WHAT IS “FIT” IN THERAPY?
Part One. Click to read Part Two.
How do you pick a therapist? What does it mean to be a “good fit” in therapy?
If you’ve ever looked into therapy, you probably heard the term “fit,” but do you really know what it means? What I found in my NYC psychology practice is that there are actually four different types of fit in therapy and you can prioritize them based on your own needs.
The 4 Types of Fit in Therapy
Clinical Fit
Financial Fit
Scheduling Fit
Personality Fit
Clinical Fit
Clinical fit is how well the therapist understands your goals and problems. For example, I specialize in stress, anxiety, and OCD, especially in overwhelmed professionals. I have found that many of the individuals with those problems also struggle with perfectionism, procrastination, boundary-setting, and people-pleasing. That means that I may be a good clinical fit for those clients who want support and strategies in those areas.
The more someone specializes in the concerns you have, the better they may be able to help you. This is because they likely have additional training, certifications, and/or experience with those issues. Even if a provider is a generalist, they likely have one or two specializations. These would be the areas in which they are most proficient, though they can often treat many other concerns as well.
Clinical fit is a great place to start when you’re looking for a therapist because you definitely want to work with someone who at least has a basic understanding of your problems, even if it's not their one and only specialty. On the flip side, a therapist may not be a good clinical fit for you if they explicitly state that they do not specialize in your concerns (or if this becomes apparent to you after several meetings, which unfortunately does happen). For example, many therapists may say that they treat OCD, when in fact, they have not had any specialized training in exposure and response prevention (the gold standard treatment for OCD). Treating clients for concerns therapists aren’t specialized in can be very harmful and can dissuade individuals from seeking additional support. If this has happened to you, please know that there are therapists out there who are a great clinical fit for you.
Financial Fit
Financial fit is whether your budget matches the fee of the therapist with whom you’d like to meet. Just because they are a good clinical fit, does not mean they are a fit in other areas, especially when you’re on a tight budget. You may have a lot of feelings about this and that’s okay.
Therapists are professionals and have to work and earn a living just like anyone else. They have bills, loans, pay rent/mortgage, and want to enjoy time off and be comfortable, just like you. They may have parents, siblings, children, pets, and other people who depend on them for financial and emotional support. They may be dealing with their own health and emotional challenges or other unpredictable stressors. They may be saving for a wedding, house, or retirement. For all these and many other reasons, they have to be very mindful when setting their session fees. You may not agree with the fee that they set, but that does not mean that they don’t care about helping people, are greedy, or only in it for the money. All it means is that they may not be a fit for you at this time.
Although most therapists charge per a certain amount of time, it’s helpful to think of the fee you pay as for everything they bring into each session, rather than for the time itself. Even if any given session doesn’t feel as productive as another, the fee you pay is for the therapist’s specialized training, experience, and unique perspective that they bring to each of your sessions and contribute to the overall outcome.
Therapists in private practice also have to factor in additional costs of running a business. Not only does your fee cover their time and expertise, it also covers overhead costs such as renting an office (even if it’s in their home - therapists have to work in a private space), utilities, office supplies, administrative or billing support, credit card charges, software, etc.
Many therapists offer sliding scale or lower fee spots. You can always ask if a therapist has any lower fee spots available and they will let you know if they do, if they have a waitlist or application process, or if this isn’t something they offer. If you are not able to afford their current rate or do not want to for any reasons, there are many other therapists who may be a better financial fit for you. For free resources, low-cost providers, and crisis centers, go to my resource page.
You may have found it to be true that the more specialized someone is, the higher their fees will be. Although this is not always the case, it’s often true, not just in therapy, but across all fields. When you get promoted, you expect a raise, right? It’s the same in private practice and in other therapeutic facilities. When a mental health professional gets additional training or experience, they will typically raise their fees (though they may also choose to do so at other points in time, or for various reasons, may not raise their rates at all).
