Scared You Won’t ‘Fit’ With a New Therapist as a Highly Sensitive Person?

A Post I Shared on Less Health Stress by Susie Schwartz

Dear Singularly Sensitive Friends,

When Susie Schwartz from Less Health Stress approached me about setting up a collaboration, I knew it was a great chance to connect with another kindred spirit! Susie brings warmth, humor, and a positive attitude to her writing on chronic illness, high sensitivity, and living a good life in the face of significant challenges.

This weekend, we’re officially exchanging posts! We’re kicking off with this article, which she shared on her Substack and I’m including here. Be sure to go to Less Health Stress and subscribe, check out Susie’s other articles, and join in the conversation. On Sunday, Susie’s article, “Being a Highly Sensitive Person is Both a Blessing and a Curse; How You Can Deal with (and even Embrace) It,” will go live on both our sites.

The power of Substack is in facilitating connections and communities of people who would likely otherwise never meet. I’m so grateful to have connected with Susie and to exchange articles with her!

Warmly,
Lori

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Scared You Won’t ‘Fit’ With a New Therapist as a Highly Sensitive Person?

A therapy office is a place of possibility, which can be both exciting and anxiety-provoking!

Guess what? Many psychotherapy clients are highly sensitive people (HSPs) and people living with various acute and chronic health challenges. Society isn’t really set up to support deep thinkers, big feelers, and people who don’t fit with ableist ideals. As someone who has worked in mental health for 25 years and been licensed as a psychologist for the last 15 of those years, I work with people who belong to these groups. I’m also an HSP and have lived with rheumatoid arthritis since I was an adolescent. And, like all therapists should be, I’m a therapy client, too.

All these experiences have taught me a great deal about what makes therapy work for highly sensitive people with health challenges and when therapy may fall short of its promises for people like us. I’d like to pass on some of what I’ve learned to help you start therapy off well or to adjust your current therapy so that it better meets your needs.

What is a “Good Fit” When it Comes to Therapy?

First, finding a “good therapist” is different from finding a therapist who is a good fit for you at this moment in your life. A good therapist is ethical. And ethics includes things like being competent, staying educated, and working within your scope of practice. For instance, while I might be a good therapist for HSP adults, I’m not able to be a good therapist for HSP kids because I have minimal training in child and adolescent therapy. 

A “good fit” therapist, on the other hand, is one with whom you have a strong therapeutic or working alliance. Researchers define this relationship as one where there is collaboration, mutual warmth and connection, and agreement about what the goals of treatment will be. Not surprisingly, research consistently shows that having a strong therapeutic alliance leads to better therapy outcomes for both in-person and virtual therapy. Like having a teacher, boss, or doctor with whom you “click” and who brings out the best of you, a good fit therapist can supportively nudge you to make the changes you desire.

How to Connect with a Good Fit Therapist

I’ll admit that there is probably an element of luck to finding a good fit therapist. A therapist might look great on paper—knowledgeable about HSPs and chronic health issues, working from a framework that you’re drawn to, with an office in your favorite part of town (or practicing virtually so you don’t have to leave the comfort of your home). But will you feel warm and connected, able to work with this person even through the tough assignments and rough patches that inevitably happen over the course of therapy? It’s hard to say. I sometimes think it’s a little bit like buying a sweater. It might be my size and favorite color, but sometimes you don’t know until you’ve worn it for a while how comfortable it really is and how it will hold up over time.

So, what can you do to increase your chance of finding a good fit therapist? Take advantage of the wealth of information available online. Therapist directories like the one on Dr. Elaine Aron’s website can help you get a feel for the range of therapists available. Use your sensitive strength of deep reflection to narrow down a list of therapists you’d potentially like to meet. 

Once you connect with a therapist, use the initial consultation and intake session to ask questions about what matters to you. Personally, I think it’s helpful to find out what a potential therapist knows about HSPs. It may surprise you to hear that not every therapy graduate program covers high sensitivity, especially if a therapist has been practicing for a longer time. Decide for yourself how much you want to do to educate a potential therapist and how receptive they may be to what you have to share. You also may want to get a sense of a potential therapist’s experience in working with individuals with health issues in general and your specific concerns.  

While it is important to listen to your intuition in selecting a therapist, it’s equally important to not assume that feeling a little uncomfortable in the early phase of therapy is a sign that your therapist is a bad fit. The therapeutic alliance is a real relationship. Like all relationships, there is a phase of getting to know each other that sometimes feels awkward, vulnerable, or uncomfortable. If you aren’t getting any clear signs that a therapist is a poor fit for you, ask yourself if you are willing to allow the relationship to bloom before deciding to move on. This is especially important if you are someone who typically is slower to form relationships of all sorts. You’ll probably find yourself creating a therapy relationship in much the same way as you would any other new connection. 

