What’s one simple trick to increase the odds that your therapist is able to meet your therapeutic needs? Ask for what you need!
Ok, this might not be a real hack, and the title of this post is just a bad spin on “How to Win Friends and Influence People”, a book I haven’t even read. But, hear me out!
For better or worse, therapists are not psychic, so your input is really valuable. This can start as soon as your first phone call or email, and can carry on in different ways throughout your entire therapy experience.
When I receive reach-outs from potential clients, I offer a phone consultation–this is my preference, and plenty of other therapists do intakes differently! During the consultation call, when I ask people what would help them know if I’m a good fit, some people have very specific questions, and others aren’t sure what to ask. Some people, especially those newer to therapy, may even feel intimidated since we’re speaking slightly different languages–if I’m talking about the modalities I use, this may sound completely baffling, or, for some people, might completely resonate and tell them helpful information. (Questions to clarify what I’m talking about are always welcome!)
I typically start by asking what people are wanting support with, so that if it’s out of my scope of practice we don’t find that out after going through scheduling and taking the time to meet, and I can instead offer referrals to therapists who might be a better fit right away. That can be a great question for you to bring up: have you worked with (what you’re wanting support with) before? Are you comfortable with clients who are wanting (a particular way to address concerns)? Is (this diagnosis or presenting problem) within your scope of practice?
You may also be able to think about past experiences in therapy and draw from that to speak to what you have learned about what does and doesn’t work for you. Questions to get a sense of whether a therapist is comfortable with working with similar presenting problems and/or using a particular modality are a great place to start! I’ll add here though, that while many therapists specialize in particular areas, many of us are open to learning more and broadening our scope, so while we may not have expertise (especially if you’re looking for help with something super specific) this doesn’t have to be a barrier! Every single client we work with is different, so we are always learning and growing in how we can meet the needs of our clients. I see this learning and growth as part of the joy of this work!
Along with questions that get at “are you able to meet the needs of a client like me”, other important questions can be kind of dry and logistical. Do we have availability at the same time? Thinking about whether you’re able to flex your availability, without it being too stress inducing, can be helpful–are you open to meeting on lunch breaks? Able to leave work a bit early? Any flexibility might help us be better able to find times that work! Another big logistical one is around cost–do you take my insurance? (Don’t assume! Unfortunately I have heard of insurance agencies providing outdated information about whether therapists are in network or not, and sometimes different people in the same practice may be in or out of network. Insurance policies can be complicated–sometimes the best way to get a clear answer about what your co-pay or co-insurance for a session would be is to get in touch with your provider directly.) Don’t be afraid to ask financial questions, and even if we don’t know we can usually help you figure out how to ask your insurance provider to get more information. If you’re doing private pay, it’s also ok to ask about sliding scale options if that is what would make therapy doable for you. Sometimes we can’t accommodate that, but therapists are often quite familiar with the places in our communities where low cost sessions are available!
Outside of the more cut and dried questions, you might have broader questions–What would help you feel confident that a therapist could be a good fit for you? For some people, the answer is, “I’m open to anything!”, and they’re just excited to begin the work! For others, there may be lots of questions that are helpful and/or really important to get an answer to.
It can be essential to know that your identity and values will be respected. Therapists typically take a stance of cultural humility and respect, even with values and identities very different to ours. However, sometimes it can feel safer to voice your need for respect and understanding about part of your life right off the bat. Would it be helpful for you to know if your (potential) therapist affirms choice and autonomy in pregnancy, including supporting people who choose abortion? If they are comfortable working with people who are polyamorous? How they support people in integrating their religion and spirituality into therapeutic work? If they are sex positive and kink affirming? Questions like this, about things that matter to you and would help you feel safer beginning our work together, are great to ask! You may also know that certain characteristics in a therapist would feel most comfortable to you. Is it important that your therapist is a person of color? The same gender as you? Close to your age? Having preferences related to shared experiences and/or knowing who will feel safe for you is ok!
At the end of the day, finding a good therapeutic fit will always be a little bit of a gamble–I know I’m not going to be the perfect therapist for everyone out there, and that’s ok! And, part of our training and our work is around being able to fine tune the areas of our expertise to fit lots of different people with lots of different identities, values, experiences, and challenges. So in addition to encouraging you to think about what matters to you in finding a good fit, I’d also encourage you to challenge yourself a bit–if you find someone who meets a lot of your criteria but is in a totally different age bracket than you were imagining, could that be ok for you? What if they don’t specialize in the area you’re wanting support with, but have some experience and are open to learning with you? There may be hard “no”s for you, and that’s ok, but it’s also ok to give a therapist a try for a few sessions if you’re on the fence. (I’d recommend at least three sessions if you’re unsure–the first few sessions are typically a lot of learning background information, so those sessions may not give you a perfectly clear idea of what later sessions will be like!)
As you move through the process of therapy, you may hit bumps in the road. Sometimes the exact things you were hoping to see get better start to feel worse, or you might feel really stuck. Part of the work can be identifying problems, and that can be a really uncomfortable space to sit in; ok, I see the problem really clearly, now what do I do about it?! Your therapist might say something that doesn’t sit quite right, or you may leave a session feeling like it wasn’t quite what you needed. There may be parts of your life that feel off limits, or that you’re not ready or willing to talk about, and your therapist may steer conversation in that direction unknowingly.
All of those things are really, really normal. And, that doesn’t mean you should just shrug them off. It can be really helpful to talk with your therapist about the process of therapy. (In fact, this focus on process vs. content is big part of what we do in therapy–we don’t talk just about the specifics or content of what’s going on, like the play by play of an argument, we look at the process, or subjective experience, patterns in how something plays out, how it relates to other things, and lots of other aspects outside of the details.) Initiating a conversation about a concern from a session, wanting to make sure something in particular is discussed, or otherwise asking for what you know would be helpful to you is very welcome. And while you could begin a session by letting us know, “There’s something in particular I want to talk about,” many therapists are open to getting a message between sessions that gives us a heads up about something that feels important for you to discuss or to give us feedback, if that feels like a more comfortable way for you to bring up a request or concern.
Whether you’re working with a new therapist or not, talking openly about your hesitations and concerns and letting your therapist in on what you’re hoping for from your time can lead to some great conversation around collaboratively setting goals, exploring your preferences, and understanding what success in therapy would look like for you. And know that even if you’ve been working with a therapist for a while, it is ok to talk openly about the process of therapy. You can let us know whether a session felt helpful or not, if we are focusing on something that you’re not ready to talk about, if we seemed to misunderstand or miss something important, or if we just plain got something wrong. We are human, and we want to help, so we welcome your questions and concerns!
Take it from Dr. J here, we are *not*, I repeat, *NOT!* psychic! We try to get it right, but sometimes we just wish you could transplant your brain into ours for a sec so we could get a really clear picture of what’s happening for you. Alas, that technology is not here yet (that’s a good thing, I’m sure), so instead any help you can give us to get it more right is really, really appreciated!
Also, I want to add that even though this is the work I do, before I became a therapist I definitely thought that, somewhere along the way, therapists got so good at reading people that they could basically be psychic. Turns out… nope.