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Therapy only works when you have the right therapist
That might seem like an obvious fact. You might be saying, “Of course, the therapist I choose has to know what they’re doing to be able to help me”, but it’s more than that. Two therapists of equal skill and experience will not be able to help you to the same degree. That might seem counter-intuitive, but since the 90’s, scientists have been studying and confirming this phenomenon.
This review of 16 meta-analysis studies from the American Psychological Association [1] (so a collection of hundreds of studies), says that the relationship between the therapist and their client, has as much or even more importance than the treatment method used. In certain approaches like humanistic therapy approaches (such as Gestalt Therapy, ANDC®, or Emotion-Focused Therapy), this importance is even greater [2].
There is also research showing that approximately 20% of clients prematurely drop out of therapy and often this is due to a therapist-client mismatch [3]. Doing 1 or 2 sessions and then dropping out is potentially worse than not having gone at all. You might get discouraged by therapy when your bank account will be missing a few hundred dollars and nothing noticeable has changed. Committing to the full process is important, and made easier when you find the right match. So now you know why it’s important, but what should you look for to avoid being a part of those 20% early drop outs?
Similar, but not too similar, is best
After you’ve decided which service you actually need (if you need help, read: Relationship therapist, sexologist, psychotherapist, etc. Which should I choose?), it’s time to start narrowing down your choices. No one wants to spend days reading different profiles so you need a way to cut down the options. Based on this study [4], a therapist’s ability to empathize with you will get the best results on average. Here’s what we recommend:
- Choose the right demographic (ethnicity/age/gender) based on what you want to work on.
- Choose the right specialty
Before going into details, it’s important to highlight a research finding [5] that showed when clients were too similar to their therapist, this could lead to reduced effectiveness. After reading several research papers on client matching, our belief is that either;
a) the client’s belief that they were similar to their therapist was in reality untrue and this eventually led to moments of feeling unseen or misunderstood.
b) that a slightly different worldview is exactly what is needed in order to break out of negative patterns.
Demographics of you and your therapist
The following points come from scientific research papers on therapist-client matching. It’s really important to remember that the scientific method necessarily clumps groups together in order to create statistics and can often miss or overlook unique individuals. While the findings are interesting and can potentially help you choose your therapist, remember to trust your own intuition when in doubt.
*Special note on gender: Past scientific papers squeezed gender and sex into a single Female/Male category. While this practice is slowly changing with time, the meta analysis papers used to write this article look at data from decades of research where this was the norm.
Ethnic/racial matching:
Based on an analysis of 154 studies, for African American clients and specifically Asian American male clients, their therapist’s ethnic/racial similarity appeared more important than for other ethnicities [5]. If you belong to one of these groups and feel a strong connection to your culture, this can be an important factor to consider in your choice.
In older clients in general, however, the ethnic/racial matching for all ethnicities did seem to see minor improvement in average therapeutic outcomes [5].
If, for example, you are an immigrant and struggling to find a therapist from your home country, you could consider a therapist who is also an immigrant regardless of their ethnicity. The experience of immigration in of itself could be a greater source of empathy than the particulars of your mismatched cultures.
Age and Gender matching:
Age and gender seemed to play a very very minor role in matching. Older therapists, regardless of actual therapy experience, tend to have a very small improvement in client outcomes [6]. Scientists believe that a client’s tendency to perceive older therapists as more skilled allows them to trust the therapist faster which is the actual factor improving their therapy sessions. Our recommendation is not to worry about this aspect too much and find a therapist you can trust based on other qualities.
Of course, if what is driving you to therapy is specifically related to your gender or age, then it will be important to choose a therapist that will have the capacity to empathize with you in this respect.
What Therapist Specialties Mean and Why They Don’t Need to be Exact
Therapists don’t become therapists by accident. They have experienced the same hardships that are likely driving you to therapy now, and along their journey to solve those problems they find themselves passionate about all the interconnected pieces and decide to help others through those same hardships. Behind every good specialty tag, hints at a therapist’s lived experiences. A specialty on addiction for example, doesn’t just mean they studied how addiction works, at some point they or a loved one was addicted enough to cause hardships.
Carl Rogers strongly favored empathy over sympathy (stepping into the shoes of the client, versus simply having concern for someone). Any therapist can show concern, but the ability to truly understand your experience, comes from their own experience matching in some way. It also means that their specialty doesn’t need to be exactly the same as what you are living through. A specialty around anger management can point to the experience of being flooded by an emotion beyond your control. That therapist may be able to empathize with a panic attack because of the similarities of lack of control in an acute moment.
What we recommend is to look for specialties you believe have similar properties to your own hardships, without getting too caught up on specifics. If you’re unsure, you can always e-mail a therapist to see if your experience does fit within their area of expertise. We also recommend avoiding profiles that list out dozens of specialties, as we believe they are inauthentic, unlived experiences, and simply an attempt to get clients regardless of the match.
Conclusion
We outlined here what the research points to, to help you make an informed choice. Our goal is to help you find the therapist best suited for your needs, so that your therapy will be more effective. We recommend at this stage make a short list of what you want to prioritize in your ideal therapist, with the most important points up top, and “nice to have” similarities on the bottom. While we obviously hope you will be able to find your therapist here at Divan bleu, our priority is that you find the help that will do you the most good no matter where you find them.
We know that difficult moments can make you reach out to the soonest available appointment, regardless of the mismatch. Therapy, however, is a slow process that can’t be rushed and it’s an act of self care to take the time to find the right therapist. It may mean waiting for a later availability, but in the long run, it’ll be the way to change your internal world for the better.
Sources
- Better relationships with patients lead to better outcomes https://www.apa.org/monitor/2019/11/ce-corner-relationships
- Flückiger C, Del Re AC, Wampold BE, Symonds D, Horvath AO. How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis. J Couns Psychol. 2012 Jan;59(1):10-7. https://doi.org/10.1037/a0025749 . Epub 2011 Oct 10. PMID: 21988681.
- Swift, J. K., Greenberg, R. P., Whipple, J. L., & Kominiak, N. (2012). Practice recommendations for reducing premature termination in therapy. Professional Psychology: Research and Practice, 43(4), 379–387. https://doi.org/10.1037/a0028291
- Elliott, R., Bohart, A. C., Watson, J. C., & Greenberg, L. S. (2011). Empathy. Psychotherapy, 48(1), 43–49. https://doi.org/10.1037/a0022187
- Cabral, R. R., & Smith, T. B. (2011). Racial/ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes. Journal of Counseling Psychology, 58(4), 537–554. https://doi.org/10.1037/a0025266
- Lehane, S., L. Medoro, A. Kelly, and E. Strodl. 2025. “ Compatibility Matching on Age and Gender in Predicting Psychotherapy Outcomes.” Clinical Psychology & Psychotherapy 32, no. 6: e70180. https://doi.org/10.1002/cpp.70180.
