How to Select the Right Therapist for You

Author Article
It’s not easy to find a good therapist. Therapy can be incredibly cost-prohibitive, for one thing, depending on insurance coverage. Then, there are scheduling constraints (it’s hard to find a therapist with open hours if you work a traditional 9-to-5), location constraints, general time constraints, and trying to suss out whether or not the person you’re spilling all your shit to is the right one to help you unpack and repack it.

There are also hundreds of different types of therapy, which is daunting when you’re not sure what kind will work best for you, in addition to a slew of different categories of mental health professional, all of which come with different credentials and training. It’s a lot to navigate, especially when you’re a first-time client. Here are some tips for selecting the right kind of help.

What kind of therapy do I need?

There are many, many different types of therapy, and mental health professionals don’t necessarily use a one-type-fits-all approach. If you’re suffering from something like generalized anxiety disorder or depression, for instance, your therapist might use a combination of treatments in your sessions. But let’s take a look at some of the most common options:

Cognitive behavioral therapy (CBT):

CBT is a common treatment that focuses on looking at certain behavioral patterns and coming up with a game plan of sorts to break them. “It’s trying to help you change your behavior through thinking differently about your situation,” Ryan Howes, PhD., a clinical psychologist in Pasadena, California, says. “So, for instance, if you get anxious about confronting your boss at work, or anxiety stops you from making any movement, CBT can help you reframe that. Instead of thinking of all the horrible things that could happen, it’ll help you imagine positive outcomes.”

CBT therapy is usually short-term—your therapist helps you determine a specific goal, and will then work with you to help regulate your emotions and develop new personal coping strategies. It can be especially good for treating anxiety and depression.

Psychodynamic therapies:

Psychodynamic therapies like psychoanalysis and Jungian therapy involve digging into your past to look at the root of whatever problems you’re trying to treat. So, for instance, if you’re anxious about confronting a boss, a psychodynamic approach will try to determine when this particular anxiety first took place, and how early traumas and relationships contributed to your current predicament. “The idea is that being able to uncover early thoughts will free you up to be able to act differently,” Howes says.

Psychoanalysis can take a long time (like, years) and many therapists will use it in tandem with a CBT approach, which is something worth bringing up in a consultation.

Specialized therapies for specific disorders:

Both CBT and psychodynamic therapies (or a combination of the two) can be effective for more general mental health disorders, but f you’re struggling with a particular disorder, like an eating disorder or post-traumatic stress, it may be more beneficial to see a mental health professional who specializes in treatments targeting those issues. For instance, if you’ve suffered from trauma, there’s Eye Movement Desensitization and Reprocessing (EMDR) therapy; if you’re mourning a tragic death, there’s grief therapy.

The thing about therapy, though, is that you might think that CBT will help you the best, or that you want deep psychoanalysis, or that only one specific kind of treatment will help you. The reality is that therapists will often use multiple approaches when treating a patient, and though it’s helpful to find a therapist who specializes in a particular disorder, when you start seeing one, you may discover it’s not just anxiety or grief that’s causing you problems.

“Nobody walks in the door with one problem,” Faith Tanney, a psychologist with a private practice in Washington, D.C., says. “You have to be able to switch around with different modalities.”

More importantly, if you like your therapist and feel comfortable opening up to them, the type of treatment they specialize in might not make a difference. “If you think your therapist is healing you, stay with them,” Tanney says. “If you don’t think your therapist is helping you, I don’t care what kind of therapy they’re doing.”

What kind of mental health professional should I see?

There are a few different kinds of people licensed and qualified to provide therapy. Psychologists have PhDs and PsyDs, and are trained in both psychotherapy and assessment testing. Licensed clinical social workers are also trained in psychotherapy and perform functionally similar mental health services to psychologists, but don’t have doctorates. A licensed mental health counselor is also trained in psychotherapy and will treat patients much in the same way as a social worker. Psychiatrists primarily focus on chemical imbalances. They have medical doctorates, and prescribe medication (in some states psychologists can also prescribe medication).

A psychiatrist is the one to see if you’re in the market for mood-correcting meds, but if you’re looking for talk therapy, you’re better off seeing a psychologist, social worker, or counselor. Psychologists tend to see people with serious mental illness, while social workers and counselors can help patients suffering from more common forms of psychological distress. In the long run, though, as long as you’re seeing someone with a valid state-issued license (states have online license lookups for psychologistscounselors, and clinical social works), if you like your therapist, their specific credentials don’t really make a difference.

What research should I do before having a consultation?

There are a lot of different factors that go into finding a therapist. Therapy is expensive, so if your health insurance will cover it, it’s a good idea to search for one through your provider, though some therapists will offer counseling on a sliding scale. Location is also a big factor—if you think it’ll be difficult for you to get to your therapist, you’ll probably be less likely to make your appointments, especially when you’re still in the “feeling it out” stage.