You and the therapist get to decide if it is a good financial fit when you start working together. That being said, if your financial situation changes for the worse while you’re already working with a therapist, be sure to let them know. They may be able to work with you so you can keep your appointments, help you think of ways to rearrange your budget to make it work, or offer you other resources, referrals, and recommendations. With the advances of teletherapy, insurance benefits, sliding scales, and nonprofit organizations, you are very likely to find a provider who is a good fit and won’t break the bank for you. I strongly advise against working with someone whose fees will cause overwhelming distress and make it difficult to commit to the treatment.
If you have been getting a low fee rate and your financial situation changes for the better, it would be kind of you to let the therapist know as well. They may raise your rate or they may keep it the same. Your financial transparency allows them to offer lower rates to clients who are currently in need who otherwise may not have had access to mental health. Therapists who don’t offer lower fee sessions often contribute to charities and nonprofit organizations. They use their time and finances to create new programs, groups, books, or online courses that impact people in different ways from their therapy work. Remember, how much something is “worth” and the value it brings are entirely subjective and are a matter of fit for you.
Scheduling Fit
A therapist may be trained in your exact concerns, they may be right in your budget, but your schedules just don’t work out.
A therapist in private practice can set their own schedule. This means they may work seven days a week, just weekends, no weekends, or only one afternoon. Although some may be flexible with their time, others may not be. Just as in the other two categories, if it doesn’t work for you and you can’t or don’t want to make it work, find a therapist who’s a better fit with your schedule.
Not only is therapy an investment of energy and finances, it is also a time commitment. One of the reasons a therapist may not be flexible with their time is because they are practicing healthy boundaries - for your sake and theirs. If they don’t respect their schedule, others may not either. If they stick to their boundaries, you may learn to stick to yours as well. This is especially meaningful if you have a hard time saying “no” to others or take on more than you can handle. Professionals often experience burnout because they are not mindful of their time or struggle upholding their boundaries. Although it might be a difficult adjustment at first, prioritizing your mental health and the time you spend in therapy can have tremendous long-term benefits, often in areas you might not have even thought of.
Is it true you can’t keep an appointment in the morning/middle of the day/evening… or are you actually choosing to prioritize something other than your mental health during that time? Maybe you are prioritizing mental health but in a way other than attending your session? This may sound harsh, but committing to a therapy time and being charged for missing it (in accordance to a provider’s cancellation policy) can actually help you learn to be more accountable for yourself, your mental health, and how you show up for other people in your life. Attending weekly sessions can improve your sense of commitment, responsibility, and consistency, which can all spread into other areas of your life. It can also send a signal to your brain that YOU are important, YOUR time is valuable, and YOU matter.
If you are constantly rescheduling or canceling your appointments or a therapist you connected with just isn’t available at a time that works for you, it may be a sign they’re not a good scheduling fit for you. You can ask them if their schedule ever opens up or changes, if they have a waitlist, and if you can check-in with them in the future. Otherwise, look for someone with different availability who will ultimately be a better fit (because you’ll actually be able to meet with them).
Personality Fit
People usually fall into two categories: Either personality is the biggest factor for them when looking for a therapist, or they overlook it and end up feeling stuck with someone they don’t feel comfortable with or who they think is just “okay.”
Do you like a therapist who talks a lot and teaches you new things in session? Do you prefer someone who sits back and lets you vent? Do you like to talk about day to day stuff or are you there to solve a specific problem? Do you want someone who asks you a lot of direct questions and guides you or lets you come to your own conclusions through a stream of consciousness? Do you want someone warm, compassionate, who maybe reminds you of your grandma? Or someone your age with similar interests and traits? Do you want someone who uses humor in session and helps you laugh? Or do you want someone very serious who doesn’t share much of their own emotions in session? Do you want your therapist to share personal stories that may help you or lighten the mood or someone who always redirects back to you and never reveals anything about themselves?
All of these questions can help you think about who would be a good personality fit for you. Many therapists offer a free initial consultation so that you get to know each other’s personality before committing to a session. However, it may take more than a 15-minute phone call to figure this out.
