Therapist Fit and the Therapeutic Relationship: How Do You Know You Have the Right Therapist?

What is therapist fit and how does the therapeutic relationship shape therapy outcomes? Learn the signs of a good relationship and how to handle fit problems.

When starting therapy, most people research the method, the specialist's training and the session fees. Yet one of the most important factors determining how therapy will go is something that is often overlooked: the relationship between you and your therapist. Therapist fit, that is, how safe, understood and collaborative you feel with your therapist, can directly affect the depth of what is discussed in therapy and the speed of change. In this article we look at what the therapeutic relationship is, why it matters so much, the signs of a good relationship and what you can do if you have concerns about fit.

What Is the Therapeutic Relationship?

The therapeutic relationship is the professional relationship established between client and therapist, based on trust, respect and a shared purpose. It differs from everyday relationships in some important ways: it is one-directional, meaning the focus is always the client's needs. It is carried out within certain boundaries; the therapist does not form a friendship, business or romantic relationship with their client. And it serves a purpose: bringing about meaningful change in the client's life.

In the psychotherapy literature, this relationship is often explained by the concept of the therapeutic alliance. The therapeutic alliance is generally accepted to have three basic components:

• Agreement on goals: The client and therapist having a shared understanding of what they are trying to change in therapy.
• Agreement on tasks: Agreement on how to reach these goals, that is, on what will be done in sessions and between sessions.
• Emotional bond: Mutual trust, respect and the client feeling accepted.

These three components feed each other. As goals become clearer, trust grows; as trust grows, the client approaches difficult tasks more willingly.

Why Does Therapist Fit Matter So Much?

Psychotherapy research has for many years examined the factors that are common across different therapy approaches. One of the most consistent findings to emerge in these studies is that the quality of the therapeutic relationship is associated with the outcome of therapy. In other words, whichever method is used, a strong relationship between client and therapist makes an important contribution to the process moving forward productively.

There are several reasons for this:

• Trust makes opening up possible: A person cannot approach the hardest subjects in an environment where they do not feel safe. Shameful memories, fears or thoughts never told to anyone can be spoken about only in a safe relationship.
• The relationship is part of the change: Many psychological difficulties are related to wounds experienced in relationships. A healthy relationship with a therapist can offer a new experience that repairs these wounds.
• It supports motivation: One of the things that keeps you going with therapy in difficult periods is the feeling that your therapist understands you and is on your side.
• It makes feedback possible: In a good relationship, the client can say "This isn't working for me", and this feedback can be used to strengthen the process.

Let's say someone who has feared being criticised for years mentions a mistake for the first time in therapy and sees their therapist receive the account with curiosity and compassion rather than judgement. This experience can be a small but powerful piece of evidence that shakes the belief "If I make a mistake, I'll be rejected". The therapeutic relationship is a space where this kind of repairing experience takes place.

What makes change possible in therapy is not only the techniques used but also the relationship within which those techniques take place.

Is There Therapist Fit? What Are the Signs of the Relationship?

Signs of a good therapeutic relationship

Fit does not form all at once; it generally starts to take shape within the first few sessions and deepens over time. The signs below can show that the relationship is moving in a healthy direction:

• You feel rested and understood in sessions.
• Your therapist meets you with curiosity and respect, without judgement.
• You can open up the subjects you struggle with at your own pace; you are not rushed.
• Decisions about the goals of therapy and how it will proceed are made together with you.
• When you disagree with something, you can say so and feel you are taken seriously.
• Your therapist explains what they are doing and why; the process is clear to you.
• Boundaries are clear: there is no uncertainty about session times, rules of communication and confidentiality.
• Although you sometimes leave sessions tired or emotionally challenged, overall you feel meaning and direction in the process.

An important point needs underlining here: a good therapeutic relationship is not always a "comfortable" one. Your therapist may sometimes ask questions that challenge you, gently draw attention to subjects you avoid or offer a perspective you are not used to. Feeling uncomfortable at such moments does not mean the relationship is bad; what matters most is that this discomfort is experienced on a safe footing.

Situations that may point to a fit problem

Sometimes, despite every effort, the relationship does not develop as hoped. The situations below may point to a serious fit problem:

• If you constantly feel judged, belittled or shamed in sessions,
• If your therapist mostly talks about their own experiences instead of listening to you,
• If you meet prejudiced attitudes about your values, identity or lifestyle,
• If your feedback is met with a defensive or angry reaction,
• If a shared understanding of the goals has not been formed for a long time,
• If boundaries become blurred: for example, the therapist tries to form a personal relationship outside sessions, does not take care over confidentiality or makes unprofessional requests.

The situations in the last point may be a breach of professional ethics rather than a fit problem. In such a case do not blame yourself; you have the right to end therapy and, if necessary, to apply to the relevant professional body.

On the other hand, not every feeling of discomfort means a fit problem. Sometimes a question from the therapist that challenges you can provoke a strong reaction because it touches an old wound. For example, someone who was often criticised in the past may experience even their therapist's kind observation as criticism. It can therefore be useful to ask yourself, "Is this feeling coming from my therapist's attitude, or from an old feeling that is familiar to me?" Both possibilities are worth talking about, and both can be addressed in therapy. Making this distinction is not always easy, but when you share your feeling with your therapist, how they receive that feedback also gives you an important clue.

How Can You Assess Fit in the First Sessions?

It is important to give yourself time to assess therapist fit. The first session often involves excitement, tension and uncertainty, so deciding on the basis of a single meeting can be misleading. Many specialists suggest seeing the first few sessions as a period of getting acquainted and assessment.

