So, you’ve been thinking about getting therapy
Maybe you’ve been feeling down, or anxious, or overwhelmed with emotions you just aren’t sure how to deal with. Perhaps you and your family members are having the same arguments over and over. Maybe your clergy, child’s school teacher, or doctor has recommended that you seek counseling to resolve one of life’s problems. You’ve lost a loved one, experienced a life change, or been passed over for a promotion.
Whatever your reason for considering therapy, you are probably doing what most people in the digital age do when they feel powerless or fearful: you are searching for answers on the internet.
How to “shop” for therapy
In an earlier post, I describe why I offer a free consultation for new clients, even though most therapists don’t. I encourage potential clients to treat therapy like a product — something you research, try out, and plan for before you settle into it. Something you shop for. Unfortunately, therapy isn’t like a bestseller on Amazon. It can be very hard to find good information, much less reviews. Worse, most people in need don’t even know the basics of what to look for.
5 things to look for in a therapist
Listen, nothing beats meeting a therapist face-to-face to assess for what feels like a good “fit.” But, there are certain things that can help you narrow down a therapist on paper before you start to schedule appointments. If a friend or family member came to me for help in choosing a therapist, here are some of the things I would encourage them to look for as they began their search. The factors are listed in order from least to most important.
Spoiler alert: the final element can’t be googled.
I put financial issues first on the list because out-of-pocket cost is important. No one should go into massive amounts of debt to get counseling support, nor should you necessarily focus on finding the cheapest deal. In recent years, many talented therapists have chosen not to work directly with insurance plans due to breaches of confidentiality, unreasonable restrictions on care, and loss of autonomy to make their own decisions in the best interest of each individual client. However, most of those therapists (including myself) are prepared to help clients bill their own insurance for “out of network” reimbursement, if that’s available with their plan.
Get to know your insurance plan, and don’t feel locked into selecting an in-network provider. Set a budget for yourself, and realize that many therapists (including myself) will offer a “sliding scale” (or discount) for a variety of financial, employment, and other factors. Be prepared to talk frankly about your financial status and understand that, whether you go through your insurance company or not, therapy will cost you money. Insurance will only cover part of your therapist’s fee, regardless of how good your plan is, even if you choose from their list.
The best therapist for you might be out of your insurance network. Be open to referrals of all kinds.
4. Degree and license
Therapists they fall into a few different types — specific graduate degrees leading to specific licenses and specializing broadly in different elements of mental health. None of these licenses is definitively better than the others, they’re just different. Sure, there are subtle (and not-so-subtle) nuances in training methods and basic philosophical stances, but each of the following professions are qualified to diagnose and carry out mental health counseling.
The professions below are listed alphabetically.
- Counselor (CMHC or LPC): A broad counseling degree.
- Marriage and Family Therapist (MFT): A master’s level training with additional specialties in treating families and couples.
- Psychiatrist (MD): A medical doctor with advanced training, psychiatrists are specifically qualified to prescribe and monitor mental health medications.
- Psychologist (PhD or PsyD): A doctoral level of training which prepares practitioners to carry out diagnostic testing and make recommendations for specific academic, psychosocial, and emotional support.
- Social Worker (LCSW): A master’s level clinician trained to connect clients with community supports and resources.
In my experience, unless what you need relates specifically to the distinctions mentioned above (i.e. you know in advance that you’ll need a prescription, or academic testing), the degree or license that your therapist has is less important than the factors below. Finding a “doctor” (MD, PhD or PsyD) will not guarantee you a better therapy experience, even if you are the kind of person who values higher education and fancy titles.
Although years of work experience are actually quite important when it comes to choosing a therapist, I would suggest that the type of experience is equally (or more) impactful. For instance, if you are looking for weekly outpatient therapy (as most googlers are), you may wish to steer clear from someone whose only experience is in a residential or hospital setting. However, having worked in those more acute settings can inform outpatient therapists about what it looks like when a higher level of care is needed, and often means that they are equipped with the resources to refer their clients out.
I wouldn’t automatically rule out someone with fewer than 5 years or experience, or automatically choose someone with 30 years of experience. For instance, a seasoned therapist is likely to be older and may not respond well with teenagers or understand their world of social media, sexting, and technology. Similarly, a younger therapist may not be prepared to support clients looking at end-of-life or other issues.
It really all depends on what you are looking for and, again, the factors below may turn out to be more important.
In addition to considering the length and setting of a therapist’s experience, it’s important to choose a therapist whose specialties align with your needs. Sometimes these specialties come in the form of therapeutic tools (in my case, I have specialized training and certification in art therapy) or specific diagnoses or issues. Sometimes, these specialties can be pursued to the point of additional certifications or other qualifications. Look for therapists who lecture, teach, publish, attend conferences, or are members of professional associations that align with your needs and interests.
1. A “good fit”
It probably feels like I am harping on the idea of finding a good fit with your therapist, but I’m not the only one. Researchers have long known that one of the biggest predictors of therapy outcome is the quality of the relationship with your therapist. Finding a good fit is like deciding to go on a second date — ideally, you “click.” You feel comfortable. You feel hopeful about your ability to be yourself around that person and you feel interested in their opinion.
The only way to find a good fit is by meeting therapists face-to-face. I’m hopeful that the first 4 items on this list will help you narrow down exactly which therapists make good candidates for that proverbial first therapy date.