It is a difficult decision for many to start therapy. Which therapist to choose is often another huge hurdle on the path. Some people have friends who can recommend someone they know, or with whom they have worked. Often, however, one starts from scratch and must navigate the world of online therapy directories, which is the go-to method these days. I have looked at those sites, and I am listed on some of them, and it is bewildering to read all the seemingly cookie-cutter profiles. How is one to know who can be trusted with the secrets of one’s life?

First, I would narrow my search based on tangible factors. Do you want to work with a man or a woman? Does age matter? What about fees? Do they need to accept your health insurance?

(Some comments about insurance: every plan is different, and it is helpful to check with your company before you start your search. For what do they pay? How many sessions per year? Is there a deductible that must be reached before you get any money back? How much will they reimburse per session? Will they reimburse if you go out of network? The whole in network or out of network question is complicated, and deserves some mention here. Often it is simply a matter of what you can afford, and out of network being generally more expensive is not an option. But if you have some wiggle room, consider some of the pros and cons of in network and out of network. In network means that the insurance company knows your business, and has power over your treatment decisions. Often the therapist has to justify the need for therapy, which can entail written or verbal explanations of your “mental illness,”  with some detail. Some are comfortable with that, others not. Some accept that sessions may be limited in number, as insurance companies don’t like to pay for therapy that goes on too long. Personally, I am not on any insurance panels except one for a local university, because they don’t ask for much information about my clients. I was on other panels, and it became more and more problematic to maintain ethical standards as I was asked to provide very personal information to justify my work. I don’t feel comfortable with that. I like the confidentiality that I have with my clients, and believe it is crucial to the success of the process. Unfortunately, that means my clients must pay my fee. Many are then reimbursed by their insurance companies, as I provide an invoice that can be submitted.)

Other basic questions have to do with office location, and availability. Then there is the question of different kinds of therapy. Some have prior experience, and an idea of what you are looking for, in terms of talk therapy, cognitive-behavioral therapy, or one of many more specific techniques that address different kinds of issues. Different approaches are good for different people, and if you have no experience, some research as to what each method entails is probably a good idea.

That is the easy part. The harder part is after you have narrowed down your list based on all those practical things, how do you choose from the many therapists who all seem very earnest in their pledge to listen, be empathic, and help you feel better? Alas, there is no simple answer.

At some point, probably after narrowing your search based on some of the above, you can then pare it down a bit more with phone calls. How does the person sound? Both their tone, and the timber of their voice are things with which you want to be comfortable, as you will likely be spending a fair amount of time with this person. Do they sound nice? Patient? Empathic? Smart?

Ok, you have selected several who all seem reasonable. Next step might be making appointments with all, and seeing what a face-to-face feels like. While trusting your gut is important, just like when meeting other people, it can be difficult to assess based on one meeting. Clearly, though, you have to make a choice, as it is not realistic to continue seeing more than one therapist. The good news is, even if you choose one and after a while it does not feel right, YOU CAN CHOOSE ANOTHER!

I write that boldly because I have been shocked by the stories of experiences clients have had with other therapists, and the leeway granted to unethical, ineffective, inappropriate, abusive behaviors. People get stuck in a therapeutic relationship that is, to an objective observer, clearly not beneficial, yet due to complicated dynamics that develop in which people often assume that the therapist must be right and they wrong, choose to stay.

If you find yourself wondering about your therapist and things they say, ways they say things, and ways they make you feel, LEAVE. Now, therapy is an often difficult process, and it can be uncomfortable to open yourself up and look at and talk about parts of yourself you don’t like. The therapist may challenge you, may ask you to look at something that is hard to look at. That is not a reason to run. But if you feel your therapist is not empathic, or is not smart, or is unethical in any way, these are reasons to change. Does your therapist pay attention to you? Do you feel that they understand you? Do they remember things you tell them, generally? (Therapists are human, and cannot remember everything.) You deserve to answer yes to those questions, as well as to feel on some intuitive level that this person, this process, is somehow working for your long-term benefit.