How to Pick a Good Therapist

How do people go about this?

In my 20s I got a lot out of talk therapy, but I never actually had to pick a therapist. I just used the one that I could afford, which typically meant showing up at a public clinic, and signing up with one of the sliding scale therapists, which was usually a student of some sort. Surprisingly I had pretty good luck. I never ran into a terrible therapist and I think I got information and encouragement that was mostly helpful.

However, I have had little luck in the last 10 years trying to find a good therapist. Oddly I now have pretty good benefits with my job, and there are any number of therapists at my disposal, but I can’t seem to find someone I’m interested in working with. I’ve tried screening over the phone, but it’s not really clear how to do this. I’ve tried picking by A) degrees B) background C) location of office. But this also seems hit or miss. It’s a lot of work to start this kind of relationship.

One time I went to a guy’s office and he had all these big bibles on his shelf. Somehow he had not told me he was a Christian therapist, which I didn’t even know they had those outside of churches. Another time I went to a guy’s office and I assume he was Jewish because one of the first things he asked me was how I felt about the middle east situation, I assume because he recognized my name as Arabic, and wanted to see where I stood. It wasn’t a big deal, but it just seemed like an odd way to start a therapeutic relationship. He also seemed to have had a porn collection on his office computer, so I gave him a pass.

I’ve also found guys who seemed to pass initial muster, but then after working with them for a few weeks/months, I realized it wouldn’t work out. One guy seemed too quick to weigh in with his opinion. Maybe I have unrealistic expectations, but I have never responded well to therapists who are eager to offer their opinion on issues it seems like each individual has to work out for him or herself.

How have others dealt with this sort of thing?

I don’t think there is a good way. You search until you find someone who you feel comfortable with. That can be very, very hard.

Recommendations are my favorite way to find therapists, but another tactic that a friend of mine used was to phone screen therapists that were listed under her “approved providers” from her health plan.* She chatted with them for awhile to see if their personality turned her off, and she also asked what kind of therapy models they adhered to. Most therapists adhere to one or more therapy methods, and you can look them up to see what you think of that method. In the unlikely situation where they can’t name their influences/techniques, then that’s probably a therapist you don’t want anyways.

*Holy mangled sentence structure, batman!

One time a therapist insisted I diagnosis and articulate my problem on my first visit. I didn’t know what to say, but he said I had to do it. He said most of his clients–like 95%–were either depressed or anxious, and which did I think I was?

I was like, Well, shit, I feel a little anxious about having to self-diagnose, so I guess I’ll go with anxious. But, I mean, WTF? Do you really need to have a particular psychiatric problem to benefit from talk therapy?

This. I’ve been through a ton, and only just recently found someone competent.

The only real suggestion I have is to ask people in a therapy related profession. E.g., a shrink is going to refer to therapists quite frequently. They’ll have a better idea than most.

Wait… I thought “shrink” and “therapist” were synonyms for the same thing: mental health professionals. (either psychologist or psychiatrist) But you’re using the words to refer to separate professions?

I think there can be a huge discrepancy between different therapists. So the gap between a good therapist and a bad one can be tremendous.

I read up on therapy methods and picked a few that made sense to me/didn’t make me feel uncomfortable.

Then I asked around to friends/acquaintances and got suggestions from them and narrowed those down based on their methods.

I looked all of them up here: and found a few that felt like good matches.

I called a few that I’d looked up and asked them a bunch of questions: how they approach therapy, if they use specific methods, if they have a particular client focus (mine works mostly with women over 25 for example), if they have areas of treatment where they specialize/have additional training, how long they’ve been in practice, and basic price and availability questions.

After calling around, I found one that clicked and I’ve been seeing her ever since. Narrowing the list with the above-mentioned stuff certainly helped but at the end of the day, I think it’s one of those “you just know” type things. I knew from the first session that it’d work out.

Maybe I need to start a new thread and maybe I need to STFU before I step on any toes (which isn’t my intention, so tell me if I do), but how many of you guys (everybody reading, not just those who already posted) are in therapy?

I’m asking because of all the suggestions about asking friends for referrals - I’m asking because that solution wouldn’t work for me, since I don’t know a single person with any experience to dole out. One friend did some therapy 10 years ago, but that’s it.
But this thread (as well as US tv-shows, which is also a bad metric to base your ideas of a society on) makes going into therapy sound like an everyday occurence. Is it?

