How To Get Good Therapy
Getting quality health care “should” be your right, unfortunately, in our current healthcare systems that can be challenging if not impossible at times.
A good place to start is by reflecting on your own needs. Answer the questions below and think about how important each one is to you. While it would be wonderful to get ALL your needs met, you might have to make some compromises (or spend a lot of time, energy, and money looking).
Checklist For Therapy
What am I looking to gain from therapy?
What are the problems or goals I want to work on?
What kind of support do I need?
What is my budget for therapy?
How important is using insurance for me?
Would I prefer in-person or virtual sessions?
How important is the therapist’s educational experience?
How important is the therapist’s age/race/gender/sexuality/religiosity/etc.?
Do I need the therapist to have specialized training?
Do I prefer structured and direct approaches or more laid back, indirect ones?
How much time am I willing to commit to therapy?
Do I want to learn new skills in sessions (that I may need to practice between sessions) or do I just want to show up and talk?
Do I want to focus on childhood stuff or would I prefer to focus on current and future goals?
Do I want a therapist who will challenge me, give me feedback, and hold me accountable?
Considerations For Starting Therapy
Whether you know it immediately or not, there is a specific reason (or multiple) that you want to go to therapy. Whether it’s to figure out a problem, resolve symptoms, improve relationships, achieve new goals, or have someone to talk to for support, there’s a reason you’re willing to part with your money to confide in a stranger. You’re going to get a lot more out of your time if you can at least be honest with yourself about why that is, or at least be open to the therapist asking you questions to help you figure it out.
Different people require different levels of support. What makes you feel heard? How do you know someone cares about you? How do you like to be shown that someone is listening? For example, some people like being asked a lot of questions because they like that someone else is showing an interest in them. Others hate being interrupted and just want to say what’s on their mind while the other person makes eye contact and gently nods in understanding. What’s more is that you might like both but on different occasions. How open are you about asking for what you need in the moment or asking the person to change what they’re doing? This in itself might be a therapy goal (i.e., learning to assert your needs in a respectful way).
Be very honest with yourself about how much you want to pay for therapy. You don’t want to be in a position where you can’t pay your rent or your bills because you need an “extra” session one week. It’s smart to talk to your insurance company before you start therapy so that there are no surprises once you start treatment. Get familiar with your benefits and ask questions to make sure you understand how much you will have to pay out of pocket, how much you will be reimbursed, what your deductible is, and what the therapist’s policies are about cancellations, no-shows, and rescheduling. When you start treatment, you agree to abide by the insurance company’s policies (if using them) and the therapist’s, so it is your responsibility to know what’s expected of you and what you can expect of them.
How much a therapist charges for their sessions is not indicative of the type of service you will get. I share more on this in an article about what “fit” means in therapy. However, you can likely expect that a therapist who has specialized training, an advanced degree, or offers a unique service may have higher rates. That does not necessarily mean that they are an inherently good therapist. It’s primarily subjective and based on your needs right now. Regardless of their fee, any therapist can exhibit “bad therapy” behaviors.
How long are you willing to commit to therapy? Do you want to be in therapy long-term or get in and get out as quickly as possible? In most instances, I don’t recommend that you make this decision based on your budget. Think about how long you want to be in therapy first, and then select a provider you can comfortably afford for that amount of time. If you need to pay more to see a specialist for a short amount of time, be clear on what exactly you want to get out of that time and have an honest conversation with the provider about what’s feasible. You may have expectations that are beyond what the provider can offer in that amount of time, or on the other hand, something might be a lot quicker than you anticipate. Just ask and be flexible with the understanding that there’s always individual variables that may impact the amount of time you need or want.
Do you want a therapist who has a shared quality to you or who embodies something specific? For example, are you looking for someone of a certain age, cultural background, sexual orientation, etc.? For some people this is very important and for others not so much. Some people benefit from the opposite qualities in order to expand and grow, while others need to share these qualities to feel safe and be able to open up. Neither is good or bad on their own, just factors for you to consider.
Do you want to be challenged and be held accountable? Do you like feedback and skills? Do you want to be doing things between sessions? If so, then you may prefer a therapist who is more direct, structured, and solution-oriented (for example, a cognitive behavioral therapist). On the other hand, if you prefer to do most of the talking, process emotions, explore past experiences, and feel supported without “homework” or agendas, then you may want a relational or psychodynamic therapist. Please note that a therapist’s psychological orientation is not usually something that can be easily shifted (or that they are interested in changing) because this is the way they were taught therapy in school (and/or received extensive additional training in). So while you may offer them feedback that you prefer more or less structure, though some therapists may be able to accommodate to an extent, others may refer you to someone else who can better accommodate your request.
Many clients stay in therapy longer than they first think they will. This is because you don’t know what you don’t know. Once you start therapy, many things you weren’t aware of as “problems” or goals may surface. This doesn’t mean there’s something wrong with you, but that you are an ever growing human like all of us. It can also mean that you enjoy the process of self-discovery and/or learning new skills and concepts. Finances and scheduling permitting, you can choose to be in therapy as long as you want. Some therapists will bring this up to you asking if you want less frequent sessions or if you want to end treatment, while others will wait for you to bring this up. Keep in mind that how long you are in therapy or what you’re working on doesn't mean anything about you as a person other than that you are invested in your personal growth.
Is there something specific you want to meet with a therapist about? Certain topics or diagnoses (such as OCD) are highly specialized and require training beyond what’s taught in graduate school alone. How important is it for you to meet with a specialist vs. a generalist? This is similar to meeting with an oncologist or a gynecologist instead of a primary care physician. Not all therapists have the same specialties or interests. At the same time, not every client needs a specialist. It all depends on your needs right now.
Finally, I encourage clients to reflect on their treatment and progress on a regular basis. This looks like reviewing new concepts and skills you’ve learned, reflecting on if you’ve reached any goals or milestones you initially sought treatment for, and thinking about what you’re still working towards. This may happen more frequently at the outset of treatment and less frequently the longer you meet with a therapist. I especially recommend doing this before ending treatment as a way to reflect on your full journey and how far you’ve come. Even if you didn’t meet with a therapist for very long for any reason, it’s still beneficial to think about what was accomplished and what you’re going to continue working on.
Remember, “good” and “bad” therapy are primarily subjective terms and don’t capture the full spectrum of experiences or individual differences. What you think is good now may seem bad in the future and vice versa. It’s all a learning experience. No matter what, try to practice kindness and compassion with yourself and your therapists. Most humans are doing the best they can with what they have at any given time. Reflecting on your ongoing needs, values, and preferences will increase the likelihood of you receiving good therapy and hopefully empower you to change providers if you don’t.
Want to see if I may be a good therapist for you? Explore the rest of my website and book a free 15-minute phone consultation today.