You’ve decided it’s time to start therapy, for yourself or child. This should be easy – you make an appointment and you finally take charge of your mental health. But, if you’re like many people, you probably have no clue where to even start. It’s not your fault; blame the system.
I’m here to help with tips from my perspective. The following is what I would consider if I were helping someone find a new therapist.
Step 1 is deciding whether you want to use your health insurance (if you have it at all, or if it even covers mental health treatment) or pay out-of-pocket for a provider. That is an individual choice (if it’s in your control at all) that will very person-by-person and family-by-family.
If you want to use your insurance, your company can provide a list of local therapists, through its online portal or representatives. This will likely be your least expensive option, although it can still get pricey. A downside of using insurance is that you can only see providers who accept your insurance. This limits your options, and may eliminate specialty providers who would be more helpful for your current needs.
What about during the COVID-19 pandemic?
Mental health professionals are busier than ever. BUT this may also be the easiest time to start therapy!
Psychologists are licensed by state. Now that they are mainly using video platforms (telehealth) for therapy, that means you can see anyone licensed in your state, not just within driving distance. That opens up a lot more providers!
If you choose to pay out-of-pocket, one option that gives you a great bang for your buck is visiting a graduate student-run clinic. Students-in-training (supervised by licensed practitioners) offer therapy services on a sliding scale, sometimes as low as $5 per session or group, depending on your income. This is a great option for someone wanting higher quality services on a tight budget.
For example, in Atlanta, check out these PhD student-run clinics:
-Emory University: http://psychology.emory.edu/.../psychological.../index.html
-Georgia State University: https://psychologyclinic.gsu.edu/about/
Others choose to pay out-of-pocket by selecting a private practice therapist (or group). Benefits of these providers include specialty care, increased flexibility for scheduling, and greater ownership of your care.
Many therapists are generalists, meaning that they are trained to treat a broad number of disorders, but they may not have the skill set for a specific recommended treatment. Some disorders (examples: Obsessive-Compulsive Disorder, Anorexia Nervosa, Selective Mutism) require specialized training in order to treat them effectively. Depending on your presenting problem, you may need to work with someone who specializes in that disorder. There may be a private practice clinic in your area that specifically focuses on that problem area. For example, my practice, Anxiety Specialists of Atlanta (if you can't tell by the name), specifically treats anxiety-spectrum disorders.
Let's talk about individual versus group therapy. Some forms of therapy are only delivered in a group format (i.e., there is not an individual-only option). For example, Dialectical Behavior Therapy (DBT) is the gold-standard treatment for people dealing with suicidality, self-harm, and other life-threatening behaviors (https://www.verywellmind.com/dialectical-behavior-therapy...). DBT always involves being part of a group. That is something to keep in mind as you are seeking out services.
Getting connected to a group can generally be a pathway to finding individual services, as well.
In other cases, group therapy can be a nice way to get quality services at a lower price. People often feel hesitant to share their feelings in front of a group of people. It can, however, provide a system of support and an extra way to work through any interpersonal problems you may be working on (for example, challenging social anxiety).
Subscription-based online chat platforms are becoming a popular modality for therapy. The most well-known company is Talkspace (https://www.talkspace.com), which offers flexible access to communicate with mental health professionals. In the anxiety world, NOCD (https://www.treatmyocd.com) is a platform specifically for individuals with OCD. Many of these services accept health insurance.
To make a general statement about these platforms, they typically offer what is called supportive therapy. Supportive therapy means that the provider offers validation and a listening ear, but they may or may not be teaching new or individualized coping skills. Supportive therapy can be helpful for someone who is experiencing mild to moderate problems or distress that is not having a *major* impact on their life/functioning. For example, supportive therapy might help someone work through a job loss, difficulties with a roommate, adjusting to life changes such as a move, or coping with a loved one's illness.
Someone experiencing suicidality, major life problems, long-lasting symptoms, or specialty issues (e.g., an eating disorder) will likely require a more intensive treatment than can be provided through these online platforms.
You've read all these tips, you've Googled therapists in your state... now how do you know who to choose!?
Ideally, you want a therapist who engages in evidence-based practice. What that means is that they combine the latest research, your unique cultural variables, and your personal preferences to create a treatment plan to address your psychological needs.
For each disorder, there are certain gold-standard recommended treatments that are well-established by research. For example, for Obsessive Compulsive Disorder (OCD), exposure and response prevention (ERP) is the treatment of choice. If you were concerned that you had OCD, you would want to look for a provider that is trained/skilled in ERP.
There are other therapies that are either not yet established by research or have proven to be poor treatments. For example, conversion therapy for the LGBTQ+ population is strongly opposed by the American Psychological Association (APA).