If you’re looking to treat a certain problem, you do want to know your therapist has some experience in that realm. If you struggle with anxiety, your therapist should know how to treat anxiety. If you have bulimia, your therapist should have experience with patients with eating disorders. Websites like therapy.organd Psychology Today will tell you a little about your prospective therapist’s areas of expertise, so you can get an idea of what you’re working with.

Then, you have to take into account your personal preferences. “Some people feel like they want someone who fits in a certain age bracket. Some want someone a little older and wiser, some people feel more comfortable talking to someone around the same age,” Howes says. “Gender is a big part of it, too. I tell people to try to make a list of three therapists that on paper seem to fit their criteria, that are the right age and specialize in that area, and go on a test drive with these therapists.”

What questions should I ask in my first session?

When you’ve selected your three therapists, you should set up a consultation, either by phone or in person. Sometimes therapists won’t charge for consultations, and sometimes they will, so it’s a good idea to suss that out beforehand.

Once you’re at the consultation, though, the most important thing is to get a feel for your therapist. “This is like a first date,” Tanney says. She recommends skipping over the “where did you go to school” part of the standard dating questionnaire—“They’re already licensed, so you can sue them,” she jokes—and getting right into your particular goals and how they might go about helping you achieve them.

“You got my name from someone. You’ve read up on me, and see that I have the skills, I have the techniques, I have the training, I have the experience. Now we’ll see if that works for you,” Tanney says. “We set goals for therapy, I’ll tell you what I think we’re going to work on first, and you say whether or not they make sense to you.”

It’s also a good idea to ask your therapist for their specific policies—some require advance notice if you’re canceling a session, for instance, or will only allow you to take a couple weeks off without being charged. Some will ask that you give them a few weeks’ heads up before you decide to end therapy. “If you feel the time has come to leave, I would ask that you let me know, so we have a couple weeks to discuss that,” Tanney, who has her patients sign a contract, says.

Ultimately, go with your gut

The real key to finding a therapist is exactly like trying to find a romantic partner—there has to be a “click.” After a couple of sessions, if you don’t feel like your therapist is someone you can open up to, then they are not the therapist for you.

“It’s about trusting your gut,” Howes says. “The therapist can be the most highly trained person in the world with years of experience and mountains of books, but if you can’t open up to them, the therapist is worthless. Or they can be a brand new trainee, but if you feel safe and comfortable talking to them, the therapy will be more beneficial.”

So if you’ve test-driven a few therapists, pick the one you felt the most comfortable talking with. And if, after a few sessions, or a few months, or a few years, you decide you’ve lost that connection, it’s okay to leave. “You have the power. This person is in your employ,” Tanney says. Don’t ghost, and do bring up your specific concerns about your therapist to them, since it’s always a good idea to give someone an explanation as to why you think things aren’t working. But you’re the boss. After all, as Tanney says, “This is not your friend, this is your worker bee.”

Should I Seek Help?

Author Article

“Doing it yourself is a fad in the United States.”  These were the first words in my first book in psychology, which I coauthored more than 40 years ago.  Turns out we were wrong.  Doing it yourself is not a fad, but a way of life in the U.S.  These days we have so many more resources available to help us help ourselves, including self-help blogs like this one.  And, of course, YouTube, which is a wonderful resource for training videos.  I’ve turned to YouTube to learn the basics of such tasks as caulking a bathroom tub and repairing a hinge on kitchen cabinets. There’s pride in doing things yourself, even if the quality of the work may not match that of a professional.  But I would draw the line at developing a winning tennis serve by following a self-instructional tutorial.  Sometimes a good coach is needed.  There is also a line to be drawn between using the Internet for self-help—even blogs like this—and seeking professional help.

My first book in the field focused on applying principles of behavior therapy to problems in living, from losing excess weight to smoking cessation to overcoming fears and sexual problems.  For many of the problems people encounter in their daily lives, behavior therapy offered practical solutions. This blog continues in that tradition, offering tips for changing your thoughts and attitudes to change your life.  We have explored how to rethink your responses to life’s twists and turns, and along the way offered tips on a range of troubling emotions, from overcoming worry and guilt to coping with fear and managing anger.  We applied the wisdom of ancient Greece to “know thyself” by turning inwardly to examine and evaluate our thoughts and beliefs, especially the negative thoughts that underlie emotional problems like anxietydepression, and anger. We confronted the two worthless emotions, worry and guilt—worthless because we don’t need to be wracked with guilt to recognize our mistakes and correct them or to be consumed with worry to take steps to protect ourselves from impending threats.

