Much has been written about choosing the right therapist, but what about the other side of the question? 

The counselor also chooses you. 

You might be surprised by the reasons colleagues have shared with me.

Some of these are obvious and essential, while others are personal. I will offer you some of both:

• You might not think of it, but not all forms of treatment take an equal amount of time. Some healers do their best work (and have been trained) with treatments extending for months or years, while many elect shorter periods from start to finish. For obvious reasons, insurance companies press for the latter.
• In evaluating you on the phone, via email, in person, or through virtual means like Zoom, the psychologist assesses your expectations and whether you will put in the effort needed to form a well-functioning therapeutic alliance. The old joke goes this way: “How many therapists does it take to change a light bulb?” Answer: One, but the bulb has to want to be changed.
• The expert is not ready to remedy every injury to the body and soul. He is wise to set limits on opening the door to those he is unprepared for. It is impossible to keep up with the latest research on mending every medical or emotional malady known to mankind.
• If the doctor is honest, he will almost always say he prefers some patients to others. Those with better-than-average verbal skills make the communication process easier for both parties.
• Other qualities of the prospective client make him more or less appealing. These include intelligence, a sense of humor, respect for the counselor’s time by coming on time, limiting unnecessary emails or phone calls, and (for in-person visits) good hygiene. I knew a therapist who terminated his relationship with a long-term patient when she pooped on the couch in his waiting room. 

• Professionals restrict their practice. A significant number of them will not treat people who require hospitalization. Other counselors avoid those at substantial risk of suicide. Outpatients exhibiting erratic and unstable mood or behavioral characteristics have made some healers hesitant to take them on. Borderline Personality Disorders and Dissociative Disorders tend to create such concerns. Alcohol and drug abuse can also cause challenges not every counselor wishes to address. Of course, all this depends on making a rapid and accurate evaluation.
• Money is not an incidental consideration. Many come to the doc with little knowledge of their insurance coverage. They can be surprised and distressed when they discover their copay is unmanageable. Some therapists permit a sliding scale of charges depending on what the patient can afford. Busy doctors may decide not to accept third-party payers and take on only those individuals who pay the fee out of their pocket.
• Younger psychotherapists are frequently less concerned with restricting who they will treat than those well-established in the profession. As their practice becomes full, that fact allows them to say no to certain of those seeking their consultation. Put differently, once a doctor creates an excellent reputation, his income becomes less dependent on taking all comers. In a time when the healing professions have long waiting lists, it is impossible for those who wish to take everyone to do so.

• Those who consult a healer have a range of expectations. Many wish to be seen in the evening or on the weekend. Others might prefer lunchtime. I have heard experienced psychologists and psychiatric nurses refer to how exhausting it can be to treat people on the internet for hours. A portion of the individuals requesting virtual therapy do so because they are uncomfortable face-to-face. At that point, the doc must decide whether avoiding fear impedes the individual’s ability to overcome it. As Woody Allen said, “Ninety percent of life is (a matter of) showing up.”
• Counselors are untrained in talents more often found in nonpsychiatric social workers. Most clinicians are not suited to deal with evictions from one’s residence, malnutrition, homelessness, etc. Life challenges can require stabilization before the work of psychotherapy begins.

Therapists have their range of likes and dislikes, preferences, and knowledge gained via experience. Patients are not equally suited to their counselor and vice versa. 

The period since the pandemic began has been unusually difficult for healthcare. Within some specialties, the shortage of physicians causes appointments to be booked six months or more in advance. Practitioners have burned out and left the field. Supply and demand create their own set of dilemmas in any part of the economy.

Ethical concerns also should prevent healthcare professionals from treating their brothers-in-law, business partners or romancing their clients.

Most therapists will do their best to match their skills to those seeking assistance. They will refer individuals when they cannot provide personal attention themselves.

We live in a challenging moment on several fronts. The National Alliance on Mental Illness offers the following:

1 in 5 U.S. adults experience mental illness each year
1 in 20 U.S. adults experience serious mental illness each year
1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
50% of all lifetime mental illness begins by age 14, and 75% by age 24
Suicide is the 2nd leading cause of death among people aged 10-14 

The widespread societal distress implicated by these numbers impacts both the clients and those who choose to serve them. When you consider the practitioner’s strengths, weaknesses, the limitations on who they can capably treat, and the recent increase in emotional suffering, remember this. They live in the same world with many of the same pressures as everyone else, but only they are expected to work magic.

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The top image is A Psychologist Treating a Patient by Jty33, sourced from Wikimedia Commons.

The remaining photos are the work of Laura Hedien, with her generous permission: Laura Hedien Official Website. The first of these is Sunflare, Ottawa State Park, Wisconsin from earlier this year. The last is Illinois Sunset, College of Lake County, Fall 2022.