Making change happen: how to find a therapist.
Image of an armchair next to a sofa and end table. Photo by Jacalyn Beales on Unsplash
Finding a therapist isn’t always easy. And there is lots of research that shows the relationship with your therapist matters as much as the kind of therapy you do. I get lots of questions about this and so want to offer some thoughts on how to navigate finding a therapist that is a good fit for you.
What is a therapist, anyway?
A psychotherapist diagnoses and treats mental health issues, as well as works with relationship challenges. They may focus on challenges going on in your life right now and changes you want to make so that the future looks different as well. Some therapists, though not all, also work with past experiences you have had and the impact these have on your current life. Psychotherapy typically is centered around conversation (i.e. talk therapy) but can also involve other experiences like skill building and education, somatic (body) experiences, and other strategies.
Every licensed psychotherapist starts by obtaining a masters or doctoral degree and several thousand hours of clinical experience before taking the licensing exam. Each state’s requirements are different and it’s a good idea to check with your state government to determine what licenses are available in your state and what they are legislated to do. In California, there are several licenses that can diagnose and treat mental health issues including psychologists, licensed marriage and family therapists, licensed clinical social workers, and licensed professional clinical counselors.
Therapist vs. coach
There is a lot of gray area between therapists and coaches. On a simple level, coaches typically focus on present and future, addressing actions that you can take to make changes in your life. They often focus on skills and strategies for making change happen.
One important difference is that a therapist is a regulated, licensed health care professional while a coach is not typically licensed or regulated by a governing body (although coaches do have professional associations with ethical codes of behavior, etc.) Coaches are not licensed to diagnose and treat mental health issues but often can provide helpful services.
Therapists can typically do all of the same things that coaches do (skills building, identifying goals and actions for positive changes, as well as provide specialized skills in career advancement and leadership, etc.) and also can diagnose and treat mental health issues.
What do all therapists have in common?
One of the hardest aspects of finding a therapist is determining who might be the right fit based on how they work. Most therapists do have some commonalities. One of these is what we call the therapeutic frame. The therapeutic frame is the set of rules and guidelines of how therapy works that make if different from other relationships and that can promote healing. We often talk about the frame as a way to differentiate our relationship with clients from friends and family members. Yes, you can tell your problems to your friends, barber, bartender, etc. but therapists “hold the frame” to promote healing and growth.
What does the frame look like? It can mean many things but one of the most important is that it is about keeping the you, the client, safe. This means that (with some exceptions) everything discussed in therapy is confidential so that you can talk about what matters to you. It is also about therapists not inserting their own agendas (like our friends and family members often do). It can also be about a predictable time and structure (often 50 minutes weekly or biweekly).
Another commonality with most therapists is that it is client-centered. The focus is on the needs of the client. What are you experiencing? What matters to you? I often tell clients that they are the expert about their own lives and my job is to support them in determining for themselves what is the best way to move their lives forward. This can differ from our friends and family who often have their own reactions and opinions about what is going on and what might be best for us.
How are therapists different?
Ultimately all therapists are working toward helping their clients change. How change happens, however, can be interpreted and implemented in many ways. Ways therapists can work with clients to make change happen include:
Helping clients change behaviors and modify thoughts that are distressing (e.g. CBT: Cognitive Behavioral Therapy),
Utilizing skills to regulate emotions and improve relationships with others (e.g. DBT: Dialectial Behavioral Therapy)
Incorporating mindfulness techniques and values clarification (e.g. ACT: Acceptance and Commitment Therapy)
Focusing on the relationship dynamics that occur both with others (e.g. psychodynamic therapy) or internally with various parts of yourself (e.g. Internal Family Systems).
This is just a snapshot and doesn’t capture all the possible therapy methods that are available.
It can be helpful to read about the various therapy methods and see which ones resonate with you. If you’ve had experience with one kind of therapy you may be interested in trying something different. I think it is also important to both check out a therapist’s website to see how they describe the kind of work they do and ask specific questions when you are interviewing therapists about how they work with clients.
Insurance vs. out-of-pocket
This is a big area for mental health care and I don’t claim to be an expert. However, you will have to decide if you would like to use your insurance benefits to pay for therapy or you would prefer to pay out-of-pocket. If you want to use your insurance benefits then a great place to start is with your insurance company. Most insurance companies offer an online directory of in-network therapists. Often therapists who do accept insurance will list this on their website as well.
Many therapists do not directly work with insurance and are considered out-of-network providers. There are lots of articles about the current state of health care and why so many therapists choose this route (read more about this here, here, and here). Many out-of-network therapists can provide a document called a superbill that can be used to submit a claim for insurance reimbursement. You will want to find out the particulars of how this works from your insurance company.
Finding a therapist
Finding a therapist can be a daunting task. There are a variety of therapist directories available and depending on your location you may get lots and lots of therapists who meet your criteria.
One thing to note is that there are general directories and specialized directories. General therapist directories (such as Psychology Today, Therapy Den, and Good Therapy) often allow you to limit your search by geography, gender, speciality, etc. There are also specialized directories that focus on specific topics or types of therapy. If you are looking to work with a therapist who utilizes a specific type of therapy there are often professional associations that have directories of therapist who practice in these specialized areas. There are also directories for therapists who work with specific populations such as therapists who work with trauma, neurodiversity, queer people, etc.
Referrals
While directories can be a helpful place to start I think that referrals can also be a useful way to find a therapist who may be a good fit. If you know a therapist, it can be helpful to ask them for referrals. Many therapists are happy to provide referrals for colleagues that they trust. Referrals from friends and family can also be helpful.
Most therapists are also happy to help with referrals even if they aren’t a good fit for you. For example, if you know of a therapist but they aren’t accepting new patients, they may be happy to provide referrals to colleagues they trust and that might be a good fit for you.
Get the most out of the initial consultation
Once you’ve identified several possible therapists it can be really helpful to set up some time to talk to them, ask questions and determine if they might be a good fit for you. Most therapists offer a free consultation call (usually 15-30 minutes) where you can get to know them a little better and ask questions. This is a great opportunity for you to share your goals for therapy and the therapist can determine if they might be able to help you.
I encourage any potential client to set up several consultations to get a feel for various therapists. While this may be time consuming, finding a therapist is a lot like dating. Even if information on a therapist’s website sounds like a perfect fit for your needs, a relationship that works for you is crucial. Take time to get to know them.
It can also help to do a little preparation before meeting a therapist for a consultation. I suggest having a clear idea of your goals or areas where you would like to focus in therapy. This can help the therapist know if they will actually be a good fit to help you or if someone else might be a better fit.
It can also be helpful to prepare some basic questions to help you understand how the therapist works and what you might expect in therapy. Some examples:
What’s their schedule like? When do they see clients?
What is their fee?
Do they work in-person, online or both?
How will they work with you to help you meet your goals? Do they prefer to work with certain therapy modalities?
How will you both know when therapy is complete?
How do they work with the issues you are wanting to focus on?
Ongoing feedback and assessment
Once you select a therapist assessment continues. If could take more than one session to determine if a therapist is a good fit for you and that’s OK. A good therapist gets this and wants you to have a good experience, even if it means referring you to someone else. After your first session and for subsequent sessions, check in with yourself - how does this relationship feel to you? How do you feel about the therapist? As therapy continues does it feel like you are meeting your goals?
Finding the right therapist takes both initial preparation and ongoing assessment. A strong therapeutic relationship is just as important as the type of therapy itself, so taking the time to research, ask questions, and trust your instincts can help you find the best fit. Remember, therapy is a collaborative effort, and checking in with yourself regularly about your progress and comfort level can help you make the most of your experience.