Working With a Therapist Guide Working With a Therapist Guide Overview Getting Started Pros and Cons Will My Insurance Cover It? Is Online Therapy Secure? Common Uses Depression Anxiety Stress Addiction Relationships By Amy Morin, LCSW, Editor-in-Chief Updated on May 16, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Carly Snyder, MD Medically reviewed by Carly Snyder, MD Facebook LinkedIn Twitter Carly Snyder, MD is a reproductive and perinatal psychiatrist who combines traditional psychiatry with integrative medicine-based treatments. Learn about our Medical Review Board Print Table of Contents View All Table of Contents Finding a Good Match Credentials Questions to Ask What to Expect Changing Therapists Next in Working With a Therapist Guide The Pros and Cons of Online Therapy It’s important to find a good therapist with whom you feel comfortable. After all, you might talk about uncomfortable subjects—or even share things you’ve never told anyone before. So you want to work with someone who you will open up to and listen to. But there are so many options and choices out there that choosing a therapist can feel overwhelming. Looking through an online directory may yield hundreds, if not thousands, of results. How do you pick someone to work with based on a short bio and picture? And if you are seeking help through an online therapy platform, how do you find a good fit when you may be speaking to a therapist primarily through a text-based or video chat? Despite the apparent abundance of therapy options, treatment does not always feel as accessible as people might hope. Verywell Mind's Cost of Therapy Survey found that 53% of Americans in therapy over the prior three months experienced difficulties with getting appointments, finding a therapist, or finding in-network providers: 30% encountered a lack of availability or flexibility 27% had difficulty finding a provider who is taking new patients 24% had difficulty finding an in-network mental health professional This article discusses some of the strategies that can help you narrow down—or expand—your options and pick a therapist who is likely to be a good match for you. 2:23 How to Choose the Right Therapist A Verywell Report: Americans Find Strength in Online Therapy The Importance of a Good Match You may have received a suggestion to work with a particular therapist. Maybe a friend said, “This therapist helped me so much. You should call them and make an appointment, too.” But will that particular therapist be able to help you as well? It depends. While the therapist may have great skills, their work with you will only be effective if you feel connected to them. So the same therapist that made a great impact on your friend may not work out well for you if you don’t feel that personal connection. If you don’t like your therapist, or you’re concerned they may judge you, you aren’t likely to share your innermost thoughts and feelings or acknowledge unflattering behaviors. If you don’t talk about these things, you might not get to the heart of your issues, and you might not gain the information you need to create positive change. Your relationship with your therapist—often referred to as the "therapeutic alliance"—will most likely be a determining factor in how helpful therapy is for you. The Therapeutic Alliance Edward Bordin, one of the first researchers to examine the effect of therapeutic alliance, found that the alliance isn’t just made up of a bond between the therapist and the patient. It also has to do with agreement on the goals of therapy and the methods used to reach those goals. The therapist and the patient need to like one another. They also need to feel there is good communication and a mutual willingness to work together. The idea that the relationship between the therapist and patient is essential to good treatment has been reinforced by multiple research studies over the years. An APA task force found that the type of therapy mattered less than this therapeutic relationship. Regardless of whether the therapist used cognitive behavioral therapy or psychodynamic therapy, patient improvement depended on how well the therapist and the patient got along. "The therapy relationship makes substantial and consistent contributions to psychotherapy outcome independent of the specific type of treatment. The therapy relationship accounts for why clients improve (or fail to improve) at least as much as the particular treatment method," suggested the report. Their report was based on multiple research studies showing that a therapeutic alliance plays an extremely important role in the process. They concluded that patients are more likely to change their lives when they feel supported by their therapist. So they recommend that therapists continuously monitor interactions with their patients and check on them in terms of how they feel the process is going. Therapists are encouraged to work on improving the relationship if there appear to be communication issues or problems with trust. Consider Who You Might Work Best With Given how important your relationship with your therapist is to your well-being, some factors you might consider when looking for a therapist include: Gender: Do you think you'd feel more comfortable with a man, woman, or nonbinary person?Age: Do you want to work with someone older, younger, or around your age?Religion: Does it matter to you if the therapist has a particular religious affiliation? You might feel like you’d connect better with an older woman. Or maybe you think you’d feel most comfortable speaking to a nonbinary person your age. It’s up to you to think about the type of person you imagine yourself opening up