“I like to open up with the psychologist because I feel like when you open up you’re gonna get the work done. That’s what they’re there for. You need to open up to them, to talk to them, to let them know if you’re having hard times, to let them know if something’s bugging ya, to let them know if you’re worried about something.” - a 33-year-old man with Bipolar Affective Disorder and substance misuse [1]

For someone who wants to improve their mental health, deciding to get therapy can be an important step. But did you know that someone’s choice of therapist can be a more important decision than the decision to get therapy in the first place? In this article, we explain why that is, then we give some simple suggestions for how to choose a therapist well.

Mistake #1: assuming that all therapists are similar

In Australia, the titles of “counsellor,” “psychotherapist,” and “therapist” can unfortunately be used by anyone, even if they don’t have relevant qualifications or experience. (In other words, these titles are not “protected” within Australian laws and regulations.)

When our patients participate in therapy, we usually recommend that it is administered by a registered or clinical psychologist. Another type of professional who is able to provide therapy (though they do so less commonly than psychologists) is a psychiatrist, which is a type of medical practitioner. At Someone.health, all our therapists are registered as either psychologists or psychiatrists. But you can’t assume that all organisations have this same rule.

So, before seeing a therapist, we recommend checking that they are a currently-registered psychologist or psychiatrist. You can do this by checking for their name on the Australian Health Practitioners Regulation Agency (AHPRA) online register.

Mistake #2: assuming that all psychologists will be similarly helpful

Evidence indicates that some of the most important aspects of psychological therapy include:

The alliance between the patient and the psychologist (sometimes called the therapeutic alliance) – this relates to how well the person and their psychologist collaborate and work together on shared goals
The level of empathy that the psychologist shows for the individual and for what they’re going through
The degree to which the psychologist and individual agree on shared goals
The degree to which the psychologist expresses positive regard for the individual
The genuineness of the psychologist
Other characteristics of the psychologist
The degree to which the therapy is culturally appropriate
The expectations of the individual and their psychologist

Another way of describing the quality of the therapeutic alliance is to talk about different levels of rapport. If someone has a high level of rapport with their psychologist, this typically means that they tend to feel that:

They are listened to and respected;
They are treated with warmth and empathy; and
They feel that their therapist has unconditional positive regard for them.

All of these factors can vary greatly from psychologist to psychologist, so the same individual can have very different levels of rapport with different psychologists. This is why, at Someone.health, we aren’t satisfied with just ensuring that all our clinicians are accredited and receive ongoing training to ensure high-quality care. We also have an online matching process to allow clients to filter through our hundreds of psychologists to identify the most appropriate profiles and skill-sets for their needs.

And we continually collect feedback on client experiences and outcomes to ensure our clinicians have a good level of rapport with their clients, because we understand that this is key to providing the best therapy.

Mistake #3: assuming that the particular type of therapy someone participates in is more important than who they’re doing it with

Even if you recognise how much variation there is in the level of rapport that people have with their psychologists, you might assume that the type of therapy is more important than the level of rapport. It might surprise you to learn that this is actually not the case! Instead, evidence suggests that the opposite is true: the factors we listed above are even more important than the type of therapy someone receives.

This doesn’t mean that the type of therapy is unimportant. Different types of therapy have different levels of evidence supporting their use in different mental health conditions and contexts, and we think it’s important to provide the most evidence-based therapy available. But we also recognise that people tend to overestimate how important this is, while underestimating just how important it is to have a good rapport between an individual and their psychologist.

Because of how important it is for an individual and their psychologist to have a high level of rapport, at Someone.health, we aim to match people with psychologists based on the characteristics of our psychologists and based on what our clients think will work for them.

Of course, someone’s predictions won’t always match reality, but that’s okay, because people don’t have to stay with the first psychologist they try. (Some people mistakenly assume that they do, though, which brings us to Mistake #4.)

Mistake #4: assuming that people have to stay with the same psychologist they start therapy with

Contrary to what you might assume, if someone thinks that they could have better rapport with another psychologist, they should try seeing another one. They do not need to stay with the same psychologist they started therapy with.

If you’ve just started seeing a psychologist and you don’t feel you have a high level of rapport with them, we encourage you to try seeing a different one. This doesn’t mean there’s anything wrong with you or with them – it just means that you don’t have a high level of rapport, and that’s all.

Finding a different psychologist who you have better rapport with could enable you to get more out of your therapy sessions, and it could also free up the original psychologist to help other patients (just as you can find a psychologist you have a better rapport with, they can find patients they have a better rapport with).

Resources Box

Hussain, S., Mia, A., & Rose, J. (2020). Men’s experiences of engaging in psychological therapy in a forensic mental health setting. The Journal of Forensic Psychiatry & Psychology, 31(3), 409-431.