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Dear Joy, How Do I Find a Therapist?

I am frequently asked by friends and family members how to find a therapist.  It can be challenging and confusing, so many people don’t try.  Others quickly give up.  I want to share with you the perspective I offered a close friend, Quinn, a few weeks ago:

Dear Quinn,

I’m thrilled that starting therapy is something you are considering.   This is big, but it doesn’t have to be scary.  Therapy isn’t for the broken.  It’s for people who want to live better lives. 

Thank you for sharing what’s happening with your parents.  Families = messy.  All of them.  Beautiful, wonderful, a blessing, annnnd hard.  Having protected time to help you untangle your thoughts about what’s happening maybe beneficial right now.  It can help you decide how you want to be responding more intentionally in your relationships. Therapy is where you practice conversations you are struggling to have in other spaces in your life. 

How do I find a therapist?” is not the most important question to think about when starting psychotherapy. Instead, ask:  How do I find the right therapist for me?”  It’s not enough to find “anyone” to see.

Here is the most crucial part of the therapist search process to understand:

The relationship you share with your clinician impacts treatment outcome more than almost anything else.   It’s more important than the approach or theoretical background (CBT, psychodynamic, etc.) of the person you choose.

In therapy, the connection with your clinician is the active ingredient in the experience.  Therapy is not something someone gives to you.  It is what you create together.

In your search, remember that at the end of the day, you are the consumer.  If you can’t (eventually) play with all the cards on the table with whoever you are working with, you won’t derive full benefit from treatment.  Trust develops over time, but listen to your gut if someone doesn’t sit right with you. 

Your relationship with your therapist is unique. Your relationship with a psychologist is unlike the one you share with your primary care physician (or anyone else for that matter). Your provider will be in a position to say things that the people around you don’t or won’t say because of the roles they play in your life.  In the therapy room, you get to discover what other people “really think” of you.  Looking into a therapeutic mirror allows you to see things you never knew about yourself. 

You won’t always look forward to therapy.  Don’t expect to be completely comfortable in your sessions all of the time.  If you are, something important is missing. Sitting with someone who will shine light on thorny truths is difficult.  We work really hard to consciously and unconsciously avoid discomfort in our lives.  It is one of the ways we limit our own growth.

Your therapist should support AND challenge you.  A good clinician will know how to appropriately dose both of these things from session to session and moment to moment. Therapy needs to be more than a chat you could have over coffee with a friend and more than some exercises or homework you could get out of a workbook online for 14.99.  If you start to sense that it is, please save your time and money and look elsewhere. 

Find someone who treats PEOPLE, not diagnoses.  You are not anxiety.  You are a person who experiences anxiety along a continuum like the rest of the human race.   You deserve to work with someone who understands this.  Don’t see someone who delivers a cookie-cutter approach to patient care.  Your struggle is not the same as everyone else who has your symptoms, so your treatment shouldn’t be identical

You won’t always like your therapist. You know how sometimes I can irritate you? Your therapist probably will, too. Your therapist is an imperfect human, just like you.  He or she will get it wrong and step on your toes from time to time.  When this happens, say something.  Please. It’s really important to speak up. Your therapist should invite and be open to courageous conversations.  Therapy is where you practice saying hard things, so you can feel stronger and more confident doing this in the rest of your life.  Patterns that commonly play out in your life will probably play out in therapy, too.  You can expect this.   Think of it as variations on a theme.   Reactions you have to your therapist may contain traces of those you have to other important people in your life.  Talk about them. Examine these experiences. Decide if you want to keep interacting and responding like this or practice showing up differently.

Finding the right therapist can be a bit like dating. When looking for a provider, prepare to possibly look around a bit.  You may or may not click with someone after the first few sessions.  That’s okay.  The earliest stage of treatment is an opportunity for both the client and clinician to assess whether the match is a good fit for you and your goals.  Your therapist should care more about whether or not he/she is the right therapist for you than they are about having you as a client.  Encounters with a mediocre therapist result in many people writing off the venture prematurely.  Please persevere.  Look until you find the right person.

Now, the practicalities of finding a therapist. . . Therapeutic logistics, if you may.  This barrier to entry stops many people straight out of the gate.  It can be overwhelming to know whom to call.  Randomly choosing from a list generated by your insurance company is a gamble.  It can be a spin of a roulette wheel to search for a good clinician online.  Some people have success with online search resources such as Psychology Today.  The site has a feature that lets you filter according to things such as office location, the gender of your therapist, and areas of clinical specialty.  Another way to find a good therapist is to ask someone in your life who has had a positive experience in therapy who he/she saw.  If your friend is currently in therapy, you may have some feelings about seeing the same shrink, so it’s something to think about and discuss.  If you decide you want to see someone different, a friend’s therapist can still be a resource for names of people in his/her professional network who they know, respect, and trust. 

Don’t automatically rule out a provider who is not in-network with your insurance company.  Most (not all) of the truly exceptional clinicians I know are out-of-network providers.  They don’t want to play games with insurance companies.  They want to spend their time and energy focused on client care.  As an out-of-network provider, I want to protect my patients’ rights to privacy and believe it is up to the individual to decide who has access to their personal diagnostic and treatment information.  I believe my clients—not their insurance companies– should have full control over their treatment.  Most of my clients do utilize their insurance benefits; I simply am not the middle man.  It’s common for out-of-network providers to provide you with a “Superbill” containing treatment and diagnostic codes that you can use for reimbursement from your insurance company.  Check with your carrier to determine what “out-of-network” benefits are available to you.  Find out if you have a deductible.  Ask about reimbursement rate for treatment code “90834 – Psychotherapy, 45 minutes” with a licensed provider is on your plan. 

What is the difference between a counselor, psychologist, and psychiatrist? Sometimes people get confused about what kind of provider they should see. 

  • Licensed Clinical Social Workers (LCSW), Licensed Professional Counselors (LPC), and Marriage and Family Therapists (LMFT) hold master’s degrees and can conduct psychotherapy.
  • Psychologists (Ph.D. or Psy.D.) have completed a doctorate and are trained in psychotherapy and psychological assessment. In a few states, psychologists can have prescribing privileges.
  • Psychiatrists (MD) have completed medical school and typically focus primarily on medication management.  Some psychiatrists also conduct psychotherapy, but most do not.

Note: Psychologists, LCSWs, LPCs, and LMFTs may all use the term “therapist” interchangeably with their degree.

My parting thought:  If your therapist has not worked through his/her own issues about being liked, confidence, etc., he or she will be limited in their ability to help you. If someone is frequently late, frazzled, flaking, non-responsive, or talking too much about him/herself, take note. These are signs you should look elsewhere. If your therapist is going to help you create stronger boundaries in your own life, theirs should be intact. Pay attention to how your therapist manages issues related to time, communication, and money. Find someone who has it together. 

Therapy is a subtle process, but when you shift your life compass a couple of degrees, it can change your entire destination.   I’m thrilled for you, Quinn.  It’s okay to be anxious, nervous, or scared.  This is new. 

Buckle up and prepare for incredible impact.  There may be bumps, but the journey of introspection is an exhilarating ride.  The path to success is paved with self-awareness. 

You’ve got this. 

– JEL

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January 20, 2021

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