What makes a good therapist?

February 25, 2022 2:53 PM

From the perspective of a psychotherapy client or a therapist, what's your nutshell version (a sentence or two) of what makes a good therapist? (It is something of a practical/timely question for me right now as I step toward the edge of the diving board beyond which is full time private practice.) Thank you!
posted by less-of-course to Grab Bag (17 answers total)

The connection with the individual person matters the most, but extra points for therapists who are mindful of 1) insurance and billing, as many people simply cannot afford to pay out of pocket or deal with submitting claims; 2) the need to communicate via email and text since not everyone can call you on the phone.
posted by corey flood at 3:22 PM on February 25, 2022 [4 favorites]

Reliability. My first attempt at therapy, my therapist cancelled on me, twice, before we even had a first appointment.
posted by champers at 3:31 PM on February 25, 2022 [3 favorites]

A good therapist knows their limits; if you do not think you can legitimately help someone with a certain constellation of diagnoses, be honest with them and most importantly know where you can send them for help. A good therapist is at least an okay case manager when necessary.

I've had so many therapists be like "holy shit, you've got $bigstuff! This is way outside my ability to help" and then give me like a printed list of therapists of off psychology today as a resource to comb through. This is incredibly demoralizing, and does not engender hope in folks in delicate mental states.
posted by furnace.heart at 3:38 PM on February 25, 2022 [11 favorites]

This is going to be more or less important depending on what kind of therapy you're doing, but check your mindset on family dynamics, ESPECIALLY if you've had what you consider a good family system.

A well-meaning (but in all reality clueless) therapist can do an awful lot of damage by encouraging someone in a toxic family system to remain a part of that system. It's pretty darn hard for someone to heal when the root of the issue is the family, and they are continually re-exposed to it. Similarly, be very careful about allowing a family member to participate in what are usually solo sessions; some abusers are really, really good at weaponizing therapy and therapists against their victims.
posted by stormyteal at 4:21 PM on February 25, 2022 [4 favorites]

The best therapists and psych docs I’ve had (and that’s quite a few) have been perceptive, so that they can point out something that makes me think, “That certainly explains a lot.”
posted by scratch at 6:20 PM on February 25, 2022 [6 favorites]

We can read the boilerplate advice on the internet and in books, and we come to you because we need something 1) deeper, 2) more customized to our particular situation, and 3) more dynamic and flexible.

I have often felt a provider applied a particular template over my individual self and literally disregarded anything that didn’t fit it. To the point that I question the utility of the exercise altogether.
posted by kapers at 6:33 PM on February 25, 2022 [7 favorites]

They’re on my side (in a continuous positive regard way). They respect my expertise on my own experience, my internal state, and my goals. They’re perceptive, insightful, and know how to put things so I’ll be receptive. I have to trust that they have strong boundaries and take care of themselves. Bonus points for being funny, wry, and not too rosy about the state of affairs in the world.
posted by Gravel at 7:11 PM on February 25, 2022 [8 favorites]

What kapers and Gravel said. To put my own spin on it, a good therapist sees * me *and not my diagnosis. I can tell that they are listening to me and trusting me on what my experience is, challenging it where necessary, but not automatically discounting my experience because I am (anxious / depressed / female /whatever other label)
posted by Zumbador at 7:56 PM on February 25, 2022 [4 favorites]

I think that a good therapist should be able to give practical advice when it's warranted. My favorite therapist once suggested I do volunteer work, and that was some of the best advice I ever got. The volunteer work led to all sorts of good things.
posted by akk2014 at 8:18 PM on February 25, 2022 [3 favorites]

Response by poster: Thanks, these are instructive and, in some cases, surprising.
posted by less-of-course at 8:44 PM on February 25, 2022

Quite honestly: one who has a small number of clients. It’s the single factor that’s been true between all my good therapists. People juggling too many slots and too many people just have too many administrative things mess up and can’t seem to be truly present.

Secondly: someone who doesn’t project onto me. I think it’s hard with clients who are in very different circumstances not to try and find commonalities but more often than not I am left feeling very unheard. (Although this has been helpful in understanding where we’re having a deep communication defect.)
posted by Bottlecap at 9:24 PM on February 25, 2022 [3 favorites]

Actually TREATING people. I’m not wanting “insight” or “positive regard” or “helping me figure it out” or “being heard.” I’m wanting treatment for a severe mental illness that has caused pain my entire adult life, and not once have I had a therapist actually try to treat illness or find anything that could. If therapists aren’t supposed to treat illness they should at least be able to refer you to someone who will.
posted by Violet Hour at 9:32 AM on February 26, 2022 [3 favorites]

Most of my therapists have been fairly aloof. I wonder if therapy students are taught that they need to maintain distance between themselves and the patient / client. I can see why this might be advisable, but there has to be some kind of middle ground. My favorite therapist (the one I referenced above) was fairly warm and approachable. I wish the other therapists had moved more in that direction on the scale.
posted by akk2014 at 11:48 AM on February 26, 2022

For me it’s attentiveness and attunement. Someone who listens carefully and doesn’t impose their own narratives on the client (to the extent that that’s possible). It seems like some therapists take their modalities almost like religious orientations and it can feel bad to be getting shoved into someone’s box (“oh that’s your inner child/thought distortion/Jungian archetype/etc”). Remembering important details later is also important.

And an interest in measurable outcomes and a sense of humor are both good too.
posted by hungrytiger at 11:50 AM on February 26, 2022

Best answer: In addition to above

I read a summary of a study of people who went to therapy and 1) didn’t feel they had changed 2) felt they had changed but no one else noticed 3) felt they had changed and it was felt by others close to them.

The difference for group #3 was that the person identified with their therapist in some way; that is to say that they saw some aspects in the therapist that they admired and wanted to incorporate into their personality / behaviors. Admire might be too strong a word here, but there was qualities in the therapist that they wanted for themselves.

That distinction really sat with me.
posted by St. Peepsburg at 1:46 PM on February 26, 2022 [2 favorites]

A good therapist for one person may not be good for another one. It needs to be someone you can relate to.
posted by Obscure Reference at 3:42 PM on February 26, 2022

I have a not entirely rare condition that has greatly complicated my patient-therapist relations: a parent who was a clinical psychologist. Knowing that you really had an ongoing handle on your countertransference would be very important to me, particularly if you have a child.
posted by Tell Me No Lies at 6:01 PM on February 26, 2022 [2 favorites]