I’ve worked as a social worker and in related positions in a few settings. A question that comes up often is how to find a therapist that is a good fit. There are an overwhelming number of options and it’s really difficult to know where to start. We can add that to the massive list of things they don’t teach in school that would have been very helpful to know. So, over time in helping clients and friends find therapists, I’ve come up with some key questions I use in the search process and some things to consider in those early meetings. A friend recently asked for this information, so I figured it was time to share it more widely. As usual, your results may vary, but hopefully this is at least a starting point.

To be clear before we begin, I am NOT encouraging therapist shopping. This is a process for finding someone who will support you but also challenge you. Therapist shopping is looking for someone that will enable whatever problematic behavior got you into therapy in the first place. That’s not therapy. It’s absolutely essential that a therapist be able to challenge you in a way that feels safe for you and also moves you toward growth and healing. That said, therapy is a relationship. Not every therapist will work for you, even if they’re a skilled therapist, so there are factors to consider when finding a therapist. This post assumes you have a choice in your therapist and options to choose from. Sadly, this isn’t the case for everyone, especially in the US where funding is so often a factor. Whenever possible, I’ll provide information that may increase your options.

Finding a therapist comes in two key steps: the search process and evaluating fit in the first sessions.

In the search process, here are some key questions to consider:

• Is it important that your therapist has (or doesn’t have) certain identities? There is sometimes value in seeing someone you wouldn’t normally be comfortable with (can be a form of exposure therapy in and of itself), but that’s not ideal, especially not if you’re early in therapy. Particularly for folks with trauma histories, gender identity is often an important factor to consider in your search. Race/ethnicity/sexuality/religious background are also important factors. Unfortunately, there is a serious shortage of therapists who aren’t cis/het/white, so depending where you’re located you may not find someone that shares your identities, but it’s still important to look for those folks first because it can improve your therapy outcome. That said, having a different identity doesn’t preclude them being able to support you.
• How are you paying for therapy? Sadly, this will really limit your options, especially if you need someone who will accept Medicaid and/or Medicare. If you’re planning on using insurance, make sure you include that in your search and verify with the insurance company. Sometimes a therapist’s website says they take insurance, but they no longer do. To expand your options, some therapists offer sliding scale therapy and usually will indicate such. Sliding scale therapists can increase your options if you’re not finding someone that accepts your insurance and/or Medicaid/Medicare. Some insurance companies also offer out-of-network benefits which can make therapy affordable, even if the therapist doesn’t take your insurance. See if they assist in that billing process.
• What are you going to therapy for? If you have a target issue in mind, focus on therapists that have some expertise, if possible. Not every therapist has the training, interest, or expertise in what you’re looking for, even if they have some general knowledge. This isn’t always a deal breaker, especially if it’s a therapist who’s willing to and interested in learning, but it can make the therapy process easier.
• Do you have a preference on in-person vs. online? The pandemic has drastically expanded online options, but that may or may not be for you. Consider what is going to feel most supportive for you and practical. For folks in areas with limited provider options, online therapy can expand your options and may also be a necessity. Noting that generally therapists need to be licensed in the state in which you live. So, looking for therapists in New York when you live in Alabama likely won’t be the best use of your time. If you can’t find someone in your state, look at neighboring states as you’ll have a higher chance of finding a therapist who has a license in your state. For example, if you live in Missouri and can’t find someone, look for online therapists in Kansas, Illinois, and Arkansas. For those using Medicaid, out-of-state providers generally won’t be covered.
• What are you looking for? Different modalities have different strengths and some may be a better fit than others. Do you want a free-lowing unstructured therapy? Are you looking for something more structured? Is your primary goal exploration or coping skills? Researching the basics on different therapy modalities can help you identify some options that seem like a fit to narrow your search.

Now that you’ve answered your questions, it’s time to start looking. PsychologyToday.com is an excellent place to start your search, as a lot of therapists post their information on there. Your insurance website (if using) will also have listings of therapists, although the information is usually very limited. Even if they’re listed somewhere like PsychologyToday, look for their professional website, if it’s available. They should have key information like their approach and specialties, but will also have a biography or introduction. That’s your first piece of data on what they’re like. It shouldn’t be the only factor, but it’s also important. Just keep in mind that you’re looking for a therapist, not a friend or a partner. Use the bio to see if this seems like someone who would understand you. Beyond that, here are some factors and red flags to look out for.

