I have been a therapist for a long time, which means I have also spent a long time knowing other therapists. I have consulted with them, referred clients to them, received clients who previously worked with them, supervised developing therapists, and watched people build careers in this profession. One thing becomes increasingly clear the longer you do this work: it can be remarkably difficult to know who is actually a very good therapist. The things that are easiest for the public to see are not necessarily the things that tell the tale.

We live in a world in which therapists have websites, social media accounts, professional photographs, directories full of specialties, certifications after their names, and increasingly sophisticated ways of marketing themselves. None of those things are bad. In fact, therapists need to help people find them, and communicating clearly about what you do is part of running a responsible practice. But marketing tells you how well someone has communicated their expertise. It cannot necessarily tell you whether the expertise is there.

That creates an unusual problem for someone trying to choose a therapist. If you were hiring someone to remodel your kitchen, you could look at kitchens they had remodeled. If you were choosing a surgeon, there might be hospital affiliations, procedure volumes, complication rates, and other data that at least begin to tell you something. Psychotherapy is private by design, so much of the actual work happens where no prospective client, and usually no other therapist, can see it.

Therapists Have the Same Problem You Do

Even therapists don't always know which other therapists are excellent. We know who is visible. We know who presents at conferences, who has impressive credentials, who runs a successful practice, and sometimes who seems to receive a lot of referrals. Those things can be meaningful, but they are still proxies for the thing we really want to know: What happens in the room?

Over time, though, therapists sometimes get glimpses of one another's work. We consult together and begin to hear how another clinician thinks about a difficult case. We refer someone and later see what changed. Sometimes we begin working with a client or couple who previously spent significant time with another therapist, and we get to see what they learned, what they understand about themselves, and whether anything meaningfully shifted.

Even those observations have to be held carefully. A client who made little progress with another therapist may not have been ready to change at the time, or the therapist may simply have been a poor fit for that particular person. A client who improved dramatically may have done so because many things in life came together at once. Therapy is far too complicated to look at one outcome and declare that a therapist is good or bad.

Still, after enough years in a professional community, patterns emerge. There are clinicians whose thinking you learn to trust. There are people you call when a case has you stumped, and there are people to whom you feel comfortable sending someone you care about. That kind of professional reputation is difficult to capture on a website because it accumulates quietly, one consultation, one referral, and one clinical interaction at a time.

Experience Matters, Except When It Doesn't

Most of us intuitively assume that a therapist who has been practicing for twenty years must be better than a therapist who has been practicing for two. I certainly believe there are things I can see in a therapy room today that I could not see early in my career. After you have encountered variations of the same relational pattern hundreds of times, you develop a kind of pattern recognition that simply cannot be acquired from a textbook. Experience gives you a library of human behavior to draw from.

But here is where the research gets interesting. Years of experience, by themselves, do not reliably predict better psychotherapy outcomes. A 2022 longitudinal study of 241 therapists and 3,432 patients found essentially no association between therapist experience and patient improvement, whether experience was measured by time in practice or by the number of patients previously treated. The researchers did find preliminary evidence that more experienced therapists may need fewer sessions to achieve similar outcomes, but the larger finding challenges something most of us probably assume: simply doing therapy longer does not necessarily make someone better at it.

Other research has been even more provocative. A large longitudinal study published in 2016 followed outcomes for 6,591 patients treated by 170 therapists and found a very small overall decline in outcomes as therapists accumulated time and cases. Importantly, individual therapists varied considerably, and some therapists clearly improved. More recent research involving tens of thousands of clients has also found small declines in some outcome domains over therapists' careers, which suggests that experience alone may not protect any of us from stagnation.

I find this fascinating rather than discouraging. Experience creates an opportunity to develop expertise, but it does not guarantee expertise. Twenty years of practice can mean twenty years of learning, consulting, reconsidering, stretching, making mistakes, changing your mind, and getting increasingly sophisticated. It can also mean repeating essentially the same year of practice twenty times.

There Are Extraordinary Young Therapists

I am particularly wary of using this discussion to suggest that younger or newer therapists are somehow inferior. I've known younger therapists who were extraordinary clinicians. They may not yet have seen enough cases to recognize some patterns as quickly as a seasoned therapist does, but they often bring strengths that those of us who trained decades ago simply did not begin our careers with. Experience is an advantage, but it is not the only advantage.

Some younger clinicians received intensive training in approaches that were only beginning to emerge when more experienced therapists were in graduate school. They may be immersed in current research or especially fluent in the role technology plays in relationships, identity, dating, parenting, sexuality, or anxiety. They may also be working under close supervision, discussing cases regularly, and thinking very deliberately about why they are doing what they are doing. Sometimes they bring sheer energy and enthusiasm to the work, and that matters too.

There is also something humbling about remembering that every experienced therapist was once an inexperienced therapist. I certainly did not begin my career charging what I charge today. I believe my earliest sessions were around $60, and like most therapists, I accumulated experience one client at a time. The therapist I was then had strengths that I still value, but she simply could not know some of the things the therapist I am today knows because she had not seen enough yet.

