how therapists choose their clients

My T and I talked recently about how he chooses the clients he will work with, and I was surprised when he said he does a lot of screening on the initial phone call. I don't remember us talking about much of anything on my initial phone call, I just said something really brief like "I'm having problems in my marriage, you were recommended to me as someone who could help," and then he scheduled me for an appointment. I asked him how he could tell and wouldn't he need to first meet with people to know whether he could help them? He says he really can tell a lot from the phone call, but if he isn't sure he might take a client on for a trial period, say 3 sessions, and then make a decision (and he said, of course the client decides too whether they want to work with him). But I got the sense he usually just decides from the phone call. I just wonder how he can decide from 2 sentences on a phone call? Maybe he talks longer to people if he has uncertainty?

He also said that on my first phone call I mentioned the name of a colleague of his as being the source of the recommendation (via a relative of mine--kind of secondhand). I got the impression that saying this name encouraged him to schedule me--opened the door? I then reminded him that the first time I called him, he never returned my call, and I had not mentioned his colleague in that message. I was pressured to call him again by my relative and to use the name of his colleague. And sure enough it worked, as he called me back the same day. My T is very embarrassed when I have reminded him of this fact.

This has made me wonder how therapists choose who to work with. I know some Ts work in a clinic where there is an intake T who does the initial interview and then assigns them to someone who he/she thinks would be a good match. And I recently came across a therapy match service in my area that does the same thing for Ts in private practice. (There's a consortium of about 25 Ts, and one who does the initial interview, and then lines the client up for sessions with 3 different Ts, and then the client chooses their favorite.) I recall that one member here has posted about having a trial period (I think it was ECHOES?).

At my first session, my T gave me some of his insights into my problem and suggested a direction we could take. He said to let him know if I wanted to schedule another appointment, and he would look forward to my call. So he definitely left it up to me, and he didn't put me on the spot in his presence about whether I wanted to see him again. (He also said he knew immediately we were a good match. )

So I wonder what other people's experience has been? How does your T decide which clients to work with? How did your T handle it at the end of the first session, when it was up in the air as to whether you would return? Has anyone ever had a first session and the therapist ended up not taking them on, steering them instead to someone else, saying that it was not a good fit, or that they could not help with that particular problem (outside of the scope of their expertise)?

My T has told me that in our initial meeting, she spent most of it wondering why I needed therapy, since I really seemed to have it together and be in control of myself.....I am amazed at that because inside I was still reeling from a horrible episode of agitated, nearly psychotic depression and a terrible anxiety/premonition of my death and a sense of everything, including me, being unreal. When I went, I was terrified she would see straight into the heart of my darkness and say, yes, you certainly need lots of help! But I presented such a calm demeanor....I think what convinced her that I needed help was when she asked about what I was struggling with and how I felt about it, and I said I was terrified....I was, but obviously it didn't show otherwise! If I had known at the beginning of my therapy how close she was to telling me she didn't think I would benefit from therapy, I would have been horrified......I am sort of horrified when I think about it, actually!
She said at the end of the session then, I do think you would benefit from therapy and I think I'll enjoy working with you.......
I remember her asking me if I had questions for her, talking about how she would understand if I felt she wasn't a good fit for me either and that she would gladly assist me in finding someone else, about a trial period, like 3 sessions or something....things like that. I was in no state to even think about an involved search for another T, though.....I felt then that I liked her and her manner and I would see where things went.....

I had a phone consultation with my T first. I honestly don't remember anything that I said. I know we talked for maybe 20 minutes, but I just don't recall the conversation...I know I was extremely nervous the whole time. I also don't really recall the first session I had with her, except for the feeling that I would really like working with her and that I felt kinda safe in her office. When my anxiety levels are super high, I tend to not be able to recall actual events, only impressions.

Now I'm curious, though. I have some other "housekeeping" stuff I want to talk about at my next session (re-visiting goals and such), so maybe I'll ask her.

My T asked me at the end of my first session if I felt like I could work with him, and I must have said yes. I guess he thought he could work with me too (although he had NO IDEA what he was getting into).

He did tell me that he always refers people with a certain diagnosis. Luckily, I don't have that diagnosis

With my old T, I was under age so my dad made the appointment for me. He just called the office and they gave me her.

There was a T I saw for one session, she was way to earth-crunchy for me, made me point to a smily-face board to tell her how I felt, then assigned me a packet of homework...not to say that that might work for some people, but I knew I woudn't be able to work with that.

