How to Tell Your Therapist What You Need (And Speak Up When Therapy Isn't Working)
One of the questions we ask new clients is what you're looking for in a therapist. Some of the answers people give are so specific and so honest that they make matching easy.
A few things we’ve heard (these are examples not exact wording of specific clients):
"I need someone to be blunt."
"I can be shy at first and need someone who will lead the conversation."
"I want my therapist to be on time, because my last one was always late."
"Non-religious, please. I'm queer and I've had bad experiences."
"Someone who won't judge and who actually cares about helping."
Each of those tells me something I can use in helping figure out which therapist would be the best match for you. And here's the thing I want you to know: you're allowed to ask for all of these specific things and more.
Is it okay to tell your therapist what you need?
Yes. Completely. Naming what you need isn't being difficult, it's giving your therapist or intake coordinator information they need to help you. And you can keep doing it once therapy has started. Telling your therapist that something isn't working is part of the work, not a complaint about it.
A lot of people don't realize that. They think therapy is something you receive rather than something you shape.
I think people worry that naming preferences makes them a demanding client. Or that a therapist will be offended. Or that they should just take whoever they get and be grateful.
Please don't do that.
You don't need to know therapy terminology
You do not have to say, "I prefer a highly structured cognitive behavioral treatment." Or a specific type of treatment. Some peopel have heard about a specific mode of therapy or their old therapist/psychiatrist/doctor recommended something specific. But many of our clients reach out without knowing exactly what type of therapist that they’re looking for.
Instead, you can say something like:
"I don't want to spend every session only talking about my week."
"I want someone who will help me notice patterns."
"I need concrete things to practice between sessions."
"Too many questions at once make me shut down."
"I need someone warm, but I also need them to call me out."
"Silence makes me panic."
"I need time before I trust someone."
"I want to understand the plan and how we'll know whether it's helping."
Honestly, those statements often tell us more than knowing the name of a treatment approach would. If you do want to understand the different approaches, we wrote a plain guide to the types of therapy and what each one is actually for. But you don't need it to get started.
What does your answer tell us?
Here's what I'm actually hearing when someone tells me something specific.
What you might sayWhat it tells us"I go blank when someone asks what I want to talk about."You'd probably do better with someone who comes in with structure and questions."My last therapist only listened."You likely want more feedback, more skills, or a more active treatment."I felt pushed before I was ready."Pace is something we need to talk about early, not assume."I'm afraid a therapist will judge my relationship."Affirming care matters here, and there may be a past experience worth knowing about."I need someone blunt."You value directness. Your therapist should also ask what blunt means to you.
You might find it odd that a therapist would ask what a simple word like “blunt” means in your eyes. However, blunt can mean honest, or challenging, or efficient, or willing to name avoidance out loud, or just less emotionally expressive. Those are different things, and it's a good conversation to have in the first session.
What kinds of preferences are useful to share?
A communication style. Direct or gentle. Someone who challenges you or someone who mostly listens. Someone who talks a lot or someone who leaves space.
Someone who leads. If you freeze up and go blank, say so. Some therapists naturally structure a session and ask a lot of questions. Others wait to see where you'll go. Neither is better, but one of them might be much better for you.
A specific approach. If you want EMDR, or you want homework between sessions, or you want structured treatment with a clear plan rather than open-ended conversation, say it. We'll tell you honestly whether that's the right fit for what you're dealing with.
A gender. People request this all the time and it's completely legitimate. Sometimes it's about trauma history. Sometimes it's just about comfort. You don't owe anyone an explanation.
An identity or values fit. If you want someone who is affirming, or who isn't going to bring religion into it, or who understands a particular cultural context, that matters. We'd much rather know upfront than have you sit through sessions where something feels off.
Practical things. Time of day. In person versus virtual. Punctuality. Whether they'll be flexible if your work schedule shifts. These aren't small. If the logistics don't work, the therapy won't happen.
Something you already know doesn't work for you. If a previous therapist did something that made you shut down, tell us. That's some of the most useful information you can give.
What if you don't know what you need yet?
That's fine, and it's more common than you'd think.
Sometimes people only figure out their preferences after a few sessions. You might realize you want more structure, or a slower pace, or clearer goals, or someone who gives you more direct feedback. That's not proof you picked wrong. That's information you can use, and you can bring it into the room whenever you notice it.
If you're at the very beginning and not sure what to say at all, we wrote a whole post on what to say when you call a therapist for the first time. The short version is that you don't need the right words.
Why does this matter so much?
Therapy works largely through the relationship, and the research on that is pretty consistent.
