Therapist Shopping: What's Really in Our Cart?
Choosing the right therapist can be the most important decision for predicting the outcome for the success of therapy, but how do we choose one? It's not unlike searching for an electrician - we're faced with a mountain of seemingly qualified and decent professionals, but who's going to do a shite job, cut corners, or learned their craft from YouTube? (No shade intended, I have learnt a lot of DIY from YouTube, I’m still shite at DIY though). In the world of therapy, we can search through a counselling directory and be faced with 50 faces all promising healing journeys and non-judgmental spaces. So how do we deal with this?
A recent study by Julie May, titled "What Factors Influence a Client's Choice of Counsellor or Psychotherapist in a Private Practice Setting?", looked at this process. I stumbled on this paper when I was writing a literature review on the presence of the halo effect in counselling (It’s present by the way). I found this paper deeply interesting and even more so when I began setting up private practice. Other counsellors I speak to are always interested to learn about the findings and factors. The findings offer interesting perspectives for clients seeking therapy too, as we can walk into biases and assumptions that we should be aware of. As I think I did, when I sought after a therapist.
The Power of Recommendation
Perhaps unsurprisingly, as most successful private practices will tell you, the study found that third-party recommendations play the primary role in therapist selection. We often rely on the advice of GPs, other professionals, friends, or even other therapists when making our choice. The importance of word-of-mouth and professional networking for therapists building their practice is not to be underestimated. This makes sense, if you require a service, a plumber, solicitor or an accountant for example, often we ask people around us, "who have you had a positive experience with?"
When personal recommendations aren't available, many of us turn to the internet to find a therapist. May's study revealed some patterns in how we do this:
Location is Key
We prioritise therapists who are conveniently located near our home or workplace. We consider factors like parking availability and public transport links, highlighting a desire of accessibility in our decision-making (Can’t get therapy if we can’t get to it). I find this interesting because there seems to be some conventional logic of the opposite, "don't shit where you eat". The world can be a small world, and we would not want to work with someone who we know or "friends of friends", this study showed the opposite, perhaps this is one of the factors in the decision to go online.
Experience Matters
While location is important, it's not the only factor. We also actively seek therapists with experience in our specific issues. We scour therapists' websites and online directory entries, looking for indications of relevant expertise or specialisations that match our needs. This is particularly important if our issues can be considered niche.
The Relatability Factor
Perhaps most intriguingly, we place significant weight on how relatable we perceive the therapist to be. This assessment is often made based on the therapist's photograph, the language used on their website, and the overall impression given by their online presence. A therapist's photograph can significantly influence our initial impression, with us often using these images to gauge the therapist's approachability and warmth.
The language and tone used on a therapist's website play a role. We are drawn to content that resonates with our feelings and needs, looking for indications that the therapist understands and can address our specific concerns.
The Power of Personal Connection and Lived Experience
Based on my own personal analytics for my website, my most popular page is the "About me" section, with more visits than my "counselling" section. This intriguing fact speaks volumes about what potential clients are looking for when choosing a therapist.
I believe we have a great desire to understand the person we are going to confide in; we have a desire to be heard without talking. For a therapist to be a construct of a story in our heads, they must know their part in the play and know the lines. This metaphorical 'script' is often what clients are searching for when they peruse a therapist's personal information.
This preference for personal information over professional services suggests that clients are seeking more than just a set of qualifications or a list of therapeutic approaches. They're looking for a person they can connect with, someone who feels real and relatable. It's as if clients are asking, "Can I see myself opening up to this person? Do they seem like someone who will understand me?"
Interestingly, this desire for connection often extends to valuing a counsellor's lived experience. Clients may be drawn to therapists who have faced similar challenges or life experiences. There's a fine line here, though. As therapists, we must carefully navigate the boundary of self-disclosure. While sharing some personal experiences can help build rapport and credibility, it's needed to ensure that any disclosure serves the client's needs, not our own.
This balancing act between professionalism and personal connection is delicate. Clients often appreciate knowing that their therapist has 'been there' in some capacity, but they don't need (or want) to know all the details. It's about conveying empathy and understanding without overshadowing the client's own experiences.
This insight underscores the importance for therapists of crafting an authentic and engaging personal narrative on their websites. While maintaining professional boundaries, sharing appropriate personal information can help potential clients feel a connection before they even make that first contact.