The situation with my current T, is exactly like you mentioned. It is a practice of about 15-20 T's and the receptionst takes an intake interview (pretty basic) over the phone, then gives that to the "referal coordinator"..who happens to be my T. He places the client with the T who he feels is best suited for them. My T put me with himself..and I'm glad he did! Our first session was a typical first session...intake, family info, the main points of my story. At the end, he said "So, what would you like to do?" I replied "I think I would like to come again"...and the rest is history.

Hmmm what an interesting question!! I've never talked to my T about this, so I have no idea, but I've never thought of T as screening potential clients. I called a couple before her, but they didn't have my insurance or weren't open for clients at the time. I then left a message for her, probably something like "Hi, my name is X and was wondering if you had any availabilty. Call me back at X." Generic.

I do remember she called back a couple of days later, apologized for the delay and asked what was going on. I briefly told her about my kitten who recently died and who knows what else.

My first session? I know I filled out paperwork, and she asked general questions. She never mentioned a trial period, just "Will this time work for you?" And that was that! It makes me wonder though, she couldn't have known very much about me by that first meeting, but never said either way. I just kind of was her client from the beginning.

When I called my T to schedule an appt., she said we would meet and she would decide if we were a good fit. I went in with a list of my goals and my problems. It seemed very formal and she pointed out that I didn't show any emotion even though I was talking about my emotions. It's not that she was formal; it's just that it was scary the first time every seeing a T.
Then we scheduled the next appt. and I remember saying something like, "I passed?" I was spared rejection. Yaaay! I have wanted to ask her about it but it was obvious that we resonated with each other from the first. So I guess there's really nothing to ask her except confirmation of what I feel already.

hmmmm, this is an interesting topic. For me, my T agreed to see me because he was already seeing my sister and so he knew a lot about our family and had an idea regarding my issues....well, he THOUGHT he did..... I think that he got WAY more than he bargained for! Anyway, I know that he says he has a waiting list right now, so he must have some way of selecting clients versus not....I've never asked him though!

sunrise, thanks for starting such an interesting thread! My first T was with an agency and she was assigned to me. I don't think she had a choice. The others I saw didn't say anything about making a decision to see me, just scheduled appointments. When I went to see my current T, it was more like I was interviewing her. She was the first T I chose myself. After that first session, she thought we were a good fit but I told her I had an appointment scheduled with someone else. She said to keep that, and let her know. I didn't like the other T. During that week, she emailed me the name of an EMDR specialist who was more experienced than she was, and suggested I call her, that it made sense to go with someone with more experience. I didn't know I wanted EMDR but I called the T. I made an appointment, but I panicked and called my T back and told her that other lady scared me. For some reason her voice made me really scared. So, my T said to go with my gut feeling of whom to see. I told her I wanted to see HER, and the rest is history!! I realize I wrote more about how I chose my T than how she chose me. I guess if my T hadn't thought we were a good fit, she would have told me. She was honest about sending me other referrals. She wanted me to find the best T for me, but right from the start I knew we would get along.

I work for a mental health clinic. I do some intakes (2 a week). Throughout the intake we keep in mind the persons needs and preferences, and then give recommendation in the write up as to who they would be best matched with. Sometimes in an intake I feel I would be best matched with the client, so I accept the referral immediately.
I keep any client who has specifically asked for me. I usually work with persons that have autism spectrum disorders, those who intense and dysfunctional family dynamics, difficult teenagers, and children with a trauma history. I also take any who request DBT services. Those are my niches.

Yes, I think they probably don't say anything about a decision unless they decide not to see you.

When I saw my first therapist, I called two others before her. One called back and said she wasn't taking new clients, so maybe I had not passed her "phone screen" with the message I left and that was a nice way of telling me (or maybe she just really was not taking clients). The second one never called back. And when the third one called and agreed to see me, I was just so relieved. I had never been to see a T before, and it is hard making those phone calls when you are falling apart. As I got to know her and her practice, I realized she was probably not doing that well, and therefore would take most any client, even if not in her areas of focus.

Treehouse, I think my T also would not take clients with certain diagnoses. For example, I don't think he would take people whose main concern was an ED. I think that is the sort of thing he could screen on the phone.

poetgirl, that's interesting that your T would turn someone down she judged didn't need therapy--like she doesn't want to work with the so-called "worried well"?