These steps can help you in this process:

1. Take short notes after sessions. After each meeting, answer the questions "How did I feel? Was there a moment when I felt understood? Was there anything that made me uncomfortable?"
2. Share your expectations. Tell your therapist what you expect from therapy, your earlier therapy experiences and what matters to you.
3. Ask what you wonder about. You have the right to ask questions about your therapist's training, the approach they use, how sessions will proceed and confidentiality.
4. Pay attention to your body's reactions. When going to sessions, do you generally feel tense but hopeful, or constantly uneasy and as if you want to run away?
5. Take your own patterns into account. If you generally struggle to trust people, it is natural to be distant with your therapist at first. In that case, giving it time and talking about this difficulty in therapy can be valuable.

You can find more comprehensive criteria for choosing a therapist in the article on how to choose a psychologist.

How important are personal characteristics?

Some clients say that the therapist's age, gender, cultural background or the language they speak is important to them. For example, someone living abroad may prefer to work with a therapist with whom they can express their feelings in their mother tongue. A teenager may feel they can talk more comfortably with a therapist they think is close to their own age. These preferences are legitimate and can be taken into account. However, the quality of the relationship often depends less on these characteristics than on the therapist's way of listening, their capacity for empathy and their professional competence. Do not hesitate to voice your preferences in the first meeting; this information helps both you and your therapist assess whether the process suits you.

What Can You Do When There Is a Disconnection in the Relationship?

Even in well-functioning therapeutic relationships, disconnections occur from time to time. Something your therapist says may hurt you, a cancelled session may wound you, or you may disagree about the direction of therapy. In the psychotherapy literature, such situations are called alliance ruptures and are seen as expected, even valuable, moments.

When you encounter a situation like this, you can try the following:

• Notice and name your feeling. For example, "After that sentence said in the last session, I felt misunderstood."
• Bring it up in the next session. Raising it at the start of the session ensures enough time is set aside.
• Observe your therapist's reaction. A good therapist listens to this kind of feedback with curiosity, owns their part and makes an effort to repair the relationship.
• See the value of repair. Openly talking through and repairing a hurt can be a very important learning, especially for someone who avoids conflict in their relationships or has experienced conflicts always ending in a break.

If the relationship cannot be repaired despite open conversation, working with another therapist is also a healthy option. For more information on this, you can look at the article on when therapy isn't working.

When Should You Seek Professional Support?

Knowing the importance of the therapeutic relationship should not cause you to put off starting therapy. The worry "What if I can't find the right therapist?" is understandable, but it is impossible to know that without taking the first step. You may consider speaking to a specialist in these situations:

• If your emotional difficulties have lasted a few weeks and are affecting your daily life,
• If you notice recurring patterns in your relationships that wear you out,
• If you struggle to trust people because of a negative experience in the past,
• If an earlier therapy experience disappointed you and you would like to try again.

If you are having thoughts of harming yourself or ending your life, do not wait to search for the right therapist; in an emergency call 112 (emergency services) or go to your nearest emergency department.

How Is the Therapeutic Relationship Handled in Therapy?

Different therapy approaches give the therapeutic relationship a place in different ways. In cognitive behavioural therapy, the relationship is described as a collaborative partnership. The therapist and client are like two teammates who treat the client's thoughts as hypotheses and investigate them together. Asking the client for feedback at the end of sessions, setting goals together and carrying out the process transparently are parts of this partnership.

In schema-focused work, the therapeutic relationship is a direct instrument of change. In this approach, while staying within boundaries, the therapist tries to partly meet the emotional needs that went unmet in the client's childhood, for example the needs for trust, acceptance, understanding and being valued. This is called limited reparenting. For example, a client who has experienced emotional deprivation can, by experiencing their therapist's care and consistency, slowly begin to question the belief "My needs don't matter". The reactions the client develops toward their therapist in this process, for example a fear of abandonment or a tendency to over-comply, also become subjects discussed in therapy.

When working with children, the relationship is mostly built through play. In child-centred play therapy, the therapist follows the child's play without directing it, reflects their feelings and shows an accepting attitude. In this safe relationship, the child learns to express their feelings and to discover their own resources. As in the individual therapy processes carried out with adults, here too the relationship is the cornerstone of change.

Frequently Asked Questions

Do I have to like my therapist?

You do not have to like your therapist personally, but it is important that you can trust them and feel respected and understood. Sometimes a strong working relationship can be built over time with a therapist you felt distant from at first.

After how many sessions can I tell whether there is therapist fit?

Although it is hard to give an exact number, the first few sessions generally help you form an idea. In this process you can pay attention to whether you feel safe and whether a shared understanding of the goals is forming. Sharing your hesitations with your therapist also makes your assessment easier.

Is it normal to feel angry with my therapist?

Yes, feeling anger, hurt or disappointment toward the therapist in therapy is quite common. Expressing these feelings can be a valuable part of the therapeutic process. A good therapist tries to understand these feelings and works with you to repair the relationship.

Can a strong therapeutic relationship be built in online therapy too?

Many clients experience being able to build a safe and strong relationship in online sessions as well. In a video session too, empathy, attentive listening and consistency form the basis of the relationship. For people living in another city or country in particular, online sessions can be a way of continuing to work with a therapist they feel a fit with.

• #therapeutic relationship
• #choosing a therapist
• #therapeutic alliance
• #therapy process

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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