Making the decision to start therapy is a big step forward for your mental wellness. The step after that, however, may feel so overwhelming that you get stuck—choosing the right therapist. It’s natural to feel anxious about wanting to “get it right” as well as confused by all the information you have to sift through before you even contact someone.
We know how hard it can be to figure it out (or even to know what you need to know), especially if you’re already struggling with depression, anxiety, stress, or crisis. Let us walk you through the most important things you need to know when choosing a therapist, and what to expect during that process.
First things to consider
Let’s start with some of the most obvious things that will affect your search. First: are you looking for services covered by your health insurance, or do you have the option to pay out-of-pocket? The Affordable Care Act made changes to how insurance must cover mental health screenings and services, so even if you think your plan doesn’t cover therapy, you should call (or have someone call for you) to find out—you might have more coverage than you think. If you can’t go through insurance and don’t think you can afford to pay out-of-pocket, don’t lose hope. Many therapists have sliding scale plans, and there are low-to-no-cost programs for mental health care all around the country. It may be prohibitively difficult to try to find a therapist who accepts your insurance, but it may be worth asking around or looking at your insurance’s list of covered therapists.
Do you prefer to go to your therapist’s office (when COVID isn’t preventing in-person therapy) or do you prefer telehealth at all times? Does your therapist’s gender or race make a difference to you? Many people prefer to see someone of their gender, and BIPOC folks may feel that a therapist who shares their race will better understand their systemic challenges.
Your therapist will also need to be licensed in the state where you live even if you meet online, so if you’re in a tri-state area or other area where people commonly live and work in different states, you’ll need to check what states your therapist is licensed in.
What type of therapist do you want? (aka “What do all those letters mean?”)
Ultimately, it’s more important that you find a therapist who really resonates with you and knows how to handle your specific concerns than to base it on what type of provider they are, but it’s good to understand what all those titles and accreditations mean anyway.
- The most important distinction you need to know is that psychiatrists and psychiatric nurse practitioners are the only mental health care professionals who can prescribe medication. (In some states, psychologists are able to receive specialized training to prescribe medication as well, but it’s still rare.) It’s common for someone to see a psychologist, social worker, or counselor for their regular therapy and to see a psychiatrist or psychiatric nurse practitioner occasionally for medication management and prescription.
- A psychologist has either a PhD (doctor of philosophy) or a PsyD (doctor of psychology) after their name. Their academic background included a lot of behavioral science and research, and some psychologists continue to pursue research throughout their career. You might want to seek out a psychologist specifically if you’re looking for someone with a particular specialty such as geropsychology (treating older patients) or rehabilitation psychology (help recovering from an injury or illness). Psychologists are also often good options if you are looking for testing particularly around autism spectrum disorder or other disorders diagnosed in children.
- Social workers hold at least a Master’s degree in social work and are able to provide therapy and assess mental health. Because their training and background involves the social systems within which an individual exists, their approach tends to take a holistic approach that can address all the circumstances of a client’s life. You’ll see an LCSW (Licensed Clinical Social Worker) or LMSW (Licensed Master Social Worker) after their name; the difference is that an LMSW is working under the supervision of another mental health professional.
- A counselor is similar to a social worker except that they received their Master’s or higher in counseling instead of social work, and therefore may focus more on the individual than on the social structures that surround them. They will have an LPC (Licensed Professional Counselor) or LMHC (Licensed Mental Health Counselor) after their name. You may also see NCC, which is a National Certified Counselor.
- A marriage and family therapist has specifically received a Master’s or higher in marriage and family therapy or something related and works with clients in the context of their relationships. They may also assess mental health like a social worker or counselor. They’ll have an LMFT (Licensed Marriage & Family Therapist) after their name.
- Pastoral counselors are mental health professionals who have undergone additional training and certification to provide services within a religious or spiritual context. This is different from a clergy person such as a priest or rabbi who is available to talk to members of their congregation—in most states, pastoral counselors hold a license like LMFT or LCSW, although in a very few states, there are pastoral counseling licenses like Clinical Pastoral Therapists.