I probably didn't word that too well.....she didn't say she would have turned me down or was planning to, just that her first impression of me was that I had it together and she wondered why I felt like I needed therapy or how much I did really need it. I didn't even act or look anywhere close to as sick as I really was then.....I didn't want to look or act as sick as I was , I wanted to hide it and not appear really sick or troubled or uncontrolled - and guess I was successful. I was hardly even sure I wanted help then....
I don't really know if she would have turned me down......or if she has or would turn others down on that sort of basis. I haven't ever asked her ?s quite like that! I don't get the feeling she really would, though.....
A few weeks into our time together, she did start talking about how she saw me as one of the 'wounded well'......but didn't imply that that meant I was in less need of therapy.

When I first started with my T, he had just opened a private practice so I honestly think he took anyone who gave him a phone call. I don't think he knew what he was getting into, now he probably thinks he should change my name to job security.

I can't speak for all, and wouldn't, but I know for myself that there are some categories of disorders that I wouldn't treat...or couldn't, didn't feel qualified. For those I would refer them to someone who did work with those disorders. I know it used to be an issue depending upon what insurance someone had, though I don't know if that's still a problem.

Generally, in a conversation, a professional can tell if someone really wants help, versus say, whether they are calling because their spouse is forcing them to.. however, many therapists take court-ordered patients as well.

In a short conversation the therapist can tell how desperate the person is feeling. Even if it may be someone they aren't sure they will work with, if a few consultation sessions will help get them out of crises, they may go with it for that...
My own pain/stress clinical psychologist has a partner who is expert with children, though they both can work with nearly anyone.

I do know some who refuse to work with abusers, preferring to leave them to other specialists so they can spend their time on the abused. I think that's admirable...can't imagine having a patient who was abused meet up in the waiting room with someone who abuse(d)(s)...

Remember, therapists are trained in hearing more than just the words you say, and they went into that profession because they are caring individuals who want to help.

My Pdoc told me she only sees the "cool" people. LOL. I was like WTF? She said that she was joking but she does filter out the people that she doesn't want to treat. She says that she will only work with patients that genuinely have a good heart. Apparently she gets a vibe when people enter her office and can tell what kind of person they are. She doesn't do this intentionally, it is just a gut feeling. She said once she agreed to see a woman on a trial basis and finally realized she didn't want to work with her. She said that she didn't want to tell her "I don't want to work with you because my gut says you are a cold, evil person" She ended up scaring her out of seeing her by being really pushy with topics she wanted to avoid to make her not want to come anymore and then she gave a referral for another T.

My Pdoc constantly reminds me that she chose to work with me because I am special and have so much potential and truly do have a good heart even though I am not always kind to myself. I don't always believe it but I do know that she wouldn't say that if it wasn't true.

My first appointment she said "I don't like psychiatry and most psychiatrists. They seem too closed minded and stuck in what they were taught in Med school and are unwilling to think outside of the box." She actually taught me about dissociation in my first appointment as I was doing that but I had no idea what it was. At the end she didn't ask me if I wanted to come back. She said "Ok Cats, I will see you on Wednesday at 3pm." That was quite awhile ago now, But we have developed a wonderful therapeutic relationship and has literally saved my life 2 times now.

Currently her wait list is a few years. Wow.

pretty much every T i've seen has refused to see me unless they knew i was also consulting a psychiatrist. ive never been hospitalised but i think my depression gets bad enough that no amount of psychotherapy will help at times, and ive been fortunate to have prospective Ts be upfront about this with me.

both austin-t and pdoc see me pro bono though. austin-t even paid me once to come back . i know they both only work with people they want to help (austin-t "chooses" his clients; whereas pdoc rejects the ones he doesn't want). i don't know why i've been fortunate enough to find these two people or why they think i'm worth helping above others, but im terribly lucky to have found them both.

Very interesting question!
I have no idea. It's like the first 2-3 weeks of therapy have been erased from my mind. I remember calling her and she asked me pretty intense questions on the phone that left me anxious and nervous but I still went to session. But I don't have a clue what she said or what I said.

I have a feeling that she said she's not really taking new clients but she'll take me... but I'm not sure if she really said that (do you know this? you feel like someone said something but you're not sure if it's true?).
If she did say that then that either means she wanted to work with me or I was desperate enough that she wanted to start working right away.

I never thought that Ts also select clients, but I guess they do. I have no idea when mine decided to see me, but she definitely wasn't (isn't) a person who takes anyone.
The first time I was too scared to call T so I emailed. She emailed me back saying "I will be back from holiday on day X and I'll call you then". I waited a week after the day X, she didn't call, so I called her. It was 2 minutes conversation, she just told me where and when to show up. The first appt was the usual stuff, family, job and so on, she didn't even ask why I came to her. I usually present myself as "I'm perfectly fine and happy", but I guess when she asked how do I feel about (whatever that was) and I said I don't feel, at all, I kind of passed "she really needs help" line. She just asked if I think I can come back and I said yes. The strange thing, she asked if I can instead of if I would like to.

