Shortly after her live-in boyfriend moved out, Helena, a lawyer in her mid-30s, added “find a younger therapist” to her post-breakup to-do list.
“It’s definitely a personal bias and comes down to my own level of comfort,” says Helena, who lives in Tampa, Florida. “I don’t feel comfortable talking to an older woman about [having sex with] randos from Tinder.”
Helena found it annoying to explain modern dating mores to her former therapist, who she guessed was in her 60s, particularly because therapy is often a scenario where time is money: “Every minute is like $2.50, so a younger therapist saves me $10 of time explaining something to an older person that they might not already fully grasp.”
When Sunita, a marketing director in New York City, was single, she also felt like older therapists might be old-fashioned or judgy about her dating life. But age bias against therapists can work the other way, too. Some patients assume young therapists lack the experience or wisdom to help them through complex or atypical issues.
“I 100 percent prefer an older therapist,” says Melinda, a TV producer in Los Angeles in her early 40s. “With younger ones, sessions felt like I was talking to a friend, not a trained professional. I literally spent 45 minutes [in one] session talking about the importance of local and organic foods.”
Melinda says younger therapists were easily distracted when she was evasive about issues important to her therapeutic progress. The older therapists she’s seen, on the other hand, “had more authority, and I didn’t feel like I could pull the wool over their eyes as easily.”
“In all therapy, there is explaining that needs to happen. No matter who you meet with, there will be some teaching you have to do.”
People choose therapists for a variety of reasons. While age doesn’t always factor into the decision, many patients say it matters. To make progress in therapy, you need to trust the person taking notes on you, and feel comfortable sharing private details with them. Is a little ageism understandable in choosing a professional confidante? Or do patients who put too much stock in a therapist’s age risk missing out on skilled clinicians?
“We’re all walking around with a certain number of biases influencing how we think and behave, whether conscious or unconscious, in all our interactions,” says Matthew Traube, a psychotherapist in San Luis Obispo, California. Anecdotally, he says, a lot of people do seem to consider age when they choose therapists.
Patients in their teens and early 20s, Traube has found, often expect healthcare providers to be two or three times their age — although seeing someone closer to their age still appears to be a perk for them. And older patients are sometimes turned off by therapists in their 20s, whose life experiences might be more limited than their own. “If patients and therapists are the same or a similar age, sometimes there’s an easier bond,” Traube says. “Each stage of life comes with certain challenges, and if they’re in the same stage, they better understand those challenges.”
Heather Stambaugh, a licensed mental health counselor in Lakeland, Florida, experienced age bias first-hand early in her career. Working at a community health center when she was 22, patients in their 40s and 50s would often ask, How could you help me? You’re a child. Sometimes they’d mistake her for an intern from the local high school, she says.
Generational identity, which is typically linked to negative stereotypes, is a related bias when it comes to picking a therapist. We often hear and read that millennials are entitled and slow to mature, that Gen Xers are apathetic underachievers and that boomers are ignorant (of say, social justice issues, language regarding sexuality and technology) and judgmental.
When people impose these generalizations on individuals, they “don’t think they’re being biased; they think they’re just observing the truth,” says psychologist Holly Parker, a lecturer at Harvard University and author of When Reality Bites: When Denial Helps & What to Do When It Hurts. “When they do that, they could wind up limiting themselves by making assumptions based on age.”
For example, if someone goes into therapy thinking they don’t want to work with an older therapist, then the bias can become a self-fulfilling prophecy and negatively affect the therapist-patient connection, which is the most important factor in successful therapy.
“If I have a bias in my head and assume an older therapist doesn’t get it, and I feel I’ll be wasting my money explaining things to them, I will have a very different reaction than if I have to explain something to a younger therapist,” Parker explains. “And in all therapy, there is explaining that needs to happen, such as aspects of your job or background. No matter who you meet with, there will be some teaching you have to do.”
