In successful therapy, you probably haven’t heard someone say, “I hate my therapist, but the therapy works.” I certainly haven’t. Usually, when I hear or read comments to the effect of “I disliked my therapist,” the story ends with the client having left therapy. At best, they leave feeling frustrated and misunderstood; at worst, they feel hopeless or disillusioned with therapy as a practice. It makes a lot of sense why some people who have had that experience don’t try therapy again. Who could blame them? On the other hand, when I do happen to meet the client in my practice who’s been burned by therapy before, I often have to do a lot of work to make up for that prior experience before the client’s other presenting concerns can be addressed.
While there is no way to guarantee that every therapy experience can be positive, there are some things you can do, as a client, to take charge and help yourself have the best experience possible.
What to look for in a therapist: The Relationship
One of the most reliable predictors of therapeutic outcomes is the quality of the relationship between the client and their therapist (Ardito & Rabellino, 2011). Basically, how you feel with your therapist is possibly the most significant factor there is in determining how successful therapy will be for you. All theory models and modalities work. While some may be more appropriate for certain clients with certain presenting concerns over others, the therapist’s theory, overall, will not make or break your success as a client. What you should be looking for is your response to them. Therapy is an intimate sort of thing, and you may very well end up telling your therapist things you’d never tell another soul. Pay attention to how comfortable you feel with your therapist, if you feel heard, and if you feel cared for.
Your Therapist’s Experience
It’s important for clients to know that therapists take practicing within their scope of competence very seriously. It is unethical for us, as therapists, to try to treat someone with a condition or concern we know little to nothing about, and/or cannot receive adequate support for. We can get in major trouble for doing so, and worse, we can harm clients in attempting to try. Some common areas of presenting concern that may require a specialist are:
- Active addiction/substance use disorders
- Disordered eating (anorexia, bulimia, binge eating disorder, etc.)
- Active psychosis/delusions
- Personality disorders
- Complex trauma
When scheduling an initial appointment with a therapist, please try to be as up front as possible about the concerns you want to bring to therapy. It is perfectly okay (and expected) that some things will need to be introduced into therapy slowly. Giving a therapist a “heads up” about something you want to eventually bring in can help both of you make an informed choice about whether they can serve you as a therapist-long term. It can be a painful (and potentially re-traumatizing) event for a client to be told by a therapist that they do not feel qualified to treat them anymore. I find this is both important and sad to note this circumstance cannot always be avoided.
If you ever happen to be on the receiving end of this conversation, please know having a therapist communicate to you they no longer feel qualified is not because you are “too much” or “too messed up.” It is what our field tells us will keep us from doing more harm than good. That said, an ethical therapist will always provide you with referrals to other therapists they do feel are qualified to treat you and will try to make the transition as painless as possible.
Shopping Around
Many therapists offer short phone or video consultations at reduced or no cost to their prospective clients. The most common one I see is fifteen minutes of time, but I’ve seen as long as thirty. This is a great way to become acquainted with a therapist and start to “feel out” if you’ll be a fit together. Take this time to ask questions, share a bit about your presenting concerns, and hear how the therapist responds. If you like their responses, there’s a good chance you’ll enjoy them as a therapist. It is also completely normal and expected to interview a few therapists before making a choice. Just make it clear to the therapists that you’re interviewing multiple people and when they can expect to hear from you about a decision.
If you went ahead and scheduled an intake appointment with a therapist, you’ll have more time to take note how you feel in the room with your therapist. It’s also a prime time to gather information about each other. Questions I often ask clients include:
- Have you been to therapy before? What was your experience like, if so?
- What specifically prompted you to seek out therapy?
- What are some important things about you that I should know?
- Do you have questions about me and my approach?
I pepper these questions throughout the session because they help me assess how much I need to introduce therapy as a concept to my client. They give me an opportunity to unpack any previous therapeutic experiences (good or bad) and allow me to begin to tailor my approach by what they’ve listed are important concepts for them (ie, culture, sexuality, religion), and gives them an opening to ask questions about me. If your therapist doesn’t ask these questions, make an offering of this information and see what happens. They probably want to know! Most importantly, if you have questions or hesitations, make it known so your therapist has a chance to address it with you.
Reminders
As you leave this article, I want to remind you:
- It’s important to give yourself (and your therapist) a little time to get to know each other and get comfortable with one another. The relationship is key, and all relationships take time.
- You do have power over how your therapy journey goes. You can find it in advocating for yourself: interview therapists, make your needs known, and ask questions.
I wish you the best of luck in your journey forward!
Sincerely,
Mia
Resources
- Think:Kids : The Biggest Predictor of Success in Helping Someone Change (thinkkids.org)
- Frontiers | Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research (frontiersin.org)
- Ardito RB, Rabellino D. Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Front Psychol. 2011 Oct 18;2:270. doi: 10.3389/fpsyg.2011.00270. PMID: 22028698; PMCID: PMC3198542.
Mia Mattingly, M.A., is an LPC-Associate licensed in the state of Texas who specializes in individual and couples/intimate partners therapy. She is currently accepting clients. You can reach out to her directly at [email protected] or (737) 707 – 3961.
Mia Mattingly, LPC-A, Licensed Professional Counselor-Associate
Supervised by Lauren Masciarelli, M.A., LMFT-S, LPC-S
