How Your Therapist Chooses You: The Consultation

Many therapists offer a free consultation for potential new clients. The format can be a phone call, video chat, or an in-person consultation. But what is the purpose of this consultation? Is it just a way of complicating things and making the process of finding a therapist even more difficult? Thankfully, no. A consultation is a great way of actually making the process of finding a therapist better. There are many reasons why a therapist may offer a consultation and it is for the benefit of the therapist and the client.

The Client/Therapist Fit

A consultation can feel like a first date or a job interview, where both parties are deciding whether to continue the relationship or not. In a consultation appointment, the therapist is thinking about therapeutic fit and business fit.

Therapeutic Fit

The therapist may offer a consultation to seek a good “therapeutic fit.” This is a fairly abstruse term that is easier to feel than to describe. We’ll describe this concept further, but one of the primary contributing factors is the match between the client and a therapist’s “ideal client.” For some therapists, their preference for an “ideal client” can be as broad as specializing in a particular mental health issue like depression, anxiety, grief, or PTSD. Other clinicians focus on particular issues and a certain population of clients: teenagers with eating disorders, the elderly with depression. Some specialize in various aspects or intersections of one’s cultural identity: christian college students, gay men in relationships, south asian working mothers, etc. Because of this, it is likely that not every therapist will feel interested or equipped to working with every individual. This is good! This allows for that therapist to go be the best therapist for someone else and for another therapist, who does feel very interested and equipped to working with you, be the best therapist for you! When a therapist is seeking a good therapeutic fit with a client during a consultation session, they will likely be making sure that the client somewhat matches their “ideal client” regarding clinical issue and cultural factors. If the client doesn’t match their ideal client in this way, the therapist may choose to refer to a clinician who’s more of a specialist in this area. However, a therapist may be interested in expanding their “ideal client” and will choose to seek consultation or supervision to be better equipped to working with you.

Business Fit

Another reason a therapist may offer a consultation is to ensure a smooth business relationship between you. It can be strange to think of a business relationship when seeking a therapist, but it is the reality, especially if you’re seeking a therapist in private practice. A therapist in private practice runs a small business and has made intentional decisions regarding the business operations such as: location of business, hours of appointment times, availability after hours, fee of service, services available, and other policies (e.g., cancellation policy, social media policy). While many of these operations will be consistent among clinicians because they are informed by ethics and standard practices of the field, other operations differ because each clinician is an individual with different needs and preferences as a business owner. They may charge their fee because of a complex calculation of their projected financial need. They may not offer evening times because they get tired and don’t feel like they can do their best work after 5pm. They may have a 72 hour cancellation policy because they prepare for their sessions that far in advance. They may not offer crisis coverage because they have small children at home and want to be fully present with their family on the weekends.

The therapist gets to decide how they want to run their practice, and you get to decide if you want to opt into their policies. A consultation is a great way of discussing these policies and ensuring that both parties are generally in agreement with the way things will be conducted. It is likely that many policies won’t be relevant or require a deep “hashing out” immediately, but if there are any glaring differences between what you expect from your therapist and what they offer, now’s a great time to find out and find someone else.

So, how do you decide?

How your therapist chooses you

When it comes to fit, the therapist will have questions about who they are as a therapist and who the client is as a client. These are some questions they may be holding in mind.

Factors about the therapist:

1. Do I feel interested in this person?
2. Would I enjoy doing this piece of work with this person?
3. Do I feel equipped clinically to help this person?
4. Do I currently have enough personal and emotional resources to care for myself so that I may care for this person?
5. Do I have space in my schedule to take on another ongoing client?
6. Are these client’s goals something I can support or generally similar to goals I may have for them?
7. Does this person remind me of someone in my own life that would make it too difficult for me to remain objective, non-judgmental, and emotionally available to them?
8. Does this person want to work on something that triggers something unprocessed in my own life?
9. Do I feel safe sitting in the room with this person?
10. Am I sexually attracted to this person, and if so, do I have professional consultation and support to manage this?

