A Step-by-step Guide to Finding a (Good!) Therapist

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The pro­cess of find­ing a good ther­a­pist is un­like the pro­cess of find­ing most pro­fes­sion­als. If your den­tist nags you to floss more ev­ery time you see them, it’s an­noy­ing, but un­likely to re­ally af­fect the qual­ity of their work. In ther­a­peu­tic work, how­ever, most of the work comes from the bond be­tween ther­a­pist and client. If you find your­self wor­ried about your ther­a­pist judg­ing you or don’t trust them to bring up im­por­tant parts of your life, you won’t be able to get the most out of ther­apy. Of course, this can make the pro­cess of start­ing ther­apy in­timi­dat­ing! It is very im­por­tant to know that you can always talk to your ther­a­pist about chang­ing what they’re do­ing or refer­ring you to some­one else—some­thing I’ve writ­ten about pre­vi­ously in my guide to ter­mi­na­tion. Here, I’ll in­stead talk about the first in these two book­ends on ther­apy: find­ing a ther­a­pist.

The first thing to re­mem­ber in find­ing a ther­a­pist is that if you have a bad ex­pe­rience, it is more likely that the ther­a­pist is a bad fit than “ther­apy doesn’t work for me”. Find­ing a good ther­a­pist is more like dat­ing than it is like find­ing a me­chanic, be­cause of the emo­tional trust and free­dom from judg­ment that I men­tioned above. This means you may have to try a few times be­fore find­ing The One, and once you do find some­one good, there is no guaran­tee that they will be af­ford­able, available, or lo­cal. Part of the rea­son I am writ­ing this guide is that I am hop­ing the ad­vice be­low will re­duce the num­ber of tries it takes to find some­one who works for you.

What are your needs?

In or­der to find some­one who works for you, you have to know what your needs are. The most ob­vi­ous needs here are the prac­ti­cal: fees, lo­ca­tion, timing, in­surance, and ac­cessibil­ity. If you don’t have much to spend on ther­apy, you may be con­fined to clinics and what­ever your in­surance cov­ers. How­ever, it is im­por­tant to know that if you’re work­ing through in­surance, they are re­quired to find you some­one who meets your prac­ti­cal and ther­a­peu­tic needs, or else they must cover some­one who is oth­er­wise out of net­work. So if you’re look­ing for an OCD spe­cial­ist and no­body on your in­surance has availa­bil­ities, they are still re­quired to help you out. Work­ing with in­surance can be frus­trat­ing, for both ther­a­pist and client. Fees are of­ten so high be­cause a ther­a­pist work­ing with in­surance may get less than half of what they charge. As­so­ci­ates, In­terns, and Trainees of­ten have much lower fees, though they are sig­nifi­cantly less likely to take in­surance be­cause they are pre­li­censed.

When it comes to ther­a­peu­tic needs, we usu­ally have a sense of what is­sues we’re strug­gling with. How­ever, there is much more in this cat­e­gory that many are un­aware of be­fore start­ing ther­apy for the first time. For starters, there is a differ­ence be­tween hav­ing ex­per­tise, knowl­edge, or fa­mil­iar­ity with the im­por­tant is­sues. On some di­rec­to­ries, ther­a­pists may list any and all is­sues they have fa­mil­iar­ity with, even if they don’t have train­ing or ex­per­tise. Check­ing their per­sonal web­site (if they have one) may provide more in­for­ma­tion, but oth­er­wise, this may be an im­por­tant thing to ask in an email or over the phone. Some­one who is strug­gling to come out as trans may need a gen­der spe­cial­ist, while some­one else who has already tran­si­tioned and is look­ing to work on some­thing else may only re­quire that their ther­a­pist be fa­mil­iar with trans is­sues.

One of the most difficult ar­eas to as­sess in our­selves is what we need the ther­a­pist to be do­ing in the room. There are so many the­o­ries and tech­niques, and of­ten times, the web­sites that ther­a­pists ad­ver­tise on don’t ex­plain what any of them mean or what they look like. Most peo­ple have a clear image of old school ther­apy (ly­ing down on the couch and talk­ing about your dreams and child­hood), but this is only one school of ther­apy (psy­cho­dy­namic, speci­fi­cally). If you look at what sorts of in­tro­spec­tion and reg­u­la­tion in­ter­ac­tions and ac­tivi­ties work for you, of­ten times those are linked to ther­a­peu­tic tech­niques. What many peo­ple think of as a “pros and cons list” is called Cost Benefit Anal­y­sis in Cog­ni­tive Be­hav­ioral Ther­apy, and if re­flec­tive listen­ing feels most helpful, Roge­rian Ther­apy (also called Per­son-Cen­tered Ther­apy) is based in just that. If you have found a CFAR tech­nique that works well for you, I can al­most guaran­tee that there is a ther­a­peu­tic tech­nique that it is based on that you may find works as well.

