Tips From a Psychotherapist on Finding a Good Fit for Therapy

Choosing a therapist is an overwhelming task at a time when, by definition, you are usually not at your peak.  But a little bit of effort now can go a long way – research clearly indicates that the relationship you have with your therapist is more important than any other factor. This includes what type of therapy is done (CBT, DBT, ACT and all the alphabet soup!). 

The following “steps” are meant to serve as a guideline for this process, but of course please remember that different things work for different people.  If you are in a serious crisis, such having thoughts about hurting yourself or others, just get yourself in somewhere as soon as possible.   Of course, call 911 if you feel like you’re in imminent danger.  You can worry later about whether this person is right for you to do more committed work with.

STEPS FOR CHOOSING A TALK THERAPIST

 

Self-Reflect.

What a “therapisty” thing to say, I know.  But if you take a little time and think about what sort of people you tend to feel the most comfortable and open with, it might save you a lot of trouble and heartache later on.  Is it important that your therapist is around your age?  Or maybe somebody older, who you feel might have more life experience to offer?  How do factors like lived experience of gender, race and ethnicity play a role for you?

Consider topic expertise. 

Many people check in with the first psychotherapist on their insurance panel, only to discover that person may not be well suited to treat the issue they are dealing with.  Some difficulties such as addictions, eating disorders and phobias really are their own animals and are not typically well treated by most generalists.  Other more common or less complex concerns such as depression, anxiety and relationship problems can generally be treated by any good generalist.

Develop a short list.

Poke around on sites such as Psychology Today and Good Therapy.  Search your zip code and those around you.  Don’t just use the search function.  Read bios to see determine if therapists truly specialize in your area of concern.

If you feel comfortable, ask family, friends, your primary care doctor, and anyone else you can think of for referrals – a personal experience is worth a thousand websites.

Look at providers’ websites critically. You are looking for a therapist, not a web designer, but there shouldn’t be evidence of unprofessionalism such as frequent misspellings or poor grammar. If they have posted pictures, are they somebody you could envision yourself talking to?

Develop a list of about ten names if you can; don’t worry – it will likely get pared down throughout the rest of the process.

Check credentials.

Make sure the people on your list are licensed professionals.  If they are a psychologist (PhD or PsyD), check the state board of psychology to make sure their license is active and in good standing.  For a LCSW or MSW, look into the State Board of Social Work.  A Licensed Professional Counselor (LPC) should be licensed through the Board of Counseling. 

Do not overloook pre-licensed professionals, though!  I cannot stress this enough, honestly.  Psychotherapists who are accruing their hours for licensure under supervision are often at the cutting-edge of the field because their education is quite fresh.  They often have smaller caseloads and more time and energy to devote directly to you. 

For example, our own Dr. Meg Seymour has been receiving training in Somatic Experiencing Therapy, a modality that is on the forefront of trauma work.  Similarly, LGPC Katie Zweig uses many elements from Internal Family Systems for eating disorders.

Think about your finances, but don’t choose the cheapest option.  

The first question here is whether or not you need to use your insurance.  I would encourage you to really challenge yourself about this, especially in metropolitan areas such as Washington DC, New York or LA (or their suburbs like Chevy Chase, MD or Westchester, NY) where very few providers are in-network with insurance companies.

The old adage “you get what you pay for” is certainly not always true when it comes to psychotherapy – but sometimes it is.  The more of a metropolitan area you live in and the more therapists in your area, the more likely it is to be the case.

There are options for getting high-quality care if your finances are limited though.  Many therapists offer a sliding scale, meaning that they are willing to lower fees for people who have difficulty affording services under certain circumstances, and it is certainly worth asking about this possibility. 

If you are in need of a specialty that is rare to find, such as eating disorders, you can often arrange a single-case agreement.  In this situation your insurance provider reimburses you for fees that go beyond the in-network rate.  You pay your bill as usual, but then get most of the money back.

Good group therapy is probably the best deal out there – five times the perspectives at one fifth the rate.

But remember that psychotherapy is generally at least a medium-term commitment, so scratch off anybody you truly can’t afford. 

Make some calls.

This isn’t just about setting up an appointment.  There are several key questions that you would do well to have answered or confirmed before you commit to a consultation:

 Questions for a Potential Therapist:

• Do you work often with the issue I am having?  Do you consider yourself to specialize in that area?  What sort of experiences have you had with people dealing with my problem, or attempting to achieve my goal?
• Where exactly are you located?  How easy is it to get to your office?  Are you near public transportation, or is parking available? 
• Is telehealth available?  What platform do you use?  Is it HIPAA-encrypted?  
• How much is the fee per session?  Do people typically pay at the time of the session, or get billed monthly?  If you are an out of network provider, do you give me the paperwork needed for my insurance company to reimburse me?  If needed, do you offer a sliding scale and, if so, how do you determine the fee in that case?
• What availability do you have?  Can I have a standing appointment (same time every week)?  If needed, do you offer weekends/evenings?

Arrange some consultations.

Choose around three of the therapists who you enjoyed talking to.  If their logistics work for you, set up in-person appointments.  I recommend this even if you plan to do telehealth.  You can get a much more vivid feel for someone in person.  When you meet with them, pay close attention to how you feel.  Do they seem to be listening to you?  Do they seem to care about what you’re saying?  Are they telling you too much or too little about themselves?  Check the books on the shelves to see if their way of thinking about people, health and healing seems to match your own.

Commit with caveats. 

It is important to be able to work through difficulties in therapy, so don’t change therapists any time there is a hint of conflict or disagreement.  But if you see any red flags such as poor boundaries, bizarre behavior, or not feeling listened to, it’s ok to continue your search.  I would recommend re-evaluating after six months to think about how therapy has been going.  Talk about this with your therapist as well.