It’s very common in the U.S., actually. Over the last maybe 20 years (hard to say exactly), psychology and mental health have become less stigmatized. In fact, we seem to be nearing the point where mental therapy is almost like seeing a physician, just something you do as part of the normal maintenance of your well-being. So I would think that most Americans know at least someone in therapy, if not many people.

Anyone who has never been to a therapist or refuses to go for whatever reason is seriously messed up in the head and needs some professional help.

US healthcare isn’t laughably wasteful all by itself. People do have to consume services to make it happen.

I think that therapy is a much more accepted part of life in the US. Over here in the UK, there’s still a fair amount of stigma attached to it.

I spent a while in therapy for a few issues, chiefly depression (which I had for the best part of a decade, starting in my teens). I went to the NHS at the start for what proved to be the most successful period of therapy I’ve yet to have. The whole process was pretty efficient, I got on with my therapist and luckily enough simple medication and therapy over about 6 months gave me a huge boost. I’ve had reason to go back for related issues but I was surprised and impressed with how good our ‘free’ healthcare was when it came to mental issues.

My friends haven’t been so lucky. It might be the case of like attracting like, but I know several people who’ve had to go into therapy, most of whom I consider to have much bigger problems to deal with than I did. Several girls suffering from sexual abuse: one a self-harmer diagnosed with Borderline Personality Disorder (this is really not fun for anyone involved), one who I consider ‘cured’ in that she now leads a happy and fulfilling like after a pretty dark period involving the death of her fiancé, and one who had a deeply traumatic childhood and has since suffered from Post-Traumatic Stress Disorder.

In all of these cases, they had to rely on the NHS for treatment. In the first case, the girl in question had disastrous results with several therapists, involving misdiagnosis and a “pick’n’mix” approach to medication. I won’t lie, she certainly hasn’t helped herself but the effects of her therapy were absolutely devestating to her at times and for a while it seemed likely that we would lose her. Eventually she found ways of coping and a medication regime that actually helped, and despite some setbacks (developing epilepsy, a bad breakup) she seems to be finally on course to having a proper life. Fingers crossed.

The ‘cured’ girl was always a fighter and I wasn’t around for the period when things were really bad. From what I gather, she went down the self-harm route after her fiancé died from a mystery heart complaint and was in a bad way for a while, but therapy & meds worked very well for her and she was determined to do what she needed to do to get better. She’s now in a happy relationship with a baby boy and the system seems to have worked perfectly for her.

The last is the most troubling. PTSD is devestating and completely changed her personality and emotional responses. The story of what happened to her as a kid is truly awful and she is from one messed-up family. She’s probably one of the most determined people I’ve ever met - she took up a sport to try and bring structure to her life and ended up at international standard - but she’s also the one who suffers her the most. She’s tried many types of therapy and only a few have helped.

I guess this would’ve been a shorter post had I typed “YMMV” but still: the point is that there’s many different types of therapy and what works for one person may not work for another. Attitude to therapy can help but it’s not the be all and end all - I was a huge skeptic before I tried it - and it really is a case of matching the right therapist with the right type of treatment. Sounds obvious, but you might well find that a therapist is 100% convinced that “their way” is correct when in truth it’s only one of several options.

If it doesn’t help, switch. And good luck.

Ask your insurance company for referrals. At least they will have to meet some standard before you go to them.

[raises hand]

Don’t have time right now to post much although I have tons of experience, but I have not found a good way. This last one is at a facility where my charges are covered 100%. In my debt-ridden mind, she’s the best one yet. :)

I can tell you a not so fun way to change is to be seeing someone for 9 months or so every one to two weeks and then have them die of a heart attack the day before an appointment. Very sad for everyone.

I, also, don’t know anyone in therapy. Work, family, extended family, etc.

I know maybe 2 or 3, no more than 4.

It is telling that I know that many in my immediate family. :)

Whatever you do, stay away from this guy:

I was pretty much in the same boat when my wife had cancer – I didn’t know anyone in therapy (still don’t, AFAIK – if I do, they haven’t told me).

In that case, we talked to a friend who was a psychologist who gave us some referrals. Then, when my wife died, I asked that therapist for recommendations for the kids.

In my experience, it was best to have a specific issue to talk about, and you can easily see if their recommendations start mitigating problems quickly. (For instance, I was yelling at the kids because the pressure was killing me. She gave me some specifics to work on while we addressed longer-term issues.) Also, having an ending-point is a good thing – for example, my kids’ therapist ended up saying “OK, they’re basically in good shape, let’s cut down to visits once in a long while,” and I thought that was great – not every therapist is that good about giving up on appointments…)