is the client’s fault. They go into therapy hoping for some kind of quick, simple solution and then quickly give up when that doesn’t happen that way.
But the most common reason therapy doesn’t “work” is because there isn’t a good fit between the therapist and the client.
For example:
- A therapist might be extremely non-directive and open-ended in how they approach therapy—rarely, if ever, giving direct advice or providing much structure in session.
- This can work well for a client who is okay initiating and self-starting in therapy. Or might be necessary for someone who has issues with being overly dependent.
- On the other hand, this might not work well for someone who’s never been in therapy before. Or for someone who has a very specific and narrow problem like insomnia that requires a lot of education and coaching.
The point is…
Finding a great therapist means finding a therapist who is great for you.
After years of thinking about this question, reading the literature, and having hundreds of conversations, here are a few suggestions I give to almost everyone.
Credentials are overrated
Don’t worry too much about whether your therapist is a psychiatrist or psychologist, has a PsyD, MSW, or PhD. It’s important that they are licensed. And that they have experience and training appropriate to your goals. But I’d pay more attention to personal factors like personality, their communication style, and how you feel when you interact with them.
Be prepared to go for some test drives
There’s no easy way to find a therapist who will be a good match for you. Like dating, it’s largely a numbers game. You need reps experiencing different people and styles to find what works for you. So don’t be afraid to talk with someone a handful of times and move on if it’s not a good fit. Also, if possible, try test driving multiple therapists at the same time. Eventually you’ll probably want to settle on one. But it can be very helpful to “interview” multiple people initially.
Look for the 2Cs: Comfort and Challenge
I’ve seen surprisingly few “common factors” in what makes a therapist effective. But there is one thing I do tend to see over and over again in particularly good therapists: They’re able (and willing) to provide both comfort and challenge. When you’re with them you feel supported, understood, and genuinely cared about. And at the same time, they’re not afraid to be direct, honest, and to push you even when it’s difficult or uncomfortable. They care deeply about the relationship, but they’re willing to risk it to help you succeed.
Don’t expect to be saved or fixed
You are responsible for doing most of the work in therapy. A great therapist helps you do the work—but they can’t do it for you. Many people make bad decisions choosing therapists because, deep down, they’re looking for a magician who will offer some secret insight or hand them a special tool that will solve their problems. This is a very dangerous mindset to get into therapy with. You’re looking for a trainer—someone who will guide and support you in doing the very hard work that only you can do.
Be careful of “eclectic” therapists
It’s common to come across therapists who describe themselves as eclectic, meaning they use a variety of tools and approaches from different schools of thought and modalities. This isn’t bad necessarily. And having a therapist who’s open-minded and not dogmatically tied to a particular theoretical position is a good thing. But “eclectic” is often code for someone who is basically throwing spaghetti against the wall to see what sticks. Not good. You want a therapist who’s flexible; but you also want someone with conviction and a point of view.
You need to interview your therapist
Often a therapist will suggest an initial consultation session or series of sessions. From their perspective, this is a chance for them to learn about you and your goals and make sure it’s a good fit for them. But this is also your opportunity to interview your therapist and figure out if they’re a good fit for you. So be bold and ask lots of questions: How would you describe your approach to therapy? How directive or structured are you in therapy? How frequently do you work with people like me? How long do you think therapy will last? How is your approach to therapy different than other therapists? Etc. Keep in mind that how they answer your interview questions is at least as important as what they say. Keep a close eye out for defensiveness… If you ask your therapist a question about themselves and they get defensive, that’s a huge red flag—and sadly, more common than you would think.
You don’t have to explain your life story right away
Many people avoid starting therapy or test driving lots of therapists because they’re understandably hesitant to dredge up all the painful details of their past over and over again to complete strangers. But you don’t have to get into all of that right away. Some context about your background is helpful for the therapist initially. But it’s totally normal for a person’s history to unfold over weeks or even months of therapy. Therapists need to earn trust just like anyone else.
It’s okay to walk away from weirdos
Therapists can be a strange bunch. And while any given therapist might be very well-intentioned—even talented—if they’re just too weird or eccentric for you, it’s okay to move on.
Many of the best therapists don’t take insurance
Like it or not, therapy is a marketplace. Which means if a therapist is in demand enough to avoid all the hassles of working with insurance companies, they probably will. And while demand for a therapist isn’t a guarantee of talent or quality, it’s actually a pretty good signal in my experience. Of course, even an extremely talented therapist isn’t necessarily going to be a good fit for you. But all other things being equal, it certainly helps.