to. Of course, you might have no idea who you want to speak to. That’s OK, too. You can usually just say you don’t have a preference if you’re asked. You may be able to learn a bit more about the therapists you have to choose from. Keep in mind most therapists don’t make much of their personal lives public. But they will often share a few basic facts in their biographies, so you can try and find someone you might relate to before scheduling the first appointment. Verywell / Bailey Mariner Start Your Search There are a number of different places where you can begin looking for a therapist. Some options include: Insurance directory: Check with your health insurance provider to see if they have a directory of therapists who accept your insurance. Recommendations from friends: Friends who have had great experiences with a particular therapist can be a great resource when you are looking for a treatment provider. Referrals from your doctor: Your primary care provider can also be an excellent place to start your search. Mental health organizations: Many mental health organizations maintain therapist directories listing professionals who are qualified to treat different conditions. Online therapist directories: You can also do an online search to find therapist directories where you can search based on education, treatment specialty, experience, and geographic location. Online therapy platforms: Many online sites also ask you to provide some basic information on what you’d like to address in therapy, such as anxiety, parenting issues, or substance use. Then, they will give you several therapists to choose from. Get Help Now We've tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. Find out which option is the best for you. Credentials Therapists often have a lot of initials after their names, and it can be confusing to figure out what all those letters stand for. While you certainly don’t need to become an expert on mental health accreditations, it can be helpful to understand a bit about what the letters mean. Here are some of the more common ones. LCSW: Licensed Clinical Social Worker LMFT: Licensed Marriage and Family Therapist NCC: National Certified Counselor LCDC: Licensed Chemical Dependency Counselor LPC: Licensed Professional Counselor LMHC: Licensed Mental Health Counselor PsyD: Doctor of Psychology PhD: Doctor of Philosophy MD: Doctor of Medicine (in the case of a physician psychiatrist) You may see some other variations as each state has its own licensing board and credentialing system. While it may seem a bit overwhelming at first, their exact license might not matter very much to you in the end. What is important is to make sure that the therapist you choose is a licensed mental health professional and that they follow guidelines and a code of ethics. This is important if you are looking for therapy as opposed to life coaching. Life coaches are not required to have a specific degree, and they don’t have oversight by a governing board. Licensed therapists must meet state qualifications, which may include the following: Passing a licensing testPassing a background checkPerforming a certain number of supervised hoursMaintaining continuing education credits While you may want to know what type of degree your therapist has, just know their credentials are proof that your state has given a stamp of approval that they are competent to provide services. What may be more important than their specific credentials is their areas of expertise. Check their bio to learn more about the experience a therapist has in treating someone with concerns similar to yours. It can also give you some insight into how that person works and what sorts of treatments they provide. You should also look for a professional who can provide the type of treatment that may be most beneficial for your specific condition, such as post-traumatic stress disorder (PTSD), social anxiety disorder (SAD), or obsessive-compulsive disorder (OCD). Post-Traumatic Stress Disorder (PTSD) A variety of mental health professionals are qualified to treat PTSD, including psychologists, licensed clinical social workers, and licensed professional mental health counselors. With only a few exceptions, these professionals cannot prescribe medication. Psychiatrists and psychiatric nurses are also qualified to treat PTSD and are able to prescribe the medications that you may need. The Department of Veterans Affairs suggests that it is ideal to work with a professional who regularly sees patients with PTSD. However, they note that primary care physicians and physicians assistants can also provide treatment and prescribe medications. Social Anxiety Disorder (SAD) Professionals qualified to treat social anxiety disorder include psychologists, psychiatrists, licensed clinical social workers, and licensed marriage and family therapists. In addition to finding someone who has the necessary educational background, you should look for a professional who has experience with treatments such as exposure therapy, cognitive behavioral therapy, dialectical behavioral therapy, or acceptance and commitment therapy. Obsessive-Compulsive Disorder (OCD) As with other conditions, there are many professionals who are qualified to treat OCD including psychologists and psychiatrists. When looking for a therapist to treat obsessive-compulsive disorder, you should look for a professional who has training and experience with effective treatments such as cognitive behavioral therapy and exposure and response prevention. Ideally, your therapist should have experience treating OCD specifically. No matter what condition or concern you have, focus on finding a professional who