One large meta-analysis pulled together 295 independent studies and more than 30,000 clients. It found a steady relationship between the quality of the working alliance and how well treatment went, across different types of therapy and different formats. You can read it here.
I want to be careful about what that does and doesn't mean. It doesn't mean you need to feel an instant connection, or that one awkward first session tells you therapy won't work. What it points to is that feeling understood, agreeing on what you're working toward, and having some confidence in how you're going about it all matter.
Which is exactly why telling us what you need isn't being picky. You're helping us do our job.
Preferences aren't guarantees
I want to be transparent with you that telling us what you prefer doesn't mean a therapist will agree to every request. Therapy is collaborative, but it's also clinical care. Your therapist might explain that an approach you've asked for isn't likely to help the problem you actually want to solve. Or that steering around every uncomfortable topic would keep you stuck.
The goal isn't for therapy to feel comfortable every minute. That's not what it's for. The goal is for the discomfort to feel purposeful, collaborative, and paced in a way you can actually tolerate.
You should be able to ask why. You should get a real answer.
How do you say it during a session without feeling awkward?
You don't need careful phrasing. Plain is fine.
"I do better with someone who's direct."
"I get quiet at first. It helps if you ask questions."
"I've done a lot of talking about this. I'd like to actually do something with it."
"Can we slow down? That was a lot."
"I want to know whether this is working."
That last one is worth saying out loud. It's a good question and any decent therapist will welcome it.
What if you're already in therapy and something isn't working?
Tell your therapist directly. Most of us genuinely want to hear it and we're trained for that conversation. You can open with something as simple as, "Can I bring up something about how our sessions have been going?"
This isn’t always easy, but it’s important and can help you get what you need out of therapy.
I know it feels uncomfortable. You might worry about hurting their feelings, or seeming ungrateful, or you might just not want the conflict. But several of our clinicians ask clients regularly how therapy is going specifically because they'd rather hear it early than have someone quietly stop coming.
Then be honest. "I feel like we talk about my week and never get to the deeper stuff." "I need more structure." "When you said that last week, it landed wrong and I've been thinking about it since."
What should a therapist do with that feedback?
Good therapy relationships aren't perfect ones. Therapists misunderstand people. A comment lands wrong. You and your therapist disagree about pace or direction. That's normal, and there's research showing that working through those moments matters for how therapy turns out.
Here's what I'd look for. Your therapist should be able to hear the feedback without making you responsible for their feelings. They might ask questions, explain their thinking, apologize, or suggest a change. They may not agree to everything you ask for. But you should be able to have a respectful, collaborative conversation about it.
If instead you feel managed, dismissed, or like you've done something wrong by bringing it up, that's real information about the fit.
When should you keep talking, and when should you switch?
I'd give the conversation a real chance first. A lot of what feels like a bad fit is fixable once it's named, and switching without saying anything means the next therapist may run into the same thing.
But if you've said it clearly and nothing changes, or the conversation itself went badly, that's a different situation.
Sometimes you do everything right, you speak up, your therapist responds thoughtfully, and it still just isn't clicking. That happens, and it isn't anyone's fault.
If you're working with someone here, come back and tell our client care team, and please be specific about why. "It just wasn't a fit" doesn't give us much. But "she moved faster than I was ready for" or "he felt too formal" or "I realized I'd rather work with a woman" gives us something real to work with.
Frequently asked questions
Can I request a male or female therapist?
Yes. This is one of the most common requests we get and you don't need to explain why.
Can I ask my therapist to change their approach?
Yes. Say what you'd like more or less of. If the approach you want isn't a good clinical fit for what you're dealing with, your therapist should tell you that honestly and explain why.
How do I tell my therapist that therapy isn't working?
Say it plainly and early. Something like, "Can I bring up something about how our sessions have been going?" works. Then name the specific thing. Most therapists would much rather hear it than have you quietly stop coming.
Is it rude to switch therapists?
No. Therapists know fit varies. We'd much rather help you switch than have you decide therapy doesn't work.
Will my therapist know if I ask to switch?
We handle it professionally either way. You can tell your therapist yourself or go through our client care team, whichever feels easier.
Do I have to explain why I want to switch?
You don't have to, but it helps a lot. The more specific you are, the better the second match will be.
Begin Therapy in Columbia or Lee's Summit, MO
Say as much as you're comfortable saying. What's going on, what you've already tried, what you want from a therapist as a person.
The people who tell us the most specific things are the ones we match best.
Call our Columbia office at 573-328-2288 or our Lee's Summit office at 816-287-1116. We see clients in person at both locations and online throughout Missouri.
Whenever you're ready for effective care and lasting change, we're here.
