I regularly speak with people looking to start therapy. Most have been postponing their search for months — or even years. Sometimes the delay is related to ambivalence about therapy, but more often than not it’s because the process of finding the right person is so damn frustrating. Many mental health professionals don’t return calls if they’re not in the market for new patients. Confusing insurance plans and high fees force too many people to put a price on their health and well-being.
After twelve years of helping people from all walks of life navigate this process, I have some thoughts about how to improve your chances of finding a good therapy match. These are crucial questions you should be asking yourself — and your potential therapist — before making this important commitment. While I can’t help with finances or insurance plans, this is the kind of stuff every prospective therapy patient should know — things I wish someone would’ve told me when I started looking for my first therapist.
What Do You Want to Work On?
Sometimes it’s pretty straightforward deciding which issue or difficult feeling you’d like to focus on. Maybe you’ve been in therapy before and already have a good sense of areas where you need a little help. Sometimes it’s not so obvious. There might be a lot of contenders, but try to identify your most pressing problem. If that just leads to greater confusion, try another approach. If you’ve ever had trouble sleeping, what challenging feelings or worries might keep you awake? If nothing comes to mind, think about any uncomfortable feedback you’ve received over the past month. Have these same criticisms ever come up before?
Where Should You Look?
Google search and platforms like Psychology Today are your friends. Type in your top problem and search for therapists who specialize in that issue. Platform search filters allow you to add other important criteria like gender, age, sexual orientation, and insurances accepted.
Just because someone is paying for an advertisement to land them on the top pages of a Google search doesn’t necessarily make them a poor choice, but try wading in a few pages deeper. Therapists are some of the last professionals who work independently or in small groups. They don’t have huge advertising budgets to compete with big companies. Google ranks sites by the amount of money they are being paid by advertisers and the popularity and usefulness of the site. Expertise doesn’t enter into the equation.. . . . . . . . .
When I was starting out, I was like a lot of therapists, casting a wide net, trying to be all things to all people. Often you’ll find therapists highlighting their “focus” on everything from soup to nuts. There’s nothing wrong with that, but if you have a specific problem, you want someone who lives and breathes that issue. Don’t worry — no matter what the problem, there’s a specialist out there to help.
It might be tempting to find a therapist based on Yelp or Google reviews, but these sites present a very skewed picture. Professional organizations that regulate our field prohibit therapists from soliciting their patients for reviews. These requests open the door to putting a potentially vulnerable person in a position where they believe they must comply with their therapist’s wishes and supply public praise for their treatment — or risk the therapist’s resentment. Furthermore, many satisfied therapy patients don’t want to violate their own privacy by publishing reviews of what is sometimes considered a very private relationship.
Finding a therapist through your insurance plan’s listing of providers is likely to be a bit of a crap shoot. These lists are not well managed and you’ll receive few responses. Therapists who actively advertise are more likely to have openings.
How to Make Sense of Those Pesky Letters at the End of Therapist’s Names
It’s really important to decode these little buggers because the number of years a therapist has spent in education, training, and practice in large part determines the quality of therapy you will be receiving.
M.D. = Psychiatrist: Typically 6–7 years of education and training after college. Psychiatrists are medical doctors specialized in psychiatry, a branch of medicine focused on the study and treatment of mental disorders. Although some psychiatrists provide therapy, most are focused on managing psychological disorders with medication.
Ph.D. and Psy.D. = Psychologist: Doctoral Level of Education and Training: After receiving a Master’s Degree, typically 3–4 years of education and training in psychological research, testing, and clinical work (i.e. providing therapy).
Master’s Degree Therapists: Typically 2–3 years of education and training in a specific area of focus that is designated by their title. MFT = Marriage and Family Therapist; LCSW = Licensed Clinical Social Worker; LPCC = Licensed Professional Clinical Counselor
Therapists with a Master’s Degree often refer to themselves as psychotherapists, a term generally applied to anyone who provides psychological treatment. It is not an accreditation.
