Are you considering starting therapy? Perhaps you have heard that chemistry is essential in a therapeutic relationship, but how important is it really? Should you like your therapist as much as you would like a potential friend, or are certain characteristics more important? Are you looking for an empathetic listener, a solution-focused coach, or an intellectual conversation partner who challenges your thinking?
Starting therapy is a courageous step towards better mental well-being. As a client, you can take an active role from the outset and identify your own needs and preferences in relation to therapy. In this article, we will examine what you can consider as a client when starting therapy, focusing in particular on preferences and their significance in the therapeutic process.
Therapy preferences
The client’s preferences, i.e., their wishes and expectations regarding the therapist and therapy, can form the core of successful therapy. Studies show that when therapy meets the client’s preferences, the risk of quitting treatment is reduced by up to 50%, and the results improve. This highlights how important it is to pay attention to your own wishes and needs.
Type/duration of therapy: As a client, you can consider what type of therapy best suits your situation: cognitive, cognitive-analytic, solution-focused, behavioral therapy, or a psychodynamic approach. It is important to choose a form of treatment that resonates with you personally. On the other hand, it is good to remember that the therapy school does not matter to everyone. Studies show that therapists from different orientations tend to do more similar things than different ones. You can also think in advance about how long you are prepared to be in therapy, what feels intuitively right, and what you can currently afford.
Choosing a therapist: Every therapist is unique, and you can consider what kind of therapist feels right for you. For some people, the therapist’s empathy is the top priority. Others feel that the therapist’s professional background (psychologist, physician, nurse, occupational therapist, theologian, etc.) is very important.
Sometimes a therapist’s similar background and/or experiences can make interaction easier. For example, factors related to religion, ethnic background, or gender diversity can feel especially important at certain turning points in life.
Methods: You can also think in advance about what kinds of therapy methods and techniques feel natural to you. Is online therapy better for you, or do you prefer traditional face-to-face sessions? What kinds of methods and topics feel personally meaningful? Are you interested in working on your childhood? Or do you mainly want to focus on overcoming a particular symptom, such as an addiction? Are you willing to do homework, or are you primarily looking for a space where you feel heard?
Common Concerns and How to Deal with Them
Sometimes a client’s wishes and the therapist’s background or possibilities do not fully align. This should, however, be addressed openly, and discussing it often leads to a deeper mutual understanding.
“I don’t know what I want or need”: It is true that as a client—especially in the beginning—you may not necessarily know what you want from therapy. This is not a problem, and the therapist can encourage discussion as needed, offering space to express wishes and preferences as they become clearer. It is also completely okay not to want anything in particular.
Wanted vs. Needed: In the role of a client, a person may want something that is not necessarily beneficial for them. A good example is the persistent wish that the therapist should always be warm, empathetic, and validating. This may feel wonderful, but in the long run, therapy requires much more. In a therapeutic relationship, the shared question is what the person fundamentally needs in their life right now, and where the answers to those needs can be found. The therapist must also be able to bring up difficult issues they observe—things the person may not recognize or be ready to face at first. In such situations, the therapist’s role is to discuss the matter openly with the client and to find together the best way to move forward.
Preferences/wishes change: The evaluation of wishes and their application in therapy usually develops as therapy progresses. You cannot know everything in advance. A good guideline is to maintain ongoing dialogue and flexibility to make the therapy as useful as possible. As a client, it is helpful to be as direct and open as possible about your thoughts—and also about any disappointments you encounter in therapy. Disappointments are a part of life, and it is good to be prepared for the possibility that the stage of therapy may not be a place where one always walks on roses. It is also important to remember that the therapist is a human being as well, trying to help their clients within the limits of their skills—and their imperfections.
Therapist matchmaking: Sometimes it can be helpful to visit a couple of different therapists before starting a therapy process if you are not sure whether the first therapist you met is a good fit for you. However, if after meeting 2–3 therapists you still haven’t found the professional of your dreams, it may be worth reflecting on your own level of expectations :). We therapists are not superhumans, and most of the time it is still enough for us to be “good enough” companions during difficult times in life.
You can take the test below, which can help you reflect on questions related to therapy and choosing a therapist. If you wish, you can go through your answers together with your therapist.
TEST
Choosing a therapist: What is important to me?
- Which of the following therapeutic approaches intuitively feels right to you?
a. Therapy that focuses on solving current problems and setting goals for the future.
b. Therapy that explores thought patterns, emotions, and experiences and their connection to past relationships.
c. Therapy that examines the functioning of the mind and behavioral change.
d. Therapy that delves into childhood experiences and unconscious thoughts. - What is most important to you in therapy?
a. Receiving concrete tools and exercises.
b. Gaining a deep understanding of past traumas and experiences.
c. Understanding the connection between feelings and thoughts.
d. Flexibly combining different styles of therapy. - How important is it that the therapist shares or understands your spiritual or religious values?
a. Very important, I want spirituality to be part of therapy.
b. Quite important, I hope the therapist understands its significance to me.
c. Not important at all, I don’t want to talk about spirituality in therapy.
d. It doesn’t matter, as long as the therapist is professional. - How important is it to you that your therapist’s gender matches your own gender or preferences?
a. Very important, I want a therapist of a specific gender.
b. Quite important, I have a strong preference regarding gender.
c. Not important at all, gender is irrelevant.
d. I would prefer a therapist who represents gender diversity. - What is the most important characteristic for you in a therapist?
a. An analytical and straightforward approach.
b. Warm and empathetic, encouraging.
c. Curious and inquisitive, delving deeper.
d. Flexible and adaptable, integrative. - Do you find the idea of remote therapy more appealing than in-person therapy, or vice versa?
a. Definitely in-person therapy. Physical presence is important to me.
b. Definitely remote therapy. Flexibility and convenience are important to me.
c. Both. I want flexibility in the implementation of therapy.
d. It doesn’t matter to me. - 7. How important is it to you that the therapist has a similar ethnic background to yours?
a. Very important — I want a therapist who understands the cultural context of my background.
b. Quite important — it creates a sense of safety and a deeper connection.
c. Not important at all — background does not matter.
d. Background is irrelevant as long as the therapist is competent. - How would you like the therapist to react if you cry during therapy?
a. Let you cry in peace and wait until you are ready to continue.
b. Ask what is behind the crying and encourage you to express your feelings.
c. Give a soft and sympathetic reaction, hug or touch you.
d. Focus only on the topic without any particular reaction to the crying. - How long would you like the therapy relationship to last?
a. Short, about 3-6 months.
b. Average, about 1-2 years.
c. Long, several years.
d. The duration is not important, as long as I get help. - What would you like to achieve in therapy in the short term (e.g., 3-6 months)?
a. Immediate relief from symptoms and anxiety.
b. Better self-awareness and understanding of my own thoughts.
c. Concrete changes in my everyday life and behavior.
d. A deeper connection with myself and others.
These questions can help you reflect on your own wishes and expectations. They provide a good foundation for discussions when you start meeting potential therapists. Remember that the answers are only indicative, and the most important thing is to find a professional who is the right fit for you.
About the author of this article
Katri Kanninen is a Doctor of Psychology, an experienced psychotherapist, a psychotherapy trainer (CAT), and a non-fiction author.