Finding a Good Therapist: A Personal Journey Aided by Books, Experience & the Internet

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)

• Psychodynamic therapy

• Client-centered therapy

• Existential therapy

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). 

Therapy is a journey; keep walking until you find the right path. Others don’t want to see you stop in the middle of the trail :)

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. 

Employer-sponsored resources

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. 

Flying solo 

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.  

Whitney Goodman, LMFT and owner of The Collaborative Counseling Center in Miami, offers great advice on finding budget counseling options:

• 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 

Take a seat, let’s talk.

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: 

1. What style of therapy do you practice the most and why? 

2. What issues do you specialize in and why? 

3. How recently have you been in therapy yourself? 

4. How often do you consult with peers?

5. 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:

• Support

• Collaboration

• Congruence

• Empathy

• Reciprocal positivity

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! 

How to Make it Work (And Know When to Move On): Relationship Advice for Couples Early On

Note: The experience and insights that form the basis of this post come from Pat Dixon, licensed family and marriage counselor for 30 years. This post is part of a multi-part series sharing her best advice for those seeking a lasting, happy romantic relationship.

I’m convinced there’s nothing more difficult than the first stage of the romance cycle, where you’re trying to find someone that’s single, attractive, interesting, and attracted to you. But I do think we often forget that interpersonal challenges don’t go away at the point of commitment; in fact, that’s kind of when the hard work begins. 

Figuring out how to make it work (and if it’s worth it) 

Once you’ve found someone you’re excited to date exclusively, it’s tempting (at least for me), to turn a blind eye to any frustrations or incompatibilities that I sense early on and just focus on how to make it work. I’ve looked so long for someone who gives a dang about me! I’m not about to give that up with nit picking. 

But you should continue to evaluate your partner at this stage of romance (albeit graciously). That’s kind of the point of dating someone seriously – you’re getting to know someone well enough to understand if they’re a compatible life partner for you. The challenge in this stage is not securing a partner, but coming to understand if they’re the right one for you in the long term. 

Pat (otherwise known as my grandma), shares her wisdom on how to approach this phase below.  

Become aware of your similarities and differences, then negotiate them

As a counselor, my grandma would administer something called the Taylor-Johnson Personality test, which measured couples along various personality traits – things like rigidity vs. impulsiveness -- to see where they were alike and where they differed. That information was then used to form the basis of discussion and help the partners get to know one another on a deeper level. This self-awareness is critical to understanding compatibility at this stage in a relationship. If two people are self-aware, she says, they can talk about what’s important to them.

Homework for couples: Take the Taylor-Johnson, Insights Discovery (a personal favorite), Meyers-Briggs and/or 5 Love Languages personality tests and set aside an hour to discuss how your results relate to one another. 

Another exercise she liked to walk couples through involved having them each describe their ideal relationship as if they were directing a love story film; what would be important to have in it? Sometimes, the partners would find that their love stories were similar and that they could build on that shared foundation. Others found out that their idealized versions were fairly different and that they’d need to openly explore compromise.  

When differences exist here, it’s important for each partner to understand how strongly those needs are felt by the other. It can be as easy as rating them on a scale of 1-10. Often, a need is much more important to one person than the other. The person who rated it as less important may be willing to agree to go along with the request based on the importance to the other person. Over time, though, this should somewhat equal out.

Homework for couples: Describe your ideal relationship to your partner as if you were directing a love story film. Ask for them to do the same. Discuss where you might be able to compromise.

Be who you are, but respect the role of compromise 

Can you be yourself with your SO, or are you modifying your behavior? Are you walking on eggshells so they don’t get upset? If you want to do something, do they go along with it, but criticize or become miserable? It probably doesn’t take a marriage counselor to tell you that any form of consistent behavior modification in your intimate relationships is unsustainable and unfair to both you and your partner. 

So be who you are, says Pat. Don’t try to change yourself to impress the person. This doesn’t mean you can’t want to improve yourself and be willing to compromise on things. You should feel like you can always be yourself, even when yourself is expressing something the other person doesn't like. Some partners will do whatever the other wants, giving up their own needs, and Pat is firm in her assertion that this is unhealthy. Negotiating your differences is a necessary and healthy skill. 

Homework for couples: Is there any behavior that you consistently edit around your partner? Try talking about this in a neutral setting to see if there’s an opportunity to own this part of your personality in the relationship. 

Traveling can be a good indicator here; before a trip together, try asking your partner, “What's most important to you?” Figuring out how to do both is an indication of a healthy relationship. For instance, my grandma and Papa mostly align, but he will bring a book when they go shopping to stay entertained. 

Case in point. You know there’s a book in that backpack.

