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How Do I Choose a Therapist? A down to Earth Guide for Anyone Thinking About Starting Psychotherapy

If you've ever sat with the question "how do I choose a therapist?", you'll know it can feel surprisingly heavy. Here you'll find A down to earth guide for anyone thinking about starting psychotherapy. You open a search tab, type something like "psychotherapy near me" or "online therapist UK", and within seconds you're scrolling through dozens of faces, qualifications, modalities, and price points. CBT, DBT, EMDR, integrative, person-centred, psychodynamic. It's a lot. And underneath the practical question, who do I pick? ; there's usually a more vulnerable one: who will actually be able to help me with this?


This piece is for anyone working that out for the first time. I'll walk through what the research says actually matters, what to look for in a therapist's training and registration, and what your first conversations with a potential therapist can tell you. I'll also talk about why this choice matters especially when you're carrying something heavy, trauma, complicated grief, the loss of a baby, because the wrong fit in those situations can leave you feeling worse, not better.


Start With What Actually Matters: The Relationship


Here is something the research has been saying clearly for over thirty years, and which doesn't get said often enough in glossy therapy directories: the single most reliable predictor of whether therapy helps you isn't the brand of therapy on the tin. It's the quality of the relationship you build with your therapist.


A landmark meta-analysis by Flückiger and colleagues pooled 295 studies covering more than 30,000 patients across face-to-face and online therapy, and found that a strong therapeutic alliance was consistently linked to better outcomes, regardless of the type of therapy delivered (Flückiger, Del Re, Wampold & Horvath, 2018). Bruce Wampold, one of the most respected psychotherapy researchers in the world, has spent decades demonstrating that what he calls the "common factors", the relationship, the therapist's warmth and skill, your sense of being understood, a shared sense of where you're heading, account for far more of the change in therapy than any specific technique (Wampold, 2015).


What does this mean for you, sitting at your laptop trying to choose? It means the question isn't really "which therapy approach is best?" It's "which therapist can I actually sit with and feel honestly met?" That's a more human question, and a more useful one.


Check the Credentials — Quickly and Without Anxiety


Before you focus on the harder question of fit, there's a simple practical filter. In the UK, the title "psychotherapist" is not legally protected, which means anyone can technically use it. Registration with a professional body is therefore your first line of safety. The main ones to look for are:





Registration means the therapist has completed substantial training, undertakes ongoing professional development, has clinical supervision, and is accountable to an ethical framework with a complaint’s procedure. It also means they carry insurance and are subject to ongoing scrutiny. If a therapist isn't registered with one of these, that's worth pausing on.


Beyond registration, look briefly at where someone trained. Established clinical training programmes, for example at the Tavistock and Portman NHS Foundation Trust, or at recognised university departments, involve years of personal therapy, intensive clinical placements, and rigorous supervision. That depth of training matters, especially for complex difficulties.

Alan Archibald from Archibald Psychotherapy offers support to find the therapy you need.

Understanding the Different Types of Therapy


You don't need to become an expert in therapy types, but a rough map helps. Broadly speaking, therapies tend to fall into a few families.


Cognitive-behavioural therapies (CBT, DBT) focus on identifying and changing patterns of thought and behaviour. They tend to be more structured and shorter-term, and are often the first line offering in the NHS. They can be very useful for specific, well-defined problems.


Psychodynamic and psychoanalytic psychotherapies take the view that what's happening in the present is often shaped by what came before, early relationships, losses, unspoken family stories, things we never got to feel at the time. The work tends to be more open-ended and exploratory, focused on understanding rather than instruction. It's often the approach of choice for trauma, grief, relational patterns, and difficulties that have a long history.


Humanistic and person-centred therapies emphasise the therapeutic relationship and the client's capacity for growth, with less focus on the unconscious or on structured technique.

Jonathan Shedler's well-known review in American Psychologist found that psychodynamic psychotherapy is at least as effective as other empirically supported therapies, and that its benefits tend to deepen after treatment ends rather than fading (Shedler, 2010). That's an important point if you're considering whether to invest in deeper, longer-term work.


There's no single "best" therapy. There's the therapy that fits your difficulty, at this particular point in your life, with a therapist whose way of working makes sense to you.


Why Specialist Experience Matters for Trauma, Grief and Infant Loss


If what you're bringing is heavy — and many of the people who reach out to me are carrying something heavy, choosing a therapist with genuine experience in that area matters more than it might for a more general difficulty.


