Human lives are complicated. We experience despair, confusion, and isolation, and throughout our lives, we will suffer losses and face dilemmas that are too great to shoulder alone. In these seasons of our lives, we might decide we need help from a professional: it’s time to see a therapist. But, who and what kind?
Therapy is best described as a journey. Choosing a therapist is a bit like selecting a travelling companion for a difficult stretch of road. Like any important relationship, it’s reasonable to take a little time to choose someone who feels like a good fit.
However, if you’ve ever searched for a therapist online, you’ve probably been confronted with dozens of pages of smiling faces, impressive credentials, and no clear idea of how to choose.
Admitting we need help is a huge step and requires immense courage. When we’re struggling and overwhelmed, deciding who to ask for help can feel impossible. Many people praise their therapists. Others share horror stories about poor fits, unethical behaviour, or money spent on sessions that went nowhere, or left them feeling just as lost. How do we choose a stranger to trust with our vulnerable selves?
It’s completely okay, even expected, that you interview a therapist before starting therapy. As a newish psychotherapist (with a longer history of working with people’s mental, emotional and physical health as a naturopathic doctor), I have come to appreciate the role of the meet-and-greet. When I offer a free 20-minute consultation, it gives us a chance to discuss therapy and sets the stage for our work together.
I notice that most potential clients aren’t sure what to ask or how to evaluate fit. Some clients seek therapists who specialize in their main concern, such as anxiety or burnout, or who have a specific set of credentials or more years of experience. Others choose therapists similar to them in terms of gender, ethnicity, or age. Others choose therapists who are different, possibly to gain broader wisdom from varied perspectives.
Most clients probably go with a certain vibe, and there may be more wisdom in that than we tend to give credit for.
The success of therapy doesn’t exactly come down to choosing the “right” therapist, but rather to several factors that researcher Michael Lambert calls the “Common Factors” (Lambert, 1989). 30% of the outcomes in therapy are attributable to the strength of the therapeutic relationship, and 40% to client factors.
The remaining 30% of therapeutic outcomes appear to come from two sources: our belief that change is possible and the specific tools and techniques used to support it. According to Lambert’s model, expectancy accounts for roughly 15% of the outcome, while therapeutic modalities such as Cognitive Behaviour Therapy or EMDR account for another 15%.
The qualities that draw you toward a particular therapist, whether credentials, age, life experience, or a simple gut feeling of resonance, may not be the most powerful predictors of success on their own, but they can strengthen hope, deepen your commitment to the work, and help create the conditions for a meaningful therapeutic relationship to emerge.
In other words, picking a therapist based on a gut feeling, or vibe, may actually be grounded in scientific fact, according to Lambert’s findings.
Rather than leaving those vibes as a wordless mystery, let’s explore some of the ingredients that make therapy work and how they can help you find a therapist who feels like a good fit.
First, what is psychotherapy?
In Ontario, psychotherapy is a regulated practice that can be provided only by a select group of registered health professionals, including registered psychotherapists, registered social workers, clinical psychologists, medical doctors, and nurse practitioners.
It is the act of “treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgment, insight, behaviour, communication or social functioning.”
While this definition tells us who can provide psychotherapy and what it is intended to treat, it doesn’t explain how it works and what makes it effective. For that, we can turn to the research on therapeutic outcomes.
According to psychologist Michael Lambert, one of the strongest contributors to successful therapy has little to do with the therapist at all: client factors, or the qualities and circumstances that bring you into therapy.
Client Factors
Client factors make up a whopping 40% of therapy’s success. This doesn’t mean that your therapist doesn’t matter. It also doesn’t mean that it’s your responsibility to do therapy “well.” This finding simply means that you arrive with important information that can help shape the work.
Before deciding which therapist to work with, it may be helpful to spend some time reflecting on yourself and what has brought you to therapy.
What are your goals for therapy?
What are your main concerns?
What are your hopes and fears regarding starting therapy?
What are your previous therapy experiences? What worked and what didn’t? What did you like? What didn’t you like about past therapy experiences or past therapists?
How do you typically relate to people?
Do you prefer structure or more go-with-the-flow pacing?
Would you like lots of space to talk and explore your problems without interruption, or do you prefer a problem-solving approach that gives you tools? Maybe you would like a little of both.
Do you have a preference for gentleness, or do you like straight-shooters who give direct feedback?
How much time and energy do you have for therapy right now? How motivated are you to change? Are there any financial barriers to getting therapy?
When you imagine being helped, what does that look and feel like?
Client factors don’t just involve motivation and readiness to change, but also what identities, stories and relational expectations you bring with you.