And know that it’s okay to opt out of something you really don’t want to do, for something you’ll find more enjoyable. In the end, both parties will be grateful that each could come back to the union feeling filled up and happy. It’s a healthy sign if partners can agree to not do everything together, says Pat. This allows for growth on both sides.

Homework for couples: Before a trip together, sit down with your partner to discuss each of your priorities for the experience. Plan your itinerary such that both person’s needs are met daily, even if that means building in solo time. 

Travel is also great for the simple fact that you will spend enough time together to really get to know who they are; How do you handle the boring times together? What are their strengths/weaknesses? This will further help inform the areas of your relationship that will have ease or require negotiation. 

The right person adds to your life (most of the time)

I think one of the hardest things to know in this stage of romance is whether we’re compromising too much. So I asked my grandma for a litmus test. She says the way that you know is simple: 

“Being together should feel good, at least the majority of the time. You should be comfortable doing things on your own, but it’s especially nice when the other person is there. They add to your life, rather than subtract.”

Ahh. Something about that response is so simple and satisfying. It makes me feel confident that the next person I’m seriously involved with, I’ll know a little more about how to “know” if he’s the one. 

For more resources on this topic, I’d recommend checking out the following helpful articles: 

1. TIME: A Guy Read 50 Years Worth of Relationship Studies. He Came Up With 17 Strategies 

2. Mind-Body Green: 10 Essential Secrets To Making A Relationship Work

3. One Love: 7 Ways to “Make it Work” When You and Your S.O. are Total Opposites

Up Next: What the Research Says About Happiness & Healthy Relationships

It's More Than Luck & Likeness: Seasoned Advice for Relationship Rookies

Note: This post was contributed by Bill Dixon, former reporter and editor, PR comms consultant and stately grandfather.

She carried herself with dignity. That’s how I knew she was the one.

That and her patience, practicality, warmth, optimism, mental flexibility and sense of adventure.

Those things mattered to me when I met Pat in the early 1980s, and they have kept us close for more than three decades of marriage.

Nurturing a successful long-term relationship

I acknowledge that luck has played a role. I fell in love with a marriage counselor, after all. I acknowledge that the more alike two people are, the more likely they are to have a successful marriage. Pat and I grew up in middle income households, earned college degrees and had careers that involved lots of office work with other middle-income, college-educated people. Our work focused on facts and data, for Pat as a representative of the circuit court and for me as a reporter and editor.

Sure, luck and similarities count for a lot. But it’s still possible to have a compatible background and have a failed marriage. I think Pat and I have a successful marriage. And I think we did some things that may prove helpful to younger people considering a long-term relationship.

Here are three of those things:

We developed a baseline of data

We used a personality test called the Taylor-Johnson Temperament Analysis. It measures nine opposing personality traits that play important roles in interpersonal relationships. Among them are “Self-disciplined or Impulsive” and “Subjective or Objective.”

I scored high for impulsivity and subjectivity. Pat didn’t. These opposing tendencies have generated quite a few spirited discussions in our marriage, almost on a daily basis. With that built-in potential for disagreement, we have evolved a decision-making style that often resembles in its speed the formation of metamorphic rock. At such times, I try to remind myself that my preferences may be guided more by my tendency to jump for the quick fix than by objective criteria.

 The Taylor-Johnson instrument is only available through licensed counselors. To me, hiring an expert for a few sessions of pre-marital counseling could be money well spent. Especially when you consider the lifetime over which you can amortize the expense, and the steep cost in money and anguish if you get the relationship wrong.

Pro Tip: For a preliminary look at your personality mix as a couple, you might consider a free option. Our daughter Phoebe, a counselor-in-training, likes The Five Love Languages profile, which focuses on emotional communication preferences. Other free options are based on the Myers-Briggs Type Indicator, which groups people according to four “dichotomies:” introversion vs. extroversion, sensing vs. intuition, thinking vs. feeling, and judging vs. perceiving. These options include Truity’s TypeFinder Personality Test or 16 Personalities or HumanMetrics.

We went to a relationship class

Actually, I went to class. Pat taught it. It was where I first saw Pat’s brains and sense of adventure assert themselves.

She would go to happy hour somewhere with a fellow counselor, put together the lesson plan and then lead a thought-provoking class, all in the same evening. It was the teaching equivalent of performing without a net, and she pulled it off every time.

As a relationship teacher, Pat emphasized the importance of self-knowledge as a prerequisite to successful relationship-building. As I remember the logic it was something like:

 Know yourself, so you can trust yourself, so you can trust others.

 One class session focused on knowing how to cope with – or as Pat put it, survive — change. We learned that we should expect to be stressed by change. Even good change, such as moving in with someone you love, will cause a stress reaction in most people. We also learned techniques for surviving change. The ones that have meant the most to me are:

• Pay attention to your thoughts. Are they rational? If not, argue with yourself.

