Department of Psychiatry
Penn Behavioral Health

PAH Outpatient Behavioral Health Clinic

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Newsletter: November 2009

Choosing the Right Therapist

Kevin S. McCarthy, PhD

You’ve decided to try psychotherapy.  What’s the next step?  There are many choices for therapy, and you might be anxious about how to choose a therapist who can help you for your specific concerns.  The good news is that, in general, people receiving psychotherapy for a variety of problems are 80% more likely to feel better after treatment than those who don’t receive any therapy.  That’s got to take some pressure off.  But there are some things that you can look for in selecting a therapist that we know are more likely to result in a good outcome.

Research shows the biggest predictor of outcome is the therapeutic alliance.  This is the relationship that develops between you and your therapist that gives you a sense of understanding and the space you need to make the changes you want in your life.    Generally, you’ll know you have a good therapeutic alliance when you have it – you’ll feel that your therapy is a place that you will feel better, even if the work you do with your therapist is tough. 

There are three things that have been identified to make up the therapeutic alliance.  The first is the agreement between you and your therapist on what the goals of therapy are.  You might come in to your first meeting with problems that you want to work on, but for some people it is just a sense of unease or a curiosity about themselves that brings them to therapy.  The way therapists approach the goals of therapy are different too.  Some therapists will discuss the goals that you two will work on in great detail.  Others will leave the goals open-ended.  What’s important is that you feel that you and your therapist want the same things out of the therapy and that you can revisit your goals any time during the treatment.  Don’t be surprised if more things that you want to work on come up during the therapy!  It’s not uncommon for the original problem bringing you to therapy to resolve, but then you find more things you’d like help understanding and changing.

The second part of the therapeutic alliance is the agreement between you and your therapist about what you will do in therapy.  Some therapists will assign homework or suggest things for you to try.  Other therapists will point out times that you repeat certain behaviors or feelings and similarities in contexts maybe you thought were very different.  Ask your therapist if you want to understand more about what he or she thinks will be most helpful for the two of you to do together, and share your own thoughts about what you think you need.  Be open to trying things differently than you first expected from therapy.  Many people come thinking they want advice from their therapists only to learn that they actually generate their own solutions for change!

The last part of the alliance is the affective bond between you and your therapist.  This is the feeling you get from the first phone contact with your therapist and the way your therapist greets you in the waiting area.  Do you believe that this person feels warmly toward you and wants to help you?  Part of any therapist’s job is to try and understand you and your unique experience.  Obviously, you and your therapist are not likely to share the exact same experiences, and maybe you and your therapist actually come from very different backgrounds.  But it’s important that you feel your therapist is trying his or her best to know what you’re feeling and will accept whatever you want to share in therapy. 

What happens if you don’t feel you have this therapeutic alliance with your therapist?  The first thing to do is to make certain you gave this therapist a good chance to develop an alliance with you.  Go at least to a couple of sessions before deciding to drop out or switch therapists.  Be open to considering why a good alliance did not develop right away – sometimes it is due to the exact problem you’re coming in for!  For instance, perhaps you are unsatisfied in your romantic relationships because you are always letting the “good ones” get away.  You might be doing the same thing with your therapist.  Therapy can sometimes be an experiment to test new types of experiences, especially when the relationship between you and your therapist gets rocky.  Second, you and your therapist may simply not have a good fit in terms of personality.  You are always welcome to give another therapist a try and even to come back to your original therapist if your feelings change.  Remember, therapy is about you and your ability to achieve the best outcomes.

Best of luck choosing a therapist and on the work you want to accomplish in your therapy!