Now, while you can claim that this may be the case in San Francisco, but not Copenhagen or Brussels, and you could also rightly claim that only those of us who are lucky enough to be of middle class and above, socio-economically speaking, have access to these services, there also truly are so many therapists available, if you want therapy, that choosing one can be a challenge. What do you do if you don't know how to translate the excruciating emotional pain you are experiencing into psychological terms? And what if you don't know what all the fancy names today's therapies call themselves mean? If you are a therapist and have therapist friends you have to know: We work and try to create a thriving practice with good results and good referrals in this huge, gray market that is relatively unregulated and a very mixed bag of great and not-so-great. But most people don't have that privilege (- or problem as some might say).
This gray market, however, also a place where many people get the help they need. The fact is that if you find a therapist you like, respect and trust, even a little, you are very likely to have a good experience with your therapy and actually feel better when you end that therapy than when you entered it. But how precisely do you find this person? Your friends have probably raved about someone you turned out not to like very much. And you've tried going to see the overly credentialed person who turned out to be limited in their social skills and empathy. Ouch. You didn't feel seen and walked away feeling exposed and a bit poorer.
If you are not a therapist with therapist-friends and you live outside of say San Francisco, New York City, Buenos Aires, London or Paris, therapy is still available but still something relatively exotic to most people. And most consumers don't know how to choose and un-choose therapists. One problem in communities where therapy is new, is that the schools of thought, the "religions" can freely move in! The Freudians, the Jungians, the Gestaltists, the humanists, the Behaviorists, the Existentialists, the primal screamers, and of late, the Mindfulnessists and the Mentalizers. With some notable and admirable exeptions many followers of these schools are so exited and thus zealous of the messages and methods of their school, and desperately want to make it known and profitable, that these schools are promoted as comprehensive solutions to every possible human problem. When you're a trauma therapist, every psychic pain you are presented with is due to some variety of trauma. I am exagerrating of course, and also confessing my own sins as a therapist (after all, I tend to believe that creative arts therapies work for most issues!). But you get the point. When you only have a hammer everything looks like a nail.
What if we could get savvier about discussing and researching what sort of therapy works for what psychic ailment or issue? What if we got better at describing what is probably going on if you are experiencing X symptom and Y consequence or dynamic in your life? What if there was more consumer information, just like the kind you can get when you search for the right computer, car, even online dating site? Why can't we work towards qualitative criteria in the field of psychotherapy just because it is a soft science, or even an art? A few great minds have created comprehensive thought systems that try to span the whole phenomenology of the human condition and pair it with the various psycho-spiritual schools of the world. Take a look at Ken Wilber's work for instance. Not that the system he has come up with is perfect. To be that comprehensive you are in great danger of stereotyping, hierarchizing and being culturally unnuanced or even insensitive. For example, if you say that a well known Buddhist technique of watching and naming your thoughts is great for people with anxiety (which tends to be true, by the way), you have now boiled an ancient, complex and much loved religion and philosophy down to a technique that can be used (and sold) for a limited purpose completely without its cultural context. You have also ignored the fact that for some people these techniques, which are often taught and commercialized in the west as mindfulness, can worsen anxiety for some. But, hey, you've also just potentially pointed some anxious souls away from a lengthy "career" in psycho-dynamic therapy (which happens to be great for relational issues) or a dangerously superficial fix through mainstream cognitive behavioral therapy (which happens instead to be great for some types of depression).
Just writing this, I am reducing the power, depth and complexity of both of these much respected schools of psychotherapy and I can already hear the angry rebuttals from their followers. And I didn't even get into the personality disorders and more derogatory terms such as "people with Borderline Personality Disorder", or the old-fashioned classic: "Neurotic" And of course, these schools are indeed going to be able to help many people with anxiety! But it does not take away the need for the consumer of therapy to know more about what generally works for what so that they can find a therapist that can help them more easily and less traumatizingly than what is generally offered as advice: Shop around. Easier said than done. It is not a lot like shopping to tell your deepest hurts and fears to strangers, listen to a variety of more or less helpful/hurtful responses and then lay down the often hefty fee. I know this from personal experience - in both chairs: the therapist's and client's.
