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LET’S say you have what you believe to be a healthy marriage. You’re still friends and lovers after spending more than half of your lives together. The dreams you set out to achieve in your 20s — gazing into each other’s eyes in candlelit city bistros when you were single and skinny — have for the most part come true.

Finding a therapist who can best help you starts with choosing the right person, but not necessarily the right therapy.

Bruce E. Wampold, PhD, a professor of counseling psychology at the University of Wisconsin–Madison, analyzed data from 6,000 patients seeing more than 500 therapists and found that all schools of talk therapy can work—if the therapist is competent and in sync with his or her patient. Watch this top psychiatrist explain why it’s important that you feel liked by your therapist, and why a growing number of experts are recommending a cognitive behavioral therapy approach for depression.

“It’s important that you agree on the purpose of therapy and how you will accomplish that,” says Keris Myrick, 46, of Pasadena, Calif., who has treatment-resistant depression and is a veteran of the mental health system. But finding the right mix of chemistry, experience, and area of expertise can be elusive.

Ask, “Have you been here?”
“I’m a little biased here, but I think you should go with someone has had to go through the process of therapy,” says Jayne Bloch, a psychoanalyst and member of the National Psychological Association for Psychoanalysis Institute in New York City. “You’re taking this journey to places unknown; it helps to go with someone who’s been there before.”

Some patients, like John Head, of Berkeley, Calif., luck out. “I chose a therapist the wrong way, based on who was closest to where I live. I didn’t ask any questions about methods, training, philosophy. But as it turns out, I got someone very good.”

Joseph, 55, had a different experience. He cycled through four therapists in his 25-year quest to find relief for debilitating depression. “I went to one old tweedy guy who said you have to commit to coming for two years. I never returned.”

“Then I went to a woman therapist who wasn’t bad, but she was very laconic and we never connected. Every time I brought up antidepressant medicine she would turn around and look it up in the Physicians’ Desk Reference. It was not very reassuring.”

He suffered unnecessarily for years as this therapist tried and failed to help him. Eventually, he says, “she threw up her hands and referred me to another, more aggressive therapist who I couldn’t stand but went to anyway until he eventually died.” Joseph finally landed in the office of a psychopharmacologist who put him on the correct medication. “Three weeks later I felt normal,” he says.

Keris Myrick has found success with a therapist who works as a collaborator when she feels well, but who is willing to take the reins when she is in the depths of despair. “Sometimes he says, ‘You’re not well enough to make this decision now, you have to trust me to make this decision, and when you are well we can discuss it.’ I like that,” she says.

While it may be impossible to avoid such experiences, agreeing on goals and a timeline in the very first session can help.

It’s also a good idea to ask what your therapist will expect of you. Myrick switched therapists when the homework her cognitive-behavioral therapist assigned made her feel childish. “For example, we were to read a newspaper, pick an article, and talk about it. This was to help with concentration, but I was feeling worse at the end of therapy sessions.”

Research suggests that shared goals and the feeling of being liked and deeply understood are better predictors of a good outcome. “Therapy will be unnecessarily difficult if you and your therapist don’t get along, don’t like each other, or are working at cross-purposes about the goals of treatment,” says William C. Sanderson, PhD, a professor of psychology at Hofstra University in Hempstead, N.Y.

Personal style matters too. Says Seeman: “You don’t want someone who really needs to unload and solve problems to be working with a therapist who sits there nodding.”

What makes a good therapist?
Some people may feel more comfortable with either a male or a female therapist, or one of certain race or age. John Norcross, PhD, professor of psychology at the University of Scranton in Pennsylvania, believes that in some patients, very specific preferences can make a difference.

“There is nascent, emerging evidence that if a patient has a strong preference of therapist, that should be honored,” Norcross says. “Some of that makes perfect sense. If a woman’s depression is due to sexual assault, she may feel more comfortable with a woman therapist.”

Most people are Never taught how to have a good relationship. We usually learn how to be in a relationship by watching others. We start by watching our parents interact with each other and usually note what we don’t like and absorb what we do. As we attract our first significant other we practice with them. We then begin to see what works and what doesn’t work for all our friends relationships until we settle into a kind of habit. This habit results from trial and error. Most people will go through the heartbreak of breaking up with someone and being on the other end of being broken up with. We learn how to deal with feelings. We communicate in the best way we know how. Over a long period of time we settle into the way we relate to our partner. Most of the time we find that our relationships are okay, not horrible but not great. After a while a lot of people lose that loving feeling and just settle into life. What if those good feelings for your partner could continue to grow?

