Ask Clare: How to find a good therapist

I "auditionned" so many therapists before finding *the one*

Welcome to Ask Clare, an advice column about life after trauma. This column has quickly become one of my favourite things to write; I appreciate your questions and love being in dialogue with you about the messy, complicated work of healing from serious trauma. 

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I’ve experienced sexual violence and am wondering if you have any advice for finding a trauma-informed therapist. I have heard very mixed things about different charities and I know the standard varies from therapist to therapist. I am exploring my options, but I always feel that it's better to have a personal recommendation because some therapists can do more harm than good. Are there trauma-informed services you would recommend?

– Don’t Know Where To Start

You’re right, Don’t Know Where To Start. Some therapists absolutely do more harm than good! I’ve been in therapy for a long time and have had several difficult, re-traumatising experiences. The mental healthcare system in Ireland (& many other places) is labyrinthine, exhausting and often deeply dysfunctional. Trying to find support in that system would challenge the healthiest of us, and most people are navigating it at a deeply vulnerable time. It shouldn’t be this way. Trauma survivors should have access to comprehensive support services, including holistic mental healthcare. These services should be adequately funded, easily accessible in every community, and free from stigma. 

It’s wrong that individual survivors have to navigate a system that isn’t fit for purpose. But since that’s the system we have, and you need support right away, I’m going to leave my anger aside and share some learnings from my own experience trying to find a good, trauma-informed therapist. 

I’ll begin with some general advice on how to think about your search and what to look for. Towards the end of this piece, I’ll include some recommendations for services in Ireland that might be a useful starting point¹. If you’re not in Ireland, please contribute your suggestions in the comments so other readers can benefit from them.

Therapy & me

I began therapy in my early teens. The hormonal deluge of puberty coupled with a very unhappy home tipped me over from being a normal if contrary kid, into a kid who needed some extra support. My mother, who was training to be a psychotherapist at the time, gently suggested that I might like to talk to someone. She gave me the names of two therapists she knew from her training, and I chose the one with the nicer name. My first therapist guided me through my teen years, the death of my mother and the early years of coming to terms with the sexual abuse I’d experienced as a child. 

In hindsight, there’s a lot about our work together that I question today. There are things I feel she missed, and ways I think she let me down.² But she was by my side through a very tumultuous time in my life, and I’m grateful for the support she provided. I stopped seeing her in my mid-twenties and, after a traumatic work trip to Gaza, I needed to find someone else. I was holding down my job, but most of my weekends were spent crying. I went to my GP who referred me to a psychiatrist who referred me to a psychologist. 

I’m the stuffed toy, being tossed among the “professionals”

Each step of the process was both financially and emotionally expensive. I’d drag myself out of bed to catch the 6.30am bus to the clinic. It was deep winter, and the mornings were dark and icy. Eventutally, cognitive behavioural therapy was recommended to me. I signed up for a few months of intensive sessions which absolutely did not work³. What I didn’t know at the time, what I only really understood when I got access to my medical records, was that the person I was paying to help me wasn’t up to the task. His work was sloppy. He made several basic errors both in conversation with me and in my paperwork. He thought, for example, that I was married and that I grew up around alcoholism, neither of which were true. When I asked him a direct question, he would laugh and try to deflect. His manner was cold and condescending. 

Like anyone experiencing a mental health crisis, I was very vulnerable at the time. I didn’t know what kind of support I needed, and also didn’t believe I really deserved it. When it didn’t work, I assumed I was doing something wrong. I assumed I just needed to try harder. I wasted a lot of time and money trying to get better, not knowing that I was actually deepening my trauma. This is all to say, Don’t Know Where To Start, that it’s not always easy to find the kind of mental health support we need. You hope that a medical professional will respond with compassion and care, but they might not. Your task is to stay close to yourself. To think about what you want, and to keep trying until you find it.  

After I quit, I took a break from therapy. I needed some time to rebuild myself. When I was ready, I tried again. Writing this piece, I went back to my journal from that time. This is part of what I found: 

“I went back, not because I felt like death, though I did sometimes, but because I wasn’t able to write. To not be able to pursue this vocation felt like too high a price to pay.”