For trauma therapy, the body of work that Bessel van der Kolk has done so much to bring into public awareness shows that traumatic experiences don't just live in memory; they live in the nervous system (van der Kolk, 2014). A therapist who hasn't worked extensively with trauma may not recognise the signs of someone becoming overwhelmed or may push too quickly into the difficult material. An experienced trauma therapist paces the work carefully, builds the foundation first, and knows that real change comes from feeling safe enough, often for the first time, to think about what happened.


For grief and bereavement, and particularly for miscarriage, stillbirth and infant loss, the right therapist matters in a different way. Research has consistently shown that perinatal loss is associated with high rates of complicated grief, grief that doesn't ease in the way other bereavements might, and which is often compounded by how little space the wider world gives it (Kersting & Wagner, 2012). Many parents who have lost a baby tell me that they've been to therapists who, with the best of intentions, didn't quite know what to do with the depth of their pain, or tried to move them along too quickly. You want someone who can sit with it, really sit with it, for as long as it takes.


When you're considering a therapist for something specific, look on their website for evidence that this is genuinely an area of focus. Not just a tick-box on a list of "issues addressed", but writing, reflection, and language that tells you they understand the territory.


What to Ask, and What to Notice, in the First Conversation


Most psychotherapists offer a short initial conversation, often free (as I do), before any commitment. This is genuinely useful, and it works both ways. You're not auditioning for them; you're finding out whether you can work with them.


Some questions worth asking:


• How do you work, and what's your training? (A therapist should be able to describe their approach in plain language.)

• Do you have experience with what I'm bringing? (Vague reassurance isn't the same as genuine experience.)

• What does an initial period of therapy look like with you? (Many psychodynamic therapists, myself included, suggest meeting twice before committing, this gives both of you time to feel into the fit.)

• What are the practicalities; fees, frequency, confidentiality, how online sessions are held? (Clarity here is a good sign.)


But just as important as the answers is what you notice in yourself during the conversation. Do you feel listened to? Does the therapist's pace feel right? Do they leave you space to think, or do they fill every silence? Is there a sense, even tentatively, that you might be able to be honest with this person?


Trust that. Your instinct in those first ten minutes is data.


Why a Safe, Containing Space Is Non-Negotiable


Whatever else you weigh up, this is the bedrock: the therapeutic space needs to feel safe enough that you can, over time, bring the parts of yourself you don't usually show anyone.

In psychodynamic work we use the word containment, borrowed from the British analyst Wilfred Bion, to describe a therapist's capacity to receive what feels unbearable, think about it without flinching, and slowly hand it back in a form you can begin to hold. For someone whose internal world is in crisis, this kind of containment can be the first time in years that the difficult material has been met without being minimised, fixed, or pushed away.


Most people coming to therapy for the first time arrive with a quiet question: is this too much? Will I be too much? A good therapist's answer, communicated not in words but in how they meet you, is: no. We can think about this together.


Online or In-Person?


Online psychotherapy has become a permanent option, not a pandemic stopgap, and the research is reassuring: online therapy produces broadly comparable outcomes to in-person work, including for the strength of the alliance (Flückiger et al., 2018). What matters more than the medium is the therapist's attentiveness within it.


Online has real advantages, you can work from your own space, with no commute either side, which many people find particularly helpful when the material is tender. It also widens your choice: you're no longer limited to the therapists in driving distance of your home. If you live in a smaller town or want a specialist in something specific, online may give you access you wouldn't otherwise have.


A Final Thought


Choosing a therapist isn't quite like choosing a plumber or a dentist. You're not buying a service so much as entering into a relationship that, if it works, will become one of the more honest you've had. That takes a little time to get right, and you may need to speak to two or three people before you find someone who feels like the right fit. That's not a failure, that's the process working as it should.


Take your time. Trust what you notice. And remember that even the act of reading something like this is part of the work; you're already doing it.


If you'd like to talk about whether we might be a good fit, I offer a free 20-minute consultation with no obligation. It's a chance to ask any questions and see how it feels to talk. Whatever you decide afterwards is genuinely up to you.

 

References


Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172

Kersting, A., & Wagner, B. (2012). Complicated grief after perinatal loss. Dialogues in Clinical Neuroscience, 14(2), 187–194.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109. https://doi.org/10.1037/a0018378

van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277. https://doi.org/10.1002/wps.20238

 

Alan Archibald is a BPC- and BACP-registered psychodynamic psychotherapist, Tavistock-trained, with nearly three decades of experience in mental health. He offers online psychotherapy to adults across the UK, specialising in trauma, grief and bereavement, miscarriage and infant loss, men's mental health, and intercultural therapy.

 
 
 

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