You don’t need to have clear, definitive answers to the above questions. In fact, part of the aims of therapy is to develop self-awareness, improve motivation, try different approaches and practice goal-setting—this is the work.
However, I’m sure that some of these questions yield ready answers that, if made explicit to a potential therapist, might make it easier for you to determine whether they are a good fit.
The Therapeutic Relationship
While client factors account for the largest share of therapeutic outcomes, the therapeutic relationship is the heart of the therapeutic process itself, the medium through which insight, healing, and change occur.
Research consistently finds that clients who feel understood, respected, and supported by their therapist tend to experience better outcomes, regardless of the therapist’s specific modality or theoretical orientation (Lambert, 1989).
The therapeutic relationship is more than simply liking your therapist. It is a real relationship characterized by trust, safety, collaboration, and mutual respect. You feel seen rather than judged, supported rather than directed, and safe enough to be honest about difficult thoughts, feelings, and experiences.
Importantly, a strong therapeutic relationship does not mean therapy always feels comfortable. Growth often requires exploring painful emotions, difficult memories, and longstanding patterns. The goal is not necessarily comfort, but safety: enough trust to approach uncomfortable experiences rather than avoid them.
A strong therapeutic relationship does not require perfection. Therapists are human and will occasionally misunderstand, misattune, or miss the mark. In fact, moments of misunderstanding can become opportunities for growth when they are acknowledged and repaired. Many therapeutic approaches recognize that transference and countertransference, or the ways clients and therapists inevitably bring aspects of their past relationships into the therapy room, can provide valuable opportunities for insight and change.
The importance of the therapeutic relationship has been explored by thinkers across psychotherapy traditions. Philosopher Martin Buber described the distinction between I-Thou and I-It relationships (Slay-Westbrook, 2020). In an I-It relationship, the other person becomes an object to be acted upon, analyzed, or managed. In an I-Thou relationship, we encounter another person as a whole and irreducible human being—someone whose depth can never be fully known. Many people describe meaningful therapy as feeling closer to this I-Thou encounter.
Carl Rogers expressed a similar idea through his concept of unconditional positive regard, while psychologist Charles Gelso referred to it as the “real relationship”: a connection characterized by genuineness, realism, and mutual humanity (Gelso, 2011; Gelso et al., 2018). While therapy differs from friendship in important ways—it is confidential, boundaried, and structured around the client’s wellbeing—it is nonetheless a deeply human relationship.
When meeting a potential therapist, pay attention not only to their credentials and expertise, but also to how you feel in their presence. Do you feel listened to? Respected? Curious rather than judged? You might even ask questions such as, “How do you handle misunderstandings in therapy?“ What does repair look like when something doesn’t land well? How do you approach the therapeutic relationship itself?
Greater than the sum of its tools and techniques, psychotherapy is ultimately a relationship: one capable of holding trust, vulnerability, and the unfolding story of a human life.
Modalities
While the therapeutic relationship provides the foundation for change, modalities offer different pathways through it. These approaches account for a relatively small proportion of therapeutic outcomes (15%) compared to client factors (40%) and the therapeutic relationship (30%), yet they can still shape how therapy feels and unfolds.
Cognitive Behavioural Therapy (CBT), Emotion-Focused Therapy (EFT), Narrative Therapy, Internal Family Systems (IFS), Psychodynamic Therapy, Acceptance and Commitment Therapy (ACT), and other modalities each offer different ways of understanding human suffering and facilitating change. Rather than asking which modality is “best,” it may be more useful to ask which approach resonates with your goals, values, and way of making sense of the world.
Cognitive therapies focus on thoughts, behaviours, and patterns of thinking, and how they shape our emotions, beliefs, and actions in the world.
Cognitive Behavioural Therapy (CBT) is one of the most extensively researched psychotherapy modalities. Trauma-focused CBT is considered a first-line treatment for many trauma-related conditions, while CBT for Insomnia (CBT-I) remains the gold-standard psychological treatment for sleep difficulties, often outperforming medication over the long term (American Psychological Association, 2017; Cunningham & Shapiro, 2018).
Cognitive therapies, including Solution-Focused Therapy, tend to be practical, actionable, and goal-oriented. I once saw someone jokingly describe CBT as “self-gaslighting” because it asks us to question our automatic assumptions and habitual ways of interpreting the world, rather than believing them wholesale.
While I understand the criticism, I find cognitive therapies offer invaluable insight and tools. They can sometimes feel systematic or impersonal, and some people find them lacking in depth, but for many, learning to observe and challenge their thinking is an essential first step in therapy. Personally, I like to blend cognitive approaches with other modalities.