Don’t assume that a higher level of education is automatically better—while social workers and counselors don’t have a doctoral requirement, by the time they’re licensed, they’ve had extensive training, supervision, and experience. An LCSW with the same number of years of professional experience as a psychologist may have spent more time with clients or working within their clients’ communities directly while the psychologist may have spent more time in a research setting. Either way, your provider will be qualified to give you the help you need.
And a word about supervision: You may be interested in a therapist who states that they are under clinical supervision. If so, don’t be nervous. Yes, they’re newer to the field, but by the time they reach that point, they’ve still gotten a lot of training and experience and internships under their belt. Sometimes a newer therapist can be exactly what you need, because their training reflects the most current practices and they may have experience with or knowledge of communities that their older colleagues don’t, such as queer, non-monogamous, and transgender communities.
What’s their approach?
When you look for a therapist, they’ll also indicate what approaches they take to their practice. All of them fall under the umbrella of “psychotherapy”. These can be pretty confusing, too, so let’s touch on a few of the more common ones:
- Cognitive behavioral therapy: Focuses on the connection between thoughts and behavior, on identifying harmful thought patterns and what behaviors they affect, and on developing more constructive ways of thinking. This can be very effective for diagnoses like eating disorders and obsessive compulsive disorder.
- Dialectical behavioral therapy: Similar to CBT, DBT puts an emphasis on emotional regulation and acceptance, helping clients understand when change is appropriate and when coping and acceptance of a situation are needed. It was originally developed for those with borderline personality disorder who are suicidal.
- Exposure therapy: Also a form of CBT, this deals with conditions like OCD, PTSD, or phobias to develop ways to cope with triggers and to safely and gradually expose the client to triggers in a controlled way.
- Eye movement desensitizing and reprocessing therapy: A more controversial and newer technique, EMDR uses eye movements to treat trauma responses by trying to create more constructive responses to trauma triggers.
- Psychodynamic therapy and psychoanalysis: This is most similar to what many people think of when they picture a therapy session—a therapist asking a series of questions about a client’s past in order to examine and overcome problems and discover better patterns of thought and behavior. Psychoanalysis is a more intense version of psychodynamic therapy.
- Emotion–focused therapy: This approach focuses on developing a greater awareness and understanding of one’s emotions, working on how to regulate them and find healthy resolutions to problems. EFT can be very effective for relationship problems, depression, and many other diagnoses.
There are many other approaches to therapy, and many therapists use a mix of them in their practice. Additionally, therapists may offer one or more options for individual, group, family, or relationship sessions, and you might decide to choose more than one—for example, a marriage counselor with your partner(s) and individual therapy for yourself.
Where can you find them?
The two best places to start your search are recommendations from friends, family, and trusted local community; and, if you’re going through your insurance plan, the in-network directory on your insurance website.
There are a few special mentions that we wanted to share beyond just doing an online search for therapists in your state:
- Kink and Polyamory Aware Professionals: Maintained by the National Coalition for Sexual Freedom, therapists who are experienced with BDSM or ethical non-monogamy can choose to be included in this database.
- Psychology Today: Many therapists also maintain pages for their practices in Psychology Today’s database of listings, which is easy to target by state.
- Open Path Collective: Dedicated to matching clients with mental health services at very reduced rates, if your budget is tight, you might start looking here.
- The National Queer and Trans Therapists of Color Network: Finding a therapist at the intersection of gender, sexuality, and race can be daunting, so this directory can help you narrow in very quickly.
Finding the right therapist for YOU
Now you understand what you’re looking at when you see a therapist’s name, title, credentials, and description of their services, but how do you know which one will be right for you specifically?
Obviously, you’re going to look at their specialties for therapists who are experienced in the issues you’re having, whether it’s depression, anxiety, substance use, eating disorders, trauma, or sexual dysfunction.