Many patients gravitate toward therapists who seem likely to understand their own life experiences, whether that’s because of age, race, religion or sexual orientation, adds Sabrina Bowen, a psychotherapist based in Rockville, Maryland. Now that many therapists have websites with their photos on them, it’s easier than ever to choose a therapist based on appearance and presumed similarities, she notes.
“But what happens inside the room, during the therapeutic hour, is more complicated,” Bowen says. “Sometimes clients and therapists are not clicking, and clients are left with the burden of figuring out why. So they make a hypothesis and decide it must be because of age, or experience or whatever, instead of it just not being a good fit, or not a therapeutic approach that speaks to them.”
“They tend to feel more comfortable working with someone their age rather than someone who was trained back when homosexuality was still a diagnosis in the DSM.”
It’s worth noting that not all biases carry equal weight. Some biases aren’t superficial, and are important to consider when evaluating your ability to develop a rapport with a therapist. Studies suggest that many women feel more comfortable disclosing personal information to female therapists compared to male therapists with the same qualifications. Shared racial identity is often important to patients as well, per one 2013 study. Last year, writer Jacy Topps, who is gay, black and female, wrote an essay for Glamour explaining why she prefers to see therapists who are women of color. Her former white therapist didn’t seem to understand racial oppression or the microaggressions she dealt with as a black woman in America, Topps wrote. Ultimately, she found translating those realities to a white person to be exhausting, frustrating and alienating.
Sexual orientation is also a factor in some LGBTQ patients’ therapist choices. Stambaugh says that her clients, who are almost all LGBTQ, usually want to know whether she’s a member of the community. An overlapping consideration for many of them, she says, is the age of potential therapists.
“They tend to feel more comfortable working with someone their age rather than someone much older who was trained back when homosexuality was still a diagnosis in the DSM, and something that has been pathologized throughout history,” she says. “Some of those concerns are valid.”
Stambaugh says this is an area where she feels that some self-disclosure from therapists can benefit patients, even though psychologists are trained to be blank slates and reveal personal information sparingly.
“I can’t be that kind of therapist,” she says. “I work a lot with clients on being their most authentic self in the world, so it’s important to me to model that.”
Stambaugh encourages patients to ask their therapist point-blank about their views regarding issues that are important to them.
“Go in prepared with questions, like, ‘What’s your perspective on being gay? Is it a disorder, or is it not?’” she suggests. “It’s OK to ask those questions. If you’re concerned a therapist could have some bias against you, ask directly about it.”
Stambaugh says she prompts a discussion about race and social justice with clients of color because it’s important to address any potential biases at the outset. “I’m absolutely comfortable having those conversations,” she says. “I hadn’t thought about asking in regard to age, but maybe I should.”
Ultimately, if people can relate to their therapists and feel heard and understood in their sessions, Traube believes that the importance of age will fade. Still, some patients might hold fast to the idea that they need a younger or older therapist and deny it has anything to do with ageism, saying they just feel more comfortable spilling everything to a therapist who gets them, Parker says. Making assumptions about what someone can or can’t do based on their age, however, can veer into problematic territory.
“Anytime someone makes assumptions, whether in the context of choosing a therapist or not, I’m hesitant to say, ‘Don’t worry about checking your stereotypes,”‘ Parker says. “If someone is more or less comfortable and they can’t figure out why, it’s worth looking at that. That discomfort could be reflective of [a confirmation] bias.”
There isn’t any evidence that a therapist needs to have had the same life experiences, or mental health conditions, in order to help a patient, she says. In many cases, it might not be in a person’s interest to embark on a therapist search with a list of rigid, narrow requirements. Someone who lives in an area with a low supply of mental healthcare providers, for instance, would likely be better off seeing a therapist outside their ideal age range than not seeing anyone.
And sometimes differences between a therapist and patient can lead to richer insights. Traube, who is white, did his training in South Central Los Angeles, where he mostly saw patients of color. Many of his African American patients told Traube that working with him helped change some of their negative perceptions of white people.
“Having very similar experiences can produce understanding faster and easier, but it can potentially be a hindrance to therapy as well,” Bowen says. “Great progress can be made when we get to see things in a different manner.”