This time, I approached my search more methodically. I thought about what I wanted and set the following criteria: 

• No-one who looked like or reminded me of the people who’d hurt me,

• No-one who, when I looked at their picture, my intuition rejected (an “ugh, no” voice)

• No-one who I thought wouldn’t be able to handle my story (which I know can be a lot for some people)

• No-one who I thought telling the truth to would feel like telling a child that Santy isn’t real! (aka no-one too young or too earnest)

• No-one who talked about mindfulness or meditation. (For an abuse victim/survivor, these modalities can be intensely triggering). 

• No-one with any bodies of water on their websites - no lakes, oceans or rivers. 

• Ugly websites were OK

Catching my breath on the grass before auditionning another therapist

With this criteria in place, I started scheduling introductory sessions with therapists around Dublin. Within a few weeks, I’d auditionned a half dozen therapists.

1. The first was an instant no. Her approach was psychoanalytic, and there was a practiced coolness to her gaze. What I remember most is the way she tossed aside the consent form I handed her, as if it didn’t matter at all. (I hadn’t signed it. I had a question about it.)

2. The second asked for a family history and when I responded with ‘asthma’, she guffawed loudly before regaining her composure and diligently writing it down.  When I reeled off my sorry tale (dead mother, sexual abuse, cPTSD, etc), she made a fist out of her hand and said “YES!”. I never went back. 

3. The third got real very quickly. She seemed kind and self-aware. She was honest about the things I might find difficult about working with her. Reflecting on it afterwards, I realized I hadn’t felt emotionally safe with her. I wasn’t sure I could feel emotionally safe with anyone, TBH, but I still didn’t go back.

4. The fourth was a disaster. When I talked about sexual abuse, she told me that three people in her class had also been sexually abused and wasn’t that mad? It was so comically bad that I stopped thinking of it as a therapy session, and more as a comedy bit I’d be able to retell one day. 

5. Another therapist described my life as horrific, which was maybe not untrue but certainly wasn’t helpful. 

Sixth time’s the charm

Eventually, I found someone. I remember her warm handshake, and how grounded she seemed. She said something in our very first session that completely reframed how I thought about my life. I remember that moment still - when the reality I’d adopted was punctured by an external piece of logic. I booked a second session. 

I don’t say all of this to overwhelm you, Don’t Know Where To Start. I say it to communicate that finding a good therapist isn’t always an easy task. It takes time and work and emotional energy. But when you find someone good, it can change your life.

Finding a new therapist isn’t a task that can be easily ticked off your to do list. You’ll need to make calls and send emails and schedule appointments during which you’ll share your deepest traumas. It’s not like finding a dentist or a plumber or a hairdresser. It’s a completely different kind of task. So my first piece of advice is to take good care of yourself while you do it. Give yourself the time, space and self-compassion you need to do it well. You are taking a brave step toward something you hope might help you heal. Try to honour the courage it takes to try. 

The single most important factor to a productive therapeutic experience is the relationship between the therapist and the client. When you’re vulnerable and suffering, it’s not always easy to know what that should look like.

 For me, some of the key qualities of a good therapist are:

• Empathetic, caring and compassionate

• Offer a fresh perspective on your experiences and help you to question things you always assumed to be true

• Insightful, curious and willing to dwell in the experience of ‘not knowing’

• Good boundaries. For me, the less you know about the therapist’s life outside the therapy room, the better. 

• Receptive to your feedback, questions and ideas

• Led by the client. The client decides what you want to discuss and at what pace. 

• Honesty. 

• Suitably qualified and accredited by the relevant professional bodies. In Ireland, that’s the IaHIP.

• That you feel safe with them, which is not the same as it feeling easy all the time. It might be horribly difficult, but a good therapist will be by your side as you navigate the hard things.

You might also want to think about your ideal therapist’s identity. Maybe you want a therapist who shares your class or racial identity or someone who’s part of the LGBTQIA+ community. It’s OK to be choosy.⁴ You might not find someone who meets all your criteria, but giving yourself some time and space to think about the kind of therapist you’d like is still a useful exercise. 