What is a suffering human to do? Let's do some culturally insensitive reducing, diagnosing and generalizing here in the service of helping more people get help. These are in no way exhaustive or fully explanatory, and risks getting you more confused but they are a way start to what I am proposing:
If you have a very hard time with relationships, can't seem to find them (let alone keep them), you don't need a therapist who does a lot of confrontational therapy or believes in emotional release as the solution to your ills. Neither do you need one who simply teaches you spiritual techniques that take you away from all the messy stuff of the earth-plane! You need someone who is relationally trained, gets what attachment means, and understands how relational trauma is created, but does not obsess with digging out all of them and having you live through them. You can find this in skilled Psychodynamic therapists, Object Relations oriented therapists and Humanistic therapists. Some trauma-trained therapists are good at this too. And you probably will benefit from someone who is warm and experienced too. Finally you may need someone who can teach you skills, yes, teach you how exactly to be in relationships with others while being yourself. Maybe the lack of solid relationships in your family background wasn't just traumatic, it also deprived you of learning the how-tos of nurturing and lasting human contact. These skills are taught by many, and as the research goes, very well by DBT therapists.
If you have had specific and powerful trauma, such as rape and other violence, war, accidents, or early childhood traume such as abuse or neglect and you experience the results of these through flash-backs, overall high tension and jumpiness or feeling very shut down and numb, you may not benefit at all from a therapist who wants to talk at length about how you feel about this. You could benefit much more from seeing someone who knows how to support you by "building your resources" before going into releasing the trauma (if ever). You can find these among the Somatic Experiencing trained, the EMDR trained and those with a Neuro Affective understanding of trauma.
If you are facing an existential depression, from loss of a loved one, from ageing or facing another of the sometimes harsh limitations of our human life, you probably don't need to be told that you should think more positively or that you need to work on your relationships. Or that you need to be more spiritual and recognize that "we are all one" and that death is really an illusion unless you are not evolved enough to get it. Maybe your relationships are fine, and your thoughts too. Maybe you need to be with a therapist who is unafraid of beign truly present with your pain, a therapist who lets you be human by showing themselves as human too (without sharing their life's story for most of the hour...but that's another topic). Someone who can tolerate sharing the fact that death and aloneness and a lack of meaning faces all of us at a certain time and if we can face them back, they can become more tolerable. Look for an Existential Therapist, an experienced Gestalt Therapist who can help you back in the present, or a body oriented therapist who is not afraid of feeling into what IS.
I could go on and we should really have a shared discourse or catalogue of these categories (as shamefully inadequate or reductionst this would be) created by therapists and clients with experience on the couch or cushion, but I will leave you for now with one more situation in which you might need a therapist and want to know what to look for:
You are experiencing what some call a spiritual opening. A connection you know and experience clearly as being with something much larger than yourself. This can be very intense and powerful. But you can still function and you are definetely not psychotic. You still know what is up and down and you can feed yourself, act somewhat normally, take showers and keep clean. You need a therapist who is not going to tell you to take your pills and be realistic. Someone who won't tell you that you are psychotic or too new age. Instead look for someone who has a solid spiritual background i.e. years of spiritual training through meditation or yoga or something similar, someone who is neither impressed nor scared of your opening and will keep letting you open while you stay grounded in life on the planet.
Until we get savvier about choosing our therapists, and until we therapists get better at discerning and disclosing what we can do and really can't do that well, or training each other in much more comprehensive ways, you can do this:
Think, read and learn about what your actual issues are, ask your friends and family for feedback. And then learn more about who is good at working with those issues. Then pick someone who has experience, a lot of good, satisfying answers to your questions, but does not claim to have all the answers. If you find someone who does seem to think they do, please know that they are probably wrong, could cost you a lot of money and trust in other people, and that they may be less interested in understanding what you need than in proving their method right.
And don't forget that most studies show that we're best off with a therapist we simply like and trust. So do shop around a bit if you can stand it, and be aware that you can be a critical consumer of therapy, and that there are some (still vague) criteria to use, aside from your gut feeling about someone which of course you should trust too.