• Are they a fit based on your answers to the questions above? If you can’t find someone that meets the criteria you develop above, consider which factors are the most important and start expanding your criteria. For example, if you wanted someone who does in-person therapy, but can’t find someone, expand your search to include online therapy.
• What populations do they work with? Are you in those populations? Listing every population possible (except perhaps in rural areas) is a red flag. Skilled therapists learn over time who they work best with. Someone listing every possible population either hasn’t figured out who they work best with or is casting a wide net because they’re struggling to get clients- not a good sign.
• What conditions/concerns do they treat? If you’re seeking therapy for a specific concern, try to find therapists that list that concern and/or related concerns. Similar to the above, a long list of conditions/concerns is a red flag for a therapist that doesn’t know their strengths and/or is desperate for clients.
• What modalities do they offer? If you’re looking for a specific modality, focus on therapists who offer that modality. Most therapists receive some basic training in several modalities, but often becoming highly skilled requires additional training and some therapies require specialized training in order to provide competent services. This is particularly true for a lot of trauma therapies, particularly EMDR. Similar to the above, a long list of modalities (especially if they’re not similar modalities) is a red flag.
• Are they taking new clients? A lot of therapists will indicate this on their website/in their voicemail/email signatures. If someone seems like an excellent fit, you can always ask if they have a wait list and to be added to it, but you’ll likely need to find someone instead. Due to the pandemic, a lot of therapists are not taking on new clients. This can be really discouraging, but keep at it and ask to be added to wait lists as you go.
• For those seeking LGBTQ-specific therapists. Most therapists will just say LGBTQ rather than specifying. Look for indications of who specifically they mean and if that includes you. This is especially true for trans folks. A lot of providers who say LGBTQ mean LG and sometimes B, but not T. If it’s unclear in their listing, ask when you follow up to schedule.

So you’ve found some options. Start contacting the people you’re interested in, noting that not all therapists will use email for scheduling. Know your availability when you reach out, including some back up options. Especially if nights/weekends work best for you, therapists may not have open appointments in the times that work easiest for you. If there are times that can work (even if they’re not ideal), keep those in mind. For those with a diagnosis, set time aside for a therapy session is an ADA reasonable accommodation. Going through that process to secure a consistent (and sometimes extended) lunch period for therapy can be worthwhile. Being open to online therapy can be helpful in expanding scheduling options, as long as you have a private location for your session.

Do NOT schedule with multiple therapists at once with the intention of going to a couple of sessions with each and deciding afterward who you like most. Therapy is an extremely vulnerable process, even as early as the intake session. If you’ve got initial appointments with several therapists, how much are you actually going to invest in being open and vulnerable in those initial sessions? Select a therapist and commit to at least two sessions (barring serious issues in the first session) before making a decision. The first session is almost entirely information collection, so it’s not always the best gauge of if a therapist is a good fit. Starting in the second session and beyond, you’ll get a better sense of how the therapist works and how you feel about them. Here are some things to consider in those initial sessions.

• Were there any deal breakers? If you felt unsafe, unheard, offended, concerned about their ethics or anything similar, even in the first session, don’t go back. Those are likely to be issues throughout the therapy. Much like in dating, the therapist is probably putting their best foot forward in the early sessions and if that’s the best they’ve got, it’s cause for concern. If you’re thinking to yourself that there’s no way you can work with them, listen to yourself and don’t schedule another appointment.
• Did their style match your needs? Some therapists are quiet. Some talk a lot. Some ask a lot of questions. In those early sessions, you’re seeing their default style. If you want/need a therapist that, for example, has a more discussion based style where you’re both speaking in session, a quiet therapist won’t work for you. Unfortunately, if you’re options are limited, the two of you will likely need to find a compromise between your respective styles to work together. Consider if it’s a style that’s workable even if it’s not ideal.
• Does their approach to therapy seem like a fit? Therapists should give an explanation of how they do therapy and some indication of how they anticipate therapy to proceed based on your needs. Does that seem like something that will help you or is at least worth trying? If you ask questions about their modality/technique, are they responsive?
• How do they respond to criticism/corrections? If you corrected them, asked them to do something differently, or anything similar, how did they respond? A good therapist will listen and make some effort toward adaptation and/or explanation. If they respond by getting defensive, you can expect more of the same moving forward. For therapy to be effective, you need to feel safe expressing criticism (especially if you struggle with people pleasing) and for your therapist to be responsive. This is especially true for those of us who aren’t cis/white/wealthy, as therapists often have a general idea of our needs/concerns that may not reflect our lived experiences. They need to be able to adjust their assumptions to meet your reality.
• Do you feel safe and respected? Vulnerability requires safety. For those of us who are skeptical of people by default, consider if your experience of the therapist matches how you feel about people generally when you first meet them. If it’s within your norm, give it some time to see how that feeling of safety evolves. But if you feel more unsafe than usual and/or experience red flags, they’re likely not a fit.
• Do they challenge you? As I said above, therapy is about being challenged in a safe way. If your therapist is just going along with everything you say and not questioning any of your actions, especially if you’re there for relationship difficulties, they’re not going to give you what you need. There are plenty of people in your life that can just tell you that everything you do is good. You don’t need to pay someone to do the same.

At the end of those first few sessions, you should have a sense of if this is someone that will work as your therapist. If not, tell the therapist they’re not a fit and continue on your list of potential therapists until you find someone that seems promising. There won’t be a perfect fit, so the key is finding someone who seems workable. The process can be frustrating, but remember that each time you do this you learn more about yourself and what you value in a therapist, which will only help you in the long run. Once you’ve found someone, keep asking yourself as you go along how therapy is going and how you feel about your therapist. Even a good fit needs some adjustment from time to time. Happy hunting and best of luck on finding a good fit to begin your healing journey!