Resources in Ireland:

The best starting point for survivors of sexual violence in Ireland is the network of Rape Crisis Centres. There’s more information about their services here. I’d recommend that you call and ask about therapy. The waiting lists are often long, so the sooner you do this the better. It takes courage to make that call. I remember how nervous I was, but I wrote myself a little script and was very relieved when it was done. Two things that aren’t on the website, but I think survivors should know: 1) there is a limit of 80 sessions per person (so about 18 months of attending weekly) and, 2) they don’t support people who are in active addiction. 

If you call your local Rape Crisis Centre, I’d also suggest that you ask for any recommendations for therapists in private practice. 

There are also some online directories (one, two) and some mental health charities that could be a useful starting point. 

Insight Matters is a collective of therapists (& other folks) working from Capel St in Dublin, run by a lesbian couple. 

If you have a good GP, they could also be a good starting point. (I also understand if you want to keep this aspect of your story separate from the doctor you see when you need a flu shot!)

Once you’ve found a therapist that feels like a good fit, give yourself some time to see how it goes. If you feel like you’re not getting what you need or are concerned about something, talk to your therapist about it. If you find yourself lying or obfuscating the truth, if you feel nervous or apprehensive about being fully honest, try to talk to them about that too. A good therapist will want to hear about your experience in the therapy room⁵. 

I wish I could say that finding a good therapist was the hardest part of the process. It wasn’t. Those first few years after Gaza, I found therapy incredibly difficult. It wasn’t unusual for me to sob through the entire session. Most days, I sobbed on the bus on the way to my appointment and again on my way home. My therapist and I often talked about how painful I found it. But even in the hardest moments, I knew I wouldn’t quit. I knew it was helping. 

If therapy feels impossibly difficult to you, please know that it isn’t just you. Often when we’re trying to heal, things get worse before they get better. I don’t say this to scare you, but to encourage you to treat yourself kindly while you’re going through it. Find some good TV to watch. Cuddle a pet. Talk long, angry walks. Do whatever it takes to mind yourself. Know that it won’t be like this forever. It feels like it will be, but that’s a lie. Time passes. Our lives change. You just have to keep going. 

A therapist once told me that she considered it an honour to be able to do her work. I was sobbing at the time, slowly disintegrating into a pile of snotty tissues. There was nothing about that moment that felt honourable. But looking back, I think she was right. Your task is to sort through the chaff and find someone worthy of walking alongside you as you rebuild your life. I wish you fortitude and good luck as you begin your search. 

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💬 In the comments, I’d love to hear about your experiences with therapy. How did you find the therapist who helped you most? And, how did it help you heal? 

💰Starting next month, the Ask Clare column will be a paid subscriber perk. Prices will be increasing from €6 to €8 per month, and I’d love to welcome you at the lower rate: 

If you enjoyed this essay, you might also appreciate:

Ask Clare: How to navigate grief and trauma in close relationships?

1. Obviously, I’m not a medical professional. This essay is based on my own personal experience. Please take what’s useful and leave the rest! 

2. I’ve written about that here.

3. I’ll write more about why another time!

4. Being able to choose is also a privilege. I was only able to audition a half dozen therapists because I had the money to pay for it. I could manage appointments around my full-time job because I didn’t have additional caring responsibilities. I was based in Dublin where there are lots of options, and had the bandwidth to navigate a messy, disjoined system.

5. One last thing to flag: I’ve heard of several therapists who refuse to work with survivors of sexual violence, particularly incest and CSA survivors. If that happens to you, please know that it’s not about you. If that makes you angry, please know that I’m right there with you. “I’ve had to live it, and you can’t even bear to listen to me talk about it,” is how my internal rant usually begins. But the truth is that we don’t know why that person has set that boundary for themselves. Maybe they’re also a survivor? Maybe they’ve got a full practice of survivors and can’t responsibly support you too? We don’t know and it doesn’t matter, because they are not the therapist for you.