• Keep change to one area at a time.

• Make sure you have support.

In another lesson, we examined the supportive relationships we already have. We students made lists of our personal “boards of directors:” people who had made a positive impact on our lives. I recall that about a third of the people on my list were college professors or high school teachers, because they set high standards and were confident that I could achieve them.

Making the list helped me realize the high level of trust that was a part of my life. It also helped me see how this new person in my life, Pat, fit into my trust network. I put her at the top of my list.

We went white-water rafting

This was very early in the relationship, and it did two things that strengthened our relationship. First, we shared an adventure. Second, it challenged us to achieve a common goal – surviving! – in an unfamiliar environment. During that trip, each of us learned how the other dealt with stress and how it felt to work together.

A young Bill and Pat on one of their white-water rafting adventures, early in the relationship.

Over three days, we rafted a 45-mile segment of the Deschutes River where it cuts through a dramatic gorge in the high desert of Central Oregon. Our crew consisted of three heavy duty inflatable rafts, with five people to a raft. We had a couple of experienced river runners along, but everyone else was a novice. We learned to paddle and negotiate the rapids very quickly. 

Each of us took a turn steering our raft from the stern. This involved not only using our own paddle as a rudder but telling our fellow passengers how to use their paddles so our raft could make tight turns around the rocks that seem to be everywhere in the Deschutes. We all made mistakes in these situations, and it was invigorating to work through them together

But the real relationship builders were on shore. Like when Pat and I tried to cook spaghetti noodles to feed the crew, couldn’t get the water hot enough and wound up with dough lumps. Or when a freight train blasted its way through the gorge at 2 o’clock one morning (yes, there’s a rail line there) and we thought it was going to run right over us as we huddled in our sleeping bags.

Then there was the skunk. This was also at night. We slept without tents because you can get away with that in arid Central Oregon and because, without much ambient light, the sky is alive with stars. The night after the train attack, I woke up to a scratching sound. It was a skunk exploring our plastic ground cloth. Being the loving partner I was, I woke up Pat, urged her not to get excited and clued her in to the skunk. When she sat up for a better look, I got behind her.

If the skunk had sprayed at that moment, Pat would have taken the full blast. Instead, our guest just shuffled off.

We have relived this moment many times over the years, and there are two things I can’t explain. One is why I got behind Pat instead of in front of her. Two is why she didn’t abandon me right then. If you figure it out, please comment on the blog.

But she didn’t abandon me, not even when . . . A couple of years ago, I thrust Pat into the role of emergency caregiver when I blew out my tendons on both knees. 

Did you know that when you walk down stairs holding large boxes in front of you, you are likely to miss a step because you (a) can’t see ahead of you very well and (b) can’t hold onto the handrail? Did you also know that when you fall from a height of about 2 feet and land on your knees you can screw them up so royally that you no longer can move your legs from the knee down? We learned all that the hard way.

THE FALL happened on Labor Day weekend 2016. A surgeon repaired the knees within 12 hours of the fall, and, legs tightly wrapped from hip to ankle, I was able to hobble around like Frankenstein within 12 hours of the surgery. But I faced at least six weeks of hobbled recovery before the casts would come off and I could bend my knees again.

There was no question of taking the trip to Hawaii that was scheduled to start in early September. All of the household chores suddenly fell to Pat. Plus she had to give me injections of an anticoagulant every night. She had to put up with my squirming through the night (I dare you to get comfortable in bed with your legs straight out) and my using the bedpan every couple of hours because I couldn’t get myself out of bed. She even had to drive everywhere, for God’s sake, after being chauffeured by me for more than 30 years.

It was a horror show.

The main factor that pulled us through was the trust we had built up. The personality data, the class, the raft trip – they put us on the right track to handle a big disruption. Throughout the busted-knee ordeal, I never doubted for one minute that Pat would help pull me through, and, as far as I can tell, she never doubted that I would make a full recovery.

THE FALL reminded me how relationship-building – focused, conscious effort -- is important. In the beginning, it brings richness to our shared lives. But at some point -- and if you're lucky this point won't come until much later in life -- it brings healing in times of crisis or loss. To paraphrase a popular phrase from Paul's Letter to the Corinthians a well-founded relationship “bears all things, believes all things, hopes all things, endures all things." 

Four Takeways To Consider:

1. Use assessment tools to learn more about each other. It’s enlightening.

2. Take a relationship class. With real people, not online.

3. Share adventures as rookies. No fair if one of you is an expert.

4. Always hold the handrail.

For more from Bill, check out From Conflicted to Conscious Consumer: How To Build & Enjoy a Mindful Shopping Habit.

Up Next: Read Positive Psychology & Relationships: What the Research Says About Happiness & Healthy Relationships