When people come to see us and they are feeling anxious it is because they don’t know what to expect. They don’t know if we are going to tell them that they are wrong, if we are going to choose sides, or if it just is not going to help. What we find is that each couple is unique. Some are commited to working through the problems. Others are here to see if something esle might work but go home and do nothing different. Still other couples come in and one partner has really already left but is putting on a good show of “trying”. What we tell everyone is that their therapy sessions could be fantastic but if they don’t change how they act with each other at home nothing will change. In order to facilitate that change we give simple homework assignments, sometimes lasting only fifteen minutes, twice a week. We also have you practice new communication skills in the office. This way we can referee when you drop back into your old habits and give you many suggestions on how you could have said something differently. We do a fair amount of talking but balance that with you talking to your partner. You will share your hopes and fears.

We are often asked how long will it take. That is up to you and how hard you work with each other at home. The fastest time that anyone has significantly turned around their relationship was five weeks and the slowest time was two years. The couple that worked fast had a deep connection and love for each other that made them want to try everything. When they did and it worked they tried even harder. The couple that took longer both had difficulty trusting their self and their partner. They had to work on personal issues while trying to make a relationship work. In the end it worked because they were in it for the long haul. We have seen that when both people have a deep commitment to making their relationship work, it eventually will.

How many of us only tell the truth to our partner when absolutely necessary? I talked to someone today who was in a fender bender 6 months ago. She was driving down the street when the woman in front of her slammed on her brakes. She hit her. They stopped and checked for damage. The woman who was hit had no damage. My friend had a small dent. They exchanged information and drove off. Last week (a full 6 months later) my friend was stopped by a policeman for speeding. When the policeman checked her record, he told her that her license had been suspended. Luckily, she had her small child in the car so the officer let her drive home with the understanding that she’d contact DMV in the morning. Imagine her surprise when she found out her license had been suspended due to an unreported accident resulting in an injury! But that wasn’t the worst part. She had explained the small dent in her car to her husband as someone probably hitting her in a parking lot while she was shopping. Oops. Now she had to tell him the truth, the whole truth. Why? Well, not only was her license suspended, but her husband’s license could be taken away as she was driving his car.

How common is it to tell a lie if we think we can get away with it? And why do we feel the need? Fear? Embarrassment? I remember taking our brand new car out for the first time and backing into a mailbox. I was 22 and newly married. When I got home I didn’t say a word. My husband noticed the dent the next morning when he got in the car to drive to work. He was furious. I’m not sure I ever copped to the truth. I was way too scared.

What else do women commonly lie about? The most common lie I hear is women who hide new clothes for a couple weeks. When they finally wear the new clothing and their husband asks, they simply reply: no, this isn’t new. I’ve had it awhile. (Well, it’s kinda true.) I have to admit, I’ve been there. So glad that’s all in my past. It’s way too stressful.

The way we work with couples and the way it usually works out is a few sessions of very honest communications. Each person puts their concerns on the table and we work through them. It usually starts with some skill building as very few people are good listeners. The other half of that communication skill is learning how to own what is going on inside you without blaming your partner. Most people don’t even know they are blaming the other and find it difficult to own their own feelings.

After practicing these skills it comes down to being honest about what you don’t like in the relationship and what you would need for it to go forward. It hurts to hear what is being said but if you can get through it and agree to any changes, compromises or requests, then your relationship has a greater chance of succeeding. Sometimes, the clear communication allows both parties to understand what is happening and change happens with an agreement that it really isn’t working. Then the mutual ending is a smooth and oftentimes peaceful one. The last scenario is one where one person doesn’t agree which leads to a lot of sadness in the breakup.

The best outcome, no matter which of these three descriptions happens, depends upon the honesty of both parties. You need to speak your truth but should always make it the “sweet truth”. Don’t go out of your way to make yourself feel good but strive for mutual respect. By doing this you guarantee the best possible outcome, which is always growth.

Well, what if you could be happier? What if it felt like life became smoother? What if you felt like you had a partner who always had your back, who had your best interests at heart? A wise man once said that a great relationship was one were each person took care of the other persons needs, so much so that the first person didn’t even need to think about what they wanted. That way they never needed to worry about what they needed because it was taken care of. This might be an ideal to strive for, or not but it does make one think. There really is no end or finish line for a good relationship. It can just keep building, developing, growing and deepening. 

With today’s incredibly fast-paced and over scheduled life you might believe working on your relationship is a good idea but not for you or not right now. I would like to suggest trying to put just a little more attention on your communication or affection, something that would demonstrate to your partner that they are important. It doesn’t take any effort and hardly any time but the rewards are tremendous. Why don’t you try it, you’ll like it.