I’ve wanted to write about this topic for a long time, but it’s back on my mind after reading a currently-trending book called “Maybe You Should Talk to Someone.” The book is authored by journalist-turned-therapist Lori Gottlieb, and it offers the single most comprehensive, unique perspective I’ve ever read on how therapists think about their work and interactions with various patients (from the wonderful to the difficult) and how therapists experience crisis and professional counseling themselves.
It was one of those 400-page books that I got from the library and finished in a week. Human vulnerability is perhaps one of my favorite topics to talk and read about, and this book is bursting with raw, honest portrayals of both human suffering and connection.
Another motivating factor in writing this: I feel like I’ve finally met “the one” when it comes to my personal search for a qualified therapist. I’m about two and a half months into my therapy with her, and it finally feels easy, right. I’m so grateful, because as Gottlieb says:
Study after study shows that the most important factor in the success of your treatment is your relationship with your therapist, your experiences of ‘feeling felt.’ This matters more than the therapist’s training, the kind of therapy they do, or what type of problem you have.
Finding a good therapist takes work
I know it’s not easy. I’ve been looking for over three years. I’ve tried going through my insurance, through my company’s EAP program, through Psychology Today, through word of mouth references, and finally, through my company’s connected health program, where I’ve been able to see someone for an hour every week at very little cost.
I’ll be the first to say that I’m extremely fortunate to work for a company that puts employee health and happiness before almost everything else. Most people will not have access to something quite like it. However, I think the tips below will help you take your first steps to finding someone that works for you and your life.
Research before anything else
Before you start shopping around, consider training, treatment, and your current resources. Not all of these things will weigh in equal proportions for all people, but they’re factors to be aware of.
Types of therapists
You’ll encounter a number of different trained professionals by a number of different names during your search (along with their confusing abbreviations). GoodTherapy.org outlines the four you’re most likely to work with:
Licensed Clinical Social Workers (LCSWs)
Licensed Marriage and Family Therapists (LMFTs)
Psychologists (PhD or PsyD)
Licensed Addiction Counselors (LACs)
I’ve worked with social workers, therapists, and psychologists with PhDs. With the specific challenges I’ve faced as a mid-twenties female living in a big city working for big companies with a (blessedly) strong support system, I’ve found the most success with LMFTs. It’s possible that this is a coincidence, and that type/training is far less important than the connection you feel and forge with any given mental health professional. I don’t remember feeling like anyone I saw was incompetent, so consider keeping your search broad in the beginning.
Something to consider is the difference between therapy and life coaching; I’ve done both and written about my experience with life coaching if you’re unfamiliar.
Types of treatment
There are many different schools of thought when it comes to treating the human mind, with the following being some of the most common:
Cognitive behavioral therapy (CBT)
Funny enough, the type of treatment has never come up as a focal point in any of my experiences with therapy. No therapist has ever looked at me and said, “Ah, I know what you need -- 5 sessions of existential therapy and we’ll finish you off with a little CBT.” It’s always been much more fluid and relational, which is perhaps one of the central points of this post. The relationship always matters more than the type of training or treatment.
At a minimum, though, I’d recommend you look for someone who specializes in your particular issue(s), whether its relationships, anxiety, identity, or something else. It’s very comforting to know that your therapist has seen people in your shoes before and can speak to what’s worked well for others (and what hasn’t).
Understand your resources
By “resources” I mean -- what in your life can you draw on to make therapy more affordable? Before finding an inexpensive, insurance-backed rate with my current therapist, I was tapping my company’s limited EAP program or paying $160 per week out of pocket for a lame 40-minute session with a guy that I really didn’t like.
I dream of a day when regular, insurance-backed, preventative therapy is viewed as an integral part of our healthcare system. Until then, I’ve broken down the resources you can try, whether you’re in a position similar to mine or flying financially solo on your journey to mental health.
For anyone who has access to employer-sponsored mental health benefits or programs, I strongly urge you to take advantage of them. If you don't know, send a quick email to your HR team to find out - companies don't always do a good job advertising these benefits:
Company-sponsored program. Pay close attention to your various healthcare options to see if your company offers one of those rare, magical options of free or discounted therapy. I get my very-affordable therapy through a clinic that only takes one type of insurance that my company offers, so it’s important to understand the details here.
Through insurance: Most insurance plans offer some form of mental health coverage, so the co-pay for an in-network therapist can be $50 or less. However, in the US, some therapists are only legally allowed to bill your insurance if they have diagnosed you with a mental health problem, which is something that concerned me -- what if I wanted to run for public office one day and a mental health diagnosis prevents me from gaining a security clearance? I know that’s a little extreme, but something to be mindful of. Find someone in-network on your insurance provider’s website or on PsychologyToday.com (recommended by Gottlieb and many other therapists in my research).
Employee Assistance Program (EAP): Most big companies offer some version of an EAP, which gives employees access to free or discounted short-term counseling for work or life challenges. At my last company, I got 8 free therapy sessions per issue through the EAP. So I could keep calling to let them know I had a new “issue” and they’d refresh my session count. At my current company, I get three free therapy sessions per qualifying issue. It was a lot easier to take advantage of at my last company, so I haven’t at my current. I’ve also never felt a strong connection with therapists I met through the EAP.