I dont know how my T chooses his clients, but he did say in our first session that he felt we could work together if I was happy with that. He has told me that if he doesnt feel he can work with someone he will refer them elsewhere. I guess Ts are pretty good at knowing quickly whether they can work with someone's personality.
Having said that, I went into T with a pretty "straightforward" problem, was meant to be there for 12 sessions, and its now coming up for session 100 and things get more and more complicated for us both everyday

At the initial meeting, my T told me that she meets with someone a few times and then decides if she thinks they can work together, and that allows the client time to decide if the client thinks they can work together.

...I was a nervous wreck at my 3rd session. lol

[quote=PTSDlovemycats;1729251]She said that she didn't want to tell her "I don't want to work with you because my gut says you are a cold, evil person" She ended up scaring her out of seeing her by being really pushy with topics she wanted to avoid to make her not want to come anymore and then she gave a referral for another T.

OMG this is how i felt my T was being

[quote=granite1;1729389]((((((Granite))))))

My T and I have talked about this. He told me that if he couldn't work with someone for whatever reason, he would simply be open and offer the person referrals....he promised me he wouldn't try to make someone uncomfortable so they would leave. I asked him about this early in therapy, because I DID feel so uncomfortable and misunderstood and scared sometimes that I wondered if he was trying to drive me away. He said that he would simply say something like "I believe that ______ would be more qualified to give you the help you need" or whatever. That was very reassuring to me, because it helped me trust that I was allowed to be there, and that even if T FELT like he was pushing me away, he really wasn't.

I wonder if you can ask your T about this?

There are so many interesting responses here.

There's something kind of nerve-wracking about being told that the first session the T is checking you out to decide whether to take you on! Even when they don't tell us that, I guess the Ts are still doing it. It just didn't occur to me when I went to see my T. My first T had signed me up right away and I thought it was kind of like going to a family doctor--if they had space for you, they would take you on. My T said one of the things he liked about me at our first session was that I let myself be vulnerable with him. I guess I cried a little. My memory of it is that I cried rather matter of factly. I was telling him some hard stuff and a few tears came out and fell, but I just let them, and kept talking, and didn't fuss about them. T was just fine about the tears. I had had the experience of crying with my first therapist, so I had this idea in my head that crying in therapy was perfectly fine and in fact might even be expected. I guess I was able to communicate to my T, with the help of the tears, that I was hurting, and this is one thing he knows how to help clients with, so maybe he saw then he could help me. I remember also how he talked about himself and his philosophy and approach. I think an important part of the first session is for the T to communicate who they are. If the client sees that clearly, and wants to continue, then that helps the consent be informed. I still remember getting his "I'm not a therapist, I'm a healer" speech, and that makes me smile. Oh, so true.

I emailed my T's clinic and requested her by name because she was really the only DBT therapist in the city. Another T emailed back and told me she was on holiday but he had 'just spoken to her and she'd email me soon'. I thought it was weird that he'd contact her on holiday just to let her know about a potential new client... I soon realised he was her husband, and he'd been on the same holiday.

My T replied, but not in the time frame he'd promised. She told me to call her to discuss it, but at that point my anxiety was too bad to use the phone at all. We emailed a bit about what she could offer, and I made an initial appointment.

My pdoc faxed all the papers to the wrong clinic, so my T had no background info on me at all. I showed up with my (same-sex) partner in tow, and T wasn't remotely phased, which was a good sign. (The T I'd road-tested before this one actually said to me "Are you telling me that the 'friend' who brought you here is your sexual partner ??" Um, yes!).
I don't remember much about that first session, or T making much of an impression on me, but the next time I saw my pdoc she said that my T had 'spontaneously told her that she liked me'. My pdoc LOVES my T and seems to use her for loads of clients after they met at a joint session with me. She should pay me a finding fee, I reckon!

It all just seems so right. I really regret not knowing about DBT and beginning earlier... but my T had only just come back from maternity leave when I found her. She's straight but had done her thesis research on lesbian issues. She's had very similar feelings in a therapeutic relationship as I have with her... it all just fits.

I like reading the posts on this thread. It's interesting how people find their therapists and the relationship they form.