A Step-By-Step Guide to Finding the Right Therapist for You
by: Ashley S. Pickard, LMFT, PMT
Whew! You made it here! Welcome. Whether you have looked for a therapist before, or this is the first time, let me start off by acknowledging the courage it takes to begin this journey.
You probably have a lot of questions about finding a therapist:
Where does a person even look for a therapist?
How can I tell that the person I found will be a good fit for me?
How much should I be willing to pay for therapy?
Is there a difference between in-person and virtual?
These are perfectly valid questions to be asking!
My hope is to be able to walk you through the process to help you know what to expect and some things to consider.
What do you want out of therapy?
When thinking about beginning therapy, it can be helpful to identify what it is you want to work on:
What are your goals?
Do you want to determine if a job is worth leaving?
Are you confused about why there is so much conflict in your personal relationship?
Do you feel anxious much of the time and want to find relief when it comes to ruminating thoughts?
In other words, what are the things in your day-to-day life that you want to change?
What are the things that you are struggling with?
I encourage you to take some time to think about these questions in order to help you identify what you want to address. Knowing what you want will help you to find the right person for the job.
The right approach
Once you have an idea of what you want to work on in therapy, you can begin to look for a therapist who specializes in addressing those things.
Therapists often specialize in working with either individual adults, adolescents, couples, families, etc. Additionally, most therapists use specific modalities or approaches in their work that focus on different aspects of healing.
For instance, CBT, or cognitive behavioral therapy, is focused on understanding and re-framing many of the automatic thoughts we have. In comparison, attachment therapy focuses more on relationships and how our interactions with others influence us.
Each of these modalities requires training and experience on the part of the therapist and asks something different from the client.
For example, in somatic therapy, the client is asked to do more reflection and body-focused work, whereas, in CBT, the client engages with the mind and their thoughts. Some clients may not be comfortable with focusing on the body, and that is okay.
But It’s good to know what kind of modality your therapist works from so you know what you are walking into… and if it’s a good fit for you.
Some therapists are what we call “generalists” and use a combination of modalities.
The modality used is less important than whether or not the therapist is skilled in working with your presenting concerns or problems.
For example, if you are wanting to address events that happened to you as a child, it is best to seek out a therapist who specializes in childhood trauma. There are too many modalities of therapies to list here, so my advice is to look for someone whose profile or website speaks to you and then look into the types of modalities they use.
It is important to note that there are many valid and effective treatment modalities. These should not be looked at as hierarchical, or one be seen as “the best.” It is all about whether or not the client feels comfortable with the type of work, or the treatment process the therapist will be asking you to engage in.
Budget and Affordability
When considering choosing a therapist, it is important to factor in cost. Ah, yes, money. Thankfully, due to increased mental health awareness, access to mental health is much easier now than ever before. But depending on whether a person goes through insurance or private pay, the cost can vary greatly.
More and more employers and insurance companies are providing direct access to mental healthcare, and when considering cost, this can be the most affordable way to go.
However, due to low reimbursement rates from insurance companies, many therapists do not accept insurance, and this has caused a shortage of therapists within approved insurance networks.
What this means for you is, you might find a therapist you like and who takes your insurance, but he or she might be full and not accepting new clients. Especially if what you are seeking requires a specialty.
This can cause a lot of frustration for you calling several therapists and not being successful in finding someone with an opening. Another lesser-known route to use insurance is to find a therapist of your choosing, pay for them out of pocket and then provide something called a “super bill” to your insurance for reimbursement. However, only a few insurance companies offer this option, so be sure to check before you assume any costs out of pocket.
By no means does this mean that you or anyone else should avoid using insurance, because if you are willing and able to make an effort, it could be worth your patience.
If not using insurance, there is the option of paying out of pocket. Many clients prefer this method because there are no strings attached to who they can see and for how long. Many insurance companies only cover a limited number of sessions or can make clients wait weeks between sessions if they do not have enough therapists to meet demand.
For those looking to heal from severe trauma or complex and chronic issues, the idea of having a limited number of sessions can be unsettling and even harmful to the healing process.
The biggest issue with private pay is that it is more expensive. Depending on your state, rates can range from $50 - $300 per session or more. But don’t let this put you off. Many private therapists, including myself, offer sliding scale rates based on need. I encourage clients to ask about this option when they have a consultation.
