Choosing a therapist can be an intimidating task. Knowing how to choose a therapist matters more than most people expect, because fit has more to do with whether therapy helps than a therapist’s particular method. A large 2018 meta-analysis of 295 studies covering more than 30,000 clients found that the quality of the working relationship between client and therapist was consistently linked to better results across different therapy approaches, types of clients and countries.
What makes a good fit is hard to measure and often comes down to trusting your instincts. The steps below can help you narrow your options and make a confident choice.
Start with what you want help with
Before you look at profiles, get clear on why you want therapy now. You don’t need a polished answer. A few honest sentences are enough:
- “I keep having the same fight with my partner.”
- “I’m successful on paper but anxious most of the time.”
- “I’m building a business and it’s affecting my relationships.”
This helps you filter. A therapist who works mostly with children or with substance use may be excellent and still not be the right fit for you. Look for someone whose stated focus matches what you’re dealing with.
Gather a few names
If you can, ask friends, family or coworkers for referrals. A recommendation from someone you trust is a good place to start. Online directories and search are also useful.
Most therapists have an online presence. Read their websites, reviews and anything they’ve written before you reach out. Blog posts and articles give you a sense of how a therapist thinks and talks, which is a useful early signal of fit.
Check licensure and training
Every licensed therapist should list their credentials and the states where they are licensed. In the U.S., a therapist generally has to be licensed in the state where you are physically located during the session, or hold a privilege to practice there through the Counseling Compact. This applies to online therapy too.
Common credentials include LPC, LPCC, LMFT, LCSW and licensed psychologist (PhD or PsyD). Each has different training, but all are qualified to provide therapy. You can verify a license through your state’s licensing board website.
Also look at experience. Years in practice don’t guarantee a good fit, but experience with your specific concern does matter.
Decide between online and in-person therapy
Online therapy has become a standard option, and controlled trials have found that therapy by video works as well as in-person therapy for conditions including depression and PTSD. The same 2018 meta-analysis found the client-therapist relationship was about as strong in online therapy as in face-to-face therapy. I cover the research in more detail in Telehealth Therapy vs. In-Person Therapy: What the Research Actually Says.
Online sessions remove commute time and widen your options. You aren’t limited to therapists within driving distance, so you can choose based on fit and specialty.
Convenience matters either way. It’s hard to get much from a session if you arrive stressed after rushing across town in traffic, or if you log on straight out of a back-to-back meeting. If you go online, set up a private space with a stable internet connection, and leave a few minutes before and after each session if you can.
Understand the cost before you start
Therapy is paid for in two main ways.
Insurance (in-network). The therapist bills your insurance and you pay a copay. Insurance usually requires a diagnosis and may limit the number of sessions or the type of treatment.
Private pay. You pay the therapist directly. Many therapists who work this way can give you a superbill, a receipt you submit to your insurance for possible out-of-network reimbursement. Private pay keeps your treatment between you and your therapist. It also means no diagnosis has to be sent to an insurer.
If you plan to use insurance benefits of either kind, do your homework first. I always recommend calling your insurance company and speaking with an actual representative to verify your mental health benefits, copay, deductible, out-of-network reimbursement and any restrictions. Don’t rely only on the information you find online about your policy. I’ve seen several people be unpleasantly surprised when their claims were rejected.
Ask each therapist about their fee, cancellation policy and payment method up front so there are no surprises.
Ask how long therapy usually takes
Many people stop therapy early. Psychologist Enrico Gnaulati, writing in Mad in America, cites conservative estimates that 28% to 33% of people who start therapy drop out, often within the first few sessions. Cost and scheduling are part of the reason. Another part is a mismatch between what clients want and the kind of therapy they get.
Many people come to therapy wanting to understand themselves and where their problems come from. Gnaulati cites a Psychotherapy Action Network survey of more than 1,500 U.S. adults, in which 88% said they preferred therapy that may take longer and addresses root causes. At the same time, many therapists are trained mainly in short, structured treatments that usually run 12 to 16 sessions. Both kinds of therapy have their place. But if you want one and get the other, you’re more likely to leave feeling it didn’t help.
So ask about length and structure before you start. Some people want practical skills for a specific problem over a few months. Others want to work on long-standing patterns in their relationships or in how they see themselves, which usually takes longer. A good therapist will tell you what to expect and adjust to what you need.
Reach out and use the consultation call
Contact a few therapists by phone, email or their website’s contact form. Most therapists have limited phone availability because they’re in sessions much of the day, so expect to leave a message. Include a few good times to call you back.
Most therapists offer a free 15–20 minute consultation. Use it. It’s your best chance to see how it feels to talk with this person before committing.
Questions to ask a potential therapist
- How long have you been in practice?
- What kinds of clients and concerns do you work with most?
- What is your approach, and what does a typical session look like?
- Do you have experience with [your specific concern]?
- Do you usually work short-term or longer-term?
- How will we decide together whether therapy is working?
- What are your thoughts on psychiatric medication?
- What is your fee and cancellation policy?
- Do you provide superbills?
- How do you handle contact between sessions?
Write your questions down before the call. First calls can feel awkward and it’s easy to forget what you meant to ask.
How to tell if it’s a good fit
After the consultation or the first session or two, ask yourself:
- Did I feel heard, or did I feel rushed or judged?
- Did they understand what I was describing?
- Could I see myself being honest with this person about difficult things?
- Did they explain how they work in a way that made sense to me?
Some discomfort is normal in therapy, especially early on. Discomfort that comes from talking about hard things is different from feeling unsafe or dismissed. Pay attention to which one you’re feeling.
If something feels off, say so. Research on dropout links a strong working relationship and a therapist’s responsiveness to a client’s needs and preferences with fewer people leaving therapy early. Telling your therapist what isn’t working gives them a chance to adjust. If they can’t or won’t, that tells you something too.
In the end, trust your gut. It may take an appointment or two to get a good feel, but you can learn a lot from that first contact. If it isn’t working, it’s fine to look for someone else. A good therapist will understand and may even help you find a better match.
Frequently asked questions
How many therapists should I talk to before choosing?
There is no set number. Many people talk to two or three before deciding. If the first consultation feels right, you don’t have to keep looking.
How long does therapy take?
It depends on what you want from it. Gnaulati reports that people in therapy receive a median of about 7 to 9 sessions. Common structured treatments run 12 to 16. Work on deeper patterns often takes longer. Ask any therapist you’re considering what they usually see.
Is it okay to switch therapists?
Yes. Fit matters for outcomes, and switching is common. You can tell your current therapist directly or simply stop scheduling.
What’s the difference between a counselor and a therapist?
In everyday use the terms mean the same thing. Licensed counselors (LPC, LPCC) and marriage and family therapists (LMFT) both provide therapy.
Next steps
I’m a Licensed Professional Counselor and have been in clinical practice since 1996. I work online with entrepreneurs, attorneys and creative professionals. My work focuses on anxiety, relationships and attachment patterns.
If you’d like to see whether we might be a good fit, you can learn more about my background and approach or request a free consultation.
