Finding A Therapist

Written By Karl Locher

All psychotherapy is not the same.  

This proposition is part of why a lot of us (therapists) think that psychotherapy works and also why it can be so difficult for people to find psychotherapy that works for them.  Unlike medicine – where a dose of aspirin is a dose of aspirin, regardless of who prescribes it – no two “doses” of psychotherapy are ever the same.  This has led many therapists to pursue “evidence-based treatments” with the intention of creating psychotherapies that are truly interchangeable between therapists and patients.  Despite these efforts, the best evidence produced in the field still suggests that the strength of the unique relationship between the therapist and patient is the best indicator of a successful outcome in psychotherapy.  Qualities such as the ability of the therapist to repair and overcome conflict in the relationship, to listen to the patient, show non-judgmental respect for the patient’s experience, and to be able to integrate the therapeutic work to focus on the patient’s concerns are all important to psychotherapy.

 

This is good news, as it validates what a lot of therapists and patients have known for over a century.  It is also frustrating news, because it complicates the process of finding a psychotherapist.  This means that finding someone who “treats your condition” is not an especially important part of what to look for in a therapist.  Certainly, it is important to find someone who will feel comfortable talking about topics that matter to you – be they substance use, sex, racism, past experiences of violence or abuse, or feeling profoundly and immovably depressed.  Yet, focusing too much on the “condition” or “subject matter” can obscure other, often more important, matters to which to attend when finding a new therapist.

 

Having helped people to find a therapist, and having found a few for myself, I am writing some thoughts that I have found helpful to the process.

Finding Someone

Uncovering a therapist is often the first barrier that people encounter to finding help. Since there are so many different paths to finding a therapist, there isn’t a right or wrong way to go about doing it. However, as many people are – understandably – overwhelmed by the number of possibilities and the frustrating obscurity of the process, I think it is worthwhile to write about some ways you can find a therapist.

First, consider how you will pay for therapy. Regrettably, Sigmund Freud’s project of providing free psychotherapy to all was thwarted by the ascendance of the Nazis. If you are relying entirely on your health insurance to pay for psychotherapy, start from that point. Some directory sites, like Psychology Today and TherapyDen allow for you to search by insurance network, however these sites often don’t include many regional insurance plans and don’t allow for you to search by particular provider networks. You may want to consider obtaining a list of therapy providers from your insurance company. Most insurance plans have a way to do this online, otherwise you can request a list by calling your plan provider. This is generally a little tedious, but it will save you time to do this upfront, before you connect with a therapist.

If you are using an HSA or FSA, or are willing to pay cash, then your options open up, but you still have some work to do. Before reaching out to any therapists, look over your finances and create a budget for how much you can spend on therapy. You may not know exactly how frequently you will work with your therapist, but if you have a sense of how much you can spend on therapy per month, this will help you and your potential therapist determine whether you can work together.

Who are you looking for

Once you find a few therapists, here are some things you might consider.

Identity

Knowing who you are, how you express who you are, and what your identity means to you are central tasks of psychotherapy. Finding a therapist who can facilitate this process, rather than get in the way, is crucial. For a lot of white, cisgender folks, this thought might not enter into consciousness when looking for a therapist, as there are so many therapists whose identities appear congruent with their own. For anyone whose identity is in some way marginalized or oppressed, this concern is often at the forefront of their minds when looking for a therapist. Finding a therapist who can support your identity development is not as simple as finding someone who shares significant aspects of your identity. Oftentimes, patients are trying to balance their need for the therapist to identify enough with them in order to empathize and validate their experiences and also to de-identify enough so that the therapist does not project their anxieties onto the patient. This is tricky and you may struggle to strike this balance when looking through therapist profiles or making initial consult calls. Oftentimes, you might get a feeling that tells you whether you made the right choice during the first few appointments.

How do they work?

This is really important. I am distinguishing between an “approach” to practice and a “theory” or “types” of practice. Theories include names like cognitive-behavioral therapy, psychoanalysis, acceptance and commitment therapy, dialectical behavioral therapy and dozens of other schools of practice. What I am talking about here is something a little more basic. It is crucial to consider questions such as how frequently does a therapist see people for therapy, how long are sessions, and who directs the focus of sessions. Some psychoanalytic and psychodynamic therapists will see patients multiple times per week – Freud used to see his patients every day except Sunday – whereas other therapists might be comfortable with a patient coming in once per month. These types of pragmatic questions are important to keep in mind as you search for a therapist.

What do you want to talk about?

Psychotherapy and mental health treatments have branched into numerous approaches and ever-expanding array of diagnostic categories. While this might give you the impression that you, as a patient, must find someone with the right training to treat your condition, this isn’t quite what psychotherapy research suggests. Instead of thinking of whether a therapist “is trained to treat my condition,” it is more helpful to think about whether a therapist “is comfortable talking about what I want to talk about.” If your concerns are about sexuality, then you might find it difficult to make progress with a therapist who is anxious and insecure about their own sexuality, or is altogether ignorant and dismissive of the subject. The same can be said about many different aspects of human experience, whether it be eating, politics, bodily sensations, experiences of oppression, self-image, substance use, relationships, or parenting to name only a few. So, even if you find a therapist you think you will like, but they don’t list their expertise as addressing your particular concern, just ask them and see how it feels to talk to them about it.

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Karl Locher
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