One of the most important mental health decisions you can make is choosing your therapist. But how do you do that and how do you know you’re ready to do that? The American Psychological Association believes it’s when you:

  • “Feel an overwhelming and prolonged sense of helplessness and sadness, and your problems do not seem to get better despite your efforts and help from family and friends
  • Find it difficult to carry out everyday activities: for example, you are unable to concentrate on assignments at work, and your job performance is suffering as a result. You worry excessively, expect the worst or are constantly on edge
  • Take actions that are harmful to yourself or to others: for instance, you are drinking too much alcohol, abusing drugs, or becoming overly argumentative and aggressive.”

When some or all these criteria describe your current situation and you want to establish a relationship with a trained, licensed psychotherapist, what should you keep in mind? Department of Psychiatry and Behavioral Sciences psychologists Linda Rinehart, PhD, LP, and Sabine Schmid, PhD, LP, have some well-informed suggestions for you.

Ask yourself what you want to get from your therapy.

Sabine Schmid, PhD, LP

That seems like it should be obvious, but according to Dr. Schmid (pictured at left), this question is too often neglected when choosing a psychotherapist. “It’s never too early to set goals. Therapy isn’t something we do to patients, it’s a collaborative process,” she said. “We depend on our patients’ input and direction.” She suggests that you ask yourself, “What do I hope to get out of therapy: new skills, someone to listen to me, or to support me? Do I want the therapy to be short-term or long-term?”

“If your goal is to focus on a particular concern, such as problematic substance use or learning mindfulness skills or coping with a prior traumatic experience, this can inform what kind of therapeutic modality would be most appropriate,” said Dr. Rhinehart. “If you are not sure what you need, a comprehensive assessment is a great place to start. Your provider can then provide tailored recommendations.”

Determine what kind of psychotherapist would be a good fit.
Dr. Schmid noted that the type of psychotherapist you choose should align with your goals for the therapy and strongly recommends finding a provider who practices evidence-based therapy. “When searching for a psychotherapist, look for those who practice therapy with support from research studies such as cognitive behavior therapy or dialectical behavior therapy,” she advises. The use of measures to assess your progress is also a good sign.

Understand what goes into a good patient/psychologist relationship.

Linda Rinehart, PhD, LP

“The therapeutic alliance is absolutely crucial,” said Dr. Rinehart (pictured at left), noting that it has three components: 

  1. Agreeing on the treatment goals. Both patient and provider should have the same goals. “If you have problematic substance use, for example, some providers may emphasize an abstinence-only framework,” said Dr. Rinehart. “If you want to take a harm reduction approach and just reduce your drinking that would cause some discord.”
  2. Agreeing on the tasks – how to achieve the therapy’s goals. “It’s important when you’re making a treatment plan that the patient and therapist agree on its components,” said Dr. Rinehart. “Because I’m a cognitive behavior therapist [CBT], I work with patients to change how they think and to set behavioral goals, which leads to changes in emotion. Another provider who takes a psychoanalytic approach will be more focused on insight. If a patient comes in and wants to focus on understanding their unconscious processes and a CBT provider says, ‘Okay, let’s work on skills,’ it’s a disconnect.”
  3. Establishing a personal bond. “Creating a good personal bond with a patient isn’t about something you can easily put your finger on – it’s not about matching in race or gender or age or other specific features,” said Dr. Schmid. “A good relationship happens when the therapist works hard to understand and help the patient. Skills, training, and being good at what you do helps build that relationship.”

Don’t assume the relationship needs to be long term.
“The vast majority of reasons that people come in for therapy can be treated more short term,” said Dr. Rinehart. “Most of the evidence suggests that symptoms can significantly improve in a few months.” Do you already have a relationship with a psychotherapist, and it isn’t working? If you are not making progress toward your goals or don’t feel that you’re even working on goals, Dr. Schmid recommends bringing it up during a session. “Talk through it, explore if your goals still align,” she said. “If that doesn’t help, you shouldn’t feel obliged to continue doing something that doesn’t work.” In addition, she advises that you give some thought to how much is enough therapy? “Completing all your goals may not be necessary,” she said.

Consider the practicalities.
“From the more practical side, patients need to consider whether they are ready for making changes in their life — are there major life events coming up soon, can they make time for it, and can they afford it,” said Dr. Schmid. “Hopefully, insurance can help.” Determining that can often be challenging to navigate, so it’s best to do it before you get started.

If you are looking for a therapist, Dr. Rinehart recommends asking your insurance company, family and friends, or other healthcare providers you see. “Or you can also reach out to a group practice with multiple different providers and ask them to make a recommendation,” she said. “Most psychologists have an online presence that gives potential patients a sense of who they are and the conditions they treat.”

At the end of the day, it’s about results. “The focus in therapy should be on working toward the client’s goals in their life,” said Dr. Schmid. “It is, of course, important to have a good connection with your therapist and, more importantly, to trust that they can help you — and won’t hurt you. A good therapeutic alliance is usually the natural result of the provider's clinical skills in active listening, empathy, compassion, genuineness, and professional integrity.”

There are many online resources to help you make this important decision. Here are a few: