For me, finding a good fit has been a matter of trial and retrial. It might take a lot of patience and perseverance, but it is worth it to get someone who can actually work with you, and from whom you can actually gain benefit.
Here are some things to take into consideration:
Credentials. It is important that the therapist has some valid licensure. Theoretically we are going to them with the understanding that they have some degree of expertise. Otherwise I could save a lot of money and just talk to my cat. The type of license, however, has not proven to be a huge factor for me. I have worked with psychiatrists, psychologists, licensed clinical social workers, and probably other designations that I frankly never paid attention to. A greater amount of schooling has not necessarily equaled greater effectiveness in dealing with my depression.
Rapport. This is a biggie. If I am not comfortable talking to a therapist, chances are I’m not going to feel like sharing my innermost thoughts/feelings/concerns. And if I can’t share openly about who and what I am, my therapy may be greatly hindered. This is not to say that my therapist is going to become my best friend, or that they have to conform to all my notions about how they should respond to me. Again, the therapist is (hopefully) the expert and is not there to win a popularity contest.
It may take some time to establish rapport. If, however, at your initial meeting the therapist totally alienates you, it may not be worth trying to stick it out. I met with a therapist once who, within our first session, felt the need to announce to me that he was not going to be my father or my lover. I was so impressed by the size of his ego that I was more than happy to announce to him that he was also not going to be my therapist. I stuck with female therapists after that, but that’s just my personal preference.
At other times, it’s just been a matter of finding what worked for us. I’ve had therapists who just sat there waiting for me to lead the session. I’m not a big talker. I can sit in silence forever without feeling the need to speak, which comes in quite handy for watching chess matches. But in therapy it is a huge waste of time and money. By addressing that concern up front, the therapists were able to make adjustments and be more proactive in guiding the sessions. That allowed us to work together much more comfortably and more productively.
Expertise. If you have specific issues you are dealing with, it’s really nice if the therapist has some experience in dealing with those issues. I worked with someone for a while who was new to private practice. Her prior experience had been working with children as a school counselor in a small rural school district. I was in a deep major depression at the time and was feeling as though I was at the end of my rope. She was nice enough to talk to, but I needed much more than that. After realizing that our therapy sessions were pretty much floundering, I finally asked her if she had any prior experience in dealing with someone who was having suicidal thoughts. I clearly remember her actually turning her head away from me, looking down at the floor, and covering her face as she formulated her answer. I don’t recall what her answer was, but her body language made it very clear that she was in way over her head and she knew it. I changed therapists immediately.
Treatment style. There are a lot of schools of thought about how to conduct psychotherapy. I’ve steered clear of the lesser mainstream modalities, but I’ve had some variety. Some therapists have wanted to delve into my childhood, wanting to “take me back” to the five year old me so that I could give her the nurturing she never had. Frankly, that just freaked me out. Maybe it works for some patients, but I don’t feel the need or inclination to relive ancient history.
I’ve been asked to tap various body parts, rip newspaper into shreds, and smoke marijuana. I have fortunately not been asked to punch pillows or let loose with primal screams. I’m a fan of the more pragmatic cognitive behavioral therapy. But that’s just me.
It basically comes down to what works for you, and sometimes it takes a while to fairly assess the value and effectiveness of any given therapy. My biggest piece of advice is to persist. Don’t waste your time on something (or someone) that’s not working for you, but also don’t assume that just because one therapeutic relationship (or two or three) doesn’t work, nothing will.
Psychotherapy has its limitations. For me, it is just one leg of the stool that comprises my mental health regimen. But it is a major component that has helped me come a long way in improving my wellbeing. I don’t know where I would be without it.
Actually, I think I do know, and it makes me shudder.
All the best,