Psychodynamic psychotherapy focuses on unconscious patterns, beliefs, and relationships. Its goal is deep self-understanding and insight.
Internal Family Systems (IFS), one of the most popular psychodynamic approaches today, explores the different parts within us. Many people resonate with the idea that we contain multiple parts, often with conflicting motivations, goals, and strategies. These internal conflicts can show up as ambivalence, procrastination, difficulty with change, or emotions that seem bigger than the situation at hand.
In psychodynamic work, we gently explore what parts may be active and where our beliefs, coping strategies, and relational patterns originated. Often, these patterns were adaptive at one point in our lives, but continue to influence us long after they have ceased to serve us.
Carl Jung famously wrote, “Until you make the unconscious conscious, it will direct your life, and you will call it fate.” Psychodynamic therapy aims to bring these hidden patterns into awareness so that we can relate to them more consciously and freely.
Somatic and body-based therapies take a different approach. While they often involve talking, they focus on the nervous system, felt sensation, and the lived experience of being in a body. My training in mindfulness, yoga, and naturopathic medicine helps me bring the body into the room. What are you noticing in your body right now? What sensations, impulses, tensions, or emotions are present?
The body holds an immense amount of information. It is often where our emotions, intuition, and reactions emerge before they become conscious thoughts. Awareness of the body and the five senses is also our connection to the present moment. For many people, reconnecting with the body can create a sense of safety and stability, particularly when processing trauma.
Humanistic therapies focus on meaning, identity, growth, and story. They grapple with some of life’s most fundamental questions: Who am I? What matters to me? What gives my life meaning? What does it mean to be human?
These approaches emphasize present-moment experience and often use the therapeutic relationship itself as a source of healing and insight. The therapy room becomes a place where relational patterns can be explored, understood, and sometimes repaired.
Narrative Therapy, one of my favourite approaches, recognizes that our lives are shaped by the stories we tell about ourselves. When people arrive in therapy, the dominant story is often organized around problems, failures, losses, or trauma. Yet there are always other stories present as well: stories of values, hopes, relationships, strengths, courage, and resilience. Therapy helps bring those stories into view.
I remember a psychology professor asking us, as naturopathic medical students, to draw ourselves divided into three parts: head, heart, and gut/body. “Draw them in proportion to one another,” she instructed.
My brainy friend sitting beside me drew a giant head perched atop a tiny heart and body. My own drawing was more evenly divided, although my heart was a little larger. In reality, I probably spend more time in my head than I’d like to admit.
When considering what type of therapy might work best for you, I often think back to that exercise. Where do you live most of the time: your head, your heart, or your body? Is it easier for you to track your thoughts, your emotions, or your physical sensations?
You might choose a therapeutic approach that leans into your strengths. If you’re a practical, analytical person who likes structure and clear strategies, a cognitive approach may feel like a natural fit. If you’re not especially interested in metaphor, meaning, dreams, or exploring the deeper layers of your psyche, I might not be the perfect therapist for you, and that’s perfectly okay.
On the other hand, you might choose therapy as an opportunity to explore territory that has been less familiar. If you’ve spent years analyzing your thoughts and understanding your patterns intellectually, a somatic therapist might help you access information that lives beyond words and ideas.
For many people, shifting out of the left-brain world of analysis and into the right-brain world of sensation, emotion, imagery, metaphor, and creativity opens up entirely new ways of understanding themselves. Sometimes insight comes not from thinking harder, but from feeling more deeply.
This is one reason I like to bring creativity, humour, and play into the therapeutic relationship. Playfulness can help move us out of despair, rigidity, and overwhelm, and into what psychologist Dan Siegel calls the Window of Tolerance: the place where emotions can be felt without flooding us, and where growth, learning, and change become possible.
All in all, therapy involves developing self-awareness. In therapy, we are given a supportive container to gain new insights into our bodies, thoughts, relational and family dynamics, history, and unconscious processes and patterns.
James Hillman described the starting material of therapy as the massa confusa, the confused mass. I think of it as the tangled collection of experiences, emotions, memories, questions, contradictions, and unfinished stories that people bring into the therapy room. Together, therapist and client begin to sort through it: separating strands, noticing patterns, making connections, and gradually finding shape where there once seemed to be only confusion.
Perhaps this is what draws me most to narrative and psychodynamic approaches. Over time, the massa confusa begins to organize itself into stories that make sense of our experience, weaving together the past, the realities of the present, and possibilities for a preferred future.
