How to choose a therapist?
You’ve already made the important decision to start therapy. But what next? It can seem like a daunting task to choose someone with whom to share your inner most world. In my experience, it comes down to three general categories: logistics, credentials, and goodness of fit.
The first step would be knowing where to look. An easy way to start is to do a quick internet search for “therapy [your preferred zip code],” and maybe what you’re looking for such as depression, grief, couples therapy, etc. Many times your medical doctor will have good referrals of therapists in your area. Psychologytoday.com and goodtherapy.org are other resources to find a therapist where you can filter your search results by location, specialty, and insurance. And then there’s word of mouth referrals. This last option does come with the caveat that even if your best friend/roommate/boyfriend’s mom loves their therapist and recommends them, a qualified therapist will recognize if there’s a potential for a conflict of interest and may be unable to take you on as a client, especially if it’s likely that you would often speak about the other person in your therapy. However, they will be able to give you referrals to other therapists they know and like or who they think may have a similar style. Finally, especially for lower fee therapy, local university counseling centers will almost always have a comprehensive list of providers and clinics that have more flexible options; however, be aware that these tend to be therapists in training.
Next, logistics. Are you willing to travel or do you want someone nearby? Would it be easier to find someone closer to your home or your office/school? Do you prefer to use someone who is in-network with your health insurance? If so, searching through your health insurance’s website may be the best place to start. However, trying to go through your insurance can present several obstacles. First, it’s important to call and check that a) the therapist is still paneled with your insurance. This can change frequently and websites are often not up to date. B) is the therapist taking new clients? C) does your insurance put any parameters on the type of therapy or number of sessions they will cover? D) does your insurance require you to meet your deductible before they will cover any services? And e) how much of your information will insurance collect from the therapist? Confidentiality and HIPPA do not typically prevent insurance companies from documenting diagnostic codes or collecting the individual session notes your therapist will keep that say what you are talking about and working on. In addition, insurance companies can decide to stop covering your sessions at any time for any number of reasons. As you can tell, privacy and flexibility of treatment are often a downside of using insurance and a major reason many therapists choose to not accept insurance and are instead “out of network” providers who you pay independently of insurance. This results in far more providers to choose from if you nix the insurance route. While rare these days, some health insurance plans offer “out of network benefits” (often after meeting a deductible) where you can pay your therapist in full up front, and then submit some documentation (usually provided by the therapist in the form of a “superbill”) to get a portion of what you paid reimbursed by your insurance. This is a nice option to be able to work with any therapist you desire but not have to incur all of the cost yourself. And of course, you can choose to pay “out of pocket” and bypass insurance (and the potential obstacles and privacy issues) altogether. While therapy can be expensive, it is an excellent investment in yourself and has been shown to lower future health costs especially those associated with high stress. Never underestimate the power of asking if they ever offer reduced or sliding scale fees. You may be surprised that therapy can be more affordable than you think and many providers are willing to negotiate their fee based on need.
Ok so you found someone who’s in the geographical area you want and who either takes your insurance or you are able to pay their fee out of pocket. But are they qualified? Let’s look at some of the various credentials you are likely to come across in your search (this is written for the state of Colorado where I practice, so some information may vary by state):
A future post will go into more detail about the specific training and qualifications that go into these titles, but for now, here is a handy link from the state of Colorado outlining various credentials. Experience and years in practice are also important considerations to some, whereas others prefer a younger therapist who they feel they may better relate to or who will better understand their particular issues and lifestyle.
Phew, that’s a lot of information. But there’s one more very important point. Not everyone who calls themselves a therapist is licensed or even trained. Especially in Colorado, state laws are not very strict about who can call themselves a therapist. Anyone can register with the state as a “registered psychotherapist.” No specific training, credentials, or degrees are required for this designation as long as they pay a fee and take an online test on state statutes. Be careful here (especially if their price seems too good to be true). Sometimes this means that the therapist is in training and is properly supervised by a licensed and trained professional which is a-ok and does often offer more flexible payment. These folks will almost always be found in some sort of clinic, community mental health center, or other group practice where they are engaged in trainings and supervision. Be wary of anyone who practices independently under this designation, especially if they cannot provide you with information about being under supervision. Which finally bring us to “coaches.” Coaching is different than therapy. Not to say there aren’t skilled and effective coaches who do help people navigate specific problems, but no formal education, training, degree, or licensure is necessarily required to call oneself a “coach.” Luckily, that field is slowly catching up to other helping professions and is starting to implement certifications and regulations, but overall it is still common to find coaches with no real training. This may be ok with you and if so, go forth and enjoy! But typically, I highly encourage you to find someone with one of the credentials listed above for mental health concerns. In sum, you get what you pay for!
An aside here is that different therapists use different techniques and theories, or in our vernacular, “theoretical orientations.” I’ll be covering this in more depth in a future article. For now, just know that you can always ask a potential therapist what their orientation is and ask them to explain what that means and if it would benefit you and what you’re seeking to accomplish. Often times, therapists describe themselves as “integrative” or “eclectic” meaning they incorporate many theories and techniques based on each individual case. (My opinion here is to steer clear of anyone who strictly adheres to only one theory and speaks negatively of any other. Many of these theories overlap and complement each other very well and often incorporate very similar concepts just using different words to describe them. Stay tuned for more on this later.)
By now, hopefully you’ve chosen someone who is a good fit in terms of logistics and credentials. The final category that I would consider equally (if not more) important is goodness of fit. By and large, the research shows that the best indicator of a successful therapy is the fit between client and therapist or what we call the “therapeutic relationship.” Put simply, do you like your therapist? Do you trust them, think they know what they’re doing, and feel like they make every effort to “get” you? Do they offer support but will also challenge you when it’s beneficial to your goals? Are you comfortable telling them when they get something wrong or something isn’t working? Would they be receptive to your feedback and work collaboratively with you to make sure your needs are being met? There’s no formula for this one, rather I suggest going with your gut. Many therapists will offer a free consultation either by phone or in person so you can start to get a feel for their personality and style before you commit and pay. One caveat to this is if you are seeking therapy for or know that you struggle with forming and/or maintaining interpersonal relationships. I highly encourage you to speak with your therapist about your concerns to see if it truly isn’t a good fit or if something is being enacted between the two of you that is reminiscent of other relationships in your life and it would benefit you to work through it. Ultimately, it is entirely your decision and a well-trained therapist will never be offended if you want to switch to someone else after speaking to them about it. Different strokes for different folks!
I encourage anyone pursuing therapy to do their research just as you would for any large or important investment. I fully believe there is someone who will meet your needs and foster a positive and effective relationship with you. If you’re in the Denver area and are interested in therapy, feel free to contact us at firstname.lastname@example.org or 720-432-9780 for a free 15 minute phone consultation to see if we may be a fit for you.
Next, check out What to Expect in a First Therapy Session.