Finding the right therapist can be a tricky business. It’s hard to know where to start. If you have never been to counselling, there may be a plethora of questions about the format, the length of treatment, cost, and insurance coverage. Therapeutic modalities can be baffling. More importantly, you will be sharing the most vulnerable parts of your life with a stranger. Without some guidance, it can be difficult to sift through the long list of names published in your local counselling directory. This article provides practical suggestions and considerations when choosing a counsellor.
Getting Started
There are online directories that list counselling therapists in your area. Psychology Today (psychologytoday.com) is a good place to start. There may be other directories that publish counsellors in your province or state (for example, counsellingbc.ca). Professional organizations that regulate counselling therapists may also provide a directory of certified counsellors (For example, the British Columbia Association of Clinical Counsellors, or the Canadian Counselling and Psycho Therapy Association). Each directory is a storehouse of information; however, the expansive list of professionals can make it impossible to make a choice. Further, it can be difficult to get a clear sense of how a therapist works by reading their descriptions alone. If a universe of options is overwhelming, here is a manageable way to start:
Word of Mouth: Friends, colleagues, family members who have worked with a counselling therapist can provide first-hand account of a therapist’s skill and effectiveness. More importantly, they can describe the therapist’s personality, their style of interaction, and overall approach. Clients are more likely to find the right fit based on the recommendation of friends and family. However, because mental health remains a subject shrouded in stigma, some people find it hard to broach the subject with their social circle. Some people feel that going to therapy reveals a flaw or weakness. Others are dealing with issues that require discretion. They are not at liberty to reveal their search for a therapist for fear of the speculation that will arise in their social circle. For these clients, the recommendation from a physician or a counselling agency may help.
Physician: For many people, a family doctor is the first point of entry into the health-care system. A physician can refer you to an appropriate mental health professional, including counsellors, psychologists, and psychiatrists. A description of your condition, both physical and mental, can help your doctor steer you in the right direction. Counselling therapists are trained to help clients process their emotional difficulties while reaching a fuller understanding of themselves; they can provide coping strategies, supportive practices, inspiration and encouragement. In some cases, a psychiatric diagnosis may be warranted. In these cases, a doctor may refer a client to a psychiatrist, who can provide a medical prescription alongside talk therapy.
Counselling Agency: Since many people do not have access to a family doctor, counselling agencies may provide another point of entry. There are usually several counsellors associated with an agency. A administrative staff will be able to identify a counsellor who is likely to be a good fit. There are usually several counselling agencies in every city. Try calling an established agency and talk to the staff to see if there is a counsellor who might be a good fit. If the agency is unable to help, they might suggest others that may better meet your needs.
Considerations for Finding the Right Counsellor
Cost and Qualification: A counsellor’s fees may be a reflection of their experience and academic qualification. Look for counsellors with professional certification from established professional bodies, such as the BCACC and CCPA. Therapists with PhDs usually charge more than those with Master’s degrees. However, academic qualification is by no means the sole determinant of a therapist’s effectiveness. Many clients benefit from working with therapists with Master’s degrees who are veterans in their field and experts in their practice. Decide on a price range that fits your budget and find the qualified professional within that field.
Positionality: A client’s race, gender, sexual-orientation, age, and neurological composition can be significant factors in choosing a counsellor. It is helpful to have a counsellor who has first-hand insights into the lived experiences of a particular demographic, who can appreciate your experiences in life, who is open to viewing the world through your perspective. A counsellor does not need to share your background in order to provide good therapy. For example, a cis-gendered, homosexual, BIPOC client who is an immigrant does not necessarily need a therapist with the exact same background in order to benefit from therapy. More important than the their background, a therapist must be able to bracket aside their worldview in order to explore the inner world of the client. Every therapist has blindspots as a result of their stations in life. This need not disqualify them from the working with clients with different backgrounds. Healing occurs when the therapist and client are open and honest about their biases and are willing to learn from them.
Chemistry: There is an aspect of personal chemistry between the therapist and client that can never be reduced to a formula. Personality and vibe are the intangible stuff of the therapeutic alliance. Some therapists are plain-spoken and direct. They do not mince words, nor do they entertain nonsense. Some clients appreciate this approach, which severs the gordian knot that keeps them entangled. However, clients who are weary of conflict may find this style off-putting. Other therapists prefer nuance and subtlety. They might suggest possibilities and point to openings, always treading carefully within the client’s inner terrain. Our therapists are not our friends, nor are they our soulmates. We should feel safe with them, but that safety should not keep us shielded from difficult work. A therapist can be a source of comfort; but we also want our therapist to push us, to tell us what we don’t want to hear. There are no fail-safe rules for discerning the right fit between you and your counsellor, but some guiding questions include: 1) do I feel safe speaking to this person? 2) does this person care about my struggles? 3) what do I feel physically and emotionally when I speak to this person? Let these question guide your search, and trust yourself to know who is right for you.