If you are self-employed, a student, or working for a company without mental healthcare coverage, fear not. There are options for you, too.
Know that, off the bat, most 50-minute therapy sessions without insurance will set you back $100-250 per session. Always ask your therapist about their sliding scale, which determines your rate based on your current financial situation.
Local universities: Goodman suggests looking into local universities and seeing someone who is going for their masters or doctorate in psychology. “The clinicians are really good. They’re being supervised by really respected people in the community, and sometimes the services are as low as $5.”
Open Path: Another option might be to look into Open Path, where you pay $49 for a lifetime membership and gain access to a directory of therapists who charge between $30-$50 per session.
A quick word of advice: Look for a therapist who will give you a full 50-minute session (rather than 40 or 45), if that’s what you want for your time/money. It’s a more than reasonable expectation (in my experience), and the extra ten minutes goes a long way.
Communicating with your therapist
Before the consultation
Although prep work isn’t necessary before your initial consultation, I’d recommend coming prepared with a list of ~5 questions that really matter to you. Keep it to no more than five, because you want to make sure the bulk of the conversation is focused on you and your therapist making a connection.
In the past, I’ve asked some of the following:
What style of therapy do you practice the most and why?
What issues do you specialize in and why?
How recently have you been in therapy yourself?
How often do you consult with peers?
How will I know I’m progressing?
For a more robust list of questions you can consider asking, check out this great article in the Washingtonian: The 14 Questions You Should Ask a Therapist Before Your First Appointment.
The initial consultation
Much like a first date, you’re using this time to understand whether you and the therapist sitting across from you have chemistry. Chemistry is an intangible phenomenon, something most people know when they feel it. For me, I knew that I’d found the right person when they radiated warmth, were quick to smile and shared words of affirmation early on.
During this time, you’ll also want to be wary of some common red flags that signal a less-than-qualified therapist, including:
The therapist is talking more than you
The therapist is interrupting you often
Any inappropriate behaviors from the therapist (sexual or otherwise)
The therapist has violated your confidentiality (this would come after at least one session)
If the initial consultation is an enjoyable experience and you sense that the therapist is equipped to help address your issues, schedule a follow up. If you’re not sure, you can always ask for time to think about it and be transparent about the fact that you’re exploring a number of options. A good therapist will encourage you to look for the best fit.
The first few weeks
After you’ve started seeing a therapist for a while, you’re looking for a special bond to form called the “therapeutic alliance.” This term “refers to the relationship between a healthcare professional and a patient. It is the means by which a therapist and a patient hope to engage with each other, and effect beneficial change in the client.”
A 2011 meta study published in Frontiers in Psychology found that:
The emerging picture suggests that the quality of the client–therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures.
Based on their research, the definition has evolved over time, but a strong therapeutic alliance is most often characterized by:
Something else to be mindful of is your level of comfort during each session. There’s a tricky line between feeling uncomfortable with some of the conversations that you’ll have with a good therapist and feeling uncomfortable with the person themselves. If you don’t feel like you connect - like this person doesn’t see or feel you in the way that you need - that is an appropriate reason to politely move on to a better fit.
Finding a therapist is a lot like dating
Goodman, in the same Greatist article referenced above, solemnly states:
In some ways, finding a therapist can be like the worst parts of dating: You find someone you think might work and take time out of your schedule to go meet them, only to find out it’s a bad fit.
During my three-year search, I spent far too much time with therapists that were a bad fit.
One very-feminist therapist hated President Trump and would launch into an impassioned speech on how he was ruining the lives of women everywhere whenever I mentioned an instance of female inequality in my life. Though we shared values, she didn’t feel objective.
One woman was between my mom and grandma’s age, and I had a hard time respecting her advice for an early-twenty year old. When I expressed discomfort about my drinking habits around age 22, she suggested that I get new friends. That felt extreme and unhelpful at the time; what I really needed was to dig deep into my personal values and understand that my worth in a given social situation was not predicated on the fact that I drank or not.
Another - the only male therapist I’ve seen - came off as slimy. His sessions were just 40 minutes, and he always spent the first 5-10 trying to corner me into another session. He had little empathy for the financial hardship that consistent therapy would impose and his pushiness irked me to no end. His insights were helpful, but I always left feeling gross about him.
A good therapist is worth the wait
I’m finally in a position where I can say that the three-year search was worth it. I adore the therapist I’ve been seeing for the last two months. She’s young and in-touch, well versed in my set of challenges, warm, empathetic, and connection-oriented. Perhaps most importantly, she’s someone I can afford to see weekly.
Something I read in “Maybe You Should Talk to Someone” stands out to me; there’s a passage in which a patient is telling Gottlieb how he hears her voice in his head throughout the week in between their sessions. She’s deeply satisfied to hear this, knowing that a goal of therapy is to get the patient to start doing their own line of questioning and self-soothing, both inside and outside the therapy room.
I hear my therapist’s voice all the time now, and it’s become a source of both comfort and strength throughout what’s been a very painful period. I look forward to our session each week and am bummed when our schedules don’t align. But I always know she’s a quick email away and would bend over backwards to be there for me in a time of need. Look for a therapist who makes you feel like that.
What’s your advice for finding a good therapist? Anything I’m missing? Please share in the comments!