There are a few parts of the ther­a­peu­tic pro­cess that are not of­ten spo­ken about, but can make a huge differ­ence. One ex­am­ple is that some ther­a­pists al­low you to text them to sched­ule and resched­ule ap­point­ments, and this can make a big differ­ence for some­one who has phone anx­iety. There is also who leads con­ver­sa­tions and how much, and fo­cus on solu­tions vs in­tro­spec­tion. A ther­a­pist who listens and tries to prod on in­tro­spec­tion isn’t go­ing to help some­one who wants guidance and solu­tions, just as a ther­a­pist who leads and looks for solu­tions isn’t go­ing to help some­one who needs to work through their emo­tions first.

For those who need a low fee ther­a­pist, there are train­ing clinics as­so­ci­ated with uni­ver­si­ties where pre­li­censed ther­a­pists prac­tice un­der the su­per­vi­sion of a more ex­pe­rienced li­censed ther­a­pist. If you find some­one who calls them­selves an As­so­ci­ate Ther­a­pist or a Ther­apy In­tern, they are prob­a­bly pre­li­censed and in train­ing. You will find pre­li­censed in­di­vi­d­u­als at train­ing clincs run by uni­ver­si­ties and in pri­vate prac­tice, though they rarely take in­surance. This is a good way to get ther­apy for cheap, while still re­ceiv­ing all of the ex­pe­rience of the ther­a­pist’s su­per­vi­sor.

Find­ing a Therapist

Two of the most com­mon ways to find a ther­a­pist are through in­surance or through a di­rec­tory. In­surance web­sites don’t ac­tu­ally have much in­for­ma­tion on the ther­a­pists be­yond lo­ca­tion and a few ar­eas of ex­per­tise; web­sites like Psy­chol­ogy To­day and Good Ther­apy al­low ther­a­pists to ex­plain their prac­tice in ways that are spe­cific to their tar­get clien­tele. Be­cause of this, not all ther­a­pists have their own web­sites, but many (es­pe­cially newer ther­a­pists) will. Psy­chol­ogy To­day’s ther­a­pist fin­der lets you search by in­surance, though it is less re­li­able as to whether the ther­a­pist ac­tu­ally takes your in­surance than go­ing through your in­surance com­pany di­rectly. It also lets you search by spe­cialty, modal­ity, gen­der, and much more. As I men­tioned above, a ther­a­pist’s listed spe­cialty may not ac­tu­ally be some­thing they’re cer­tified in, so it’s of­ten best to ask di­rectly if this is im­por­tant to you.

Another way of find­ing a ther­a­pist is through refer­rals. Most com­monly, peo­ple get refer­rals through their gen­eral prac­ti­tioner or psy­chi­a­trist. Some­times, you can get a refer­ral through a friend, though this can pose a prob­lem if you and a very close friend are see­ing the same ther­a­pist, and some ther­a­pists may re­fuse to see some­one close to a client due to the pos­si­bil­ity of each com­ing up in the other’s ses­sions. This is also why you usu­ally can­not have the same ther­a­pist for cou­ples and in­di­vi­d­ual coun­sel­ing, or for in­di­vi­d­ual for you and your part­ner. I am cur­rently com­piling a list of pro­fes­sion­als in the Bay Area ap­proved by those in the ra­tio­nal­ist com­mu­nity, and other com­mu­ni­ties of­ten times have similar lists (for LGBT, poly, kink, fat-friendly, etc). Often times, the best refer­rals come from an ex­ist­ing pro­fes­sional. All ther­a­pists have refer­rals ready in case they end up with a client who can’t see them any­more, for any rea­son. The bet­ter and more well con­nected the ther­a­pist, the bet­ter their refer­rals are go­ing to be. Thus, ad­vice I of­ten give for find­ing a good ther­a­pist is to find some­one who is the best match for you (ie some­one who wrote a book on your niche is­sue or did an im­por­tant re­search study on a tech­nique you love) and ask them for refer­rals (un­less you luck out and they are available and af­ford­able).

