It seems more challenging than ever to find a good therapist. Many loved ones have come to me for help finding a therapist in recent months. They contact dozens of therapists, most never respond and those that do are not accepting new patients. Kaiser therapists have been on an open-ended strike for two months because they do not have adequate staffing to provide enough therapy for everyone who needs it. It’s a courageous act to ask for help. And it can be especially difficult to have the patience, tenacity, and follow through required to find a therapist when you’re struggling with burnout, mental health, or significant life stressors. While I may not be able to fix the workforce shortage, I will offer the following guidance to hopefully make the process a tiny bit easier.
Step 1: Take Time to Reflect
Get clear on why you are looking for help and what you hope to achieve. Journal or talk it over with a friend. Ask yourself the following questions:
What do I want to work on?
What do I expect from a therapist?
What do I want my life to look like at the end of our work together?
Make a list of your priorities. Consider these factors:
Location of therapy office.
In-person or virtual visits.
The clinician’s hourly rate if not covered by health insurance.
Demographics such as the therapist's race, gender, age, sexuality, etc.
Education and experience.
Expertise or therapeutic modality.
Schedule availability.
Personality factors, e.g. maybe you want someone funny or serious, quiet or talkative, etc.
Step 2: Find Prospective Therapists
Ask for recommendations. Ask trusted friends or people you know in the profession for recommendations. Ask them why they think the person they are recommending may be a good fit for you. If you find someone who you think you might like to work with but they are not accepting clients, ask them who they would recommend.
Explore professional organization registries. If you’re looking for someone with someone with a specific expertise or orientation, there are likely organizations that have lists of providers. For example, you can find referral directories for sex therapists, art therapists , or therapists certified in Internal Family Systems to name just a few.
Ask you health insurance for a list of approved providers. If therapy will be covered by your health insurance, the health insurance company will be able to provide a list of therapists on their panels.
Find low cost alternatives. If using health insurance is not an option and you have limited budget, consider looking for low to no cost options like Open Path or community mental health clinics. The US government website, Find Treatment, allows you to search for therapists that offer a sliding scale in your community. Psychotherapy and support groups can also be low to no cost, including 12 step groups for a range of issues.
And of course there’s Google. Googling therapists in your area will likely bring you to Psychology Today, which is a popular directory in which therapists can pay to be listed.
Step 3: Conduct Consultation Interviews
Success in psychotherapy is best predicted by the quality of the relationship between the therapist and the client. Therefore, it is critically important that you find someone with whom you click. Many therapists offer free 15 minute consultations. If possible, I highly recommend that you interview several people to get a sense of what and who resonates with you. Start by giving them a sense of what you’d like to work on in therapy and then ask them questions based on your priorities.
Examples of questions you may ask include:
What is your expertise?
What kind of training do you have?
What is your license?
What might the work we do together look like?
Have you had success working with people like me?
After the interview, do a gut check. Did the therapist make you feel comfortable, seen, or heard? Did you like them? Was there any emotional resonance?
Some red flags to watch out for:
Promising outcomes. While there are no restrictions on coaches or other healers, licensed therapists are not allowed to make promises regarding specific treatment outcomes.
Talking too much about themselves. While some clients feel comforted knowing some personal information about their therapist, the focus of therapy should always be you.
Power struggles. A skilled therapist is going to encourage growth but is not going to dig in their heels and try to convince you of anything.
Criticism or judgment. Therapists should be open minded and non-judgemental of your lifestyle and choices. A therapist may offer some gentle confrontation regarding choices that interfere with your goals but you should feel respected.
Lack of interest or compassion. Your therapist should express curiosity and kindness to you. The first therapist I ever saw repeatedly nodded off during sessions but I didn’t know enough to know that I could expect more.
Breach of confidentiality. A therapist should not give information about you, including the fact that you are in therapy, to your friends, family, anyone else unless you’ve given them permission to do so.
Boundary violations. A therapist must maintain a professional relationship; your therapist shouldn’t hang out with you between sessions, go into business with you, etc. Most importantly, therapy never includes sex, romance, or non-consensual touch.
Ineffective communication. It’s unhelpful if a therapist speaks in psychobabble or in jargon you don’t understand. If you find yourself having to repeatedly re-explain things friends or family members would easily understand, it may not be a good fit.
Lack of professional license. An individual must have a professional license to practice therapy, unless they are trainees and practicing under the supervision of another licensed professional.
Inadequate training. You may require a therapist to have specific training in the issue you are looking to address, e.g. PTSD, eating disorder, or phobias.
Poor emotional regulation. Your therapist should not become easily overwhelmed or upset by the information you share with them. Therapists may be appropriately moved to tears or feel anger on behalf of their clients but you need to feel as though your therapist has the emotional fortitude to handle whatever you share.
Over- or under-directive. Therapy is a collaborative effort; you and your therapist should influence the direction of therapy. A therapist should be supportive but also help you stretch, take risks, and change.
Once you make a decision about who to work with, give it a little time. All new relationships come with some anxiety and therapy is not always going to be easy. We go to therapy because we want things to change and change can be difficult. Stay tuned for another blog post about making the most of therapy.