Many therapists, on their websites or online listings, will also make note of other areas of expertise that might be important to you. If you’re LGBTQIA+, transgender or nonbinary, interested in BDSM, ethically non-monogamous or polyamorous, practice an “alternative” path like witchcraft or Paganism, are a veteran, are disabled or chronically ill, are BIPOC, or have any other identity that isn’t widely understood, you can look for someone who mentions having experience with the things that affect your life the most. (If you can’t find anyone, don’t lose heart—it’s hard to mention everything, and you can find out more when you contact them.)
You might also have an idea about what it is you’re looking to get out of your sessions. Do you picture yourself mostly being able to process out loud and vent about what’s happened during your week, or are you looking more for someone who will help you focus on a specific issue and develop coping skills? Do you want to be given suggestions of things to do between sessions? Do you want the option to bring a partner or parent into your session occasionally? You probably won’t be able to tell for sure just from a website or listing, but knowing what you want will help you get a sense for who to contact.
As you narrow down your search, try to find 3-5 people you feel good about. Especially after two years of pandemic stress, many therapists are completely booked with waiting lists and may not be taking new clients. And even if they are, you’ll want to talk to at least a couple of them to find the best possible match.
When you’ve confirmed that someone you’re interested in is taking new clients, you’ll generally have a consultation (often by phone) to talk about why you’re seeking therapy and what you’re looking to get out of it. This is the time to ask any questions you have about their experience, their specialties, how they work, their billing procedures, their office policies, and anything else you’re wondering about.
In some cases, a therapist you’re feeling really good about may not have much experience in an area that’s important to you, for example polyamory. Ask if they are willing and able to spend time educating themselves in order to help you better, and ask how they feel about that thing. If they sound hesitant or judgmental, or they want you to get them up to speed, they may not be right for you. If, however, they’re open-minded and willing to put in the work on their own, you might feel comfortable with them despite their lack of experience.
Your first session—what to expect
Congratulations! You’ve booked your first therapy session. You’ll be asked to either come a little early to that appointment to fill out some intake forms, or the forms will be sent electronically beforehand for you to fill out. They may include HIPPA forms and medical history.
That first session will mostly be a time for your therapist to get to know you and your situation a little better. They will probably have a number of questions, ask you about your personal history, and will go over some things with you including when they may be required to break confidentiality. They may also make sure you understand policies such as showing up on time or how to cancel. This is another chance for you to ask questions, too, and you should get a sense for how you feel with them. Do they put you at ease? Are you intimidated? Do you feel safe talking about vulnerable issues with them?
It can take three or more sessions before you and your therapist really establish your relationship. That doesn’t mean that nothing will happen before then—just that you’re both still figuring out how to best work together. By about the fourth session, you should have a pretty good idea whether you feel like this is the person to help you right now.
When it’s time for change
A therapist-client dynamic is a relationship, and relationships can change. You might discover that the style of therapy you thought you needed isn’t feeling effective, or you might have discovered something about who you are (e.g., coming out as transgender) that your therapist isn’t able to help you with. You might simply realize that they don’t feel like a good fit—and yes, it’s possible to “outgrow” a therapist.
If your sessions aren’t working for you, tell your therapist. It’s possible that they’ll be able to change their approach in some way to fit your needs better, or they might even be able to refer you to someone they think will be better for you. Don’t feel you need to stick with your therapist out of loyalty or because you’re afraid of hurting their feelings. They’re working for you, and you need to do what’s best for you.
The good news is, now that you’ve had some experience with therapy, you’ll have a better idea what you do or don’t want when you start your search again. Use that knowledge to prepare questions for your consultations so that you’ll feel confident of getting what you need.
It’s not unusual to stick with one therapist for many years when you find someone you like and trust, but it’s also not uncommon to have to try a few different people at first or to move among several therapists over the course of your life. While the search for the right therapist can feel like a big job, your mental health and wellness is worth taking the time to get right.
Looking for a therapist in DC, MD, or VA who’s experienced in couples counseling, sex therapy, polyamory, kink, body-positivity/HAES, or LGBTQIA+ and transgender concerns? Our associates have extensive experience in all of these and more, so make mental health your priority this year and reach out to us.