The reverse deserves to be said just as clearly. An experienced therapist can stop developing. We can become overly confident in our formulations, rely too heavily on what has worked before, stop seeking consultation, or become so familiar with a particular kind of problem that we stop being curious about the particular person sitting in front of us. Longevity deserves respect, but it should never grant any of us immunity from continuing to learn.

Credentials Matter, But They Don't Tell the Whole Story

Credentials are useful. I want therapists to be appropriately educated, licensed, trained, and practicing within the bounds of their competence. If you are seeking couples therapy for a marriage in significant distress, I think it is reasonable to ask whether the therapist actually has substantial training and experience working with couples rather than simply accepting couples as one small part of a broad general practice. Specialization matters because different kinds of therapy require different kinds of clinical thinking.

At the same time, collecting certifications can create an illusion of expertise. A therapist can attend a training, complete a certification, and legitimately add another credential to a website. That tells you the therapist has been exposed to that body of knowledge and, depending upon the credential, may have demonstrated some level of competence. It does not tell you what happens when a furious couple sits down in front of them and begins fighting before the office door is completely closed.

That is where clinical work becomes much harder to quantify. Can the therapist understand the content of what people are saying while simultaneously seeing the pattern underneath it? Can they challenge someone without humiliating them, remain empathic without colluding with them, and change course when their original understanding turns out to be wrong? Those capacities are difficult to put after someone's name.

What About Fees?

People sometimes assume that a more expensive therapist must be a better therapist, and that is certainly not something I would tell consumers. Anyone can set a fee. A therapist can charge $100, $200, $300, or considerably more, and the number itself tells you very little about what happens during the session. Price and quality are not the same thing.

Over time, however, the economics become somewhat more interesting. A therapist who has maintained a strong private-pay practice for many years at a substantial fee has received some form of repeated market feedback. People have not merely called for a first appointment. Enough of them have chosen to continue, other clients and professionals have referred people, and the practice has remained viable over time.

Even that is not proof of clinical excellence. A charismatic therapist may retain people without helping them change very much, while an excellent therapist may work in a community where higher fees simply are not sustainable. Insurance participation, geography, specialty, reputation, socioeconomic factors, and business skill all affect what a therapist can charge. Fee is a piece of information, but I would never make it the deciding one.

The Therapist Matters More Than We Sometimes Acknowledge

One of the more important findings in psychotherapy research is sometimes called the therapist effect. Simply put, therapists differ from one another in their outcomes. Research involving thousands of clients has found meaningful differences among therapists even after accounting for characteristics of the clients they treat, and some research suggests those differences become more pronounced as treatment continues.

That is worth knowing because psychotherapy is often marketed by modality. People search for CBT, EFT, EMDR, Gottman Method, psychodynamic therapy, or whatever approach they have heard might help their particular problem. The model matters, and therapists should know how to use the treatments they claim to provide. But two therapists can be trained in precisely the same model and still not be equally effective therapists.

One study of 69 therapists and 4,580 clients found that therapist age, years of experience, profession, highest qualification, caseload, and degree of theoretical integration did not significantly predict client-reported outcomes. What was associated with better outcomes in a smaller subsample was time therapists spent specifically trying to improve their therapeutic skills. That research should be interpreted cautiously, and later research on deliberate practice has not settled the question, but I think the broader point is important: expertise appears to require more than simply accumulating years.

So How Do You Choose?

I wish there were a formula I could give people. There isn't. I would pay attention to whether the therapist has genuine depth in the problem you are bringing, whether they can explain how they understand that problem, whether their approach makes sense to you, and whether you begin to experience the therapy as something more than an expensive conversation.

In couples therapy, I would pay particular attention to whether the therapist can hold both people without making the work artificially symmetrical. Not every relationship problem is 50/50, and good systemic work does not require pretending that it is. At the same time, a couples therapist who consistently identifies one person as the problem and the other as the reasonable one may simply be joining the couple's existing polarization rather than helping them change it.

I would also pay attention to whether your therapist is willing to talk about the therapy itself. If you are not improving, can that be discussed? If something the therapist is doing isn't helping, is there room to say so? Does the therapist seem interested in whether the work is producing movement, or does therapy simply continue because another appointment appears on the calendar?

And finally, I would pay attention to something much less measurable: Do you have the sense that this person is still curious? Not young or old, not newly licensed or thirty years into a career, but curious. Do they seem capable of being surprised by you, reconsidering what they thought they understood, and continuing to learn?

I have come to believe that experience is tremendously valuable, but only if we do something with it. Younger therapists bring things to this profession that experienced therapists need, just as experienced therapists have something to offer that cannot be accelerated or downloaded. There is room, and a need, for both.

Perhaps the better question isn't simply, "How long has this therapist been practicing?" It is, "What have they been doing with those years?" That is harder to answer from a website, but it may tell you considerably more about the therapist you are choosing.