How to choose a therapist… and how to know when to leave one.

In the UK, many people that seek therapy will often be referred to NHS services via their GP or another healthcare professional. In these services, you are often assigned to a mental health worker or service and you don’t really have a clear choice on who is providing your therapy. When people begin to search for a private counsellor or psychotherapist, the sheer volume of choice can feel very overwhelming.

In this article, we will look at the things you may wish to consider when choosing a therapist. Some of these you may already know and some may come as a surprise. We will then look at how to identify when therapy might need to end and how to end that relationship.

.How do I choose the right therapist for me?

Therapist Characteristics

It might be tempting to scroll through endless lists of therapists and hope that this provides some inspiration. It might, but it doesn’t feel much like an informed choice and you want to feel like you’re making the best decision for you and your care.  The first question you need to ask yourself is; what do I need from a therapist?

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You might be thinking in terms of what you’d like to fix, and that’s okay. So, you might want to choose a therapist based on their experience of working with phobias, abuse or depression, etc. This is a really good place to start and very important if you want to be sure of competence. I will talk a bit more about competence later.

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But other things are also important when looking to build a therapeutic relationship with a counsellor. It’s okay to choose someone based on their sex, their ethnicity, their faith and their sexuality (if known). It’s not discriminatory for you to look for the values you think will help you to make progress and/or recover. Abuse victims often need to work with a specific sex in order to reduce the risk of their trauma triggers being a block to therapy. Some people feel more comfortable with a therapist who is most likely to understand their cultural background.

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Are there any characteristics that you might need to help you feel safe and comfortable in counselling?

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What type of counselling would best suit me?

There are so many different ways of working and sometimes even two therapists using the same model, will not work with it in the same way. This can make it difficult to know what might help based only on the name of the therapy.

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However, you can think about what kind of help you feel you need. None of the counselling models are going to tell you how to fix your life. What they all do offer is a framework to help you to explore and understand yourself better. It’s this knowledge and the trust you build in therapy that helps you to find your own answers and make the changes you need to make.

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If you want someone to listen without judging you and without giving you homework or pushing you where you are not ready to go yet, you may wish to look for a counsellor or therapist who is trained in person-centred therapy. This approach is non-directive and means you have total control of the sessions, but the therapist may gently challenge any beliefs or thoughts you have that are unhealthy or unhelpful.

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If you like having a game plan and you like analysing your thoughts, feelings and behaviours, you might choose something that is cognitively based. Examples of this include: Cognitive behavioural therapy (CBT), Dialectal Behavioural Therapy (DBT), Cognitive Analytical Therapy (CAT) – they each differ slightly on how they approach the mix of thoughts, feelings and behaviours but they all do link these 3 elements.

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If you prefer deeper introspection to unearth patterns then psychodynamic therapy (for example) is a good place to start. It’s not just about your childhood and blaming your parents! This and Transactional Analysis looks at behaviour patterns and interactions which may be just outside of your conscious awareness and brings them into the conscious so you can choose how to respond. For example, recognising how you get pulled into the same destructive communication cycle with a person so that you can decide how you might change that cycle.

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These are not an exhaustive list of available therapies. You can look at NICE recommended therapies but bear in mind that this doesn’t mean they are the only option for treating a particular diagnosis. For example, Eye movement desensitisation and reprocessing (EMDR) is recommended for PTSD, but psychoanalysis, CAT, CBT, DBT and more are also used to work with PTSD.

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Success of therapy requires 3 things: a good relationship with your therapist, for you to believe it will work and for you to be committed to doing the work.

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How do I know who is properly trained?

All therapists who are on a PSA accredited register, meet the minimum requirements to be a qualified counsellor. You can check a counsellor or psychotherapist that you’ve found here.

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In sum, it means that the counsellor is a member of a membership body and they choose to follow its ethical framework. There are different membership levels within each of these organisations but as long as the counsellor is a registered member and not a student, then they are fine to work with you in a private practice setting.

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However, if you have a specific issue, you may have to ask more questions.

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Are they competent to work with my issue?

Whilst all therapists are trained to a minimum standard to be qualified, not all of them will have the same areas of expertise. It’s okay to ask them questions about their suitability.

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• What experience do you have in this area?
• What training have you undertaken in this area?
• How do you tend to work with this issue?
• What is your philosophy of recovery?

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You can add our own. This list is to get you thinking about what you would like to know and how you might start to sort through a list of potential therapists. If you experience dissociation, you can ask them how they will seek to ground you. Avoid any therapist who seeks to treat dissociation with mindfulness. Barring a set of very specific circumstances, mindfulness is contraindicated for disassociation – meaning it is seen as more harmful than it is helpful.

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I have a few possible counsellors who meet my criteria, how do I choose between them?

You’ll need to make contact. In person is best if you plan to work in person. Therapists expect you to be trying them out to see if they are a good fit for you, so a good therapist will not be upset or angry if you tell them that it didn’t feel right and you’re going to choose someone else.

Next comes simply listening to your gut.

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• Do they make you feel safe?
• Can you understand what they are saying and do they take the time to explain things?
• Have they explained confidentiality to you?