Accessibility is a real issue
Unfortunately, therapy is simply out of reach for many people—either because of cost or access. I don’t have a good answer for this but it seems important to acknowledge.
What you get out of therapy largely depends on what you put into it
And this is especially true of the initial “pre-work” of researching, interviewing, and test-driving different therapists. Remember, there’s nothing magical about therapy. People who benefit from therapy long-term are usually the ones who are willing to stick with it. Not necessarily with one therapist for years and years, but stick with the process. If one therapist isn’t working, they’re willing to move on and try someone else. And they’re willing to be honest about their own motivations, expectations, and frustrations, and how they might be impacting their progress.
Therapy is not always the answer
Many people get more benefit out of a good self-help book at the right time than years of psychotherapy. For some, medication seems to work more effectively than therapy. Others just need a real friend, not a therapist. Frequently, there are major environmental or structural factors in your life that therapy isn’t in a position to do much about. Therapy can even be a form of avoidance or too easily lead to codependency in certain people. And while none of those things invalidate therapy as a possible answer, they should give pause for deeper reflection about what your motivations and expectations around therapy really are.
21 Comments
Add YoursI could not agree more with what you have said. Yes on all counts. My experience over the past 31yrs has led me to see therapy as a horizontal relationship. Push and pull is needed and certainly challenges are welcome.
Mentioning the things you don’t want know, in a way that helps to hear.
Thanks Marion! I like your phrase… “horizontal relationship”
I am a therapist, and it’s very true what you say about a client not needing to give their life story right away. Clients open up when they are ready to – and that’s the way it should be, rather than being pressured to discuss things they don’t want to.
Thanks for the article, some interesting thoughts you give 🙂
best wishes, Ruthie Holloway / healmenow.co
Thank you, Ruthie!
Thank you for covering this subject. It was very helpful information as I’m sure many are in search of a good therapist during these turbulent times !!
You’re very welcome, joy!
Hi, Nick –
Great article, thank you!
I just want to comment that with the availability of online therapy, I think more people are in a position to access help than ever before. Online formats are less expensive for the client and they make the process of selecting a therapist much less daunting.
I work for Better Help and although I was initially skeptical, I am really impressed with the online format and the ease of using the technology for both therapist and client. I have clients who, because of where they live or what they can afford, would once have had a hard time finding someone to work with. But with online therapy as an option, all they need is access to a computer and wireless to be able to select from among many types of therapists.
I have the sense that the online format is the wave of the future – and in many ways, I think it’s a very positive thing.
And – everything you mentioned in your article applies to choosing an online therapist, so thank you for articulating that. I feel like Better Help should post your article on their website!
Hey Amy, thanks for this note—it’s much appreciated!
I’ve heard good things about BetterHelp as well. I don’t feel like I personally have enough experience with virtual therapy to have a strong opinion yet, but like you say, I’m sure it’s going to be a big part of the future.
Thank you, Nick. I hope a lot of ppl thinking of therapy read this..it’s superb information…
I appreciate that, Tracy!
Dear Nick, thank you for another excellent article and for writing things that I haven’t read elsewhere. For me, some particularly salient points: some Clients are looking for a magician, & some Therapists may be too weird or too non-directive for a given Client.
Thanks Anne-Eli. Yeah, both of those can be uncomfortable to acknowledge, but I think it’s important to acknowledge.
Thanks for the helpful article, Nick. I would add check for cultural and spiritual compatibility. For example, I have the gift of being psychic and it’s important to me to work with a therapist who has expertise and openness to my spirit-centered life.
Hi Nick, I’ve been a grateful subscriber to your emails for a while now. This is the first time I’ve commented on an article and this one makes so much sense to me. I am a counsellor and often say to my clients how most of the work is done between sessions and that I am there to support them along the way. I like to think the relationship with clients is a collaborative one. There are many reasons why sometimes the relationship doesn’t work out; a bad fit,
client’s unreadniess etc.
Perhaps the client had been coerced into therapy, which rarely works.
This was a refreshing and honest article about clients, therapists and the therapeutic relationship.
Thank you.
I respectfully disagree about your judgment regarding eclectic and fee for service providers. Glad you have much more often quite helpful knowledge than trumpting down opinions from a high horse.
Great article! Now, I wonder…where might
I find a great therapist? Sometimes, it feels like looking for a needle in a haystack.
