“Good fit” is a phrase that therapists use to identify clients that they think will work well with them, and encompasses a lot of things. I am going to try to break it down. Here are some of the considerations:
- Logistics –
- virtual or in person therapy
- availability
- payment & insurance
- level of care
- Demographics
- diagnosis specific concerns or specialties
- Therapy Approach
- Personality match between the therapist and client (rapport and trust)
- The “vibe”
I am a person who likes a lot of information, so there is a lot packed in this post. If you want something simpler, check out these links:
5 Questions to Ask if a Therapist is Right for You – Psychology Today
15 Questions to Determine if your Mental Health Provider is a Good Fit – US News and World Report
How to Find the Right Couples Therapist – New York Times
How well you and your therapist work together, or how “good the fit” is can be a big factor in why therapy works or doesn’t. One thing I notice a lot is that clients who have negative therapy experiences like they were forced to go as a kid or it did not “work” – I will suggest that this is because it was not a good fit. It may have been a good fit for your parent, but not for you. They may not have been specialized. They may have reminded you of someone you did not get along with. There are lots of potential reasons, but that is not a reason to dismiss the therapy process entirely. If you can find someone who fits, you may have a totally different experience.
We are going to look at the list in kind of a “black and white” to more “gray” area order. Some of these are easy to determine and it gets a little more complicated along the way.
Logistics
In today’s world, the first thing you have to ask yourself is if you think virtual therapy will work for you. There are many more options for virtual therapists and I do not see them going away any time soon – hopefully, this means that more people will access therapy since it is not as difficult to see someone if they’re on your computer as opposed to going to an office.
Virtual Therapy – Pros and Cons
Getting the Most out of Virtual Therapy
What to Expect from Tele-Therapy at Wind Over Water
Obviously, I am a little biased in favor of virtual therapy!
However, some people really do not like virtual therapy – clients or therapists. If you are one of those people – maybe you just need to sit in an office and look someone in the eye – then don’t short change yourself! Find someone in person! It is a filter question on sites like Psychology Today’s Therapist Finder or TherapyDen, so you can specifically search for that information.
The next question is availability – if you need a certain time or day of the week, just say so! If the therapist does not work weekends and you need weekend availability, it is best to talk it through up front. If you are really invested in working with a particular specialist, that might not be possible, but know what you are willing to compromise.
For payment issues, it is fairly black and white – if you want to use your insurance, the provider needs to be in-network to fully use that benefit! This is information the therapist knows and it will be your responsibility to verify what your insurance will pay. For out of network benefits, the client needs to confirm with their insurance company what the policies are – there is a list of questions on my fees page to help guide you. It is actually required that providers charge clients who are using out of network benefits the same way you would charge out of pocket clients. The therapist’s fee and your insurance’s allowed benefit may not be the same. Sometimes things change, though – you get new insurance or lose insurance, the therapist goes out of network, etc. As with any other healthcare professional, you then have a choice to continue seeing them or find someone new. Also be aware that self-pay providers generally raise their rates every 6-12 months.
There are generalist and specialist providers – just like with doctors. If you have a complicated concern – like an eating disorder or trauma or addiction – you want the provider to be up on the latest research and have clinical expertise in that area. They do not need to have a specific certification, but it is an indication that they do ongoing education on the topic and work with that population regularly.
Generalist providers are like internists or family doctors – they handle a variety of things well and do education on various topics for their patients. There are some more prevalent mental health issues – like depression, grief, or anxiety – that happen to everyone at some point. All therapists have the training to work with these issues. But think about the varying ways that depression can affect a person – there are providers who work with different aspects of these more successfully.
Demographics, Specialities & Therapeutic Approach
So I am going to approach this a little differently – kind of like I would when I meet a stranger and someone asks me what I do. The first question is the most general and goes from there. Here is how it goes:
Stranger: “What kind of work do you do?”
Therapist: “I am a therapist” (note: I never say this on an airplane or at jury duty. I usually tell them I am the clinical director of a treatment center – which is my old job – and they just assume management stuff and leave it alone)
Stranger: “What kind? Are you a physical therapist?”
Therapist: “Mental Health.”
Stranger: “Oh, do you work with kids? My child has been doing this thing…” or “Does that mean you are analyzing me right now?”
Therapist: “I work with people struggling with things like eating disorders and trauma. But I turn it off when I am not at work, mostly, just like any other job.”
Stranger:
- “Oh, that’s interesting. What about outside of work?” [or some other way of getting away from the conversation] or
- “I have the opposite problem, I like to eat too much!” [with a chuckle/guffaw/look of shame or combination thereof] or
- “I could never do that job.”
- “I love my therapist, do you know…?”
Therapist:
- “Oh, I have a ton of hobbies, but I like to travel the most. Do you like to travel?” [if someone does not want to talk to a therapist, they do not have to] or
- “Oh, you have a healthy relationship with food? That’s great!” or
- “I enjoy it, though it can be a challenge. What do you do?”
- “That’s so great, mental health care is so important! I don’t know…”
And then they ask a bunch of things about my job and I get on my soapbox about weight stigma or compassion or we start talking about something else.
Demographics
Therapists generally work with a certain age range – you really want someone who matches your needs here! If their profile indicates that they only work with kids, adults, or couples (very rarely would it be all of these), stick with that.
You may also be looking for a therapist with similar demographics to you – this often works because it gives you a starting point of shared/similar experiences. So if what you want is a person of color or someone in the queer community to be your therapist, you can screen for that on Psychology Today’s Therapist Finder or TherapyDen also. It is important that you feel comfortable in order to build trust and rapport.