It is important to note that cost does not always equate with the quality of the therapy. I know many therapists who are very reasonably priced and extremely good at what they do. It is a personal choice for them that they have calculated is right for their practice. And, of course, the inverse can be true. Just because someone charges $200 a session does not mean they are the best.
If thinking about private pay, something else to consider is the frequency of sessions. I recommend that all clients begin seeing a therapist with weekly appointments in order to build rapport, continuity of care and to manage any current crises. However, once the client feels stabilized, they may choose to move to an every-other-week schedule, monthly, or even as needed. This can dramatically lower the cost of therapy both when using insurance and paying privately. Having a therapist, who you already have a working relationship with, available “as life happens” can be a very good resource.
All this being said, mental health is not a luxury item. Its value cannot be overstated, as it impacts every aspect of your life.
When considering what you can pay for your mental health, try to look at this just as you would treat any health issue. If you had a broken collar bone, would you continue to ignore it and live with the pain? Chances are, the answer is no. This can help to put in perspective what you might be able or willing to afford.
Where to look
Okay, so we know what we want to work on and how we want to pay. Now, where do I go to find this person?
If you are planning to use insurance, you will want to start there. For many insurance companies, this means you will call them or your doctor directly and ask for a list of referrals. Some companies provide this list on-line and won’t require a referral from your physician. They will provide you with a list of therapists that have been approved by them. This is referred to as an “in-network referral.” An “out-of-network referral” is a referral to a therapist whom your insurance has not approved. Approved and not approved has nothing to do with the competence of the therapist. This just separates the therapist the insurance company has a working agreement with.
Part of the process of getting an in-network referral might include an intake assessment form for you to fill out, either online or over the phone. This assessment determines whether or not you need therapy. If you find that you need to complete one of these, it is important to answer the questions honestly.
Some of us have a tendency to downplay the impact our mental health has on us, especially when being asked directly about it by a stranger.
I encourage you to not do this. This would be like going to the doctor with a broken ankle and telling her that it “isn’t that bad.” If the intake assessment is not an accurate reflection of what you are experiencing, it will directly impact the amount of help you get. I suggest answering the questions when thinking of the days when it is really hard for you. On your “worst” days, so to speak. Please keep in mind the person asking you these things is a professional. They are not there to judge you. Best to be honest so that you can be paired with the best therapist to meet your needs and with enough sessions to help you.
Once you complete the assessment form they will schedule an intake appointment. The therapist will ask you to share more about the intake form you have filled out. This session will be the beginning of you getting to know your therapist. In some larger mental health practices this initial intake is done by an intake therapist, and not the therapist you will be scheduled with regularly. In this case, this session will be used to place you with the best therapist for your needs. In either situation, this session will be important in determining the frequency and duration of therapy. All this will be a part of authorization from the insurance company which will give the approval for you to be seen by a therapist
If going through your insurance provider directly seems too daunting, there are third-party companies who act as a middleman in finding a therapist. Companies such as Octave, Alma, and Headway, allow you to choose from their list of therapists, and they take care of assessing your need, finding you an appropriate therapist (with availability!) and billing your insurance. Many clients find working with these companies easier than insurance because they remove the step of calling several therapists to find out if they have any openings. Which is often the most off-putting part of finding a therapist.
Another option to look for a therapist is to use a search engine like: Psychology Today, Therapy Den, or Good Therapy, to name a few. These search engines are pretty much “google” for therapists. You will be asked to enter what you are wanting to address in therapy and any specialties or experience you want your therapist to have. Maybe you want someone who specializes in social anxiety and is familiar with BIPOC or LGBT related issues? You can search for therapists who meet these exact criteria.
You can also indicate if you would like in-person therapy or virtual. Once you have reviewed the bios of a few therapists and found one or two you like, I would encourage you to reach out to them and request a consultation.
Many therapists offer a free 15-20 min call in which you can get a feel for who they are and whether or not you want to work with them.
Lastly, if using a search engine, be sure to note whether the therapists you like takes insurance, if you plan to use it, and are within your network. The last thing you want to do is find someone you absolutely love and vibe with and then find out that they don’t take their insurance or that their hourly rate is out of your budget.
Take a test drive
As mentioned earlier, it’s a great idea to have a consultation call with a therapist, if possible, before committing to a first session. However, it is important to note, some insurance companies, such as Kaiser, do not offer this as an option, and you have much less choice in who you are paired with.
