How to Select a Psychotherapist or Counselor

When you are feeling really bad, like you'd prefer to be hiding under a rock, it can feel like you don't have the energy or fortitude to get through the maze of finding and selecting the right helper.  Yet it is important and even vital to seek help when you need it. So today's post is meant to give you some guidance to help make your process as smooth and painless as possible. (This post addresses individual therapy. In a future post I will address specifics related to finding a couple or family therapist.)

First of all it can be helpful to know if you prefer counseling or psychotherapy. Are you thinking of short term, tightly focused, get-in-get-tuned-up and get back on the road? Or do you have a hankering for more of an open ended, process oriented approach? And It is okay if you don't to know yet! A good therapist can help you figure that part out, but the question should at least be addressed early on. The two terms counseling and psychotherapy, respectively, imply these two different approaches to a therapeutic relationship.

What's the difference between Counseling and Psychotherapy?

The terms counseling and psychotherapy are frequently used interchangeably  and although they are not technically the same, in practical terms there is often overlap.

The word counsel is defined as advice; opinion or instruction given in directing the judgment or conduct of another (  Counseling implies advising and directing, whereas in psychotherapy advice giving is not the primary method, and indeed for some therapists is avoided. Counseling is usually of shorter duration, whereas psychotherapy tends to go into greater breadth and depth and hence takes more time. Counseling is usually aimed at helping you identify and address a specific problem and find solutions. It is more direct and focused on the problem or problems you bring. In counseling, you may be given suggestions, observations and advice.

Psychotherapy is a broad term and encompasses the practice of numerous theoretical orientations, each one having different ways of conceptualizing problems. The theoretical frame that a therapist uses will largely determine how the therapist sees your problem (i.e. how the problem developed, what maintains it and how intervene).  For example some therapists will want to work with you to become aware of the roots of the problem (i.e. psychodyamic) while others may be concerned instead with addressing what maintains the problem (i.e. cognitive behavioral).

With some exceptions such as intentionally brief models like solution focused therapy and narrative therapy, most psychotherapy is a longer term process and tends to look at the big picture - your personality, history, experiences, culture, environment, your strengths, your ways of coping with the goals of personal growth and behavioral changes. In a psychotherapeutic context, advice giving is not considered the best method for helping, although at times of it may be necessary. Over reliance on giving advice is considered a band-aid at best, addressing symptoms but not truly dealing with the causes of the problem. At worst, it is thought to undermine your sense of self efficacy.

No Matter Whom You Choose - Therapy Should be a Healing Relationship

These days, most therapists have an online presence where you can learn about how they view problems and how they work with clients. You can also find out if they are qualified to help with any specific mental health issues you may be facing, if you require psychological testing, or other special needs. There are situations where it would be wise to work with someone who specializes, especially with severe mental health issues. Most therapists will offer a complimentary consultation because they can appreciate what a big investment it is to enter into a therapeutic relationship (if not in person at least over the phone.)

A word about theoretical orientation. There are many different orientations out there and in reality most therapists use an eclectic approach, meaning they use what is called for with the specific person they are helping. Yet even therapists who blend typically lean strongly on a particular branch of theory - and this can be illuminating and helpful to know because it allows you to get a sense of how the therapist thinks about problems and intervenes.  

But don't get too caught up in theory, especially if you find it uninteresting! In the end, research outcomes of therapy say that the theoretical orientation of a therapist matters relatively little compared to your relationship with the therapist. As social creatures, relationships of connection and trust are indeed the grounds for real change to occur. Finding a qualified therapist that you can develop a good relationship with is what is essential, the rest as they say, is gravy.

Some Questions to Ask Yourself When Seeking a Therapist

So beyond basic qualifications, how do you know if there is trust and connection? This is a very personal question and while some people "just know", for others it may take a little time to find out. A good place to start is to meet with a few therapists for a consultation and notice how you feel in the presence each person. Did you feel at ease, like the person was interested in you and could help you with your problems?

Below are some questions you could consider before you pick up the phone and contact a therapist. This is by no means an exhaustive list, but more of a way to get your brain thinking about what is important to you. A good therapist will be helpful and support you in understanding what you need to know to decide if there is a fit.

  • What can I commit to this process in terms of time, money?
  • Do I feel at ease with this person?
  • Do I feel like this person can help me with my problems?
  • What are the persons qualifications, are they equipped to help me with my particular situation? (see my post on the different professional titles and what they mean)?
  • What approach to helping (counseling, cognitive behavioral therapy, narrative therapy, psychodynamic, etc.) does the therapist use, does it resonate with me?
  • Do I have a single issue that I want some help with?
  • Do I seem to have a pattern of problems that keep coming up over and over again?
  • Do I have special needs that the therapist should be qualified to address?
  • What do I hope to get out of coming to therapy?

Good luck in your search, may you find what you are looking for!