On­line ther­a­peu­tic ser­vices are get­ting more and more com­mon. Some web­sites func­tion as refer­rals, like Reflect (which matches peo­ple in SF and the East Bay to ther­a­pists who match their per­son­al­ity via video chat con­sul­ta­tions). Others al­low you to chat di­rectly with a ther­a­pist, like Bet­ter Help. Some, like 7 Cups of Tea, match you to a trained listener rather than a ther­a­pist, so they can provide ther­a­peu­tic ser­vices for free. There are also web­sites like Mood Gym, a CBT self help tool that is par­tic­u­larly helpful in point­ing out bugs. Many ther­a­pists also do video ses­sions. This can be very im­por­tant for peo­ple with chronic ill­ness, dis­abil­ities, or so­cial anx­iety; you can get help with­out even leav­ing the house.

Once you’ve found some­one, you can some­times figure out whether or not they’re a good fit based on on­line pro­file alone. If you want a tech-savvy ther­a­pist who can recom­mend apps and on­line tools, a ther­a­pist who doesn’t have a web­site or doesn’t check email very of­ten is prob­a­bly not a good fit. A ther­a­pist’s web­site or di­rec­tory pro­file of­ten has a blurb that is di­rected at their tar­get clien­tele. Th­ese tend to con­tain phrases like “Do you feel lost in your life?” and “It can be difficult to find a safe space to ex­press our feel­ings”. If a ther­a­pist’s blurb doesn’t speak to you, that doesn’t nec­es­sar­ily mean it’ll be a bad fit, but one that does is more likely to be a bet­ter fit. Some­times, the blurb can give us in­sight into our­selves. You may read a sen­tence like “Do you ever get anx­ious and push peo­ple away?” and re­al­ize that yes, you ab­solutely do that. This is a good sign that this per­son may be a good fit, be­cause the blurb is meant to at­tract the kind of per­son the ther­a­pist feels con­fi­dent they can work with.

Ini­tial Consultation

Of course, you can’t fully judge whether a ther­a­pist is a good fit with­out talk­ing to them. While it is pos­si­ble to sched­ule an ap­point­ment blind, it is not recom­mended un­less you feel con­fi­dent that they are the ther­a­pist for you (ie if you are already fa­mil­iar with their work via books or a blog). Ideally, a con­sul­ta­tion would hap­pen over phone or video, but some­times it is just eas­ier to talk via email. It is im­por­tant to note, though, that if you and the ther­a­pist have difficulty schedul­ing time for a phone call, you are likely to also have difficulty schedul­ing ses­sions.

In the ini­tial con­sul­ta­tion, you will both be learn­ing about each other. Your ther­a­pist will be listen­ing to your de­scrip­tion of your symp­toms and needs to as­sess whether they feel they can take you on as a client, and you will be notic­ing their re­sponses to de­cide whether you trust this per­son enough to make an ap­point­ment. No­tice how com­fortable they are or aren’t to talk to, and how the ex­pe­rience of the con­sul­ta­tion feels. Do you feel heard? Judged? Un­der­stood? Ig­nored?

This is also the time to make sure they ac­tu­ally fit your needs, prac­ti­cal and oth­er­wise. On­line in­for­ma­tion may be dated, your sched­ules may not mesh, and they may have only taken a class or two in a tech­nique that you need an ex­pert in. If you have ques­tions about fees, this is also the time to ask about that; many ther­a­pists have slid­ing scale fees and can make ac­com­mo­da­tions for those pay­ing out of pocket, though a lot of these ther­a­pists won’t ad­ver­tise this un­less there is an ex­pressed need for cheaper ther­apy, so it’s good to ask. Try and set­tle on a fee be­fore you sched­ule an ap­point­ment, so you aren’t shocked by the num­bers once you’re charged. Once you’re talk­ing to them, you should also find out what the eas­iest way to reach them is in case you need to con­tact them be­fore the ses­sion. It is good to know how to get in touch with them if you have trou­ble find­ing their office or are run­ning late.

