How do you choose a therapist when you have never been to therapy before, or when the last one did not help? Start by checking credentials and experience, then narrow your search to therapists who work with your specific concern. From there, the relationship matters as much as the methods. A therapist you can talk to honestly will help you more than one with the perfect credentials but no connection.
Research confirms that the therapeutic alliance, the collaborative working relationship between you and your therapist, is one of the strongest predictors of whether therapy works. A meta-analysis of 295 studies covering more than 30,000 patients found a consistent positive relationship between alliance and outcome across treatment types, patient characteristics, and countries (Flückiger et al., 2018). The relationship you build is not a bonus. It is part of how therapy works.
What Credentials Should a Therapist Have?
Licensed therapists have completed specific graduate training and passed state licensing exams. Each state regulates who can practice independently, and licensing boards make sure therapists meet minimum standards for competence (APA).
The most common licenses you will see are:
- Psychologist (PhD, PsyD): Doctoral-level training in assessment and therapy. Licensed as a psychologist.
- Licensed Clinical Social Worker (LCSW, LMSW): Master's degree in social work with clinical training. In Michigan, LMSW is the independent license; LCSW requires additional years of supervised practice.
- Licensed Professional Counselor (LPC, LLPC): Master's degree in counseling. LLPC is the limited license; LPC is the independent license after supervised hours.
- Licensed Marriage and Family Therapist (LMFT): Master's degree specializing in relational and family systems.
All of these professionals are trained to provide therapy. The degree type matters less than whether they are licensed in your state and whether they have experience with your particular concern.
How Do You Verify a Therapist's License?
Most states have online license verification tools. Search for your state's licensing board and look up the therapist by name. The listing will show their license type, status, any disciplinary actions, and when the license expires.
If the therapist is not licensed or their license is inactive, they should not be offering independent therapy. Unlicensed therapists working under supervision can be effective, but you should know their status before you start.
What Questions Should You Ask a Potential Therapist?
The American Psychological Association recommends asking about experience, treatment approach, and logistics before committing to ongoing therapy (APA).
Ask about their experience with your concern:
- How many years have you been practicing?
- What experience do you have helping people with anxiety, depression, trauma, relationship issues, or whatever brought you to therapy?
- What approach do you typically use for this concern?
Ask about their methods:
- What kinds of treatments do you use, and what evidence supports them?
- How will we know if therapy is working?
- How long does treatment usually take for someone with my concern?
Ask about practical details:
- What are your fees?
- Do you accept my insurance, or do you offer a sliding scale?
- What is your availability?
- Are sessions in person or by video?
Most therapists will answer these questions during a brief phone consultation or in the first session. If a therapist will not answer basic questions about their approach or experience, that tells you something about how they work.
Why Does the Therapeutic Alliance Matter So Much?
The therapeutic alliance is the emotional connection and collaborative partnership between you and your therapist. It includes agreement on the goals of therapy, agreement on how you will work together, and a sense of trust and mutual respect.
There is consistent evidence that the quality of the therapeutic alliance is linked to the success of psychotherapeutic treatment across a broad spectrum of types of patients, treatment modalities used, presenting problems, contexts, and measurements (Stubbe, 2018). That consistent relationship across all therapy types is significant.
The alliance develops over time, but early signs matter. If you feel judged, misunderstood, or dismissed in the first session, those feelings usually do not resolve on their own. A good therapist will make space for you to bring up concerns about the relationship, and they will take your feedback seriously.
What Does a Good Fit Feel Like?
A good fit does not mean you feel comfortable every moment. Therapy asks you to talk about hard things, and discomfort is part of the process. But even when the content is difficult, you should feel safe enough to keep going.
Signs of a good fit:
- You feel heard, not rushed or dismissed
- The therapist explains things in a way you understand
- They ask about your goals and involve you in decisions
- You can be honest without worrying about judgment
- The therapist notices when something is not working and adjusts
Signs of a poor fit:
- You leave sessions feeling worse without any sense that the difficulty is productive
- The therapist talks more than you do
- They push you toward goals that do not feel right to you
- You feel judged or misunderstood
- The therapist does not acknowledge their own mistakes or limitations
Trust your instincts. If something feels off after three or four sessions, it probably is. You can bring it up directly, or you can look for someone else. Switching therapists is not a failure. Finding the right person is part of the process.
Should You Try More Than One Therapist Before Deciding?
If you have the option, meeting with two or three therapists for an initial consultation can help you compare. Some therapists offer a free or reduced-rate first call. Others count the first session as an evaluation, which insurance may cover.
You do not need to commit after one session. If the first therapist does not feel right, schedule a consultation with another. If the second one feels better, go with that person. If neither feels right, keep looking.
