You know you need help. You aren't sure you are going to make it another day if you don't do something. Your world is falling apart, and you just don't know where to turn. Someone has suggested therapy. Talk to someone, anyone. How do you choose? We live in a world where psychotherapists' schedules are full, many don't take insurance, and the sessions are expensive. Maybe your insurance gave you some names of a few who do. How do you narrow it down to the right fit for you?
What matters most when choosing a therapist?
Research tells us that the single most important factor within our control as therapists is our relationship with you (Flückiger et al., 2018). That's right, while you want to work with someone qualified, their credentials are not the most important. I will define credentials in another post; they refer to what they have done to earn the list of letters after their name.
Now, I bet you are wondering what I mean when I say our relationship with you matters more than the letters after our name as we work together. Well, if you don't trust the person you are talking with, how much are you going to share? I want to provide you with some questions to ask to help you muddle through the mess. Teenagers are vocal about that lack of trust. They will tell you about it in some way. They make therapists earn trust. They should. It's that important.
1. Will we be a good fit?
The short answer is maybe. You are the only one who can decide if you will be able to get along well with the therapist you are talking to. While this is not the first question you ask a potential therapist, it is the question you need to be asking yourself as you talk with that person. Currently, I do not allow cold scheduling of initial appointments on my website. You cannot schedule without talking with me first. I offer a free fifteen-minute consultation to provide an opportunity to determine if we think we can work together.
Occasionally, you may need someone other than me, and that is OK. Once we talk, I will schedule your first appointment and establish an online portal for you. After that, I will send you the initial intake paperwork so we can get down to business as soon as you walk through the door.
2. Are you qualified to treat my condition?
Probably, but you can verify it on my website. I believe most therapists will tell you what they treat on their website. However, this should still be one of the first things you ask. You want a therapist experienced with your problem, not just someone who attended school.
While a therapist's education offers a lot of well-rounded general information, we can't specialize in everything. We can't treat everything, and we shouldn't try. Just as medical doctors specialize in one or two areas, we do the same thing. While my education prepared me to work with young children, my career has taken a different path. I haven't worked with young children ever. You don't want me to engage in play therapy with your five-year-old. I would refer you to someone else for your child.
I also don't have much experience with couples and shouldn't take on that responsibility, even though my education says I can. If you ask me to see you as a couple, I will offer you other options.
However, if you are an adult with a mood disorder such as anxiety or depression, then you want me. You especially want me if you have experienced trauma and are beside yourself with what to do because you can't function. You also want me if you are crawling around in the dark because you spend so much of your life trying to please other people, you can't breathe anymore. Maybe you think you are going to die if something doesn't change. I can probably help. You can click the button above to schedule that free consult.
3. What type of therapy do you recommend for me and why?
Most of the time I recommend Accelerated Resolution Therapy, but not always. I always rely on Family Systems Theories as well. Every therapist I know says they use Cognitive Behavioral Therapy. That's just a fancy way to say we help you change the way you think.
Be careful with this question. The therapist likely will fall into a bunch of psycho-babble that makes no sense. There are many treatment models. I heard someone say the other day that there are about eight hundred of them (I'm not sure that is true). I believe every therapist is a unique individual, and because of that, there are as many treatment models as there are therapists.
No therapist can be true to one pure model, even though many of us try. Break this question down, ask for explanations and definitions of words even if you think you know what they mean. I will give you a couple of examples. When you ask me that question, I am going to tell you that I prefer Accelerated Resolution Therapy. You know all three of those words; you speak English, well, unless this was translated by someone besides me. Still, you have no earthly idea of what I just wrote. When I go on to explain that it means I use bilateral stimulation with a mixture of Gestalt techniques as well as voluntary image replacement, and on and on, don't shut me down just yet. Keep asking until I tell you that with Accelerated Resolution Therapy, I have you move your eyes side to side in short sets and follow my instructions. I don't need to know everything you are thinking or everything that happened. If you give me an outline, then we can use eye movements to access the back of your mind and help your brain let go of the hurt. Keep asking the questions until you are satisfied with the answer.
