How to find a therapist who’s a good fit

Why fit matters

Researchers call the working relationship between a client and a therapist the “therapeutic alliance.” A 2018 review pulled together 295 studies covering more than 30,000 people in therapy. Across very different kinds of therapy, people who had a stronger alliance with their therapist tended to have better results. That held for telehealth and online therapy too.

A separate review of 53 studies found that people who got the kind of therapy they said they preferred were less likely to quit early.

So it’s reasonable to be choosy. Your sense of whether you can work with someone is useful information.

What a good fit looks like

The alliance is usually described in three parts:

• You feel respected and understood. You don’t have to like everything your therapist says, but you trust that they’re on your side.
• You agree on the goals. You both know what you’re working toward, in words that make sense to you.
• You agree on how to get there. The way you spend sessions, whether that’s talking things through, practicing skills or doing homework between visits, feels like a reasonable path to those goals.

None of this needs to be perfect at the first session. It should get clearer over the first few.

Decide what matters to you first

Before you search, write down a few things that would make a therapist a better match for you. For example:

• what you want help with, such as anxiety, grief, a life change or trouble at home
• whether you’d feel more comfortable with someone of a particular gender, age, culture or faith
• a language you’d like to have sessions in
• whether you want therapy for yourself, your child, your family or you and a partner
• telehealth, an office, or either
• days and times you can actually make
• what you can spend, and whether you’ll use insurance

It’s fine to have strong preferences, and it’s fine to have none. The list just helps you compare profiles without starting from scratch each time.

Common approaches, in plain words

Therapists often list the methods they use. You don’t need to pick one before you start, but it helps to recognize the names:

• Cognitive behavioral therapy (CBT) looks at how thoughts, feelings and actions affect each other, and usually includes practice between sessions.
• Dialectical behavior therapy (DBT) teaches skills for handling strong emotions and relationships. It’s often offered with a skills group.
• EMDR is a structured approach used for trauma and distressing memories.
• Psychodynamic therapy looks at patterns from your past and how they show up now.
• Family therapy and couples counseling work with more than one person in the room.

If a therapist lists a method you haven’t heard of, ask them to explain it in a sentence or two. A good therapist can.

Check the license

Every state licenses therapists, and every state has a public lookup. Before your first session, search the therapist’s name on your state’s licensing board site. You’ll see whether the license is active and whether the board has taken any public action.

The letters after a therapist’s name tell you their license. Common ones include LPC or LPC-MHSP (licensed professional counselor), LCSW (licensed clinical social worker), LMFT (licensed marriage and family therapist), and PhD or PsyD for licensed psychologists. Some therapists are still finishing their hours toward a full license and work under a supervisor. That’s normal, and it’s fair to ask who the supervisor is.

In Tennessee, the Department of Health’s licensure verification site covers counselors, social workers, marriage and family therapists and psychologists.

Use the first call

Many therapists offer a short call by phone or telehealth before the first session. Use it to ask a few questions:

• “Have you worked with people dealing with [what you want help with]?”
• “What would our sessions usually look like?”
• “How will we know if it’s helping?”
• “How often would we meet, and for how long?”
• “Do you see clients by telehealth, in person, or both?”
• “What’s your fee, and do you take my insurance?”
• “What happens if I need to cancel?”

Pay attention to how the answers feel as well as what they say. You’re looking for someone who listens, answers plainly and doesn’t rush you.

Give it a few sessions

The first session is mostly paperwork and getting to know each other. Many people need two or three sessions before they can tell whether a therapist fits.

After that, ask yourself:

• Do I feel safe being honest here?
• Do I understand what we’re working on?
• Do I leave with something to think about or try?
• When I’ve disagreed with my therapist, did they take it seriously?

You can bring any of this up with your therapist directly. Saying “I’m not sure this is helping” often makes therapy better, because it gives your therapist something specific to adjust.

Signs to look elsewhere

Move on if a therapist:

• dismisses your concerns or makes you feel judged
• talks mostly about themselves
• pushes their own beliefs on you
• shares what you’ve told them without your permission, outside the limits they explained at the start
• suggests any kind of relationship outside of therapy

If a therapist does something that seems unethical, you can report it to your state’s licensing board.

Switching therapists is normal

People change therapists all the time, and therapists expect it. You don’t owe anyone a long explanation. A short message is enough:

“Thank you for our sessions. I’ve decided to look for a different fit. Could you suggest anyone who might suit what I’m looking for?”

Therapists often know colleagues who’d be a better match, so that last question is worth asking.

Using the LunahUP directory

LunahUP’s directory lets you filter by therapy type, language, age group, gender, telehealth or in person, and fees. Many profiles come from public records and haven’t been filled in by the therapist yet, so a missing detail usually means it hasn’t been added. It doesn’t mean the therapist doesn’t offer it.

Use the filters to build a short list, check each license, then use the first call to decide.

The short version

• The relationship with your therapist is one of the most consistent predictors of how therapy goes.
• Write down what matters to you before you search.
• Check the therapist’s license on your state board’s site.
• Use a short first call to ask how they work.
• Give it two or three sessions, then ask yourself whether it’s helping.
• Switching therapists is common, and you can ask for a referral when you do.