Choosing a therapist: Common mistakes and how to avoid them

“I like to open up with the psychologist because I feel like when you open up you’re gonna get the work done. That’s what they’re there for. You need to open up to them, to talk to them, to let them know if you’re having hard times, to let them know if something’s bugging ya, to let them know if you’re worried about something.” – a 33-year-old man with Bipolar Affective Disorder and substance misuse. [1]

For someone who wants to improve their mental health, deciding to get therapy can be an important step. But did you know that someone’s choice of therapist can be a more important decision than the decision to get therapy in the first place? In this article, we explain why that is, then we give some simple suggestions for how to choose a therapist well.

Mistake #1: assuming that all therapists are similar

In Australia, the titles of “counsellor,” “psychotherapist,” and “therapist” can unfortunately be used by anyone, even if they don’t have relevant qualifications or experience. (In other words, these titles are not “protected” within Australian laws and regulations.)

When patients participate in therapy, it is recommend that it is administered by a registered or clinical psychologist. Another type of professional who is able to provide therapy (though they do so less commonly than psychologists) is a psychiatrist, which is a type of medical practitioner. At Someone.health, all therapists are registered as either psychologists or psychiatrists.

So, before seeing a therapist, it’s recommended to check that they are a currently-registered psychologist or psychiatrist. You can do this by checking for their name on the Australian Health Practitioners Regulation Agency (AHPRA) online register.

Mistake #2: assuming that all psychologists will be similarly helpful

Evidence indicates that some of the most important aspects of psychological therapy include:

• The alliance between the patient and the psychologist (sometimes called the therapeutic alliance) – this relates to how well the person and their psychologist collaborate and work together on shared goals
• The level of empathy that the psychologist shows for the individual and for what they’re going through
• The degree to which the psychologist and individual agree on shared goals
• The degree to which the psychologist expresses positive regard for the individual
• The genuineness of the psychologist
• Other characteristics of the psychologist
• The degree to which the therapy is culturally appropriate
• The expectations of the individual and their psychologist

Another way of describing the quality of the therapeutic alliance is to talk about different levels of rapport. If someone has a high level of rapport with their psychologist, this typically means that they tend to feel that:

• They are listened to and respected;
• They are treated with warmth and empathy; and
• They feel that their therapist has unconditional positive regard for them.

All of these factors can vary greatly from psychologist to psychologist, so the same individual can have very different levels of rapport with different psychologists. This is why Someone.health ensures that all clinicians are accredited and receive ongoing training to ensure high-quality care. They also have an online matching process to allow clients to filter through hundreds of psychologists to identify the most appropriate profiles and skill-sets for their needs.

Mistake #3: assuming that the particular type of therapy someone participates in is more important than who they’re doing it with

Even if you recognise how much variation there is in the level of rapport that people have with their psychologists, you might assume that the type of therapy is more important than the level of rapport. It might surprise you to learn that this is actually not the case! Instead, evidence suggests that the opposite is true: the factors listed above are even more important than the type of therapy someone receives.

This doesn’t mean that the type of therapy is unimportant. Different types of therapy have different levels of evidence supporting their use in different mental health conditions and contexts, and it’s important to provide the most evidence-based therapy available. But also recognise that people tend to overestimate how important this is, while underestimating just how important it is to have a good rapport between an individual and their psychologist.

Because of how important it is for an individual and their psychologist to have a high level of rapport, Someone.health aims to match people with psychologists based on the characteristics of individual psychologists and what clients need.

Of course, someone’s predictions won’t always match reality, but that’s okay, because people don’t have to stay with the first psychologist they try. (Some people mistakenly assume that they do, though, which brings us to Mistake #4.)

Mistake #4: assuming that people have to stay with the same psychologist they start therapy with

Contrary to what you might assume, if someone thinks that they could have better rapport with another psychologist, they should try seeing another one. They do *not* need to stay with the same psychologist they started therapy with.

If you’ve just started seeing a psychologist and you don’t feel you have a high level of rapport with them, it is encouraged to see a different one. This doesn’t mean there’s anything wrong with you or with them – it just means that you don’t have a high level of rapport, and that’s all.

Finding a different psychologist who you have better rapport with could enable you to get more out of your therapy sessions, and it could also free up the original psychologist to help other patients (just as you can find a psychologist you have a better rapport with, they can find patients they have a better rapport with).

This blog was written by bulk billed and online psychology service Someone.health.

Resources

1. Hussain, S., Mia, A., & Rose, J. (2020). Men’s experiences of engaging in psychological therapy in a forensic mental health setting. The Journal of Forensic Psychiatry & Psychology, 31(3), 409-431.