Finding a therapist

How should I choose a therapist?

I believe strongly in psychodynamic psychotherapy, and, in particular, in psychoanalysis. Psychoanalysis has changed my life. Twice. (I'm at the tail end of my second analysis.) I often evangelize for psychoanalysis. I don't do that here, and I wouldn't. I think only one thing matters in choosing a therapist: that you feel comfortable and safe with them, that you feel like they would be a good partner in your psychic journey. All sorts of empirical evidence exists supporting the thesis that, more than anything, the "therapeutic alliance" (jargon for "relationship") plays a preponderant role in determining the "efficacy" of therapy. Said differently, you're more likely to feel your therapy's been a success with a therapist with whom you feel a genuine connection than with one with whom you don't.

The therapeutic alliance outweighs every other consideration: nothing matters more than how you and your therapist get along. Not their theoretical approach (except to the extent that how you feel depends on their theoretical approach); not their years of experience (except to the extent that how you feel depends on their years of experience). Not their gender identity, not their sexual identity, not their ethnic or racial identity. Nothing. If there's only one factor to consider, consider how you feel in your gut. Have consultations with a few people. See what they're like. See how they differ. And then? Trust your gut.

Ok. But how should I find a therapist?

Some people use Psychology Today, or ZenCare, or MyWellbeing, or Therapy for Black Girls, or some other marketing platform to find a therapist. Typically, they search by geographic area, or by diagnosis, or by some or other keyword. And they form an initial feeling about someone (transference) based on their photo (if there is one), their profile, and their web site (if they have one). This seems to me a perfectly reasonable, if inefficient, way to go about it.

Others tap their networks - social networks, professional networks, clinicians of friends. This seems to me a much better way to go about the task. The people you know offer two distinct advantages to the "marketing platform" route: first, they offer the possibility of a strong initial transference right off the bat. A therapist recommended by a good friend or colleague comes with an implicit (or even explicit) "stamp of approval" that can go a long way toward establishing an initial positive - even idealizing - transference. Over time, if you work with someone, no idealization will survive. But it sure can help in the beginning. And second, your friends and colleagues know you. They have things in common with you. The people they're likely to refer have a greater likelihood of being the kind of people you'd like to work with, for that reason alone.

Ok - I have a couple of candidates to consider. Now what?

I wrote above that you should have consultations with a few people. That's my view. That's how I found my second analyst. (It's not how I found my first analyst, or the therapist I saw before that.) My view is just that: my view. Many people disagree.

Many clinicians think it's best to get a single referral and to give them a chance, to have an initial consultation or two or three, and to see how you feel. This seems perfectly reasonable to me, too. Some people feel overwhelmed at the possibility of opening themselves up to multiple people, having multiple first sessions, making themselves vulnerable, and, inevitably, experiencing the loss associated with not working with someone. And/or the pain or discomfort associated with "rejecting" someone. I respect these feelings, and encourage you to, as well. By all means: if you can't imagine having three, four, or more first sessions, or if the idea of "rejecting" some number of people feels intolerable, don't do it. I would never suggest you should subject yourself to discomfort in service of some notion of how you're "supposed" to select a therapist.

That said, I recommend, if it's available to you, to sift among the various criteria I listed above - theoretical approach, gender identity, geography, specialization, identity, etc. - and identify which one(s) matter most to you. When you've done that, tap into your networks and get some recommendations. Look at people's marketing platform profiles, at their web sites. Or, if it's not your speed, don't. Regardless, you'll find a path to two, three, four, or more folks, and you'll meet with them. Maybe once each. Maybe twice or more, with a couple. And you'll know, soon enough, who's right for you. Unless you know that none of those is, in which case, rinse and repeat.

Fundamentally, what makes you comfortable, secure, and safe should drive your search for a therapist, and you should - again - trust your gut when it comes to how to proceed.