“I have thought for a long time about whether I want to go into therapy, and I have now decided that the time has come. But how can I find a good therapist?”
Why research cannot answer this directly
That is a very good question, and not an easy one to answer. Unfortunately, research cannot help much in this process. It is very clear from research that so-called therapist effects exist, meaning that outcomes vary depending on the therapist. There is also research showing that some therapists are better at helping people with one type of problem, while others are better at helping people with a different type. However, there is currently no evidence-based rule that can tell an individual patient which therapist will be best for their particular problem.
Even so, there are a few principles that can help.
Check the license and the experience
First, when you look for a therapist, make sure they hold the correct license to provide therapy. Which license is required depends on the country or state where you live.
A second general recommendation is to find a therapist who has experience with the type of problem you are dealing with. A therapist specialized in eating disorders may not be the best choice if you have depression or personality problems. It can be difficult to know in advance exactly what kind of mental health problem you have, because assessing the diagnosis is usually one of the first parts of treatment. Still, most patients do have a general idea of the problem they are dealing with.
Look for evidence-based treatments
When you search for a therapist, it is also important to choose someone who uses evidence-based treatments. Many therapists indicate on their websites whether they focus on such treatments. If a therapist does not describe their methods, or if those methods are not evidence-based, it is less certain that their approach will really work for you.
Be cautious of promises of rapid cures, unusual claims, or too much focus on a single method as the solution for everything.
The practical issues
Then there are the practical matters. In some universal health care systems, psychotherapy is part of the care provided to anyone, sometimes after referral by a general practitioner or another doctor. In other situations, it may be covered by a health insurance plan. However, psychotherapy is often not included in insurance plans, and then the patient has to pay for it themselves.
Another important practical issue is the waiting list. In some places, patients must wait a long time for a first appointment. Most therapy is also provided during working hours, so if you have a job, you may need to take time off or make other arrangements.
What to look for in the first meeting
When you have your first meeting with a therapist, you can check whether this is what you were hoping for. Ask, for example, whether the therapist has much experience with patients like you. You can ask what the treatment will look like, whether the therapist expects it to work in your case, and what can be done if it does not.
During this first meeting, try to get a sense of whether the therapist seems transparent and collaborative, is open to feedback, can explain the therapy and why they think it will work, and makes you feel both understood and challenged. Be careful if the therapist claims that only their method will work, or becomes defensive when questioned.
Keep evaluating your progress
Once you decide to start with a therapist, evaluate your progress regularly. A good therapist will review progress after a few sessions, but if they do not, you can always ask for it. And if you feel that you are not making enough progress, do not hesitate to discuss this with the therapist. Another treatment, an additional therapy, or even a different therapist may be a better option if things are not working for you.
- For what to do when treatment is not helping, see What can I do if therapy does not seem to work?
- For why the therapeutic relationship matters, see Is the therapeutic alliance the most important part of therapy?
- For why an evidence-based treatment may still not work for you, see Why does a treatment not work, while it is evidence-based?
Pim Cuijpers is professor emeritus of clinical psychology and scientific director of Metapsy. He has been involved in more than 1,100 scientific studies, mostly on psychological treatments of mental health problems. This is one of a series of evidence summaries in which Prof. Cuijpers tries to answer questions from patients and clinicians, based on what is known in science about treatments. The knowledge is mostly drawn from collective work of the Metapsy collaboration of at least 15 years. Do you have other questions you would like Prof. Cuijpers to discuss? Feel free to contact us.