Research shows that the quality of the therapeutic relationship is an important component of successful therapy, along with the training and experience of the therapist. I would dare to say that it is tea basis of therapy and the context in which healing occurs. Certainly without an established working relationship our techniques are likely to be very effective!

Those who have experienced trauma (Big T or little t) in the context of relationships are faced with quite a dilemma. Relationships in the past have led to wounds: abandonment, betrayal, unmet needs. Now you have to find a relationship in which to heal. It makes sense that after the trauma there are a series of responses that make it difficult to connect. As I have previously written, childhood trauma can cause disruption of basic developmental tasks such as calming down, seeing the world as a safe place, trusting others, thinking in an organized way to make decisions, and avoiding exploitation.

Do you ever feel like a double bind? Seeking to feel safe in the therapeutic relationship when relationships in general feel dangerous?

How have you navigated that?

As a potential client, what signs do you look for to feel confident enough to start therapy?

Do you start evaluating even before the meeting? Some clients have given me feedback that even the tone of voice in a therapist’s voicemail message can take into account.

As a therapist, how do you approach the issue of safety and relationship?

I think it is important first of all to name the dilemma. I recognize all the ways that beginning therapy can be challenging. Sometimes taking the first step is one of the hardest parts! I also believe and express to potential clients that I see trust in myself and the process as something that will build over time. I strive to earn trust by being trustworthy: authentic, consistent, matching what I do with what I say. I also believe that a good therapeutic relationship is not exempt from empathic ruptures or lack of communication. There is no such thing as a perfect relationship, not even in therapy. Instead, what matters is how we address disconnections and how we do the necessary repair work.

I would love to hear input from both sides of the therapy relationship. Below is a list of factors that come to mind. What about you?

How do you try to evaluate a potential therapist? What makes a good enough fit?

1. Ease of access: How can you contact the therapist? You prefer phone, email. How quickly does the therapist respond? Too many phone tags turn you off?
2. Rent: I am always amazed at how many clients choose a therapist based on location alone! How far are you willing to travel? Do you want in-person therapy or would some form of online therapy work for you? Do you take into account the type of office space? How accessible is it by public transportation?
3. Availability: How soon can you see him? What hours and days are appointments available? Is the therapist available for more than one session a week? Between scheduled or crisis contact if necessary?
4. Credentials: Do you have a preference for a psychologist? A social worker? Does the type of degree or training matter to you?
5. Identity Demographics: Do you want to have certain things in common with a therapist? Do you have a preference for a particular gender, age, race, ethnicity, religion, or sexual orientation? Some of these may be initially apparent, others may not. Do you want a therapist to reveal any identifying information? Therapists: Are you comfortable/willing to do this? How much is too much? Sometimes people from marginalized groups (such as LGBT communities) want to seek out LGBT therapists. Is it enough to know that her therapist knows and affirms her culture or seeks a shared identity or background?
6. Areas of expertise: Does the therapist have experience with the problems you present? How do you know? Is the therapist licensed? Do you know how to access that information? What is the theoretical orientation of the therapist? Are they trained in specific techniques such as EMDR, which are considered effective in treating trauma? Does the therapist practice trauma informed care? If you are treating dissociative disorders, are you aware of the Treatment Guidelines developed by the International Society for the Study of Trauma and Dissociation?

Pragmatic aspects such as location and availability, as well as the professional training and experience of the therapist are important factors to consider. But what about the sometimes more subjective factors? I truly believe that therapy is both an art and a science. The therapist’s self (expressed within appropriate ethical limits) factors into the equation. Being authentic, consistent, insightful, able to model the expression of emotions, the ability to be present listening to painful and unspeakable truths, conveying warmth and understanding, humor can be a factor in the healing relationship and show up in different ways for each therapist. A therapist who is a great match for one client may not work for another.

It is crucial to interview potential therapists to determine goodness of fit! You may want to write a list of questions or concerns ahead of time, to make sure you cover all your bases. Dr. Bessel van der Kolk suggests that trauma survivors also consider their experience with the potential therapist: “Pay attention to whether the therapist really wants to hear the issues you have to tell. Ask yourself, ‘Do I feel validated? Does the therapist really listening to my story?'”

Trust your gut and intuition, but also work to resolve triggers from the past. Does your gut tell you that this therapist won’t work for you, or are you afraid of therapy in general? Can you determine that in one session or do you need several to make an informed decision? Unless there are major red flags (unethical behavior, lack of trauma education, homophobia/transphobia, for example), I encourage potential clients to share their questions and concerns with the therapist. How this is approached will tell you a lot! It is important for any therapist to listen to your criticism with empathy and not defensiveness.

What do you look for when looking for a therapist? And how do you know it when you see it?

I would love to hear your thoughts and experiences!

Kathleen Young, Psy.D.