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A lot of the relationship can take time to build, especially if your background makes it difficult to trust.  So, feeling safe might look like the therapist giving you enough personal space that they didn’t increase your anxiety. Feeling safe might look like noticing the counsellor lets you speak and doesn’t shut down your opinions. They won’t be perfect and there will be some hiccups along the way, but they shouldn’t be making you feel more unsafe.

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A note for trauma survivors: it is okay if you don’t want to continue because the therapist reminds you of an abuser. Therapy is challenging enough without you having to try and get past the fact they look like your abuser or they sound like them.

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• A good therapist should make you feel understood and accepted without judgement.
• A good therapist should make you feel supported on your journey.
• A good therapist should not tell you what to do. Some therapists might offer up suggestions for discussions, but you should always be in control of deciding what to do.
• A good therapist is NOT your friend and will make sure that you are aware of the boundaries and differences in your relationship.

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How do I know when I need to leave a therapist?

This is a difficult one to give a straightforward answer to because there are many factors involved but there are also some clear signs to look out for.

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Hopefully this will have been explained to you by your therapist, but if not, I will explain here. Not all therapy makes us feel immediately better. In fact, for the most part it makes us feel the opposite and it can take a while to feel the benefits. This is because it doesn’t feel great to pull up all the stuff we have been running from or denying.

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The cycle of therapy

This is completely normal. Regular therapy tends to have an associated cycle. On the day of the session you’re at your most hyped up and so you feel relieved/happier after going to the session. This differs slightly for everyone but later that day or up to a few days later, you experience a dip as your brain tries to integrate what you learnt in therapy into your life. You may feel the urge to journal more or want to talk about the things that brought you to therapy; if you feel those things, do them. That is a healthy outlet and will help you to integrate that learning. You now, hopefully, feel relieved again but its much closer to the next appointment and your anxiety raises knowing you may have a difficult session and have to experience the cycle all over again! It becomes like another body clock but understanding that can help you to be self-compassionate and seek support.  

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If you have a therapist that doesn’t appear to understand that or, worse, punishes you for having that cycle, they don’t appear to have the most basic understanding of the therapeutic process. You may decide that this is a deal breaker for you. But it’s best to try and have a chat with them and check if there has been a misunderstanding. Maybe they weren’t very clear. It’s always a deal breaker if a therapist punishes you for how you are feeling.

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Boundaries

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This is a complex subject but as a brief introduction…

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Boundaries are the rules we keep to feel safe and respected when interacting with others. One of our boundaries might be that we don’t like hugging and another might be that we won’t engage in a shouting match. Whatever they are, we all have them. Therapeutic boundaries expand on this idea. Whilst therapist may try to equalise the relationship so you don’t feel disempowered, it is still a relationship with differing expectations and these can make us feel unequal.

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As an example, whilst therapy can sometimes feel like a chat with a friend, the boundaries of therapy mean that the client should be sharing much more about themselves than the therapist shares. Personal disclosures can be therapeutic but they are usually very brief and about helping the client. If you feel your therapist is seeking your support or oversharing, then the therapist is not holding appropriate boundaries with you.

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If you feel safe to, you can attempt to discuss this with them. If you’ve built up trust, you might say that you feel that the sessions have become more about them then you and you’d like to refocus that attention. How they respond to this may help you decide whether to stay. If they try to make you feel bad for asserting your boundaries, this isn’t okay and could potentially be abusive. You can leave and you don’t need to return to do an “ending session”. If you feel that they have been abusive, absolutely do not go back to them for that session. You don’t owe them anything. Your safety and wellbeing are a priority.

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A note on sexual boundaries:

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It might be common knowledge that a therapist shouldn’t have sex with a client. This also includes encouraging a client to masturbate in the session or attempting to sexually arouse a client for the therapist’s benefit.

Sexual arousal occurs in therapy but when it is talked about, the focus is not on the arousal but on the trigger for that arousal. For example, if talking about your abuse triggers a physical arousal response, the therapist will talk about how abuse creates connects to arousal that may feel shameful and inappropriate; but aren’t.

If a therapist is trying to tell you that you need to touch yourself or them to heal sexual wounds, they are being manipulative and abusive. They are also potentially committing a crime.  

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How do I leave a therapist?

You can just leave. Seriously. If the therapy is abusive or harmful, you don’t have to come back. You don’t even have to tell them you’re not coming back. But you may feel less anxious if you send an email or letter to formally end the counselling. You don’t have to say why, you can simply say:

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Dear…

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This letter is a formal notification that … wishes to cease counselling sessions with immediate effect. Signed …

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If you had a good relationship with your therapist and you don’t feel like the best fit, you might want to have another session to talk it over and/or close down the session. Having a formal ending can help you process moving from them to another therapist or even just the act of ending.

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If you had an excellent relationship and the therapy is working, then hopefully you will have both been discussing a planned ending i.e. Set a date for the last session. But you can ask to start working towards ending whenever you want. You decide when the sessions end, not just your counsellor.

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Written by Tara Shennan, Project Manager, CTUK.

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P.S. Many people do not find the right therapist at first so do not give up. Try again.