I have been in and out of therapy for a long time. I have progressed in personal growth, discovered my gift of “hearing” music and pursuing that gift which led to composing, a music video on TV, writing a screenplay which has had recognition. For me, the best therapist was Dr. John Elliot Bradshaw, author of “The Inner Child.” He met my needs, gave advice that led to my composing music. He was exactly right. I didn’t pay a cent. I saw him on PBS, immediately felt what he offered was right for me, attended his lectures in NYC where I lived and followed him as much as possible. He changed my life. So, dollars are not the issue although, of course, I paid to hear him at a PBS fundraiser, paid to get into his lectures, paid to buy his books. The therapist has to fit what is at the core of your issues. I found it in Dr. Bradshaw and yes, in one other therapist in NYC who was a very successful writer turned therapist. “The good therapists don’t take insurance.” They should. Yes, I use the word “should.” First and foremost, they must be humanitarians, if they aren’t, they ought to get out of that business. If they do not have a feel for a person’s plight, then what are they? Yes, they must get paid but it’s very hard hearted to be so fixated on not being flexible about payment. I would gladly have paid for one on one sessions with Dr. Bradshaw but he lived in Houston, I was in NYC. His lectures on TV, in person in New York, his books, his candidness about his early struggles with alcohol and depression, how he laid bare his own demons, that he was a bad marriage partner at one point, not a good father; in short, his honesty and vulnerability, his empathy for those who suffer psychologically – he was a humanist first and foremost. Find what is right for you. I went to many therapists, stumbled on Dr. Bradshaw and am eternally grateful for turning on PBS that night. Rest in Peace, Dr. John. I am eternally grateful to you.
In my opinion, finding a good therapist who is the right fit for you is like finding a needle in a haystack!! Also, the availability, flexibility (ie working with the clients financial restraints and/or insurance) is very tricky for both the client and the therapist. Interviewing many different therapists, or even just one for several weeks can be a costly investment (even with insurance) with no guarantee they are going to get to know your needs enough to help you at all. I think biggest problem with psycho therapy, and the reason most people don’t get the help they need (and I apologize for the rant) is that it’s such a hairy involved process to get started (sometimes taking several weeks for even the initial intake), that it is nearly impossible to get the help you really need when you are actually in a moment of real crisis that may or may not not be life threatening. I tend to agree with the person who noted that a vein of philanthropy is essential for the individual who decides to be a therapist, if they truly desire be effective to their clients, who happen to be vulnerable human beings. That being said, I greatly acknowledge therapists who offer their wisdom, and support of learning how to help yourself, through free and easily accessible platforms such as this. Thank you, Nick! Your articles are very practical and helpful, and so deeply appreciated.
How do I sign up for personal therapy session with you ? 🙂 is that a service you offer?
Nick, could you recommend some reading that would enable those of us that are not in therapy but might be contemplating the need to better understand ourselves and dtermine the level of need?
Thanks
There is a great need for therapist who are willing to help those with C-PTSD. This diagnosis is real yet it has not landed in the DSM-5 yet. C-PTSD’s is more chronic than PTSD, and clients dissociate and have depersonalization episodes as coping mechanisms stemming from childhood abuse or trauma. Borderline personality disorder is in the DSM-5, but there is stigma attached to these sufferers, who really need therapists who are willing to be present for them. I have both C-PTSD and borderline personality disorder. I had a therapist who provided EMDR to process my childhood trauma. I just moved to Florida, and it has been 5 months, and I still cannot find a therapist who treats C-PTSD. There are only 3 hospitals in the United States that treat this diagnosis. I am frustrated that C-PTSD is avoided when there is such a great need for it. I have yet to see C-PTSD in a therapist’s bio when searching for one. And just because it is not in the DSM-5, it is recognized as a valid diagnosis by many mental health professionals and organizations, including the National Center for PTSD. Complex post-traumatic stress disorder has some controversy surrounding the diagnosis.
Some experts argue that complex PTSD is not a distinct disorder but rather a subtype of PTSD. Others argue that it is a separate disorder that requires its own diagnostic criteria. The PTSD diagnosis may not adequately account for difficulties with emotional control, self-concept, and interpersonal relationships in people with complex PTSD (Sabino Recovery, 2024).
I had 3 split seconds of suicidal ideation hitting brick walls in my search for a C-PTSD therapist. I am dissociating at times by the triggers so Internal Family Systems would benefit me a great deal. I cannot find an IFS therapist who takes my insurance to save my life.
I wanted to voice this disparity and raise awareness of the need for therapists to explore and provide specialized therapeutic approaches for C-PTSD sufferers.