Psychoanalyst: This term generally refers to a therapist who has undergone an approved program in Freudian psychoanalysis. After receiving a Master’s or Doctoral degree, the therapist goes on to train in this specific orientation.
What Type of Therapy Are You Looking For?
CBT, ACT, DBT, EMDR… again with the letters! Don’t be alarmed if your head is spinning. These days you’ll find Cognitive-Behavioral Therapy prescribed for just about everything under the sun. No doubt it’s effective, but there are plenty of other evidenced-based treatments that are just as useful and might better suit your needs. Most therapists integrate several approaches depending on the problem being addressed, but they usually have one or two go-to orientations. Therapists go to school to learn about these approaches so you don’t have to. The best way to tackle this question is to ask your potential therapist how their orientation goes about helping people with problems like yours. Don’t be shy — you can even ask for examples.
Another way to determine if a therapist’s orientation is suited to your needs is to think about how you’d like to feel when you’re with them. Do you like people who are more interactive or do you need space to reflect and not feel crowded? Do you want a therapist to provide you with concrete feedback about things that have helped other people in your position? If you’ve been in therapy before, what helped? What didn’t help? Keep in mind that any effective treatment is bound to trigger uncomfortable feelings and frustrations. That doesn’t necessarily mean that you’re out of alignment with your therapist’s approach.
Another good question to ask yourself is how long you expect to be in treatment. Are you looking for open-ended therapy with goals that will be defined over time or do you want to dig in for two months on a single issue and then move on? There are many brief treatments that are great at addressing specific problems like phobias or everyday types of stress and low mood. If you’re dealing with problems that have taken a lifetime to accumulate — the type of problems that seriously impact your mind space and ability to function — then you need to be realistic about the amount of time it will take to experience true transformation.
Weekly meetings are still the norm though this can vary with the types and severity of problems you’re working on. Be sure to ask what the therapist recommends with regard to the frequency of meetings. It’s crucial to meet regularly to get good traction on addressing the problems at hand. If you can’t commit to a weekly time slot, ask how flexible the therapist is with scheduling.
Finances
Several years ago laws were passed saying that insurance companies must provide the same access to mental health help as they do to medical services. This has been a blessing and a curse for everyone involved. On the one hand, people who never had access to therapy can now find help. However, powerful insurance companies have made the hurdles of being a provider quite high with bargain basement compensation to boot. More and more therapists are saying “no more” making it harder than ever to find the right person.
This needn’t be a roadblock. Most insurance plans provide reimbursement for services outside their network. That means you pay your therapist upfront and then get paid back by your insurer. Any therapist worth their salt will be able to walk you through this process and have the proper paperwork on hand for you to share with your insurer.
If you find a therapist’s fee unaffordable, ask if they have a sliding scale. You might also work out a plan to meet every other week if it makes sense given the severity of your symptoms and the goals you’ve set for treatment.
A Few More Things to Remember
You’re likely in a rush to get to work once you’ve started actively looking for a therapist, but it’s a good idea to interview at least four people. This is an important investment in money and time — it’s also one of your best shots at improving your quality of life.
Don’t be afraid to trust your gut. There are many intangibles to relationships that can’t be captured on a checklist. Check-in with yourself after the initial call. Overall, how did the call make you feel? Did you want to move closer to the person or do you feel like you’d like to withdraw? Were you feeling hopeful? Listened to? Did you feel neutral or nothing at all?
Therapists don’t agree to work with everyone who reaches out. This can be especially hard if you’ve experienced a lot of rejection and abandonment. Try your best not to take it personally if things don’t work out. During the initial call — and in the first few sessions — the therapist is trying to determine if you are a good fit for their skills and current caseload. Most therapists are total softies and would love to help everyone who reaches out. From our side it can be very difficult — but sometimes necessary — to give the tough-love feedback, “I don’t think I’m the right person to help you.”
Referrals from friends, family, and physicians are a common path to finding a new therapist. That’s fine, but remember that you are looking for the best fit for you. Just because a referral is convenient, don’t throw all of the above advice out the window. Vet these professionals in the same way you would with someone you found online.
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