HOW TO FIND THE RIGHT THERAPIST FOR YOU
Written by Dr. Kat Harris
Finding the right therapist is not always as easy as it should be. I’ve talked with many people looking for a therapist who feel overwhelmed at the prospect and don’t know where to start. Or they have already started but their searches have provided an overwhelming array of options. Or alternatively, very few options that fit their needs. Then they find someone who seems like a good fit, call or email the therapist to set up an appointment, only to find out that the therapist either doesn’t accept their insurance, doesn’t have availability that matches, or isn’t accepting new clients at all.
Making the decision to see a therapist is a brave one, and it’s unfortunate that the task can sometimes be daunting. My hope is to outline a few considerations to help make the task easier. Finding the “right” therapist can be so rewarding in so many ways and worth the work to find one.
License Types and Degree Types
What are all of those letters after a person’s name? In short, the letters often indicate one of three things: degree type, license type, and additional certifications. For example, someone with the letters MA, LCPC, CADC after their name is someone with a Master of Arts degree (MA), licensed as a Licensed Clinical Professional Counselor (LCPC) and are certified as a Certified Alcohol and Drug Counselor. There are many types of degrees in the field of mental health (e.g., PhD, PsyD, MA, MSW) in various areas of study (e.g,. Psychology, Counseling, Social Work, Marriage and Family Therapy). And there are many different licenses (e.g., Licenced Clinical Psychologists, Licensed Clinical Social Worker, Licenced Professional Counselor) that vary across states, with some denoting full licensure and some denoting partial licensure (still requiring supervision). And there are even more kinds of certifications, some that come with additional letters after the person’s name, and some that don't.
At the end of the day, what I believe is most important is not so much the letters after someone’s name, but what the therapist’s competency level is in the areas which they claim to treat, their professional value system, and the therapist-client relationship.
Where to Start Looking
Where to even start? Here are some ideas:
Therapist directories specifically designed to help consumer’s find counselors. Examples of these include Psychology Today, Theravive, and Good Therapy to name a few. Most of these directories allow you to filter out options to best match your needs such as finding a therapist who accepts your insurance or who claims to specialize in what you need help with.
Specific mental health organizations also have their own internal therapist directories that can be an excellent way of finding therapists who specialize in treating your symptoms. For example, the International OCD Foundation and the Anxiety and Depression Association of America both have therapist directories to help people with symptoms of OCD and Anxiety ind specialists.
If you have insurance, you can also contact your insurance provider or go on your insurance provider finder website page to obtain a list of providers in your area who accept your insurance.
Asking a friend or family member for counselor’s whom they would recommend is another great place to start.
Navigating Insurance and/or Affordable Therapy
Navigating insurance alone can feel like you need a direction manual. Here are some basic things to consider:
If you have insurance, you will likely want to find a therapist who is “in-network” with your insurance company. This means that they officially contract with that insurance company and have negotiated rates with that insurance company. That way you can pay “in-network” rates for co-insurance/co-pays/deductibles rather than out-of-network co-insurance/co-pays/deductibles which can often be significantly more expensive. Check your personal contract with your insurance provider to determine what your in-network and out-of-network responsibilities are as the client.
A co-pay means you are paying a set amount (e.g., $20) per session and the insurance company is paying the rest of what your therapist bills. A co-insurance means you pay a certain percentage (e.g., 20%) of the contracted rate for a therapy session and the insurance company pays for the rest. A deductible refers to the amount of money you have to pay out-of-pocket before your co-pays/co-insurance kicks in. Deductibles can range greatly and can be anywhere from $0 to thousands of dollars. Until your deductible is met, you have to pay 100% of the therapist’s session fees.
Not all therapist’s will be in-network with all kinds of insurance companies. In fact, some therapist’s choose to only be in network with one or two companies.
PPO’s do not usually require a physician’s referral for therapy sessions to be covered but may require pre-authorization depending on the service. Most therapist’s are in network with PPO’s.
HMO’s require a physician’s referral for therapy sessions and fewer outpatient therapists tend to be in network with HMO’s. If you have an HMO it would likely be easiest to contact your insurance company and ask for a list of therapist’s in your area whom they will cover.
If you don’t have insurance, community organizations such as community mental health centers, and sometimes private practices, have sliding scale options. Training clinics are also a good place to try because they often offer sliding scale fees. Open Path is an organization that can be a good start to find a therapist if you need a sliding scale as well.
