Is This the Right Fit?

FAQs About Readiness, Insight, and Depth in Therapy with Dr. Kathy Russeth

Choosing a therapist is a deeply personal decision—not just about credentials or specialties, but about fit. As an integrative psychiatrist who works at the intersection of giftedness, sensitivity, and emotional complexity, I’m often asked:

“What makes someone a good fit to work with you?”

Here are some reflections, based on the kinds of work we do together in my practice and what tends to support a strong therapeutic alliance over time.

What kind of patients tend to benefit most from your approach?

People (of all ages) who resonate most with this work are often:

• Deep thinkers and feelers, even if they’ve been told they’re “too much” or “too sensitive”

• Curious about their own patterns and open to self-reflection—even if it’s hard

• Willing to sit with complexity, contradiction, or uncertainty without needing quick fixes

• Motivated to grow, not just symptom-manage

This includes many twice-exceptional (2e) individuals—people with cognitive gifts and emotional, attentional, or sensory challenges—who are seeking a deeper, more integrative path to healing.

What does it mean to have "ego strength" to do this work?

Ego strength is a clinical term, but here’s a simple way to think about it:

It’s the capacity to tolerate discomfort without falling apart, to be open to feedback without crumbling, and to explore your inner life even when it feels messy, unresolved, or painful.

In my practice, this shows up when someone can:

• Let go of black-and-white thinking

• Reflect on painful experiences without needing to blame or collapse

• Sit with the tension between what is and what they hoped for

• Recognize that insight alone won’t solve everything—and still want to keep going

This doesn’t mean someone has to be “strong” all the time. It just means they’re willing to be real, and ready to engage in a process that can be transformative—but also emotionally demanding.

What if I’m not sure I have that kind of strength?

That’s okay. A lot of people don’t—yet.

Sometimes part of our work together is building that very capacity:

• Learning how to self-regulate

• Practicing self-compassion

• Getting more curious than critical

There’s no shame in needing structure, pacing, or even a gentler beginning. What matters most is your openness to the process—and your willingness to come back, reflect, and try again.

What about children and teens? Is this just for adults?

Not at all. Some of the most rewarding work I do is with children and adolescents. In fact, many young people already have the ego strength I’m describing—even if they don’t have the words for it yet.

What I look for is a child’s or teen’s:

• Capacity for reflection (“I don’t know why I did that... but I kind of do.”)

• Sensitivity to meaning or fairness

• Longing to be seen and understood, even if it’s buried under resistance

The process often includes family work—helping parents interpret behavior as communication, not defiance, and supporting healthier patterns of connection at home.

What are signs that it might not be the right time or fit?

Therapy is a mutual investment. Sometimes it’s not the right match—or the right moment—if:

• There’s a strong desire for a quick fix or diagnostic label only

• There’s no interest in reflection, insight, or self-responsibility

• There’s a mismatch in goals (e.g., someone wants medication only, with no interest in therapy or collaboration)

• There’s a need for a higher level of care than outpatient therapy can offer

In those cases, I’m always happy to help guide you toward services that better meet your current needs.

Do you ever talk with people before starting therapy to explore fit?

Yes. I offer a free 15-minute consultation to talk about what you’re looking for, what I offer, and whether it feels aligned.There’s no pressure—it’s just a conversation.

Bottom Line: The Work We Do Together Is Gentle, but Deep

Therapy with me isn’t about “fixing” you. It’s about understanding you—your wiring, your story, your strengths, and your struggles. It’s about helping you build a life that honors both your intensity and your sensitivity.

If you or your child has been described as “bright but struggling,” “too sensitive,” or “complicated,” and that description leaves you feeling unseen, let's find a time to talk.