As a therapist who offers initial consultation calls, I often notice that people who are new to therapy are uncertain about how best to use that time to determine whether they would like to work together. This is often referred to as “goodness of fit”, and there are multiple factors to consider when deciding whether to work with a new therapist. In this series of posts, we’ll look at some of those factors: relationship, culture, practice approach and practicality.
The Role of Relationship
If you do any online searching for “therapist-client fit” or “therapist-client alliance” you’ll find article after article about the importance of that therapeutic connection. It’s a question that has been researched for decades: How much of a successful therapeutic outcome is due to the relationship, versus any other variable? Often, it is suggested that the quality of that alliance is more important than the type of therapy being provided- as detailed in this article from the American Psychological Association.
The connection that forms between a therapist and a client provides the foundation on which the helping and healing take place. When there is an atmosphere of trust and safety, clients can become more open to sharing and to receiving information that will allow them to make the changes they’re looking for. The “work” within the therapeutic orientation can only happen if that foundation is solid.
There are some therapist characteristics (such as warmth, empathy, curiosity, authenticity, and acceptance) and skills (including reflective listening and reflecting, accurate interpretation, asking thoughtful questions, and facilitating expression of feelings) that are generally found to allow for the formation of a strong therapeutic relationship. When meeting with a new therapist for a consultation or initial appointment, some things to notice include:
Do I notice my body tensing up, or getting more physically relaxed, in response to the therapist’s verbal and non-verbal expression? Is this reaction typical for me, or is it unusual?
How comfortable do I feel about sharing information? Do I feel comfortable with the therapist’s reaction to any reluctance I may have to sharing?
Does the therapist tend to ask open-ended or structured questions? Does this style feel comfortable to me?
Does the therapist seem to understand me accurately? Do they seem to “get me”?
For example, let's say you're looking for a therapist who is warm, empathetic, and accepting, and who uses reflective listening and thoughtful questioning to facilitate expression of feelings. In your consultation with a potential therapist, you notice that you feel tense and guarded, and that the therapist's questions feel too structured and rigid for your liking. When you leave the meeting, you second-guess things you shared, or wonder if the therapist really understood you. This might be a sign that this therapist is not a good fit for you.
On the other hand, while talking with the therapist, you might find you’re feeling comfortable. You may notice that your body is relaxed, and that the flow of conversation feels natural to you. They appear interested in what you have to say, and their style of questioning draws you into the discussion. You end the meeting on a positive note, and maybe even find yourself thinking that you wished you had more time. If this is the case, this therapist might be a good fit for you.
The role of relationship is an important factor to consider, but only one of several important things to assess. In the next post, we’ll look at the ways in which culture plays a role in goodness of fit.