As you are searching for a therapist, you want to look out for key words that either show that the therapist is trained in the recommended treatment for your problem area or that they may be using practices that are not recommended. APA's Division 12 keeps an updated list of the recommended treatments for each disorder or problem area (https://div12.org/diagnoses/). Division 53 has a similar list specifically for children (https://effectivechildtherapy.org/concerns-symptoms.../). It is helpful to consult these lists to know what kind of treatment may be appropriate for you in order to guide your search for a therapist.
Another way to find a qualified therapist is to look at the membership of professional organizations. Providers (and supervisors, if your therapist is in-training) who belong to certain organizations are more likely to practice in accordance with the values of that organization. For example, cognitive-behavioral therapy (CBT) is one of the most well-established treatments for disorders such as depression, anxiety, and bulimia. Therapists who belong to ABCT (https://www.findcbt.org/FAT/) typically are experts in delivering CBT treatment. Members of ADAA (https://members.adaa.org/page/FATMain?) specialize in depression and anxiety interventions. OCD specialists typically belong to the IOCDF (https://iocdf.org). Psychologists can also earn board certification, meaning that they are at the highest level in their field in a particular specialty area (https://www.abpp.org/Directory).
Of course, there are many more professional organizations for different problem areas and treatments. This is just a sampling to help jumpstart your search!
How important is "fit"?
It's fairly common when people seek therapy for them to want their therapist to match them on certain cultural variables, such as ethnicity, gender identity, or age range. Sometimes these factors are enough to make or break the fit between therapist and patient, and they are important in that they can help someone feel better understood and heard in the therapy space.
There is a lot of research on the therapeutic alliance, which is essentially a measure of the strength of the relationship between therapist and patient/client. Some experts argue that therapeutic alliance is the most important factor in making change in therapy.
I do think the alliance is important, but I disagree that it is the highest priority factor. I'll put it this way: How would you feel if you found the perfect therapist based on age, gender, ethnicity, etc., you liked the same cat videos, they were incredibly warm and empathetic... but you weren't getting better??
To me, the most important thing in therapy is that you are feeling better and meeting your life goals. My only suggestion is this: When you are seeking out a therapist, do check out their unique cultural variables, but also ensure that their training and expertise meets your needs.
And if you are ever not feeling things are a good fit: tell your therapist! That is okay to do. You might easily resolve the issue with them, or you might both agree that another clinician may be a better match for you. Either way, the discussion only benefits you.
How do you know if you're "getting better" in treatment?
There are two main outcomes in therapy. First, there's symptom improvement. Ideally, whatever someone presented to therapy with should be improving: mood, irritability, sleep, weight status, pain, etc. If that's not happening, something about treatment may not be working.
More important, in my opinion, is functional improvement. Are things improving in your real life? You might obtain a job after months of low motivation to send out applications; maybe you start dating or maintain a serious relationship; you are getting better grades/performance reviews; you begin to approach situations that make you anxious, such as performing or talking to acquaintances. These are the things that matter!
Measuring improvement is vital to doing well in therapy. You might fill out questionnaires, expecting certain symptom ratings to change as you gain skills. You may target your movement toward personal goals and values.
As you are searching for a therapist, you are 100% allowed to ask them questions about what treatment will look like. Ask whether and how they measure outcomes in therapy. You deserve to know and it's not a secret or magic!
A few other ideas if you are still having trouble finding a provider...
If you Google "therapist in my area" what will likely come up is Psychology Today. You can use the tips provided in earlier posts to help you determine the listed therapists' qualifications. Of note, Psychology Today does not list all local providers, just those who have chosen to create a profile on their website.
Your primary care physician, child's pediatrician, psychiatrist, and other medical providers may be able to recommend therapists in your area.
Every county has community mental health centers to provide therapy services to those who do not have health insurance or cannot pay for sessions.
Schools can also provide therapy free of cost to children who qualify for services. Of note, you generally do not have much control over these services and often parents are not involved in treatment.
Lastly, call centers can assist with locating therapy services. For example, the Georgia Crisis and Access Line (https://www.georgiacollaborative.com/.../georgia-crisis.../) can assist someone needing more acute treatment. The Autism Response Team (https://www.autismspeaks.org/autism-response-team-art) provides resources specifically for individuals with Autism Spectrum Disorder.
I want to conclude by saying that finding a therapist can be so challenging. Even those of us with a lot of knowledge can have difficulty finding an appropriate referral. Like I said, there are system issues that need to be resolved by advocating to local and national government.
I am so glad that you are seeking help. Therapy is so wonderful and when you find the right fit, it can be life-changing. Good luck as you begin this journey.
Please comment below if there are lingering questions that I did not address in this post!