At a glance
Choosing a therapist asks you to judge someone’s skill before you have shown them the part of you that needs it. The clearest evidence arrives when you tell them something has not landed and watch what they do. This article sets out what to look for, what to ask over video, and when to move on.
Clinical insights from 22 years in psychotherapy
I’m Mark Colclough, MA, psychotherapist in Copenhagen. Qualified at the Psychosynthesis Education Trust and the University of East London. 22 years of full-time, face-to-face clinical practice.
- Fit is felt before it is understood. My clients usually know whether they can talk to me some time before they can say why.
- Relief and progress are different hours. The sessions clients later describe as turning points were seldom the ones they left feeling lighter.
- A small doubt spoken early helps the work. When clients tell me of a reservation about me in the first weeks, I find the reservation becomes something to work with rather than something they carry alone.
Clinical notes: My observations are anonymised and compounded from my session notes since 2004.
How much does the choice of therapist matter?
What happens between you and your therapist carries a large share of what the therapy can do for you.
Within the first few meetings I can usually tell whether a client and I have found the footing the work depends on. What counts is whether you can offer me a thought you are slightly ashamed of, still half-formed, and see me take it seriously. When that goes well, you risk the next one. When it goes badly, you begin to tidy what you say, and I end up working with a curated version of you without knowing it.
- You feel followed. You leave a session feeling that someone kept pace with you, rather than steered you somewhere.
- The aim is shared. Both of you could say, roughly, what you are working on and what change would look like.
- Disagreement is welcome. When you say something was unhelpful, the conversation deepens instead of stalling.
- The method makes sense. Your therapist can tell you what they are doing and why, in ordinary language and without a lecture.
The research I find most useful here pools more than 300 studies covering around 30,000 patients. It finds a steady, modest link between the strength of this working bond and how well the therapy turns out1: a correlation a little under 0.3, or something like 8% of the difference in outcomes. The studies were mostly of face-to-face therapy, mostly in North America and Europe, and they show the two rising together rather than proving that the bond causes the improvement. I read it as confirmation that the bond matters, alongside what your therapist actually knows how to do.
Rapport tells you whether you can speak to this person; training tells you whether they can do something useful with what you say. You sense the first within minutes of a video call, and no profile page shows you the second.
Why can’t I tell after one session?
In the first hour you are testing whether you could trust this person, while also trying to come across well to them.
Most people arrive with their difficulty already shaped into a story. It has a beginning, a reasonable account of the other people involved, and an explanation for the delay in asking for help. You tell it competently, and part of your attention stays on how you are coming across. What brought you often lies just outside that story: the feeling you are embarrassed by, the resentment that sounds petty, the fear you have never said aloud to anyone.
So while you are watching for signs that it would be safe to say more, a good therapist is listening for the gap in the account and moving towards it with care. You may feel your throat tighten as you start to answer, and catch yourself adding that it probably does not matter. That moment, and how it is received, tells you more about the fit than whether the hour felt pleasant. Over video this unfolds in much the same way.
What should I check before I book?
Look past the job title to the training underneath it, because the same word can rest on very different preparation.
Most advice on how to find a good therapist starts with credentials, and they do matter. Searching online, you may be reading profiles of therapists who trained and work in a different country from yours. In my experience of working with clients from many countries, a title that is protected in one place can be open to anyone in another, so the word on a profile is a weak guide. Ask about what sits behind it.
- Training. Ask how many years it took, at what level, and how much supervised client work it included.
- Relevant experience. Ask what they have worked with that resembles your difficulty, and notice whether the answer is specific or merely soothing.
- Supervision now. Ask whether they currently take their work to supervision, which says more about their present practice than an old certificate.
- Language. Ask whether you can work in your first language, and whether you may switch when a feeling only has a word in another one.
- Privacy on video. Ask which platform they use, what notes they keep, where those notes are stored and who can read them.
- Time and frequency. Ask how often you would meet, how time zones are handled, and what happens when you need to cancel.
Look for clear answers, given without hurry. Irritation at these questions tells you something before you have spent an hour. If working in English from wherever you live matters to you, read more about online psychotherapy.
How do we choose a therapist as a couple?
Each of you needs to feel fairly heard by someone trained to work with couples, and being fairly heard does not mean the blame is split evenly.
Notice what the search has already set up between you. Usually one partner did the looking and the other agreed to it, so one arrives hopeful and a little impatient, and the other arrives guarded, expecting to be found at fault. The guarded partner tends to say less, and the hopeful one can read that quiet as not caring. A therapist who notices this early and names it without taking a side is showing you their skill. Over video, make sure both of you can be seen and heard properly, whether you sit side by side or join from two screens.
- Couples training. Ask what specific training they have in couples work, such as Emotion-Focused Therapy for couples.
- When a session tilts. Ask how they respond if one of you feels they have sided with the other.
- Different hopes. Tell the therapist early what each of you wants, even when your answers do not match.
If one of you is unsure whether to stay, say so at the start, because therapy that helps you decide is shaped differently from work towards repair. Where your partner refuses to take part, you can still work on the relationship from your side. Read more about online couples therapy and couples therapy on your own.
How do I tell my therapist it isn’t working, and when should I stop?
Name the particular moment that did not help, then watch closely how your therapist responds.
- Write it down soon. After a session, note one thing that helped and one thing that jarred.
- Choose one point. Bring a single thing to the next session, since several at once tends to put anyone on the defensive.
- Make it concrete. Point to what was said and how it left you feeling, so they have something real to respond to.
- See what changes. Someone who listens, asks more and adjusts is giving you a preview of the whole therapy.
- Allow uncertainty a little time. If you feel safe but unconvinced, a few more sessions can give you more to judge by. That is a suggestion, not a rule.
- You may simply leave. You do not have to win an argument with your therapist before you end the work.
These steps are not enough if you have spoken plainly and nothing shifts, if you feel pressed to keep booking, or if your therapist seems unable to accept that anything misfired. They do not apply at all where a professional boundary has been crossed: then you stop first, and any explanation is optional. In my clinical view, a single plain remark about what is failing reveals more about a therapist than their qualifications, so make it early rather than after months of quiet doubt. A first session over video is often enough to find out how someone responds when you do.
Questions people ask
Can a good therapist help me if they live in another country?
Yes, if they are trained for your difficulty and you can speak freely with them over video. Distance matters less than whether the work can happen in a language and at a time that suit you.
How many sessions should I try before deciding?
If you feel safe but unsure, give it three or four sessions, and if you do not feel safe, stop sooner. That number is a rough guide rather than a clinical threshold, and it simply keeps one hard hour from deciding everything.
Is therapy over video private enough?
It can be, once you know which platform your therapist uses and you have a room where you will not be overheard. It is also fair to ask what notes are kept and where they are stored.
Should I choose individual or couples therapy for a relationship problem?
Choose couples therapy if the two of you want to work on the relationship together, and individual therapy if the real question is what you yourself want. Working alone on a relationship is a full form of the work.
What should I ask in a first conversation with a therapist?
Ask what they would focus on in the first few sessions with a difficulty like yours. A concrete answer tells you more than credentials do.
If you are still searching for the right fit, you are welcome to read how I work in online psychotherapy and see whether it sounds like me.
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Sources
How this article was written: I choose the subject and the angle. An AI assistant researches and drafts. I read the draft, correct and improve it and stand behind every clinical statement. The professional and clinical judgement is mine.
