Study: It's Important to Match Therapists and Clients Based on Specialty

When people are seeking mental health care in the United States, they are not necessarily referred to clinicians who are the best fit for their needs. Instead, the cost of mental health care is what often takes precedence in the referral process. But a new study finds that may not always benefit the patient.

A new study, published in both the JAMA Psychiatry and the Journal of Consulting and Clinical Psychology in June, took a deeper look at how the therapist-patient matching process affects therapy's ability to help.

Researchers found that people who were matched with therapists who had a strong history of treating the patients' main concerns exhibited better results than patients who were not matched in this way.

Michael G. Wetter, PsyD, FAPA, a licensed clinical psychologist and the director of psychology at UCLA Medical Center's division of adolescent and young adult medicine, who was not involved with the study, tells Verywell that in the U.S., people seeking mental health care are often referred based on their insurance coverage. Insurance providers typically generate an automated list of providers.

Referrals come "not based on specialty," Wetter says, "but based on coverage that isn't necessarily a reliable source in which to determine if it is a good fit."

Matching Patients to Therapists

Researchers at the University of Massachusetts Amherst wanted to know what would happen if a person was matched with therapists who had strengths in treating that person's primary mental health concerns.

The trial included 48 therapists and 218 patients at six community clinics in a healthcare system in Cleveland, Ohio.

Before the trial began, the therapists were assessed as being effective, neutral, or ineffective at helping patients manage different mental health concerns.

The mental health concerns fell into 12 categories:

• Depression
• Quality of life
• Mania
• Panic or somatic anxiety
• Psychosis
• Substance use
• Social conflict
• Sexual functioning
• Sleep
• Suicidality
• Violence
• Work functioning

The researchers categorized the therapists as being efficient at treating all, some, or none of a patient's concerns. Neither the therapists nor the patients knew how the therapists had been scored.

Patients were randomly assigned to either a "good match" therapist or assigned to a therapist using the standard process. To qualify for matching, the therapists had to have completed a minimum of 15 cases with patients who shared similar concerns.

The results showed that therapists were most effective at helping patients when they had a track record for treating their specific mental health concerns.

How to Assess Potential Therapists

Currently, patients are often given a list of therapists to contact for treatment, but experts recommend that people do their research to find a therapist that's the "right" fit. For example, searching databases for mental healthcare providers who treat their condition is an "unofficial" way of matching.

Marla W. Deibler, PsyD, a licensed clinical psychologist and the executive director of the Center for Emotional Health of Greater Philadelphia, tells Verywell that people should "look for therapists who have that expertise."

To start their search, patients can turn to organizations and groups that provide resources on the conditions that they have been diagnosed with. "For example, if they have obsessive-compulsive disorder, there's a national advocacy organization called the International OCD Foundation, IOCDF, and they have a provider database on their website," Diebler says.

If someone is undiagnosed, Deibler says that they can still research therapists who treat their symptoms or a condition that they think they may have. For example, if someone thinks that they have symptoms of borderline personality disorder, it could be helpful to search for therapists who use dialectical behavior therapy (DBT).

What You Should Ask a Provider

Experience isn't the only factor to consider when looking for a therapist. Wetter says that people should also look into potential providers' training and education.

"Few potential clients and patients actually look into the training of the therapists, they're going to be working with, and that's really important," Wetter adds. "If you were seeing somebody for example, for adult-related issues, but all of their training was focused on pediatrics, is it going to be a good fit?"

The National Institute of Mental Health (NIMH) recommends that people ask prospective therapists certain questions to help assess whether the therapist is a good fit.

When you are talking to a potential mental health provider, the NIMH suggests getting answers to the following questions:

• What approach will the therapist take to help you? Do they practice a particular type of therapy? What is the rationale for the therapy and its evidence base?
• Does the therapist have experience in diagnosing and treating the age group and the specific condition for which treatment is being sought? If a child is the patient, how will parents be involved in treatment?
• What are the goals of therapy? Does the therapist recommend a specific timeframe or the number of sessions?
• Are medications an option? Is this therapist able to prescribe medications?
• Are the meetings confidential? How is confidentiality assured? Are there limits to confidentiality?

Once a person has done their research and asked questions, it's important to take a step back and consider whether they feel that a particular mental healthcare provider would be someone that they would feel understood by and that they would feel safe working with.

"When someone does identify a potential therapist, it's important to have that assessment," Deibler says. "And make sure that they feel comfortable and that they find that the treatment plan sounds like the right plan for them."

Limitations of Therapist and Patient Matching

While Deibler sees the value in official or unofficial matching, they are concerned that "insurance companies could potentially take advantage of that, in a way that negatively impacts therapists, through demanding outcome data."

Matching based on shared concerns—whether through a confidential system like in the study or through a database—could be helpful. However, as with any matching service, the person one is matched with is not always perfect.  

"A dating app may help narrow the field so you can decide who is it that you would like to pursue and then find it's a good fit," Wetter says. "The same goes with this."