A Good Fit? What to Ask When Looking for a New Therapist
Decades of research show that success in therapy is not the interventions used, the modality someone works from, or even in-person-v-virtual therapy. Its not that these factors don’t matter at all; they just aren’t whats most valuable. The most important factor in reaching your goals in therapy has always been goodness of fit between patient and therapist.
The term, goodness of fit was first coined by Sella Chess and Alexander Thomas in 1977 when they were doing research on children and their characteristics that help them meet the expectations of their environment (Thomas & Chess, 1977). It has since been applied to numerous person-facing environments and relationships overall, especially within the context of therapy.
So what exactly is ‘Goodness of fit’? Goodness of fit refers to how well a therapist, their style, and the therapeutic approach align with a client’s personality, needs, values, culture, and stage of change. It’s not about whether a therapist is “good” or “bad,” but about whether they are the right therapist for you. This is the relationship between a therapist and patient. If the patient feels their therapist is rooting for them, understands them, can be a safe place for them, is their advocate, that what they can offer is going to help, and is generally enjoyable to engage with, you have goodness of fit.
Goodness of fit will impact many crucial factors in therapy including the patient’s willingness to:
Come to sessions consistently
Take healthy risks in therapy (and out of therapy)
Reflect authentically and honestly
Practice the skills learned in sessions
Remain engaged when therapy becomes hard
Receive feedback from the therapist as it is intended to be
Feel safe enough to say when something isn’t working, made them feel badly, and just generally address issues within the therapy relationship
Fit is a dynamic experience, not fixed and thus is something that the therapist should be continuously evaluating both internally but also explicitly with their patient in their work. If the therapist is willing to show that degree of vulnerability; asking questions that are tough like “how is this feeling for you?” “It seems like that didn’t land the way I intended”, and taking time in sessions dedicated to processing the process of therapy, then how can a therapist expect a patient to be brave enough to speak up when therapy feels off?
When you start the search process, you will want to consider numerous factors. This can be an overwhelming process, which most people don’t know where to begin and can only further compound issues to accessing treatment. Below are a few things that I would recommend you ask at your first phone call with a potential new therapist, that helps to assess goodness of fit.
Do you take my insurance?
While, yes this a logistical question, its extremely important to know if you are able to afford therapy with this provider or not before you even begin discussing the issues you’re looking to address. Why waste your time and get discouraged sharing parts of your experience only to find out that you won’t be able to work with them? This is why I have my prices and that I do not take insurance clearly outlined on my website so that you don’t even need to ask this— but some therapists don’t, so if that is the case with the therapist you’re talking to, don’t be afraid to ask this question!
Do you work with populations that look like me?
I believe that a core tenant of therapy is advocacy for our patients both on the micro level (in therapy) and macro levels (the greater society at large). Knowing that a therapist has experience with and/or specialized training in working with people with identities that make up who you are can help you feel safer and more ready to open up.
What is your experience in treating what I’m coming to therapy to address?
While we all receive a generalist education, therapists cannot specialize in every issue that patients bring to therapy. Some issues like depression and anxiety might be easier to find a therapist for but things like trauma treatment, addiction, OCD, or eating disorders are complex experiences that require complex, specialized care. You want to know that your therapist has the needed training and experience to support your progress.
How do you think about how problems begin and how people change? This can also be asked as “what is your style in therapy?”
This will look different across different therapy modalities but the basic thing you’re wondering with this question is does your therapist have a foundation that they understand our unique needs from that guides their treatment? Its important to know that your therapist isn’t just flying by the seat of their pants but rather will have a nuanced and individualized way to understand you and your needs.
What do you do if something isn’t working in therapy?
Just like I said before that therapists can’t know everything, its important to know what happens when they run into something that they are not equipped to handle or if therapy is just not yielding results. How will they navigate that? Do they seek further training, do they bring in a second, specialized therapist for the specific issue, or do they discuss a transfer of care? How do you navigate difficult situations in our therapy relationship? Bumps in therapy aren’t expected but they are possible so you want to know your therapist has an understanding of the way they approach these situations.
How do you address a crisis?
This can be suicidal thoughts or thoughts to hurt someone else but also things like job loss, a terrifying diagnosis, separation, etc. Its important to understand if you are able to reach out in times like these to try to meet prior to your next session or if you are expected to address these situations on your own and then process them with the therapist when you next meet, as well as how the therapist will approach crises you face.
The main takeaway from this is that not all therapy is created equal. You may need to try out different therapists to finally find the right one for you. While that is certainly a frustrating process, its also essential to not only wasting your time but also preventing possible harm to you. I hope you consider goodness of fit when searching and advocate for yourself by asking these and any other questions you might have. Therapy is one of the most intimate relationships you’ll ever have, so its important that you feel as informed as possible before starting.