The Surprise Fifth Category: Fit Is A Two-Way Street
Something to keep in mind as you decide on a therapist is similar to a job interview process. Although you might think they are the perfect fit for you, they may disagree. You might think they have all the necessary clinical skills, but they may see something you don’t. You might think you can stretch your budget, but they can see the potential strain. You might be willing to bend your scheduling and be inconvenienced, but they can see the problems ahead. You might connect with their personality, but they don’t connect with yours. This last one can be really tough, and is often hard to recognize. If conversations feel strained on a regular basis, if it’s hard for either of you to talk or express yourselves naturally and honestly, if there’s just something there that you or they might not be able to name, they could recognize it as not a good fit after all. This doesn’t have to be a dealbreaker to switch therapists, but it’s definitely something to discuss.
Remember, it’s not you. You didn’t do anything wrong. There’s nothing else you need to do, fix, flex, or apologize for. It’s not a mistake. You’re not broken or flawed. Through all their training and experience, therapists can sometimes just tell it’s not a good fit. Just like any other fit category, all it means is you have an opportunity to find someone else who will be a stronger fit overall. Someone you will love working with, even when it’s hard. Someone with whom you share mutual respect. It is this person who will help you get more of your needs met. This could be several different people at different points in your life, because of course, your needs change! So just because a specific therapist isn’t available for whatever reason, doesn’t mean you won’t find another therapist who’s a great fit.
What If My Therapist Isn’t A Good Fit For Me?
Once you pick a therapist, it’s normal and even encouraged to meet with them at least several times before deciding if they’re a good fit. The first few sessions are generally considered “intake sessions” so that both of you can determine if it is a good fit after all based on additional information. Even if you thought it was at first, at some point you may change your mind. You’re allowed to change your mind. Just because you started meeting with a therapist or maybe have even been seeing them for years, doesn’t mean you’re not allowed to change therapists. However, it is encouraged that you talk to your current therapist about it first instead of ghosting them - regardless of whether you just met or known each other a while.
If you don’t think a therapist is a good fit after all, it’s important to ask yourself why. Is it because they disagreed with something you said? That’s not necessarily a reason to jump ship yet. A therapist won’t and shouldn’t agree with everything you say. They’re not there to be your “yes” person. A good therapist will challenge you and help you see when there might be other perspectives or maybe even when you’re in the wrong. However, they won’t intentionally shame you or criticize you for it, although you may sometimes feel that way - another topic to bring up to them! Yes, you can say you felt worse after something they did or said. A huge benefit of seeing a therapist is saying what’s really on your mind, expressing your true feelings, and learning to have challenging conversations. It may be clunky. You may feel weird. They may feel awkward too. It’s all part of the process.
If you feel bad about yourself after therapy on a regular basis, if they’re not open to feedback or questions from you, if they are critical or judgmental or offensive and not open to discussing it, it’s time to find someone who’s a better fit for you.
Summary
You have a right to choose your own therapist, regardless of how long you’ve seen your previous one or if you’ve never had one before. It may take you more than one try before you find someone you connect with really well. It will probably take more than one session with each new therapist, so hang in there. Finding a therapist who is a good fit in every category is really worth it and can turn your entire life around. When you’re in a bind, prioritize the categories by order of importance and try to find someone who meets as many of them as possible: Clinical, financial, scheduling, and personality - and hopefully they will agree that you’re a fit for them too.
Click to read part two, Reasons A Therapist Can’t Work With You, Even When It’s A Good Fit
Disclaimer: Nothing in this article should be construed as legal or ethical advice or evidence-based data. These are simply my views and opinions based on my personal and professional experience as a psychologist in NYC. I have my own unique perspective which may be very different from yours or your therapist’s. This is for informational purposes only.
If you’re a professional in NY or FL and you struggle with stress, anxiety, or OCD, schedule your free 15-minute phone consultation with me to see if we’re a good fit for each other.