Self-Care Is Self-Help

With all this emphasis on self-help, we can lose sight of the importance of a basic principle of self-care—seeking help from others when help is needed.  But how do you know when going it alone is just not cutting it?  The benchmark clinicians typically use is whether problems are persistent and cause significant emotional stress or impair daily functioning.  If you regularly struggle to get out of bed and get going in the morning because you’re feeling down in the dumps, your state of mind is affecting your ability to function effectively.  If you can’t shake off intrusive worrisome or guilt thoughts, or if angry outbursts damage your relationships with others, or if you are continually on edge and can’t sleep at night or relax during the day, then it’s clear your daily functioning is impaired.

Where to Turn for Help

In the forty or so years I’ve been in practice, I’ve witnessed many changes in the field, including the emergence of cognitive behavioral therapy (CBT) as the leading modality of psychotherapy in use today. When I began my practice, psychodynamic therapists schooled in the Freudian and neo-Freudian traditions dominated the field. Today, there are many different forms of therapy and many different types of therapists, from psychologists and psychiatrists to mental health counselors and clinical social workers.  Some forms of therapy, like CBT, offer briefer and more problem-focused treatment approaches than traditional therapies, such as psychoanalysis.  CBT has become the treatment of choice for a range of psychological problems from phobias to social anxiety to insomnia, and evidence from controlled trials shows that CBT more than holds its own when stacked up against other therapies for treating depression and other emotional disorders and when compared to psychiatric medication.

Over the years, the field of psychiatry has become increasingly medicalized, as psychiatrists (medical doctors with specialized training in psychiatry) largely turned from practicing psychotherapy toward medication management. Though psychiatric drugs have important roles to play in the treatment of mental health disorders, especially so with more severe disorders such as bipolar disorder and schizophrenia, popping a pill does not help people solve problems in their daily lives or learn skills they need to change how they think or improve their relationships with others. Moreover, relapse rates are high when patients stop taking psychiatric meds, and for good reason, as these drugs help manage symptoms but do not address underlying emotional or interpersonal problems. On the other hand, patients can carry the techniques they learn in psychotherapy well beyond the course of treatment and continue to apply them in their daily lives.

Am I Ready to Reach Out?  A 10-Item Checklist

If you’re thinking about whether it makes sense to seek help from a professional, you may find the following checklist to be a useful guide. There is no set number of items that determine whether you could benefit from seeking help.  But as a general guideline, answering at least a few of these questions in the affirmative suggests it might be helpful to talk to a psychologist or other mental health professional.

Yes or No? (You be the Judge)

1.       Are my efforts to change my thinking or attitudes working?

2.       Do I continue to struggle with anxiety, depression, or other negative feelings that impact my daily functioning?

3.       Am I able to step back and examine my own thoughts, or would it help to have another person’s perspective?

4.       Do I give up too easily rather than persevere in changing my thoughts and behaviors?

5.       Are other people telling me I would benefit from “talking to somebody”?

6.       Are worries making it difficult to sleep or function effectively during the day?

7.       Am I avoiding situations out of fear or anxiety?

8.       Is my behavior affecting my relationships in negative ways?

9.       Do I find it difficult to make changes on my own or to stick with them?

10.     Might I work better with a professional than going it alone?

Finding a Therapist

If you do decide to seek help, select a therapist who best fits your needs.  Do you want to work with a therapist who uses psychological methods of treatment, such as a psychologist or counselor, or would benefit more from psychiatric medication prescribed by a psychiatrist?

Find a practitioner with the appropriate licensure and credentials—for example, a licensed psychologist, or a licensed psychologist holding advanced credentials (e.g., a Diplomate in Clinical Psychology awarded by the American Board of Professional Psychology, or ABPP), or a board-certified psychiatrist.  Find out whether your medical insurance covers mental health services (check it out with your health care provider) and whether are you covered for out-of-network providers.  As with other specialists, you may need to pay the therapist’s fee upfront and be reimbursed afterwards if the services are covered by your insurance plan, less any deductibles, co-pays, and so on.

Word of mouth is a good source for finding a therapist but be aware that what works well for one person might not work for another.  You might also “google” the practitioner to see if anything untoward turns up or ask your state licensing board if there are any complaints filed against the individual. Be prepared to ask a potential therapist a lot of questions, like whether the therapist is experienced in treating people with similar problems as your own, what specific form of treatment will be used and what evidence supports its effectiveness,  how long treatment is expected to last, what adverse experiences might be expected, such as drug side-effects, whether you are responsible for cancellation fees, and so on.  Licensed professionals will openly discuss these and other questions with potential clients.  If they balk, take that as a sign to look for someone else.

Whether you try going it alone or reaching out for help, the good news is that there is a range of effective therapeutic techniques that can help people live happier and more fulfilling lives.

© 2019 Jeffrey S. Nevid

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