Things to Consider When Shopping for Therapy

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Co-authored by Emma Preston, Elizabeth Aviv, and Darby Saxbe

For the last three weeks, Tommy has been feeling really down. He hasn’t wanted to do any of the things he usually enjoys, like working out or chatting with his friends. The last time he can remember feeling this down was in college, and his mom encouraged him to go to the school therapist. He felt like those therapy appointments were a waste of time—they didn’t make him feel better at all. Now his boyfriend has been suggesting that he try therapy again, and Tommy is torn. Could it help him this time? Or will it just be another waste?

Maybe you relate to Tommy’s dilemma. Maybe you have tried therapy and it didn’t work or you had a therapist you didn’t like. Maybe you’re feeling like, “I’ve tried therapy and it doesn’t work for me. I just need to get over my problems by myself.” Or maybe you’ve never been to therapy, and you have no idea where to start.

If you Google “therapy for depression,” you’ll find many different types of therapy on offer. In your search for a treatment, you may come across books or websites claiming that some new therapy is the best, or that all therapies are equally effective. To understand why some people make these arguments, we should explain how we know whether a therapy “works” and which might be “best.” Just like when a new drug is coming on the market, scientists can test the effectiveness of a psychotherapy treatment using something called a randomized control trial. In a randomized control trial, a group of study participants are randomly assigned to either a treatment group or a control group. The treatment group then gets whatever kind of psychotherapy the researchers are studying. The control group might receive a different type of therapy, be entered into an informal supportive relationship, or be put on a waitlist while the other group gets treatment. At the end of the study, the scientists compare how many people had reduced symptoms in the treatment group relative to how many people had reduced symptoms in the control group. These trials help scientists and therapists better understand what kinds of treatment work best for which symptoms. Some treatments get tested but aren’t effective and other treatments never get tested at all. Sometimes, research shows that one or more therapies can be effective for a similar set of symptoms. These effective treatments are known as evidence-based treatments, and they’re usually the place to start your search!

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Two common evidence-based treatments for depression are cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). More information about both of these types of therapy can be found here. It may be that you do your research, and you feel like IPT and CBT could be equally effective for you. Feeling unsure about a therapy approach is completely normal! This is why you can and should shop for a therapist. You know yourself best! As important as it is to consider the type of treatment offered by the therapist, it is also important to consider if you and your therapist get along. Research has shown that a good relationship with a therapist dramatically increases the likelihood of treatment success. Many therapists offer a 30-minute initial consultation that is free or at a reduced price, and this is a great way to “therapist shop” until you find the right fit. You can fire a therapist for any reason, and no therapist should make you feel stupid, dumb, or unreasonable. Many therapists ask that you give them two to four sessions to get to know each other, but the choice is yours.

To make therapist shopping a little bit easier, here are some intangibles to look for and questions to ask yourself:

• Does this therapist respect me? Do they care about me as a person?
• Does this therapist take my symptoms seriously? Do I feel heard?
• Does this therapist listen to me? Do we decide what to work on together?
• Do I like this therapist? Can I commit to spending an hour a week for several months with them?
• Can this therapist talk about issues that are important to me? Do I feel comfortable talking to them about my identity (gender, sex, culture, race, religion, etc.)?

Here are some questions to ask your therapist in an initial consultation to get an idea for what therapy with them might be like:

• Your website says that you do X treatment, can you tell me some more about your approach to treatment and what kinds of symptoms it is effective for?
• I understand that it may take some time for you to get to know me. If, after a few sessions, you feel that I am not a good candidate for treatment with you, will you tell me and refer me to a more appropriate option?

Shopping for therapy can be confusing, but it doesn’t have to be! Remember to look for treatments that have evidence showing they are effective for your specific symptoms, and be picky when you meet with a therapist for the first time. Taking the time to find a therapist who practices an evidence-based treatment, and who makes you feel safe and heard, is the most effective way to care for yourself and to start feeling better.

To find a therapist, please visit the Psychology Today Therapy Directory.

Co-authors Lizzie Aviv and Emma Preston are both graduate students within the University of Southern California's doctoral Clinical Science program.

Emma Preston

Source: Courtesy of author

Lizzie Aviv

Source: Courtesy of author