has experience treating the issue and is trained in evidence-based treatments for your condition. Questions to Ask a Therapist Before You Meet During a consultation, you might ask some questions about how they conduct treatment and how they help people who are looking to reach goals similar to yours. You can even ask how they help their patients get comfortable with therapy. Some therapists will offer a free brief consultation over the phone prior to scheduling your first appointment. This can allow you to get to know the person a little and ask any questions you may have. If you’re given this opportunity, take it. While a phone call won’t guarantee you’ll be able to tell whether the therapist is a good match, it may help you narrow down your options. Studies show that a therapist’s ability to show warmth, genuineness, and empathy is key to their ability to form a therapeutic alliance. So consider this your chance to conduct a brief interview with the therapist and see how you feel about their responses. What to Expect During Your First Appointment During an initial session, your therapist will likely explain how therapy works, provide you with information on confidentiality, and ask you to sign some forms. From there you may be interviewed about the problems or symptoms you are experiencing and your goals for treatment. The therapist may ask questions about your childhood, your medical history, your family, and any history of past mental health treatment. Your answers can help them gain an overall view of you. And it will help them work with you on establishing goals. Your experience during the initial therapy appointment may vary a bit, depending on whether you’re meeting online or in person. Another factor is whether you’re paying cash or billing your insurance company. A therapist may need to conduct a thorough assessment that helps them identify whether you meet the criteria for a mental health diagnosis. Most insurance companies only cover mental health treatment for people who have been diagnosed with a mental illness. On the other hand, if you’re meeting with an online therapist and want to address a specific issue (like a conflict you’re having with a spouse), the therapist may focus mostly on that topic as opposed to trying to gain a broad view of your life. Remember, the first appointment is a great time to ask any questions about the therapy process as well. How to Choose the Best Type of Therapy For You What to Do If Your Therapist Isn’t a Good Match Whether you realize your therapist isn’t a good match for you during the first appointment, or you begin feeling like you aren’t being supported well into your therapy process, you can always change therapists. If you’ve been working with your therapist a while, you may want to talk about the fact that you aren’t feeling a connection. This can feel a bit awkward or uncomfortable, but therapists have these conversations often. If there’s an issue that can be addressed, they may want to address it with you. They might also help you find someone who is better suited to your needs and refer you to that person. If you don’t feel comfortable talking to your therapist directly about wanting to see someone else, you can still change therapists. If you’re seeing someone at an agency, you can ask the receptionist or someone else in the office to transfer you to a new therapist. Changing Your Online Therapist If you’re seeing a therapist online, you can request to change therapists there too. Sometimes, a few clicks of a button is all it takes to transfer you to someone new. You may be asked to give some feedback on why you and the other therapist weren’t a good match. And you might also be able to provide additional input about what type of therapist you want to work with in the future. Don’t feel bad if you change therapists. Sometimes, for one reason or another, the therapist and the patient just don’t click. And that’s OK. It’s important to make sure you work with someone that you feel comfortable with, so you can get the most out of treatment. How to Break Up With Your Therapist A Word From Verywell It’s important to find the best therapist for you and your needs. And while the process of finding someone you think you can connect with may seem a little daunting, it’s well worth the effort. When you find someone you feel comfortable talking to, and you feel as though that person is invested in helping you grow and change, you’re much more likely to benefit from therapy. What Conditions Does Online Therapy Treat? 5 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Bordin ES. The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice. 1979;16(3):252-260. doi:10.1037/h0085885 Norcross JC. Conclusions and Recommendations of the Interdivisional (APA Divisions 12 & 29) Task Force on Evidence-Based Therapy Relationships. Society for the Advancement of Psychotherapy. Goldfried MR. What should we expect from psychotherapy?. Clinical Psychology Review. 2013;33(7):862-869. doi:10.1016/j.cpr.2013.05.003 U.S. Department of Veterans Affairs. Types of therapists. Lambert MJ, Barley DE. Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training. 2001;38(4):357-361. doi:10.1037/0033-3184.108.40.2067 By Amy Morin, LCSW, Editor-in-Chief Amy Morin, LCSW, is the Editor-in-Chief of Verywell Mind. She's also a licensed clinical social worker, psychotherapist, and international bestselling author. Her books, including "13 Things Mentally Strong People Don't Do," have been translated into more than 40 languages. Her TEDx talk, "The Secret of Becoming Mentally Strong," is one of the most viewed talks of all time. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.