“Good Fit”–Understanding the Therapeutic Relationship


A few years ago, I wrote a post for World Mental Health Day about some of the basic things to consider when you are thinking about seeing a therapist.  But I had a conversation this week that made me think this topic was worth revisiting.

Good Fit

So here’s the deal. At its heart, therapy is a relationship.  And the therapeutic relationship is incredibly important.  In fact, most outcome research suggests that a strong therapeutic relationship is the single factor that consistently predicts therapeutic success.  But people pick a therapist for many reasons: insurance coverage, geographic convenience, provider specialty, recommendations from others, etc.  And sometimes, you can start doing therapy work and realize that the relationship just doesn’t feel right to you.  In mental health circles, we refer to that sense of feeling right in the relationship as “good therapeutic fit.”

Good fit is a mysterious thing.  It has something to do with the skill of the provider you are working with, but that’s not the whole picture.  In some ways, good fit is the therapeutic parallel to relationship chemistry.  You want to be doing therapy with a psychologist or other provider who connects with you.  This can mean that they get your sense of humor, or that they use explanations that make a lot of sense to you, or that they help you feel safe and heard.  Good fit is hard to describe, but easy to recognize.

What Happens when the Fit isn’t Good?

Now we come back to the conversations I have had, in many forms, with many people, about clients feeling able to find a “good fit” relationship.  My clients over the years have said things like, “It is hard enough to tell this story. The idea of telling it to multiple people feels awful.”  I have also heard, “I don’t really feel comfortable in this relationship, but I don’t want to make my therapist feel bad.”

Those statements make a lot of sense to me.  After all, as I said up top, therapy is a relationship.  Many of us will suffer through uncomfortable or unhelpful relationships because we are not sure how to go about leaving that relationship without causing conflict.  And just getting to therapy in the first place is a difficult process for many folks, so I understand why the idea of seeking a new therapist can feel overwhelming.

Therapy is about Self-Care

But here’s the thing.  As I talked about in my post about what makes therapy different, you are paying to participate in the therapy relationship.  It is a unique relationship that is supposed to be entirely about your health and well-being.  So if you aren’t getting the connection and support that you need, you deserve a different therapeutic relationship.

If you are just starting on your path to therapy, it is worth taking some extra time and energy to find a therapist who is a good fit from the start.  This might mean that you check with people you trust about recommendations.  It might mean that you go out of your insurance network.  It might mean that you conduct several interviews with prospective therapists.  You can learn a lot from a therapist in an initial phone conversation.  I always offer a free phone consultation to new clients–because I want to try to be sure that I’m a good fit before we get started.  And I tell clients that we’ll treat our first few sessions as a trial period.  If they don’t feel like our relationship is working, I help them connect with someone else.

I know that sounds like extra work, but I hope that you check out some of these steps. Therapy is an important investment in your health, and you’ll be doing some heavy emotional lifting, so you deserve to have a therapeutic relationship that is the best fit for you.

I’ll be writing a bit more about the therapeutic relationship next week.  Until then, as always, if you have more questions about this, you are welcome to ask in the comments or reach out to me by phone or email.


Image Credit: Photo “Puzzled Path” by Magnus A. via Flicker

7 thoughts on ““Good Fit”–Understanding the Therapeutic Relationship

  1. Ann,
    I like the way you point out that this is a relationship that one pays for, unlike almost any other relationship. It has to be comfortable and intimate, so it is part of self care to choose the right person. I tell people that those of us in the field understand that none of us will provide the right fit for every client who walks in the door. No hard feelings when people are shopping or when they make a change–as long as we can talk about it. We always want to talk, right?

  2. So, so true. I’m not sure what constitutes a good fit either, but when I client tells me they feel like it’s a good fit, I’m usually feeling it too, and if a client doesn’t feel like it’s a great fit, I’ve often already come to the same conclusion.

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