Factors about the client:

1. Does this person have the financial means to invest in the work I recommend pursuing?
2. Does this person seem ready for change and generally ready to commit to therapy?
3. Does this person seem comfortable with me?
4. Is there a colleague of mine who is more equipped to care for this person because of their specialty, availability, or resources?
5. Are these client’s goals for treatment reasonable?
6. Does this client seem open to my business practices, including my hours, cancellation policy, and availability?
7. Does this client appear to value therapy enough for the financial and emotional commitment, sacrifice, and investment?
8. What level of insight does this client have into their internal world and their current concerns?
9. How much social support and emotional resources does this client have?
10. Do I happen to be in relationship with someone close to this client (e.g., other client, family member, friend)?

How you choose your therapist

There are no universal rules for choosing a therapist. Since so much of the work is based on the therapeutic relationship, it makes sense that the reasons for committing to this relationship may be difficult to articulate. In a consultation appointment, you (the client) may be holding in mind these questions:

1. Does this location work for me in that it is close enough to where I live, work, or spend my time?
2. Is this room too ugly, smelly, noisy, or distracting for me to feel comfortable?
3. Does this person seem like someone I can eventually feel safe with?
4. Does this person seem knowledgeable about the issues I’m wanting to work on?
5. Does this person appear stable enough or self-aware enough to support me?
6. Do I feel encouraged to think and talk freely?
7. Do I have a basic sense of respect for this clinician and their ability to help me?
8. Do I want to use my insurance in or out of network and will this be possible with this clinician?
9. Does this clinician offer reduced rates if I encounter financial hardship?
10. Am I sexually attracted to this person, and if so, would I be able to talk to them about this?

So what if you have that consultation appointment and have answers to these questions? What happens next? How do you actually make the decision on choosing someone? Are there right or wrong motivations for deciding who is your best fit?

Legitimate reasons for choosing a therapist:

• You called 3 therapists and they were the first one to call you back.
• They wrote their dissertation on a topic freakishly similar to the topic you’re wanting to work on.
• You like their Psychology Today or Therapy Den profile picture.
• They have the same first name as your 2nd grade teacher and you always felt really safe and connected to your 2nd grade teacher.
• Your mom’s friend’s daughter’s husband’s sister’s coworker went to this therapist 5 years ago and had a great experience.
• You like their couch.

Legitimate reasons for not choosing a therapist:

• Their office was too messy and you didn’t feel at peace in it.
• They aren’t fully licensed and you don’t want to work with someone under supervision.
• They are unavailable during your preferred time for an appointment.  
• Their office is too far away and you don’t want that commute.
• They don’t take your insurance.
• They go to your gym and you don’t want the heightened chance of running into them outside of therapy.

Clearly, my bias is that there are way more legitimate reasons for choosing or not choosing a therapist than there are silly or wrong reasons. This is you choosing to be in relationship with someone and this is another person choosing to be in relationship with you. The approach can be any combination of being logical, methodical, vulnerable, “woo-woo,” random, spiritual, and emotional. It can be important to you to find someone through a referral from a friend, professor, pastor/religious leader, or attorney. Maybe you search “therapist near me” on Google and connect with the first person who looks legit. Maybe you want to set up multiple consultation appointments to “shop around” and only commit to a person that checks all your boxes. All of these methods are real and legitimate ways for you to approach this vulnerable step.

So you choose a therapist, but things aren’t jiving:

It is okay to ask to switch therapists! Sometimes you won’t really get a sense of the working relationship until several weeks into treatment. It is always preferred to have a conversation with your therapist so you can discuss your concerns or frustrations with treatment (unless the therapist has acted unethically and/or you do not feel safe within the relationship). Most therapists will not take it personally if you want to find a better fit with another clinician because they also will desire you to get the best help. Still, some therapists may encourage you to stay to try and work these issues out within the relationship because it’ll allow both of you to learn and grow. This can be important if it’s a pattern of yours to switch therapists when things get uncomfortable or you avoid the awkwardness in ending relationships. However, whether or not repair within the therapeutic relationship is possible, you are always free to discontinue treatment and request referrals for a better match.

Your turn

This whole process is hard. It takes so much courage to look for a therapist, make the first contact, and then actually show up to your appointment! (Blind date, anyone?) Hopefully, thinking about these points when approaching a consultation can make the process a little easier. I hope you find the right fit!

If you’d like to talk with someone about which Relational Psych therapist is the best fit for you, get in touch!