I also wonder how often we choose a therapist based on what we want to transfer onto them. I know I was guilty of this. Perhaps in reading about a therapist's personal qualities or hints of their life experiences, we're unconsciously looking for qualities that resonate with our needs or past experiences, setting the stage for the therapeutic relationship before it even begins.
The First Meeting
The First Meeting The initial face-to-face encounter often proves decisive. We rely heavily on this interaction to assess the therapist's ability to listen, understand, and create a comfortable, trusting environment. The ability for a therapist to sell themselves in a genuine authentic way I feel to be the best way forward.
Follow your gut
Interestingly, May's study highlighted the significant role of unconscious projection and "gut instinct" in the selection process. Many reported making their final decision based on an intuitive sense of connection with the therapist, often formed during the first meeting. This point also ties in with my suggestion of our deliberate (albeit sometimes unconsciously) choice of transference in an interesting way.
What biases are at play here? Do we seek a parental figure, or someone who resembles a friend? Transference, a concept from psychoanalytic theory, suggests that we unconsciously redirect feelings about one person (often from our past) onto another in the present. In the context of choosing a therapist, we might be drawn to someone who reminds us of a nurturing figure from our past, or perhaps someone we wish we had in our lives. This unconscious process can significantly influence our choice, for better or worse.
This reliance on intuition raises questions about the selection process. While personal comfort and rapport are undoubtedly required for effective therapy, it's worth considering whether this approach might lead to overlooking other factors, such as qualifications or specific therapeutic approaches. But as a counter point, it has been proven time and again in research that the relationship is the most important factor in successful outcomes. Qualifications, tenure and papers are not always indicative of ability.
Surprising Findings
Contrary to what many might expect, the study found that formal qualifications, professional standing, and theoretical orientation were of limited importance to most clients in their selection process. This raises questions about how well-informed clients are about the significance of these factors. We know that CBT is the most recognised and desired therapy in the UK, despite not always being what people want in practice. I can't help but wonder how often someone comes to a therapy expecting or needing something other than the modality that is practiced, and write off counselling altogether.
The Awareness Gap
Perhaps most concerningly, the study uncovered a general lack of awareness among clients about the regulatory status of the counselling profession in the UK. Many assumed that therapists were already subject to statutory regulation, unaware of the current voluntary registration system. This knowledge gap extended to understanding professional bodies, complaints procedures, and how to validate a therapist's credentials. The good news is that most sites, including counselling directory, do require vetting and proof of qualification.
Implications for Clients and Therapists
For potential clients, these findings show how we can potentially walk into a poor choice of counsellor. Perhaps knowledge about how to choose a qualified and suitable therapist is needed. While factors like personal comfort and convenience are essential, understanding a therapist's Modality and the regulatory landscape can help ensure a safer and more effective therapeutic experience.
For therapists, the study shows the importance of building a strong professional network, maintaining a compelling online presence, clearly communicating areas of expertise, and creating a positive first impression. It also suggests an opportunity – and perhaps a responsibility – to educate clients about professional standards and regulations.
TL;DR
I hope you have found my commentary on May's study and my thoughts valuable. These insights into the client experience can help both therapists and regulatory bodies work towards ensuring informed decisions and better care, while also guiding our marketing and practices.
While factors like recommendations, location, and personal rapport remain important, there's a clear need for increased public awareness about therapist qualifications and regulation. As clients become more informed, they'll be better equipped to make choices that lead to effective, safe, and transformative therapeutic experiences.
The process of choosing a therapist is complex and often subjective. It highlights the importance for therapists of creating a strong, authentic online presence and fostering a welcoming, empathetic environment from the very first interaction. At the same time, it emphasizes the need for greater transparency and education about professional standards in the field.
Ultimately, choosing a therapist is a deeply personal and intuitive process, influenced by multiple factors from location and recommendations to unconscious biases and gut feelings. While this intuitive approach has its merits, May's study highlights the need for a more informed selection process.
For clients, the challenge is to balance personal comfort with an understanding of therapist qualifications, modalities, and the regulatory landscape. For therapists, it's about authentically presenting ourselves while educating potential clients about the therapeutic process and professional standards.
As the field of therapy evolves, so too must our approach to choosing and marketing therapeutic services. Through greater transparency, education, and awareness, we can work towards a system where clients are empowered to make informed choices, and therapists can practice with integrity and effectiveness. After all, the goal is not just to find a therapist, but to find the right therapist - one who can truly support and guide us on our 'journey of personal growth' and 'healing', rather than just presenting a bio with claims.