Clients of­ten for­get key in­for­ma­tion dur­ing ini­tial phone con­sul­ta­tions. Re­mem­ber to men­tion your name and age, as well as what you’re com­ing into ther­apy for. In­clud­ing a gen­eral sense of your weekly sched­ule and any con­cerns about in­surance or abil­ity to pay can also be very helpful. Depend­ing on how much time you have for a con­sul­ta­tion, you may not have time to get to cul­ture and ex­pe­rience in ther­apy, but these should be brought up ei­ther in the con­sul­ta­tion or within the first cou­ple of ses­sions. Cul­ture in­cludes el­e­ments of iden­tity, such as sex­u­al­ity, lan­guages spo­ken, mil­i­tary back­ground, etc. Depend­ing on your con­cerns, these may be more im­por­tant to bring up in con­sul­ta­tion (ie if you need an LGBT friendly ther­a­pist or if you pre­fer a ther­a­pist who can speak your moth­er­tongue). Similarly, pre­vi­ous ther­apy ex­pe­rience, di­ag­noses, and psy­chi­a­tric meds taken can give your ther­a­pist im­por­tant in­for­ma­tion about what your con­cerns are and what does or doesn’t work. Some of this stuff may be cov­ered in the in­take (also called biopsy­choso­cial), but it’s im­por­tant to dis­cuss it in ses­sion nonethe­less.

First session

Some ther­a­pists give you in­take pa­per­work dur­ing the first ses­sion, while oth­ers send it to you be­fore the first ses­sion. If you have the op­tion, it’s always best to get it finished be­fore the first ses­sion; oth­er­wise, you may end up spend­ing half of your first ses­sion filling out pa­per­work and not get to talk to the ther­a­pist very much. Re­gard­less of when you fill this out, note that it can be pretty in­tense and in­volve a lot of in­va­sive ques­tions. Some of these ques­tions may seem to­tally un­re­lated to what you’re com­ing in for, but in fact it may not be. Eat­ing and sleep­ing habits, fam­ily his­tory, child de­vel­op­ment, how you were par­ented, and events you ex­pe­rienced as trau­matic (even if you feel they don’t count!) can make a huge differ­ence in some­one’s life. Depend­ing on your his­tory, the in­take may in­volve re­vis­it­ing old wounds. This is an­other rea­son it can some­times be bet­ter to do pa­per­work be­fore ses­sion; you can take your time and go at your own pace, rather than feel­ing rushed like you might in ses­sion.

What other forms you need signed de­pends on where you live and who you’re see­ing. There will most likely be at least an in­formed con­sent form, that tells you about some of the risks and benefits of ther­apy. There may be a sep­a­rate form to con­sent to be­ing filmed or recorded, or one to con­sent to ther­apy over phone or video. A ther­a­pist who uses on­line record­keep­ing may be re­quired to give you a packet of in­for­ma­tion on their pri­vacy prac­tices, and have you sign a form say­ing you re­ceived it. If you have other providers you see (ie a psy­chi­a­trist, cou­ples/​fam­ily ther­a­pist, so­cial worker, etc) you have the op­tion to sign a re­lease to al­low them to com­mu­ni­cate. You can use this same form (Autho­riza­tion to Ob­tain In­for­ma­tion) to al­low a pre­vi­ous ther­a­pist to speak with or send their notes to your cur­rent ther­a­pist. On top of this, child, cou­ples, and fam­ily ther­apy may re­quire other forms, like a spe­cific in­formed con­sent for minors or a no se­crets policy for cou­ples, de­pend­ing on the ther­a­pist and how they con­duct ther­apy.

When schedul­ing a first ses­sion, make sure you are not rush­ing to or from ther­apy. In­tense emo­tions can come up in ther­apy, so go­ing to an im­por­tant meet­ing right af­ter is a bad idea, if it can be avoided. Re­lat­edly, check in with your ther­a­pist about their can­cel­la­tion policy and if they do phone or video ses­sions. This is of­ten in­cluded in the pa­per­work some­where, but it can be helpful to es­tab­lish ahead of time. Most ther­a­pists have 24 hour or 48 hour can­cel­la­tion poli­cies, so if you can­cel within the time win­dow or don’t show up at all, you will still get charged. In this sense, it is bet­ter to resched­ule or have a phone or video ses­sion than to pay for a ses­sion you couldn’t at­tend.

Lastly, it can be helpful to take notes dur­ing the week to re­mind your­self of things to bring up in ther­apy. Jour­nal­ling helps a lot with this, as does keep­ing an or­ga­nized sched­ule, but you can even just jot down a few quick re­minders on your phone. This can in­clude difficult events dur­ing the week, re­al­iza­tions about your­self and your progress, or goals you have for ther­apy. Not ev­ery­one has the abil­ity to put in a lot of work out­side of ther­apy, but a lit­tle can go a long way.

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