Therapeutic Modalities: There are many therapeutic modalities. For the layperson, it can be hard to decide which therapeutic modality is appropriate. Cognitive Behavioural Therapy (CBT) is probably the best known psychotherapy, one that has been comprehensively researched and studied. CBT entails recognizing and replacing negative thought and behaviour pattern, thus re-shaping one’s overall mood and outlook. Narrative Therapy frames life events in the shape of a story and invites us to generate meaning by re-interpreting past events while authoring the next chapter of our lives. Mindfulness instills a gentle and warm way of being with ourselves, so that we face life’s upheavals with a measure of equanimity and self-acceptance. Each of these modalities has its own merits. It is not the client’s job to be well-versed in these modalities, but a cursory understanding may help you identify a modality that resonates with you. I believe that the therapeutic bond between counsellor and client is more important than the modality. A course in CBT may not be effective if therapist and client do not have a basis of trust and rapport. Let the modality be one part, but not the determining factor in your search for a therapist.
Considerations during the Therapy Process
Your health is your responsibility: Good counselling therapy helps clients claim their own healing. There is wholeness in each us, but we need to actualize the wholeness from within. A counsellor is not the source of healing, but a partner who helps us discover our own wisdom and resilience. Much of the therapeutic work happens between sessions, when clients live their daily lives, putting into practice the techniques and ideas discussed in therapy. To rely on the counsellor to make things better is to mis-locate the axis of healing. Your life is yours to live. The work is yours to do. By claiming your wholeness, your wellness belongs to you entirely and no one else.
Be aware of expectations: Our unchecked expectations can often hamper the course of good healing. Some clients expect counselling to expunge their grief, or expel their anxiety. They feel that their struggles are an affliction, and they want the pain eradicated. When counselling does not erase their pain immediately, they may prematurely judge the counselling as ineffective. Healing takes time and commitment. Because grief stems from our love for the departed, anguish will often linger in the aftermath of loss. The pain may never go away, but it can shift and transform into a source of meaning and wisdom. Counselling therapy can help us create meaning from our pain and glean wisdom from the soil of anguish. If we can shift our expectations to include a longer timeframe, we may see growth not otherwise possible within a shorter duration.
Therapy is a process: Counselling sessions have a life of their own. Some sessions are deep and insightful. Others are emotional, maybe even gut-wrenching. Other times the conversation feels bland and aimless. If we expect fireworks of insight after each session, disappointment inevitably follows. I believe that even when a session does not seem particularly engaging, something deeper may be happening. The therapeutic rapport may be ripening, or the direction of exploration may be undergoing a re-orientation. Perhaps the materials discussed will prove significant in a later session. A comment that seems unremarkable now may later return with poignancy in a moment of reflection. Rather than looking for earth-shattering insight, ask yourself: was this a worth-while conversation? Was I able to start reflecting on something that would otherwise be left attended?
Exercise your agency: Good counselling therapy is a collaborative, rather than directive, process. Clients may look to their counsellor for advice, but good counsellors help clients discover their inner sage. Working with clients to reach clarity and access their intuition, therapists help clients build confidence in their own resources. A directive approach forestalls opportunities for the client’s inner growth. A strong therapeutic rapport will foster conversations about the effectiveness of therapy, allowing clients and therapists to calibrate and adjust accordingly. Clients should have the final say as to the frequency of sessions and the length of the therapy process. Beware of counsellors who recommend sessions more frequent than once per week (currently, I do not know of any research which indicates the effectiveness of therapy at such frequency). Finally, trust yourself to know when therapy has done its job, and when you have come to the end of the therapy process.*
Final Thought
Whether you are seeking help during a tumultuous time in your life, or looking for a partner in the ongoing search for meaning, counselling therapy can be a means of growth and maturation. Finding the right counsellor is the start of that journey. Be aware of “counsellor shopping,” which corrupts our perception and interrupts the healing process by fixating on the shortcomings of therapists. No counsellor is perfect. The primary factor that influences a positive therapeutic outcome is you: your commitment, courage, and willingness to engage in your healing and growth. A counsellor who is the right fit for you is part of the equation, but by no means the whole.
* In cases of diagnosed mental illness, the duration of therapy may be determined by a team of health-care professionals.