4. What is your approach to therapy?
I can be pretty direct with people. You came looking for insight and understanding. I don't mind helping you get there. Some people respond well to this approach; others need a gentler approach.
You should ask: are you more directive with people, or do you wait to let them figure things out? Some people don't like to have someone say things directly to them, and others prefer to hear things flat out. I responded to a client with the phrase, "So, you are a functional alcoholic?" She didn't like hearing that and laughed it off. This wasn't one of my better therapist moments. It is an example, though, of how I tend to shoot straight with people and call them on things. You may not be wired to hear things that way. You may prefer someone who talks around the topic until you decide that for yourself. You will want to know what to expect because if you prefer one way over the other, then you and that therapist may not be a good fit.
5. What is your worldview?
My worldview is Biblical. I consider everything we work on based on what the Bible says. Most therapists will tell you that their worldview doesn't matter; the approach to therapy is from your perspective and your worldview.
This question truly is not an issue for most people. However, there are some of us for whom it matters. As I said initially, I try to look at the world from the perspective of the Bible and what it says. I am far from perfect, and I get that belief about myself from the Bible. I don't want to say I come from a Christian worldview because I struggle with American Christianity and how it doesn't always appear to me to be consistent with the Bible.
I don't quarrel with therapists who say worldview doesn't matter. I do disagree with many of the things they will tell you as a client. I don't believe I have the authority to affirm, justify, condone, or condemn anyone. I will not do that. Instead, I will treat everyone who walks through my door with the utmost respect and compassion. The Bible tells us that "two are better than one, because they have a good reward for their toil. For if they fall, one will lift up his fellow. But woe to him who is alone when he falls and has not another to lift him up!" (Ecclesiastes 4:9-10, ESV). We need to hear from people who love us when we feel lost and don't know what to do.
Final thoughts: the relationship is everything
These are just a few questions to think about asking a therapist you are considering seeing. Remember, the most important question you ask yourself throughout the interview is, "Are we a good fit?" I use an outcome measure called MyOutcomes. I use it at the beginning of the session to track how you have been doing through the week and see if you are improving. I use it at the end of the session to help determine the quality of the session and look for ways I can work to improve your outcomes. I am finding that this helps preserve our relationship by providing you with an opportunity after each session to assess if I am meeting your needs, because in therapy, the relationship is everything.
I am Vickie, a Licensed Marriage and Family Therapist in Maryville, TN. If you are ready to talk, click the button above and schedule your free fifteen-minute consultation.
Frequently Asked Questions
What is the most important thing to look for in a therapist? The relationship. Research shows the strongest, most consistent predictor of whether therapy works is the trust and connection between you and your therapist, more than their specific credentials or model. So as you talk with someone, keep asking yourself one question: do I feel safe enough with this person to be honest?
Should I choose a therapist who takes my insurance? Not necessarily. Insurance can lower the cost, but it can also limit who you can see and put your diagnosis on your record. Some people choose to pay privately to protect their privacy and to see the therapist they actually connect with. The right answer depends on what matters most to you.
Is it OK to ask a therapist about their faith or worldview? Yes. For most people it won't matter, but for some it matters a great deal. You are allowed to ask, and a good therapist will answer honestly. If sharing a faith perspective is important to you, it is fair to look for someone who understands it.
Clinical Content Disclaimer
All clinical content on this website is written or reviewed by Vickie Starkey, LMFT, a Licensed Marriage and Family Therapist in Tennessee since 2005 (License #579). Vickie holds a Bachelor of Arts in Psychology and Sociology from Carson-Newman College (1989) and a Master of Divinity in Psychology and Counseling from New Orleans Baptist Theological Seminary (1995), and is a Certified Master ART Practitioner since 2023. This content is for educational purposes only and is not a substitute for professional diagnosis or treatment. Verify my license here: https://internet.health.tn.gov/Licensure/
Crisis Resource
If you or someone you know is in crisis, call or text 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room. If you are in immediate danger, call 911.
References
English Standard Version Bible. (2001). Crossway Bibles.
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172
Tennessee Department of Health, Health Related Boards. (n.d.). License verification. https://internet.health.tn.gov/Licensure/