My own approach to therapy is eclectic and collaborative. Grounded in a biopsychosocial understanding of health, I am interested in the ways our thoughts, emotions, bodies, relationships, histories, and environments interact to shape our lives. My training includes Mindfulness-Based Cognitive Therapy, Narrative Therapy, Motivational Interviewing, and Cognitive Behaviour Therapy, while my work is also informed by psychodynamic, humanistic, existential, and somatic perspectives.
Ultimately, I find it more useful to begin with the person than with the modality. Each individual arrives with a unique story, set of challenges, strengths, preferences, and goals. Together, we explore what is happening, what has shaped it, and what possibilities for healing, growth, and change might emerge.
Interviewing a Potential Therapist
Remember that therapists have a fiduciary duty to their clients, meaning that therapy exists for your benefit. Therapists should be accustomed to being interviewed, open to your questions, and interested in helping you find a good fit. A good therapist won’t take it personally if you book a meet-and-greet and ultimately decide to work with someone else.
The meet-and-greet is an opportunity for both of you to gather information. You might begin by sharing what brings you to therapy, what you’re hoping will change, and any previous experiences you’ve had with therapy, what worked, what didn’t, and what you’re looking for now.
I encourage potential clients to ask whatever questions they have. Common questions include:
- What is your approach to therapy?
- What kinds of clients do you usually work with?
- What does a typical session look like?
- How do you know if therapy is working?
- What happens if we disagree about something?
- Do you feel competent to work with my particular concerns, goals, diagnoses, cultural background, or preferred therapeutic approach?
Of course, a meet-and-greet is about more than information gathering. It is also about getting a feel for one another. How does it feel to talk together? Do you feel comfortable asking questions? Does the therapist seem open, transparent, and willing to explain their thinking? Do you feel listened to?
Signs that you may have found a good fit often show up as a sense of relief, ease, curiosity, or recognition. You may feel understood, respected, and taken seriously. You may feel that the therapist is genuinely interested in you and willing to be challenged, corrected, or told when something doesn’t land. Often, a good fit includes a sense that you can be both supported and productively nudged beyond familiar patterns.
Humility is one quality I particularly value in therapists. We cannot truly engage in an I-Thou relationship—an appreciation of another person’s full humanity—without recognizing how much about them we do not know and can never fully know. A good therapist is often willing to say, “I might be wrong. Tell me more.”
Signs that a therapist may not be a good fit can also come from the body. You might feel judged, dismissed, pressured, lectured, dominated, or persistently misunderstood. While difficult emotions can arise even in healthy therapeutic relationships, it is worth paying attention if something feels off from the outset.
If you do experience discomfort, consider whether it feels speakable. Can you tell the therapist? How do they respond? Do they become defensive, or do they welcome the conversation? The answer may tell you as much as the feeling itself.
It’s also perfectly acceptable to try more than one therapist. Some people know within a meet-and-greet that the fit is right. Others need a few sessions to find out. Therapy is a significant investment of time, energy, money, and trust. It is worth taking the time to find someone who feels like a good match.
At its core, therapy is a collaborative process of understanding. It involves getting to know someone’s story, exploring the patterns that shape their life, and creating space for new possibilities to emerge.
If you’re considering therapy, one question you might begin with is this: Is there someone I feel safe enough with to explore my life honestly?
Good therapy is less about someone “fixing” you and more about creating a space where you can understand yourself more deeply in the presence of someone who is paying attention.
Who do you trust your story to?
References:
American Psychological Association. (2017). Practice guidelines for the treatment of Posttraumatic Stress Disorder (PTSD) in Adults. [PDF]. https://www.apa.org/ptsd-guideline/ptsd.pdf
Cunningham, J. E., & Shapiro, C. M. (2018). Cognitive behavioural therapy for insomnia (CBT-I) to treat depression: A systematic review. Journal of Psychosomatic Research, 106, 1–12. https://doi.org/10.1016/j.jpsychores.2017.12.012
Gelso, C. J. (2011). The real relationship in psychotherapy: The hidden foundation of change. American Psychological Association. https://doi.org/10.1037/12349-000
Gelso, C. J., Kivlighan, D. M., & Markin, R. D. (2018). The real relationship and its role in psychotherapy outcome: A meta-analysis. Psychotherapy, 55(4), 434–444. https://doi.org/10.1037/pst0000183
Lambert, M. J. (1989). The individual therapist’s contribution to psychotherapy process and outcome. Clinical Psychology Review, 9(4), 469–485. https://doi.org/10.1016/0272-7358(89)90004-4
Slay-Westbrook, S. (2020). Respect-focused therapy. Routledge.