How to Improve Your Fit with the Therapist You Have

Once you’re engaging in regular therapy, your relationship with your therapist will continue to evolve. The therapist is primarily responsible for making sure that the relationship is healthy. Part of my job as a therapist is to help people experience a healthy relationship with me, so that they can improve their other relationships. That means the therapist should be doing things to set and keep boundaries, move you toward your goals, and talk with you about how you’re experiencing them and the therapy process. You’ll notice that these are things that support a strong therapeutic/working alliance.

But you play a role in this process. My mind reading powers are not flawless. I need my clients to tell me what they like and dislike about therapy, what they need more or less of from me, and how they feel about the goals we’re working toward. In fact, I really enjoy when my clients are “real” with me and share honestly. It makes me feel closer to them, because it helps me see their uniqueness. So, give feedback, ask questions about the therapy process, and accept responsibility for co-creating the therapeutic relationship.

One of the worst feelings as a therapist is to have someone end therapy by telling me they’ve been dissatisfied with the process for some time. Please bring that up when it happens so that we have a chance to figure out other ways of working together. My ego is not so fragile that you can’t tell me that you hated the homework I gave you or you can’t stand something that I do each session. It’s better to risk feeling awkward or upsetting your therapist than to keep silent and feel like the goodness of fit is breaking down. Just like when we have a difficult conversation with a friend or a partner, the temporary challenge of doing it is worth the closeness it creates in your relationship. 

What if the Fit isn’t Good?

Sometimes, problems with fit can signal that it may be time to find a new therapist. I’ve seen a couple things happen that can get in the way of maintaining a good fit. One is that something happens in a client’s life that the therapist may not be well suited to support a client through. It could be something situational that has nothing really to do with you as a client. For example, your therapist may be dealing with something like a divorce or a death in their own life that makes it difficult to support a client. In those cases, switching to a different therapist may be the best route forward.

Another situation that may arise is that you may have something new occur in your life or something develop in your therapy that your therapist isn’t ethically qualified to treat. In my practice, if someone discloses that they have an eating disorder or an addiction to alcohol or other drugs, I work to get that client referred out to someone in the community with expertise in these specialty areas. I can’t maintain a good fit with someone whose needs are not within my scope of practice. That’s in no way a fault of the client, but it’s my duty as a professional to make that tough referral. It’s a bit like if your family physician refers you to a cardiologist. It’s nothing personal, just a limitation of what I can provide.

You might also discover that you’re not feeling like you have a good fit with a therapist based on how they work with clients. Perhaps you’re longing for a therapist to give you very blunt feedback or use structured activities and homework exercises as the focus of treatment. If your therapist is like me and is much more permissive and therapy sessions are individualized and client-directed, you might realize at some point that you’re not getting the kind of therapy you want. (And many clients don’t realize this until they’ve had the experience of not fitting with a particular therapist’s way of working.) In that case, consider switching to a therapist whose theoretical orientation gives you what you need. Your current therapist can even help you understand how to look for that in the future. 

Ideally a therapist should be your partner in deciding when and how to end therapy. Hopefully there have been discussions about how to adjust therapy to improve the fit. However, if your therapist cannot or will not make the changes you wish, you face a difficult choice. Some clients will stick out these situations. After all, it can be hard to find a therapist and work out logistics like scheduling and payment or insurance. The thought of starting over with a new therapist may be very unappealing. You may hope that things will get better and decide to give that a chance to happen. Or you may decide it’s not worth it to start over.

Many times, clients will eventually decide that they need to discontinue working with their  therapist because the fit isn’t good enough anymore. You are completely entitled to make that decision. In fact, it can be a good thing to recognize when you’ve outgrown a therapist or you want something else from therapy. Therapists have a lot of experience with endings, so you should never stay in therapy for the sake of your therapist.

Therapy is a great place to practice healthy ways of ending a relationship. Very often in everyday life, endings happen to us—our partner dumps us, a friend moves and the relationship fizzles, someone dies. In therapy, you can choose to participate in a healthier, direct, intentional ending. That’s no easy assignment. You’ll need to manage any tendency you might have as an HSP to care more about other people’s feelings than your own. And you’ll have to do it in a way that respects whatever spoons you have available as you deal with your health at the same time. However, I think this opportunity to expand your interpersonal skills is worth the effort.

Planning to discontinue therapy is also your opportunity to give your therapist feedback that may help them improve how they work and grow as people. We cannot get better as therapists if no one is honest with us about what it’s like to be our client. And while we’re trained to manage it, therapists don’t like being ghosted by clients either. It hurts us, too.

Don’t Settle

The biggest takeaway I want to leave you with is that you deserve to have a good fit with your therapist. Do your part to work on the relationship you have with your therapist, but if you still aren’t satisfied, give yourself the gift of self-loyalty and find a new one. There are plenty of therapists who have the knowledge, experience, and heart to be a great support to HSPs with health issues. Don’t settle for less.