Choosing a therapist is not like choosing a doctor for a broken bone, where the technical skill is the main thing. It is more like choosing a coach or mentor. The credentials matter, but so does the relationship.
What If You Need a Specialist?
Some concerns benefit from working with a therapist who specializes in that area. If you have obsessive-compulsive disorder, a therapist trained in exposure and response prevention will help more than a generalist. If you have trauma, someone trained in trauma-focused therapy will know how to work with your symptoms without retraumatizing you.
Ask directly: Have you worked with people who have this concern before? What approach do you use? How much of your practice focuses on this issue?
A therapist who treats a wide range of concerns can still be effective, but a specialist brings focused training and more practice with the specific patterns you are dealing with.
How Important Is the Therapist's Theoretical Orientation?
Therapists often list their theoretical orientation: cognitive behavioral therapy (CBT), psychodynamic therapy, acceptance and commitment therapy (ACT), internal family systems (IFS), and others. The orientation describes how the therapist thinks about change and what methods they use.
For some concerns, the evidence points to specific approaches. CBT and exposure therapy work well for anxiety and OCD. Trauma-focused CBT and prolonged exposure are effective for PTSD. Interpersonal therapy and CBT both have strong support for depression.
For other concerns, the therapist's orientation matters less than their skill and your relationship with them. If you do not know which approach is best, ask the therapist what they recommend for your situation and why.
Can You Switch Therapists If It Is Not Working?
Yes. If therapy is not helping after several sessions, or if you do not feel comfortable with your therapist, you can stop and try someone else.
Before switching, consider bringing it up with your current therapist. A good therapist will not be defensive. They might adjust their approach, or they might agree that a referral to someone else makes sense. Either response is useful.
If you do switch, you do not need to explain in detail. You can say the fit was not right, thank them for their time, and move on. Most therapists understand that not every therapeutic relationship works, and they would rather you find help elsewhere than give up on therapy entirely.
What About Cost and Insurance?
Therapy costs vary widely. Psychologists and licensed therapists in private practice typically charge between $100 and $250 per session, though rates in some cities are higher. Therapists who accept insurance are often reimbursed at lower rates, which can make therapy more affordable if your plan covers mental health services.
If cost is a barrier:
- Check whether your insurance includes mental health benefits and ask for a list of in-network providers
- Ask therapists if they offer a sliding scale based on income
- Look for community mental health centers, which often charge on a sliding scale
- Ask about reduced-rate sessions with a therapist still completing supervised hours toward full licensure
Many therapists will work with you on cost if you ask. Do not avoid therapy because you assume you cannot afford it. Ask what options are available.
How Many Sessions Should You Try Before Deciding?
Give therapy at least three to four sessions before deciding whether to continue. The first session is mostly evaluation. The second and third sessions are where you start the actual work. By the fourth session, you should have a sense of whether the approach fits and whether you feel comfortable with the therapist.
If you are not sure after four sessions, it is okay to ask the therapist directly: Is this helping? What should I expect next? A good therapist will check in on progress with you and adjust if needed.
Some people feel better quickly. Others need more time. There is no single right timeline, but you should feel like something is moving, even if the progress is small.
What If You Have Tried Therapy Before and It Did Not Work?
If therapy did not help in the past, that does not mean therapy will never work for you. It might mean:
- The therapist was not the right fit
- The approach was not matched to your concern
- You needed more time than you gave it
- You were not ready at that point in your life
- The therapist was not skilled enough
Trying again with a different therapist or a different approach can lead to a completely different experience. Be clear with your new therapist about what did not work before. That information helps them tailor the work to what you actually need.
When Should You Start Looking for a Therapist?
You do not need to wait until things are severe to reach out. If your mood, anxiety, relationships, or daily functioning are suffering, or if you have been thinking about therapy for a while, that is reason enough to start looking.
Early intervention often prevents symptoms from becoming more entrenched. Therapy works best when you have enough energy and stability to engage in it, not after you are already in crisis.
If you are in Michigan and want support choosing the right therapist or getting started with therapy, email us at advbehavioralhealth@gmail.com or use the short form at /get-started. Hanna Newton, LMSW, and the team at Advanced Behavioral Health offer evidence-based therapy for anxiety, depression, trauma, OCD, ADHD, and relationship concerns by video for children, teens, adults, couples, and families across Michigan. Appointments are often available within the week.
References
American Psychological Association. How to choose a psychologist. https://www.apa.org/topics/psychotherapy/choose-therapist
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172
Stubbe, D. E. (2018). The Therapeutic Alliance: The Fundamental Element of Psychotherapy. Focus, 16(4), 402–403. https://pmc.ncbi.nlm.nih.gov/articles/PMC6493237/