Choosing a Therapist
by Tom Moon, MFT

Q: I have decided to see a psychotherapist. Unfortunately, in this town there is a shrink every hundred feet. How do I find the right one? What do I look for in a therapist?Which kind of therapy has the highest success rate?

R: Psychotherapy is a serious commitment, and it is important to be careful and deliberate about finding the right person to help you. The first step is to get several (at least three) referrals from a trusted source, such as your doctor. Do some thinking about the kind of person you want to be in therapy with: Man or woman? Gay or straight? etc. Honor your own preferences and biases and get referrals to the kind of people with whom you believe you would feel most comfortable. Ideally, you should interview all of the therapists on your list. In doing this, remember that you are a consumer of psychological services, and that you and the therapist are interviewing each other to see if there is a match.

You have as much right to ask questions as the therapist. You may want to know about his or her education, background and qualifications. You may want to know how much experience he or she 'has had in dealing with the kinds of issues you want to discuss. You may have some personal questions. Therapists differ in how much personal information they are willing to share with clients, and it will be important to get a good idea of what will be the ground rules and boundaries of the relationship.

Probably the most important factor in successful therapy is the "fit" between client and therapist. One interesting study of the outcome of treatment showed that the early reaction of a client to a therapist is highly predictive of the outcome. If you feel a "click", and sense that a particular therapist is someone with whom you would feel comfortable sharing the details of your life, then this person is probably the right one for you. If you have an early negative reaction, you may ultimately be able to get past it and work together, but this is less likely than if the initial take is warm and positive. Remember that therapy happens in a relationship. It is a professional relationship, but it is still a dialogue between two human beings who are trying to reach an understanding about important issues in your life. The factors that make it work are really not very different from those that make any intimate relationship work -- trust, mutual respect, a sense of safety, warmth, genuineness, and so on.

What kind of therapy is most effective? There are so many different schools of thought about how it should be done that it would be a full-time job just to sort them all out. Professionals tend naturally to become partisans of the approach which best fits them, but there is not really very much evidence that decisively favors any one school over another. A Vanderbilt University study found that differences in theoretical orientations among different therapists did not make much difference in their success rate.

The study did find that some therapists were more effective than others. Those who were more effective were those who provided clients with information, encouragement and opinions, made special efforts to facilitate discussion of problems' focused more on the here-and-now than on early childhood experiences, and encouraged the client to seek new social activities. In other words, active involvement rather than passive listening, appears to be more successful, regardless of the school of psychology to which the therapist belongs.

There are some client factors involved in success in therapy, too. One of the most important of these is patience. Therapy is often time-consuming and frustrating; change is usually incremental rather than dramatic. Clients who are impatient or intolerant of slow change seem to benefit less than those who can tolerate careful exploration and a series of small changes over a period of time.

Remember, too, that any good psychological treatment stirs up a lot of feelings and may bring many conflicts to the surface. In addition, it is common for the client to relive old interpersonal conflicts in the relationship with the therapist (a phenomenon called "transference"). It is important to keep this in mind, because, while I have been emphasizing the importance of trust and safety, even the best therapeutic relationship is likely to experience rocky times, and periods of distrust or uncertainty, and the temptation to terminate can be compelling during these periods. If you feel let down, misunderstood, or angry, with the therapist, it is important to talk about these feelings openly. They are a vital part of the work. You should also discuss any thoughts about stopping treatment directly with the therapist. One of the most common causes of treatment failure is premature termination.

Tom Moon is a licensed psychotherapist in San Francisco. To contact him, email

(reprinted by permission from author)
©Tom Moon, 2001