If able to have a consultation, I encourage you to ask your therapist about their modalities/approach in therapy, share a little bit about what you are looking for, and inquire about sliding scale prices. This is the time to pay attention to whether or not you feel safe with them. Are they using language that makes sense to you? Do they respond to you in a way that makes you feel validated and like they understand you?
If you like someone initially and things are off to a quick and cohesive start, great! But, if you talk to a few and none of them stand out to you, I like to suggest that the client pick the best one and give it a few sessions before you can expect to know whether it is truly a good fit.
If after about four sessions you are still not comfortable with the therapist, chances are there is someone out there who is a better fit. Find them. You will not hurt your therapist’s feelings, and even more importantly, it is not your responsibility to take care of your therapist. You are the client and the priority. Think of this as an exercise in learning to put your needs first, even if it feels a little uncomfortable.
A professional therapist will acknowledge the courage and strength it took to express your needs and help you find someone else. If a therapist ever becomes defensive, blaming, or hostile, then you certainly know you made the right decision.
Speaking to a therapist should never leave you feeling badly about yourself, or that there’s something wrong with you. If you feel judged after talking to a therapist, please know that there are other therapists out there who will not make you feel this way. It is best to find someone who understands you and makes you feel safe and comfortable so that you can be your real self and not hide feelings, behaviors or reactions.
In-person vs. telehealth
Many therapists have turned their entire practice virtual since the onset of the pandemic. However, if you are in the position to be able to choose whether you want in-person or virtual sessions, here are some things to consider.
Telehealth sessions have become increasingly popular, and for a good reason. Virtual sessions allow you to see your therapist for any reason you can’t or don’t want to leave your home. Maybe you are sick, in a hospital, have a broken leg? No problem. Virtual sessions also allow you to meet from just about anywhere. Not to mention, if you are a person who struggles to get up and out of bed, pulling out your phone and meeting with a therapist exactly where you are can be extremely helpful. Telehealth also completely cuts out commute time to and from your therapist’s office, making it easier to attend regularly if you have a tight or fluctuating schedule.
As wonderful as telehealth is, there are a few drawbacks. For instance, when not in the same room as your therapist, they may miss out on some physical cues of how your body is responding to your emotions. For instance, the therapist can’t see your leg nervously bouncing when you begin to talk about your boss or that your hands begin to clench when you talk about your parents over a computer screen.
Unless your therapist is trained or experienced enough to ask about these things, it can take longer for the therapist to understand the whole picture of what is going on for you.
Also, some therapists use modalities of therapy that are much more effective when done in person because they incorporate touch, movement, smell, etc. I often use TRE (Trauma Releasing Exercises) in my work with clients and invite them to do them in our sessions together to process trauma held in the body. Although this can be done over the computer, it is much more effective to do it in person, and for these clients I suggest in-person sessions.
It is also important to consider that doing therapy from your home can be less private if you live with others, especially in small quarters. It might be hard to feel safe to speak freely about what you are feeling and experiencing if you are preoccupied that someone might hear you. There are workarounds to this, of course, including meeting in your car or going for a walk. But again, these are things to consider when deciding if telehealth is appropriate for you.
Finally, some people just feel more comfortable being in the office with their therapist. If this is you, that is okay. If you know that being with another person in the same space is the most helpful to your healing, I suggest you listen to this.
Having said this, I do want to point out that there are many skilled and intuitive therapists who provide virtual therapy and do so in a way in which the screen almost completely disappears during the session. My suggestion is to try the method you are drawn to first, and if it doesn't work for whatever reason, try the other.
There are no mistakes in trying new things in therapy, just more opportunities to gather information.
Final Thoughts
Looking for a therapist is not unlike interviewing someone for a job. You may need to see a few candidates before you find the right person. This is okay, in fact, it’s totally normal. This is an important position you are filling. Your therapist will be engaging with you in an intimate way, asking you questions, and hopefully challenging you. Making sure that you feel safe with them is important.
In fact, there is a ton of evidence to support that the most important aspect of therapy is the relationship between the therapist and the client.
More important than the modality the therapist uses, whether the sessions are virtual or in person, the alliance between the client and therapist is the best predictor for positive outcomes.
I encourage you to try your best to listen to your gut instincts, both positive and negative. Trust that if not right away, eventually, you will find someone you feel comfortable and safe with. And he or she will be worth the effort.
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Ashley Pickard is a licensed marriage and family therapist and practices in both California and Florida. She has a private practice in Tallahassee, FL where she offers sessions both in-person and online.