How to choose a therapist.
Choosing a therapist for the first time, or any time, can be daunting. Unless you’ve been in therapy before, or have spent a lot of time with your nose stuck in self help books, you can easily be lost in the morass of acronyms and terminology for the modalities that therapists offer. Narrative, EMDR, Existential, CBT, DBT, ACT, Internal Family Systems, Gestalt, Jungian, and Psychodynamic are just a few and the list goes on. Indeed new therapies are probably being invented and patented as I’m writing this. Most therapists will offer a free consultation call, but making a decision based on a 20 minute interaction can be tricky.
Don’t panic. It’s easier than you might think. For one, you don’t need to worry about therapeutic models for the most part unless you’re looking for a more structured program to tackle things like addiction or disordered eating. In those cases the structure of the program itself is part of the theoretical approach. However most people seeking a therapist are doing so for your “average” run of the mill Depression and Anxiety (even if a specific event precipitated your awareness of said depression and anxiety, prompting you to seek help).
When it comes to treating most clients for your more common psychological aliments, the majority of therapists don’t adhere to a specific methodology because most aren’t trained or certified in specific methodologies anyway. (Doing so requires shilling out large sums of money to those that certify and the ROI on that is debatable.) According to the BBS 2025 Sunset Review, “The Board is responsible for the regulatory oversight of over 148,000 licensees and registrants. “ Of those 148 thousand the percentage that are certified in any specific modality is, well… I couldn’t find it. In trying to research more concrete numbers for this writing I quickly came to the realization that A. no organization tracks who is certified in what modality. B. Even a therapist “certified” in a particular modality may not utilize that modality in their work and C. Even if a therapist does practice a specific modality, there aren’t oversight bodies that enforce how a modality is utilized. A Therapist can use the bits of the process they like withouth adhereing to a strict structured by the book methodology.
This isn’t to say that there aren’t therapists that do work with specific theories and abide by the methodologies. It’s to say that it’s not the average therapist that does this. A search through directories like Psychology Today don’t allow you to filter results by certifications, but by “Types of Therapy” offered. Any therapist can list “CBT” as a type of therapy that they perform, because therapists do often use elements of CBT techniques in sessions, whether or not they are certified in it.
Let’s remove the notion of certifications for a moment and focus on theories and methods. Hypothetically It would be advantageous to work within a theoretical framework that better describes the psychological issues one is suffering from. It would be like having a more detailed and accurate trail map for the territory you’re attempting to navigate. You would be better off in most cases with a high resolution GPS satellite mapped navigation app over a crude representation hand drawn on a napkin. If it were the case that a theoretical model in psychology more accurately mapped the psyche, then it would stand to reason that this model would rise to the top because it would be so much better at helping clinicians and clients navigate through therapy and growth. Yet no theory has risen and our psyches are hard to map.
Mapping the psyche is more like trying to map the surface and contours of the ocean. It’s always moving and changing. Coastlines, islands, and major land masses may stay the same, just like the underlying elements of our human psychological makeup stay the same. (which is why the theoretical models almost all describe the same stable elements (land masses) not the surface of the waters.) That theories and modalities tend to describe the same underlying phenomena with different words is known as Theoretical isomorphism. A rose by any other name is still a rose. For example: Psychoanalytic theory considers the source of our psychic woes the unconscious repressed feelings or experiences that lead to disfunction, where as Internal Family Systems calls them “parts of the self” and what i’m calling “psychic woes” are referred to in that framework as “Exiles”. In Narrative therapy however we could refer to them as “dominant problem stories”. Each theory would have a different approach and the specific interventions towards resolving these repressed, exiled, wrong stories. Yet these interventions all attempt the same thing when you get to the bottom of it. They try to produce experiences that aim at reorganizing patterns. These can be patterns of feelings, thoughts, or behaviors.
Therapists utilize these theories to inform and guide their work with clients. They might have a certification in a particular mothod, or have specific training in say trauma, addiction, eating disorders etc., yet despite all of this it’s understood that a large factor in the success of therapy is rooted in the strength of the therapeutic relationship itself. (whether or not you as the client feel like its a good fit).
An apt metaphor might be that these approaches to therapy are more like navigational tools. A compass, a star chart, maps that identify land masses, indications of currents, and wind patterns that help you. In seeking a therapist you want one that can help you use these tools and teach you how to use them. Consider also that each person is their own ocean. No two people are alike, and no two people have had the exact same experience in life. A good therapist in my opinion is one that can work with you to draw out the map of your unique self. The lovely part of this idea is that it also takes into account self-determination. Your willingness to pick up the tools, try them out, and learn, is a big part of the success you have in your journey of personal growth.