Finding a Specialist
Do I need a specialist? In short, it depends on a number of factors. These factors include severity of symptoms, symptom presentation, and prevalence of the disorder. For example, I would recommend that someone with OCD find someone who specializes in the treatment of OCD. Particularly using a form of therapy called Exposure and Response Prevention. Why? Because research has demonstrated that this is the gold-standard treatment for this disorder and not all therapists have training in this treatment or in treating OCD. Someone with mild depression on the other hand may not need to find a specialist because the majority of therapists have training and experience treating at least mild to moderate depression.
What makes a specialist? I have always suggested that what makes a specialist is someone who has the following four pillars of specialty practice: Formal Training, Supervision and/or Intensive Consultation, Experience, and Continued Education. Formal training can include graduate school training, internship or postdoctoral training, trainings at conferences and other intensive trainings. Supervision and/or Intensive Consultation means that the person has received supervision or consultation from another professional who is already a specialist in the area. Experience means that the therapist has seen a large enough number of cases to have had the opportunity to refine skills, learn from their experiences (preferably under supervision or consultation), and develop nuanced approaches for a variety of presentations. Finally, continued education means that the therapist is passionate enough about their speciality that they want to continue to learn and grow. This may mean that they seek out up-to-date research, regularly attend conferences and trainings, are members of speciality interest groups, etc.
It is impossible for a therapist to specialize in everything. Therapists who list 20 “specialties” under their profiles or in their bios are likely not specialists in all they claim to be.
It’s 100% OK to reach out to a prospective therapist by email or phone and ask a few questions to ascertain whether they would be a good match for you, including whether they meet some basic qualifications for claiming to be a specialist in a given area. If a therapist makes you feel badly for asking questions then they might not be the best match for you in the first place. Here is an example list of questions for someone interested in finding an OCD therapist authored by the International OCD Foundation: https://iocdf.org/ocd-finding-help/how-to-find-the-right-therapist/
Levels of Care
Another consideration is that there are varying levels of care. Many people think of two things when they think of therapy: traditional outpatient therapy, where you meet one-on-one with a therapist, or inpatient therapy where you are locked on the unit for safety reasons. However, there are actually several in-between options that may be a good match for your needs depending on the “dose” of treatment you need. The more severe the symptoms, the more likely a higher level of care will be indicated to best help you get better.
Outpatient: This is the most traditional level of care and will fit most people’s needs. Usually in this setting you see a therapist once or twice a week for between 40-53 minutes.
Intensive Outpatient Programs (IOP): At this level of care, client’s would attend a therapy program anywhere between 3-4 hours a day. The therapy program might include group therapy, psychoeducation presentations, meetings with an individual therapy, meetings with a psychiatrist, and an experiential component (e.g, music therapy). At this level of care you go home at the end of the day and your participation is voluntary.
Partial Hospital Programs (PHP): This level of care is very similar to an IOP settings (and most of the time client’s start in a PHP and then “step down” to an IOP setting within the same location and program. With this level of care a client might attend anywhere between 5 and 6 hours a day and have additional components such as family therapy. At this level of care you go home at the end of the day and your participation is voluntary.
Residential Treatment: This level of care is similar to PHP programming; however, the client’s sleep on a unit in the program and programming might last a little longer throughout the day. At this level of care you don’t go home at the end of the day and your participation is voluntary.
Inpatient: This level of care is reserved for situations where a client’s symptoms are severe enough that the person’s safety or ability to function are at risk, and therefore the person needs to be closely monitored. This is a short-term treatment, and the person is usually “stepped down” to a PHP/IOP program as soon as possible. At this level of care you don’t go home at the end of the day and a person's ability to end treatment is sometimes partially determined by the attending physicians.
It might be helpful to be open to the possibility that you might need to meet with more than one therapist before finding a good match. My heart breaks when I meet a client for the first time and they inform me that they tried finding help a decade ago but gave up after a meeting with a therapist didn’t go as they had hoped (and there can be many reasons for this). I think of the decade lost and what could have been if they had met the “right” therapist for their needs. There are many factors that go into whether a therapist is a good match, but some of the ones that stand out most to me are whether you feel safe, whether you feel understood and heard, and whether the therapist demonstrates some level of competence in diagnosing and treating your symptoms.
Finding a therapist in some areas of the county can be considerably more difficult than other areas. Especially if someone is looking for a particular specialist or another important variable. Telehealth might be a good option for individuals with limited options in their communities.
There is a therapist for you! And there are treatments that work! Best wishes on your journey!