Levels of Care
I just want to throw this phrase out there for y’all – it is especially important in treatment for people with eating disorders. Outpatient care is the least intensive of the five levels of care. There are a lot of considerations for the ethics of treating someone with an eating disorder, so if you have any questions about that or levels of care, check out this repost from 2020.
When people think of therapy, they are generally talking about outpatient therapy – you usually go once a week for an hour and see someone for individual or couples or family therapy. This is where the whole “goodness of fit” question comes into play – because at the higher levels of care, you will be dealing with multiple providers.
Specialities
Then there are specific disorders and types of therapy that you would use with kids or couples that you would not with individual adults. And really, the more you handle a certain type of client, the more efficient it will be. Just as an example, I have been working with people suffering with eating disorders since 2000, and with the therapeutic modality of DBT since 2004. I recently added a trauma certification because there was so much overlap with my clients in both of those areas with people who had suffered trauma. This means that I have to do 6-20 continuing education hours each year in each of these to maintain my certification, and makes it very likely I will work with these clients daily.
Though clients present their problems in a variety of ways, I generally know what approach to take without too much doubt, research, or additional exploration if a client has one of these issues. If someone presented with addiction, I would not have as much to offer them in terms of appropriate treatment and would likely refer them to another, more qualified, clinician. I have managed all types of clients, and like working with some variety, which is another reason I like working with clients with eating disorders or trauma – with eating disorders, 94% of clients have a co-occuring diagnosis of depression, anxiety, or trauma; the diagnosis of PTSD requires some symptoms of anxiety or depression to be present.
Therapeutic Approach
Training also applies to therapeutic approaches. There are a lot of different modalities or frameworks for treatment – Cognitive Behavioral Therapy, Dialectical Behavior Therapy, ABA, Acceptance & Commitment Therapy, Radically Open DBT, Motivational Interviewing, Internal Family Systems, Mindfulness Based Stress Reduction, Psychodynamic, Gestalt, Rational Emotive Therapy, Family Based Therapy, Cognitive Processing, EMDR, and so many others. They are all recommended for certain types of concerns, ages, etc. and most therapists use a combination of them.
I come from a DBT framework, primarily, though use several other modalities as well, depending on the client and their needs. Right now, Compassion Focused Therapy is something I have been doing a lot of training in and use with many of my clients. It is likely that I will, in the next few years, do more training and perhaps get certified in this as well. I also like RO-DBT because it fits with the presentation a lot of clients have and offers some new directions and insights. Here is a little more about me and my treatment philosophy.
All of these are encompassed by what therapists call our “niche” – for instance, I generally say that “I help adults with eating disorders or trauma who want to work within a DBT framework and like their therapist to be straightforward and goal oriented.” That is the short version!
Personality & “Vibe”
This last category for consideration is a bit more ephemeral. Did you know that when you meet someone, your brain processes a ton of information about them in milliseconds, mostly based on body language? Usually, you know if you could be friends with someone pretty quickly. But trust takes longer – some estimates say it takes about 7 months of knowing someone before you truly trust them, and that is based more on genuineness and generosity demonstrated over time.
These are two different processes, but both can have a significant impact on the efficacy of therapy. You have to have a good feeling about your therapist and believe that you will communicate well and that they are trustworthy fairly quickly. The first is your gut or intuition, and you should probably listen to it – no matter how knowledgeable someone is, if you do not trust them it will not be the most effective relationship. If you do not have a good feeling about a therapist, look for another. There will be another therapist out there who will be a better fit for you.
From the therapist’s perspective, I know when a client is a wrong fit, but there is a range. The wrong fit is generally about one of the other things like age or therapy style or level of care needed. Every once in a while, personalities will clash or there will be ‘transference.’ Transference is a complicated concept, but in this context it is usually about what either the client or the therapist represent to the other. If I remind someone of their mom, and they do not have a good relationship, it makes rapport and trust much more difficult. In these instances, it is better to listen to your gut. It is one of the reasons I like to do consults – because sometimes, you just have a reaction to someone (positive or negative) and it will influence everything that comes after that.
What makes a great fit? Sometimes a client and provider ‘click’ personality wise, so it makes the rapport building and trust process smoother. Other clients invest more in the therapy relationship or recovery over time and it becomes a more fulfilling therapy partnership. Sometimes clients are exactly in my niche, and some have clear expectations of therapy that match my style so it is a smoother process. And in some cases, it is all of these, but this does not happen all that often.
Some clients will be “good fit” on paper or in the initial consult, and we will work well together, but you do not always know how it will go. Generally, these clients will learn what they can from the therapist, solve a particular problem, and then move on. This is the majority of clients, since usually they come to therapy to meet a goal or solve a problem and do not need ongoing therapy. It is a good relationship and serves the purpose, and is exactly what you need at that point in your life.
These are a lot of considerations! Try not to let it overwhelm you too much, or let it discourage you from seeking out a therapist. If you are thinking about it, it is probably a good idea to explore your options.
5 Questions to Ask if a Therapist is Right for You – Psychology Today
15 Questions to Determine if your Mental Health Provider is a Good Fit – US News and World Report
How to Find the Right Couples Therapist – New York Times
I hope that was not too overwhelming for y’all! Let me know if you have questions!
I will be back next week with more about Why Size Doesn’t Matter – What You Can Do to Challenge It.